Effect of Anesthesia Staffing Ratio on First-Case Surgical Start Time

2016 ◽  
Vol 40 (5) ◽  
Author(s):  
York Chen ◽  
Rodney A. Gabriel ◽  
Bhavani S. Kodali ◽  
Richard D. Urman
Keyword(s):  
Start Time ◽  
First Case ◽  
Staffing Ratio

scholarly journals Lack of impact of nil-per-os (NPO) time on goal-directed fluid delivery in first case versus afternoon case starts: a retrospective cohort study

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
R. Ryan Field ◽  
Tuan Mai ◽  
Samouel Hanna ◽  
Brian Harrington ◽  
Michael-David Calderon ◽  
...  
Keyword(s):  
Operating Room ◽  
Medical Center ◽  
Fluid Administration ◽  
Fluid Replacement ◽  
Primary Study ◽  
Start Time ◽  
Fluid Delivery ◽  
First Case ◽  
Patient Reported ◽  
The Impact

Abstract Background Goal Directed Fluid Therapy (GDFT) represents an objective fluid replacement algorithm. The effect of provider variability remains a confounder. Overhydration worsens perioperative morbidity and mortality; therefore, the impact of the calculated NPO deficit prior to the operating room may reach harm. Methods A retrospective single-institution study analyzed patients at UC Irvine Medical Center main operating rooms from September 1, 2013 through September 1, 2015 receiving GDFT. The primary study question asked if GDFT suggested different fluid delivery after different NPO periods, while reducing inter-provider variability. We created two patient groups distinguished by 0715 surgical start time or start time after 1200. We analyzed fluid administration totals with either a 1:1 crystalloid to colloid ratio or a 3:1 ratio. We performed direct group-wise testing on total administered volume expressed as total ml, total ml/hr., and total ml/kg/hr. between the first case start (AM) and afternoon case (PM) groups. A linear regression model included all baseline covariates that differed between groups as well as plausible confounding factors for differing fluid needs. Finally, we combined all patients from both groups, and created NPO time to total administered fluid scatterplots to assess the effect of patient-reported NPO time on fluid administration. Results Whether reported by total administered volume or net fluid volume, and whether we expressed the sum as ml, ml/hr., or ml/kg/hr., the AM group received more fluid on average than the PM group in all cases. In the general linear models, for all significant independent variables evaluated, AM vs PM case start did not reach significance in both cases at p = 0.64 and p = 0.19, respectively. In scatterplots of NPO time to fluid volumes, absolute adjusted and unadjusted R2 values are < 0.01 for each plot, indicating virtually non-existent correlations between uncorrected NPO time and fluid volumes measured. Conclusions This study showed NPO periods do not influence a patient’s volume status just prior to presentation to the operating room for surgical intervention. We hope this data will influence the practice of providers routinely replacing calculated NPO period volume deficit; particularly with those presenting with later surgical case start times.

Spinal anesthesia in a designated block bay for total joint arthroplasty: improving operating room efficiency

2020 ◽  
Vol 45 (12) ◽  
pp. 975-978
Author(s):  
Ryland Kagan ◽  
Stephanie Zhao ◽  
Andrew Stone ◽  
Alicia J Johnson ◽  
Thomas Huff ◽  
...  
Keyword(s):  
Spinal Anesthesia ◽  
Operating Room ◽  
Total Joint Arthroplasty ◽  
Group Versus ◽  
Joint Arthroplasty ◽  
Start Time ◽  
Serious Adverse Events ◽  
Mixed Effect ◽  
Exact Test ◽  
First Case

BackgroundCreating highly efficient operating room (OR) protocols for total joint arthroplasty (TJA) is a challenging and multifactorial process. We evaluated whether spinal anesthesia in a designated block bay (BBSA) would reduce time to incision, improve first case start time and decrease conversion to general anesthesia (GA).MethodsRetrospective cohort study on the first 86 TJA cases with BBSA from April to December 2018, compared with 344 TJA cases with spinal anesthesia performed in the OR (ORSA) during the same period. All TJA cases were included if the anesthetic plan was for spinal anesthesia. Patients were excluded if circumstances delayed start time or time to incision (advanced vascular access, pacemaker interrogation, surgeon availability). Data were extracted and analyzed via a linear mixed effects model to compare time to incision, via a Wilcoxon rank-sum test to compare first case start time, and via a Fisher’s exact test to compare conversion to GA between the groups.ResultsIn the mixed effect model, the BBSA group time to incision was 5.37 min less than the ORSA group (p=0.018). The BBSA group had improved median first case start time (30.0 min) versus the ORSA group (40.5 min, p<0.0001). There was lower conversion to GA 2/86 (2.33%) in the BBSA group versus 36/344 (10.47%) in the ORSA group (p=0.018). No serious adverse events were noted in either group.ConclusionsBBSA had limited impact on time to incision for TJA, with a small decrease for single OR days and no improvement on OR days with two rooms. BBSA was associated with improved first case start time and decreased rate of conversion to GA. Further research is needed to identify how BBSA affects the efficiency of TJA.

scholarly journals Lack of Impact of Nil-Per-Os (NPO) Time on Goal-Directed Fluid Delivery in First Case versus Afternoon Case Starts: A Retrospective Cohort Study

2019 ◽  
Author(s):  
R Ryan Field ◽  
Tuan Mai ◽  
Samouel Hanna ◽  
Brian Harrington ◽  
Michael-David Calderon ◽  
...  
Keyword(s):  
Operating Room ◽  
Medical Center ◽  
Fluid Administration ◽  
Fluid Replacement ◽  
Primary Study ◽  
Start Time ◽  
Fluid Delivery ◽  
First Case ◽  
Patient Reported ◽  
The Impact

Abstract Background: Goal Directed Fluid Therapy(GDFT) represents an objective fluid replacement algorithm. The effect of provider variability remains a confounder. Overhydration worsens perioperative morbidity and mortality; therefore, the impact of the calculated NPO deficit prior to the operating room may reach harm. Methods: A retrospective single-institution study analyzed patients at UC Irvine Medical Center main operating rooms from September 1, 2013 through September 1, 2015 receiving GDFT. The primary study question asked if GDFT suggested different fluid delivery after different NPO periods, while reducing inter-provider variability. We created two patient groups distinguished by 0715 surgical start time or start time after 1200. We analyzed fluid administration totals with either a 1:1 crystalloid to colloid ratio or a 3:1 ratio. We performed direct group-wise testing on total administered volume expressed as total ml, total ml/hr, and total ml/kg/hr between the first case start (AM) and afternoon case (PM) groups. A linear regression model included all baseline covariates that differed between groups as well as plausible confounding factors for differing fluid needs. Finally, we combined all patients from both groups, and created NPO time to total administered fluid scatterplots to assess the effect of patient-reported NPO time on fluid administration. Results: Whether reported by total administered volume or net fluid volume, and whether we expressed the sum as ml, ml/hr, or ml/kg/hr, the AM group received more fluid on average than the PM group in all cases. In the general linear models, for all significant independent variables evaluated, AM vs PM case start did not reach significance in both cases at p=0.64 and p=0.19, respectively. In scatterplots of NPO time to fluid volumes, absolute adjusted and unadjusted R2 values are < 0.01 for each plot, indicating virtually non-existent correlations between uncorrected NPO time and fluid volumes measured. Conclusions: This study showed NPO periods do not influence a patient’s volume status just prior to presentation to the operating room for surgical intervention. We hope this data will influence the practice of providers routinely replacing calculated NPO period volume deficit; particularly with those presenting with later surgical case start times.

Tu1019 Indicators for Quality Improvement: An Analysis of First Case Start Time on Interventional Endoscopy Unit Efficiency

2016 ◽  
Vol 83 (5) ◽  
pp. AB532-AB533
Author(s):  
Yaseen B. Perbtani ◽  
Dennis Yang ◽  
Qi An ◽  
Robert J. Summerlee ◽  
Alejandro L. Suarez ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Interventional Endoscopy ◽  
Start Time ◽  
Endoscopy Unit ◽  
First Case

A COMIT Model Utilization to Improve First-Case Start Time

2001 ◽  
Vol 6 (1) ◽  
pp. 38-46 ◽  
Author(s):  
Pamela E. Windle ◽  
Karen Barron ◽  
Doris Walker ◽  
Joanie Cormier
Keyword(s):  
Start Time ◽  
First Case

scholarly journals Operating Room Efficiency for General Anesthesia Cases in the Department of Ophthalmology in a Public Tertiary Hospital

2021 ◽  
Vol 55 (1) ◽  
Author(s):  
Maria Isabel N. Umali ◽  
Teresita R. Castillo
Keyword(s):  
General Anesthesia ◽  
Operating Room ◽  
Third Party ◽  
Team Approach ◽  
Operating Room Efficiency ◽  
Start Time ◽  
Tertiary Institution ◽  
Cross Sectional ◽  
First Case ◽  
Department Of Ophthalmology

Objective. To determine operating room efficiency for elective ophthalmologic surgeries requiring general anesthesia in a public tertiary institution based on standard efficiency parameters. Methods. Prospective observational cross-sectional study of randomly selected elective cases requiring general anesthesia from April 2019 to June 2019 in the Department of Ophthalmology of the Philippine General Hospital. A single third-party observer recorded operating room milestones from which efficiency parameters were determined and compared with local and international guidelines and efficiency benchmarks. Results. A total of fifty cases from the Retina, Plastic, Orbit, Glaucoma, and Motility services were observed. None started on the specified start time of 6:30 a.m., with surgeries starting an average of 52 ± 11.90 minutes after. Across subspecialties, median surgical preparation time was statistically significant (χ2: 12.01, p: 0.02), with the Retina and Orbit services having the most extended duration. Across age groups, pediatric cases had lower mean anesthesia preparation times (t: 2.15, df: 48, p: 0.04) and median trans-out lag times (χ2: 4.56, p: 0.03) than adults. Overall, more than 60% of cases reached targets for induction and surgical lag time. Turnaround for adult and pediatric patients was 75 ± 22.77 minutes and 71 ± 14.91 minutes, respectively. Benchmarking analysis showed that the first case on time, entry lag, and exit lag were below the 50th percentile while the room turnover time was above the 95th percentile. Conclusion. Ensuring efficiency requires a multidisciplinary team approach. This research can guide administrators in determining interventions to increase operating room efficiency.

scholarly journals Efficient perioperative time-management methods for operating theatres: a systematic review showing how to reduce overall patient waiting times for elective surgery

2021 ◽  
Author(s):  
Dimuthu Rathnayake
Keyword(s):  
Systematic Review ◽  
Time Management ◽  
Elective Surgery ◽  
Waiting Times ◽  
Experimental Studies ◽  
Cochrane Library ◽  
Start Time ◽  
Randomized Controlled Studies ◽  
First Case ◽  
Patient Waiting

Abstract Introduction: The effects on long waiting times for elective surgeries from lower operating theatre (OT) performance have been reported in many studies. The timeliness of perioperative processes and adherence to scheduled times is crucial for efficient performance in OT but the perioperative workflow includes multiple tasks assigned to different work teams. Each of these needs to be completed in a timely manner. This systematic review investigates the effects of efficient preoperative systems on the timeliness of upstream and downstream processes in surgical care pathways in order to reduce overall patient waiting times for elective surgery. Methods: We searched PubMed, EMBASE, SCOPUS, Web of Science and Cochrane Library databases during December 2019 and January 2020, for articles published after 1 January 2014. All studies pertaining to perioperative time-management methods, which had an intention to reduce waiting times for elective surgery were eligible for this review. Eligibility criteria included major elective surgery lists of adult patients, excluding cancer and cancer-related surgeries. Both randomized trials and non-randomized controlled studies were considered and the quality of studies was assessed using ROBINS-I and CASP tools. The review findings are presented as a narrative synthesis due to the heterogeneity of included studies. The PROSPERO registration is CRD42019158455. Results: The electronic search yielded 7543 records and 20 articles were eligible after deduplication and full article screening. There were two experimental studies, five quasi-experimental studies and 13 observational studies. The studies varied widely in design, scope, reported outcomes and overall quality. The first-case-start-time and patient change-over-time at OT were the main time related measures considered as affecting timeliness in many studies. Conclusion: This review suggests that a significant amount of time could be saved with efficient scheduling and planning perioperative processes, which could reduce overall patient waiting time for elective surgeries. Managing perioperative time in isolation could be an enabling factor for an overall increase in both theatre utilisation and theatre efficiency. However, only a small number of good quality studies were available and further evaluation with higher quality study designs and rigour is recommended in order for firm conclusions to be reached.

scholarly journals Lack of Impact of Nil-Per-Os (NPO) Time on Goal-Directed Fluid Delivery in First Case versus Afternoon Case Starts: A Retrospective Cohort Study

2019 ◽  
Author(s):  
R Ryan Field ◽  
Tuan Mai ◽  
Samouel Hanna ◽  
Brian Harrington ◽  
Michael-David Calderon ◽  
...  
Keyword(s):  
Operating Room ◽  
Medical Center ◽  
Fluid Administration ◽  
Fluid Replacement ◽  
Primary Study ◽  
Start Time ◽  
Fluid Delivery ◽  
First Case ◽  
Patient Reported ◽  
The Impact

Abstract Background: Goal Directed Fluid Therapy(GDFT) represents an objective fluid replacement algorithm. The effect of provider variability remains a confounder. Overhydration worsens perioperative morbidity and mortality; therefore, the impact of the calculated NPO deficit prior to the operating room may reach harm. Methods: A retrospective single-institution study analyzed patients at UC Irvine Medical Center main operating rooms from September 1, 2013 through September 1, 2015 receiving GDFT. The primary study question asked if GDFT suggested different fluid delivery after different NPO periods, while reducing inter-provider variability. We created two patient groups distinguished by 0715 surgical start time or start time after 1200. We analyzed fluid administration totals with either a 1:1 crystalloid to colloid ratio or a 3:1 ratio. We performed direct group-wise testing on total administered volume expressed as total ml, total ml/hr, and total ml/kg/hr between the first case start (AM) and afternoon case (PM) groups. A linear regression model included all baseline covariates that differed between groups as well as plausible confounding factors for differing fluid needs. Finally, we combined all patients from both groups, and created NPO time to total administered fluid scatterplots to assess the effect of patient-reported NPO time on fluid administration. Results: Whether reported by total administered volume or net fluid volume, and whether we expressed the sum as ml, ml/hr, or ml/kg/hr, the AM group received more fluid on average than the PM group in all cases. In the general linear models, for all significant independent variables evaluated, AM vs PM case start did not reach significance in both cases at p=0.64 and p=0.19, respectively. In scatterplots of NPO time to fluid volumes, absolute adjusted and unadjusted R2 values are < 0.01 for each plot, indicating virtually non-existent correlations between uncorrected NPO time and fluid volumes measured. Conclusions: This study showed NPO periods do not influence a patient’s volume status just prior to presentation to the operating room for surgical intervention. We hope this data will influence the practice of providers routinely replacing calculated NPO period volume deficit; particularly with those presenting with later surgical case start times.

scholarly journals SP10.2.13 Theatre-team meeting start times during the COVID-19 pandemic: An audit of elective orthopaedic theatre practices at a high volume elective orthopaedic centre during the COVID-19 pandemic

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Habeeb Bishi ◽  
Fanuelle Getachew ◽  
Nardeen Kader ◽  
Deiary Kader
Keyword(s):  
High Volume ◽  
Clinical Governance ◽  
Start Time ◽  
Team Members ◽  
Team Meeting ◽  
Team Meetings ◽  
First Case ◽  
Theatre Team

Abstract Aims The estimated cost of running an NHS theatre is 20 pounds per minute therefore it is essential that theatres runs as efficiently as possible to reduce waste. After elective services were restarted a disproportionate increase in late theatre start times was observed. An audit was carried out to evaluate whether team meetings were beginning on time (08:00) and if not; the length of and reason for the delay. These findings were presented at Clinical Governance and a re-audit was done to see if there had been any improvement. Method Data was recorded on an audit proforma in each theatre before the first case. This was done for 2 weeks over 12 days of theatre sessions and subsequently analysed to evaluate if practice was compliant with local theatre protocols. Results First cycle – average team brief start time of 08:05 with 17/18 (94%) of late starts due to surgeon/anaesthetist lateness. Second cycle - average team brief start time of 08:08 with 10/22 (45%) of late starts due to surgeon/anaesthetist lateness. Conclusions Late starts led to further delays to the patient being sent for and arriving in theatre; late starts were usually caused by doctors/surgeons. The proportion of late starts due to the surgeon/anaesthetist (45%) decreased compared to the first cycle (94%) suggesting that theatre team members successfully adapted their practices following changes to local protocols during the COVID-19 pandemic. A number of extraneous factors were also attributed to the later average start times in the second cycle.

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