Chapter 16 Minor Procedure Room Setup

2022 ◽  
Keyword(s):  
Minor Procedure ◽  
Procedure Room

WALANT Hand and Upper Extremity Procedures Performed With Minor Field Sterility Are Associated With Low Infection Rates

2021 ◽  
pp. 229255032110038
Author(s):  
Alba Avoricani ◽  
Qurratul-Ain Dar ◽  
Kenneth H. Levy ◽  
Joey S. Kurtzman ◽  
Steven M. Koehler
Keyword(s):  
Patient Safety ◽  
Surgical Site Infection ◽  
Upper Extremity ◽  
Site Infection ◽  
Infection Rates ◽  
Workflow Efficiency ◽  
A Minor ◽  
Main Operating ◽  
Minor Procedure ◽  
Procedure Room

Background: The use of minor field sterility in hand/upper extremity cases has been shown to improve workflow efficiency while maintaining patient safety. As this finding has been limited to specific procedures, we investigated the safety of performing a wide array of hand/upper extremity procedures outside the main operating room using minimal field sterility with Wide-Awake Local Anaesthesia No Tourniquet (WALANT) anaesthesia by evaluating superficial and deep infection rates across a diverse series of cases. Methods: This study was a case series conducted between October 2017 and June 2020. Of all, 217 patients underwent hand/upper extremity procedures performed in a minor procedure room via WALANT technique with field sterility. Primary outcome measures include superficial and deep surgical site infections within 14 days post-surgery. Results: Of all, 217 patients were included in this study; 265 consecutive hand/upper extremity operations were performed by a single surgeon, with notable case diversity. The majority of patients (n = 215, 99.1%) did not report or present with signs of infection before or after their operation. We report 0% 14-day and 0.37% 30-day surgical site infection rates for such hand/upper extremity procedures performed in a minor procedure room with field sterility. Conclusion: Hand/upper extremity procedures performed via WALANT technique with field sterility in a minor procedure room are associated with low surgical site infection rates. These rates are comparable to surgical site infection rates for similar surgeries performed in main operating rooms with standard sterilization procedures. Thus, the implementation of this technique may allow for improved workflow efficiency and reduced waste, all while maintaining patient safety.

scholarly journals Bargain Hunting for Buffered Lidocaine: A Collaborative Discovery of Cost-saving Strategies That Can Improve Patient Care

2020 ◽  
Author(s):  
Curtis L Simmons ◽  
Laura K Harper ◽  
Kathryn J Holst ◽  
Nathan J Brinkman ◽  
Christine U Lee
Keyword(s):  
Sodium Bicarbonate ◽  
Hospital Pharmacy ◽  
Cost Savings ◽  
Improve Patient Care ◽  
Medical Waste ◽  
Radiology Department ◽  
Access Pricing ◽  
Bundled Payments ◽  
Improve Patient ◽  
Procedure Room

Abstract Buffered lidocaine is a local anesthetic option during percutaneous needle-directed procedures in the breast. At our institution, sodium bicarbonate (the buffer) is dispensed in volumes that frequently lead to medical waste and shortages. In this study, we describe how moving the buffering of lidocaine from the procedure room to our clinical hospital pharmacy results in a reduction in costs and improves satisfaction across the breast radiology department. While cost savings are difficult to tease out in practices that opt for bundled payments, we were able to access pricing and supply data and coordinate with our pharmacy to change our practice. Making these changes saves our practice $26 000 a year and allows us to continue to offer buffered lidocaine even during sodium bicarbonate shortages. This manuscript describes how these changes came about and their economic impact.

scholarly journals Impact of a Family Medicine Minor Procedure Service on Cost of Care for a Health Plan

2020 ◽  
Vol 52 (6) ◽  
pp. 417-421
Author(s):  
Ian Nelligan ◽  
Tamara Montacute ◽  
Michael-Anne Browne ◽  
Steven Lin
Keyword(s):  
Family Medicine ◽  
Health Plan ◽  
Average Cost ◽  
Primary Care Physicians ◽  
Health Spending ◽  
Cost Of Care ◽  
Care Organization ◽  
Data Set ◽  
The Impact ◽  
Minor Procedure

Background and Objectives: Academic medical centers (AMC) are among some of the most expensive places to provide care. One way to cut costs is by decreasing unnecessary referrals to specialists for procedures that can be provided by well-trained primary care physicians. Our goal is to measure the financial impact of an office-based minor procedure service driven entirely by family physicians. Methods: We examined claims data for procedures performed on patients insured under our AMC’s home-grown accountable care organization-style health plan (Stanford Health Care Alliance [SHCA]). Descriptive statistics was used to compare the volume and cost of procedures performed by family medicine (FM) versus specialty care (SC). We preformed a subanalysis of SC procedures to explore the degree to which consultation and facility fees increased costs for SC. We used mathematical modeling to estimate the impact on cost of care if procedures were shifted from SC to FM and to calculate a return on investment (ROI). Results: Our data set examined 6,974 outpatient procedures performed on SHCA patients from 2016-2018 at a cost of $5,263,720 to SHCA. FM performed 6% of procedures at an average cost of $236 per procedure, while SC performed 94% of procedures at an average cost of $787 per procedure. FM saved money for all 12 types of skin, musculoskeletal, and reproductive procedures assessed; the average saved per procedure was $551. This represents a 70% cost savings. ROI was 2.33; for every $1 spent on FM procedures, SHCA saved $2.33. Conclusion: A family medicine minor procedure service significantly lowered health spending at our AMC.

Preoperative Patient Evaluation for Anesthesia Care Outside of the Operating Room

2011 ◽  
pp. 8-19 ◽  
Author(s):  
Bobbie Jean Sweitzer
Keyword(s):  
Operating Room ◽  
Preoperative Evaluation ◽  
Interventional Cardiology ◽  
Anesthesia Practice ◽  
Portosystemic Shunts ◽  
Time And Energy ◽  
To Receive ◽  
Postanesthesia Recovery ◽  
Preoperative Patient ◽  
Minor Procedure

Preoperative evaluation and optimization of medical status of patients are important components of anesthesia practice. Increasing numbers of patients with serious comorbidities undergo procedures that require anesthesia services outside of the operating room (OOOR). Often the location alters the challenges of caring for these patients. Surgical, anesthesia, or nursing personnel who can assist with airway and resuscitation management may not be available; equipment and medications may be limited. Many OOOR locations will not have the usual support of an intensive care unit (ICU), skilled postanesthesia recovery personnel, respiratory therapy, or ready access to an inpatient bed, blood banking, interventional cardiology, or diagnostic services. Many of the patients are elderly, ill, and even unlikely candidates for conventional surgery (e.g., transmucosal resection of gastric tumors, transjugular intrahepatic portosystemic shunts). Yet patients and/or providers may be reluctant to expend time and energy in extensive preoperative evaluation before a seemingly minor procedure. This chapter will outline the basics of preprocedure preparation of patients scheduled to receive anesthesia in OOOR settings.

scholarly journals Assessment of Intravitreal Injection Training among U.S.-Based Ophthalmology Residents

2019 ◽  
Vol 11 (01) ◽  
pp. e43-e49
Author(s):  
Jacob J. Liechty ◽  
Michael J. Wilkinson ◽  
Esther M. Bowie
Keyword(s):  
United States ◽  
Intravitreal Injection ◽  
Povidone Iodine ◽  
The United States ◽  
Intravitreal Injections ◽  
First Year ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Residency Program Directors ◽  
Procedure Room

Purpose To describe the intravitreal injection training of ophthalmology residents in the United States in 2018. Design Cross-sectional survey. Methods An anonymous, 29-question, internet-based survey was emailed to 119 ophthalmology residency program directors with the instructions to forward the survey to their ophthalmology residents. Results A total of 117 ophthalmology residents (7.89%) responded to the survey. The majority of residents stated that their intravitreal injection training began during their first year of ophthalmology training, PGY 2 year, (92.3%). The majority of residents performed at least 25 injections per year (78.6%). All residents use antiseptic on the conjunctiva prior to the injection, 94% use a lid speculum, and 84.6% avoided talking in the procedure room. Most injections are performed with gloves (83.8%). A minority of residents stated that they are trained to use povidone-iodine on the eyelids prior to performing an injection (45.3%). Only 6.0% of residents claimed to use postinjection antibiotic drops. Performance of bilateral, simultaneous intravitreal injections was split with nearly half of residents not being trained in this method (47.9%). Conclusion Ophthalmology residents from across the country experience a variety of different injection protocols when being trained on how to perform intravitreal injections. Conjunctival antisepsis has reached a clear consensus while topics such as simultaneous, bilateral injections and eyelid antisepsis are still uncertain among the resident community.

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