Case costing in spine surgery: Can surgeons assist with accurate capture of operating room costs?

Surgical case costing is critical for health leaders to make decisions about resource utilization. Synoptic reporting offers the potential for surgeons to capture these costs and work with other leaders to make evidence-based decisions. The purpose of this study was to determine whether surgeons documented intra-operative cost drivers as part of their operative report. This article outlines a synoptic reporting system at a quaternary spine care centre. Data were captured from 2015 to 2020. Surgeon rates of documentation for specific devices, bone graft, and surgical adjuncts were evaluated. It is hoped that the results of this survey will help to guide programs to capture costs in other settings.

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Variability in Anesthesia Models of Care in Cardiac Surgery

Surgeries ◽

10.3390/surgeries2010001 ◽

2021 ◽

Vol 2 (1) ◽

pp. 1-8

Author(s):

Dianne McCallister ◽

Bethany Malone ◽

Jennifer Hanna ◽

Michael S. Firstenberg

Keyword(s):

Cardiac Surgery ◽

Best Practices ◽

Operating Room ◽

Models Of Care ◽

Surgical Team ◽

Cardiac Anesthesia ◽

Complex Environment ◽

Surgical Case ◽

Cardiac Procedures ◽

Cardiac Operations

The operating room in a cardiothoracic surgical case is a complex environment, with multiple handoffs often required by staffing changes, and can be variable from program to program. This study was done to characterize what types of practitioners provide anesthesia during cardiac operations to determine the variability in this aspect of care. A survey was sent out via a list serve of members of the cardiac surgical team. Responses from 40 programs from a variety of countries showed variability across every dimension requested of the cardiac anesthesia team. Given that anesthesia is proven to have an influence on the outcome of cardiac procedures, this study indicates the opportunity to further study how this variability influences outcomes and to identify best practices.

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A Hospital-Based Standardized Spine Care Pathway: Report of a Multidisciplinary, Evidence-Based Process

Journal of Manipulative and Physiological Therapeutics ◽

10.1016/j.jmpt.2010.12.004 ◽

2011 ◽

Vol 34 (2) ◽

pp. 98-106 ◽

Cited By ~ 22

Author(s):

Ian Paskowski ◽

Michael Schneider ◽

Joel Stevans ◽

John M. Ventura ◽

Brian D. Justice

Keyword(s):

Care Pathway ◽

Evidence Based ◽

Spine Care

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The reporting of anal cytology and histology samples: establishing terminology and criteria

Sexual Health ◽

10.1071/sh10140 ◽

2012 ◽

Vol 9 (6) ◽

pp. 562 ◽

Cited By ~ 6

Author(s):

Jennifer Margaret Roberts ◽

Deborah Ekman

Keyword(s):

Reporting System ◽

Intraepithelial Neoplasia ◽

Hpv Infection ◽

Classification Systems ◽

Low Grade ◽

Evidence Based ◽

High Grade ◽

Anal Neoplasia ◽

Anal Cytology ◽

Bethesda System

Our understanding of the human papillomavirus (HPV) related cytomorphology and histopathology of the anal canal is underpinned by our knowledge of HPV infection in the cervix. In this review, we utilise cervical reporting of cytological and histological specimens as a foundation for the development of standardised and evidence-based terminology and criteria for reporting of anal specimens. We advocate use of the Australian Modified Bethesda System 2004 for reporting anal cytology. We propose the use of a two-tiered histological reporting system for noninvasive disease – low-grade and high-grade anal intraepithelial neoplasia. These classification systems reflect current understanding of the biology of HPV and enhance diagnostic reproducibility. Biomarkers such as p16INK4A may prove useful in further improving diagnostic accuracy. Standardisation is important because it will increase the value of the data collected as Australian centres develop programs for screening for anal neoplasia.

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Implementation of the Comprehensive Operating Room Ergonomics Program for Surgeons Through an OT Approach: A Feasibility Study

American Journal of Occupational Therapy ◽

10.5014/ajot.2021.75s2-po314 ◽

2021 ◽

Vol 75 (Supplement_2) ◽

pp. 7512515314p1-7512515314p1

Author(s):

Pamela Hess ◽

Penelope Moyers Cleveland

Keyword(s):

Operating Room ◽

Feasibility Study ◽

Mixed Methods Research ◽

Implementation Process ◽

Evidence Based ◽

Health And Wellness ◽

Design And Implementation ◽

The Core ◽

Core Program ◽

Primary Author

Abstract Date Presented 04/22/21 The Comprehensive Operating Room Ergonomics (CORE) program was developed to address the physical and environmental demands among surgeons. This feasibility study examined the design and implementation process of an evidence-based OT ergonomics intervention using a mixed-methods research design. The CORE program supports the American Occupational Therapy Association’s Vision 2025 of promoting population health and wellness, especially among surgeons who are essential to our health care system. Primary Author and Speaker: Pamela Hess Additional Authors and Speakers: Elena Donoso Brown

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Primary Care May Be Dying in the United States—Further Endangering Evidence-Based Spine Care

The Back Letter ◽

10.1097/01.back.0000756844.00334.bd ◽

2021 ◽

Vol 36 (7) ◽

pp. 75-75

Keyword(s):

United States ◽

Primary Care ◽

The United States ◽

Evidence Based ◽

Spine Care

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Releasing Operating Room Nursing Time to Care through the Reduction of Surgical Case Preparation Time: A Lean Six Sigma Pilot Study

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph182212098 ◽

2021 ◽

Vol 18 (22) ◽

pp. 12098

Author(s):

Patricia Egan ◽

Anthony Pierce ◽

Audrey Flynn ◽

Sean Paul Teeling ◽

Marie Ward ◽

...

Keyword(s):

Operating Room ◽

Six Sigma ◽

Quality Care ◽

Lean Six Sigma ◽

Nursing Time ◽

Surgical Case ◽

Improvement Methodologies ◽

Increasing Demand ◽

Set Up ◽

Room Nursing

Healthcare systems internationally are working under increasing demand to use finite resources with greater efficiency. The drive for efficiency utilises process improvement methodologies such as Lean Six Sigma. This study outlines a pilot Lean Six Sigma intervention designed to release nursing time to care within a peri-operative environment; this was achieved by collaborating with stakeholders to redesign the process for laparoscopic hernia surgical case preparation (set up) material. Across 128 laparoscopic hernia surgical cases, the pilot resulted in a 55% decrease in overall nursing time spent in gathering and preparing materials for laparoscopic hernia surgical cases, with a corresponding reduction in packaging waste. The major impact of releasing nursing time to care within busy Operating Room environments enabled nurses to focus on continuing to deliver high-quality care to their patients and reduce pressure expressed by the Operating Room nurses. The results have led to an ongoing review of other surgical procedures preparation to further release nursing time and will be of interest to perioperative teams internationally.

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Incidence and Impact of Reported Infectious Endophthalmitis Events Following Cataract Surgery in Pennsylvania Ambulatory Surgery Centers

Patient Safety ◽

10.33940/infection/2019.12.3 ◽

2019 ◽

pp. 30-39

Author(s):

Lynette Hathaway ◽

Shawn Kepner ◽

Rebecca Jones

Keyword(s):

Cataract Surgery ◽

Infection Prevention ◽

Reporting System ◽

Ambulatory Surgery ◽

Evidence Based ◽

Healthcare Staff ◽

Ambulatory Surgery Centers ◽

Safety Reporting ◽

Eye Infection ◽

Infectious Endophthalmitis

Infectious endophthalmitis is a severe eye infection that can occur following cataract surgery. In this study, we sought to explore post-cataract infectious endophthalmitis events reported by ambulatory surgery centers (ASCs) in Pennsylvania. We queried the Pennsylvania Patient Safety Reporting System (PA-PSRS) database for post-cataract endophthalmitis events that occurred between 2009 and 2018. In the 10 calendar years analyzed, we identified 174 reports of post-cataract endophthalmitis, with rates per 1000 cataract procedures ranging from 0.05 in 2009 to 0.19 in 2018. The vast majority of these events were classified as serious (93%; n = 162 of 174), reflecting harm to patients, with one resulting in enucleation (the need to remove the affected eye). Healthcare staff and all involved stakeholders should act now by identifying sources of potential perioperative contamination, adhering to evidence-based infection prevention practices, and prioritizing areas of opportunity for improvement.

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Method to Assist in the Scheduling of Add-on Surgical Cases-Upper Prediction Bounds for Surgical Case Durations Based on the Log-normal Distribution

Anesthesiology ◽

10.1097/00000542-199811000-00024 ◽

1998 ◽

Vol 89 (5) ◽

pp. 1228-1232 ◽

Cited By ~ 72

Author(s):

Jinshi Zhou ◽

Franklin Dexter

Keyword(s):

Normal Distribution ◽

Operating Room ◽

Statistical Distribution ◽

Distribution Free ◽

Surgical Case ◽

Normal Method ◽

Log Normal ◽

Or Manager ◽

Log Normal Distribution

Background A problem that operating room (OR) managers face in running an OR suite on the day of surgery is to identify "holes" in the OR schedule in which to assign "add-on" cases. This process necessitates knowing the typical and maximum amounts of time that the case is likely to require. The OR manager may know previous case durations for the particular surgeon performing a particular scheduled procedure. The "upper prediction bound" specifies with a certain probability that the duration of the surgeon's next case will be less than or equal to the bound. Methods Prediction bounds were calculated by using methods that (1) do not assume that case durations follow a specific statistical distribution or (2) assume that case durations follow a log-normal distribution. These bounds were tested using durations of 48,847 cases based on 15,574 combinations of scheduled surgeon and procedure. Results Despite having 3 yr of data, 80 or 90% prediction bounds would not be able to be calculated using the distribution-free method for 35 or 49% of future cases versus 22 or 22% for the log-normal method, respectively. Prediction bounds based on the log-normal distribution overestimated the desired value less often than did the distribution-free method. The chance that the duration of the next case would be less than or equal to its 90% bound based on the log-normal distribution was within 2% of the expected rate. Conclusions Prediction bounds classified by scheduled surgeon and procedure can be accurately calculated using a method that assumes that case durations follow a log-normal distribution.

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