Optimizing Operating Room Throughput

2021 ◽  
Author(s):  
◽  
Amanda Brendel
Keyword(s):  
Operating Room ◽  
Patient Flow ◽  
Clinical Care ◽  
Statistical Significance ◽  
Care Transitions ◽  
Flow Process ◽  
Patient Capacity ◽  
Lengths Of Stay ◽  
Practice Problem ◽  
Improve Hospital

Practice Problem: Throughput is an instrumental aspect for hospitals to maximize patient capacity; therefore, methods to improve patient flow should be consistently implemented. Surgical areas are a major contributor to inpatient admissions and the subsequent revenue; however, without the appropriate oversight, patient throughput can be negatively impacted. PICOT: The PICOT question that guided this project was: In operating room patients who require inpatient admission (P), how does the implementation of a standardized bed flow process (I), compared to the current methods for care transitions (C), reduce perioperative delays and improve hospital financial metrics (O), over a three-month period (T)? Evidence: A review of the evidence revealed that streamlining operating room throughput was essential to the quality of clinical care and patient safety as well as to improve efficiencies associated with patient volumes, lengths of stay and hospital census. Intervention: A dedicated bed flow manager was implemented in the project setting with the overall goal to enhance throughput measures within the operating room. Outcome: While the intervention did not achieve statistical significance as determined by the data analysis, the results did demonstrate clinical significance as the organization was able to maximize capacity and throughput during the Covid-19 pandemic. Conclusion: The addition of a dedicated surgical bed flow manager was beneficial to the optimization, standardization and systemization of the perioperative throughput process.

Impact of Hybrid Operating Rooms on Long-Term Clinical Outcomes Following Fenestrated and Branched Endovascular Aortic Repair

2021 ◽  
pp. 152660282199672
Author(s):  
Giovanni Tinelli ◽  
Marie Bonnet ◽  
Adrien Hertault ◽  
Simona Sica ◽  
Gian Luca Di Tanna ◽  
...  
Keyword(s):  
Operating Room ◽  
Clinical Outcomes ◽  
Cox Regression ◽  
Statistical Significance ◽  
Aortic Aneurysms ◽  
Study Patient ◽  
Cox Regression Analysis ◽  
Significant Difference ◽  
The Impact

Purpose: Evaluate the impact of hybrid operating room (HOR) guidance on the long-term clinical outcomes following fenestrated and branched endovascular repair (F-BEVAR) for complex aortic aneurysms. Materials and Methods: Prospectively collected registry data were retrospectively analyzed to compare the procedural, short- and long-term outcomes of consecutive F-BEVAR performed from January 2010 to December 2014 under standard mobile C-arm versus hybrid room guidance in a high-volume aortic center. Results: A total of 262 consecutive patients, including 133 patients treated with a mobile C-arm equipped operating room and 129 with a HOR guidance, were enrolled in this study. Patient radiation exposure and contrast media volume were significantly reduced in the HOR group. Short-term clinical outcomes were improved despite higher case complexity in the HOR group, with no statistical significance. At a median follow-up of 63.3 months (Q1 33.4, Q3 75.9) in the C-arm group, and 44.9 months (Q1 25.1, Q3 53.5, p=0.53) in the HOR group, there was no statistically significant difference in terms of target vessel occlusion and limb occlusion. When the endograft involved 3 or more fenestrations and/or branches (complex F-BEVAR), graft instability (36% vs 25%, p=0.035), reintervention on target vessels (20% vs 11%, p=0.019) and total reintervention rates (24% vs 15%, p=0.032) were significantly reduced in the HOR group. The multivariable Cox regression analysis did not show statistically significant differences for long-term death and aortic-related death between the 2 groups. Conclusion: Our study suggests that better long-term clinical outcomes could be observed when performing complex F-BEVAR in the latest generation HOR.

scholarly journals Development of a Surgical Video Atlas for Resident Education: 3-Year Experience

OTO Open ◽  
2020 ◽  
Vol 4 (3) ◽  
pp. 2473974X2093906
Author(s):  
C. Scott Brown ◽  
Calhoun D. Cunningham ◽  
Walter T. Lee ◽  
Liana Puscas
Keyword(s):  
Operating Room ◽  
Teaching And Learning ◽  
Resident Education ◽  
Surgical Simulation ◽  
Clinical Care ◽  
Effective Means ◽  
The United States ◽  
Surgical Video ◽  
Key Indicator ◽  
Work Hour

Objective To create a high-quality annotated online surgical video atlas of key indicator otolaryngology cases and assess its use and overall journal trends over time. Methods Videos are recorded from multiple viewpoints within the operating room and compiled into a single stream. Postediting includes chaptering videos and overlaying relevant text annotations. Videos are published online and viewership trends analyzed. Results Over 3 years, 29 otolaryngology videos were published out of 161 journal publications (18%). Eight of the 14 key indicator procedures are included (57%). From the beginning of 2017 to the end of 2019, viewership of otolaryngology pages increased from 548 to 11,139 views per month, totaling >150,000 views. These now represent 10% of the total journal monthly views and 10% of the overall views. Users originate from the United States and from >10 other countries. Discussion Residents and faculty face challenges of providing the highest standard of clinical care, teaching, and learning in and out of the operating room. Inherent difficulties of surgical training, high-fidelity surgical simulation, and imposed work hour restrictions necessitate additional, more efficient and effective means of teaching and learning. Surgical videos demonstrating key anatomy, procedural steps, and surgical dexterity with hand positioning are increasing in their popularity among learners. Implications for Practice Surgical video atlases provide a unique adjunct for resident education. They are enduring and easily accessible. In a climate of work hour restrictions or elective case reduction, they may supplement how residents learn to operate outside the operating theater.

scholarly journals An assessment of the quality indicators of operative and non-operative times in a public university hospital

2015 ◽  
Vol 13 (4) ◽  
pp. 594-599 ◽  
Author(s):  
Altair da Silva Costa Jr ◽  
Luiz Eduardo Villaça Leão ◽  
Maykon Anderson Pires de Novais ◽  
Paola Zucchi
Keyword(s):  
Standard Deviation ◽  
Operating Room ◽  
Operative Time ◽  
Patient Flow ◽  
Cross Sectional Study ◽  
Public University ◽  
Major Effect ◽  
University Hospital ◽  
Cross Sectional ◽  
Using Data

ABSTRACT Objective To assess the operative time indicators in a public university hospital. Methods A descriptive cross-sectional study was conducted using data from operating room database. The sample was obtained from January 2011 to January 2012. The operations performed in sequence in the same operating room, between 7:00 am and 5:00 pm, elective or emergency, were included. The procedures with incomplete data in the system were excluded, as well as the operations performed after 5:00 pm or on weekends or holidays. Results We measured the operative and non-operative time of 8,420 operations. The operative time (mean and standard deviation) of anesthesias and operations were 177.6±110 and 129.8±97.1 minutes, respectively. The total time of the patient in operative room (mean and standard deviation) was 196.8±113.2. The non-operative time, e.g., between the arrival of the patient and the onset of anesthesia was 14.3±17.3 minutes. The time to set the next patient in operating room was 119.8±79.6 minutes. Our total non-operative time was 155 minutes. Conclusion Delays frequently occurred in our operating room and had a major effect on patient flow and resource utilization. The non-operative time was longer than the operative time. It is possible to increase the operating room capacity by management and training of the professionals involved. The indicators provided a tool to improve operating room efficiency.

scholarly journals The impact on patient flow after the integration of nurse practitioners and physician assistants in 6 Ontario emergency departments

CJEM ◽  
2009 ◽  
Vol 11 (05) ◽  
pp. 455-461 ◽  
Author(s):  
James Ducharme ◽  
Robert J. Alder ◽  
Cindy Pelletier ◽  
Don Murray ◽  
Joshua Tepper
Keyword(s):  
Health Care ◽  
Nurse Practitioners ◽  
Emergency Departments ◽  
Patient Flow ◽  
Physician Assistants ◽  
Wait Times ◽  
Care Providers ◽  
Lengths Of Stay ◽  
Left Without Being Seen ◽  
The Impact

ABSTRACT Objective: We sought to assess the impact of the integration of the new roles of primary health care nurse practitioners (NPs) and physician assistants (PAs) on patient flow, wait times and proportions of patients who left without being seen in 6 Ontario emergency departments (EDs). Methods: We performed a retrospective review of health records data on patient arrival time, time of initial assessment by a physician, time of discharge from the ED and discharge status. Results: Whether a PA or NP was directly involved in the care of patients or indirectly involved by being on duty, the wait times, lengths of stay and proportion of patients who left without being seen were significantly reduced. When a PA or NP were directly involved in patients' care, patients were 1.6 (95% confidence interval [CI] 1.3–2.1, p < 0.05) and 2.1 (95% CI 1.6–2.8, p < 0.05) times more likely to be seen within the wait time benchmarks, respectively. Lengths of stay were 30.3% (95% CI 21.6%–39.0%, p < 0.01) and 48.8% (95% CI 35.0%–62.7%, p < 0.01) lower when PAs and NPs, respectively, were involved. When PAs and NPs were not on duty, the proportion of patients who left without being seen were 44% (95% CI 31%–63%, p < 0.01) and 71% (95% CI 53%–96%, p < 0.05), respectively. Conclusion: The addition of PAs or NPs to the ED team can improve patient flow in medium-sized community hospital EDs. Given the ongoing shortage of physicians, use of alternative health care providers should be considered. These results require validation, as their generalizability to other locations or types of EDs is not known.

scholarly journals Heterogeneous effects of hospital competition on inpatient expenses: an empirical analysis of diseases grouping basing on conditions’ complexity and urgency

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Liyong Lu ◽  
Xiaojun Lin ◽  
Jay Pan
Keyword(s):  
Regression Model ◽  
Patient Flow ◽  
Statistical Significance ◽  
Healthcare Delivery ◽  
Hospital Competition ◽  
Process Of Care ◽  
Healthcare Delivery System ◽  
Discharge Data ◽  
Heterogeneous Effects ◽  
Hospital Administrative

Abstract Background Multiple pro-competition policies were implemented during the new round of healthcare reform in China. Differences in conditions’ complexity and urgency across diseases associating with various degrees of information asymmetry and choice autonomy in the process of care provision, would lead to heterogeneous effects of competition on healthcare expenses. However, there are limited studies to explore it. This study aims to examine the heterogeneous effects of hospital competition on inpatient expenses basing on disease grouping according to conditions’ complexity and urgency. Methods Collecting information from discharge data of inpatients and hospital administrative data of Sichuan province in China, we selected representative diseases. K-means clustering was used to group the selected diseases and Herfindahl-Hirschman Index (HHI) was calculated based on the predicted patient flow to measure the hospital competition. The log-linear multivariate regression model was used to examine the heterogeneous effects of hospital competition on inpatient expenses. Results We selected 19 representative diseases with significant burdens (more than 1.1 million hospitalizations). The selected diseases were divided into three groups, including diseases with highly complex conditions, diseases with urgent conditions, and diseases with less complex and less urgent conditions. For diseases with highly complex conditions and diseases with urgent conditions, the estimated coefficients of HHI are mixed in the direction and statistical significance in the identical regression model at the 5% level. For diseases with less complex and less urgent conditions, the coefficients of HHI are all positive, and almost all of them significant at the 5% level. Conclusions We found heterogeneous effects of hospital competition on inpatient expenses across disease groups: hospital competition does not play an ideal role in reducing inpatient expenses for diseases with highly complex conditions and diseases with urgent conditions, but it has a significant effect in reducing inpatient expenses of diseases with less complex and less urgent conditions. Our study offers implications that the differences in condition’s complexity and urgency among diseases would lead to different impacts of hospital competition, which would be given full consideration when designing the pro-competition policy in the healthcare delivery system to achieve the desired goal.

scholarly journals Cytotoxicity of three-dimensional paper-based models from a three-dimensional paper-based printer

NEMESIS ◽  
2018 ◽  
Vol 3 (1) ◽  
pp. 15 ◽  
Author(s):  
Marcin Kozakiewicz ◽  
Piotr Szymor ◽  
Raphael Olszewski
Keyword(s):  
Operating Room ◽  
Dermal Fibroblast ◽  
Statistical Significance ◽  
Three Dimensional ◽  
Dermal Fibroblasts ◽  
Tissue Adhesive ◽  
Biological Behaviour ◽  
Sterilization Method ◽  
Significant Difference ◽  
Before And After

Objective: Our study aimed to determine the possibility of using models created with a low-cost, paper based 3D printer in an operating room. Therefore influence of different methods of sterilization on models was tested and cytotoxicity of generated models was determined. Material and methods: 30 cuboids divided into three groups were used for verification of shape stability after sterilization. Each group was sterilized either with: Ethylene oxide in temperature 55˚C, Hydrogen peroxide gas plasma in temperature 60˚C or Gamma irradiation at 21˚C, 25kGy. Each cuboid was measured using calliper three times before and three times after sterilization. Results were analysed statistically in Statgraphics Plus. Statistical significance was determined as p< 0.05. Sixty cylinders divided into six groups were used for cytotoxicity tests. Three of those groups were covered before sterilization with 2-octyl-cyanoacrylate. Each group was sterilized with one of the previously described methods. Cytotoxicity was tested by Nanostructural and Molecular Biophysics Laboratory in Technopark Lodz using normal adult human dermal fibroblasts. Survival of cells was tested using spectrophotometry with XTT and was defined as ratio of absorbency of tested probe to absorbency of control probe. Calcein/Ethidium dyeing test was performed according to LIVE/DEAD Viability/Cytotoxicity Kit protocol. Observation was done under Olympus GX71 fluorescence microscope. Results: There was no statistically significant difference for established statistical significance p=0.05 in cuboids dimensions before and after sterilization regardless of sterilization method. In XTT analysis all samples showed higher cytotoxicity against normal, human, adult dermal fibroblast culture when compared to positive control. ANOVA statistical analysis confirmed that 2-octyl cyanoacrylate coating of paper model improved biological behaviour of the material. It decreased cytotoxicity of the model independently of sterilization method. In calcein/ethidium dyeing test due to the high fluorescence of the background caused by cylinders of analysed substance it was impossible to perform the exact analysis of the number of marked cells. Conclusions: Acquired results allow to conclude that Mcor Technology Matrix 300 3D paper-based models can be used in operating room only if covered with cyanoacrylate tissue adhesive. Nemesis relevance: We found no statistically significant difference in cuboids dimensions before and after sterilization regardless of sterilization method. Three-dimensional paper-based models present with high cytotoxicity without coating.

715 Early Ambulation for Enhanced Recovery After Burn Surgery: A Systematic Review and Meta-analysis

2020 ◽  
Vol 41 (Supplement_1) ◽  
pp. S189-S189
Author(s):  
Tomer Lagziel ◽  
Margarita Ramos ◽  
Kevin M Klifto ◽  
Stella Steal ◽  
Julie Caffrey ◽  
...  
Keyword(s):  
Systematic Review ◽  
Enhanced Recovery ◽  
Meta Analysis ◽  
Statistical Significance ◽  
Burn Patients ◽  
Early Ambulation ◽  
Lengths Of Stay ◽  
Operative Care ◽  
Burn Surgery ◽  
Operative Recovery

Abstract Introduction Accurate models are a fundamental prognostic tool for risk stratification, therapy guidance, resource allocation, and comparative effectiveness research. Enhanced recovery after surgery protocols are developed to increase early post-operative recovery rates in surgical patients. Due to the unique nature of burn injuries and post-operative care, there is a need to develop a protocol unique to burn surgery, enhanced recovery after burn surgery. Methods The PubMed, Embase, Cochrane, and Web of Science databases were systematically searched. Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) and Cochrane guidelines were strictly followed throughout the study. Search terms were utilized to capture the relevant studies relating to early ambulation of adult burn patients (&gt;18 years of age) and their post-surgical outcomes such as graft take, time to discharge, pain levels, VTEs, and length-of-stay. Results Thirteen of 888 studies retrieved from the search query were eligible for systematic review and meta-analysis. Patients with delayed ambulation, after 5 or more days were found to have increased pain levels at rest (p=0.02) and when ambulating (p=0.08). One study found an increased infection rate in late ambulatory patients (p=0.22). Most results from studies did not have significant data that was relevant to our extraction. For example, only one study assessed pain levels and only three studies notes zero venous thromboembolisms (without statistical significance). Conclusions Limited evidence exists relating to thromboembolic events and time-to-ambulation in post-operative burn patients. There are no significant differences in the number of events between early and late ambulation groups. Early ambulation should be included as part of the ERABS protocol for lower risks of hospital-acquired infections due to shorter lengths-of-stay. Decreased associated pain levels could lead to decreased risk for opioid dependence. Due to limited literature references, these conclusions are immature and more studies should be performed in order to develop more accurate and effective protocols. Applicability of Research to Practice Burn surgery recovery patients are unique. Therefore, specialized protocols must be developed to enhance their post-operative care.

scholarly journals Frequent users of emergency departments and patient flow in Alberta and Ontario, Canada: an administrative data study

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Anqi Chen ◽  
Scott Fielding ◽  
X. Joan Hu ◽  
Patrick McLane ◽  
Andrew McRae ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Emergency Departments ◽  
Patient Flow ◽  
Flow Characteristics ◽  
Initial Assessment ◽  
Cox Models ◽  
Lengths Of Stay ◽  
Random Samples ◽  
High System ◽  
And Control

Abstract Background This paper describes and compares patient flow characteristics of adult high system users (HSUs) and control groups in Alberta and Ontario emergency departments (EDs), Canada. Methods Annual cohorts of HSUs were created by identifying patients who made up the top 10% of ED users (by count of ED presentations) in the National Ambulatory Care Reporting System during 2011–2016. Random samples of patients not in the HSU groups were selected as controls. Presentation (e.g., acuity) and ED times (e.g., time to physician initial assessment [PIA], length of stay) data were extracted and described. The length of stay for 2015/2016 data was decomposed into stages and Cox models compared time between stages. Results There were 20,343,230 and 18,222,969 ED presentations made by 7,032,655 and 1,923,462 individuals in the control and HSU groups, respectively. The Ontario groups had higher acuity than the Alberta groups: about 20% in the Ontario groups were from the emergent level whereas Alberta had 11–15%. Time to PIA was similar across provinces and groups (medians of 60 min to 67 min). Lengths of stay were longest for Ontario HSUs (median = 3 h) and shortest for Alberta HSUs (median = 2.2 h). HSUs had shorter times to PIA (hazard ratio [HR] = 1.03; 95% confidence interval [CI] 1.02,1.03), longer times from PIA to decision (HR = 0.84; 95%CI 0.84,0.84), and longer times from decision to leaving the ED (HR = 0.91; 95%CI 0.91,0.91). Conclusions Ontario HSUs had higher acuity and longer ED lengths of stay than the other groups. In both provinces, HSU had shorter times to PIA and longer times after assessment.

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