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

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.

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

Regional Anesthesia and Pain Medicine ◽

10.1136/rapm-2020-101773 ◽

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.

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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

10.21203/rs.2.11714/v2 ◽

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.

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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

10.21203/rs.2.11714/v4 ◽

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.

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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

10.21203/rs.2.11714/v5 ◽

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.

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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

10.21203/rs.2.11714/v3 ◽

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.

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Operating room first case start times: a metric to assess systems-based practice milestones?

BMC Medical Education ◽

10.1186/s12909-019-1886-2 ◽

2019 ◽

Vol 19 (1) ◽

Cited By ~ 1

Author(s):

Christopher Ryan Hoffman ◽

Jay Horrow ◽

Shreyas Ranganna ◽

Michael Stuart Green

Keyword(s):

Regression Model ◽

Operating Room ◽

Delay Time ◽

Day Surgery ◽

Operating Room Efficiency ◽

Mixed Effect ◽

First Case ◽

Operative Care ◽

Physical Status Classification ◽

Day Of The Week

Abstract Background Resident competence in peri-operative care is a reflection on education and cost-efficiency. Inspecting pre-existing operating room metrics for performance outliers may be a potential solution for assessing competence. Statistical correlation of problematic benchmarks may reveal future opportunities for educational intervention. Methods Case-log database review yielded 3071 surgical cases involving residents over the course of 5 years. Surgery anticipated and actual start times were evaluated for delays and residents were assessed using the days of resident training performed at the time of each corresponding case. Other variables recorded included day of week, attending anesthesiologist name, attending surgeon name, patient age, sex, American Society of Anesthesiologists physical status classification (ASA PS), and in-patient versus day surgery status. Mixed-effect, multi-variable, linear regression determined independent determinants of delay time. Results The analysis identified day of the week (F = 25.65, P < 0.0001), days of training (F = 8.39, P = 0.0038), attending surgeon (F = 2.67, P < 0.0001), and anesthesiology resident (F = 1.67, P = 0.0012) as independent predictors of delay time for first-start cases, with an overall regression model F = 3.09, r2 = 0.186, and P < 0.0001. Conclusions The day of the week and attending surgeon demonstrated significant impact of case delay compared to resident days trained. If a learning curve for first-case start punctuality exists for anesthesiology residents, it is subtle and irrelevant to operating room efficiency. The regression model accounted for only 19% of the variability in the outcome of delay time, indicating a multitude of additional unidentified factors contributing to operating room efficiency.

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The impact of electronic medical record implementation on operating room efficiency

Journal of Hospital Administration ◽

10.5430/jha.v5n1p48 ◽

2015 ◽

Vol 5 (1) ◽

pp. 48 ◽

Cited By ~ 1

Author(s):

Richard Frazee ◽

Alisa Cames ◽

Yolanda Munoz Maldonado ◽

Timothy Bittenbinder ◽

Harry T Papaconstantinou

Keyword(s):

Learning Curve ◽

Medical Record ◽

Operating Room ◽

Electronic Medical Record ◽

Control Charts ◽

Analysis Data ◽

Operating Room Efficiency ◽

Start Time ◽

Implementation Level ◽

The Impact

Background: First start delays in the operating room have a downstream effect on operating room efficiency and patient satisfaction. In accordance with the American Recovery and Reinvestment Act, in February 2014, our institution adopted EPICTM as our electronic health record (EHR). The impact of the transition from paper to electronic documentation on operating room efficiency is not known. This study analyzed first start data as a measure of overall operative suite efficiency, looking at the initial impact and the learning curve to return to baseline parameters.Methods: A retrospective review of on time start data was reviewed for three months prior and 4 months after implementation of the EHR. A start was considered delayed if the patient arrived to the room after the 7:30 start time. Patients transported from the intensive care unit were excluded from analysis. Data was analyzed using control charts for the percentages and comparison of means using Dunnet’s methods. Confidence intervals were calculated at .05 and .01 for significance.Results: After EPIC implementation, there was an initial drop in on time starts from over 60% to 41% followed by gradual return to pre-implementation level within 4 months (p < .01).Conclusions: Implementation of an EHR produced decreased efficiency in on time first starts in the operative suite, but the learning curve was brief, returning to baseline values in 4 months. These findings can serve as a guide for other institutions that are undergoing transition from a paper to an electronic medical record.

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Assessment of COVID-19 Related Misinformation among the Community in Basrah, Iraq

Iraqi National Journal of Medicine ◽

10.37319/iqnjm.2.csi.2 ◽

2020 ◽

Vol 2 (CSI) ◽

pp. 12-18

Author(s):

Ali Al-Rubaye ◽

Dhurgham Abdulwahid ◽

Aymen Albadran ◽

Abbas Ejbary ◽

Laith Alrubaiy

Keyword(s):

Cross Sectional Study ◽

Bachelor's Degree ◽

Public Knowledge ◽

Age Group ◽

Cross Sectional ◽

Educational Levels ◽

The Public ◽

First Case ◽

Significant Difference ◽

Central District

Background: There has been a rapid rise in cases of COVID-19 infection and its mortality rate since the first case reported in February 2020. This led to the rampant dissemination of misinformation and rumors about the disease among the public. Objectives: To investigate the scale of public misinformation about COVID-19 in Basrah, Iraq. Methods: A cross-sectional study based on a 22-item questionnaire to assess public knowledge and understanding of information related to the COVID-19 infection. Results: A total of 483 individuals completed the questionnaire. The most frequent age group was 26–35 years (28.2%); there were 280 (58%) males and 203 (42%) females. Of the participants, 282 (58.4%) were with an education level below the Bachelor’s degree, 342 (70.8%) were married, and 311 (64%) were living in districts in Basra other than the central district. Overall, 50.8% (11.8/ 22 * 100%) of individuals had the correct information regarding COVID-19. There was a significant association between the level of COVID-19 related misinformation and participants’ educational levels and occupation (p <0.05). However, there was no significant difference found across sex, age group, marital state, and area of residence. Conclusions: Misinformation related to COVID-19 is widely spread and has to be addressed in order to control the pandemic. Keywords: COVID-19, misinformation, knowledge, Iraq

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Analisis Faktor Yang Berhubungan Dengan Penerapan Surgical Safety Checklist Di Kamar Operasi Rumah Sakit Kota Batam

Jurnal Endurance ◽

10.22216/jen.v4i3.4501 ◽

2019 ◽

Vol 4 (3) ◽

pp. 456

Author(s):

Endang Yuliati ◽

Hema Malini ◽

Sri Muharni

Keyword(s):

Patient Safety ◽

Operating Room ◽

Work Experience ◽

Improve Patient Safety ◽

Standard Procedure ◽

City Hospital ◽

Chi Square ◽

Cross Sectional ◽

Surgical Safety Checklist ◽

Surgical Safety

The use of the Surgical Safety Checklist (SSC) is associated with improving patient care according to nursing process standards includes the quality of work of the operating room nurse team. The form of professionalism in the operating room is how the application of a surgical safety checklist as the standard procedure for patient safety in the operating room. This study aims to determine the relationship of characteristics, knowledge, and motivation of nurses in the application of the surgical safety checklist in the operating room of a Batam city hospital. This research is quantitative using an observational analytic research design. This study was conducted on 67 nurses who were taken by total sampling. This research was conducted in three Batam City Hospitals, with hospital accreditation at the same level. Data were analysed by univariate and bivariate using the chi-square test. The results of the study found that most nurses had education at diploma level, with a working period experiences of > 6 months (82%); good knowledge (53.7%) with low motivation (57.7%). There is a relationship between education (p = 0.042); length of work experience (p = 0.010); knowledge (p = 0.002); and motivation (p = 0.05) with the application of SSC. It is expected that health services carry out SSC following the applicable SOPs in the Hospital so that it can reduce work accident rates and improve patient safety. Penerapan Surgical Safety Checklist (SSC) berhubungan langsung dengan kualitas asuhan keperawatan yang termasuk adalah bagaimana perawat menerapkan fungsi sebagai bagian dari kamar operasi. Bentuk profesionalisme ini menjadi standar bagaimana kemampuan perawat menerapakan SSC. Tujuan penelitian adalah mengetahui hubungan karakteristik perawat, pengetahuan dan motivasi dengan penerapan SSC di kamar operasi. Penelitian ini menggunakan desain kuantitatif Cross Sectional dengan jumlah sampel 67 orang perawat kamar operasi. Data dianalisa dengan distribusi frekuensi dan uji hubungan bivariat. Didapatkan penerapan SSC perawat kota Batam masih kurang baik, dengan faktor yang mempunyai hubungan adalah Pendidikan, pelatihan dan pengetahuan. Diharapkan perawat mampu menerapkan SSC sesuai dengan Standar pelaksanaan fungsi perawat dikamar operasi.

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