scholarly journals Organization of surgical services and operating room efficiency in Norwegian hospitals

2013 ◽  
Vol 2 (2) ◽  
pp. 61
Author(s):  
Dag Bratlid ◽  
Svein Petter Raknes
Keyword(s):  
Operating Room ◽  
Turnover Time ◽  
Macro Level ◽  
Organizational Strategies ◽  
Operating Room Efficiency ◽  
Or Efficiency ◽  
Emergency Operations ◽  
Surgical Services ◽  
Micro Level ◽  
Future Hospital

Background Most studies on operating room (OR) efficiency have focused on how local factors within the surgical facilities (micro level), such as turnover time, case duration and non-operative time, affects operating room efficiency. Few studies have analyzed how different strategies for organizing surgical services on the departmental or hospital level (macro level) might affect OR efficiency. Norwegian hospitals have organized their surgical services on the macro level along two different strategies. Most hospitals have separate facilities for out-patient surgery and in-patient surgery, often also geographically separated. Most hospitals also have specialty specific OR (orthopedics, gastroenterology, gynecology etc.), while in other hospitals different subspecialties share the same OR. This study was undertaken to analyze any effect of these different organizational strategies in relation to OR efficiency. Methods Data on organization of surgical services and operation volume for 2009 was gathered from eleven Norwegian university and larger county hospitals with a similar case mix. Total OR efficiency and OR efficiency during ordinary work hours were analyzed separately for out-patient and in-hospital surgery, including emergency operations. Calculation of OR during ordinary hours (8am-3pm) was based on 230 workdays per year, and included emergency operations. Results OR efficiency was 721 operations per OR per year with a range from 525 to 1049 and was not related to the different strategies for organizing these services. Furthermore, no correlation was found between OR efficiency and operation volume or number of OR. OR efficiency during ordinary hours and workdays was 3.6 operations per day for out-patient surgery and 1.8 for in-patient surgery including emergency operations. This was considerably less than standards used in planning surgical facilities in Norwegian hospitals. Conclusion OR efficiency is probably more related to organization of the surgical services on the micro level than to strategies for organizing these services on the macro level. The large variation in operating room efficiency in Norwegian hospitals indicates that many hospitals have a potential for improvement. The discrepancy between actual OR efficiency and standards used for planning of surgical facilities represents a challenge in future hospital planning.

Causes and Effects of Inefficient Operating Room Flow during Working Hours in a University Hospital

2020 ◽  
Vol 103 (9) ◽  
pp. 897-903
Keyword(s):  
Operating Room ◽  
Elective Surgery ◽  
Tertiary Care ◽  
Working Hours ◽  
Turnover Time ◽  
University Hospital ◽  
Or Efficiency ◽  
Average Delay ◽  
First Case ◽  
Cancellation Rate

Background: Operating rooms (ORs) are major source of both hospitals’ revenue and expenses; hence, OR efficiency is not only essential, but challenging for providing high-quality care, whilst utilizing limited resources. Materials and Methods: A prospective, observational study was conducted in a tertiary care university hospital to identify both causes and effects of inefficient OR flow, including the rate of first case tardiness, time delays while patients are in room, turnover time, cancellation rate, and OR-overutilization. Patients scheduled for elective surgery between September 2014 and February 2015 were recruited. Results: Three thousand nine hundred sixty-five elective surgical cases were recruited. The rate of first case tardiness was 48%. The average delay time of the first case was 25±16.6 minutes, with the main cause being late arrivals of surgical teams (97.4%). The rate of time delay while the patients were in room, was 73.2%. This is being associated with both the surgical and the anesthesia teams (83%), as well as positioning and procedures-related to the general anesthesia. The delay in turnover time was 12.9% with an average of 32.3±23.3 minutes, with most common causes being swapping of cases between ORs (22.7%) and delays in transferring patients from the ward (21.7%). The cancellation rate was 11.8%, with General surgery having the highest rate (15.5%) due to insufficient OR time (26.2%). Sixty-four-point-eight percent of the operations continued after working hours, with an average of 121.7±106.1 minutes (range 4 to 670 minutes). Conclusion: The present study identified five process points of OR inefficiency in a university hospital, demonstrating that there are substantial opportunities for enhancement of OR efficiency. Keywords: Efficiency, Operating room, First case, Tardiness, Cancellation, Turnover time, Utilization

Impact of the reduction of anaesthesia turnover time on operating room efficiency

2002 ◽  
Vol 19 (08) ◽  
pp. 560 ◽  
Author(s):  
E. Sokolovic ◽  
P. Biro ◽  
P. Wyss ◽  
C. Werthemann ◽  
U. Haller ◽  
...  
Keyword(s):  
Operating Room ◽  
Turnover Time ◽  
Operating Room Efficiency

Impact of the reduction of anaesthesia turnover time on operating room efficiency

2002 ◽  
Vol 19 (8) ◽  
pp. 560-563 ◽  
Author(s):  
E. Sokolovic ◽  
P. Biro ◽  
P. Wyss ◽  
C. Werthemann ◽  
U. Haller ◽  
...  
Keyword(s):  
Operating Room ◽  
Turnover Time ◽  
Operating Room Efficiency

Statistical Method to Evaluate Management Strategies to Decrease Variability in Operating Room Utilization 

1999 ◽  
Vol 91 (1) ◽  
pp. 262-274 ◽  
Author(s):  
Franklin Dexter ◽  
Alex Macario ◽  
David A. Lubarsky ◽  
David D. Burns
Keyword(s):  
Operating Room ◽  
Structural Equation ◽  
Tertiary Care ◽  
Management Strategies ◽  
Turnover Time ◽  
Equation Model ◽  
Surgical Services ◽  
Management Interventions ◽  
The Relationship ◽  
Surgery Center

Background Operating room (OR) managers seeking to maximize labor productivity in their OR suite may attempt to reduce day-today variability in hours of OR time for which there are staff but for which there are no cases ("underutilized time"). The authors developed a method to analyze data from surgical services information systems to evaluate which management interventions can most effectively decrease variability in underutilized time. Methods The method uses seven summary statistics of daily workload in a surgical suite: daily allocated hours of OR time, estimated hours of elective cases, actual hours of elective cases, estimated hours of add-on cases, actual hours of add-on cases, hours of turnover time, and hours of underutilized time. Simultaneous linear statistical equations (a structural equation model) specify the relationship among these variables. Estimated coefficients are used in Monte Carlo simulations. Results The authors applied the analysis they developed to two OR suites: a tertiary care hospital's suite and an ambulatory surgery center. At both suites, the most effective strategy to decrease variability in underutilized OR time was to choose optimally the day on which to do each elective case so as to best fill the allocated hours. Eliminating all (1) errors in predicting how long elective or add-on cases would last, (2) variability in turnover or delays between cases, or (3) day-to-day variation in hours of add-on cases would have a small effect. Conclusions This method can be used for decision support to determine how to decrease variability in underutilized OR time.

scholarly journals Operating room efficiency in a low resource setting: a pilot study from a large tertiary referral center in Ethiopia

2022 ◽  
Vol 16 (1) ◽  
Author(s):  
Samuel Negash ◽  
Endale Anberber ◽  
Blen Ayele ◽  
Zeweter Ashebir ◽  
Ananya Abate ◽  
...  
Keyword(s):  
Operating Room ◽  
Operating Rooms ◽  
Turnover Time ◽  
High Rate ◽  
Start Time ◽  
Or Efficiency ◽  
Tertiary Referral Center ◽  
Resource Setting ◽  
Cancellation Rate ◽  
Patient Preparation

Abstract Background The operating room (OR) is one of the most expensive areas of a hospital, requiring large capital and recurring investments, and necessitating efficient throughput to reduce costs per patient encounter. On top of increasing costs, inefficient utilization of operating rooms results in prolonged waiting lists, high rate of cancellation, frustration of OR personnel as well as increased anxiety that negatively impacts the health of patients. This problem is magnified in developing countries, where there is a high unmet surgical need. However, no system currently exists to assess operating room utilization in Ethiopia. Methodology A prospective study was conducted over a period of 3 months (May 1 to July 31, 2019) in a tertiary hospital. Surgical case start time, end time, room turnover time, cancellations and reason for cancellation were observed to evaluate the efficiency of eight operating rooms. Results A total of 933 elective procedures were observed during the study period. Of these, 246 were cancelled, yielding a cancellation rate of 35.8%. The most common reasons for cancellation were related to lack of OR time and patient preparation (8.7% and 7.7% respectively). Shortage of facilities (instrument, blood, ICU bed) were causes of cancelation in 7.7%. Start time was delayed in 93.4% (mean 8:56 am ± 52 min) of cases. Last case completion time was early in 47.9% and delayed in 20.6% (mean 2:54 pm ± 156 min). Turnover time was prolonged in 34.5% (mean 25 min ± 49 min). Total operating room utilization ranged from 10.5% to 174%. Operating rooms were underutilized in 42.7% while overutilization was found in 14.6%. Conclusion We found a high cancellation rate, most attributable to late start times leading to delays for the remainder of cases, and lack of preoperative patient preparation. In a setting with a high unmet burden of surgical disease, OR efficiency must be maximized with improved patient evaluation workflows, adequate OR staffing and commitment to punctual start times. We recommend future quality improvement projects focusing on these areas to increase OR efficiency.

Varieties of non-obvious meaning in CL and CADS: from ‘hindsight post-dictability’ to sweet serendipity

Corpora ◽  
2017 ◽  
Vol 12 (3) ◽  
pp. 339-367 ◽  
Author(s):  
Alan Partington
Keyword(s):  
Case Studies ◽  
Corpus Linguistics ◽  
Macro Level ◽  
Discourse Studies ◽  
Micro Level ◽  
Special Relevance

In this paper, I want to examine the special relevance of (non)obviousness in corpus linguistics through drawing on case studies. The research discussion is divided into two parts. The first is an examination of (non)obviousness at the micro-level, that is, in lexico-grammatical analyses, whilst the second looks at the more macro-level of (non)obviousness on the plane of discourse. In the final sections, I will examine various types of non-obvious meaning one can come across in Corpus-assisted Discourse Studies (CADS), which range from: ‘I knew that all along (now)’ to ‘that's interesting’ to ‘I sensed that but didn't know why’ (intuitive impressions and corpus-assisted explanations) to ‘I never even knew I never knew that’ (serendipity or ‘non-obvious non-obviousness’, analogous to ‘unknown unknowns’).

Panpsychism versus Panprotopsychism and the Subject-Summing Problem

2017 ◽  
Author(s):  
Philip Goff
Keyword(s):  
Macro Level ◽  
Human Beings ◽  
Making Sense ◽  
Combination Problem ◽  
The Subject ◽  
Micro Level ◽  
Russellian Monism ◽  
Nature Of Matter

This is the first of two chapters discussing the most notorious problem facing Russellian monism: the combination problem. This is actually a family of difficulties, each reflecting the challenge of how to make sense of everyday human and animal experience intelligibly arising from more fundamental conscious or protoconscious features of reality. Key challenges facing panpsychist and panpsychist forms of Russellian monism are considered. With respect to panprotopsychism, there is the worry that it collapses into noumenalism: the view that human beings, by their very nature, are unable to understand the concrete, categorical nature of matter. With respect to panpsychism, there is the subject-summing problem: the difficulty making sense of how micro-level conscious subjects combine to produce macro-level conscious subjects. A solution to the subject-summing problem is proposed, and it is ultimately argued that panpsychist forms of the Russellian monism are to be preferred on grounds of simplicity and elegance.

scholarly journals Young Children’s Belonging in Finnish Educational Settings: an Intersectional Analysis

2021 ◽  
Author(s):  
Anna-Maija Puroila ◽  
Jaana Juutinen ◽  
Elina Viljamaa ◽  
Riikka Sirkko ◽  
Taina Kyrönlampi ◽  
...  
Keyword(s):  
Educational Policy ◽  
Educational Programs ◽  
Macro Level ◽  
Educational Settings ◽  
Policy Documents ◽  
Meso Level ◽  
Continuity And Change ◽  
Positional Power ◽  
Micro Level ◽  
Similarities And Differences

AbstractThe study draws on a relational and intersectional approach to young children’s belonging in Finnish educational settings. Belonging is conceptualized as a multilevel, dynamic, and relationally constructed phenomenon. The aim of the study is to explore how children’s belonging is shaped in the intersections between macro-, meso-, and micro-levels of young children’s education in Finland. The data consist of educational policy documents and ethnographic material generated in educational programs for children aged birth to 8 years. A situational mapping framework is used to analyze and interpret the data across and within systems levels (macro-level; meso-level; and micro-level). The findings show that the landscape in which children’s belonging is shaped and the intersections across and within the levels are characterized by the tensions between similarities and differences, majority and minorities, continuity and change, authority and agency. Language used, practices enacted, and positional power emerge as the (re)sources through which children’s (un)belonging is actively produced.

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