Increasing Operating Room Efficiency Through Parallel Processing

Friedman, David M.; Sokal, Suzanne M.; Chang, Yuchiao; Berger, David L.

doi:10.1097/01.sla.0000193600.97748.b1

Cited by 181 publications

(118 citation statements)

References 4 publications

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“…Third, even though we achieved more on-time OR starts, shorter turnover times, more total TJA cases per OR, and apparent shorter average length of stay, it is not clear these accomplishments were more cost-effective or provided equal or improved results for our patients. Our project confirms previously published efforts in improving OR efficiency through process and resource analysis [2,9], improved communication, elimination of silo mentalities, team work [3,8,11], and high-efficiency OR teams adapting parallel processing [4,7].…”

Section: Discussionsupporting

confidence: 76%

“…The second strategy was the creation of A teams for the high-efficiency TJA OR, with the same OR team (nurse-circulator, scrub technician, room attendant, and additional person for turnover) assigned to individual surgeons, as well as identified anesthesiology teams specifically committed to the success of the project [7,9,11,12]. The third strategy helped establish the culture of parallel processing, which replaced the existing perfunctory serial steps; eg, the patient was not allowed in the OR until the OR team was ready, anesthesia did not start until the surgeon was available, the subsequent patient was not sent for and prepared unless the OR called the request, etc [4]. Steps were also taken to reduce and standardize trays of instruments for primary THA and TKA procedures to cut costs, reduce related preparation times, and avoid unnecessary delays associated with incorrect postings or missing instruments sets.…”

Section: Methodsmentioning

confidence: 99%

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Developing a High-efficiency Operating Room for Total Joint Arthroplasty in an Academic Setting

Attarian

Wahl

Wellman

et al. 2013

Clinical Orthopaedics &Amp; Related Research

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Background Developing a high-efficiency operating room (OR) for total joint arthroplasty (TJA) in an academic setting is challenging given the preexisting work cultures, bureaucratic road blocks, and departmental silo mentalities. Also, academic institutions and aligned surgeons must have strategies to become more efficient and productive in the rapidly changing healthcare marketplace to ensure future financial viability. Questions/purposes We identified specific resources and personnel dedicated to our OR for TJA, assessed the typical associated work process delays, and implemented changes and set goals to improve OR efficiencies, including more on-time starts and shorter turnover times, to perform more TJA cases per OR. We then compared these variables before and after project initiation to determine whether our goals were achieved. Methods We gathered 1 year of retrospective TJA OR time data (starting, completion, turnover times) and combined these data with 1 month of prospective observations of the workflow (patient check-in, patient processing and preparation, OR setup, anesthesia, surgeon behaviors, patient pathway). The summarized information, including delays and inefficiencies, was presented to a multidisciplinary committee of stakeholders; recommendations were formulated, implemented, and revised quarterly. Key strategies included dedicated OR efficiency teams, parallel processing, dedicated hospital resources, and modified physician behavior. OR data were gathered and compared 3 years later. Results After project changes, on-time OR starts increased from less than 60% to greater than 90% and average turnover time decreased from greater than 60 minutes to 35 minutes. Our average number of TJA cases per OR increased by 29% during the course of this project. Conclusions Our project achieved improved OR efficiency and productivity using strategies such as process and resource analysis, improved communication, elimination of silo mentalities, and team work.

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Section: Discussionsupporting

confidence: 76%

Section: Methodsmentioning

confidence: 99%

Developing a High-efficiency Operating Room for Total Joint Arthroplasty in an Academic Setting

Attarian

Wahl

Wellman

et al. 2013

Clinical Orthopaedics &Amp; Related Research

View full text Add to dashboard Cite

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“…Second, the altered policy of medicine, in general -in accordance with the growing patients' demands -has brought about a change of the overall objective of surgical interventions' need to be minimal invasive, cost-efficient, and as easy on the patients as possible. The new policy therefore relies on more resources, such as economic [2][3][4], social, psychological, qualitative, practical, and technological aspects, enhancing patient safety and eliminating medical malpractices [5].…”

Section: Surgical Process Models (Spms) -Motivation Definition and mentioning

confidence: 99%

Surgical process modeling

Neumuth

2017

Innovative Surgical Sciences

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Due to the rapidly evolving medical, technological, and technical possibilities, surgical procedures are becoming more and more complex. On the one hand, this offers an increasing number of advantages for patients, such as enhanced patient safety, minimal invasive interventions, and less medical malpractices. On the other hand, it also heightens pressure on surgeons and other clinical staff and has brought about a new policy in hospitals, which must rely on a great number of economic, social, psychological, qualitative, practical, and technological resources. As a result, medical disciplines, such as surgery, are slowly merging with technical disciplines. However, this synergy is not yet fully matured. The current information and communication technology in hospitals cannot manage the clinical and operational sequence adequately. The consequences are breaches in the surgical workflow, extensions in procedure times, and media disruptions. Furthermore, the data accrued in operating rooms (ORs) by surgeons and systems are not sufficiently implemented. A flood of information, "big data", is available from information systems. That might be deployed in the context of Medicine 4.0 to facilitate the surgical treatment. However, it is unused due to infrastructure breaches or communication errors. Surgical process models (SPMs) alleviate these problems. They can be defined as simplified, formal, or semiformal representations of a network of surgery-related activities, reflecting a predefined subset of interest. They can employ different means of generation, languages, and data acquisition strategies. They can represent surgical interventions with high resolution, offering qualifiable and quantifiable information on the course of the intervention on the level of single, minute, surgical work-steps. The basic idea is to gather information concerning the surgical intervention and its activities, such as performance time, surgical instrument used, trajectories, movements, or intervention phases. These data can be gathered by means of workflow recordings.These recordings are abstracted to represent an individual surgical process as a model and are an essential requirement to enable Medicine 4.0 in the OR. Further abstraction can be generated by merging individual process models to form generic SPMs to increase the validity for a larger number of patients. Furthermore, these models can be applied in a wide variety of use-cases. In this regard, the term "modeling" can be used to support either one or more of the following tasks: "to describe", "to understand", "to explain", to optimize", "to learn", "to teach", or "to automate". Possible use-cases are requirements analyses, evaluating surgical assist systems, generating surgeon-specific training-recommendation, creating workflow management systems for ORs, and comparing different surgical strategies. The presented chapter will give an introduction into this challenging topic, presenting different methods to generate SPMs from the workflow in the OR, as well as various...

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“…Due to the importance and sensitivity of the working condition at emergency departments, this department should be assessed in terms of nurses performance and productivity (12,13). In the health care system, performance evaluation and productivity are important issues both at the individual level and also at the national and organizational level (14). Regarding the important role of nursing manpower in hospital performance and productivity and lack of evidences to assess these matters in the hospitals of Iran and especially at emergency departments, conducting such studies is crucial and may lead to improvement in the performance and productivity of these departments.…”

Section: Introductionmentioning

confidence: 99%

Correlation of Performance Indicators and Productivity: A Cross Sectional Study of Emergency Departments in Tehran, Iran During Year 2016

Nobakht¹,

Jahangiri²,

Hajinabi³

2018

Trauma Mon

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Background: Effective manpower is the main factor in success and the most significant achievement of health organizations. Objectives: This study was conducted to assess nursing perceptions about performance indicators and its correlation with productivity within the emergency departments of hospitals affiliated to Shahid Beheshti University of Medical Sciences in Tehran, Iran, during year 2016. Methods: This study was conducted by the cross sectional method, during year 2016. In this cross sectional study, the emergency departments of 4 hospitals of Shahid Beheshti University of Medical Sciences in Tehran were assessed. All nurses of emergency departments were selected through Census sampling methods. One of the researchers made a set of questionnaires for the assessment of the performance of nurses and a checklist as a means of productivity indicators to collect the data. Statistical analysis was conducted by the SPSS software version 18 and Pearson correlation test, T test, and analysis of variance (ANOVA). Results: The performance of the nurses had a positive aptitude with the percentage of the patients, whose condition was determined within 6 hours and the percentage of the remaining patients, whose condition was resolved within 12 hours in the studied hospitals. On the contrary, the performance of the nurses had a negative correlation with average triage duration in the studied hospitals. Moreover, according to Pearson's correlation coefficient, it could be said that the performance of the nurses had a negative correlation with unsuccessful CPR percentage indicator and also with the percentage of discharge against medical advice in the studied hospitals. Conclusions: According to the results, in order to achieve maximum outputs as productivity, the dimensions of performances are needed to be improved. The items for Kardex evaluation items and shift reception evaluation achieved the lowest scores and need greater attention.

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Increasing Operating Room Efficiency Through Parallel Processing

Abstract: This study demonstrates a system of increasing operating room efficiency by changing patient flow rather than simply working to streamline existing steps. This increase in efficiency is not associated with the expansion of hospital budgets or a decrease in patient safety or satisfaction.

Cited by 181 publications

References 4 publications

Developing a High-efficiency Operating Room for Total Joint Arthroplasty in an Academic Setting

Developing a High-efficiency Operating Room for Total Joint Arthroplasty in an Academic Setting

Surgical process modeling

Correlation of Performance Indicators and Productivity: A Cross Sectional Study of Emergency Departments in Tehran, Iran During Year 2016

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