Lean and Green Hand Surgery

Demark, Robert E. Van; Smith, Vanessa J.S.; Fiegen, Anthony

doi:10.1016/j.jhsa.2017.11.007

Cited by 109 publications

(84 citation statements)

References 17 publications

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“…Potentially infectious operating room waste makes up only 10%–25% of the total waste but requires several times more energy to process. 10 – 12 Infectious medical waste is frequently incinerated, releasing greenhouse gases and carcinogens. Many healthcare workers do not understand what constitutes infectious waste, and as a result, “safe” trash is frequently overprocessed.…”

Section: Resultsmentioning

confidence: 99%

Four Ways Plastic Surgeons Can Fight Climate Change

Brown

Meals

2020

Plastic and Reconstructive Surgery - Global Open

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Background: The climate crisis demands that surgeons reduce their environmental impact. Operating rooms are resource-intensive and are often wasteful. This makes them fitting targets for climate-conscious decision making. Methods: We searched for peer-reviewed literature describing how plastic surgeons might positively affect the environment through action in the operating room. Results: Several evidence-based, pro-climate practices may be undertaken by plastic surgeons. These strategies may be grouped into 4 types: material, energy, technique, and dissemination. Each strategy is a way to reduce, reuse, recycle, research, or rethink. Conclusions: Administrative obstacles to greener operating rooms are predictable and surmountable, especially because environmentally minded decisions are likely to save money. We anticipate a surge of environmental consciousness in healthcare. Plastic surgeons, as thought leaders, are well positioned to champion this cause.

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Section: Resultsmentioning

confidence: 99%

Four Ways Plastic Surgeons Can Fight Climate Change

Brown

Meals

2020

Plastic and Reconstructive Surgery - Global Open

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“…The "epinephrine myth" postulated that "never inject epinephrine in fingers, nose, penis or toes", epinephrine being incriminated as a cause of digital necrosis, being used with procaine in local anesthesia in hand surgery (1,2). Time has shown that the reason for these serious complications was procaine acidity, which changes its pH when kept for a long time.…”

Section: Discussionmentioning

confidence: 99%

Use of WALLANT technique in hand surgery, safe and advantageous. Personal experience

Perţea¹,

Poroch²,

Grosu³

et al. 2018

J Clin Invest Surg.

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To cite this article: Pertea M, Poroch V, Grosu OM, Manole A, Velenciuc N, Lunca S. AbstractObjectives. To confirm the efficiency of using local anesthesia with lidocaine and epinephrine in hand surgery.Materials and methods. 75 patients in whom we used local anesthesia with 1% lidocaine and epinephrine in solution 1: 100 000. We evaluated the amount of used anesthetic, the time to onset of anesthesia, intraoperative bleeding, the duration of intervention and hospitalization, immediate postoperative complications.Results. It has been no case of digital necrosis or other vascular complications and no intraoperative bleeding. The amount of the used anesthetic varied. In no case it was necessary to use of phentolamine as an antidote to the effects of adrenaline.Conclusions. Wide awake local anesthesia no tourniquet technique is safe, having many advantages: it is not necessary to use the tourniquet with or without intravenous sedation, the surgeon and patient comfort is maximum, there is no risk of digital necrosis, hospitalization time is short and the costs are minimal.

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“…Its role in generating supply waste-solid materials that must be disposed of-suggests it may be an area for potential cost savings. Supplies and materials average 47% of the OR spending (Park & Dickerson, 2009) and they account for 70% of the 4 billion pounds of healthcare waste produced in the United States annually (Van Demark, Smith, & Fiegen, 2018). In the operations management literature, we find that reductions in waste may lead to improvements in quality and performance (Benner & Veloso, 2008).…”

Section: Introductionmentioning

confidence: 92%

“…A large portion of U.S. healthcare spending is wasted. Supplies and materials average 47% of the OR spending (Park & Dickerson, 2009) and they account for 70% of the 4 billion pounds of healthcare waste produced in the United States annually (Van Demark, Smith, & Fiegen, 2018). Thus, understanding sources of waste is imperative.…”

Section: Introductionmentioning

confidence: 99%

The impact of planning and communication on unplanned costs in surgical episodes of care: Implications for reducing waste in hospital operating rooms

Dreyfus

Nair

Rosales

2019

J of Ops Management

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This ethnographic study of more than 90 surgeries (referred to as episodes of care) identifies the antecedents to operating room (OR) supply waste. The study specifically considers the role of planning instances and communication patterns among members of the surgery team on supply waste within the OR. We operationalize planning instances in terms of the number of changes to the physician preference card (PPC), the key document that is used to plan items needed for surgery. Communication patterns among members of the surgery team are captured by measuring the density of communication among the OR team members during an episode of care. The unplanned costs during an episode of care are used as a measure of OR supply waste. Hundreds of hours were spent observing episodes of care and tracking supplies. A combination of participant-observation, survey, and secondary data were analyzed to extract theoretical and practical insights. The results show that planning instances have a curvilinear relationship with unplanned costs. In particular, as the number of changes to the PPC increases, unplanned costs first increase and then decrease. Higher density of the OR team's communication network is associated with lower unplanned costs. This study has significant theoretical and managerial implications that we discuss and offer directions for future research. K E Y W O R D Seconometric analysis, ethnography, healthcare, operating room, physician preference card, planning, social network analysis, team communication, unplanned costs, waste

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Lean and Green Hand Surgery

Cited by 109 publications

References 17 publications

Four Ways Plastic Surgeons Can Fight Climate Change

Four Ways Plastic Surgeons Can Fight Climate Change

Use of WALLANT technique in hand surgery, safe and advantageous. Personal experience

The impact of planning and communication on unplanned costs in surgical episodes of care: Implications for reducing waste in hospital operating rooms

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