Status quo and current trends of operating room management in Germany

Baumgart, André; Schüpfer, G.; Welker, Andreas; Bender, Hans-Joachim; Schleppers, A.

doi:10.1097/aco.0b013e328336b8b4

Cited by 23 publications

(21 citation statements)

References 32 publications

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“…Our study is limited insofar that medical students were analyzed only in the operating room, representing the most cost-intensive area of a surgical department [29,30]. On the other hand, medical students can gain their most valuable learning experiences being involved in the operating room [31,32].…”

Section: Discussionmentioning

confidence: 99%

Contribution of final-year medical students to operation room performance—economical and educational implications

Schuld

Justinger

Kollmar

et al. 2011

Langenbecks Arch Surg

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Final-year medical students contribute significantly to surgical operation room performance, similarly but less intensively than residents. Employment of students may counterbalance staff shortage in operating rooms. Therefore, it is likely that the German health care system relies on unpaid medical students to minimize the total cost of surgery. According to the extent of workload accomplished by final-year medical students, a remuneration of the "practical year" seems reasonable.

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Section: Discussionmentioning

confidence: 99%

Contribution of final-year medical students to operation room performance—economical and educational implications

Schuld

Justinger

Kollmar

et al. 2011

Langenbecks Arch Surg

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

confidence: 99%

“…Medical disciplines, especially surgery, are slowly merging with technical disciplines. The number of technical and technological appliances in the operating room (OR) is steadily on the rise, requiring the surgeons to adopt -in addition to their medical formation -a more technical background and to gather knowledge and experience regarding the best possible application of modern technology [6,7] for the sake of the best possible outcome for the patients and to adhere to current best-practice as well as to economic aspects.Although the OR, in general, is the most expensive hospital unit with regard to patient treatment [8,9], the current information and communication technology (ICT) in hospitals is not able to support the clinical and operational sequence adequately [10][11][12][13], thus creating breaches in the surgical workflow, prolongations in routines, additional staff or room idle times, and media disruptions. The growing amount of information gathered in the OR by means of technology, the big data, and the knowledge concerning surgical "modi operandi" that might support Medicine 4.0 are not sufficiently inspected, selected or discarded, interpreted, and employed to the advantage of the intervention at hand or to that of the overall management of all ORs and the hospital or the patients in general.…”

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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“…Operating theaters in particular require thorough planning to streamline management of highly complex and expensive processes. Based on agreed-upon standardized times in Germany, tasks of process analysis and improvement have often been left to anesthesiologists (2, 3). …”

Section: Introductionmentioning

confidence: 99%

Timeliness of Operating Room Case Planning and Time Utilization: Influence of First and To-Follow Cases

et al. 2017

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Resource and cost constraints in hospitals demand thorough planning of operating room schedules. Ideally, exact start times and durations are known in advance for each case. However, aside from the first case’s start, most factors are hard to predict. While the role of the start of the first case for optimal room utilization has been shown before, data for to-follow cases are lacking. The present study therefore aimed to analyze all elective surgery cases of a university hospital within 1 year in search of visible patterns. A total of 14,014 cases scheduled on 254 regular working days at a university hospital between September 2015 and August 2016 underwent screening. After eliminating 112 emergencies during regular working hours, 13,547 elective daytime cases were analyzed, out of which 4,346 ranked first, 3,723 second, and 5,478 third or higher in the daily schedule. Also, 36% of cases changed start times from the day before to 7:00 a.m., with half of these (52%) resulting in a delay of more than 15 min. After 7:00 a.m., 87% of cases started more than 10 min off schedule, with 26% being early and 74% late. Timeliness was 15 ± 72 min (mean ± SD) for first, 21 ± 84 min for second, and 25 ± 93 min for all to-follow cases, compared to preoperative day planning, and 21 ± 45, 23 ± 61, and 19 ± 74 min compared to 7:00 a.m. status. Start time deviations were also related to procedure duration, with cases of 61–90 min duration being most reliable (deviation 9.8 ± 67 min compared to 7:00 a.m.), regardless of order. In consequence, cases following after 61–90 min long cases had the shortest deviations of incision time from schedule (16 ± 66 min). Taken together, start times for elective surgery cases deviate substantially from schedule, with first and second cases falling into the highest mean deviation category. Second cases had the largest deviations from scheduled times compared to first and all to-follow cases. While planned vs. actual start times differ among specialties, cases of 61–90 min duration had the most reliable start times, with neither shorter nor longer cases seeming to improve timeliness of start times.

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Status quo and current trends of operating room management in Germany

Cited by 23 publications

References 32 publications

Contribution of final-year medical students to operation room performance—economical and educational implications

Contribution of final-year medical students to operation room performance—economical and educational implications

Surgical process modeling

Timeliness of Operating Room Case Planning and Time Utilization: Influence of First and To-Follow Cases

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