Surgical Workflow Simulation for the Design and Assessment of Operating Room Setups in Orthopedic Surgery

Neumann, Juliane; Angrick, Christine; Höhn, Celina; Zajonz, Dirk; Ghanem, Mohamed; Röth, Andreas; Neumuth, Thomas

doi:10.21203/rs.2.13640/v5

Cited by 5 publications

(10 citation statements)

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“…The surgeon, as well, has a theoretical rotational movement range of 90 degrees to the scrub nurse, which he also reduces by using the arms. In the currently-used setup, significantly more rotational movements are necessary [9], so that air turbulence could be reduced with the new setup. In addition, it is not necessary to hand over the instruments from behind via the surgeon's back, as was often the case with the currently-used setup.…”

Section: Discussionmentioning

confidence: 99%

“…In the context of the underlying work, the existing OR setups for hip and knee arthroplasties were simulated and analysed with the computer program Delmia Quest [10] and new setup suggestions were developed based on these [9]. For the optimized setup, special attention was paid to the table position, optimization of times and improved practicability.…”

Section: Methodsmentioning

confidence: 99%

“…An important factor is the structuring of processes for standardization and simplification, to improve the quality and finally to reduce the handover and surgery times. After an analysis of the handover times and the table positions, a new setup was designed using computer simulation [9]. This was integrated and tested in the clinical routine.…”

Section: Introductionmentioning

confidence: 99%

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Increasing efficiency by optimizing table position for elective primary THA and TKA: a prospective monocentric pilot study

et al. 2020

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Introduction Hip and knee arthroplasties are very frequently performed surgeries with high quality standards and continuous optimization potential. Intraoperative processes can be standardized and simplified by optimization of table setups in the operating room to improve the quality and to increase efficiency. Patients and methods The existing surgical setups for primary hip and knee arthroplasties in a university maximum care hospital with endoprosthesis center were simulated and analysed with a computer program and optimized setup suggestions were worked out, based on handover times, walking distance and ergonomic aspects determined in the program. In a prospective monocentric analysis, primary hip arthroplasties and knee arthroplasties were examined in currently used and in the new optimized setups (standard procedure according to in-house SOP, senior and main surgeons, no assistants). The surgeries were externally and independently supervised and analysed, whereby the time between incision and suture beginning, handovers per minute and handover times were documented, amongst other things. In addition, an evaluation sheet, which showed the satisfaction with the new setup, was filled by the surgical team. Results In the period from April 2016 to December 2018, 19 hip arthroplasties in currently used and 15 in the new optimized setup as well as 9 knee arthroplasties in currently used and 13 in the new setup were performed. Attention was paid to constant conditions in the compared groups and disruptive factors (assisted surgeries, complex surgeries, different cementings, etc.) were excluded. In the group of hip arthroplasties, the handover times were significantly different (old 1.82 +/− 1.43 s.; new 1.08 +/− 0.78 s.; p <0.001), as well as the handovers per minute (old 1.62 +/− 0.45 handovers/min.; new 2.10 +/− 0.32 handovers/min.; p = 0,001). The time between incision and suture beginning indicated no significant difference (old 53.89 +/− 18.92 min.; new 49.73 +/− 12.18 min; p = 0.466): During the knee arthroplasties, handovers per minute were significantly different (old 1.83 +/− 0.38 handovers/min.; new 2.40 +/− 0.35 handovers/min.; p = 0.002). The time between incision and suture beginning (old 71.11 +/− 20.72 min.; new 70.69 +/− 17.12 min.; p = 0.959) and the handover times (old 1.06 +/− 0.64 s.; new 0.91 +/− 0.59 s.; p = 0.152) indicated no significant difference. The evaluation of the questionnaires showed a significant difference (p < 0.001) in the group of hip arthroplasties in the category “visibility”. For the knee arthroplasties, all items except “visibility” (p = 0.261) differed significantly. Overall, a high level of staff satisfaction with the new setup was achieved. Conclusions In both groups, more handovers per minute could be achieved in the optimized setup and in the group of the hip arthroplasties, the handover times were significantly faster. The evaluation sheet showed a high satisfaction of the surgical staff with the new setup. No reduction of the time between incision and suture beginning could be determined. This can be attributed to a certain training effect, the adjustment to the setup modification and the low number of cases. The new setup offers a practical alternative for hip arthroplasties as well as for knee arthroplasties as it optimizes the events in the operating room in many ways. For example, there were more handovers per minute possible and passing of the surgical instruments free from interferences. Moreover, it increases the efficiency and achieves a high satisfaction of the staff.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Increasing efficiency by optimizing table position for elective primary THA and TKA: a prospective monocentric pilot study

et al. 2020

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“…Optimization is an approach for finding the best solution related to the objective functions and constraints. The method is widely adopted to improve hospital management [ 51 , 52 ]. The common objective functions aim to minimize overflow rate [ 53 ], minimize waiting time [ 54 – 56 ], and minimize the length of stay [ 57 , 58 ].…”

Section: Related Workmentioning

confidence: 99%

Resource management framework using simulation modeling and multi-objective optimization: a case study of a front-end department of a public hospital in Thailand

Tanantong

Pannakkong

Chemkomnerd

2022

BMC Med Inform Decis Mak

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Background The overcrowded patients, which cause the long waiting time in public hospitals, become significant problems that affect patient satisfaction toward the hospital. Particularly, the bottleneck usually happens at front-end departments (e.g., the triage and medical record department) as every patient is firstly required to visit these departments. The problem is mainly caused by ineffective resource management. In order to support decision making in the resource management at front-end departments, this paper proposes a framework using simulation and multi-objective optimization techniques considering both operating cost and patient satisfaction. Methods To develop the framework, first, the timestamp of patient arrival time at each station was collected at the triage and medical record department of Thammasat University Hospital in Thailand. A patient satisfaction assessment method was used to convert the time spend into a satisfaction score. Then, the simulation model was built from the current situation of the hospital and was applied scenario analyses for the model improvement. The models were verified and validated. The weighted max–min for fuzzy multi-objective optimization was done by minimizing the operating cost and maximizing the patient satisfaction score. The operating costs and patient satisfaction scores from various scenarios were statistically compared. Finally, a decision-making guideline was proposed to support suitable resource management at the front-end departments of the hospital. Result The three scenarios of the simulation model were built (i.e., a real situation, a one-stop service, and partially shared resources) and ensured to be verified and valid. The optimized results were compared and grouped into three situations which are (1) remain the same satisfaction score but decrease the cost (cost decreased by 2.8%) (2) remain the same satisfaction score but increase the cost (cost increased up to 80%) and (3) decrease the satisfaction score and decrease the cost (satisfaction decreased up to 82% and cost decreased up to 59%). According to the guideline, the situations 1 and 3 were recommended to use in the improvement and the situation 2 was rejected. Conclusion This research demonstrates the resource management framework for the front-end department of the hospital. The experimental results imply that the framework can be used to support the decision making in resource management and used to reduce the risk of applying a non-improvement model in a real situation.

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“…For the teams, simulation based team training provides a basis for a focused feedback during the training on both technical as well as non-technical team working skills [23,24] . It also helps improving the theatre ergonomics such as the instrument handover time between the surgeon and the scrub nurse, the travel paths of the team members and a general improvement in the team dynamics resulting in a positive impact on overall theatre efficiency [25] . System-level improvements can be achieved following in situ simulation by identifying and highlighting system issues that reduce efficiency or affect the patients safety during these sessions and enabling a team discussion to reach the possible solutions which involves all of the team members in the shared decision making [26] .…”

Section: Simulation Based Training (Sbt)mentioning

confidence: 99%

Review article: Strategies to improve emergency theatres efficiency

Elshiekh¹,

Abdelkhalek²,

Mabrouk³

et al. 2021

Int. J. Surg. Sci.

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Surgical Workflow Simulation for the Design and Assessment of Operating Room Setups in Orthopedic Surgery

Cited by 5 publications

References 50 publications

Increasing efficiency by optimizing table position for elective primary THA and TKA: a prospective monocentric pilot study

Increasing efficiency by optimizing table position for elective primary THA and TKA: a prospective monocentric pilot study

Resource management framework using simulation modeling and multi-objective optimization: a case study of a front-end department of a public hospital in Thailand

Review article: Strategies to improve emergency theatres efficiency

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