Perioperative Care and Operating Room Management最新文献

Background

Nearly half of hospitalization costs for patients undergoing surgery are attributed to operating room expenses. Surgical supplies that include consumables and implantable devices account for the bulk of surgical spending. Surgeons heavily influence surgical supply selection; however, few can estimate pricing for routinely used items correctly. The lack of cost transparency can contribute to higher costs without improved patient outcomes. The Balanced Scorecard (BSC) is a cost feedback tool that can increase surgeon cost awareness and empower them to achieve significant cost savings while maintaining positive patient outcomes.

Methods

Six months of retrospective data collection was completed to establish baselines for surgeon median surgical supply costs, patient disposition, 30-day readmissions, and surgical time from cut-to-close, for surgeons (n = 6) performing single-level transforaminal lumbar interbody fusions (TLIF). During the eight weeks of the implementation phase, each surgeon received customized, biweekly BSC reports displaying their median surgical supply costs, the group's median surgical supply costs, the group best, and a list of the five items that mostly contributed to costs. Additionally, surgeons received a dashboard exhibiting anonymous median surgical supply costs for all participants to encourage peer comparison and stimulate practice change. The primary outcome was decreased surgical supply costs. Patient outcomes were measured to evaluate the initiative's impact on quality and safety. Surgeons completed pre- and post-intervention surveys used to calculate the BSC's influence on surgical supply selection, the value of the initiative, and their interest in expanding this practice.

Results

Surgeons (n = 6) from the orthopedic spine and neurosurgery specialties performed eight single-level TLIF procedures. The group's median surgical supply costs decreased by $2,767.73, representing a 9.8 % reduction. A 7.75-min decrease in surgical time from cut-to-close and a 0.57-day reduction in patient length of hospital stay was identified. There were no reports of 30-day readmissions. Sixty seven percent of participating surgeons completed pre- and post-intervention surveys. Survey results revealed that 83 % of surgeons agreed the BSC has value in reducing surgical costs, and 100 % agreed that lower-cost alternatives do not increase the risk for poor patient outcomes. Over 80 % of surgeons were interested in supporting future BSC initiatives.

Conclusion

The surgeon's lack of surgical supply cost awareness can limit their ability to reduce spending. The BSC can increase cost transparency and inspire performance improvement to deliver value-based care with favorable patient outcomes.

Purpose

The aim of this study was to understand the operating room experiences of patients operated under regional anaesthesia.

Design

Interpretive phenomenology design was used in this study.

Methods

The universe and sample of the study consisted of 11 patients who were operated under regional anaesthesia in a training and research hospital in Istanbul. The study was conducted using the criterion sampling method and the individual in-depth face-to-face interview method. The data were collected with a patient information form and a semi-structured interview form. In the analysis of the data, the answers given by the patients to the semi-structured interview form were brought together under the themes determined in accordance with the purpose and grouped and evaluated using the content analysis method.

Findings

Nine themes and 16 sub-themes specific to the study subject were determined under four main categories. The patients described the operating room as a cold and scary place, told that they did not get enough information about the operating room and anaesthesia before the operation, complained that the clothes they wore while going to the operating room were uncomfortable.

Conclusions

Patients who underwent surgery experienced widespread anxiety and fear due to a lack of knowledge about the surgical process and the operating room environment. Due to the limited number of studies in the literature on patients' operating room experiences, we believe that the results of this study will be valuable in planning patient management in the operating room and understanding the experiences of patients undergoing surgery.

In the past year, the effects of the COVID-19 pandemic have continued to ripple through healthcare and society. The perioperative spectrum of care remains impacted–with early and upfront challenges such as operating room closures and large case backlogs giving way to ever more questions about perioperative risk for patients with recent COVID infections and post-COVID complications. This review will update a literature review on the data regarding COVID-19-related perioperative risk and articulate ongoing areas of uncertainty to empower perioperative teams to deliver evidence-based, patient-centered peri‑COVID care as we emerge from the COVID-19 pandemic.

Pulmonary hypertension, characterized by increased pressure in the pulmonary vasculature, can stem from various causes. This condition strains the thin-walled right ventricle of the heart, leading to potential dilation and reduced function over time. Anesthesiologists encounter challenges when managing PH patients during surgery, as the right ventricle poorly responds to inotropic support and undergoes additional stress from surgical conditions. Pulmonary hypertension requires multidisciplinary management in the perioperative setting to ensure appropriate and safe care of patients.

Ensuring safe anesthesia for patients with pulmonary hypertension entails careful planning, including a thorough history and physical examination, preoperative testing, optimization of the disease and comorbidities, and comprehensive risk assessment. It is crucial to identify signs and symptoms of progressing pulmonary hypertension and right heart dysfunction. Symptomatic patients with undiagnosed pulmonary hypertension will benefit from referrals to specialists for further evaluation and testing.

Diagnostic tools such as electrocardiograms, echocardiography, and right heart catheterization offer valuable information for anesthetic planning and risk assessment. They provide insight into the severity of pulmonary hypertension. Right heart catheterization allows direct measurement of hemodynamic parameters, guiding treatment decisions. Hemodynamic classification distinguishes between pre-capillary, post-capillary, and combined pre- and post-capillary pulmonary hypertension. Another categorization method is clinical grouping based on underlying pathological characteristics, which helps tailor management and treatment choices.

This article underscores the significance of perioperative management and the need for a comprehensive evaluation and multidisciplinary approach in patients with pulmonary hypertension. It provides valuable information for anesthesiologists and other healthcare professionals involved in the care of these patients, with a focus on preoperative assessment, risk stratification, and treatment considerations.

There is an increased frequency of patients with cardiac implantable electroic devices (CIEDs) who are undergoing surgical or interventional procedures. The function of a CIED may be affected by electromagnetic interference in the operating room which can threaten the safety and hemodynamic stability of patients. It is important for anesthesiologists to understand the perioperative approach for dealing with CIEDs. Perioperative management of CIEDs should include implementing an exact algorithm and/or developing a specific plan with an interdisciplinary team if necessary.

Perioperative medicine is a growing specialty around the world. In this article, we discuss the difficulties of creating a perioperative medicine department and fellowship in a middle-income country with limited resources and with severe challenges in accessing essential surgical and medical care. Our fellows navigate in a personal way to the patient through the institution to optimize resources, reduce waiting times and improve outcomes in high-risk patients Powered

Cirrhosis can be challenging to recognize and manage in the perioperative setting. The Fibrosis 4 (FIB-4) score is a screening test that can help determine the likelihood of underlying advanced fibrosis or cirrhosis in patients with chronic liver disease. Liver stiffness correlates with severity of fibrosis and cirrhosis and can be measured noninvasively with transient elastography or MR elastography; a normal liver stiffness effectively rules out cirrhosis. Perioperative risk calculators include the Child-Turcotte-Pugh Score, the Mayo Risk Score, the Veterans Outcomes and Costs Associated with Liver Disease-Penn (VOCAL-Penn) score; each has its limitations. In addition to reviewing the above tools, we will briefly discuss common perioperative dilemmas in patients with cirrhosis, including selection of patients for umbilical hernia repair or bariatric surgery, and will highlight methods to optimize patients with cirrhosis prior to surgical interventions.

This paper examines the application of the Surgical Safety Checklist (SSC) within NHS hospital operating theatres England. The aim of the study, through a combination of open-ended questions, was to solicit specific information including views and opinions from operating theatre experts to establish from how the World Health Organisations (WHO) SSC is being applied, and therefore and why intraoperative ‘Never Events’ continue to occur more than a decade after the SSC was introduced. Participants were from the seven regions identified by NHS England.

The intention of this paper is not to establish definitively whether the quantitatively identified themes; including a lack of training and engagement with human factors explains the increased presence of intraoperative ‘Never Events’. However, these themes, when subjected to methodological triangulation with the current literature, do appear consistent, and therefore provide an exploratory approach to inform research intended to improve safety in the operating theatre by informing policy and its application to safe practice ultimately towards quality improvements.

Background

Inefficiencies in the OR such as slow patient transfers can have a negative financial impact and affect patient safety. This study sought to determine whether decreasing the number of patient transfers in hand, wrist, and elbow surgery can improve patient flow from the time they arrive in the operating room to the time they arrive in the post-operative anesthetic unit (PACU).

Methods

Elective cases performed between April to August 2022 were retrospectively reviewed at two surgical centers. The pre-operative wait time (arrival time into the OR to the start of surgery); post-operative transfer time (end of surgery to when the patient leaves the OR); emergence time (when the patient leaves the OR to arrival in the PACU; and total patient flow time (entry into OR until arrival in PACU) were analyzed. Data from procedures where patients remained on their surgical bed (group 1) were compared against procedures where patients were transferred to and from the OR table (group 2).

Results

Data from 259 cases (group 1 n = 191, group 2 n = 68 cases) were collected. There were significant differences between: the pre-operative wait time (p < 0.001; 95% CI, 15:40 to 17:36); post-operative transfer time (p = 0.001; 95% CI, 3:25 to 5:59); emergence time (p = 0.02; 95% CI, 1:36 to 2:02); and total flow time (p < 0.001; 95% CI, 1:05:39 to 1:21:20). The average differences between the two groups in each phase are 3–9 min. There was no difference between the types of procedures performed (p > 0.05); the average difference in total flow time was 50 min.

Conclusions

Keeping patients on the same surgical bed for hand, wrist, and elbow procedures can help maximize OR efficiency in an outpatient ambulatory care setting.

Background

We purposed to assess and compare the effectiveness and safety of covering with the single-drape method versus the standard two-drape method recommended by the Association of Perioperative Registered Nurses (AORN) in reducing contamination of the prepared sterile instrument tables (PSITs) with airborne bacteria-carrying particles (ABCPs).

Methods

Six agar plates (n = 810) were used to measure the load of ABCPs on each PSIT both at rest (static period) and during a simulated surgical operation (dynamic period). At every time point, this arrangement was repeated two times during data collecting (81 PSITs were established in total). Experimental groups contained PSITs covered with the single-drape and the standard two-drape methods or no cover. We collected the plates after 60, 120, 180, 240 min, and 24 h.

Results

At all-time points, covering the PSITs during static and dynamic operating theater (OT) conditions led to a meaningfully reduced load of ABCPs on the PSITs (P < 0.05). Moreover, no differences were found between the recommended two-drape method by the AORN and the single-drape method (P > 0.05).

Conclusion

Covering the PSITs during nonuse and active surgeries helps prevent the PSITs from becoming contaminated and thus can help decrease the incidence of surgical wound infection (SWI). Covering the PSITs with a sterile drape helps protect them from ABCPs that may be shed from the hair and skin of OT nurses (OTNs). Our study showed no priority for using the standard two-drape method compared with the single-drape method.