Perioperative Care and Operating Room Management最新文献

Introduction

First case surgical delays cause domino effects resulting in subsequent case delays, staff overtime pay, and patient dissatisfaction. A total of 23,690 min were lost during March to June 2022. The project goal was to implement the surgical enhanced readiness dashboard (SERD) to increase efficiency, resulting in the increased first case on-time starts (FCOTS) by 5 % in the March-June/fiscal year (FY) 2022 versus March-June/FY 2021.

Materials/Methods

FCOTS were captured by an institutional data analysis program. Data was pulled from the electronic health record from when the nurse recorded time the in the operating room (OR) time. A pre-and post-implementation survey was distributed to OR nurses and analyzed. Data was collected for one quarter and compared to the previous year's quarter. A statistical T-test was used to compare the pre-and post-implementation data and the pre-and post-implementation surveys.

Theory/Calculation

The Donabedian Model evaluated the safety and quality of the SERD's structure, process, and outcome. Data collected from the project provided quality metrics that led to transformative change.

Results

Of the 35 anonymous surveys submitted, 54.3 % of participants value using the SERD as a surgical readiness tool to improve their workflow. FCOTS during the implementation period of FY 2022 March-June averaged 72.3 %, an overall increase of 0.6 % of the same time frame in FY 2021 (71.7 %).

Discussion

The SERD's central location in the preoperative area and incorporation into the nursing workflow standardize the preoperative process and bridge communication gaps between nurses, anesthesia, residents, and surgeons. Efficient transitions through the preoperative area decrease healthcare organizations' overall costs.

Conclusion

Delays in patient surgery are costly to healthcare organizations. Patients scheduled for first surgical cases arrive early and expect to be prepared for surgery efficiently. Implementing an electronic dashboard to increase the number of FCOTS will be instrumental in streamlining patients throughout the perioperative stay. The data collected will help drive perioperative nurses to decrease costly delays in patient care.

Background

One of the primary principles governing operating room management includes maximizing clinical efficiency and optimizing the time used in the high-cost, high-revenue environments represented by operating rooms. Under-utilized and over-utilized times are elementary metrics that describe the operating room performance. Performance frontiers, the graphical representation of a hypothetical maximum performance of a manufacturing unit given a set of operating choices, visualize the maximal efficiency of systems and their existing constraints.

Methods

Monthly aggregated operating room metrics from services at the University of Vermont Medical Center (UVM), Stanford Hospital, and the University of Alabama (UAB) at Birmingham Hospital were extracted. Paired under- and over-utilized times were plotted against each other. Performance frontiers representing the optimal performance of each service were overlaid.

Results

The Kolmogorov-Smirnov test for goodness-of-fit at 95 % level of significance confirms that the performance frontiers representing UVM and Stanford (K-S = 0.9507, p < 0.0001), UVM and UAB (K-S = 0.9989, p < 0.0001), and Stanford and UAB (K-S = 0.9773, p < 0.0001), indicating each service is represented by a different performance frontier.

Conclusions

Our analysis shows that the performance frontier defining the optimal efficiency of UVM is more efficient than that of Stanford and UAB. Differences in efficiency may be the result of a collection of factors that must be the subject of future research, including but not limited to organizational differences limited in scale of institutions. Choices in operating room management must be made in relation to the existing organizational structures of each institution and their specific capacity to make changes in tactical decisions. Systemic interventions should be implemented via qualitative analysis of more efficient services, defined by the relative positioning of relevant performance frontiers.

Background

Anemia is the most hematological condition found in surgical patients. Pieces of empirical evidence shows that pre-operative anemia accounts for one- third of surgical patients. Yet, pre-operative anemia & blood transfusion for surgical patients has been associated with many complications such as lengthy hospital stay, post operation surgical wound infections, mortality and morbidity.

Purpose

This Pilot preliminary study sought to determine the prevalence of pre-operative anemia in elective surgical patients and to assess health workers’ awareness and knowledge regarding patient blood management in Saudi Arabia.

Material and methods

A questionnaire was used to collect data from the 129 healthcare workers in a selected hospital in Saudi Arabia. Additional data was obtained from the hospital electronic data records regarding the incidences of pre-operative anemia. Therefore, the study applied both retrospective and cross-sectional designs. The collected data was then analyzed using the Statistical Package for Social Services [SPSS].

Results

This study established the prevalence of pre-operative anemia in elective surgical patients to be 30 % (291 out of 970). In addition, 129 participants completed the questionnaires, from different hospital departments. From the questionnaire, it was noted that 74.2 % of the of physicians had the knowledge about patient blood management while 65 % (n = 50) were aware of the written protocol for the management of pre-operative anemia. This study also found out that 48.1 % of physicians rarely get to meet their patients assessed for possible anemia 4–8 weeks prior surgical operation. In addition, a relatively high number of physicians (42.6, n = 55 rarely investigate the cause of anemia after it has been established while 45.7 % confirm to rarely transfer their patient to pre-operative clinic for anemia management. Low intervention in correction of anemia of low iron origin by the physicians was established to be 44.2 %, and the most preferred hematology analyzer for point of care management was CBC Analyzer Sysmex (79.8 %).

Conclusion

This study finds a significant lack of knowledge about pre-operative anemia management in line with the patient blood management protocol. Also, majority of physicians fail to follow the guidelines for anemia management despite the high incidence.

Surgical site infections (SSIs) are infections of the incision site or organ space following a surgical procedure. The ramifications of an SSI extend beyond individual patient morbidity; SSIs lead to a substantial strain on healthcare systems, irrespective of the economic standing of the country. The utilization of a “care bundle” is a recommended approach for reducing the incidence of SSIs. These bundles typically involve the integration of evidence-based interventions, spanning preoperative, intraoperative, and postoperative phases of care, which aim to standardize healthcare delivery and infection prevention practices. While there is evidence supporting the efficacy of various care bundles, comparisons between specific bundles implemented in high-income countries (HICs) and low- to middle-income countries (LMICs) remain largely unreported. Understanding variations in implemented care bundles in these settings is central to optimize approaches for SSI risk reduction on a global scale.

Introduction

Surgery plays a critical role in global health, often facing significant quality challenges such as high rates of postoperative complications, variability in patient outcomes, and inconsistencies in care pathways, due to the complex nature of the perioperative journey. The My Surgical Pathway (MSP) app is an e-health intervention designed to address these challenges by supporting self-management and integrated care throughout the entire perioperative journey. This study aims to describe the features and functions of MSP and report on the results of usability testing from both patients and healthcare workers.

Methods

This mixed-methods study evaluated the usability of the My Surgical Pathway (MSP) app using quantitative surveys, qualitative feedback, and observation data from patients and healthcare workers. Structured 2-hour user testing sessions included interaction with the MSP app, completion of the User Version of the Mobile Application Rating Scale (uMARS), and think-aloud activities. Data analysis combined quantitative and qualitative insights to identify usability issues and inform potential improvements.

Results

The mixed-method user-testing evaluation of the co-designed e-health intervention revealed high overall app quality scores, with an average of 4.50 out of 5. All user-type interfaces received mean scores above the minimum acceptability threshold of 3.0, demonstrating the intervention's efficacy in supporting patient surgery journeys, enhancing healthcare worker coordination, and meeting diverse user needs. Notably, the highest individual item scores were for credibility of source (4.92) and interactivity (4.85), highlighting the application's reliability and engaging nature.

Conclusions

The study evaluated the 'My Surgical Pathway' (MSP) e-health intervention, co-designed with consumers and healthcare workers to support self-management of surgical care. Results indicate high user satisfaction, with an overall app quality score of 4.50 out of 5 on the uMARS tool. Users praised MSP's engagement, education, and responsiveness, highlighting its potential to improve patient experiences and clinician workflows. Recommendations for future research include expanding participant diversity and hospital settings, and employing longitudinal designs for a comprehensive evaluation.

Background

Video-assisted thoracoscopic surgery (VATS) is a minimally invasive technique with shorter recovery times and lesser postoperative pain than open thoracotomies. Regional blocks decrease the anesthetic and postoperative analgesic requirements.

Methods

105 patients scheduled for VATS under general anesthesia were included. Patients were randomly allocated to receive 20 ml of bupivacaine 0.5 % mixed with adrenaline 2 mcg/ml by ultrasound-guided erector spinae plane block (ESPB) at T5 level (Group ESPB, n = 35), 20 ml of bupivacaine 0.5 % mixed with adrenaline 2 mcg/ml by paravertebral block (PVB) at T5 level (Group PVB, n = 35), or multiple intercostal nerve blocks (Group MICNB, n = 35) where 2–3 ml of bupivacaine 0.5 % mixed with adrenaline 2 mcg/ml for each intercostal space from the third to the eighth intercostal nerve were injected by the surgeon through the thoracoscope. The objectives of this study were primarily to assess the effectiveness of the erector spinae plane versus paravertebral versus multiple intercostal nerve blocks on the intraoperative patient anesthetic requirements and secondarily to assess the postoperative analgesic requirements.

Results

No significant differences were observed regarding End tidal Sevoflurane (Et Sevo) all over the operative time between the ESPB and the PVB group; however there were highly significant differences between either group and the MICNB group immediately after induction of anesthesia till 60 min later, No significant difference between ESPB and the PVB groups as regards to the total amount of intraoperative fentanyl consumption, on the other hand there were highly significant difference between the ESPB or the PVB group and the MICNB group; while all the three groups provide comparable postoperative analgesia with non-significant difference regarding the postoperative VAS either during rest or cough.

Conclusion

ESPB and PVB provided better intraoperative anesthetic sparing effect than MICNB; however all the three blocks provide comparable postoperative analgesia either during rest or during cough in patients undergoing VATS.

This systematic review delves into the complex and multifaceted nature of Postoperative Delirium (POD) and Postoperative Cognitive Dysfunction (POCD), conditions sharing common phenotypes and risk factors. The pathophysiology of POD/POCD, particularly prevalent in vulnerable groups like the elderly, is explored, highlighting the roles of inflammation, cellular stress, and neural injuries. The review scrutinizes 24,354 research publications, selecting 176 and a subset of 24 for in-depth analysis, to unravel the intricate web of potential biomarkers and their associations with cognitive decline post-surgery. This systematic review was performed according to norms of Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA). The findings underscore the lack of universally accepted biomarkers, reflecting the diversity in clinical presentations and the myriad of underlying pathophysiological mechanisms. The review also emphasizes the evolving nature of POCD's definition and the need for further research to elucidate the genetic underpinnings of these postoperative complications. Future directions in neuropsychology and biomedicine are proposed to bridge existing knowledge gaps and enhance our understanding of POD and POCD.

Background

Immediate Use Steam Sterilization (IUSS), formerly known as Flash Sterilization, is a rapid process that allows the timely sterilization of surgical instruments in the event of accidental contamination. The infrequency of use and dependence on expedited reprocessing raised concern over omitting essential steps such as pre-cleaning, decontamination, weighing, and biologically verified sterilization cycles.

Methods

A multidisciplinary systematic workflow analysis was conducted utilizing Lean A3 methodology to reduce IUSS inefficiencies and enhance evidence-based guideline compliance.

Results

Revised IUSS workflows and protocols were implemented, focusing on effective communication, adherence to evidence-based principles for all IUSS processes, and delegating infrequent tasks to subject matter experts in the Sterile Processing Department.

Conclusions

Attempts to reduce the utilization of IUSS have proven effective. Due to these efforts, perioperative managers may face the challenge of dealing with outdated workflows that are no longer being utilized frequently enough to allow perioperative staff to become familiar with them and develop the necessary skills. The IUSS workflows should be subjected to process improvement methodologies to adapt them to optimize performance while minimizing risks to the organization.

Post intubation tracheal stenosis is narrowing of tracheal lumen mainly due to endotracheal intubation associated problems. This iatrogenic complication commonly occurs after prolonged intubation. However, this case report revealed that severe tracheal stenosis could occur even after intubation last less than a week and can be misdiagnosed as bronchial asthma as first encountered with the patient. The case was 32 year old female patient who was admitted to ICU intubated for the management of status epilepticus. She was intubated for 3 days and discharged to medical ward. One month later, she experienced dyspnea and difficulty for breathing and admitted to the hospital. The three-dimensional CT scan showed trachea stenosis of 29 mm length with 8 cm wall thickness at the lower tracheal level. The stenosis was treated surgically with resection and anastomosis. This evidenced showed the occurrence of early intubation-related tracheal stenosis that mimic pulmonary problem presentation. As a conclusion if patient intubated for acceptable duration of time, patient consultation for the probability of the complications, sign and symptom and early admission will help in early treatment