时间管理在洁净手术室运作流程优化中的应用研究

目的探讨洁净手术室应用时间管理优化运作流程的方法与效果。方法 2009年采用洁净手术室常规运作管理。2010年采用时间管理优化手术室工作流程,即规定第1台手术的手术人员于8:30前入手术室、9:00前手术切皮;优化手术患者接送流程、开通手术患者专用电梯、缩短术后患者在麻醉复苏室的停留时间。结果 2010年较2009年手术量增加8.34%;年成本下降2.43%,年收益增加30.21%;麻醉复苏室接收术后患者量增加29.31%;2010年与2009年第1台手术患者入室-切皮时间、接台手术患者入室-切皮时间、麻醉恢复室停留时间、第1台手术切皮延误率比较,差异有统计学意义(均P<0.01)。结论应用时间管理优化手术室工作流程能提高洁净手术室运作效率、降低手术成本。     

信息技术联合现场督导管理对手术室运行效率的影响

目的探讨信息技术联合现场督导管理提高手术室运行效率的效果。方法按时间段将2013年5~6月的首台手术597例、连台手术5 039例作为对照组,2015年5~6月的首台手术601例、连台手术5 512例作为观察组。对照组按常规实施管理,即应用常规手麻信息系统,手术医生、护士按常规实施手术;观察组在原信息系统中融入患者入手术间、麻醉开始、手术开始等6项关键时间节点,设查询专栏;建立健全相关制度,现场督导落实到位。结果观察组首台手术准点率显著高于对照组,连台手术等待时间及手术时间显著短于对照组;2015年手术间手术量显著高于2013年(均P0.01)。结论信息技术联合现场督导管理,可有效提高首台手术准时开始率及缩短连台手术等待时间,提高手术室运行效率。     

Predictive Model of Surgical Time for Revision Total Hip Arthroplasty

BackgroundMaximizing operating room utilization in orthopedic and other surgeries relies on accurate estimates of surgical control time (SCT). A variety of case and patient-specific variables can influence the duration of surgical time during revision total hip arthroplasty (THA). We hypothesized that these variables are better predictors of actual SCT (aSCT) than a surgeon's own prediction (pSCT).MethodsAll revision THAs from October 2008 to September 2014 from one institution were accessed. Variables for each case included aSCT, pSCT, patient age, gender, body mass index, American Society of Anesthesiologists Physical Status class, active infection, periprosthetic fracture, bone loss, heterotopic ossification, and implantation/explantation of a well-fixed acetabular/femoral component. These were incorporated in a stepwise fashion into a multivariate regression model for aSCT with a significant cutoff of 0.15. This was compared to a univariate regression model of aSCT that only used pSCT.ResultsIn total, 516 revision THAs were analyzed. After stepwise selection, patient age and American Society of Anesthesiologists Physical Status were excluded from the model. The most significant increase in aSCT was seen with implantation of a new femoral component (24.0 min), followed by explantation of a well-fixed femoral component (18.7 min) and significant bone loss (15.0 min). Overall, the multivariate model had an improved r² of 0.49, compared to 0.16 from only using pSCT.ConclusionA multivariate regression model can assist surgeons in more accurately predicting the duration of revision THAs. The strongest predictors of increased aSCT are explantation of a well-fixed femoral component, placement of an entirely new femoral component, and presence of significant bone loss.     

层流手术室腔镜器械的流程管理

遵循层流手术室洁污分开原则,建立并实施腔镜器械统筹安排、发放、回收、清洗、灭菌、储存等管理流程,实施全程跟踪管理。结果提高了管理质量及手术医生、器械护士的满意度。     

多部门协作的手术室精益化管理研究

目的提高手术室工作效率。方法成立多部门协作的手术室效率管理小组,实施精益管理,包括改进硬件设施,优化工作职责及流程,确保首台手术准时开始,充分利用信息化手段,优化奖惩机制,建立"3个1"响应机制。比较管理前(2016年1～12月)与管理后(2017年4月至2018年3月)平均接台间隔时间、准点开台率、延迟手术率、患者及手术医生满意度。结果与管理前比较,管理后平均接台手术时间缩短,准点开台率提高,延迟手术率降低,患者及手术医生对护理工作的满意度提高(P0.05,P0.01)。结论多部门协作实施精益化管理可加快手术运转,提高手术室整体效率、手术医生和患者满意度。     

脊柱后入路手术相关皮肤压力性损伤的风险管理

目的 探讨风险管理在脊柱后入路手术中预防压力性损伤的效果.方法 选取2019年4月～2020年3月行脊柱后入路手术患者117例,手术过程中预防压力性损伤的管理方法是采用本手术室基于风险管理循证基础上新创建的护理模式,通过识别脊柱后路手术中发生压力性损伤的风险点,建立风险管理小组,制定人员同质化培训机制、标准体位摆置流程...     

Increased efficiency of endocrine procedures performed in an ambulatory operating room

Background

Thyroid and parathyroid procedures historically have been viewed as inpatient procedures. Because of the advancements in surgical techniques, these procedures were transferred from the inpatient operating room (OR) to the outpatient OR at a single academic institution approximately 7 y ago. The goal of this study was to determine whether this change has decreased turnover times and maximized OR utilization.

Methods

We performed a retrospective review of 707 patients undergoing thyroid (34%) and parathyroid (66%) procedures by a single surgeon at our academic institution between 2005 and 2008. Inpatient and outpatient groups were compared using Student t-test, chi-square test, or the Kruskal–Wallis test where appropriate. Multiple regression analysis was used to determine how patient and hospital factors influenced turnover times.

Results

Turnover times were significantly lower in the outpatient OR (mean 18 ± 0.7 min) when compared with the inpatient OR (mean 36 ± 1.4 min) (P < 0.001). When compared by type of procedure, all turnover times remained significantly lower in the outpatient OR. Patients in both ORs were similar in age, gender, and comorbidities. However, inpatients had a higher mean American Society of Anesthesiologists score (2.30 versus 2.13, P < 0.001) and were more likely to have an operative indication of cancer (23.1% versus 9.2%, P < 0.001). Using multiple regression, the inpatient OR remained highly significantly associated with higher turnover times when controlling for these small differences (P < 0.001).

Conclusions

Endocrine procedures performed in the outpatient OR have significantly faster turnover times leading to cost savings and greater OR utilization for hospitals.     

手术室护士腹腔镜手术空间管理能力的培训

目的提高手术室护士腹腔镜手术空间管理能力,提高工作效率及医生满意度。方法成立空间管理能力培训考核小组,制定涉及20种腔镜手术配合空间管理的质量标准,空间管理的细则、培训与考核计划,对护士进行患者手术体位、静脉输液部位的选择、仪器设备的布局摆放等8个方面的培训。比较培训前后手术室护士空间管理能力、术前准备时间及医生满意度。结果培训后手术室护士空间管理能力及医生满意度显著高于培训前,术前准备时间显著短于培训前(均P0.01)。结论腹腔镜手术空间管理能力培训可提高腹腔镜手术配合效率及手术医生的满意度。     

Criteria for assessing operating room utilization in a free-standing children's hospital

Background: The staffed hours of operation in any surgical facility are a valuable institutional resource. The realistic target for the utilization of this resource is dependent on many factors including scheduling, efficiency, and culture of the facility. There is no previously reported measure for the actual utilization of staffed regular operating room (OR) hours in an academic pediatric institution. The leadership of the perioperative services at Children’s Hospital Boston (CHB) sought to define the utilization of surgical suite staffed block time hours at that institution and in addition determine whether changes in workflow could increase the measured utilization. Methods: Operating room efficiency in fiscal year 2009 was measured using two variables: utilization and turnover measured in hours for each month in fiscal year 2009, recorded in hours expressed as ratios (observed/expected) and as differences (observed – expected). A total of 27 851 cases from October 1, 2008, through September 30, 2009, were analyzed. All elective cases were scheduled electronically following institutional guidelines; urgent or emergent procedures were scheduled into vacant time slots on the day of the procedure. Time series analysis based on a generalized autoregressive moving average process was used to compare expected with observed utilization and to evaluate changes in utilization and turnover ratios. Results: Efficiency as measured by capped utilization divided by total available time in the OR averaged 79%. Utilization ratios ranged from a low of 73% in February 2009 to a high of 87% in July 2009. An improvement in on‐time first‐case starts may have contributed to the increase in the utilization of staffed block time. Turnover time as defined by turnover ratio decreased significantly over time, indicating an improved efficiency in the OR starting in April 2009. Conclusions: Adhering to the specific guidelines that are followed at CHB, the mean utilization of scheduled block time was 79%. This was achieved by maximizing workflow in the surgical, anesthesia, and nursing disciplines to shorten turnover time, fill gaps in the elective schedule with emergency procedures, and provide staffing to accommodate cases that extend beyond the scheduled staffed time prior to the reporting period. Simulated models from other pediatric institutions suggest that the optimal utilization of designated time periods in a surgical facility may range from 85% to 90%.     

Directed Air Flow to Reduce Airborne Particulate and Bacterial Contamination in the Surgical Field During Total Hip Arthroplasty

This study evaluated the use of a system that delivers a small field of local, directed air from a high-efficiency particulate air (HEPA) filter to reduce airborne particulate and airborne bacteria in the surgical field during total hip arthroplasty. Thirty-six patients were randomized into 3 groups: with directed air flow, with the directed air flow system present but turned off, and control. Airborne particulate and bacteria were collected from within 5 cm of the surgical wound. All particulate and bacterial counts at the surgical site were significantly lower in the directed air flow group (P < .001). The directed air flow system was effective in reducing airborne particulate and colony-forming units in the surgical field during total hip arthroplasty.     

Audit of the utilization of time in an orthopaedic trauma theatre

Background: The efficient use of operating theatres is important to ensure optimum cost–benefit for the hospital and to clear waiting lists. This audit uses the orthopaedic trauma theatre as a model to assess the theatre efficiency at our institution. Methods: We performed a retrospective audit using data gathered from the operating theatre database at our institution. We considered each component of the operating theatre process and integrated them to give a combined value for surgical and anaesthetic time (end utilization) and total theatre efficiency (operating theatre utilization). Results: Results showed that relative to the standards set, changeover time and start times were sub‐standard, with consistently prolonged changeovers and late starts. End utilization and operating theatre utilization were 78.8 and 81%, against a standard of 77 and 85–90%, respectively. However, these figures may be misleading due to sub‐standard performance in changeover time and other variables. Conclusions: We have highlighted inefficiency in the orthopaedic trauma theatre at our institution and suggest various strategies to improve this that may be applied universally.     

Surgical Case Order Has an Effect on the Risk of Subsequent Periprosthetic Joint Infection

Background

Periprosthetic joint infection (PJI) after total joint arthroplasty (TJA) is a serious complication with multiple etiologies. Prior spine literature has shown that later cases in the day were more likely to develop surgical site infection. However, the effect of case order on PJI after TJA is unknown. This study aims to determine the influence of case order, prior infected case, and terminal cleaning on the risk for a subsequent PJI.

手术室药品管理质量评价指标体系的构建与应用

目的 构建手术室药品管理质量评价指标体系,提高手术室药品管理质量。方法 基于2轮专家函询,确立手术室药品管理质量评价指标体系;针对评价指标进行培训与监测,比较干预1年后手术室药品管理质量。结果 构建了包含3个一级指标、6个二级指标、29个三级指标的手术室药品管理质量评价指标体系。手术室护理人员药品知识考核合格率从70.07%上升至98.18%,手术室药品分类分区固定放置率、药品账物相符率及医护人员满意率显著提高,药品过期、变质发生率显著降低（均P＜0.05）。结论 构建的手术室药品管理质量评价指标体系科学、实用,有利于手术室药品管理质量的提升。     

How to perform a thyroidectomy in an outpatient setting

Purpose  In France, the current practice for postoperative care of thyroidectomy is still inpatient care. No series of outpatient thyroidectomy has been reported. The aim of this work was to assess the acceptability, feasibility, and safety of outpatient unilateral thyroid lobectomy in a university hospital. Materials and methods  The procedure was proposed to patients presenting with nodule(s) in one lobe of the thyroid and fulfilling predetermined inclusion criteria. The surgical protocol included no drainage and, progressively, no dressing. Standard anesthetic, analgesic, and antiemetic protocols were used. Unplanned admission, complication, and re-operation rates were evaluated. Results  Among 153 unilateral thyroid lobectomies performed, 95 (62%) were planned for outpatient surgery. The proportion of outpatient unilateral thyroid lobectomies increased during an 8-year period from 36% to 90%. One patient was re-operated because local hemorrhage was diagnosed in the recovery room. He was discharge the next day. Eighteen patients (13.7%) were admitted because of nausea (n = 6), dizziness, and physical discomfort mostly due to anxiety (n = 5). Seventy-seven patients were discharged as planned 6 to 8 h after the operation. No patient was readmitted. Conclusions  Outpatient unilateral thyroid lobectomy is feasible and safe in the setting of appropriate facilities and management protocol. Strict control of postoperative nausea is essential, and a preoperative education for ambulatory surgery is useful to minimize patient anxiety and increase acceptability.     

Use of External Fixation and Primary Wound Closure in an Open Comminuted First Metatarsal Fracture: A Case Report

Management of open, comminuted fractures presents a challenge for the foot and ankle surgeon. Reconstructive surgery for such injuries has a high potential for the development of serious complications, and factors such as the extent of soft tissue injury, neurovascular status to the foot, and fracture stability must be taken into consideration before determining a surgical plan. This article describes the case of a patient who presented with an open, comminuted first metatarsal fracture as a result of a chainsaw injury. The patient was treated with a uniplanar mini-external fixator, demineralized bone matrix, primary wound closure, and external bone growth stimulation. At 1-year follow-up, the interview and examination revealed the patient to be pain free with a functional first ray. ACFAS Level of Clinical Evidence: 4.