High-throughput operating room system for joint arthroplasties durably outperforms routine processes.
BACKGROUND: Recent publications have focused on increased operating room (OR) throughput without increasing total OR time. The authors hypothesized that a system of parallel processing for lower extremity joint arthroplasties sustainably reduces nonoperative time and increases throughput. METHODS: T...
| Publicado en: | Anesthesiology Vol. 109; no. 1; pp. 25 - 36 |
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| Autores principales: | , , , , , , |
| Formato: | research Journal Article |
| Publicado: |
Lippincott Williams & Wilkins
2008 Jul
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=105784522&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 105784522 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 00033022 1V8 jtl: Anesthesiology issn: 00033022 maglogo: N pubinfo: dt: 2008 Jul vid: 109 iid: 1 pid: 433 pub: Lippincott Williams & Wilkins place: Baltimore, Maryland artinfo: ui: 105784522 105784522 2009972964 10.1097/aln.0b013e31817881c7 NLM18580169 105784522 ppf: 25 ppct: 11 formats: tig: atl: High-throughput operating room system for joint arthroplasties durably outperforms routine processes. aug: au: Smith MP Sandberg WS Foss J Massoli K Kanda M Barsoum W Schubert A affil: Department of General Anesthesiology, Cleveland Clinic, Cleveland, Ohio 44195, USA. sug: subj: Appointments and Schedules Arthroplasty Methods Operating Rooms Methods Aged Aged, 80 and Over Anesthesia Economics Anesthesia Methods Anesthesia Utilization Arthroplasty Economics Arthroplasty Utilization Female Male Middle Age Operating Rooms Economics Operating Rooms Utilization Organizational Efficiency Economics Personnel, Health Facility Economics Personnel, Health Facility Utilization Retrospective Design Time Factors Time Management Economics Time Management Methods Human Aged: 65+ years Aged, 80 & over Middle Aged: 45-64 years Female Male ab: BACKGROUND: Recent publications have focused on increased operating room (OR) throughput without increasing total OR time. The authors hypothesized that a system of parallel processing for lower extremity joint arthroplasties sustainably reduces nonoperative time and increases throughput. METHODS: The high-throughput parallel processing strategy included neuraxial anesthesia performed in an 'induction room' adjacent to the OR, patient selection, an additional circulating nurse, and end-of-case transfer of care to a recovery room nurse who transported the patient from the OR to recovery. Instruments and supplies were prepared in a dedicated sterile setup area. Data were extracted from administrative databases. Group comparisons used standard statistical methods; statistical process control was used to evaluate performance over time. RESULTS: There were 688 historic control cases from 299 days over 16 months, and 905 high-throughput cases from 304 days spanning 24 consecutive months starting September 1, 2004. Throughput increased from 2.6 +/- 0.7 (mean +/- SD) to 3.4 +/- 0.8 arthroplasties per day per room. Nonoperative time decreased by 36 min (or 50%) per case. Operative time also decreased by 14 min (12%) per case. The end time for the high-throughput OR day was only 16 min later than control. Nonoperative time, operative time, and throughput remained significantly improved after 2 yr of operation. Contribution margin increased 19.6%. CONCLUSION: Reorganizing the perioperative work process for total joint replacements sustainably increased OR throughput. Because joint arthroplasties generated a positive margin greater than the incremental cost, the high-throughput system improved financial performance. pubtype: Academic Journal doctype: research Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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