Design and Impact of an Intraoperative Pathway: A New Operating Room Model for Team-Based Practice

Lee, Bernard T.; Tobias, Adam M.; Yueh, Janet H.; Bar-Meir, Eran; Darrah, Lynn; Guglielmi, Charlotte L.; Wood, Elizabeth R.; Carr, Justine M.; Moorman, Donald W.

doi:10.1016/j.jamcollsurg.2008.08.016

Cited by 48 publications

(49 citation statements)

References 25 publications

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“…One study described a prospective longitudinal quasi-experimental study (13), and another study described an observational prospective design (14). All studies were of non-randomised study design; five were purely observational (with no specific improvements/interventions applied) (14-18), one was a controlled before-and-after study (19), and the remainder had before-and-after study designs without controls (7,13,(20)(21)(22)(23)(24)(25)(26)(27)(28). Table 1 lists more detailed study characteristics.…”

Section: Study Characteristicsmentioning

confidence: 99%

“…Nine studies that included real-time process observations were at risk of the Hawthorne effect, an observational bias where study subjects change their behaviour in the knowledge that they are being studied (7,(13)(14)(15)20,(22)(23)(24)26). However, only three studies acknowledged this (13,24,28), and only one controlled for this by including an "observer-effect" period, where "fake" observation data collection by research team members was conducted for 3 months at the start of the study (13).…”

Section: Risk Of Bias Within Studiesmentioning

confidence: 99%

“…However, only three studies acknowledged this (13,24,28), and only one controlled for this by including an "observer-effect" period, where "fake" observation data collection by research team members was conducted for 3 months at the start of the study (13). Analysis later revealed no differences between baseline database values and values during the "observer-effect" period (13).…”

Section: Risk Of Bias Within Studiesmentioning

confidence: 99%

See 2 more Smart Citations

A systematic review of intraoperative process mapping in surgery

Chung¹,

Hunter-Smith²,

Spychal³

et al. 2017

Gland Surg.

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Section: Study Characteristicsmentioning

confidence: 99%

Section: Risk Of Bias Within Studiesmentioning

confidence: 99%

Section: Risk Of Bias Within Studiesmentioning

confidence: 99%

See 1 more Smart Citation

A systematic review of intraoperative process mapping in surgery

Chung¹,

Hunter-Smith²,

Spychal³

et al. 2017

Gland Surg.

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“…Greater anatomical flap dissection or surgical mentorship can help reduce this source of error. This also argues for a standardization of flaps, something that is not reflected in our series but has only briefly been talked about by other plastic surgeons [35,36].…”

Section: Discussionmentioning

confidence: 92%

“…A prominent sign hung over the ether curtain has been far more consistent. Hence, the benefit of a culture of microsurgery [35,36].…”

Section: Discussionmentioning

confidence: 99%

Anatomy of Free Flap Failures: Dissection of a Series

Davison¹,

Clemens²,

Kochuba³

2013

MPS

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Introduction: Free flap success rates have remained stable in recent years ranging 93% to 98%. Historically, the causes of free flap failures were attributed to the surgeon's inexperience and technique. However, there are factors beyond the surgical anastomosis that contribute to flap failure. The purpose of this study is to review each case of total flap loss in detail to develop a better understanding of complications. Methods: A retrospective study was performed over eleven years in a single surgeon's practice, a predominantly head and neck reconstructive practice. All charts were independently reviewed. In patients who sustained total flap loss, a review was conducted of patient comorbidites, anesthesia records, perioperative and follow-up notes. Results: A total of 514 free flaps were performed. 76% (392) of these flaps were for head and neck reconstruction. There were 22 total flap losses (4%) and 26 partial flap losses (5%). Of the 22 total flap losses, four flaps were avulsed, five flaps were in patients later found to have coagulation disorders (homozygous mutations of the MTHFR gene and factor V Leiden), four patients were exposed to neosynephrine, two patients remained hypotensive perioperatively, and four delayed flap losses were attributed to pseudomonal infection. Five losses were technical or related to flap inexperience. Several representative case scenarios are illustrated. Conclusion: Careful review of free flap failures indicates that a thorough workup (particularly coagulation disorders), flap selection, surgeon to anesthesia communication, proper securing of the flap, and postoperative patient blood pressure and infection control have a greater part to play in this new era of anastomotic success.

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Analysis of Pediatric Direct Laryngoscopy and Bronchoscopy Operative Flow

Shah

Cohen²,

Patel³

et al. 2012

Arch Otolaryngol Head Neck Surg

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Although a common pediatric otolaryngology procedure, direct laryngoscopy and bronchoscopy operative flow is ideal in less than half the cases. Areas for improvement include obtaining intravenous access, reducing operating room personnel turnover, verifying equipment, and educating staff on operating room setup. To our knowledge, this is the first observational quality improvement initiative in otolaryngology to study the operative flow of a specific procedure and provide insight into areas of patient risk and opportunities for improvement in efficiency.

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Design and Impact of an Intraoperative Pathway: A New Operating Room Model for Team-Based Practice

Cited by 48 publications

References 25 publications

A systematic review of intraoperative process mapping in surgery

A systematic review of intraoperative process mapping in surgery

Anatomy of Free Flap Failures: Dissection of a Series

Analysis of Pediatric Direct Laryngoscopy and Bronchoscopy Operative Flow

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