The enhanced postoperative care system

Weissman, Charles

doi:10.1016/j.jclinane.2004.10.003

Cited by 36 publications

(28 citation statements)

References 53 publications

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“…In the more specific area of medicine and hospital management (Ahn 2006), Solberg (2007) has studied diabetes care and Weissman (2005) postoperative care but the most active area is in error prevention and management (Wieman and Wieman 2004). Again this is a classic situation where the reductionist approach would tend to see errors and failures as being one-off events often attributable to an individual's failure whereas the systems approach sees that although they occur to individuals it is generally the wider process and context that generate them.…”

Section: Medicine and Healthmentioning

confidence: 99%

A review of the recent contribution of systems thinking to operational research and management science

Mingers

White

2010

European Journal of Operational Research

353

229

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The systems approach, or systems thinking, has been intimately connected with the development of OR and management science initially through the work of founders such as Churchman and Ackoff and latterly through innovations such as soft systems. In this paper we have undertaken a review of the contribution that systems thinking has been making more recently, especially to the practice of OR. Systems thinking is a discipline in its own right, with many theoretical and methodological developments, but it is also applicable to almost any problem area because of its generality, and so such a review must always be selective. We have looked at the literature from both a theoretical and an applications orientation. In the first part we consider the main systems theories and methodologies in terms of their recent developments and also their applications. This covers: the systems approach, complexity theory, cybernetics, system dynamics, soft OR and PSMs, critical systems and multimethodology. In the second part we review the main domains of application: strategy, information systems, organisations, production and operations, ecology and agriculture, and medicine and health. Our overall conclusion is that while systems may not be well established institutionally, in terms of academic departments, it is incredibly healthy in terms of the quantity and variety of its applications.

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Section: Medicine and Healthmentioning

confidence: 99%

A review of the recent contribution of systems thinking to operational research and management science

Mingers

White

2010

European Journal of Operational Research

353

229

View full text Add to dashboard Cite

show abstract

“…The latter is provided in intensive care units (ICUs), intermediate care units, and during prolonged (N12 hrs) recovery room stays This study was part of a health services research project designed to explore the functioning of inpatient surgical care systems. The project's aims were to identify and develop methods to evaluate such systems and then to use these tools to provide administrative and clinical insights into their workings [6,7]. Among the observations made during the project was that 12% of the patients undergoing surgery in one tertiary-care center received either intensive or intermediate care immediately after surgery.…”

Section: Introductionmentioning

confidence: 99%

Who receives postoperative intensive and intermediate care?

Weissman

Klein

2008

Journal of Clinical Anesthesia

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“… a Values are presented as number and percentage of patients unless specified otherwise b From logistic regression analysis and were summarized with odds ratios and corresponding 95 % confidence intervals c Phase I postanesthesia recovery within 90 min of arrival d Phase I postanesthesia recovery at >90 min of arrival e The median [interquartile range] number of antihypertensive medications for hypertensive patients was 2 [1–2] f Obstructive sleep apnea was diagnosed through polysomnography in 479 cases, and 25 additional patients were deemed at high risk through preoperative screen on the day of surgery g The other patients received isoflurane, sevoflurane, several volatile agents throughout the surgery, or a mixed technique of propofol infusion with a volatile agent h Consisted of droperidol (0.625 mg), dexamethasone (4 mg), and ondansetron (4 mg) i Seven patients in each study group received hydralazine (all patients in each group also received β-adrenergic blocking medications) j Given as bolus doses of either phenylephrine or ephedrine …”

Section: Tablementioning

confidence: 99%

“… e The median [interquartile range] number of antihypertensive medications for hypertensive patients was 2 [1–2] …”

Section: Tablementioning

confidence: 99%

“…The postanesthesia care unit (PACU) is the lynchpin of this system and where patients undergo immediate phase I recovery from anesthesia before discharge to phase II recovery (in ambulatory settings, postoperative wards, and advanced monitoring wards). Effective movement of patients through the postoperative care system is critical to avoid patient flow bottlenecks and disruption of surgical practices [1]. Thus, identifying and mitigating potential delays in postanesthesia care are important.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Factors Associated with Prolonged Anesthesia Recovery Following Laparoscopic Bariatric Surgery: a Retrospective Analysis

et al. 2014

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Background Phase I postanesthesia recovery is often prolonged after laparoscopic bariatric surgery. We hypothesized that postoperative respiratory depression is a major contributor to this delayed recovery. Methods Medical records of all patients who had a laparoscopic bariatric surgical operation from January 1, 2009, to December 31, 2012, were reviewed for clinical, anesthetic, and postanesthesia variables. Recoveries were defined as discharge from the recovery room in ≤90 min and in >90 min (prolonged postanesthesia recovery). We compared characteristics of patients without prolonged recovery to those with prolonged recovery. Results Of 781 bariatric patients, 304 (38.9 %) had prolonged recovery. These patients had more respiratory depression (29 vs 6 patients), more postoperative nausea and vomiting (106 vs 92 patients), more treatments of hypertension in the recovery room (49 vs 33 patients), and more opioid treatment (median intravenous morphine equivalents [interquartile range], 10.0 [3.0–15.0] vs 5.0 [0.0–10.5]) (P<0.001 for all). On multivariable analysis, preoperative history of hypertension (P=0.03), fewer prophylactic antiemetics received (P= 0.02), and longer surgical duration (P=0.03) were associated with prolonged postanesthesia recovery. Conclusions Inadequate antiemetic prophylaxis and the treatment of postoperative hypertension were associated with prolonged postanesthesia recovery. Surprisingly, diagnosis of obstructive sleep apnea was not associated with prolonged recovery, which may be attributable to use of continuous positive airway pressure devices following emergence from anesthesia. Prolonged recovery in patients treated for hypertension may be related to institutional guidelines that require additional monitoring time after these medications are administered.

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The enhanced postoperative care system

Cited by 36 publications

References 53 publications

A review of the recent contribution of systems thinking to operational research and management science

A review of the recent contribution of systems thinking to operational research and management science

Who receives postoperative intensive and intermediate care?

Factors Associated with Prolonged Anesthesia Recovery Following Laparoscopic Bariatric Surgery: a Retrospective Analysis

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