Use of Operating Room Information System Data to Predict the Impact of Reducing Turnover Times on Staffing Costs

Dexter, Franklin; Abouleish, Amr E.; Epstein, Richard H.; Whitten, Charles W.; Lubarsky, David A.

doi:10.1213/01.ane.0000082520.68800.79

Cited by 152 publications

(107 citation statements)

References 26 publications

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“…Second, the altered policy of medicine, in general -in accordance with the growing patients' demands -has brought about a change of the overall objective of surgical interventions' need to be minimal invasive, cost-efficient, and as easy on the patients as possible. The new policy therefore relies on more resources, such as economic [2][3][4], social, psychological, qualitative, practical, and technological aspects, enhancing patient safety and eliminating medical malpractices [5].…”

Section: Surgical Process Models (Spms) -Motivation Definition and mentioning

confidence: 99%

Surgical process modeling

Neumuth

2017

Innovative Surgical Sciences

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Due to the rapidly evolving medical, technological, and technical possibilities, surgical procedures are becoming more and more complex. On the one hand, this offers an increasing number of advantages for patients, such as enhanced patient safety, minimal invasive interventions, and less medical malpractices. On the other hand, it also heightens pressure on surgeons and other clinical staff and has brought about a new policy in hospitals, which must rely on a great number of economic, social, psychological, qualitative, practical, and technological resources. As a result, medical disciplines, such as surgery, are slowly merging with technical disciplines. However, this synergy is not yet fully matured. The current information and communication technology in hospitals cannot manage the clinical and operational sequence adequately. The consequences are breaches in the surgical workflow, extensions in procedure times, and media disruptions. Furthermore, the data accrued in operating rooms (ORs) by surgeons and systems are not sufficiently implemented. A flood of information, "big data", is available from information systems. That might be deployed in the context of Medicine 4.0 to facilitate the surgical treatment. However, it is unused due to infrastructure breaches or communication errors. Surgical process models (SPMs) alleviate these problems. They can be defined as simplified, formal, or semiformal representations of a network of surgery-related activities, reflecting a predefined subset of interest. They can employ different means of generation, languages, and data acquisition strategies. They can represent surgical interventions with high resolution, offering qualifiable and quantifiable information on the course of the intervention on the level of single, minute, surgical work-steps. The basic idea is to gather information concerning the surgical intervention and its activities, such as performance time, surgical instrument used, trajectories, movements, or intervention phases. These data can be gathered by means of workflow recordings.These recordings are abstracted to represent an individual surgical process as a model and are an essential requirement to enable Medicine 4.0 in the OR. Further abstraction can be generated by merging individual process models to form generic SPMs to increase the validity for a larger number of patients. Furthermore, these models can be applied in a wide variety of use-cases. In this regard, the term "modeling" can be used to support either one or more of the following tasks: "to describe", "to understand", "to explain", to optimize", "to learn", "to teach", or "to automate". Possible use-cases are requirements analyses, evaluating surgical assist systems, generating surgeon-specific training-recommendation, creating workflow management systems for ORs, and comparing different surgical strategies. The presented chapter will give an introduction into this challenging topic, presenting different methods to generate SPMs from the workflow in the OR, as well as various...

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Section: Surgical Process Models (Spms) -Motivation Definition and mentioning

confidence: 99%

Surgical process modeling

Neumuth

2017

Innovative Surgical Sciences

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“…[1][2][3][4][5] Analyses can be performed when targeting specific ORs for reductions in turnover times, surgical times, and first-case of the day starts. 2,3,5 A screening process can be used to decide whether a comprehensive analysis is warranted. 4 The screening process identifies ORs where focused efforts to ensure on-time first case of the day starts may have value.…”

Section: Résumémentioning

confidence: 99%

“…23,24 It follows that OR time can reasonably be treated as a fixed cost. [1][2][3][4][5][6][7][8] In addition, completing more cases should be unexpected because small (e.g., five minutes) reductions in time are insufficient for reliably scheduling additional cases. 25,26 Overall revenue far exceeds variable costs because of the large fixed costs of surgical care, [27][28][29] and not performing a scheduled case increases net societal costs.…”

Section: Résumémentioning

confidence: 99%

Cohort study of cases with prolonged tracheal extubation times to examine the relationship with duration of workday

Epstein

Dexter

Brull

2013

Can J Anesth/J Can Anesth

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Purpose The economics of the use of an anesthetic drug or device that produces benefit through reduction in operating room (OR) time depends on the day of the week and the total hours of surgical cases in the OR in which they are performed. Principally, this has to do with different durations of the regularly scheduled workday in the ORs within and among hospitals. We tested hypotheses relevant to the economic benefit of avoiding prolonged tracheal extubation times. Methods Observational data were obtained from a multiple-specialty academic tertiary hospital that uses an anesthesia information management system. Prolonged tracheal extubation times were considered those with tracheal extubations occurring 15 min or more after the end of surgery. The assessment of prolonged tracheal extubation times was limited to cases for which the patient's trachea was intubated and extubated while physically in the OR. Percentages were calculated for each of n = 39 four-week periods. Results are reported as mean (standard error of the mean) of these percentages, and the phrases ''at most/least'' are used to refer to the corresponding 95% confidence limits.Results At most, 6.1% [mean 5.5 (0.3)%] of the prolonged tracheal extubation times were attributable to cases that did not end during regular workdays from 7:00 AM-10:59 PM. At least 55.6% of prolonged tracheal extubation times occurred during cases on regular workdays and in an OR with more than eight hours of cases and turnovers [mean 57.0 (0.9)%; P \ 0.0001]. This percentage was 23.8 (0.8)% larger than for all other cases. Conclusions In the absence of an accurate facilityspecific cost analysis, prolonged tracheal extubation times should not be treated as fixed costs but as resulting in proportionally increased OR variable costs. RésuméObjectif En anesthésie, les économies résultant de l'utilisation d'un médicament ou d'un dispositif qui entraîne des avantages en réduisant le temps en salle d'opération (SO) dépendent du jour de la semaine et du nombre total d'heures de cas chirurgicaux réalisés dans cette salle. Ces économies ont surtout à voir avec les différences de durée d'une journée de travail normale planifiée dans les SO à l'intérieur de chaque hô pital et entre les hô pitaux. Nous avons testé des hypothèses pertinentes aux avantages économiques liés à la prévention d'un délai d'extubation trachéale prolongés. Méthode Nous avons obtenu des données observationnelles d'un hô pital tertiaire, universitaire et pluri-spécialisé qui se sert d'un système de gestion de l'information en anesthésie. Nous avons défini qu'il y avait

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“…Once the first three components are completed, the new patient can be 'greenlighted' and wheeled in to proceed with surgery. Several hospitals nationwide have attempted to increase the efficiency of the overall process (Dexter et al,2003), though most discussions tend to focus on refining the 'assembly line processes' that occur during 'Wheels out to OR ready'. During the Measure and Analyze phases we agreed on improving the 'Wheels out to OR Ready' process; however, it is essential to concentrate on increasing the efficiency of the 'Patient Ready' process to fully optimize performance and improve OR TOT.…”

Section: …………………………………………………………………………………………………… Introduction:-mentioning

confidence: 99%