Implementing a system to ensure the surgical team uses the most effective practices resulted in significant improvements in operating room (O.R.) performance, suggests research being presented at the American Society of Anesthesiologists PRACTICE MANAGEMENT 2014.
The study and other research presented at the meeting reflect trends and substantial efforts being made in anesthesiology departments across the country to improve practice performance and patient care. Research presented at the meeting includes:
• Improving efficiency in the O.R.: O.R. performance improved significantly after implementation of a system that ensures surgical team members understand and use proven effective practices, according to a University of Pittsburgh Medical Center study. Two years after implementing the system in six hospitals, researchers measured a 47 percent improvement in on-time starts, a 64 percent improvement in surgical incision time and a 12 percent improvement in time between cases (turnover time). Lead author Trent Emerick, M.D., anesthesiology resident, along with senior author Mark Hudson, M.D., M.B.A., associate professor and vice chair for clinical operations, noted that poorly managed O.R.s can lead to excessive cost in the delivery of care as well as low patient satisfaction due to unnecessary wait times. Standardizing O.R. procedures increases awareness among O.R. team members of areas needing attention, leading to significant improvements, Emerick said.
• Reducing overstock saves money: By applying supply chain theory to one item alone, researchers at the University of Texas MD Anderson Cancer Center-Houston calculate the center will save $21,500 the first year of implementation and $15,500 in subsequent years. To conduct the study, researchers chose the Arrow 12 Fr. Triple lumen central venous catheter, used in surgical cases where rapid infusion of blood or blood products is anticipated. Although these procedures typically are scheduled in one of five specific O.R.s, the catheter was unnecessarily stocked in all 30 O.R.s and the ambulatory care center. Because the catheters expire, overstocking leads to waste, notes lead author Charles E. Cowles, Jr., M.D., M.B.A., assistant professor of anesthesiology and perioperative medicine. Calculating how many catheters would be required -- including factoring in ordering time -- researchers determined only 10 catheters should be stocked, whereas the hospital had 49 in stock. Savings would be significant if the supply chain theory is applied to the thousands of items overstocked in hospitals nationwide, researchers note.
• Putting out the fire: Fire usually doesn't top the list of potential O.R. concerns, yet approximately 600 surgical fires occur in the United States every year. More than two-thirds of these fires are caused by electrosurgical equipment and the use of supplemental oxygen is a factor in most cases. To reduce or prevent O.R. fires, physician anesthesiologists and other surgical team members at the University of Florida, Jacksonville, focused on improving policies, education and training, as well as communications to create a culture of safety. Lead author Linda W. Young M.D., M.S., UF Health, Jacksonville, said the group developed a tool to identify patients at high risk of experiencing a surgical fire and employed other risk-reduction strategies, including electronic prompts with the electronic medical record, periodic fire drills and provision of education to surgical staff members. Researchers are still tabulating the data, but have noted a reduction in incidents due to the increase in awareness and adherence to the protocol.
• Comparing apples to apples: Being able to benchmark clinical productivity allows anesthesiology groups and hospitals/facilities to identify areas for possible improvement. But it is important to compare the benchmarking data of similar facilities in order to provide meaningful comparisons. Researchers from several institutions surveyed the members of the Association of Academic Anesthesiology Chairs about anesthesiology clinical work by facility. This resulted in benchmarking data based on 143 different facilities accounting for more than 2.5 million cases. Comparing like facilities, the results showed that shorter surgical duration at children's, community and smaller facilities led to more units billed per hour of care, resulting in fewer billed hours for similar productivity per O.R., said lead author Amr Abouleish, M.D., M.B.A., professor of anesthesiology at University of Texas Medical Branch, Galveston.
• Standardizing preoperative evaluations: To improve care, lower costs and reduce morbidity and mortality (death and other problems that can occur during surgery), Georgia Regents University in Augusta developed protocols towards the creation of a "surgical home," including computer-assisted health screening questionnaires for various scenarios. With the increasing focus on the surgical home concept, which facilitates coordinated and integrated care, the goal is to standardize preoperative evaluation to ensure careful triage and appropriate treatment as well as decrease unnecessary actions. For example, the protocol guides nursing and anesthesia staff on tests and measures needed before surgery, and clarifies which medications patients should avoid on the day of surgery. About 65 percent of hospital expenses are due to morbidity and mortality, and administrators anticipate the cost of the new system will be offset by savings from minimizing redundancy, avoiding surgery delays and cancellations and improved reimbursement coding, said lead author Mary E. Arthur, M.D. associate professor in the Department of Anesthesiology and Perioperative Medicine. The ASA applauds the effort, having recently committed more than $500,000 in support and scholarship to jumpstart the development of a learning collaborative of health care organizations working to improve surgical care through the Perioperative Surgical Home (PSH) model.
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