Shaping the operating room and perioperative systems of the future: innovating for improved competitiveness.

Purpose Of Review: To review the current state of anesthesiology for operative and invasive procedures, with an eye toward possible future states.

Recent Findings: Anesthesiology is at once a mature specialty and in a crisis--requiring breakthrough to move forward. The cost of care now approaches reimbursement, and outcomes as commonly measured approach perfection.

Visualizing patient trajectories on wall-mounted boards - information security challenges.

Since operating room departments are among the costliest resources at a hospital, much attention is devoted to maximize their utilization. Operating room activities are however notoriously hard to plan in advance. This has to do with the unpredictable, problem-solving nature of the work and that the work is carried out by a multidisciplinary team of health personnel, members of which also have commitments outside the operating room department.

Implementation of a direct-from-recovery-room discharge pathway: a process improvement effort.

Background: The authors describe a process improvement effort to achieve direct-from-recovery-room discharge for elective laparoscopic cholecystectomy patients--without prior patient selection.

Methods: The authors developed and implemented a new pathway, and then measured the learning curve (ie, success rate over time for direct discharge) and compared patients achieving direct discharge with patients admitted after surgery.

Results: The learning curve between the first patient and steady-state performance was 56 patients.

Causes of cancellations on the day of surgery at two major university hospitals.

Cancellations of elective cases on the day of surgery waste valuable operating-room time. The authors studied cancellations at an American hospital and a Norwegian university hospital to test (a) whether the quality of hospital administrative data on cancellations is sufficient for meaningful comparative analysis and (b) whether causes of cancellations at these 2 major academic hospitals are comparable. Large retrospective cause-of-cancellation data sets were obtained from each hospital.

Automatic time-motion study of a multistep preoperative process.

Background: Hospitals use time-motion studies to monitor process effectiveness and patient waiting. Manual tracking is labor-intensive and potentially influences system performance. New technology known as indoor positioning systems (IPS) may allow automatic monitoring of patient waiting and progress.

Clinical processes in an innovative vascular surgeon community. Implications for workflow modeling.

Objective: To identify factors influencing variations in clinical work in the care of patients with abdominal aortic aneurism.

Method: Ethnographic observations of 26 meetings between surgeons and patients in two community hospitals and one university hospital. Observations data were abstracted into scenarios that describe the typical clinical workflow.

Real-time checking of electronic anesthesia records for documentation errors and automatically text messaging clinicians improves quality of documentation.

Introduction: The quality of electronic anesthesia documentation is important for downstream communication and to demonstrate appropriate diligence to care. Documentation quality will also impact the success of reimbursement contracts that require timely and complete documentation of specific interventions. We implemented a system to improve completeness of clinical documentation and evaluated the results over time.

Small changes in operative time can yield discrete increases in operating room throughput.

Background And Purpose: Operating room throughput is influenced by the efficiency of the perioperative process (for nonoperative time) and by the surgeon (for operative time). Operative time is thought not to be easily amenable to deliberate reductions. We tested the hypothesis that gradual improvements in operative time had allowed one surgeon to perform additional cases during scheduled hours.

The effect of direct-from-recovery room discharge of laparoscopic cholecystectomy patients on recovery room workload.

Ambulatory laparoscopic cholecystectomy pathways move patients through the hospital without encountering delays caused by congested inpatient bed units. However, redirecting patients to a direct discharge pathway might not be beneficial if recovery capacity is further taxed by additional workload. In this study, we attempt to assess the operational impact on recovery room workload of directly discharging laparoscopic cholecystectomy patients to home.

Does parallel workflow impact anesthesia quality?

Redesigns of workflow to allow parallel processing of OR tasks in the Operating Room of the Future at Massachusetts General Hospital have reduced non-operative time, increasing OR throughput. Automatically gathered anesthesia times were studied to address concerns that the new process constricted anesthesia work time. Upon close examination, it was found that 'Induction Time' was the only time interval not impacted by extraneous influences that invalidated other metrics based on the automatic data.