Evaluation and implementation of a Just-In-Time bed-assignment strategy to reduce wait times for surgical inpatients.

Early bed assignments of elective surgical patients can be a useful planning tool for hospital staff; they provide certainty in patient placement and allow nursing staff to prepare for patients' arrivals to the unit. However, given the variability in the surgical schedule, they can also result in timing mismatches-beds remain empty while their assigned patients are still in surgery, while other ready-to-move patients are waiting for their beds to become available. In this study, we used data from four surgical units in a large academic medical center to build a discrete-event simulation with which we show how a Just-In-Time (JIT) bed assignment, in which ready-to-move patients are assigned to ready-beds, would decrease bed idle time and increase access to general care beds for all surgical patients.

Low-Volume Bowel Preparation Is Associated With Reduced Time to Colonoscopy in Hospitalized Patients: A Propensity-Matched Analysis.

Introduction: Delays in inpatient colonoscopy are commonly caused by inadequate bowel preparation and result in increased hospital length of stay (LOS) and healthcare costs. Low-volume bowel preparation (LV-BP; sodium sulfate, potassium sulfate, and magnesium sulfate ) has been shown to improve outpatient bowel preparation quality compared with standard high-volume bowel preparations (HV-BP; polyethylene glycol ). However, its efficacy in hospitalized patients has not been well-studied.

Design and Performance of a COVID-19 Hospital Recovery Model.

Unlabelled: To determine the accuracy of a predictive model for inpatient occupancy that was implemented at a large New England hospital to aid hospital recovery planning from the COVID-19 surge.

Background: During recovery from COVID surges, hospitals must plan for multiple patient populations vying for inpatient capacity, so that they maintain access for emergency department (ED) patients while enabling time-sensitive scheduled procedures to go forward. To guide pandemic recovery planning, we implemented a model to predict hospital occupancy for COVID and non-COVID patients.

The Power of Modeling in Emergency Preparedness for COVID-19: A Moonshot Moment for Hospitals.

Before coronavirus disease 2019 (COVID-19), few hospitals had fully tested emergency surge plans. Uncertainty in the timing and degree of surge complicates planning efforts, putting hospitals at risk of being overwhelmed. Many lack access to hospital-specific, data-driven projections of future patient demand to guide operational planning.

Achieving Surgical Supply Savings through Preference Card Standardization.

Among high volume procedures considerable variation exists in the average cost per case (ACPC) of surgical supplies used between surgeons. A contributing factor to these cost differences are divergences in surgeons' preference cards, which act as a guide to hospital staff for the supplies a surgeon requires to successfully perform a procedure. This article documents efforts and results of an initiative to standardize preference cards for Laparoscopic Cholecystectomies.

Using Real-Time Locating Systems to Optimize Endoscope Use at a Large Academic Medical Center.

Massachusetts General Hospital (MGH) manages a large inventory of surgical equipment which must be delivered to operating rooms on-time, efficiently, and according to a set of quality standards and regulatory guidelines. In recent years, flexible scope management has become a topic of interest for many hospitals, as they face pressure to reduce costs, prevent infections that can result from mismanagement, and are under increased regulatory oversight. This work conducted at MGH proposes a novel method for surgical equipment management in a hospital.

Development and Validation of a Machine Learning Model to Aid Discharge Processes for Inpatient Surgical Care.

Importance: Inpatient overcrowding is associated with delays in care, including the deferral of surgical care until beds are available to accommodate postoperative patients. Timely patient discharge is critical to address inpatient overcrowding and requires coordination among surgeons, nurses, case managers, and others. This is difficult to achieve without early identification and systemwide transparency of discharge candidates and their respective barriers to discharge.

Implementation of a prehospital air medical thawed plasma program: Is it even feasible?

Background: The Prehospital Air Medical Plasma (PAMPer) trial demonstrated a 30-day survival benefit among hypotensive trauma patients treated with prehospital plasma during air medical transport. We characterized resources, costs and feasibility of air medical prehospital plasma program implementation.

Methods: We performed a secondary analysis using data derived from the recent PAMPer trial.

Non-clinical delays in transfer out of the surgical ICU are associated with increased hospital length of stay and delayed progress of care.

Purpose: The impact of non-clinical transfer delay (TD) from the ICU to a general care unit on the progress of the patient's care is unknown. We measured the association between TD and: (1) the patient's subsequent hospital length of stay (LOS); (2) the timing of care decisions that would advance patient care.

Methods: This was a single center retrospective study in the United States of patients admitted to the surgical and neurosurgical ICUs during 2013 and 2015.

Systematic OR Block Allocation at a Large Academic Medical Center: Comprehensive Review on a Data-driven Surgical Scheduling Strategy.

Objective: To alleviate the surgical patient flow congestion in the perioperative environment without additional resources.

Background: Massachusetts General Hospital experienced increasing overcrowding of the perioperative environment in 2008. The Post-Anesthesia Care Unit would often be at capacity, forcing patients to wait in the operating room.

Pooled Open Blocks Shorten Wait Times for Nonelective Surgical Cases.

Objective: Assess the impact of the implementation of a data-driven scheduling strategy that aimed to improve the access to care of nonelective surgical patients at Massachusetts General Hospital (MGH).

Background: Between July 2009 and June 2010, MGH experienced increasing throughput challenges in its perioperative environment: approximately 30% of the nonelective patients were waiting more than the prescribed amount of time to get to surgery, hampering access to care and aggravating the lack of inpatient beds.

Methods: This work describes the design and implementation of an "open block" strategy: operating room (OR) blocks were reserved for nonelective patients during regular working hours (prime time) and their management centralized.

Elective change of surgeon during the OR day has an operationally negligible impact on turnover time.

Study Objective: To compare turnover times for a series of elective cases with surgeons following themselves with turnover times for a series of previously scheduled elective procedures for which the succeeding surgeon differed from the preceding surgeon.

Design: Retrospective cohort study.

Setting: University-affiliated teaching hospital.

Locking and nonlocking plate fixation pubic symphysis diastasis management.

We evaluated the stability of locking and nonlocking plate fixation of the pubic symphysis in a cadaveric model of an unstable pelvic injury. Five fresh cadaver pelves--intact and with an unfixed simulated Tile B injury--were tested under compressive load simulating a 2-legged stance. On each pelvis, 3 pubic symphysis fixation constructs were tested: a 4-hole unicortical locking plate, a 4-hole bicortical locking plate, and a 4-hole bicortical compression plate.

A model for understanding the impacts of demand and capacity on waiting time to enter a congested recovery room.

Background: When a recovery room is fully occupied, patients frequently wait in the operating room after emerging from anesthesia. The frequency and duration of such delays depend on operating room case volume, average recovery time, and recovery room capacity.

Methods: The authors developed a simple yet nontrivial queueing model to predict the dynamics among the operating and recovery rooms as a function of the number of recovery beds, surgery case volume, recovery time, and other parameters.

Financial and operational impact of a direct-from-PACU discharge pathway for laparoscopic cholecystectomy patients.

Background: We assessed the operational and financial impact of discharging laparoscopic cholecystectomy (LC) patients directly from the postanesthetic care unit (PACU) in comparison with post-transfer discharge from a hospital bed in a busy academic hospital.

Methods: We retrospectively compared 6 months of performance (bed utilization; recovery room and hospital length of stay; complications; readmissions; hospital costs, revenue, and margin) after implementation of PACU discharges (case patients) to the corresponding 6 months in the prior year (control patients).

Results: After implementation, 66% of LC case patients were discharged on the day of surgery, compared with 29% in the control group (P < .

Reorganizing patient care and workflow in the operating room: a cost-effectiveness study.

Background: Many surgeons believe that long turnover times between cases are a major impediment to their productivity. We hypothesized that redesigning the operating room (OR) and perioperative-staffing system to take advantage of parallel processing would improve throughput and lower the cost of care.

Methods: A state of the art high tech OR suite equipped with augmented data collection systems served as a living laboratory to evaluate both new devices and perioperative systems of care.

INCOMING!--A web tracking application for PACU and post-surgical patients.

Background: Capacity constraints necessitate improving hospital efficiency. An integrated real time system facilitating patient flow between the post-anesthesia care unit (PACU) and surgical ward would ease PACU workload by reducing the effort of discharging patients.

Methods: We developed INCOMING!, a web-based platform that monitors patient progress from the operating room to the PACU.

Automatic detection and notification of "wrong patient-wrong location'' errors in the operating room.

When procedures and processes to assure patient location based on human performance do not work as expected, patients are brought incrementally closer to a possible "wrong patient-wrong procedure'' error. We developed a system for automated patient location monitoring and management. Real-time data from an active infrared/radio frequency identification tracking system provides patient location data that are robust and can be compared with an "expected process'' model to automatically flag wrong-location events as soon as they occur.

Perchlorate and nitrate remediation efficiency and microbial diversity in a containerized wetland bioreactor.

We have developed a method to remove perchlorate (14-27 microg/L) and nitrate (48 mg/L) from contaminated groundwater using a wetland bioreactor. The bioreactor has operated continuously in a remote field location for more than 2 yr with a stable ecosystem of indigenous organisms. This study assesses the bioreactorfor long-term perchlorate and nitrate remediation by evaluating influent and effluent groundwater for oxidation-reduction conditions and nitrate and perchlorate concentrations.