Streamlining variability in hospital charges for standard thyroidectomy: Developing a strategy to decrease waste.

Background: We assessed the efficiency, consistency, and appropriateness of perioperative processes for standard (total) thyroidectomy and devised a valuable strategy to decrease variability and waste.

Methods: Our multidisciplinary team evaluated <23-hour stay standard thyroidectomy performed by 3 surgical endocrinologists. We used the nominal group technique, process flowcharts, and root cause analysis to evaluate 6 perioperative processes.

A case series of thoracic paravertebral blocks using a combination of ropivacaine, clonidine, epinephrine, and dexamethasone.

Five patients who underwent surgery for breast cancer were followed for 6 days after placement of a multiple-injection, one-time paravertebral block. Data were collected on patient satisfaction, analgesic consumption, side effects, and complications. Ropivacaine as a sole agent in paravertebral blocks has a clinical duration of up to 6 hours.

Adaptation of the OODA Loop to reduce postoperative nausea and vomiting in a high-risk outpatient oncology population.

Postoperative nausea and vomiting (PONV) remains a ubiquitous concern for surgical outpatients with published rates ranging from 14% to 80%. An evidence-based approach was used to reduce PONV in a high-risk adult outpatient oncology population. The Observe, Orient, Decide, and Act (OODA) Loop, a rapid cycle management strategy, was adapted for use in an outpatient surgery center with six ORs.