Biomedical subjects

Bethany Daily

Publications and source records attributed to Bethany Daily.

5 recordsLinked to original sources

PubMed2006

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. INCOMING! integrates available data, automatically determining when a patient enters the PACU. An automated paging system alerts clinical unit managers to 'pull' their patients from the PACU after a set recovery period. General surgery patients were included in the INCOMING! system in late 2004 with paging added in mid-March 2005. Mean PACU length of stay was calculated for the intervention group (general surgery patients with INCOMING!) and compared to a control group (general surgery patients without INCOMING!) and an orthopedic surgery group before and after paging. RESULTS: The system successfully gathers data and generates automated pages when events occur. After paging, there was a significant difference between the orthopedic surgery control group and the general surgery intervention group (235 min versus 185 min, P = 0.001). The mean PACU LOS decreased in the INCOMING! intervention group by 26 min while the mean LOS increased by 28 min in the general surgery control group (P = 0.27). CONCLUSION: Pilot implementation demonstrates that INCOMING! performs the desired integration and automatic notification. Given the minimal cost and potential large gains from a wider deployment, we plan to implement the system for all PACU patients and all post-PACU care units.

Computer Systems↗

PubMed2006

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. The OR suite and all the experimental studies carried out in this setting were designated as the OR of the Future Project (ORF). Before constructing the ORF, modeling studies were conducted to inform the architectural and staffing design and estimate their benefit. In phase I a small prospective trial tested the main hypothesized benefits of the ORF: reduced patient intra-operative flow-time, wait-time and operative procedure time. In phase II a larger retrospective study was conducted to explore factors influencing these effects. A modified process costing method was used to estimate costs based on nationally derived data. Cost-effectiveness was evaluated using standard methods. RESULTS: There were 385 cases matched by surgeon and procedure type in the retrospective dataset (182 ORF, 193 standard operating room [SOR]). The median Wait Time (12.5 m ORF vs 23.8 m SOR), Operative Procedure Time (56.1 m ORF vs 70.5 m SOR), Emergence Time (10.9 m ORF vs 14.5 m SOR) and Total Patient OR Flowtime (79.5 m ORF vs 108.9 m SOR) were all shorter in the ORF (P < .05 for all comparisons). The median cost/patient was $3,165 in the ORF (interquartile range, $1,978 to $4,426) versus $2,645 in SORs (interquartile range, $1,823 to $3,908) (P = ns). The potential change in patient throughput for the ORF was 2 additional patients/day. This improved throughput was primarily attributable to a marked reduction in the non-operative time (ie, those activities commonly accounting for "turnover time") rather than facilitation of faster operations. The incremental cost-effectiveness ratio of ORF was $260 (interquartile range, $180 to $283). CONCLUSION: The redesigned perioperative system improves patient flow, allowing more patients to be treated per day. Cost-effectiveness analysis suggests that the additional costs incurred by higher staffing ratios in an ORF environment are likely to be offset by increases in productivity. The benefits of this system are realized when performing multiple, short-to-medium duration procedures (eg, <120 m).

Cost-Benefit Analysis↗

PubMed2006

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 < .05). Eighty percent of the day-of-surgery discharges were directly from the PACU. Shifting to PACU discharge saved 1 in-hospital bed transfer and 1 bed-day for each PACU discharge. Recovery room length of stay for PACU discharge patients was 26% longer than for hospital discharge patients (P = NS). Average hospital length of stay for all patients discharged on the day of surgery was 3.2 hours shorter (P < .05) for case patients (80% PACU discharge) than for control patients. There were no readmissions in the PACU discharge group and no difference in complications. While costs, revenue, and net margin for PACU discharge patients were reduced by 40% to 50% (P < .02) relative to floor discharge patients, the hospital's net margin for the combined case patient group was preserved relative to the control group. CONCLUSIONS: PACU discharge of LC patients significantly reduces bed utilization, decreases in-hospital transfers, and allows congested hospitals to better accommodate patient care needs and generate additional revenue.

Adult↗

PubMed2005

Deliberate perioperative systems design improves operating room throughput.

BACKGROUND: New operating room (OR) design focuses more on the surgical environment than on the process of care. The authors sought to improve OR throughput and reduce time per case by goal-directed design of a demonstration OR and the perioperative processes occurring within and around it. METHODS: The authors constructed a three-room suite including an OR, an induction room, and an early recovery area. Traditionally sequential activities were run in parallel, and nonsurgical activities were moved from the OR to the supporting spaces. The new workflow was supported by additional anesthesia and nursing personnel. The authors used a retrospective, case- and surgeon-matched design to compare the throughput, cost, and revenue performance of the new OR to traditional ORs. RESULTS: For surgeons performing the same case mix in both environments, the new OR processed more cases per day than traditional ORs and used less time per case. Throughput improvement came from superior nonoperative performance. Nonoperative Time was reduced from 67 min (95% confidence interval, 64-70 min) to 38 min (95% confidence interval, 35-40 min) in the new OR. All components of Nonoperative Time were meaningfully reduced. Operative Time decreased by approximately 5%. Hospital and anesthesia costs per case increased, but the increased throughput offset costs and the global net margin was unchanged. CONCLUSIONS: Deliberate OR and perioperative process redesign improved throughput. Performance improvement derived from relocating and reorganizing nonoperative activities. Better OR throughput entailed additional costs but allowed additional patients to be accommodated in the OR while generating revenue that balanced these additional costs.

Anesthesia↗

PubMed2005

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. The system also generates messages that are automatically sent to process managers via the hospital paging system, thus creating an active alerting function to annunciate errors. We deployed the system to detect and annunciate "patient-in-wrong-OR'' events. The system detected all "wrong-operating room (OR)'' events, and all "wrong-OR'' locations were correctly assigned within 0.50+/-0.28 minutes (mean+/-SD). This corresponded to the measured latency of the tracking system. All wrong-OR events were correctly annunciated via the paging function. This experiment demonstrates that current technology can automatically collect sufficient data to remotely monitor patient flow through a hospital, provide decision support based on predefined rules, and automatically notify stakeholders of errors.

Automation↗