PubMed · 13786652
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R F WOOLMER. 1961. Information please.. https://pubmed.ncbi.nlm.nih.gov/13786652/
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HYPOTHESIS: Operating room turnover time (TOT) and daily caseload can be improved by analyzing the routine tasks of the operating team and minimizing inefficiencies. DESIGN: In this prospective study, the assigned tasks and work flow patterns of the anesthesiologist, circulating nurse, and surgical technologist during operations and operating room turnover were studied and changes were implemented where inefficiencies were observed. A brief pilot followed by a broader-scale study was conducted. SETTING: Tertiary care center. PARTICIPANTS: Circulating nurses and surgical technicians were routinely assigned to work with one anesthesiologist and one surgeon during the pilot study; 4 surgeons and 32 anesthesiologists participated in the follow-up study. INTERVENTIONS: The work flow diagram of each individual was redrawn, and changes were implemented. Critical moments were identified, in which brief assistance from other personnel was needed to improve efficiency. MAIN OUTCOME MEASURES: Operative TOT and number of daily operations were the main outcomes. A 2-tailed t test was used to compare the TOTs; chi(2) analysis was used to compare the number of cases completed. Significance was defined as P<.05. RESULTS: A total of 401 operations and 253 turnovers were evaluated. Redesign decreased operating room TOT from 43.7 to 27.7 minutes (P<.001). The mean number of cases completed per day increased from 1.78 to 2.34 (P<.001). CONCLUSION: Interdisciplinary work flow assessment and redesign resulted in decreased operating room TOTs and additional cases being completed each day for 4 different surgeons.
PURPOSE: To assess the feasibility, validity, and reliability of a multi source feedback program for anesthesiologists. METHODS: Surveys with 11, 19, 29 and 29 items were developed for patients, coworkers, medical colleagues and self, respectively, using five-point scales with an 'unable to assess' category. The items addressed communication skills, professionalism, collegiality, continuing professional development and collaboration. Each anesthesiologist was assessed by eight medical colleagues, eight coworkers, and 30 patients. Feasibility was assessed by response rates for each instrument. Validity was assessed by rating profiles, the percentage of participants unable to assess the physician for each item, and exploratory factor analyses to determine which items grouped together into scales. Cronbach's alpha and generalizability coefficient analyses assessed reliability. RESULTS: One hundred and eighty-six physicians participated. The mean number and percentage return rate of respondents per physician was 17.7 (56.2%) for patients, 7.8 (95.1%) for coworkers, and 7.8 (94.6%) for medical colleagues. The mean ratings ranged from four to five for each item on each scale. There were relatively few items with high percentages of 'unable to assess'. The factor analyses revealed a two-factor solution for the patient, a two-factor solution for the coworker and a three-factor solution for the medical colleague survey, accounting for at least 70% of the variance. All instruments had a high internal consistency reliability (Cronbach's alpha > 0.95). The generalizability coefficients were 0.65 for patients, 0.56 for coworkers and 0.69 for peers. CONCLUSION: It is feasible to develop multi source feedback instruments for anesthesiologists that are valid and reliable.