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PubMed1987

Organization of a major ambulatory surgery program.

Ambulatory surgery is a successful venture for the health care system and the consumer. It provides many challenges and opportunities to keep our health care costs down while providing the patient with education and a concentration of care. This article describes the organization of a free-standing hospital-owned program and the basic policies and procedures that are required to ensure its quality.

Ambulatory Surgical Procedures↗
PubMed1995

Prevention of blood exposure. Body and facial protection.

Regardless of the specific clinical setting in the operating room, it is clear that better protection of all personnel is an appropriate objective in the current environment. Better protection through improved PPE and modification of operational practices is essential. A prompt response to blood contact when it does occur is likewise appropriate. With conscientious applications of methods to reduce blood exposure, it is hoped that the operating room can become a safer place with respect to occupational infections from bloodborne pathogens.

Blood-Borne Pathogens↗
PubMedDate not supplied

Measuring intra-operative interference from distraction and interruption observed in the operating theatre.

An observational tool was developed to record distraction and interruption in the operating theatre during surgery. Observed events were assigned to pre-defined categories and rated in relation to the level of team involvement - the sum of which was treated as a measure of intra-operative interference. Many events (0.29 +/- 0.02 per min) were observed and rated in 50 general operations sampled from a single operating theatre. The rating of individual events (r(s) = 0.65) and of cases (r(s) = 0.89) correlated between independent observers. Interference levels (1.04 +/- 0.07/min) also correlated with door opening frequency (0.68 +/- 0.03/min) (r = 0.47, p < 0.001). Some sources of interference were intrinsic to the work of the surgical team, including equipment, procedure and environment, while others were extraneous, including bleepers, phone calls and external staff. The findings highlight the need to further develop measures of interference, to assess its variation, intensity and its effect on surgical team performance.

Anesthesiology↗
PubMed2002

Operating room managers' use of integer programming for assigning block time to surgical groups: a case study.

UNLABELLED: A common problem at hospitals with fixed amounts of available operating room (OR) time (i.e., "block time") is determining an equitable method of distributing time to surgical groups. Typically, facilities determine a surgical group's share of available block time using formulas based on OR utilization, contribution margin, or some other performance metric. Once each group's share of time has been calculated, a method must be found for fitting each group's allocated OR time into the surgical master schedule. This involves assigning specific ORs on specific days of the week to specific surgical groups, usually with the objective of ensuring that the time assigned to each group is close to its target share. Unfortunately, the target allocated to a group is rarely expressible as a multiple of whole blocks. In this paper, we describe a hospital's experience using the mathematical technique of integer programming to solve the problem of developing a consistent schedule that minimizes the shortfall between each group's target and actual assignment of OR time. Schedule accuracy, the sum over all surgical groups of shortfalls divided by the total time available on the schedule, was 99.7% (SD 0.1%, n = 11). Simulations show the algorithm's accuracy can exceed 97% with > or =4 ORs. The method is a systematic and successful way to assign OR blocks to surgeons. IMPLICATIONS: At hospitals with a fixed budget of operating room (OR) time, integer programming can be used by OR managers to decide which surgical group is to be allocated which OR on which day(s) of the week. In this case study, we describe the successful application of integer programming to this task, and discuss the applicability of the results to other hospitals.

Elective Surgical Procedures↗
PubMed2002

Use of linear programming to estimate impact of changes in a hospital's operating room time allocation on perioperative variable costs.

BACKGROUND: Administrators at hospitals with a fixed annual budget may want to focus surgical services on priority areas to ensure its community receives the best health services possible. However, many hospitals lack the detailed managerial accounting data needed to ensure that such a change does not increase operating costs. The authors used a detailed hospital cost database to investigate by how much a change in allocations of operating room (OR) time among surgeons can increase perioperative variable costs. METHODS: The authors obtained financial data for all patients who underwent outpatient or same-day admit surgery during a year. Linear programming was used to determine by how much changing the mix of surgeons can increase total variable costs while maintaining the same total hours of OR time for elective cases. RESULTS: Changing OR allocations among surgeons without changing total OR hours allocated will likely increase perioperative variable costs by less than 34%. If, in addition, intensive care unit hours for elective surgical cases are not increased, hospital ward occupancy is capped, and implant use is tracked and capped, perioperative costs will likely increase by less than 10%. These four variables predict 97% of the variance in total variable costs. CONCLUSIONS: The authors showed that changing OR allocations among surgeons without changing total OR hours allocated can increase hospital perioperative variable costs by up to approximately one third. Thus, at hospitals with fixed or nearly fixed annual budgets, allocating OR time based on an OR-based statistic such as utilization can adversely affect the hospital financially. The OR manager can reduce the potential increase in costs by considering not just OR time, but also the resulting use of hospital beds and implants.

Accounting↗
PubMed2000

Safety in the OR.

Explore the source record for details and available documents.

Accidents, Occupational↗
PubMed1990

Health effects associated with exposure to anaesthetic gases in Ontario hospital personnel.

In a retrospective study (by questionnaire) of 8032 personnel exposed to anaesthetic gases in operating and recovery rooms in Ontario hospitals, and 2525 non-exposed hospital staff, the response was 78.8% for the exposed and 87.2% for the unexposed personnel during the period 1981-5. Logistic regression analysis, with age and smoking standardised, showed that women in the exposed group had significantly increased frequencies of spontaneous abortion and their children had significantly more congenital abnormalities (p less than 0.05). No chronic disease was significantly associated with the exposed group. These findings, together with similar ones from other studies, suggest that it is prudent to minimise exposure to waste anaesthetic gases.

Abortion, Habitual↗
PubMed2000

The support worker in theatres.

This article will consider various aspects of the use of the support worker in theatre and will propose that the support worker can undertake the scrubbed role. The position of NATN is that it 'does not recommend that the role of the support worker encompasses the scrub role' (NATN 1996): it will be argued here that this stance is based on arguments which are fundamentally flawed.

Clinical Competence↗