Computers and nursing: the five W's.
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Mean anaesthetic, surgical and turnover times were used to predict finishing times for elective general surgical operating lists. A predicted early finish was correct in 70 per cent, a predicted on-time finish in 19 per cent, and a predicted late finish in 56 per cent. Overall, predictions of an early or late finish had a low sensitivity (62 per cent and 65 per cent) and high false positive rate (30 per cent and 44 per cent). Over-runs, caused by too many cases, and early finishes, owing to insufficient cases were reliably predicted. It is suggested that mean procedure times can be used to identify under or over utilisation caused by under or over-booking but indiscriminate use will not improve list utilisation.
The changing health care climate has triggered important changes in the management of high-cost components of acute care facilities. By integrating and better managing various elements of the surgical process, health care institutions are able to rationally trim costs while maintaining high-quality services. The leadership that physicians can provide is crucial to the success of this undertaking.
Computers and information management are long-standing tools for the Perioperative Manager. As paperless nursing documentation makes its way into the operating room, the staff nurse must become adept at the use of the computer. How to get the staff nurse comfortable with this new role, and concerns the staff nurse may voice are the subject of this article.
Technology is changing the way work in a department is processed, often leading to greater efficiency and cost savings over time. How nurses engage in the process of business reengineering may help to determine the agency's competitive edge. This article discusses the process and the use of computer technology in the perioperative area.
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The goal of this project was to determine whether a standardized surgical time, generated by the Operating Room Information System (ORIS), could be used as an accurate predictor of actual surgical time. Utilizing retrospective, quantitative data from the ORIS database, frequency distributions by surgical speciality, were completed. Chi-square analysis was applied to determine the significance of the frequency distributions. The study outcome indicates that ORIS computer generated procedure times were not an accurate predictor of actual surgical time. Further follow-up will be required to determine if alternate scheduling methodologies would lead to higher accuracy rates.
STUDY OBJECTIVE: To examine whether the establishment of dedicated pediatric operating rooms (ORs) staffed exclusively by pediatric anesthesiologists has had a significant impact on anesthetic efficiency during surgery. STUDY DESIGN: Before and after design. SETTING: General and pediatric operating rooms at Yale-New Haven Hospital. MEASUREMENTS AND MAIN RESULTS: Using Operating Room Information System data (1991 to 1997), we examined whether the anesthesia-controlled time, the time it takes for induction and emergence of anesthesia of a selected surgical procedure (tonsillectomy and adenoidectomy), was affected by the change of practice from general to pediatric ORs. The average length of anesthesia induction decreased by 30% (p = 0.0007). Similarly, the average length of emergence from anesthesia decreased by 42% (p = 0.01) and anesthesia-controlled time decreased by 31% (p = 0.0008). Of particular importance is the decrease by 75% in the anesthesia-controlled time range (maximum-minimum). CONCLUSIONS: The establishment of dedicated pediatric ORs resulted in significantly shorter anesthesia induction and emergence times. Furthermore, the decreased variability of anesthesia-controlled time may allow for better scheduling of surgical cases and for better surgeon and patient satisfaction.
Utilization of the surgical suite is of significant concern to administrators because of the high costs associated with this facility. Scheduling systems, which control the flow of patients into the surgical arena, are frequently cited as a primary means of improving resource utilization. The objective of the research reported herein was to test the hypothesis that the implementation of a centralized advance surgical scheduling system is associated with a significant improvement in operating room (OR) team utilization rate. Data were collected at a test hospital and at a control hospital for three months prior to implementation of a scheduling system at the test hospital, and for an additional three months starting nine months after implementation. The mean OR team utilization rate at the test hospital rose 12% from 0.68 prior to implementation to 0.77 postimplementation. The mean OR team utilization rate at the control hospital fell 8%, from 0.78 preimplementation to 0.73 postimplementation. The research hypothesis was supported using multiple regression, which controlled for various intervening variables that could affect utilization rate independently of the scheduling system. A literature review showed that experimental designs such as the one used in this study have not previously been used to evaluate scheduling systems in hospital settings, despite the increasing need to justify the purchase and implementation of such systems.
PURPOSE OF REVIEW: Advances during the past year in operational decision making using information management systems data have been predominantly in better understanding of how to allocate operating room time based on operating room efficiency, not just operating room utilization. RECENT FINDINGS: Each quarter, operating room allocations based on maximizing operating room efficiency can be calculated with 6-10 months of data. Analysis can be performed using operating room or anesthesia information management system data. Uncertainty in knowing the operating rooms in which cases were performed (i.e. in knowing turnover times) has little effect on operating room allocations or efficiency. It is important, however, that when a service has filled its allocated operating room time and has a new case to schedule, the case be scheduled into the operating room time of another service. The service whose operating room time is released can be the service with the largest difference between allocated and scheduled operating room time at the time when the new case is scheduled. If optimal operating room allocations and case scheduling based on maximizing operating room efficiency are not implemented, the resulting increase in anesthesia group labor costs can be used in negotiations as a statistically sound estimate for the increased labor cost to the group. SUMMARY: During the last couple of years there has been continual advancement in our understanding of how to analyze operating room information system data based on operating room efficiency. Work has expanded from operating room allocations to case scheduling, releasing allocated operating room time, and addressing implementation challenges including poor data quality or lack of interest in change.
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Surgical scheduling and data collection is a field that has a long history as well as a bright future. Historically, surgical cases have always involved some amount of data collection. Surgical cases are scheduled and then reviewed. The classic method, that large black surgical log, actually still exists in many hospitals. In fact, there is nothing new about the recording or reporting of surgical cases. If we only needed to record the information and produce a variety of reports on the data, then modern electronic technology would function as a glorified fast index card box--or, in computer database terms, a simple flat file database. But, this is not the future of technology in surgical case management. This article makes the general case for integrating surgical data systems. Instead of reviewing specific software, it essentially addresses the issues of strategic planning related to this important aspect of medical information systems.
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As healthcare organizations look for ways to gain new efficiencies and reduce costs, they are examining surgical services with a critical eye. In many cases, the operating room (OR) was not included in enterprisewide reengineering efforts, thereby limiting the positive impact of those efforts. Healthcare organizations are recognizing that every point along the patient care continuum is interrelated. To truly maximize reengineering efforts, they need to integrate the entire process and information flow within the OR and across the enterprise.
BACKGROUND AND OBJECTIVE: In this preliminary study we wanted to explore the attitudes of anaesthesiologists to a point-of-care information system in the operating room. The study was conducted as a preliminary step in the process of developing such a system by the European Society of Anaesthesiologists (ESA). METHODS: A questionnaire was distributed to all 2240 attendees of the ESA's annual meeting in Gothenburg, Sweden, which took place in April 2001. RESULTS: Of the 329 responders (response rate of 14.6%), 79% were qualified specialists with more than 10 yr of experience (68%), mostly from Western Europe. Most responders admitted to regularly experiencing lack of medical knowledge relating to real-time patient care at least once a month (74%) or at least once a week (46%), and 39% admitted to having made errors during anaesthesia due to lack of medical information that can be otherwise found in a handbook. The choice ofa less optimal but more familiar approach to patient management due to lack of knowledge was reported by 37%. Eighty-eight percent of responders believe that having a point-of-care information system for the anaesthesiologists in the operating room is either important or very important. CONCLUSIONS: This preliminary survey demonstrates that lack of knowledge of anaesthesiologists may be a significant source of medical errors in the operating room, and suggests that a point-of-care information system for the anaesthesiologist may be of value.
OBJECTIVE: To capture communication patterns in operating room (OR) management to characterize the information needs of OR coordination. BACKGROUND: Technological applications can be used to change system processes to improve communication and information access, thereby decreasing errors and adverse events. The successful design of such applications relies on an understanding of communication patterns among healthcare professionals. METHODS: Charge nurse communication was observed and documented at four OR suites at three tertiary hospitals. The data collection tool allowed rapid coding of communication patterns in terms of duration, mode, target person, and the purpose of each communication episode. RESULTS: Most (69.24%) of the 2074 communication episodes observed occurred face to face. Coordinating equipment was the most frequently occurring purpose of communication (38.7%) in all suites. The frequency of other purposes in decreasing order were coordinating patient preparedness (25.7%), staffing (18.8%), room assignment (10.7%), and scheduling and rescheduling surgery (6.2%). CONCLUSION: The results of this study suggest that automating aspects of preparing patients for surgery and surgical equipment management has the potential to reduce information exchange, decreasing interruptions to clinicians and diminishing the possibility of adverse events in the clinical setting.