Saw Niharika, Vacanti Joshua C, Liu Xiaoxia, SaRego Monica, Flanagan Hugh, Kodali Bhavani Shankar, Urman Richard D
Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
J Invest Surg. 2015 Apr;28(2):95-102. doi: 10.3109/08941939.2014.987408. Epub 2014 Dec 17.
On time start of the first surgical case improves operating room (OR) utilization, physician, and patient satisfaction and decreases delays in subsequent cases. The goal of our study was to evaluate the effect of a multidisciplinary initiative to improve first patient in the room (FPIR) and first case on time start (FCOTS) metrics in a tertiary care setting.
A multidisciplinary committee focused on first case start data collection. Reasons for both anesthesia and surgical delays were analyzed. Improvement efforts focused on the timely completion of surgical consent, a requirement of a surgical, anesthesia, and nurse team member presence at the patient's bedside by specific time, and parallel processing in the OR.
Over 65,100 OR cases were analyzed between 2007 and 2014. There was a statistically significant improvement in FPIR (82.80% versus 69.60%, p < .0001) and FCOTS (66.60% versus 55.90%, p < .0001). Surgical consent completion rate increased from 35% baseline to 68%-100%, depending on the surgical subspecialty. Improvements appeared sustainable several years following process implementation for both FPIR (84.60% versus 69.60%, p < .0001) and FCOTS (67.60% versus 55.90%, p < .0001).
Our study demonstrates a successful targeted, multidisciplinary initiative to improve first case surgical starts in an academic setting. Our approach was organizational rather than punitive or rewarding on an individual basis. Strategies included establishing concrete, time-specific goals and posting them visibly, empowering individuals to fulfill them, and ensuring no compromise in patient safety. In the complex environment of academic medicine including research protocols and teaching in the ORs, our organizational approach proved sustainable over several years.
首例手术病例按时开始可提高手术室利用率、医生满意度和患者满意度，并减少后续病例的延误。我们研究的目的是评估一项多学科倡议在三级医疗环境中对手术室首位患者（FPIR）和首例病例按时开始（FCOTS）指标的影响。
一个多学科委员会专注于首例病例开始数据的收集。分析了麻醉和手术延误的原因。改进措施集中在手术同意书的及时完成、要求手术、麻醉和护士团队成员在特定时间出现在患者床边，以及手术室的并行处理。
2007年至2014年间分析了超过65100例手术室病例。FPIR（82.80%对69.60%，p<.0001）和FCOTS（66.60%对55.90%，p<.0001）有统计学意义的改善。手术同意书完成率从基线的35%提高到68%-100%，具体取决于手术亚专业。在流程实施后的几年里，FPIR（84.60%对69.60%，p<.0001）和FCOTS（67.60%对55.90%，p<.0001）的改善似乎是可持续的。
我们的研究表明，在学术环境中，一项成功的有针对性的多学科倡议可改善首例手术的开始情况。我们的方法是基于组织层面，而非针对个人的惩罚或奖励。策略包括设定具体的、有时间限制的目标并公开张贴，赋予个人实现目标的权力，并确保患者安全不受影响。在包括研究方案和手术室教学在内的学术医学复杂环境中，我们的组织方法在几年内被证明是可持续的。
