van Veen-Berkx Elizabeth, Bitter Justin, Kazemier Geert, Scheffer Gert J, Gooszen Hein G
Department of Operating Rooms, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands.
Department of Operating Rooms, Bernhoven Hospital Uden, Uden, The Netherlands.
J Am Coll Surg. 2015 Jun;220(6):1070-6. doi: 10.1016/j.jamcollsurg.2015.02.012. Epub 2015 Feb 21.
Poor inter-professional collaboration might negatively influence adequate planning of operative procedures. Interventions capable of improving inter-professional collaboration will positively impact professional practice and health care outcomes. Radboud University Medical Center (UMC) redesigned their operating room (OR) scheduling method by implementing cross-functional teams (CFTs). In this center, positive effects of CFTs were already demonstrated in a mono-center study. This study aims to confirm these effects by comparing the Radboud data with data from 6 other similar centers using a nationwide OR benchmark collaborative.
The effect of CFTs was measured by the performance indicator "raw utilization." The Kruskal-Wallis one-way ANOVA was applied to compare OR performance among all 7 centers. The Wilcoxon-Mann-Whitney test was used to determine differences in OR performance between Radboud UMC and the control group.
Operating room performance differed significantly among all 7 centers (p<0.0005). Radboud UMC demonstrated the highest median raw utilization of 94% vs 85% in the control group (p<0.0005). Box-and-whisker plots validated the reduced variation during the years, indicating an organizational learning effect. Therefore, not only a better performance than the control group, but also a gradual improvement of this performance during the years.
This study shows that multidisciplinary collaboration in CFTs during the perioperative phase has a positive influence on OR scheduling and use of OR time. Other national databases considering mortality rates also support the idea that introducing CFTs is not only an important condition for improving OR performance, but also for improving quality of care.
跨专业协作不佳可能会对手术程序的充分规划产生负面影响。能够改善跨专业协作的干预措施将对专业实践和医疗保健结果产生积极影响。拉德堡德大学医学中心(UMC)通过实施跨职能团队(CFT)重新设计了其手术室(OR)调度方法。在该中心,一项单中心研究已经证明了CFT的积极效果。本研究旨在通过使用全国性的手术室基准协作,将拉德堡德的数据与其他6个类似中心的数据进行比较,以确认这些效果。
通过绩效指标“原始利用率”来衡量CFT的效果。应用Kruskal-Wallis单因素方差分析来比较所有7个中心的手术室绩效。使用Wilcoxon-Mann-Whitney检验来确定拉德堡德大学医学中心与对照组之间手术室绩效的差异。
所有7个中心的手术室绩效存在显著差异(p<0.0005)。拉德堡德大学医学中心的原始利用率中位数最高,为94%,而对照组为85%(p<0.0005)。箱线图验证了这些年来变化的减少,表明存在组织学习效应。因此,不仅表现优于对照组,而且这些年来这种表现还在逐步改善。
本研究表明,围手术期CFT中的多学科协作对手术室调度和手术时间的使用有积极影响。其他考虑死亡率的全国性数据库也支持这样一种观点,即引入CFT不仅是提高手术室绩效的重要条件,也是提高护理质量的重要条件。