Section of Pediatric Urology, The Hospital for Sick Children, Toronto, Ontario, Canada; The Institute of Health Policy, Management, and Evaluation (IHPME), The University of Toronto, Toronto, Ontario, Canada.
Section of Pediatric Urology, The Hospital for Sick Children, Toronto, Ontario, Canada.
J Pediatr Urol. 2018 Feb;14(1):20-24. doi: 10.1016/j.jpurol.2017.08.002. Epub 2017 Sep 8.
To standardize and reduce surgical instrumentation by >25% within a 9-month period for pediatric inguinal hernia repair (PIHR), using "improvement science" methodology.
We prospectively evaluated instruments used for PIHR in 56 consecutive cases by individual surgeons across two separate subspecialties, pediatric surgery (S) and pediatric urology (U), to measure actual number of instruments used compared with existing practice based on preference cards. Based on this evaluation, a single preference card was developed using only instruments that had been used in >50% of all cases. A subsequent series of 52 cases was analyzed to assess whether the new tray contained the ideal instrumentation. Cycle time (CT), to sterilize and package the instruments, and weights of the trays were measured before and after the intervention. A survey of operating room (OR) nurses and U and S surgeons was conducted before and after the introduction of the standardized tray to assess the impact and perception of standardization.
Prior to creating the standardized tray, a U PIHR tray contained 96 instruments with a weight of 13.5 lbs, while the S set contained 51, weighing 11.2 lbs. The final standardized set comprised 28 instruments and weighed 7.8 lbs. Of 52 PIHRs performed after standardization, in three (6%) instances additional instruments were requested. CT was reduced from 11 to 8 min (U and S respectively) to <5 min for the single tray. Nurses and surgeons reported that quality, safety, and efficiency were improved, and that efforts should continue to standardize instrumentation for other common surgeries.
Standardization of surgical equipment can be employed across disciplines with the potential to reduce costs and positively impact quality, safety, and efficiencies.
在 9 个月内，通过“改进科学”方法，将小儿腹股沟疝修补术（PIHR）的手术器械标准化并减少 25%以上。
我们前瞻性地评估了两位独立亚专科（小儿外科[S]和小儿泌尿科[U]）的 56 例连续病例中用于 PIHR 的器械，通过个别外科医生使用偏好卡来测量实际使用的器械数量与现有实践的比较。基于此评估，使用超过 50%的所有病例中使用的器械，仅使用一种偏好卡开发了一种单一的偏好卡。随后分析了 52 例后续病例，以评估新托盘是否包含理想的器械。在干预前后测量了器械的循环时间（CT）、消毒和包装时间以及托盘的重量。在引入标准化托盘前后，对手术室（OR）护士以及 U 和 S 外科医生进行了调查，以评估标准化的影响和认知。
在创建标准化托盘之前，小儿泌尿科的 PIHR 托盘包含 96 种器械，重量为 13.5 磅，而小儿外科集包含 51 种，重量为 11.2 磅。最终的标准化集由 28 种器械组成，重量为 7.8 磅。在标准化后的 52 例 PIHR 中，有 3 例（6%）需要额外的器械。U 和 S 的 CT 分别从 11 分钟减少到 8 分钟（分别为 U 和 S），到单托盘的<5 分钟。护士和外科医生报告说，质量、安全和效率得到了提高，应继续努力使其他常见手术的器械标准化。
跨学科采用手术设备的标准化具有降低成本和积极影响质量、安全和效率的潜力。
