Department of Otolaryngology-Head and Neck Surgery, University Cincinnati, Cincinnati, Ohio.
Department of Otolaryngology-Head and Neck Surgery, St Johns Providence Health System, Madison Heights, Michigan.
JAMA Otolaryngol Head Neck Surg. 2018 Apr 1;144(4):330-334. doi: 10.1001/jamaoto.2017.3165.
Obtaining sufficient operating room time for inpatient consults requiring an operative intervention is a persistent challenge for otolaryngologists.
To examine the institution of an otolaryngology-specific operating room (OR) for unscheduled (add-on) cases for its association with time from initial consultation to surgery and, secondarily, to determine utilization of a dedicated block of time.
DESIGN, SETTING, AND PARTICIPANTS: Retrospective review of medical records of a tertiary care pediatric hospital for patients treated between January 1, 2015, and March 31, 2016; analysis was concluded by June 2016. Included were all patients undergoing inpatient otolaryngology consultations who required nonemergency operative procedures.
In August 2015, a once-weekly 5-hour block of OR time dedicated to inpatient otolaryngology consults was instituted. Prior to this, cases were placed on an add-on list shared between all surgical services.
It was hypothesized that institution of a dedicated block of OR time would decrease the time from initial consultation to operative intervention and would be utilized at a high rate. Operating room utilization was calculated by dividing scheduled OR time by actual OR time utilized. Time from initial consultation to OR intervention was compared before and after the institution of the dedicated OR block.
A total of 316 inpatient add-on pediatric cases (including 108 patients from the intensive care unit [ICU]) were scheduled during the study period. The most common cases were microlaryngoscopy/bronchoscopy (79%) and tracheostomy (8%). Mean (SD) time between consultation and OR intervention was 7.8 (1.6) days prior to establishing the add-on OR and 4.4 (1.3) days after it was established (absolute difference of 3.4 days; 95% CI, 3.1-3.7 days). Mean (SD) time between consultation and OR intervention was 7.4 (5.0) days for ICU patients prior to intervention and 5.6 (3.0) days after intervention (absolute difference of 1.8 days; 95% CI, 1.6-2.0 days). Total utilization of the OR block time was 74%, and adjusted utilization was 86%. There was a 15% drop in the number of unscheduled add-on cases after the intervention (from 10 cases/mo to 8.5 cases/mo; absolute difference of 1.5 cases; 95% CI, 1.1-1.9 cases).
Instituting a dedicated otolaryngology add-on OR was associated with significantly reduced time between initial consultation and operative care, by approximately 3 days, decreased the number of unscheduled add-on cases, and was utilized at a high level.
为需要手术干预的住院会诊获得足够的手术室时间，是耳鼻喉科医生面临的一个持续挑战。
检查为非计划性（附加）病例设立耳鼻喉科专用手术室（OR）与从初始咨询到手术的时间之间的关联，其次是确定专用时间段的利用率。
设计、设置和参与者：对 2015 年 1 月 1 日至 2016 年 3 月 31 日期间在一家三级儿童医院接受治疗的患者的医疗记录进行回顾性分析；分析于 2016 年 6 月结束。包括所有需要非紧急手术的住院耳鼻喉科会诊患者。
2015 年 8 月，每周设立 5 小时的 OR 专用时间，用于住院耳鼻喉科会诊。在此之前，病例被列入所有手术科室共享的附加清单。
假设设立专用 OR 块将减少从初始咨询到手术干预的时间，并将得到高度利用。手术室利用率通过将计划手术室时间除以实际使用手术室时间来计算。在建立专用 OR 块前后，比较了从初始咨询到 OR 干预的时间。
在研究期间，共安排了 316 例住院附加儿科病例（包括 108 例 ICU 患者）。最常见的病例是显微镜检查/支气管镜检查（79%）和气管切开术（8%）。在建立附加 OR 之前，咨询和 OR 干预之间的平均（SD）时间为 7.8（1.6）天，建立之后为 4.4（1.3）天（绝对差异为 3.4 天；95%CI，3.1-3.7 天）。在干预之前，ICU 患者的咨询和 OR 干预之间的平均（SD）时间为 7.4（5.0）天，干预之后为 5.6（3.0）天（绝对差异为 1.8 天；95%CI，1.6-2.0 天）。OR 块时间的总利用率为 74%，调整后的利用率为 86%。干预后，非计划性附加病例数减少了 15%（从每月 10 例降至每月 8.5 例；绝对差异为 1.5 例；95%CI，1.1-1.9 例）。
建立专用耳鼻喉科附加 OR 与初始咨询和手术护理之间的时间显著缩短，约为 3 天，减少了非计划性附加病例的数量，并得到了高度利用。
