From the Department of Ophthalmology, University of California, San Francisco, California, USA.
From the Department of Ophthalmology, University of California, San Francisco, California, USA.
J Cataract Refract Surg. 2018 Feb;44(2):186-189. doi: 10.1016/j.jcrs.2017.11.014.
To examine the effect of group goal and group performance theories on operating room efficiency in resident-performed cataract surgery.
Zuckerberg San Francisco General Hospital and Trauma Center, Department of Ophthalmology, University of California, San Francisco, California, USA.
Prospective case series.
This study assessed 4 specific segments of operating room utilization identified as room-to-incision time, incision-to-close time, close-to-exit time, and room turnover time. The time segments were measured for resident-performed cataract cases before the proposed intervention. Then, group goals were set for ideal times of each utilization segment. Behaviors of the surgery, anesthesia, nursing, pharmacy, and housekeeping teams that would improve group performance were identified. Utilization segments were measured again after the intervention.
The time segments were measured for 134 resident-performed cataract cases before the proposed intervention and again after the intervention for 136 resident-performed cataract cases. Before the intervention, the mean overall case time was 55 minutes, allowing for 10 cases in a 10-hour day. After the intervention, the mean overall case time was 46 minutes, allowing for 13 cases in a 10-hour day. The decrease in postintervention times for overall case time, room-to-incision time, and close-to-exit time were statistically significant.
Operating room utilization for resident-performed cataract surgery was enhanced by setting group goals. A multidisciplinary effort to enhance group performance through behavior modification can be implemented immediately and improve efficiency without compromising patient safety or resident teaching.
研究群体目标和群体绩效理论对住院医师施行白内障手术的手术室效率的影响。
美国加利福尼亚大学旧金山分校 ZSFG 医院和创伤中心眼科，旧金山，加利福尼亚州。
前瞻性病例系列研究。
本研究评估了手术室利用的 4 个特定部分，分别为手术间到切口时间、切口到关闭时间、关闭到离开时间和手术间转换时间。在提出干预措施之前，测量了住院医师施行的白内障病例的这些时间段。然后，为每个利用段设定了理想时间的群体目标。确定了可提高群体绩效的手术、麻醉、护理、药剂和家政团队的行为。干预后再次测量利用段。
在提出干预措施之前，对 134 例住院医师施行的白内障病例进行了时间段测量，在对 136 例住院医师施行的白内障病例进行了干预后再次进行了测量。在干预之前，平均整体病例时间为 55 分钟，允许在 10 小时的工作日内进行 10 例手术。在干预之后，平均整体病例时间为 46 分钟，允许在 10 小时的工作日内进行 13 例手术。术后整体病例时间、手术间到切口时间和关闭到离开时间的时间减少具有统计学意义。
通过设定群体目标，可以提高住院医师施行白内障手术的手术室利用率。通过行为改变来增强群体绩效的多学科努力可以立即实施，并在不影响患者安全或住院医师教学的情况下提高效率。
