Ammanuel Simon G, Chan Andrew K, DiGiorgio Anthony M, Alazzeh Mohanad, Nwachuku Kelechi, Robinson Leslie C, Lobo Errol, Mummaneni Praveen V
Department of Neurosurgery, University of California San Francisco, San Francisco, CA, USA.
David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA.
Neurospine. 2020 Jun;17(2):390-397. doi: 10.14245/ns.1938318.159. Epub 2020 Feb 5.
Lean management strategies aim to increase efficiency by eliminating waste or by improving processes to optimize value. The operating room (OR) is an arena where these strategies can be implemented. We assessed changes in OR efficiency after the application of lean methodology on perioperative anesthesia associated with posterior cervical spine surgeries.
We utilized pre- and post-lean study design to identify inefficiencies during the perioperative anesthesia process and implemented strategies to improve the process. Patient characteristics were recorded to assess for differences between the 2 groups (group 1, prelean; group 2, post-lean). In the pre-lean period, key steps in the perioperative anesthesia process were identified that were amenable to lean implementation. The time required for each identified key step was recorded by an independent study coordinator. The times for each step were then compared between the groups utilizing univariate analyses.
After lean implementation, there was a significant decrease in overall perioperative anesthesia process time (88.4 ± 4.7 minutes vs. 76.2 ± 3.2 minutes, p = 0.04). This was driven by significant decreases in the steps: transport and setup (10.4 ± 0.8 minutes vs. 8.0 ± 0.7 minutes, p = 0.03) and positioning (20.8 ± 2.1 minutes vs. 15.7 ± 1.3 minutes, p = 0.046). Of note, the total time spent in the OR was lower for group 2 (270.1 ± 14.6 minutes vs. 252.8 ± 14.1 minutes) but the result was not statistically significant, even when adjusting for number of operated levels.
Lean methodology may be successfully applied to posterior cervical spine surgery whereby improvements in the perioperative anesthetic process are associated with significantly increased OR efficiency.
精益管理策略旨在通过消除浪费或改进流程以优化价值来提高效率。手术室是可以实施这些策略的场所。我们评估了在颈椎后路手术围手术期麻醉中应用精益方法后手术室效率的变化。
我们采用精益实施前后的研究设计来识别围手术期麻醉过程中的低效率情况，并实施改进流程的策略。记录患者特征以评估两组（第1组，精益实施前；第2组，精益实施后）之间的差异。在精益实施前的阶段，确定了围手术期麻醉过程中适合应用精益方法的关键步骤。由一名独立的研究协调员记录每个确定的关键步骤所需的时间。然后利用单变量分析比较两组中每个步骤的时间。
实施精益方法后，围手术期麻醉总过程时间显著减少（88.4±4.7分钟对76.2±3.2分钟，p = 0.04）。这是由以下步骤的显著减少推动的：转运和准备（10.4±0.8分钟对8.0±0.7分钟，p = 0.03）以及定位（20.8±2.1分钟对15.7±1.3分钟，p = 0.046）。值得注意的是，第2组在手术室花费的总时间较低（270.1±14.6分钟对252.8±14.1分钟），但即使调整手术节段数量后，结果也无统计学意义。
精益方法可能成功应用于颈椎后路手术，由此围手术期麻醉过程的改善与手术室效率显著提高相关。
