Improving Operating Room Efficiency via Reduction and Standardization of Video-Assisted Thoracoscopic Surgery Instrumentation

Journal of Medical Systems - 2018
Tynan H. Friend1, Ashley Paula1, Jason Klemm1, Mark Rosa1, Wilton Levine1
1Massachusetts General Hospital, Boston, USA

Tóm tắt

Being the economic powerhouses of most large medical centers, operating rooms (ORs) require the highest levels of teamwork, communication, and efficiency in order to optimize patient safety and reduce hospital waste. A major component of OR waste comes from unused surgical instrumentation; instruments that are frequently prepared for procedures but are never touched by the surgical team still require a full reprocessing cycle at the conclusion of the case. Based on our own previous successes in the perioperative domain, in this work we detail an initiative that reduces surgical instrumentation waste of video-assisted thoracoscopic surgery (VATS) procedures by placing thoracotomy conversion instrumentation in a standby location and designing a specific instrument kit to be used solely for VATS cases. Our estimates suggest that this initiative will reduce at least 91,800 pounds of unnecessary surgical instrumentation from cycling through our ORs and reprocessing department annually, resulting in increased OR team communication without sacrificing the highest standard of patient safety.

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Tài liệu tham khảo

Spaner, S. J., and Warnock, G. L., A brief history of endoscopy, laparoscopy, and laparoscopic surgery. J. Laparoendosc. Adv. Surg. Tech. 7:369–373, 1997. https://doi.org/10.1089/lap.1997.7.369.

Reynolds, Jr., W., The first laparoscopic cholecystectomy. JSLS J. Soc. Laparoendosc. Surg. 5:89–94, 2001.

Eldar, S., Sabo, E., Nash, E. et al., Laparoscopic versus open cholecystectomy in acute cholecystitis. Surg. Laparosc. Endosc. 7:407–414, 1997.

Sauerland, S., Jaschinski, T., and Neugebauer, E. A., Laparoscopic versus open surgery for suspected appendicitis. Cochrane Database Syst. Rev. CD001546. https://doi.org/10.1002/14651858.CD001546.pub3.2010.

Conacher, I. D., Soomro, N. A., and Rix, D., Anaesthesia for laparoscopic urological surgery. Br. J. Anaesth. 93:859–864, 2004.

Powell, F., and Khaund, A., Laparoscopy and laparoscopic surgery. Obstet. Gynaecol. Reprod. Med. 26:297–303, 2016. https://doi.org/10.1016/j.ogrm.2016.07.004.

Gopaldas, R. R., Bakaeen, F. G., Dao, T. K. et al., Video-assisted thoracoscopic versus open thoracotomy lobectomy in a cohort of 13,619 patients. Ann. Thorac. Surg. 89:1563–1570, 2010. https://doi.org/10.1016/j.athoracsur.2010.02.026.

McKenna, R. J., Houck, W., and Fuller, C. B., Video-assisted thoracic surgery lobectomy: experience with 1,100 cases. Ann. Thorac. Surg. 81:421–426, 2006. https://doi.org/10.1016/j.athoracsur.2005.07.078.

Copenhaver, M. S., Friend, T. H., Fitzgerald-Brown, C. et al., Improving operating room and surgical instrumentation efficiency, safety, and communication via the implementation of emergency laparoscopic cholecystectomy and appendectomy conversion case carts. Perioper Care Oper. Room Manag., 2017. https://doi.org/10.1016/j.pcorm.2017.09.001.

Hanna, J. M., Berry, M. F., and D’Amico, T. A., Contraindications of video-assisted thoracoscopic surgical lobectomy and determinants of conversion to open. J. Thorac. Dis. 5, 2013. https://doi.org/10.3978/j.issn.2072-1439.2013.07.08.

Hansen, H. J., Petersen, R. H., and Christensen, M., Video-assisted thoracoscopic surgery (VATS) lobectomy using a standardized anterior approach. Surg. Endosc. Other Interv. Tech. 25:1263–1269, 2011. https://doi.org/10.1007/s00464-010-1355-9.

Onaitis, M. W., Petersen, R. P., Balderson, S. S. et al., Thoracoscopic lobectomy is a safe and versatile procedure. Trans . Meet. Am. Surg. Assoc. 124:86–91, 2006. https://doi.org/10.1097/01.sla.0000234892.79056.63.

Wormer, B. A., Augenstein, V. A., Carpenter, C. L. et al., The green operating room: Simple changes to reduce cost and our carbon footprint. Am. Surg. 79:666–671, 2013.

Farrokhi, F. R., Gunther, M., Williams, B., and Blackmore, C. C., Application of lean methodology for improved quality and efficiency in operating room instrument availability. J. Healthc Qual. 2013.

Blackmore, C. C., Bishop, R., Luker, S., and Williams, B. L., Applying lean methods to improve quality and safety in surgical sterile instrument processing. Jt. Comm. J. Qual. Patient Saf. 39:99–105, 2013. https://doi.org/10.1016/S1553-7250(13)39014-X.

Halton, K., Graves, N., and Hall, L., Opportunity cost of unavailable surgical instruments in Australian hospitals. ANZ J. Surg. 84:905–906, 2014. https://doi.org/10.1111/ans.12822.

Friend, T. H., Jennings, S. J., Copenhaver, M. S., and Levine, W. C., Implementation of the Vocera communication system in a quaternary perioperative environment. J. Med. Syst. 41. doi:https://doi.org/10.1007/s10916-016-0652-9. 2017.

Divisi, D., Zaccagna, G., Gabriele, F., and Crisci, R., Role and utility of the national registers of VATS major procedures. Video-Assist. Thorac. Surg. 2:3, 2017. https://doi.org/10.21037/vats.2017.01.01.

Augustin, F., Maier, H. T., Weissenbacher, A. et al., Causes, predictors and consequences of conversion from VATS to open lung lobectomy. Surg. Endosc. Other Interv. Tech. 30:2415–2421, 2016. https://doi.org/10.1007/s00464-015-4492-3.

Smith, D. E., Dietrich, A., Nicolas, M. et al., Conversion during thoracoscopic lobectomy: Related factors and learning curve impact. Updates Surg. 67:427–432, 2015. https://doi.org/10.1007/s13304-015-0334-z.

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Journal of Medical Systems

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