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Effectiveness of an early operating room start time in managing pediatric trauma.
Kym, Dan; Kaur, Japsimran; Pham, Nicole Segovia; Klein, Eric; Langner, Joanna Lind; Wang, Ellen; Vorhies, John Schoeneman.
Afiliação
  • Kym D; Department of Orthopaedic Surgery, Stanford University School of Medicine, Palo Alto, CA 94304, United States.
  • Kaur J; Department of Orthopaedic Surgery, Stanford University School of Medicine, Palo Alto, CA 94304, United States.
  • Pham NS; Department of Orthopaedic Surgery, Stanford University School of Medicine, Palo Alto, CA 94304, United States.
  • Klein E; Lucile Packard Children's Hospital, Palo Alto, CA 94304, United States.
  • Langner JL; Department of Orthopaedic Surgery, Stanford University School of Medicine, Palo Alto, CA 94304, United States.
  • Wang E; Department of Anesthesiology, Pain and Perioperative Medicine, Stanford University School of Medicine, Palo Alto, CA 94304, United States.
  • Vorhies JS; Department of Orthopaedic Surgery, Stanford University School of Medicine, Palo Alto, CA 94304, United States. john.vorhies@stanford.edu.
World J Orthop ; 14(7): 516-525, 2023 Jul 18.
Article em En | MEDLINE | ID: mdl-37485431
ABSTRACT

BACKGROUND:

The timing of operative treatment for pediatric supracondylar humerus fractures (SCHF) and femoral shaft fractures (FSF) remains controversial. Many fractures previously considered to be surgical emergencies, such as SCHF and open fractures, are now commonly being treated the following day. When presented with an urgent fracture overnight needing operative treatment, the on-call surgeon must choose whether to mobilize resources for a late-night case or to add the case to an elective schedule of the following day.

AIM:

To describe the effect of a program allowing an early operating room (OR) start for uncomplicated trauma prior to an elective day of surgery to decrease wait times for surgery for urgent fractures admitted overnight.

METHODS:

Starting in October 2017, patients were eligible for the early slot in the OR at the discretion of the surgeon if they were admitted after 2100 the previous night and before 0500. We compared demographics and timing of treatment of SCHF and FSF treated one year before and after implementation as well as the survey responses from the surgical team.

RESULTS:

Of the 44 SCHF meeting inclusion criteria, 16 received treatment before implementation while 28 were treated after. After implementation, the mean wait time for surgery decreased by 4.8 h or 35.4% (13.4 h vs 8.7 h; P = 0.001). There were no significant differences in the operative duration, time in the post anesthesia care unit, and wait time for discharge. Survey results demonstrated decreased popularity of the program among nurses and anesthesiologists relative to surgeons. Whereas 57% of the surgeons believed that the program was effective, only 9% of anesthesiologists and 16% of nurses agreed. The program was ultimately discontinued given the dissatisfaction.

CONCLUSION:

Our findings demonstrate significantly reduced wait times for surgery for uncomplicated SCHF presenting overnight while discussing the importance of shared decision-making with the stakeholders. Although the program produced promising results, it also created new conflicts within the OR staff that led to its discontinuation at our institution. Future implementations of such programs should involve stakeholders early in the planning process to better address the needs of the OR staff.
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Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Tipo de estudo: Prognostic_studies Idioma: En Revista: World J Orthop Ano de publicação: 2023 Tipo de documento: Article

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Tipo de estudo: Prognostic_studies Idioma: En Revista: World J Orthop Ano de publicação: 2023 Tipo de documento: Article