RESUMO
The difficult financial situation in German hospitals requires measures for improvement in process quality. Associated increases in revenues in the high income field "operating room (OR) area" are increasingly the responsibility of OR management but it has not been shown that the introduction of an efficiency-oriented management leads to an increase in process quality and revenues in the operating theatre. Therefore the performance in the operating theatre of the University Medical Center Göttingen was analyzed for working days in the core operating time from 7.45 a.m. to 3.30 p.m. from 2009 to 2014. The achievement of process target times for the morning surgery start time and the turnover times of anesthesia and OR-nurses were calculated as indicators of process quality. The number of operations and cumulative incision-suture time were also analyzed as aggregated performance indicators. In order to assess the development of revenues in the operating theatre, the revenues from diagnosis-related groups (DRG) in all inpatient and occupational accident cases, adjusted for the regional basic case value from 2009, were calculated for each year. The development of revenues was also analyzed after deduction of revenues resulting from altered economic case weighting. It could be shown that the achievement of process target values for the morning surgery start time could be improved by 40 %, the turnover times for anesthesia reduced by 50 % and for the OR-nurses by 36 %. Together with the introduction of central planning for reallocation, an increase in operation numbers of 21 % and cumulative incision-suture times of 12% could be realized. Due to these additional operations the DRG revenues in 2014 could be increased to 132 % compared to 2009 or 127 % if the revenues caused by economic case weighting were excluded. The personnel complement in anesthesia (-1.7 %) and OR-nurses (+2.6 %) as well as anesthetists (+6.7 %) increased less compared to the revenues or were slightly reduced. This improvement in process quality and cumulative incision-suture times as well as the increase in revenues, reflect the positive impact of an efficiency-oriented central OR management. The OR management releases due to measures of process optimization the necessary personnel and time resources and therefore achieves the basic prerequisites for increased revenues of surgical disciplines. The method presented can be used by other hospitals as a guideline to analyze performance development.
Assuntos
Cirurgia Geral/economia , Cirurgia Geral/organização & administração , Hospitais Universitários/economia , Hospitais Universitários/organização & administração , Salas Cirúrgicas/economia , Salas Cirúrgicas/organização & administração , Anestesia/economia , Anestesia/métodos , Grupos Diagnósticos Relacionados , Eficiência , Humanos , Recursos Humanos em Hospital/economia , Melhoria de Qualidade , Desenvolvimento de Pessoal , Recursos HumanosRESUMO
BACKGROUND: The current situation in hospitals is characterized by financial limitations and simultaneously by increasing demands on quality and safety. The operative interface between anesthesia and transfusion medicine affects both factors. AIM: A detailed analysis was performed to evaluate the process quality at this operative interface at the University Hospital of Göttingen. The aim of the project was to revise und develop the structures and responsibilities at this interface, to dispose of weak points and to realize the optimization potential in the supply of blood products. MATERIAL AND METHODS: A databank-based electronic data processing solution was established with the clear definition of responsibilities for the various workflow procedures and the written documentation of these definitions in standard operating protocols. In order to guarantee the necessary transparency a routine reporting system to the department of surgery was established. In addition, a continuous further development of the blood supply standard based on electronic report data was implemented. RESULTS: By implementing the above named measures the rate of supplied to transfused blood products could be increased from 43.1 % to 55.7 %. The compliance with the blood supply standard improved continually over the first 18 months from 60.3 % to 92.3 %. The rate of supplied blood product deliveries without subsequent operation could be reduced from 9.0 % to 4.6 %. As a result of this optimization the supply costs in the internal cost allocation were reduced from 9,406
Assuntos
Anestesia/tendências , Anestesiologia/tendências , Transfusão de Sangue/tendências , Garantia da Qualidade dos Cuidados de Saúde/tendências , Anestesia/economia , Anestesia/normas , Anestesiologia/economia , Anestesiologia/normas , Bancos de Sangue/normas , Transfusão de Sangue/economia , Transfusão de Sangue/normas , Controle de Custos , Bases de Dados Factuais , Alemanha , Humanos , Segurança do Paciente , Garantia da Qualidade dos Cuidados de Saúde/economia , Fluxo de TrabalhoRESUMO
BACKGROUND: Exact information on the anatomical in situ position of extraglottic airway (EGA) devices is lacking. We used magnetic resonance imaging (MRI) to visualize the positions of the i-gel™ and the LMA-Supreme™ (LMA-S) relative to skeletal and soft-tissue structures. METHODS: Twelve volunteers participated in this randomized, prospective, cross-over study. Native MRI scans were performed before induction of anaesthesia. Anaesthesia was induced, and the two EGAs were inserted in a randomized sequence. Their positions were assessed functionally, optically by fibrescope, and with MRI scans of the head and neck. RESULTS: The LMA-S protruded deeper into the upper oesophageal sphincter than the i-gel™ (P<0.001). Both devices reduced the area of the glottic aperture (P<0.001), and the LMA-S had the largest effect (P=0.049). The i-gel™ significantly compressed the tongue (P<0.001). Both devices displaced the hyoid bone ventrally (P<0.001); the i-gel™ to a greater degree (P=0.029). The fibreoptically determined position of the bowl of the devices was identical. CONCLUSIONS: The LMA-S and i-gel™ differ significantly with regard to in situ position and spatial relationship with adjacent structures assessed by MRI, despite similar clinical and fibreoptical findings. This could be relevant with regard to risk of aspiration, glottic narrowing, and airway resistance and soft-tissue morbidity.