Can machine learning optimize the efficiency of the operating room in the era of COVID-19?

SUMMARY: The cancellation of large numbers of surgical procedures because of the coronavirus disease 2019 (COVID-19) pandemic has drastically extended wait lists and negatively affected patient care and experience. As many facilities resume clinical work owing to the currently low burden of disease in our community, we are faced with operative booking protocols and procedures that are not mathematically designed to optimize efficiency. Using a subset of artificial intelligence called "machine learning," we have shown how the use of operating time can be optimized with a custom Python (a high-level programming language) script and an open source machine-learning algorithm, the ORTools software suite from the Google AI division of Alphabet Inc. This allowed the creation of customized models to optimize the efficiency of operating room booking times, which resulted in a reduction in nursing overtime of 21% - a theoretical cost savings of $469 000 over 3 years.

Burnout, resilience and moral injury: How the wicked problems of health care defy solutions, yet require innovative strategies in the modern era

Summary: Physician burnout is an increasingly concerning issue that affects patient care, costs and the sustainability of our health care system. Burnout is not solely related to personal resilience; it is important to recognize the major role of the institution of health care in creating this wicked problem. Only this way can we fully understand the shared responsibility required to develop local strategies to tilt the fulcrum in our favour.

How well do we do what we do, and how do we know it? The importance of patient-reported experience measures in assessing our patients' experience of care

Summary: As highly trained practitioners in the practice of patient care, at times we may not emphasize the art of the patient experience. Multiple studies have shown that patients' attitudes and expectations have an effect on their outcomes after surgery. Our patients' perceptions of their care, through proxies like respect, courtesy, compassion, emotional connection and listening, may be as important to them as the actual care received. In this discussion, I review the importance of measuring patient experiences through patient-reported experience measures, and I describe our practice at Oakville Trafalgar Memorial Hospital with mass surveying using an Internet-based survey tool. Oakville Trafalgar Memorial Hospital is a 469-bed facility in Oakville, Ont., in which 13 401 surgical procedures were performed in 2016.

Optimization of communication in the surgical program via instant messaging, Web-based surveys, newsletters, websites, smartphones and telemedicine: the experience of Oakville Trafalgar Memorial Hospital.

Summary: As our surgical program has rapidly expanded, new modalities are required for safe, effective and efficient communication. In this discussion we review how we have used Web-based survey tools, the Signal instant messaging app, a new departmental newsletter, personal surgeon office websites, a department of surgery website and encrypted video calls via the Ontario Telemedicine Network to address our evolving communication needs.

Reducing catheter-associated urinary tract infections using a multimodal approach - the NSQIP experience of Oakville Trafalgar Memorial Hospital.

Summary: Catheter-associated urinary tract infections (CAUTI) cause significant morbidity and mortality in the surgical population as well as significant costs to health care. It can be surprisingly difficult to address this common complication without a multifaceted, multimodal team-based approach to the problem. We used our National Surgical Quality Improvement Program (NSQIP) data on the incidence of CAUTI in our "procedure targeted" and "essentials" general surgery and orthopedic surgery cases before and after the implementation of our reduction strategy and found a significant improvement. This article discusses our multimodal approach to CAUTI.

Can surgical site infections be reduced with the adoption of a bundle of simultaneous initiatives? The use of NSQIP incidence data to follow multiple quality improvement interventions.

SUMMARY: Surgical site infections (SSI) are a common complication after surgical procedures. To reduce the incidence of SSIs, Oakville Trafalgar Memorial Hospital decided to institute a bundle of initiatives to change multiple factors simultaneously based on best available evidence and the understanding of infection pathophysiology. We used National Surgical Quality Improvement Program data on the incidence of SSIs in our targeted and essentials, general surgery and orthopedic surgery cases before and after the implementation of an SSI reduction bundle. This article discusses whether the use of intervention bundles may assist in the reduction of a variety of postoperative surgical complications.