RESUMEN
Background: Preoperative patient evaluation and optimization in a preoperative evaluation center (PEC) has been shown to improve operating room (OR) efficiency and patient care. However, performing preoperative evaluation on all patients scheduled for surgery or procedure would be time- and resource-consuming. Therefore, appropriate patient selection for evaluation at PECs is one aspect of improving PEC efficiency. In this study, we evaluate the effect of an enhanced preoperative evaluation process (PEP), utilizing a nursing triage phone call and information technology (IT) optimizations, on PEC efficiency and the quality of care in bariatric surgery patients. We hypothesized that, compared to a traditional PEP, the enhanced PEP would improve PEC efficiency without a negative impact on quality. Methods: The study was a retrospective cohort analysis of 1550 patients from January 2014 to March 2017 at a large, tertiary care academic health system. The study was a before/after comparison that compared the enhanced PEP model to the traditional PEP model. The primary outcome was the efficiency of the PEC, which was measured by the reduction of in-person patient visits at the PEC. The secondary outcome was the quality of care, which was measured by delays, cancellations, and the need for additional testing on the day of surgery (DOS). Results: The enhanced PEP improved the primary outcome of efficiency, as evident by an 80% decrease in in-person patient visits to the PEC. There was no reduction in the secondary outcome of the quality of care as measured by delays, cancellations, or the need for additional testing on the DOS. The implementation of the enhanced PEP did not result in increased costs or resource utilization. Conclusions: The enhanced PEP in a multi-disciplinary preoperative process can improve the efficiency of PEC for bariatric surgery patients without any decrease in the quality of care. The enhanced PEP process can be implemented without an increase in resource utilization and can be particularly useful during the COVID-19 pandemic.
RESUMEN
OBJECTIVE: To evaluate the effects of active infant orthopedic treatment on dental arch relationships and determine the effect on maxillary growth in children born with unilateral complete cleft lip and palate (UCCLP). DESIGN: The GOSLON Yardstick was used to assess dental models taken on patients treated with and without active infant orthopedics. PATIENTS: Two groups of nonsyndromic Caucasian children born with UCCLP (total n = 40), all treated by the same surgeon and ranging from 5 to 10 years of age, were evaluated. INTERVENTIONS: One group had a Latham dentomaxillary alignment (DMA) appliance inserted at 5 to 6 weeks of age, after which a lip-nasal adhesion was performed at an average age of 3.5 months. This was followed by more definitive nasolabial repair at the average age of 5.9 months. Those patients treated without preoperative orthopedics underwent a lip-nasal adhesion at average age 1.5 months followed by nasolabial repair at average age 5.1 months. MAIN OUTCOME MEASURES: Randomized assessments using the GOSLON Yardstick were done independently at two separate times by three different examiners. Differences in GOSLON scores between the active orthopedic group and nonorthopedic group were evaluated by both categorical and continuous statistical analyses. RESULTS: The mean GOSLON score was 3.30 for the orthopedic group and 3.21 for the nonorthopedic group. There was no significant group difference in the modal scores of the two groups. CONCLUSIONS: This study showed that active infant orthopedics does not affect the dental arch relationships in preadolescent children with repaired UCCLP, compared with a similar group treated without orthopedic intervention at this center.
