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1.
Ann Ig ; 33(5): 513-517, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34224553

RESUMO

Abstract: Starting from the minimum requirements indicated by Lombardy Region, a validation checklist has been developed by experts in design, healthcare layout planning, hygiene and public health, planning and compliance, in order to provide managers of COVID-19 massive vaccination centers with a useful and easy-to-use tool to ensure quality, safety and efficiency of the different activities performed.


Assuntos
Vacinas contra COVID-19 , COVID-19/prevenção & controle , Centros Comunitários de Saúde/organização & administração , Vacinação em Massa/organização & administração , SARS-CoV-2 , Estudos de Validação como Assunto , Vacinas contra COVID-19/provisão & distribuição , Lista de Checagem , Centros Comunitários de Saúde/normas , Eficiência Organizacional , Arquitetura de Instituições de Saúde , Humanos , Higiene , Itália , Segurança do Paciente , Garantia da Qualidade dos Cuidados de Saúde , Indicadores de Qualidade em Assistência à Saúde
2.
Medicine (Baltimore) ; 100(26): e26515, 2021 Jul 02.
Artigo em Inglês | MEDLINE | ID: mdl-34190182

RESUMO

BACKGROUND: Reablement is 1 approach to conduct rehabilitation in the community (ie, home environment), which aims to enhance an individual's functional ability to perform everyday activities that individuals perceive as important. We investigated the effects of a home-reablement program on different rehabilitation outcomes in people with stroke. METHODS: A single-blind randomized clinical trial was conducted. Twenty-six people with stroke were randomly assigned to the home-reablement group or control group. For 6 weeks, participants in the home-reablement group received training for activities of daily living (ADL) that they perceived as important but difficult to perform. Participants in the control group received conventional rehabilitation in the hospital. Outcome measures included the Fugl-Meyer Assessment for the upper-extremity (FMA-UE) and the Stroke Impact Scale 3.0 (SIS 3.0) subscales. RESULTS: No statistically significant differences between the 2 groups were noticed in the FMA-UE and the SIS 3.0 subscales (P = .226-1.000). Small effect size (success rate difference = 0.12-0.25) were noticed in the FMA-UE and the 5 SIS 3.0 subscales. The home-reablement group exhibited a greater proportion of participants with scores greater than the minimal detectable change in the FMA-UE and the 6 SIS 3.0 subscales (ie, strength, ADL/instrumental ADL, mobility, emotion, memory, and participation). CONCLUSIONS: People with stroke that underwent the 6-week home-reablement program showed potential for improving their motor function, ADL/instrumental ADL, emotion, memory, and activity participation.


Assuntos
Atividades Cotidianas , Recuperação de Função Fisiológica , Reabilitação do Acidente Vascular Cerebral/métodos , Acidente Vascular Cerebral , Idoso , Eficiência Organizacional , Feminino , Estado Funcional , Serviços de Assistência Domiciliar/organização & administração , Humanos , Masculino , Avaliação de Resultados em Cuidados de Saúde , Projetos Piloto , Método Simples-Cego , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/fisiopatologia , Acidente Vascular Cerebral/psicologia
3.
Ann Ig ; 33(5): 499-512, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34113956

RESUMO

Abstract: After SARS-CoV-2 vaccines development came at an unprecedented speed, ensuring safe and efficient mass immunization, vaccine delivery be-came the major public health mandate. Although mass-vaccination sites have been identified as essential to curb COVID-19, their organization and functioning is challenging. In this paper we present the planning, implementation and evalua-tion of a massive vaccination center in Lombardy - the largest Region in Italy and the most heavily hit by the pandemic. The massive hub of Novegro (Milan), managed by the Gruppo Ospedaliero San Donato, opened in April 2021. The Novegro mass-immunization model was developed building a la-yout based on the available scientific evidence, on comparative analysis with other existing models and on the experience of COVID-19 immunization delivery of Gruppo Ospedaliero San Donato. We propose a "vaccine islands" mass-immunization model, where 4 physicians and 2 nurses operate in each island, with up to 10 islands functioning at the same time, with the capacity of providing up to 6,000 vaccinations per day. During the first week of activity a total of 37,900 doses were administered (2,700/day), most of them with Pfizer vaccine (85.8%) and first doses (70.9%). The productivity was 10.5 vaccines/hour/vaccine station. Quality, efficiency and safety were boosted by ad-hoc personnel training, quality technical infrastructure and the presence of a shock room. Constant process monitoring allowed to identify and promptly tackle process pitfalls, including vaccine refusals (0.36%, below expectations) and post-vaccinations adverse reactions (0.4%). Our innovative "vaccine islands" mass-immunization model might be scaled-up or adapted to other settings. The Authors consider that sharing best practices in immunization delivery is fundamen-tal to achieve population health during health emergencies.


Assuntos
COVID-19/prevenção & controle , Centros Comunitários de Saúde/organização & administração , Vacinação em Massa/organização & administração , Modelos Teóricos , Pandemias , SARS-CoV-2 , COVID-19/epidemiologia , Vacinas contra COVID-19 , Centros Comunitários de Saúde/estatística & dados numéricos , Eficiência Organizacional , Utilização de Instalações e Serviços , Arquitetura de Instituições de Saúde , Humanos , Itália/epidemiologia , Vacinação em Massa/métodos , Vacinação em Massa/estatística & dados numéricos , Melhoria de Qualidade
4.
Am J Manag Care ; 27(6): 225-226, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-34156214

RESUMO

OBJECTIVES: The COVID-19 pandemic has fundamentally changed the workflow of clinics. We applied Lean Six Sigma processes to optimize clinic workflow to reduce patient wait times and improve the patient experience. STUDY DESIGN: Prospective cohort study. METHODS: We implemented (1) pushing most extended wait times to the end of the workflow by rooming the patient directly and (2) using distractions during the waiting process by using educational videos and a timer for physician arrival in the patient exam room. We compared the patient wait times and subcomponents of Press Ganey scores as a surrogate for changes in patient experience and satisfaction from the preimplementation period (n = 277) to the 3-month (September 1, 2020, to November 30, 2020) postimplementation period (n = 218). RESULTS: There was a significant reduction in overall throughput time (38 vs 35 minutes) and wait before rooming (11 vs 8 minutes), and increased physician time with patients (15 vs 17 minutes) (P < .0001 for all). These results corresponded with a significant improvement in Press Ganey subcomponents of (1) waiting time in the exam room before being seen by the care provider, (2) degree to which you were informed about any delays, (3) wait time at clinic (from arriving to leaving), and (4) length of wait before going to an exam room (P < .001 for all). CONCLUSIONS: Simple, inexpensive measures can improve patient engagement and provide a safe setting for patients for clinic visits in the wake of COVID-19. In the future, clinics' common wait areas could be reappropriated to increase the number of clinic exam rooms.


Assuntos
Instituições de Assistência Ambulatorial/normas , COVID-19/epidemiologia , Eficiência Organizacional , Gestão da Qualidade Total , Fluxo de Trabalho , Humanos , Pandemias , Satisfação do Paciente , Projetos Piloto , Pneumonia Viral/epidemiologia , Pneumonia Viral/virologia , Estudos Prospectivos , SARS-CoV-2 , Listas de Espera
5.
Indian J Tuberc ; 68(3): 401-404, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34099209

RESUMO

BACKGROUD: Coronavirus disease (COVID-19) is a new respiratory infectious disease, and there is no vaccine currently. Previous studies have found that BCG vaccination can provide extensive protection against respiratory infectious diseases. METHODS: Herein, we obtained the latest data from the World Health Organization (WHO) as of August 12, 2020, and determined the relationship between three parameters (including the BCG vaccination coverage, human development index (HDI), and transmission classifications) and the incidence rate and mortality of COVID-19. RESULTS: The results showed that the morbidity and mortality of COVID-19 in countries with BCG vaccination recommendation were significantly lower than these in countries without BCG vaccination recommendation, and countries with lower HDI have lower morbidity and mortality. In addition, we also found that the mode of virus transmission is also related to the morbidity and mortality of COVID-19. CONCLUSIONS: Although our data supports the hypothesis that BCG vaccination is beneficial in reducing the morbidity and mortality of COVID-19, the data supporting this result may be inaccurate due to many confounders such as PCR testing rate, population characteristics, and protection strategies, the reliability of this result still needs to be verified by clinical trials.


Assuntos
Vacina BCG , COVID-19 , Saúde Global/estatística & dados numéricos , Programas de Imunização , Adjuvantes Imunológicos/uso terapêutico , Vacina BCG/imunologia , Vacina BCG/uso terapêutico , COVID-19/epidemiologia , COVID-19/prevenção & controle , Países em Desenvolvimento/estatística & dados numéricos , Eficiência Organizacional , Regulamentação Governamental , Humanos , Programas de Imunização/legislação & jurisprudência , Programas de Imunização/métodos , Mortalidade , Determinação de Necessidades de Cuidados de Saúde , SARS-CoV-2
7.
J Public Health Policy ; 42(2): 211-221, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-34088978

RESUMO

In order to effectively control spread of coronavirus 2019 (COVID-19), it is essential that jurisdictions have the capacity to rapidly trace close contacts of each and every case. Best practice guidance on how to implement such programs is urgently needed. We describe the early experience in the City and County of San Francisco (CCSF), where the City's Department of Health expanded contact tracing capability in anticipation of changes in San Francisco's 'shelter in place' order between April and June 2020. Important prerequisites to successful scale-up included a rapid expansion of the COVID-19 response workforce, expansion of testing capability, and other containment resources. San Francisco's scale-up offers a model for how other jurisdictions can rapidly mobilize a workforce. We underscore the importance of an efficient digital case management system, effective training, and expansion of supportive service programs for those in quarantine or isolation, and metrics to ensure continuous performance improvement.


Assuntos
COVID-19/epidemiologia , COVID-19/prevenção & controle , Busca de Comunicante/métodos , Administração em Saúde Pública/métodos , COVID-19/diagnóstico , Teste para COVID-19/estatística & dados numéricos , Gerenciamento de Dados/organização & administração , Eficiência Organizacional , Humanos , Pandemias , Quarentena/psicologia , SARS-CoV-2 , São Francisco/epidemiologia , Serviço Social/organização & administração
8.
Mayo Clin Proc ; 96(5): 1250-1261, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-33958056

RESUMO

The administration of spike monoclonal antibody treatment to patients with mild to moderate COVID-19 is very challenging. This article summarizes essential components and processes in establishing an effective spike monoclonal antibody infusion program. Rapid identification of a dedicated physical infrastructure was essential to circumvent the logistical challenges of caring for infectious patients while maintaining compliance with regulations and ensuring the safety of our personnel and other patients. Our partnerships and collaborations among multiple different specialties and disciplines enabled contributions from personnel with specific expertise in medicine, nursing, pharmacy, infection prevention and control, electronic health record (EHR) informatics, compliance, legal, medical ethics, engineering, administration, and other critical areas. Clear communication and a culture in which all roles are welcomed at the planning and operational tables are critical to the rapid development and refinement needed to adapt and thrive in providing this time-sensitive beneficial therapy. Our partnerships with leaders and providers outside our institutions, including those who care for underserved populations, have promoted equity in the access of monoclonal antibodies in our regions. Strong support from institutional leadership facilitated expedited action when needed, from a physical, personnel, and system infrastructure standpoint. Our ongoing real-time assessment and monitoring of our clinical program allowed us to improve and optimize our processes to ensure that the needs of our patients with COVID-19 in the outpatient setting are met.


Assuntos
Antivirais/administração & dosagem , COVID-19 , Procedimentos Clínicos , Terapia por Infusões no Domicílio , SARS-CoV-2 , Glicoproteína da Espícula de Coronavírus , Anticorpos Monoclonais/administração & dosagem , COVID-19/epidemiologia , COVID-19/terapia , Protocolos Clínicos , Procedimentos Clínicos/organização & administração , Procedimentos Clínicos/tendências , Eficiência Organizacional , Terapia por Infusões no Domicílio/métodos , Terapia por Infusões no Domicílio/normas , Humanos , Colaboração Intersetorial , Cultura Organizacional , Desenvolvimento de Programas/métodos , SARS-CoV-2/imunologia , SARS-CoV-2/isolamento & purificação , Índice de Gravidade de Doença , Glicoproteína da Espícula de Coronavírus/antagonistas & inibidores , Glicoproteína da Espícula de Coronavírus/imunologia , Estados Unidos/epidemiologia
9.
BMJ Health Care Inform ; 28(1)2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33972270

RESUMO

OBJECTIVES: We describe a hospital's implementation of predictive models to optimise emergency response to the COVID-19 pandemic. METHODS: We were tasked to construct and evaluate COVID-19 driven predictive models to identify possible planning and resource utilisation scenarios. We used system dynamics to derive a series of chain susceptible, infected and recovered (SIR) models. We then built a discrete event simulation using the system dynamics output and bootstrapped electronic medical record data to approximate the weekly effect of tuning surgical volume on hospital census. We evaluated performance via a model fit assessment and cross-model comparison. RESULTS: We outlined the design and implementation of predictive models to support management decision making around areas impacted by COVID-19. The fit assessments indicated the models were most useful after 30 days from onset of local cases. We found our subreports were most accurate up to 7 days after model run.DiscusssionOur model allowed us to shape our health system's executive policy response to implement a 'hospital within a hospital'-one for patients with COVID-19 within a hospital able to care for the regular non-COVID-19 population. The surgical scheduleis modified according to models that predict the number of new patients withCovid-19 who require admission. This enabled our hospital to coordinateresources to continue to support the community at large. Challenges includedthe need to frequently adjust or create new models to meet rapidly evolvingrequirements, communication, and adoption, and to coordinate the needs ofmultiple stakeholders. The model we created can be adapted to other health systems,provide a mechanism to predict local peaks in cases and inform hospitalleadership regarding bed allocation, surgical volumes, staffing, and suppliesone for COVID-19 patients within a hospital able to care for the regularnon-COVID-19 population. CONCLUSION: Predictive models are essential tools in supporting decision making when coordinating clinical operations during a pandemic.


Assuntos
COVID-19 , Eficiência Organizacional , Serviço Hospitalar de Emergência/organização & administração , Modelos Organizacionais , Pandemias , Previsões , Recursos em Saúde/organização & administração , Humanos , SARS-CoV-2
11.
Artigo em Inglês | MEDLINE | ID: mdl-33925160

RESUMO

Healthcare is a highly sophisticated segment of the public sector, which requires not only highly professional and competent staff, but also a properly set ratio of healthcare professionals. In the Czech Republic, the state, as the main guarantor of health care, applied strong control through price and volume control. The aim of the paper is to define the differences in the technical efficiency of public hospitals, with regard to the size of hospitals and partial types of human resources. An input-oriented Data Envelopment Analysis model (DEA model) was chosen for modeling the technical efficiency of 47 public hospitals. The personnel performance concept of the evaluation of technical efficiency was further implemented in eight specific models, from the perspective of individual input variables relative to output variables and according to different assumptions regarding the character of economies of scale. The results of technical efficiency were analyzed using correlation, regression analysis, and the Bootstrap method. The least efficient hospitals in terms of hospital size are large hospitals, and the most balanced results have been achieved by medium-sized hospitals. The average efficiency rate in models that include all selected input and output variables is highest in medium-sized hospitals, with a value of 0.866 for CRS and an efficiency rate of 0.926 for VRS. The rationalization of human resources should be implemented in order not to reduce the quality of care provided.


Assuntos
Eficiência Organizacional , Hospitais Públicos , República Tcheca , Humanos , Setor Público , Recursos Humanos
12.
Health Care Manag Sci ; 24(2): 356-374, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33835338

RESUMO

COVID-19 has disrupted healthcare operations and resulted in large-scale cancellations of elective surgery. Hospitals throughout the world made life-altering resource allocation decisions and prioritised the care of COVID-19 patients. Without effective models to evaluate resource allocation strategies encompassing COVID-19 and non-COVID-19 care, hospitals face the risk of making sub-optimal local resource allocation decisions. A discrete-event-simulation model is proposed in this paper to describe COVID-19, elective surgery, and emergency surgery patient flows. COVID-19-specific patient flows and a surgical patient flow network were constructed based on data of 475 COVID-19 patients and 28,831 non-COVID-19 patients in Addenbrooke's hospital in the UK. The model enabled the evaluation of three resource allocation strategies, for two COVID-19 wave scenarios: proactive cancellation of elective surgery, reactive cancellation of elective surgery, and ring-fencing operating theatre capacity. The results suggest that a ring-fencing strategy outperforms the other strategies, regardless of the COVID-19 scenario, in terms of total direct deaths and the number of surgeries performed. However, this does come at the cost of 50% more critical care rejections. In terms of aggregate hospital performance, a reactive cancellation strategy prioritising COVID-19 is no longer favourable if more than 7.3% of elective surgeries can be considered life-saving. Additionally, the model demonstrates the impact of timely hospital preparation and staff availability, on the ability to treat patients during a pandemic. The model can aid hospitals worldwide during pandemics and disasters, to evaluate their resource allocation strategies and identify the effect of redefining the prioritisation of patients.


Assuntos
COVID-19 , Eficiência Organizacional , Equipamentos e Provisões Hospitalares/provisão & distribuição , Hospitais , Pandemias , Alocação de Recursos , Cuidados Críticos , Procedimentos Cirúrgicos Eletivos , Humanos , Salas Cirúrgicas , Alocação de Recursos/métodos , SARS-CoV-2 , Reino Unido
13.
N Z Med J ; 134(1534): 99-113, 2021 04 30.
Artigo em Inglês | MEDLINE | ID: mdl-33927442

RESUMO

We examined the documentation underlying the decision to permit the Southern District Health Board (SDHB) to join the National Bowel Screening Programme (NBSP) at a time when it was not providing an adequate colonoscopy service for symptomatic patients. A coordinated sequence of relevant Official Information Act 1982 (OIA) requests was lodged with the New Zealand Ministry of Health (MoH), which is responsible for determining the readiness of district health boards (DHBs) to join the NBSP. However, the MoH OIA process was obfuscating, unduly long and responded only after they anticipated imminent intervention by the Office of the Ombudsman. The amount of information provided was massive, partly irrelevant and presented in an inconvenient format. It revealed that the MoH readiness process was incomplete, and permission for the SDHB to join the NBSP was given prematurely without following due process and despite concerns expressed by some MoH staff. Subsequently, the MoH has failed to admit that they made errors in this case or have any weaknesses in their readiness assessment process. The MoH readiness process failed to determine that the SDHB was not ready to join the NBSP in 2018. Concerns have been expressed in the public media that such failures have occurred with the assessment of other DHBs. The process needs to be overhauled or replaced before further permissions are granted to DHBs. Requests for information under the OIA from the MoH, and similar public entities and agencies subject to the OIA, are too easily deferred, derailed or declined. The OIA is in need of revision.


Assuntos
Neoplasias Colorretais/prevenção & controle , Detecção Precoce de Câncer/normas , Administração em Saúde Pública/legislação & jurisprudência , Garantia da Qualidade dos Cuidados de Saúde/legislação & jurisprudência , Neoplasias Colorretais/diagnóstico , Eficiência Organizacional , Acesso aos Serviços de Saúde/legislação & jurisprudência , Humanos , Nova Zelândia , Avaliação de Processos e Resultados em Cuidados de Saúde
14.
Artigo em Inglês | MEDLINE | ID: mdl-33799752

RESUMO

Companies operate in a competitive and changing environment requiring increasingly effective and efficient management strategies. Lean is a proven philosophy in the industrial sector having helped companies to adapt to rapid market changes; to economic, technical, and social complexities; and to customer needs. For this reason, companies in the service sector are adopting Lean to improve their service management and to achieve economic, social, and environmental sustainability. This paper presents a model which uses Lean tools to facilitate the introduction of Lean in the management of primary care centers. The results show the implementation of Lean improved primary care center management, achieved stated objectives, and demonstrated faster adaptation to environmental needs and changes. The Lean philosophy developed and applied in the primary care center proved useful at a professional level facilitating developmental changes and prompting lasting improvements by developing a sustainable work culture.


Assuntos
Atenção à Saúde , Melhoria de Qualidade , Eficiência Organizacional , Instalações de Saúde , Atenção Primária à Saúde
15.
Health Care Manag Sci ; 24(2): 273-285, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33651316

RESUMO

Malaysia was faced with a life-threatening crisis in combating COVID-19 with a number of positive cases reaching 5305 and 88 deaths by 18th April 2020 (the first detected case was on 25th January 2020). The government rapidly initiated a public health response and provided adequate medical care to manage the public health crisis during the implementation of movement restrictions, starting 18th March 2020, throughout the country. The objective of this study was to investigate the relative efficiency level of managing COVID-19 in Malaysia using network data envelopment analysis. Malaysia state-level data were extracted from secondary data sources which include variables such as total number of confirmed cases, death cases and recovered cases. These variables were used as inputs and outputs in a network process that consists of 3 sub processes i) community surveillance, ii) medical care I and iii) medical care II. A state-level analysis was performed according to low, medium and high population density categories. The efficiency level of community surveillance was highest compared to medical care processes, indicating that the overall inefficiency is greatly influenced by the inefficiency of the medical care processes rather than the community surveillance process. Results showed that high-density category performed well in both community surveillance and medical care II processes. Meanwhile, low-density category performed better in medical care I process. There was a good overall performance of the health system in Malaysia reflecting a strong preparedness and response level to this pandemic. Furthermore, resource allocation for rapid response was distributed effectively during this challenging period.


Assuntos
COVID-19/tratamento farmacológico , COVID-19/prevenção & controle , Atenção à Saúde/normas , Eficiência Organizacional , Algoritmos , Bases de Dados Factuais , Humanos , Malásia , Pandemias/prevenção & controle , Vigilância da População , Saúde Pública , SARS-CoV-2
16.
Int J Pediatr Otorhinolaryngol ; 144: 110650, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33756390

RESUMO

OBJECTIVES: By utilizing process improvement methodology, we aim to: 1) create an ambulatory surgical efficiency model (SEM) confined to an inpatient setting, and 2) reduce patient wait time and improve patient flow within the operating room. METHODS: A prospective cohort of all otolaryngology cases performed from May 2016 to October 2017 at a tertiary, academic, pediatric hospital. Intraoperative timestamps were collected to determine turnover times. Time to procedure was collected from clinic visit to the day of operation. RESULTS: A total of 5955 patients were enrolled. 3393 cases were performed prior to the implementation of SEM and 2562 after. Of the 2562 cases, 819 were deemed appropriate for the SEM. Prior to the SEM, the average number of working days between the clinic visit and operating room (WD) was 31.1 days (95% CI 30.7-31.4). After the SEM, the WD for non-SEM cases was 30.0 days (95% CI 29.7-30.2), and the WD for SEM cases was 14.4 days (95% CI 14.2-14.6). The average turnover time was significantly less for SEM cases at 11.4 min (95% CI 10.7-12.2) vs. non-SEM cases at 24.4 min (95% CI 23.9-25.0) (p < 0.0001). CONCLUSION: Process improvement methodology is effective in improving perioperative patient flow. This quality improvement project decreased the average time from diagnosis to surgical procedure, as well as decreased the average turnover time between cases. Patient flow can improve with a high-volume SEM within an inpatient hospital operating room setting. This strategy can be instrumental in improving patient care by providing increased access to the operating room.


Assuntos
Procedimentos Cirúrgicos Ambulatórios , Pacientes Internados , Criança , Eficiência Organizacional , Humanos , Salas Cirúrgicas , Estudos Prospectivos , Melhoria de Qualidade
17.
BMC Health Serv Res ; 21(1): 271, 2021 Mar 24.
Artigo em Inglês | MEDLINE | ID: mdl-33761931

RESUMO

BACKGROUND: Since operating rooms are a major bottleneck resource and an important revenue driver in hospitals, it is important to use these resources efficiently. Studies estimate that between 60 and 70% of hospital admissions are due to surgeries. Furthermore, staffing cannot be changed daily to respond to changing demands. The resulting high complexity in operating room management necessitates perpetual process evaluation and the use of decision support tools. In this study, we evaluate several management policies and their consequences for the operating theater of the University Hospital Augsburg. METHODS: Based on a data set with 12,946 surgeries, we evaluate management policies such as parallel induction of anesthesia with varying levels of staff support, the use of a dedicated emergency room, extending operating room hours reserved as buffer capacity, and different elective patient sequencing policies. We develop a detailed simulation model that serves to capture the process flow in the entire operating theater: scheduling surgeries from a dynamically managed waiting list, handling various types of schedule disruptions, rescheduling and prioritizing postponed and deferred surgeries, and reallocating operating room capacity. The system performance is measured by indicators such as patient waiting time, idle time, staff overtime, and the number of deferred surgeries. RESULTS: We identify significant trade-offs between expected waiting times for different patient urgency categories when operating rooms are opened longer to serve as end-of-day buffers. The introduction of parallel induction of anesthesia allows for additional patients to be scheduled and operated on during regular hours. However, this comes with a higher number of expected deferrals, which can be partially mitigated by employing additional anesthesia teams. Changes to the sequencing of elective patients according to their expected surgery duration cause expectable outcomes for a multitude of performance indicators. CONCLUSIONS: Our simulation-based approach allows operating theater managers to test a multitude of potential changes in operating room management without disrupting the ongoing workflow. The close collaboration between management and researchers in the design of the simulation framework and the data analysis has yielded immediate benefits for the scheduling policies and data collection efforts at our practice partner.


Assuntos
Salas Cirúrgicas , Admissão e Escalonamento de Pessoal , Agendamento de Consultas , Simulação por Computador , Eficiência Organizacional , Humanos , Políticas , Fluxo de Trabalho
19.
Bone Joint J ; 103-B(2): 347-352, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33517742

RESUMO

AIMS: Surgical costs are a major component of healthcare expenditures in the USA. Intraoperative communication is a key factor contributing to patient outcomes. However, the effectiveness of communication is only partially determined by the surgeon, and understanding how non-surgeon personnel affect intraoperative communication is critical for the development of safe and cost-effective staffing guidelines. Operative efficiency is also dependent on high-functioning teams and can offer a proxy for effective communication in highly standardized procedures like primary total hip and knee arthroplasty. We aimed to evaluate how the composition and dynamics of surgical teams impact operative efficiency during arthroplasty. METHODS: We performed a retrospective review of staff characteristics and operating times for 112 surgeries (70 primary total hip arthroplasties (THAs) and 42 primary total knee arthroplasties (TKAs)) conducted by a single surgeon over a one-year period. Each surgery was evaluated in terms of operative duration, presence of surgeon-preferred staff, and turnover of trainees, nurses, and other non-surgical personnel, controlling cases for body mass index, presence of osteoarthritis, and American Society of Anesthesiologists (ASA) score. RESULTS: Turnover among specific types of operating room staff, including the anaesthesiologist (p = 0.011), circulating nurse (p = 0.027), and scrub nurse (p = 0.006), was significantly associated with increased operative duration. Furthermore, the presence of medical students and nursing students were associated with improved intraoperative efficiency in TKA (p = 0.048) and THA (p = 0.015), respectively. The presence of surgical fellows (p > 0.05), vendor representatives (p > 0.05), and physician assistants (p > 0.05) had no effect on intraoperative efficiency. Finally, the presence of the surgeon's 'preferred' staff did not significantly shorten operative duration, except in the case of residents (p = 0.043). CONCLUSION: Our findings suggest that active management of surgical team turnover and composition may provide a means of improving intraoperative efficiency during THA and TKA. Cite this article: Bone Joint J 2021;103-B(2):347-352.


Assuntos
Artroplastia de Quadril , Artroplastia do Joelho , Eficiência Organizacional , Equipe de Assistência ao Paciente/organização & administração , Humanos , Relações Interprofissionais , Duração da Cirurgia , Reorganização de Recursos Humanos , Estudos Retrospectivos
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