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      Assessment of operative times of multiple surgical specialties in a public university hospital Translated title: Avaliação dos tempos operatórios das múltiplas especialidades cirúrgicas de um hospital universitário público

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          ABSTRACT

          Objective

          To evaluate the indicators duration of anesthesia, operative time and time patients stay in the operating rooms of different surgical specialties at a public university hospital.

          Methods

          It was done by a descriptive cross-sectional study based on the operating room database. The following stages were measured: duration of anesthesia, procedure time and patient length of stay in the room of the various specialties. We included surgeries carried out in sequence in the same room, between 7:00 a.m. and 5 p.m., either elective or emergency. We calculated the 80th percentile of the stages, where 80% of procedures were below this value.

          Results

          The study measured 8,337 operations of 12 surgical specialties performed within one year. The overall mean duration of anesthesia of all specialties was 178.12±110.46 minutes, and the 80th percentile was 252 minutes. The mean operative time was 130.45±97.23 minutes, and the 80th percentile was 195 minutes. The mean total time of the patient in the operating room was 197.30±113.71 minutes, and the 80th percentile was 285 minutes. Thus, the variation of the overall mean compared to the 80th percentile was 41% for anesthesia, 49% for surgeries and 44% for operating room time. In average, anesthesia took up 88% of the operating room period, and surgery, 61%.

          Conclusion

          This study identified patterns in the duration of surgery stages. The mean values of the specialties can assist with operating room planning and reduce delays.

          RESUMO

          Objetivo

          Avaliar os indicadores de tempo da anestesia, da operação e da permanência do paciente em sala de diversas especialidades do centro cirúrgico de um hospital universitário.

          Métodos

          Foi realizado em estudo descritivo transversal a partir da base de dados do centro cirúrgico e mensuradas as seguintes etapas: duração de anestesia, tempo do procedimento e tempo de permanência do paciente em sala das diversas especialidades. Foram incluídas as operações realizadas em sequência na mesma sala, das 7h às 17h, eletivas ou de urgências. Realizamos o calculo do percentil 80 da duração das etapas, onde 80% dos procedimentos ficaram abaixo deste valor obtido.

          Resultados

          O estudo incluiu 8.337 operações realizadas no período de 1 ano de 12 especialidades cirúrgicas. A média geral da duração da anestesia de todas as especialidades foi de 178,12±110,46 minutos, e o percentil 80 foi de 252 minutos. A média do tempo operatório foi 130,45±97,23 minutos, e o percentil 80 foi de 195 minutos. A média do tempo total do paciente em sala operatória foi de 197,30±113,71 minutos, e o percentil 80 foi de 285 minutos. A variação da média geral em relação ao percentil 80 foi de 41% na anestesia, 49% nas operações e 44% no tempo de sala. Na média geral, a anestesia ocupou 88% do tempo de sala e a operação, 61%.

          Conclusão

          Este estudo identificou padrões nas durações das etapas das operações. A informação das médias históricas das especialidades pode auxiliar no planejamento do centro cirúrgico e diminuir os atrasos.

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          Most cited references13

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          Operating room planning and scheduling: A literature review

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            Use of lean and six sigma methodology to improve operating room efficiency in a high-volume tertiary-care academic medical center.

            Operating rooms (ORs) are resource-intense and costly hospital units. Maximizing OR efficiency is essential to maintaining an economically viable institution. OR efficiency projects often focus on a limited number of ORs or cases. Efforts across an entire OR suite have not been reported. Lean and Six Sigma methodologies were developed in the manufacturing industry to increase efficiency by eliminating non-value-added steps. We applied Lean and Six Sigma methodologies across an entire surgical suite to improve efficiency. A multidisciplinary surgical process improvement team constructed a value stream map of the entire surgical process from the decision for surgery to discharge. Each process step was analyzed in 3 domains, ie, personnel, information processed, and time. Multidisciplinary teams addressed 5 work streams to increase value at each step: minimizing volume variation; streamlining the preoperative process; reducing nonoperative time; eliminating redundant information; and promoting employee engagement. Process improvements were implemented sequentially in surgical specialties. Key performance metrics were collected before and after implementation. Across 3 surgical specialties, process redesign resulted in substantial improvements in on-time starts and reduction in number of cases past 5 pm. Substantial gains were achieved in nonoperative time, staff overtime, and ORs saved. These changes resulted in substantial increases in margin/OR/day. Use of Lean and Six Sigma methodologies increased OR efficiency and financial performance across an entire operating suite. Process mapping, leadership support, staff engagement, and sharing performance metrics are keys to enhancing OR efficiency. The performance gains were substantial, sustainable, positive financially, and transferrable to other specialties. Copyright © 2011 American College of Surgeons. Published by Elsevier Inc. All rights reserved.
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              Optimization and planning of operating theatre activities: an original definition of pathways and process modeling

              Background The Operating Room (OR) is a key resource of all major hospitals, but it also accounts for up 40 % of resource costs. Improving cost effectiveness, while maintaining a quality of care, is a universal objective. These goals imply an optimization of planning and a scheduling of the activities involved. This is highly challenging due to the inherent variable and unpredictable nature of surgery. Methods A Business Process Modeling Notation (BPMN 2.0) was used for the representation of the “OR Process” (being defined as the sequence of all of the elementary steps between “patient ready for surgery” to “patient operated upon”) as a general pathway (“path”). The path was then both further standardized as much as possible and, at the same time, keeping all of the key-elements that would allow one to address or define the other steps of planning, and the inherent and wide variability in terms of patient specificity. The path was used to schedule OR activity, room-by-room, and day-by-day, feeding the process from a “waiting list database” and using a mathematical optimization model with the objective of ending up in an optimized planning. Results The OR process was defined with special attention paid to flows, timing and resource involvement. Standardization involved a dynamics operation and defined an expected operating time for each operation. The optimization model has been implemented and tested on real clinical data. The comparison of the results reported with the real data, shows that by using the optimization model, allows for the scheduling of about 30 % more patients than in actual practice, as well as to better exploit the OR efficiency, increasing the average operating room utilization rate up to 20 %. Conclusions The optimization of OR activity planning is essential in order to manage the hospital’s waiting list. Optimal planning is facilitated by defining the operation as a standard pathway where all variables are taken into account. By allowing a precise scheduling, it feeds the process of planning and, further up-stream, the management of a waiting list in an interactive and bi-directional dynamic process.
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                Author and article information

                Journal
                Einstein (Sao Paulo)
                Einstein (Sao Paulo)
                eins
                Einstein
                Instituto Israelita de Ensino e Pesquisa Albert Einstein
                1679-4508
                2317-6385
                Apr-Jun 2017
                Apr-Jun 2017
                : 15
                : 2
                : 200-205
                Affiliations
                [1 ]Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
                [2 ]Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil;
                [3]Hospital São Paulo, Universidade Federal de São Paulo, São Paulo, SP, Brazil.
                Author notes
                Corresponding author: Altair da Silva Costa Jr. – Rua Napoleão de Barros, 715, 4th floor – Vila Clementino – Zip code: 04024-002 – São Paulo, SP, Brazil – Phone: (55 11) 5576-4295. E-mail: altair.torax@ 123456gmail.com

                Conflict of interest: none.

                Article
                S1679-45082017GS3902
                10.1590/S1679-45082017GS3902
                5609617
                28767919
                ecd7eca2-5992-4cd7-96d4-46ccc4b90629

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 20 October 2016
                : 28 January 2017
                Page count
                Figures: 8, Tables: 6, Equations: 0, References: 16, Pages: 6
                Categories
                Health Economics and Management

                quality indicators, health care,operating rooms,operative time,health information management,time management,specialties, surgical

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