Surgical Services

Labor and delivery nurse staffing as a cost-effective safety intervention

Numerous studies have identified a relationship between staffing levels and nurse-sensitive outcomes for medical and surgical patients, but little has been published on the impact of nurse-sensitive outcomes for the childbearing family and even less that examines the relationship of intrapartum staffing on adverse perinatal outcomes.

1.3 million adverse events prevented in U.S. hospitals since 2010, feds say

The Agency for Healthcare Research and Quality estimates that 1.3 million fewer patients were harmed in U.S. hospitals from 2010 to 2013 amid focused and widespread efforts to reduce surgical-site infections, adverse drug events and other preventable incidents.

Hospitals are finally starting to put real-time data to use

In the past few years, healthcare organizations in the United States have spent tens of billions of dollars on IT. Much of this investment has been in response to the "meaningful use" section of the American Investment & Recovery Act of 2009 and provisions in the Affordable Care Act of 2010, which required health providers to invest in patients' electronic health records and allow for electronic data reporting to the government.

"Empowering staff can't be just lip service": Interview with Dr. Greg Jacobson

The more cumbersome it is for someone to engage in improvement work, the less likely they are to do so. I think that the key is: People need to feel empowered, but it can't be just lip service. It has to go that extra step, where people recognize and see that they are empowered.

Perioperative Efficiency Tool Kit 2013 - AORN

Patient safety, patient satisfaction, and patient flow are all important elements of operational efficiency in the perioperative setting. Opportunities exist to improve patient safety, the coordination of care, minimize delays and wastes, increase operating room utilization, and enhance the perioperative experience for the patient and family, as well as the perioperative team members. This learning activity is intended to discuss ways to implement actions to optimize perioperative patient flow and operational efficiency with an emphasis on safe patient preparation, starting surgeries on time (first case starts), and room turnover.

Clemson University IE department researcher focuses on patient safety initiatives

Clemson University research assistant professor Ashley Kay Childers has been selected to participate in a forum to discuss quality improvement programs in U.S. hospitals that reduce preventable readmissions, prevent medical errors, improve patient outcomes and cut costs.

Operating Room staffing and allocation

Dr. Dexter provides an innovative and practical approach to staffing and allocation of operating room (OR) time to reduce overall OR expense and reduce variability in late staffing. The presentation has links to an intensive course in OR management offered through the University of Iowa.

Re-engineering the operating room using variability methodology to improve healthcare value

This is a summary presentation of one year results from a project at Mayo Clinic in Florida aimed at improving the operational performance of a hospital's operating rooms by assessing and managing variability. The changes resulted in a 5 per cent increase in OR utilization and net revenue and a 27 percent reduction in overtime. These data were also published in the June 2013 Journal of The American College of Surgeons.

Use of Lean and Six Sigma methodology to improve operating room efficiency in a high-volume tertiary-care academic medical center

Researchers applied Lean and Six Sigma methodologies to improve OR efficiency. Multidisciplinary teams addressed minimizing volume variation; streamlining the preoperative process; reducing non-operative time; eliminating redundant information; and promoting employee engagement.

Using lean methods to improve OR turnover times

The article describes the application of lean methods to improve OR turnover times. Key to the approach is differentiating turnover requirements by surgical specialty and developing standard work in a job breakdown structure for individual roles in the process. This approach can be applied to other healthcare processes where consistent performance is necessary for safe patient care and improving cycle times.

Complexities in the operating room - Focus on OR turnover times

Identifying the areas of improvement in an effort to reduce operation room turnaround time and the inaccuracy of surgery scheduling is explored through case study examples including first person observations from the University of Pittsburgh industrial engineering case study at UPMC Presbyterian and Montefiore Surgery Departments. This article was previously published in the proceedings of the 2012 Industrial and Systems Engineering Research Conference.

Evaluating the financial viability of particular operative procedures using TDABC - 2013 Healthcare Systems Process Improvement Conference presentation

To improve revenues, the Sir Mortimer B. Davis Jewish General Hospital needed to determine the financial viability of particular surgical procedures. This presentation discusses how the hospital used TDABC to determine costs, utilization, and potential process improvements for cataract surgeries to determine whether it should do more or less of them. The approach can be applied to other surgical specialties to identify areas of opportunities and priorities.

Driving value through clinical practice variation reduction: A case study for total joint replacement process improvement

This paper and presentation delivered at the 2013 Healthcare Systems Process Improvement Conference describes work done in the Ochsner Health System to reduce orthopedic joint replacement costs and improve quality for the patient. High quality care at an affordable cost is an attainable goal that is both in the best interest of the patient and the healthcare system. Driving value through minimization of clinical variation enabled OHS to meet a higher standard of patient care while ensuring the long-term financial stability of the organization.

Effective use of simulation in scenario development for relocation planning

This presentation was originally delivered at the Society for Health System's 2013 Healthcare Systems Process Improvement Conference in New Orleans. Shands Healthcare's Management Engineering was asked to model the impact to resource utilization of the Pre-Op/PACU/OR area resulting from relocating the current GI/ENDO procedure suites from North to South Tower. A dynamic simulation model was developed as the most effective and timely method to model the current operational state plus three future growth scenarios.

Applying science and strategy to operating room workforce management

This article in Medscape Today describes an approach at Cleveland Clinic to improving management of the operating room workforce. It provides some interesting reference values for average staffing per room, skill mix and in-room staff utilization percentages.

Behind the scenes of inventory management: A generalized approach

This presentation at the 2013 Healthcare Systems Process Improvement Conference is focused on describing a generalized strategy for improving inventory management using communication, spatial layout, and physical organization, standardization of process and inventory par levels. In healthcare settings, particularly surgery, creating or establishing this standard requires a complete system perspective of inventory.

Surviving the global healthcare perfect storm

The authors describe the application of operational planning and capacity management methods to improve patient care, improve revenue, and lower costs. Article 

Tools for Improvement - Education in operating room management 

The University of Iowa has a public access website that provides lecture slides for a comprehensive OR Management course offered by the Carver College of Medicine. Readers may contact the University of Iowa for more information about the course or Web conferencing options.

Original films of Frank B. Gilbreth 

Part 1 & Part 2
From Internet Archive website, these films are essentially a summary of work analysis films which were taken by Frank B. Gilbreth between 1910 and 1924 showing a number of industrial operations from which the motion study technique was developed.
This movie is part of the collection: Prelinger Archives.
Producer: Presented by James S. Perkins in collaboration with Dr. Lillian M. Gilbreth & Dr. Ralph M. Barnes
Sponsor: Chicago Chapter of the Society for the Advancement of Management

Total productive maintenance in the OR - A case study at Kadlec Regional Medical Center

A team at Kadlec Regional Medical Center in Richland, Wash., took a lean approach to improving the availability and reliability of anesthesia related equipment in the OR. The team included physicians, staff, and external consultants. The article describes the background of total productive maintenance and how it was applied by a multidisciplinary team including physicians, OR staff, and clinical engineering. View related photos 

Purdue industrial engineering researchers investigate using surgeon hand gestures to improve surgery 

Vision based recognition of hand gestures is being researched at Purdue University to control a robotic scrub nurse and access images during surgical cases. The research could lead to short case lengths and reduced infections according to the Purdue University News website.

Helping a hospital shine

In an article previously published in Industrial Engineer magazine, industrial engineering researchers at Clemson University assisted Cannon Memorial Hospital in Pickens, S.C., in a number of hospital-wide and service specific improvements resulting in increased efficiency.

The art of implementing Lean from AORN Management Connections

A recent article in AORN Management Connections by Carina Stanton describes how three healthcare organizations are implementing lean.

Adding value to the surgical PAT process

Using Lean Six Sigma tools, a hospital redesigns its PAT department process so that all charting is completed 72 hours prior to the day of surgery.

Pioneers of Industrial Engineering and Health Care : Part 1

This article profiles Frank Gilbreth and Henry Ford. Gilbreth initiated the study of time and motion in the OR, and Ford was the first to attempt to decrease wasted motion among nursing staff.

Helping a Hospital Shine

Lean tools are used to redesign processes throughout a hospital.

Paging Dr Toyota

Discussion of applications of lean within the OR.

Attacking Waste and Variation Hospital-Wide: A Comprehensive Lean Sigma Deployment

Improvement projects in surgery, nursing, and the ED are discussed. The process of moving a hospital towards adoption of Lean Six Sigma is also described.

Using Lean Methodology to Improve Patient Safety and Clinical Quality

Three successful lean projects are discussed in detail. Specimen Labeling, Surgery and Endoscopy Pre-Op, and Inpatient Nursing Crash Cart projects all demonstrate significant improvement.

Putting Data Into Action in the Operating Room Setting

New ways to display OR data are proposed in this presentation.

Optimization of Surgical Scheduling

An OR's case scheduling process is studied; improvement projects are proposed.

Improving Patient Care - Case Carts and the Operating Room

Reasons for delay in creation of case carts are addressed. SPD often has inefficient workarounds as part of their daily routine.

Continued Barriers to Operational and Financial Performance in Surgical Services

Surgical services projects often have many barriers to success; this presentation helps illuminate and identify where they may be for your hospital.

Streamlining Your OR

A hospital undertakes a systemic improvement of their OR suite. The process and final results are detailed.

Optimization of Overtime Costs and Operating Room Utilization

A program is proposed that effectively confronts a majority of the issues with scheduling patient surgeries.

Our Lean Journey Continues and What A Year It's Been!

Lean projects at Kaiser Permanente are detailed and discussed. The report is a system-level presentation showing many departmental improvements.

Reducing Inventory Waste Through Material Pull

A pull system is implemented within a surgical suite, saving on inventory cost. Other accomplishments and lessons learned are discussed.

Using Lean Techniques to Improve Turnaround Time and First Case Starts in the Operating Room

Turnarounds and first case starts are improved using a variety of lean techniques. Sustainability, achievement of buy-in and metric details are also discussed.

Improving Surgical Services Through Enhanced Ancillary Support

Lean improvement projects are performed within the supplies delivery function of a surgical services suite.