Nurse-doctor integration management mode in improving surgical room operation efficiency

Objective To explore the clinical application of 5S methodology in the operation room of nursing management, and to provide reference for daily management. Methods A total of 2 459 patients were chosen from October 2012 to May 2014. 1 147 Patients from October 2012 to June 2013 were in the control group that given regular nursing management, while 1 312 patients from July 2013 to May 2015 were as experimental group and underwent 5S methodology. Quality of operation nursing management were compared before and after using 5S methodology, and managerial experience was summarized. Results The items readiness rate, equipment readiness rate, use of intact rate and emergency items readiness rate were 96.95%, 98.70%, 99.77% and 97.79%, respectively, and there were statistically significance between the two groups (χ2=10.52, 12.33, 8.76, 9.28, respectively; P<0.05). In the experimental group, the air bacteria detection index, time of fetching items and time of supplementing items were (29.71±5.94)cfu/m3, (18.34±6.42)and (17.85±5.89)s, which were better than those in the control group (t=132.48, 21.27, 26.18, respectively; P<0.05). For the satisfaction of medical staffs and patients, the experimental group (89.42% and 92.38%) were better than control group, the differences were statistically significant (χ2=8.56, 9.41; P<0.05). Conclusions The implement of 5S methodology can help to improve the efficiency of nursing management in operation room, and promote the operation room overall work efficiency and quality. Key words: Operation room nursing; 5Smethodology; Quality of management

Objective To study the effect of teamwork combined with risk management in pediatric nursing. Methods A total of 188 pediatric patients were selected as the research objects of this study from February 2013 to December 2014. Among them 92 pediatric patients admitted to the hospital from February to December 2013 were set as the control group, who adopted the traditional routine nursing management mode; another 96 pediatric patients admitted to hospital fromJanuary 2014 to December 2014 were set as the observation group, who accepted teamwork combined with risk management nursing mode. Quality of care, nursing complaints, risk events, team total score and satisfaction index of two group were compared. Results The therapeutic nursing, psychological nursing, health education, nursing quality of life scored 98.02±2.61, 97.27±2.46, 97.16±3.18, 98.21±3.08 in the observation group, which were significantly higher than those of the control group (84.28±1.92, 86.09±1.87, 82.64±2.17, 85.58±2.29) with significant difference (t=6.891-9.426, P<0.01). The risk events ratio, nursing complaints ratios were 2.08% (2/96), 2.08% (2/96) in the observation group, which were lower than those of the control group 10.87% (10/92), 13.04% (12/92), and the difference was statistically significant (χ2=6.069,8.187, P<0.05). The total score of team cooperation was 3.86±1.09 in the observation group, and 2.67±1.05 in the control group (t=2.410, P<0.01). The satisfaction degree in the observation group was 51.04% (49/96), which was significantly higher than the control group, 44.57% (41/92) , with significant difference (χ2=7.221, P<0.05). Conclusions Applying teamwork combined with risk management nursing mode to pediatrics may improve teamwork and the quality of nursing management and nursing quality, reduce risk events and nursing complaints, ease the poor mental symptoms of families, and improve satisfaction. Key words: Pediatric nursing; Risk adjustment; Cooperative behavior; Nursing audit

Objective To summarize the application effects of two different methods of replacing quilt covers in the operating room. Methods Between February 2016 to August 2016, 360 cases in thousand-grade clean surgery with elective surgical procedures, were randomly divided into control group (n=180) and observation group (n=180) . The observation group used improved method to replace quilt covers, and the control group used the traditional method. Air sampling at different time points, the turnaround time between operations and the nurse and patient satisfaction of the two groups were compared. Results Compared with the control group, air cleanliness at different time points changed significantly in the observation group. Moreover, the turnaround time in the observation group was significantly shorten than that in the control group, and the nurse and patient satisfaction were more improved in the observation group. All the differences were statistically significant (P<0.05) . Conclusions Application of improved method to replace quilt covers can effectively improve air cleanliness, reduce the surgical infection rate, shorten the cohesion of the surgery time and improve the patients' satisfaction. Key words: Operating room; Nursing care; Patient satisfaction; Replace quilt cover

Effective leadership is critical to ensuring safety, efficiency and maximum productivity in the operating room (OR). This practical, evidence-based book unpicks the dynamics of a successful OR environment to underline the key techniques for management of policies, systems, staff members and teams. Fully updated to include recent clinical guidelines, the book provides the 'A-Z' of OR management, including sections on metrics, scheduling, human resource management, leadership principles, economics, quality assurance, recovery and ambulatory practice. New chapters include future healthcare models, emergency preparedness and budgets amongst other topics. Written by authors with unrivalled experience in the field, chapters are laid out in an easy and clinically helpful format to assist learning, and real-life case studies cover 73 different clinically relevant pain topics. This book is an essential guide for anyone working in the OR including anaesthesiologists, surgeons, nurses, and administrators.

Because most anesthesiologists work in the operating room setting, anesthesiologists are involved with the management of the operating room suite (or “theater”). Even if they are not responsible for the management, anesthesiologists still want to understand the decision-making process and metrics that affect their daily schedule and duties. In the United States, anesthesiologists can attend in-person conferences and seminars on leadership, practice management, and operating room management offered by national associations, online webinars and resources, and textbooks. Although these offerings will give anesthesiologists groundwork for calculations of metrics, e.g., productivity and efficiency, an in-depth discussion is not done.In contrast, Practical Operating Theater Management: Measuring and Improving Performance and Patient Experience provides the reader in-depth materials on data-driven metrics, including operating room efficiency, productivity, utilization, and scheduling. The book purposely is designed not to cover leadership or management styles but focuses on collecting and employing operating room data in a manner that is practical and applicable.The book has two functional sections. The first includes an introduction and eight chapters that cover the terms and principal content, as well as efficiency, productivity, scheduling, planning, staffing and contracts, operating room finances, and preoperative patient preparation. The second section contains five chapters examining operating room management in different countries, including Japan, The Netherlands, Switzerland, Australia, and the United States. Chapter 14 then covers operating room safety, and chapter 15 (the last) provides an overview of the book by a contributor.Some of the topics discussed include the different formats used to manage surgical block times, as well the importance of normalizing terms and definitions so the collected data can be reported, analyzed, and acted upon effectively. Among the data that proves useful to collect is operating room capacity, demand by surgeons, utilization rate, overruns, cancellation rate, start times, and turnover times, with some of these bundled into key performance indicators. Of these, efficiency (as defined in chapter 2), on-time start, and turnover times are considered fundamental.Chapter 2 is central to the book, and in it the author cautions that the much-used and maligned measurement of on-time starts or cancellation rates by themselves are a poor measure of overall operating room efficiency. Efficiency as a measurement is clearly defined in a mathematical formula, and the manner in which operating room management decisions affect it is discussed in detail. Subsequent chapters cover measures of productivity (chapter 3) and strategies for scheduling (chapter 4), with an emphasis on maintaining and utilizing a real-time database of facility-specific surgical times, capacity planning of schedules, and add-on operating room capacity (chapter 5). Operating room staff contracts and the prominent role of staffing in providing the capacity is covered in chapter 6. Chapters 7 and 8 cover operating room finances and preoperative patient preparation, respectively.Although the book’s editor and major contributors are from the United Kingdom, the concepts are applicable to operating room management in the United States as well as other countries. In fact, the latter half of the book explores the similarities and differences in operating room management in different countries, including New Zealand, Japan, The Netherlands, Switzerland, and the United States. It is amazing that anesthesiologists from many different countries face similar challenges.For data-driven metrics, it is not surprising that the book relies on a mathematical approach to data. This math-heavy approach would be more appealing to business-trained operating room managers rather than physicians, although the author did attempt to make it more accessible by incorporating these formulas into Excel spreadsheets. We believe anyone interested in implementing data-driven decision-making processes will be able to follow the mathematical progression that occurs in the first half of the book.Overall, this book is a useful resource to anesthesiologists, operating room managers, and financial analysts on the topics of data-driven metrics. It provides a unique educational resource for those who are new to the topic of operating room efficiency, utilization, and productivity. For those who have been working with these concepts, the book provides a resource to reexamine our formulas with an international perspective.

MP68-19 USE OF THE OR BLACK BOX® TO EVALUATE OPERATING ROOM ECONOMIC EFFICIENCY

Gains in operating room (OR) scheduling may be obtained by using accurate statistical models to predict surgical and procedure times. The 3 main contributions of this article are the following: (i) the validation of Strum's results on the statistical distribution of case durations, including surgeon effects, using OR databases of 2 European hospitals, (ii) the use of expert prior expectations to predict durations of rarely observed cases, and (iii) the application of the proposed methods to predict case durations, with an analysis of the resulting increase in OR efficiency. We retrospectively reviewed all recorded surgical cases of 2 large European teaching hospitals from 2005 to 2008, involving 85,312 cases and 92,099 h in total. Surgical times tended to be skewed and bounded by some minimally required time. We compared the fit of the normal distribution with that of 2- and 3-parameter lognormal distributions for case durations of a range of Current Procedural Terminology (CPT)-anesthesia combinations, including possible surgeon effects. For cases with very few observations, we investigated whether supplementing the data information with surgeons' prior guesses helps to obtain better duration estimates. Finally, we used best fitting duration distributions to simulate the potential efficiency gains in OR scheduling. The 3-parameter lognormal distribution provides the best results for the case durations of CPT-anesthesia (surgeon) combinations, with an acceptable fit for almost 90% of the CPTs when segmented by the factor surgeon. The fit is best for surgical times and somewhat less for total procedure times. Surgeons' prior guesses are helpful for OR management to improve duration estimates of CPTs with very few (<10) observations. Compared with the standard way of case scheduling using the mean of the 3-parameter lognormal distribution for case scheduling reduces the mean overreserved OR time per case up to 11.9 (11.8-12.0) min (55.6%) and the mean underreserved OR time per case up to 16.7 (16.5-16.8) min (53.1%). When scheduling cases using the 4-parameter lognormal model the mean overutilized OR time is up to 20.0 (19.7-20.3) min per OR per day lower than for the standard method and 11.6 (11.3-12.0) min per OR per day lower as compared with the biased corrected mean. OR case scheduling can be improved by using the 3-parameter lognormal model with surgeon effects and by using surgeons' prior guesses for rarely observed CPTs. Using the 3-parameter lognormal model for case-duration prediction and scheduling significantly reduces both the prediction error and OR inefficiency.

Objective To explore the effects of WeChat group in teaching of standardized training among Operating Room nurses. Methods A total of 28 nurses accepting standardized training in Operating Room were selected as control group (standardized training) from July 2011 to December 2012. A total of 28 nurses accepting standardized training in Operating Room were selected as intervention group (standardized training & WeChat group teaching ) from January 2013 to July 2014. What was compared after intervention among nurses between two groups included theoretical knowledge, the score of operation skill, nurses′ satisfaction with training, the satisfaction degree of patients and family members and surgeons′ satisfaction with nurses. Results After the intervention with WeChat group teaching, scores of theoretical knowledge and technical knowledge were (96.3±3.6) and (94.5±4.6) in intervention group which were higher than those in control group with significant differences (t=-8.652, -7.254; P 0.05). Scores of suture needle, aseptic technique, transferring equipment in operation, arranging surgical position, surgery cooperation were (92.1±6.2), (91.6±5.2), (95.6±3.3), (96.2±3.6), (97.1±2.6) in intervention group which were higher than those in control group with significant differences (t=-4.125, -4.526, -3.856, -5.846, -9.032; P<0.01). Satisfaction degrees of nurses with training, surgeons with nurses, patients′ family members with treatment in intervention group were obviously better than those in control group with significant differences (P<0.01). Conclusions Training with WeChat group in nurses can visibly improve nurses′ study enthusiasm, theoretical knowledge, operation skill, satisfaction degrees of nurses with training, surgeons with nurses, patients and their family members with treatment and improve the quality of care in operating room at the same time. Key words: Operating Room; Standardized training; WeChat group

Objective To investigate application effect of micro-courses in the clinical teaching of operating room nursing, and to improve practice quality. Methods A total of 81 nursing interns of Grade 2012, majored in Nursing of Cangzhou Medical College, had internship from July 2014 to November 2014 were treated as the control group; another 82 nursing interns, who had internship from December 2014 to April 2015 were treated as the observation group. The control group applied traditional one-one teaching style, while observation group used an extra operating room nursing micro curriculum on this basis. At the end of the operating room practice, theory, skills assessment, self-satisfaction and satisfaction of teaching methods were compared. Results Observation group theory and skills assessment scores were better than the control group[(83.72±3.53) vs (71.21±4.36), (89.72±3.53) vs (81.21±4.36); t=14.58, 11.15; P<0.01)]. nursing interns self-learning satisfaction of the control group and the observation group were 88.9% and 98.8% respectively(Z=12.73, P<0.01). Nursing interns teaching methods satisfaction for operating room teaching of the control group and the observation group were 90.1% and 100.0% respectively (Z=17.12, P<0.01). Conclusions During clinical teaching of operating room nursing, micro courses could improve the quality of practice, improve nursing interns′ self-study and clinical teaching satisfaction. Key words: Nursing education; Operating room; Nursing intern; Micro courses; Clinical teaching

Objective To explore the 5S quality management for analyzing the hidden danger of nursing safety at operation room and the results. Methods 10 nurses from the operation room of our hospital were selected to form a 5S quality management group. The operating room patients from January to April, 2008 were selected before 5S quality management as a control group; and the patients from May to July 2018 after 5S quality management were selected as a study group. The item management situations before and after 5S quality management and the patients’ satisfaction to the nurses were compared between these two groups. Results After 5S quality management, the occurrence of expired items decreased obviously, and the working environment finishing time and the time of taking and putting items were shortened obviously [ (2.85±0.87) per month vs. (0.34±0.14) per month, (26.38±4.40) min vs. (15.34±2.91) min, and (33.25±12.54) min vs. (24.37±5.34) min, all P<0.05]. The patient’ satisfaction to the nurses was significantly higher in the study group than in the control group [(90.24±5.14) vs. (81.24±3.27)], with a statistical difference (P<0.05). Conclusion Application of 5S quality management in operation room nursing care can reduce the occurrence of expired articles, create a clean working environment, and improve patients' satisfaction. Key words: 5S management; Operation room; Nursing care; Results

Objective To investigate the effect of risk management in operating room of primary hospital to prevent risk in surgical nursing.Methods Nursing-related risk event in 1,124 cases of surgery from September 2012 to May 2013 (control group) was retrospectively analyzed to investigate risk factors and countermeasures.Risk management was applied for 1,182 cases of surgery from June 2013 to February 2014 (observation group) to prevent risk in surgical nursing.Incidence of risk event,satisfaction rate of surgeons and risk awareness of nurses were compared between two groups.Results Incidence of nursing-related risk event was 16.10％ in control group,and 5.16％ in observation group; satisfaction rate of surgeons on overall nursing quality was 65.6％ in control group,and 91.7％ in observation group.Before application of risk management,general awareness of risk factors in nurses scored (16.25 ± 1.04),awareness of risk management (15.50 ± 0.93),attitude toward risk management (15.25 ± 1.04) and behavioral intention of risk management (14.75 ± 1.28);after application of risk management,general awareness of risk factors scored (22.00 ± 2.07),awareness of risk management (19.63 ± 2.13),attitude toward risk management (21.37 ± 2.33) and behavioral intention of risk management (21.88 ± 2.30).Conclusion Implementation of risk management in primary hospital can reduce surgical risk and improve quality of surgical nursing. Key words: Risk management; Operating room; Risk prevention

Objective To discuss the management modes of integrated operating rooms.Methods Five special management modes were implemented,including specialist operating room management,specialist equipment management,specialist apparatus management,specialist operative cooperation management and specialist quality management,in order to establish a standardized management system for integrated operating rooms.Results Equipment utilization and work efficiency were improved,work flow was optimized,and operative cooperation was perfected.Conclusions Implementation of specialist and standardized management of integrated operating rooms can effectively improve operational efficiency and beneficial results. Key words: Hospital,specialist; Integrated operating room; Nursing management

Objective To explore the effects of application of information management in performance appraisal for staff members transferring surgery patients. Methods The information management system was used in the personnel performance appraisal for staff members transferring surgery patients in the Operation Room of Xinchang People's Hospital in Zhejiang Province from June 2015. Transferring time of surgery patients, application time of transferring surgery patients, statistical time of staff' workload, rate of adverse events during transferring and satisfaction of staff members were compared before (June 2014 to May 2015) and after (June 2015 to May 2016) the applying of information management system. Results After the application of information management system, transferring time of surgery patients was (15.80±3.16) min and applying time of transferring surgery patients was (5.30±1.20) s, which were reduced when compared to those before the application of system. The difference was statistically significant (t=22.52, 293.25, P<0.01) . The rate of satisfaction of staff members to workload evaluation increased from 40.2% to 97.6%, with significant difference (χ2=153.76, P<0.01) . Conclusions Application of information management in performance appraisal for staff members could increase the efficiency of the operating room and improve the safety of surgical patients as well as satisfaction of staff members. Key words: Management; Operation room; Informatization; Staff members; Performance appraisal

Objective To investigate the application effect of point-factor method in constructing nursing performance management mode in Operating Room, so as to provide reference for improving quality of operating room nursing. Methods Relative indexes were collected and compared before (December 2014) and after (December 2015) implementation of nursing performance management mode in Operating Room basing on point-factor method, including performance assessment of nurses, professional standard test of nurses and satisfaction of nursing. Results The nursing performance management mode constructed by point-factor method included 4 first-level indexes and 20 second-level indexes, after implementation of which, Operating Room nurses′ scores of theoretical level, duty work quality, equipment operating quality, round going quality and total scores were all improved (P<0.05); scores of their three basis theory, three basis operation and professional achievements were also improved (P<0.05); satisfaction of patients, doctors and Operating Room nurses to the nursing work were improved (P<0.05). Conclusions The nursing performance management mode constructed by point-factor method can promote management efficiency in the Operating Room and improve quality of nursing. Key words: Operating Room; Personnel management; Performance management; Point-factor method

Operating Room (OR) is the core sector in hospital expenditure, the operation management of which involves a complete three-stage surgery flow, multiple resources, prioritization of the various surgeries, and several real-life OR constraints. As such reasonable surgery scheduling is crucial to OR management. To optimize OR management and reduce operation cost, a short-term surgery scheduling problem is proposed and defined based on the survey of the OR operation in a typical hospital in China. The comprehensive operation cost is clearly defined considering both under-utilization and overutilization. A nested Ant Colony Optimization (nested-ACO) incorporated with several real-life OR constraints is proposed to solve such a combinatorial optimization problem. The 10-day manual surgery schedules from a hospital in China are compared with the optimized schedules solved by the nested-ACO. Comparison results show the advantage using the nested-ACO in several measurements: OR-related time, nurse-related time, variation in resources' working time, and the end time. The nested-ACO considering real-life operation constraints such as the difference between first and following case, surgeries priority, and fixed nurses in pre/post-operative stage is proposed to solve the surgery scheduling optimization problem. The results clearly show the benefit of using the nested-ACO in enhancing the OR management efficiency and minimizing the comprehensive overall operation cost.