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SPACE PLANNING: How to determine number of ORs needed

Tips for the planning process for a new surgical suite are given in this brief newsletter article by an experienced health care architect.  There are some interesting facts that are otherwise difficult to find in the literature:

  • What is the difference between an operating room and a procedure room?
  • What is a hybrid operating room?
  • How are some of the metrics used defined – room time, room turnaround time, throughput?
  • What is a target room turnaround time? (“…usually 15 to 20 minutes”)
  • How many hours are procedure rooms open? (“Most procedure rooms are available eight hours per day for a total of 480 minutes per day”)

Scheduling efficiency: A scheduling efficiency factor is multiplied by the annual minutes available per procedure room to account for periods of time that a case cannot be scheduled.  This factor may range from 70 percent for ORs or procedure rooms used for complex (and sometimes unscheduled) procedures — such as cardiothoracic, neurosurgery, and trauma/orthopedics — to 90 percent for an outpatient suite where all procedures are scheduled.”  (page 3)

Source:  Hayward, C. (2017, Winter). How many operating rooms? It’s complicated. Click here for newsletter: https://www.spacemed.com/newsletter/news101.html  Posted by AHA Resource Center (312) 422-2050 rc@aha.org

STROKE: Cleveland Clinic pioneers deep brain stimulation

On December 19, 2016, Dr. Andre Machado, chair of the Neurological Institute at the Cleveland Clinic, performed the first deep brain stimulation procedure on a stroke patient.  This lengthy surgery, part of an ongoing clinical trial, involved implantation of electrodes in the brain that are connected to a pacemaker-like device.  As the patient recovers from the brain surgery, physical therapy will be combined with stimulation of areas of the brain to overcome damage done by the stroke.  A key objective of this groundbreaking surgery is to help stroke patients recover from stroke-induced paralysis.  An estimated 400,000 Americans a year – or half the number of patients who have a stroke each year – end up disabled.

Sources:

Cleveland Clinic performs nation’s first deep brain stimulation for stroke recovery. (2017, January 4). News release. Click here: https://newsroom.clevelandclinic.org/2017/01/04/cleveland-clinic-performs-nations-first-deep-brain-stimulation-stroke-recovery/; and, Sifferlin, A. (2017, January 4). Doctors perform groundbreaking surgery for stroke. Time. Click here: http://time.com/4620618/doctors-perform-groundbreaking-surgery-for-stroke/  Posted by AHA Resource Center (312) 422-2050, rc@aha.org

PATIENT SAFETY: Handoffs between ICU and OR

There is a lot of literature describing problems with, and best practices for, the transfer of care of post-surgical patients moving into the intensive care unit setting.  However, after conducting a comprehensive literature search, the authors of this brief commentary found no comparable literature about the reverse type of handoff – for patients going from the special care unit into surgery.  They suggest that a checklist be adopted and give an example of one such checklist.  They also recommend that a verbal handoff be required.

What do I like about this article?  The authors are authoritative (Mount Sinai and Johns Hopkins medical schools) and I like the actual example of the handoff checklist.  Also, I like it that they appear to be filling a gap in the medical literature – at least at the time that they wrote this commentary.

Source: Evans, A.S., Yee, M.S., and Hogue, C.W. (2014, Mar.). Often overlooked problems with handoffs: From the intensive care unit to the operating room.  Anesthesia & Analgesia, 118(3), 687-689.  Click here for free full text: http://journals.lww.com/anesthesia-analgesia/Fulltext/2014/03000/Often_Overlooked_Problems_with_Handoffs___From_the.31.aspx  Posted by AHA Resource Center (312) 422-2050, rc@aha.org

OPERATING ROOMS: Cost benefit of synthetic gloves

Natural rubber latex gloves are less expensive to buy than synthetic latex surgical gloves but can cause allergic reactions in staff and patients.  This study conducted at Alta Bates Medical Center (Berkeley, CA) prepared a cost benefit analysis comparing the different types of gloves and including the cost of treating cases of allergy.  The hospital did already use a large number of synthetic gloves, but converting completely to the synthetic gloves was found to save nearly $75,000 or 25 percent of overall OR operating costs.

Source: Wharton, K.R., and others. (2016, June). Can converting to synthetic surgical gloves lower hospital operating room costs? OR Manager, 32(6), 22-23, 25-26.  Click here for the publisher’s website: http://www.ormanager.com/can-converting-synthetic-surgical-gloves-lower-hospital-operating-room-costs/   The article mentions that a full case study can be requested from one of the authors – Philippe Henderson – by emailing him at: philippe.henderson@kraton.com   Posted by AHA Resource Center (312) 422-2050, rc@aha.org

SURGERY: Use of surgical robots has changed the way radical prostatectomy procedures are done in the U.S.

The volume of radical prostatectomy procedures decreased 7 percent from 1425 procedures per million men over age 45 in the late ’90s to 1330 per million in 2010-2011.  There was a big change, however, in the way that the surgery was performed as surgical robots came to the fore in urological surgery.  This study of national data shows that open radical prostatectomy procedures dropped from 1424 per million older men to 435 per million during the 14-year time period.  Much of that procedure volume was moved over to robotic surgery.

This study also analyzes hospital procedure volume – finding that 18 percent of hospitals stopped providing open radical prostatectomy since 2006.  The number of hospitals providing the minimally invasive version of the procedure increased by 191 percent during the same period.  The percentage of hospitals with a low-volume (fewer than 50 procedures) program of minimally invasive radical prostatectomy doubled – to 26 percent – by the end of the study period.

Source: Tyson, M.D., and others. (2016, Jan.). Radical prostatectomy trends in the United States: 1998 to 2011. Mayo Clinic Proceedings, 91(1), 10-16.  Click here for full text: http://www.mayoclinicproceedings.org/article/S0025-6196%2815%2900771-5/pdf  Posted by AHA Resource Center (312) 422-2050, rc@aha.org

TRENDS: nearly 450,000 hip replacements each year

The U.S. Agency for Healthcare Research and Quality (AHRQ) has a number of free databases on the web that can be used to take an interesting historical look at health care utilization data.  I recently posted on this blog about hip fracture – and got an unusual number of hits! – so thought I might explore another aspect of the same topic here using some AHRQ data.

HIP REPLACEMENT: Inpatients discharged who had total or partial hip replacement, 1995-2013

  • 267,034 (or 100.3 per 100,000 persons) in 1995
  • 298,631 (or 105.8 per 100,000 persons) in 2000
  • 371,754 (or 125.8 per 100,000 persons) in 2005
  • 439,838 (or 142.2 per 100,000 persons in 2010
  • 439,945 (or 156.2 per 100,000 persons) in 2013

The fine print: What is this exactly?  First of all, these numbers represent inpatients only.  The rates per 100,000 persons means per 100,000 resident population.  The data source is the National Inpatient Sample based on the “CCS category” code 153: Hip replacement, total and partial.  It is also possible to run data using ICD-9 codes or DRGs.  The most current data year is 2013.

We notice from these data that both the actual number of inpatients who have had hip replacement and the rate per 100,000 persons are trending upward over time.

HIP REPLACEMENT: Ambulatory surgery?

AHRQ also has a database of ambulatory surgery procedures for 29 reporting states (representing two-thirds of the U.S. population).  As of this writing, the database can be queried for just the year 2012 but, with an added nice feature, provides comparable inpatient data for the same states.  Setting this database up for the same CCS category as above (153: Hip replacement, total and partial, all listed) shows that only about 3 percent of hip replacements were done on an outpatient basis in 2012.

Source: Agency for Healthcare Research and Quality. Welcome to HCUPnet. Click here for free access to this database http://hcupnet.ahrq.gov/  Posted by AHA Resource Center (312) 422-2050, rc@aha.org

HIP FRACTURES: Patient characteristics, outcomes, surgical volume: Data from Kaiser Permanente registry

What are the outcomes for patients who have had surgery after breaking a hip?  This is a study of the Kaiser Permanente Hip Fracture Registry – looking at over 12,000 patients in California in 2009 through 2011.  The registry data includes 33 medical centers and 474 surgeons.  Here is a look at this data-rich article:

Characteristics of Patients with Broken Hips

  • Two-thirds are female
  • Two-thirds are 75 years or older
  • Over half have 3 or more other medical problems (comorbidities)
  • Two-thirds have hypertension

Patient Outcomes

  • 4-day length of stay (median)
  • 6.2 percent death within 30 days
  • 12.3 percent death within 90 days
  • 12.2 percent readmission within 30 days
  • 22.1 percent readmission within 90 days
  • 11.4 percent contracted pneumonia
  •   1.1 percent surgical site infection

Surgeon Characteristics

  • 12.1 percent low volume (less than 10 procedures / year)
  • 68.4 percent medium volume (10 to 29 procedures / year)
  • 19.5 percent high volume (30+ procedures / year)

Hospital Characteristics

  •   1.7 percent low volume (less than 60 procedures / year)
  • 35.3 percent medium volume (60 to 129 procedures / year)
  • 63.0 percent high volume (130+ procedures / year)

Source: Inacio, M.C.S., and others. (2015, Sum.). A community-based hip fracture registry: Population, methods, and outcomes. The Permanente Journal, 19(3), 29-36.  Click here for free full text: http://www.thepermanentejournal.org/files/Summer2015/Registry.pdf  Posted by AHA Resource Center (312) 422-2050, rc@aha.org