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SURGICAL SUITE: Implementing ERAS at Kaiser Permanente

Engagement among patients and clinicians is excellent, and the ERAS team is working toward realizing the vision of enhanced recovery hospitals where the ERAS paradigm becomes the standard of care for the 190,000 adult inpatients hospitalized in KPNC each year.”

How Kaiser Permanente Northern California implemented an Enhanced Recovery After Surgery (ERAS) project in 20 KPNC medical centers is described in this lengthy, scholarly article.  The initiative began with colon surgery patients, but success in reducing inpatient length of stay and post-op complication rates has led to expansion of the ERAS model to other surgical patients.  This article is well illustrated with graphics which will be helpful to other providers working through similar implementation projects, including a sample “My Calendar: Recover Safely and Quickly” intended for colon surgery patients.

Source: Liu, V.X., and others. (2017, Summer). The Kaiser Permanente Northern California enhanced recovery after surgery program: Design, development, and implementation. The Permanente Journal, 21(3), 53-61.  Click here: http://www.thepermanentejournal.org/issues/2017/summer/6477-the-kaiser-permanente-northern-california.html  Posted by AHA Resource Center (312) 422-2050, rc@aha.org

SURGICAL SUITE: Neurosurgical operating room of the future incorporates aeronautical industry concepts

The next phase of the OR of the future is to focus at the cellular level through next-generation imaging that will allow advanced interrogation of normal and diseased neural tissue…which will be systematically captured in the background, curated, and analyzed by the informatics system.”

How to redesign the neurosurgical operating room to incorporate concepts borrowed, in part, from the aeronautical industry is explored in this scholarly article.  How to improve patient safety by focusing on data collection and on honing the science of surgery is discussed.  This article is based on pioneering work being done at the Aurora Neuroscience Innovation Institute (Milwaukee) in collaboration with vendors Storz Corp., Stryker Corp., Synaptive Medical, and Nico Corp.

Source: Kassam, A.B., and others. (2017, June). The operating room of the future versus the future of the operating room. Otolaryngology Clinics of North America, 50(3), 655-671.  Click here for the publisher’s website: http://www.sciencedirect.com/science/article/pii/S0030666517300166

Here is a link to the Aurora Neuroscience Innovation Institute website: https://www.aurorahealthcare.org/services/neuroscience  Posted by AHA Resource Center (312) 422-2050, rc@aha.org

SURGICAL SUITES: Guidelines on best practices to prevent surgical site infections

The number of unresolved issues in this guideline reveals substantial gaps that warrant future research.” (page E6)

Best practices in avoiding surgical site infections were studied by the Centers for Disease Control and Prevention with the assistance of the Healthcare Infection Control Practices Advisory Committee.  This guideline is based on the full text review of nearly 900 journal articles and studies.  The guideline is organized according to specific surgical practices – for example the efficacy of wearing a space suit during orthopedic surgery – and assigns each practice a rating on a continuum as to whether the practice is highly recommended, unresolved, or somewhere in between.  The rating on the space suits, for instance, is that it is unresolved.

Source: Berrios-Torres, S.I., and others. (2017, May 3). Centers for Disease Control and Prevention guideline for the prevention of surgical site infection 2017. JAMA Surgery. Click here: http://jamanetwork.com/journals/jamasurgery/fullarticle/2623725  Posted by AHA Resource Center (312) 422-2050, rc@aha.org

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