Improving outcomes in a high-output pediatric otolaryngology practice Article

Full Text via DOI: 10.1016/j.ijporl.2014.10.018 PMID: 25458165 Web of Science: 000347663800037

Cited authors

  • Carter, John M.; Riley, Charles; Ananth, Ashwin; Guarisco, J. Lindhe; Rodriguez, Kimsey; Amedee, Ronald

Abstract

  • Objectives: To identify factors associated with efficient operating room work flow on high volume pediatric otolaryngology days and the effects on provider and perceived parent satisfaction.; Methods: Retrospective review was performed of a sample of 20 days with greater than 10 cases per day performed by a pediatric otolaryngologist operating in 2 rooms. Turnover time and complications were the main outcome measures. Providers from otolaryngology and anesthesia that participated in these days were surveyed regarding efficiency, safety, and satisfaction.; Results: 223 cases were performed over 20 operative days. The average turnover time was significantly longer in "major" surgeries (p = 0.03), cases with multispecialty involvement (p = 0.01), cases requiring intubation (p < 0.001), and in cases where a fellowship trained pediatric anesthesiologist (p = 0.01) or CRNA was present (p < 0.001). When comparing "fast" (<25 min average turnover) operative days vs. "slow" (>25 min average turnover) days, presence of a non-fellowship trained anesthesiologist (p < 0.001), and the presence of an anesthesiology resident (p = 0.03) were significantly associated with "fast" days, while the presence of a CRNA was associated with "slow" days (p < 0.001). A significantly greater proportion of patients required intubation on "slow" turnover days vs. "fast" days (p = 0.13). Only one complication was observed (0.4%). 48 providers were surveyed with a 63% response rate. Reported satisfaction amongst providers was significantly greater on days with at least 10 cases (p = 0.047) and on days with turnover times of 25 min or less (p < 0.001). Pre-operative nursing evaluation/preparation of the patient, inter-provider communication and delays in room cleaning/setup were identified most often as causative factors responsible for delays in turnover.; Conclusions: High-operative volume operating days are common in pediatric otolaryngology and can be safely performed in an efficient manner. Appropriate scheduling and high-level communication between providers is needed to ensure success on these days. Identified areas of potential inefficiency can be a starting point for work flow optimization practices. (C) 2014 Elsevier Ireland Ltd. All rights reserved.

Authors

Publication date

  • 2014

Published in

International Standard Serial Number (ISSN)

  • 0165-5876

Start page

  • 2229

End page

  • 2233

Volume

  • 78

Issue

  • 12