2017 HSC Section 2 - Practice Management

Shams et al

Table 1. Operating Room Efficiency Data Collected from Anesthesia and Nursing Logs for the Year before and after TeamSTEPPS Implementation.

TeamSTEPPS

Before

After

P Value

Total, n

Cases

1322

1609

Turnovers

644 497 231

769 677 336

First starts in year First starts in 6 mo

On-time starts in 6 mo, n (%)

107 of 231 (46.3)

171 of 336 (50.8)

.28

Average time, min Turnover

35.2 11.6 17.0 107 147

41.4 12.1 17.8

.54 .63 .11 .32 .40

In room to turnover-to-surgeon Turnover-to-surgeon to surgical start

Surgeon

111.6 152.0

Total case

Table 2. Data in 6-Month ‘‘Washout’’ Period after TeamSTEPPS Implementation.

believe that maintaining efficiency during the initial months after a TS rollout are essential to keeping team member ‘‘buy-in’’ for the program. Allowing for a washout interval would therefore have weakened the relevance of our conclu- sions. However, we did measure the efficiency intervals for the first 6 months after TS implementation separately as a check to examine whether there were differences in the intervals that could be attributed to washout. Results The study compared 1322 cases and 644 turnovers in the year prior to TS with 1609 cases and 769 turnovers in the year fol- lowing the implementation of the program. Table 1 shows the OR efficiency data before and after the TS rollout. There was no statistically significant change in any of the efficiency metrics after the TS rollout. Table 2 shows the OR efficiency for the first 6 months after TS rollout, and these data show no major differences from the 1-year intervals. Discussion TS has been shown to improve patient safety by fostering better communication, teamwork, and leadership among OR personnel. 3 Due to extraordinary operating costs, hospitals are financially motivated to minimize delays in the OR. 2 Such motivation could cause hesitation in adopting TS, despite the growing body of literature that supports its util- ity in improving patient safety. Widespread adaptation of TS would be difficult if it caused significant delays in and around the OR; thus, it is important to consider the potential for decreases in efficiency before adapting new policies or procedures. Several other authors have suggested that TS could, in fact, improve surgical case times and decrease OR delays. 8,9 One such study was conducted by the urology ser- vice at our institution, and it showed decreased mean case times within the department in the year following the imple- mentation of TS. 8 However, the study did not include data

After TeamSTEPPS, 6 mo

Cases, n

784

Average time, min In room to turnover-to-surgeon Turnover-to-surgeon to surgical start

13.7 19.1

Surgeon

112.4 153.3

Total case

from other surgical services. To our knowledge, there are no published examinations of how TS affects efficiency in an otolaryngology service. OR times and turnover times are well-recognized mea- sures of hospital efficiency. Not only do hospitals have financial motivation to minimize lost time in the OR due to high operating costs, 2 but there are potential patient benefits of decreased anesthesia time and better satisfaction due to shorter wait times. 1 The results of this study suggest that TS is not changing OR efficiency significantly in the ENT department at our institution. The lack of impact that TS has had on efficiency does not reflect negatively on the pro- gram’s overall merit, because TS is a tool aimed primarily at improving patient safety. To the contrary, the fact that TS does not compromise efficiency will lead to hospitals con- tinuing it as a patient safety measure without concern for adverse effects on the financial bottom line. Our study is not powered to measure the impact of TS on patient safety. Because sentinel events such as retained sponges and wrong site surgeries are relatively rare, more data are needed to determine if TS is having the expected positive impact on patient safety within the ENT department.

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