Introduction
Rationale
Background
Timing | 1st Trial | 2nd Trial |
---|---|---|
Column A | Column B | |
1 | Ward exit | Ward exit |
2 | Entrance ORB | Entrance ORB |
3 | Identification by nurse anesthetist | |
4 | Entrance anesthesia room | |
5 | Start anesthesia | Start anesthesia |
6 | End anesthesia | |
7 | Entrance OR | Entrance OR |
8 | Start surgical procedure | Start surgical procedure |
9 | End surgical procedure | End surgical procedure |
10 | Exit OR | Exit OR |
11 | Entrance RR | |
12 | Exit RR | |
13 | Identification by healthcare assistant | |
14 | Transport ICU | |
15 | Exit ORB | |
16 | Ward re-entry |
Materials and methods
n° of delta times and description | Formula |
---|---|
1 Patient moving time from ward to ORB | Entrance ORB – ward exit |
2 Waiting time in ORB reception (AR induction) | Identification by NA – entrance ORB |
3 Waiting time in ORB reception (OR induction) | Identification by NA – entrance ORB |
4 Waiting time for anesthesia in AR | Start anesthesia – entrance AR |
5 Waiting time for anesthesia in OR | Start anesthesia – entrance OR |
6 Anesthesia time | End anesthesia – start anesthesia |
7 Sum of anesthesia time and transport to OR | Identification by NA – entrance in OR |
8 Transport time from AR to OR | Entrance in OR – end anesthesia |
9 Waiting time in OR | Start surgical procedure – entrance in OR |
10 Surgical time | End surgical procedure – start surgical procedure |
12 Total pre-surgery time | Exit OR – end surgical procedure |
11 Awakening time | Start surgical procedure – identification by NA |
13 Total time from admission in ORB | To surgical starting time start surgical procedure – entrance ORB |
14 Stay time in OR | Exit OR – entrance OR |
15 Waiting time to come back in ward | Exit OR – exit ORB |
16 Transport time from OR to RR | Entrance RR – exit OR |
17 Stay time in RR | Exit RR – entrance RR |
18 Waiting time at reception | Identification by healthcare assistant – exit ORB |
19 Transport time to come back in ward | Ward re-entry – exit ORB |
20 Stay time in ORB | Exit ORB – entrance ORB |
21 Out ORB - transport in ICU | Transport ICU – exit ORB |
22 Turnover time | Entrance OR next pts – exit OR previous pts |
23 Over-time | Scheduled end of the daily work – exit OR last case |
24 Start time tardiness | Scheduled start of the daily work – start surgery 1°case |
25 Under utilization | Scheduled end of the daily work – exit OR last case |
n° | Description | Limit inferior | Limit superior |
---|---|---|---|
1 | Patient moving time from ward to ORB | 5 | 20 |
2 | Waiting time in ORB reception (AR induction) | 5 | 20 |
3 | Waiting time in ORB reception (OR induction) | 5 | 20 |
4 | Waiting time for anesthesia in AR | 5 | 20 |
5 | Waiting time for anesthesia in OR | 5 | 20 |
6 | Anesthesia time | 10 | 60 |
7 | Sum of anesthesia time and transport to OR | 15 | 70 |
8 | Transport time from AR to OR | 2 | 10 |
9 | Waiting time in OR | 10 | 60 |
10 | Surgical time | 15 | 720 |
11 | Awakening time | 5 | 30 |
12 | Total pre-surgery time | 20 | 80 |
13 | Total time from admission in OB to surgical starting time | 30 | 120 |
14 | Stay time in OR | 20 | 720 |
15 | Waiting time to come back in ward | 5 | 90 |
16 | Transport time from OR to RR | 1 | 10 |
17 | Stay time in RR | 10 | 180 |
18 | Waiting time at reception | 5 | 20 |
19 | Transport time to come back in ward | 5 | 20 |
20 | Stay time in ORB | 40 | 720 |
21 | Out ORB - transport in ICU | 5 | 20 |
22 | Turnover time | 10 | 120 |
23 | Over-time | 30 | 300 |
24 | Start time tardiness | 6 | 120 |
25 | Under utilization | 10 | 90 |
Window | Subject | Level | Type of data |
---|---|---|---|
M1 | Facility | Global | Quantitative |
M2 | Productivity units | Comparison | Quantitative |
M3 | Productivity unit | Comparison | Performance |
M4 | Facility | Efficient indicators | |
M5 | Surgical procedure | Qualitative | |
A1 | Facility | Performance | |
A2 | ORB | Pathway | |
A3 | Surgical procedure | Qualitative | |
A4 | Pathway | Timing | |
S1 | Facility | Global | Performance |
S2 | Productivity unit | Comparison | Quantitative |
S3 | Surgical procedure | Qualitative | |
S4 | DRG | Quantitative |
Manager (M)
Anesthesiologist (A)
Surgeon (S)
Results
Surgical unit | GS | TV | ENT | UR | OT | |||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Years | 2009 | 2010 | 2011 | 2009 | 2010 | 2011 | 2009 | 2010 | 2011 | 2009 | 2010 | 2011 | 2009 | 2010 | 2011 | |
High | no
| 466 | 486 | 448 | 142 | 191 | 210 | 107 | 127 | 125 | 188 | 186 | 165 | 27 | 80 | 84 |
% | 39 | 42 | 49 | 48 | 48 | 45 | 7 | 9 | 9 | 21 | 22 | 25 | 4 | 6 | 7 | |
Low | no
| 730 | 672 | 466 | 154 | 206 | 256 | 1415 | 1281 | 1261 | 706 | 658 | 494 | 639 | 1254 | 113 |
% | 61 | 58 | 51 | 52 | 52 | 55 | 93 | 91 | 91 | 79 | 78 | 75 | 96 | 94 | 93 |
Procedures / Years | 2009 | 2010 | 2011 | Procedures / Years | 2009 |
---|---|---|---|---|---|
Scheduled | 75 | 82 | 86 | Scheduled | 75 |
Unscheduled | 25 | 18 | 14 | Unscheduled | 25 |
High complexity | 19 | 19 | 21 | High complexity | 19 |
Low complexity | 81 | 81 | 79 | Low complexity | 81 |
Over time | 28 | 23 | 21 | Over time | 28 |
Overtime | 2009 | 2010 | 2011 |
---|---|---|---|
Number of events | 336 | 371 | 324 |
Minutes | 78 ± 57* | 77 ± 54* | 78 ± 54* |
Percentage (over surgical procedures) | 28 | 23 | 21 |