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Putting patient-focused care into practice.

Patient-focused care relies on a framework supported by staff member empowerment and cross training, decentralization, patient care teams, and computerization. Decisions are made based on what is best for the patient rather than what is best for the staff members. How patient-focused care is applied is influenced by the basic structure, beliefs, and values of the institution. Empowering staff members and physicians and creating specialty cluster teams were our first steps toward a patient-focused care model. Cross training ancillary personnel to perform all tasks reduced nursing staff members' overtime and allowed for quicker response times during emergencies. Switching to a computerized documentation system enhanced departmental efficiency, removed much of the paperwork burden from nurses, and reduced costs. Patient-focused care is measurable. We have reduced operating expenses, reduced staff turnover, increased productivity, and increased patient and physician satisfaction.

Hospital-Patient Relations↗

Operating room: 2010.

Using expert systems, virtual reality, and commercial and futuristic technology, visionary operating room (OR) nurses will have the opportunity in the 21st century to dramatically improve the way the OR functions. Eliminating counting, decreasing occurrences of patient injuries, and improving staff and patient education are just some of the possibilities!

Forecasting↗

Process-optimized operating room: implementation of an integrated OR system into clinical routine.

The surgeon's working environment has changed continuously in recent years regarding the technical complexity of the components in use in the operating room (OR). Parallel to this development, demands for process-optimized procedures have also grown constantly. The impetus for these changes was the beginning of use of minimally invasive techniques in surgery. In contrast, overall development of the OR itself has been slight or nonexistent. What we are typically confronted with currently is an OR outfitted with high-tech medical equipment, whereas only to a limited extent can the design of the OR itself be regarded as ergonomic or holistic. This situation has spread to related specialties as well, and represents a general tendency. Whereas dentists, for example, already enjoy the benefits of a centralized management and operation workplace, this development has not yet reached a satisfactory level for surgeons.

Facility Design and Construction↗

Cost-effective use of operating room supplies based on the REMEDY database of recovered unused materials.

It is estimated that $200 million worth of prepared materials are discarded unused in operating rooms in the United States each year. Although some of these materials have been successfully recovered for overseas donation, they nevertheless constitute an undesirable burden on health care efficiency. This situation has prompted a reevaluation of the procedures that result in the overpreparation of surgical supplies, in the hope of reducing hospital, patient, and third-party payer expenditures. A database, which was initially developed to track the overseas donation of recovered supplies from Yale-New Haven Hospital, is now being applied to measure approaches to waste reduction. This report summarizes the application of this database to an integrated program designed to modify nursing procedures and physician prespecified supply lists.

Budgets↗

Scheduling of elective surgical cases within allocated block-times: can the future be drawn from the experience of the past?

UNLABELLED: We determined a strategy to regulate the elective occupation of operating rooms; it was based on the determination of a median operating room occupation time, per procedure and per operator. METHODS: Median occupation times were determined from a retrospective analysis of 12 consecutive months of operating activity (966 patients). These data were prospectively used in surgical planning, with a daily occupation limit set at 10 hours. After four months collecting data, daily recorded (ROT) and predicted (POT) occupation times were compared. The surgical activity during that test period (group A) was compared to the activity of the same period in the previous year (group B) and the evolution of the waiting lists for surgery were analysed for each of the operators. RESULTS: At the end of the four-month observation period, 317 surgical cases spread over 105 operating days were recorded. The correlation between ROT and POT was strong (r = 0.911, p < 0.001). The relative error in this prediction was 13 +/- 11 min. In comparison with group B, group A was characterized by a significant reduction in occurrence (p = 0.015) and duration (p = 0.007) of time limit overruns and in variability of daily occupation time (p < 0.001). The waiting list was reduced for all operators at the end of the test period. CONCLUSION: Determination of individualized median occupation times, associated with definition of a daily limit, resulted in reduction of time overruns and delays before surgery.

Appointments and Schedules↗

Comprehensive surveillance of surgical wound infections in outpatient and inpatient surgery.

A surgeon-specific computer-generated monthly questionnaire was used to improve surveillance of surgical wound infections in outpatients as well as inpatients following discharge. From July 1988 through June 1989, 20,536 surgical procedures were performed at our medical center, of which 53% were for outpatients. The total wound infection rate was 0.63%: 0.13% in outpatients and 1.2% in inpatients (p less than .005). Of the infected wounds, 20% were reported by the survey alone and would have gone undetected by conventional surveillance methods (71.4% of outpatient and 13.8% of inpatient wound infections). As a whole, clean and clean-contaminated wounds in outpatients were much less likely to become infected than those in inpatients. Wound cultures were not obtained in 85% of infections reported by the survey alone, and were less likely to be obtained in outpatients. The average time spent by the infection control department on the survey was approximately two hours per week.

Ambulatory Surgical Procedures↗

Integrated myocardial revascularization.

The integration of minimally invasive coronary artery bypass grafting with catheter-based interventions is being practiced with increasing frequency both in the standard and high risk patient populations. The procedures can be staged on different days or done concurrently in either an operative cathlab or an operating room with imaging capabilities. The new clinical issues raised with these new approaches are reviewed for practitioners considering adopting this new treatment strategy.

Equipment Design↗

Flipping assumptions and revisioning perioperative services.

As we approach a fully capitated healthcare environment, total revisioning and restructuring of hospitals as a whole, and perioperative services in particular, will be necessary to maintain the financial viability of our healthcare institutions. Nurse executives will be in pivotal roles in leading and influencing these hospital initiatives. The authors present a vision of the new hospital and discuss methods of responding to change within the healthcare environment, with an emphasis on perioperative services. An analysis of the findings of an operating room survey conducted with nurse executives is included in the discussion.

Capitation Fee↗

Advanced technology in the operating room.

Today's operating room is a high-tech environment. Minimally invasive procedures are fast becoming a standard for certain conditions. Lasers have taken their place as routine surgical tools in many specialties. On the horizon are new imaging technologies. If you are planning for new ORs, you'll want to consider the role of advanced technology in your new suite.

Endoscopes↗