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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↗

Holiday and weekend operating room on-call staffing requirements.

BACKGROUND: Every facility that performs cases on holidays has in some way decided on its operating room (OR) and anesthesia staffing for holidays. Previous studies have not examined how best to calculate appropriate holiday staffing. METHODS: We analyzed weekend and holiday data from a university hospital. RESULTS: There were high rank correlations between the number of cases starting during each 12-h period of a holiday, the total hours of OR time used, and the patients and surgeons waiting for cases to start. Weekend and holiday 12-h periods were divided into 8 categories (e.g., Saturday 7:00 am to 7:00 pm). There was perfect rank correlation between the mean number of cases starting during each 12-h period and appropriate staffing during the 12-h period, whether quantified by total hours of cases or by the under-utilized and over-utilized OR time resulting from staffing decisions. CONCLUSIONS: The number of cases starting during each period of a holiday is a statistically valid end point for OR managers to use to evaluate how busy holidays are relative to weekend days. To be useful, the statistic must be combined with mathematically valid assessments of appropriate weekend staffing on-call, whether in-house, or from home.

Holidays↗

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↗