A decision support system for surgery sequencing at UZ Leuven's day-care department.

In this paper, we test the applicability of a decision support system (DSS) that is developed to optimize the sequence of surgeries in the day-care center of the UZ Leuven Campus Gasthuisberg (Belgium). We introduce a multi-objective function in which children and prioritized patients are scheduled as early as possible on the day of surgery, recovery overtime is minimized and recovery workload is leveled throughout the day. This combinatorial optimization problem is solved by applying a pre-processed mixed integer linear programming model. We report on a 10-day case study to illustrate the performance of the DSS. In particular, we compare the schedules provided by the hospital with those that are suggested by the DSS. The results indicate that the DSS leads to both an increased probability of obtaining feasible schedules and an improved quality of the schedules in terms of the objective function value. We further highlight some of the major advantages of the application, such as its visualization and algorithmic performance, but also report on the difficulties that were encountered during the study and the shortcomings that currently delay its implementation in practice, as this information may contribute to the success rate of future software applications in hospitals.Decision support system; Optimization; Visualization; Health care application;

Taxonomic classification of planning decisions in health care: a review of the state of the art in OR/MS

We provide a structured overview of the typical decisions to be made in resource capacity planning and control in health care, and a review of relevant OR/MS articles for each planning decision. The contribution of this paper is twofold. First, to position the planning decisions, a taxonomy is presented. This taxonomy provides health care managers and OR/MS researchers with a method to identify, break down and classify planning and control decisions. Second, following the taxonomy, for six health care services, we provide an exhaustive specification of planning and control decisions in resource capacity planning and control. For each planning and control decision, we structurally review the key OR/MS articles and the OR/MS methods and techniques that are applied in the literature to support decision making

The development of facility standards for common outpatient procedures and implications for the context of abortion.

BackgroundIn recent years, an increasing number of states have enacted laws that impose specific requirements for facilities in which abortions are performed. In this study, we sought to understand the processes used to develop facility standards in the context of other, less politically charged areas of health care and consider implications for the context of abortion.MethodsWe conducted key informant interviews with 20 clinicians and accreditation professionals involved in facility standards development for common outpatient procedures (endoscopy, gynecology, oral surgery, plastic surgery). We examined the motivations for and processes used in facility standards development, use of scientific evidence in standards development, and decision-making in the absence of evidence. Interview data were thematically coded and analyzed using an iterative approach.ResultsIn contrast to U.S. state laws that target abortion facilities, standards for other outpatient procedures are commonly set by committees of clinicians organized by professional associations or accreditation organizations. These committees seek to establish standards that ensure patient safety without placing unnecessary burden on clinicians in practice. They aim to create evidence-based standards but can be hampered by lack of relevant research. In the absence of research evidence, committees rely on their clinical expertise and sense of best practices in decision-making. According to respondents, considerations of potential harm (e.g., deeper levels of sedation, invasiveness), rather than the specific procedure, should prompt additional requirements.ConclusionsIf facility standards in the context of abortion were developed through processes similar to other outpatient procedures, 1) professionals who perform the procedure would be involved in standards development and 2) in the absence of clear research evidence, the expertise of clinicians, and the guidelines and standards of other organizations, are used to describe a best practice standard of care

A survey of health care models that encompass multiple departments

In this survey we review quantitative health care models to illustrate the extent to which they encompass multiple hospital departments. The paper provides general overviews of the relationships that exists between major hospital departments and describes how these relationships are accounted for by researchers. We find the atomistic view of hospitals often taken by researchers is partially due to the ambiguity of patient care trajectories. To this end clinical pathways literature is reviewed to illustrate its potential for clarifying patient flows and for providing a holistic hospital perspective

Nursing knowledge and the expansion of day surgery in the United Kingdom

Background: The amount of surgery undertaken within United Kingdom Day Surgery Units has risen considerably over the past 15–20 years. Throughout this pioneering era, nursing roles and responsibilities within the modern surgical environment have developed although have largely shadowed medical advances. Evidence based nursing knowledge appears to have contributed very little to the recent success of day surgery. This may be due, in part, to the lack of attention given to modern surgical practices within current pre-registration nurse education programmes of study. Aim: The aim of this educational audit was to evaluate the consideration given to modern surgical practices in the programmes of study of recently qualified staff nurses employed within Day Surgery Units in the United Kingdom in order to gauge the extent of the challenge. Method: A postal audit was designed and sent to n = 247 Day Surgery Units. The audit was intended to elicit information from the staff nurses regarding their experiences of modern, elective day surgery during their nurse education programmes of study. Results: Two hundred and seventy seven staff nurses responded revealing that the level of attention to day surgery practices within pre-registration programmes was extremely low. The professions’ actual and potential theoretical contribution to modern surgical practices was virtually nil. Their experience of pre-operative nursing intervention appeared mainly to involve the teaching of traditional surgical in-patients nursing skills. The inclusion of modern surgical practices into the theoretical assignments within the programmes of study was very limited. Once qualified, the vast majority of staff nurses experienced no additional formal education for their new role. Conclusions: The results are discussed in relation to the re-focusing of pre-registration nurse education, changing clinical roles and the future of nursing within the modern surgical arena

ANESTHESIA PREOPERATIVE INCLUSION CRITERIA FOR TOTAL KNEE REPLACEMENT IN AMBULATORY SURGERY CENTERS: A CLINICAL PRACTICE GUIDELINE

Traditionally, total knee arthroplasty has been performed in the hospital setting. There has been a trend in healthcare that has moved this invasive procedure to the outpatient setting, in ambulatory surgery centers. In order for anesthesia providers to be prepared for the shift of this special population of patients, a clinical practice guideline was created to fulfill this scholarly project. It was expected that the application of this guideline would result in an increased use of the current evidence and the subsequent readiness of anesthesia providers to accept this patient population into surgery centers. It was also anticipated that the guideline would increase in safety for patients and demonstrate to surgeons and administration that it was appropriate to perform total knee replacement in ambulatory surgery centers. The scholarly project took place at South Ogden Specialty Surgery Center in Ogden, Utah, and included a thorough literature review, needs assessment, Delphi studies, and a proposed plan of implementation. It was hoped that the utilization of this guideline in the center would improve care and make a difference in the lives of patients

Business Process Redesign in the Perioperative Process: A Case Perspective for Digital Transformation

This case study investigates business process redesign within the perioperative process as a method to achieve digital transformation. Specific perioperative sub-processes are targeted for re-design and digitalization, which yield improvement. Based on a 184-month longitudinal study of a large 1,157 registered-bed academic medical center, the observed effects are viewed through a lens of information technology (IT) impact on core capabilities and core strategy to yield a digital transformation framework that supports patient-centric improvement across perioperative sub-processes. This research identifies existing limitations, potential capabilities, and subsequent contextual understanding to minimize perioperative process complexity, target opportunity for improvement, and ultimately yield improved capabilities. Dynamic technological activities of analysis, evaluation, and synthesis applied to specific perioperative patient-centric data collected within integrated hospital information systems yield the organizational resource for process management and control. Conclusions include theoretical and practical implications as well as study limitations

Implementation of a Warming Protocol to Prevent Inadvertent Perioperative Hypothermia in the Ambulatory Surgical Setting

The implementation of a standardized warming protocol aims to improve patient outcomes by preventing inadvertent perioperative hypothermia (IPH) and its complications in the ambulatory surgical setting. All patients, regardless of age or gender, are at risk for experiencing a 1-2° C drop in body core temperature within thirty minutes of anesthesia induction. The global aim of this project is to prevent IPH and its complications in the ambulatory surgical setting by implementing a warming protocol at a freestanding ambulatory surgery center. While an audit of the microsystem revealed a normothermia rate of 28%, a standardized warming protocol is expected to increase the normothermia rate to 90%. The project is vital because it reduces costs from postoperative complications, promotes best safe practices and quality care, and enhances the patient’s surgical experience and satisfaction. Based on clinical best practice guidelines recommended by the National Institute for Health and Care Excellence and American Society of Perianesthesia Nursing, a temperature management policy and warming protocol were implemented. Staff was educated about IPH and its complications, and post-tests and follow-up meetings with each department were held to assess staff understanding. The project is currently an ongoing change, and evaluation of the results is expected to occur in December 2015. The nursing profession is constantly pressured to find innovative ways to improve patient care, eliminate waste, and maintain affordability through process improvement projects. A process improvement project, such as the warming protocol, is both essential and meaningful when adopted in the ambulatory surgery setting

Operating room planning and scheduling: A literature review.

This paper provides a review of recent research on operating room planning and scheduling. We evaluate the literature on multiple fields that are related to either the problem setting (e.g. performance measures or patient classes) or the technical features (e.g. solution technique or uncertainty incorporation). Since papers are pooled and evaluated in various ways, a diversified and detailed overview is obtained that facilitates the identification of manuscripts related to the reader's specific interests. Throughout the literature review, we summarize the significant trends in research on operating room planning and scheduling and we identify areas that need to be addressed in the future.Health care; Operating room; Scheduling; Planning; Literature review;

Use of a Simplified Protocol for the Prevention of Postoperative Nausea and Vomiting in Adult Ambulatory Surgical Patients

Postoperative nausea and vomiting (PONV) remains a common complication affecting surgical patients after receiving anesthesia. Prevention of PONV is important in an ambulatory surgical setting where patient access to rescue treatment is limited after discharge. A quality improvement (QI) project introduced a simplified PONV prevention strategy to decrease the incidence of PONV at a Veterans Health Administration ambulatory surgery center. A retrospective chart audit of all facility surgical patients receiving anesthesia care (n = 94), excluding ophthalmology patients, was conducted prior to COVID-19 restrictions to establish baseline PONV incidence. An evidence-based, simplified PONV prevention protocol was developed and implemented. After a 2-week protocol familiarization period an 8-week chart audit of all surgical patients receiving anesthesia care (n = 81) was performed determining post-protocol PONV incidence. The incidence of PONV post-protocol implementation was significantly lower (8.6% vs 19.1%, p \u3c .001). The type of anesthesia administered, monitored anesthesia versus general anesthesia (p = .827), did not influence the incidence of PONV. An unanticipated finding was a significant increase in PACU length of stay between post-protocol and baseline samples (86 minutes vs 71.5 minutes, p = .001). Implementation of a simplified protocol for the prevention of PONV resulted in a significant reduction in PONV incidence