A Comprehensive Unit-based Safety Program to Improve Perioperative Efficiency in Adolescent Idiopathic Scoliosis.

Autor:	Raman DL; NewYork-Presbyterian Hospital., Bixby EC; NewYork-Presbyterian Hospital.; Department of Orthopedics, Columbia University Irving Medical Center, New York, NY., Wang K; NewYork-Presbyterian Hospital.; Department of Orthopedics, Columbia University Irving Medical Center, New York, NY., Rossi D; NewYork-Presbyterian Hospital., Ringler J; NewYork-Presbyterian Hospital., Wiggins DA; NewYork-Presbyterian Hospital., Arora S; NewYork-Presbyterian Hospital., Delfin J; NewYork-Presbyterian Hospital., Guida S; NewYork-Presbyterian Hospital., McLeod L; Department of Pediatrics, Children's Hospital Colorado, Denver, CO., Vitale MG; NewYork-Presbyterian Hospital.; Department of Orthopedics, Columbia University Irving Medical Center, New York, NY.
Jazyk:	angličtina
Zdroj:	Journal of pediatric orthopedics [J Pediatr Orthop] 2022 Mar 01; Vol. 42 (3), pp. 123-130.
DOI:	10.1097/BPO.0000000000001992
Abstrakt:	Background: Addressing operational inefficiencies in operating rooms (ORs) enhances patient access to care, reduces delays, and improves employee and patient satisfaction. The Comprehensive Unit-based Safety Program (CUSP) promotes patient safety through increased teamwork, empowerment of frontline staff, and utilization of science of safety principles. CUSP has demonstrated success in outpatient and inpatient settings to decrease complication rates and establish a culture of safety but has been used minimally in the perioperative setting. In this study, the CUSP methodology was utilized to improve perioperative efficiency in pediatric spine surgery, and preimplementation and postimplementation efficiency were compared, using the rate of first case on-time starts (FCOTS) as the primary metric. Methods: A CUSP quality improvement workgroup including nurses, technicians, surgeons, anesthesiologists, and administrators sought feedback on opportunities for improvement and tracked key performance metrics in the OR from 2015 to 2020. Key interventions developed in response to feedback included standardizing and streamlining room setup and adjusting staffing models for greater efficiency. Univariate analysis was conducted to compare time periods pre-CUSP and post-CUSP implementation. Results: First case on-time starts increased from 38% to a high of 81% after implementation. For more complex cases, the average patient in the room to anesthesia ready time improved by 31% with decreased variance over time, and average closure to patient out of room time improved by 45%. Improvements were sustained through Year 3, while CUSP remained a primary focus for the team. Conclusions: CUSP is effective in enhancing perioperative efficiency, demonstrating strong improvement in on-time starts over 5 years. The results indicate that process improvement in ORs requires consistent attention to sustain gains over time. Engaging frontline staff in quality improvement fosters collaboration and provides employee buy-in to promoting a culture of safety and improving value in patient care. Level of Evidence: Level III-retrospective comparative study. Competing Interests: M.G.V. is a paid consultant and receives intellectual property royalties from Zimmer Biomet. He is also a paid consultant for Stryker. He receives other financial or material support from the FOX Children’s Spine Foundation, as well as research support from the Children’s Spine Foundation, Orthopaedic Research and Education Foundation, Scoliosis Research Society, Pediatric Orthopaedic Society of North America (POSNA), and Orthopaedic Science and Research Foundation. He is also a board or committee member for the Children’s Spine Foundation, the International Pediatric Orthopaedic Symposium, POSNA, and the Project for Safety in Spine Surgery. The remaining authors declare no conflicts of interest. (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)
Databáze:	MEDLINE
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