A Dedicated Pediatric Spine Deformity Team Significantly Reduces Surgical Time and Cost
| Autor: | Barbara Dezayas, John M. Flynn, Wallis T. Muhly, Wudbhav N. Sankar, Jeffrey M. Feldman, Brendan M Striano, Blair Kraus, Michael Blum, Vaidehi Mehta, Ron Keren |
|---|---|
| Rok vydání: | 2018 |
| Předmět: |
medicine.medical_specialty
medicine.medical_treatment Operative Time MEDLINE Pediatric spine 03 medical and health sciences Surgical time 0302 clinical medicine Health care Deformity Humans Medicine Orthopedics and Sports Medicine Child Retrospective Studies Patient Care Team 030222 orthopedics business.industry General surgery Retrospective cohort study General Medicine Spinal Fusion Scoliosis Spinal fusion Costs and Cost Analysis Surgery medicine.symptom business Value (mathematics) 030217 neurology & neurosurgery |
| Zdroj: | Journal of Bone and Joint Surgery. 100:1574-1580 |
| ISSN: | 1535-1386 0021-9355 |
| Popis: | As high-quality health care becomes increasingly expensive, improvement projects are focused on reducing cost and increasing value. To increase value by reducing operating room (OR) utilization, we studied the effect of a dedicated team approach for posterior spinal fusion (PSF) for scoliosis.With institutional support, an interdisciplinary, dedicated team was assembled. Members developed standardized protocols for anesthetic management and patient transport, positioning, preparation, draping, imaging, and wake-up. These protocols were initially implemented with a small interdisciplinary team, including 1 surgeon (Phase 1), and then were expanded to include a second surgeon and additional anesthesiology staff (Phase 2). We compared procedures performed with a dedicated team (the Dedicated Team cases) and procedures performed without a such a team (the Casual Team cases). Because of the heterogeneous nature of PSF for scoliosis, we developed a case categorization system: Category 1 was relatively homogeneous and indicated patients with fusion of ≤12 levels, no osteotomies, and a body mass index (BMI) of25 kg/m, and Category 2 was more heterogeneous and indicated patients with fusion of12 levels and/or ≥1 osteotomy and/or a BMI of ≥25 kg/m.In total, 89 Casual Team and 78 Dedicated Team cases were evaluated: 71 were in Category 1 and 96 were in Category 2. Dedicated Team cases used significantly less OR time for both Categories 1 and 2 (p0.001). In Category-1 cases, the average reduction was 111.4 minutes (29.7%); in Category-2 cases, it was 76.9 minutes (18.5%). The effect of the Dedicated Team was scalable: the reduction in OR time was significant in both Phase 1 and Phase 2 (p0.001). The Dedicated Team cases had no complications. Cost reduction averaged approximately $8,900 for Category-1 and $6,000 for Category-2 cases.By creating a dedicated team and standardizing several aspects of PSFs for scoliosis, we achieved a large reduction in OR time. This increase in team efficiency was significant, consistent, and scalable. As a result, we can routinely complete 2 Category-1 PSFs in the same OR with the same team without exceeding standard block time. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
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