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Can Anesthesia Induction Rooms Improve Operating Room Efficiency? Theodore Ganley, MD Seema Sonnad, PhD Amol Narang, ¼ MD ACL Reconstruction Associated with immediate post-operative pain Post-operative analgesia Intra-articular (IA) administration of medications
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Can Anesthesia Induction Rooms Improve Operating Room Efficiency? Theodore Ganley, MD Seema Sonnad, PhD Amol Narang, ¼ MD
ACL Reconstruction • Associated with immediate post-operative pain • Post-operative analgesia • Intra-articular (IA) administration of medications • Femoral Sciatic Nerve Block (FSNB)
IA vs. FSNB • FSNB better clinically • Lower post-op opioids • Better post-op analgesia Ganley, Theodore. Intra-articular Bupivacaine-Clonidine-Morphine versus Femoral Sciatic Nerve Block in Pediatric Patients Undergoing ACL Reconstruction. Anesthesiology & Analgesia. 2005;101:1304-10.
p < .001 IA vs. FSNB • Increased anesthesia administration time Ganley, Theodore. Intra-articular Bupivacaine-Clonidine-Morphine versus Femoral Sciatic Nerve Block in Pediatric Patients Undergoing ACL Reconstruction. Anesthesiology & Analgesia. 2005;101:1304-10.
Anesthesia Induction Room • Reduce costly OR time • Increase time spent on other services • Additional cases scheduled • Decreased overtime costs • Intangible benefits
Literature • Dexter et al. (1999) • 80% reduction in non-operative time to schedule additional 45 minute case • Torkii et al. (2005) • 45.6% decrease in non-operative time • Additional case scheduled per 7 hours
Study Design • Retrospective and prospective observational study • Patients undergoing knee arthroscopy • Study duration • Retrospective: 7/2007 – 12/2007 • Prospective: 7/2008 – 12/2008
Study Design • Primary endpoint: mean and standard deviation of non-operative time spent in the OR • Time intervals in the OR process: • AS ↔ AR ↔ PS ↔ SS ↔ ES ↔ POR • AS ↔ AR ↔ AOR ↔ PS ↔ SS ↔ ES ↔ POR Torkii, Paulus. Use of Anesthesia Induction Rooms Can Increase the Number of Urgent Orthopedic Cases Completed within 7 Hours. Anesthesiology. 2005; 103:401-5.
Study Design • Confounding variables • Height, Weight, ASA Physical Status, Block Type, Personnel Type, Time of Year, Time of Day • Learning curve analysis
Early Results • Pre-Induction Room Post-Induction Room N = 111 N = 12
Other Goals • Secondary endpoints • OR utilization • Cases performed per unit time • Overtime hours • Scheduled OR times versus actual OR times • Scheduling algorithm
Other Goals • Translating per operation time savings into per day time savings • Translating time savings into cost savings • Cost of OR time • Overtime costs
Thanks! • Mentors: Dr. Sonnad and Dr. Ganley • Joanne Levy • Kelly, Tina, and Lisa • SMUR Scholars
Special thanks to the following organizations for their generous support: • The University of Pennsylvania Provost’s Diversity Fund • The Center for Health Equity Research and Promotion (CHERP) • Pennsylvania Department of HealthOffice of Health Equity