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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

Can Anesthesia Induction Rooms Improve Operating Room Efficiency?

Theodore Ganley, MD

Seema Sonnad, PhD

Amol Narang, ¼ MD

acl reconstruction
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
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.

ia vs fsnb4

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
Anesthesia Induction Room
  • Reduce costly OR time
  • Increase time spent on other services
  • Additional cases scheduled
  • Decreased overtime costs
  • Intangible benefits
literature
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
Study Design
  • Retrospective and prospective observational study
  • Patients undergoing knee arthroscopy
  • Study duration
    • Retrospective: 7/2007 – 12/2007
    • Prospective: 7/2008 – 12/2008
study design8
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 design9
Study Design
  • Confounding variables
    • Height, Weight, ASA Physical Status, Block Type, Personnel Type, Time of Year, Time of Day
  • Learning curve analysis
early results
Early Results
  • Pre-Induction Room Post-Induction Room N = 111 N = 12
other goals
Other Goals
  • Secondary endpoints
    • OR utilization
    • Cases performed per unit time
    • Overtime hours
  • Scheduled OR times versus actual OR times
    • Scheduling algorithm
other goals13
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
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
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