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October 21, 2019
10/21/2019 9:30:00 AM - 10/21/2019 11:30:00 AM
Room WA2 - Area C
Effect of Preoperative Intravenous Line Placement on Operating Room Efficiency
Erin Pizarro, M.D., David J. Fealey, M.D., Katherine E. Nixon, M.D., Samir M. Kendale, M.D., Germaine Cuff, Ph.D.
NYU School of Medicine, New York, New York , United States
Disclosures: E. Pizarro: None.D.J. Fealey: None.K.E. Nixon: None.S.M. Kendale: None.G. Cuff: None.
There are opportunities to optimize operating room (OR) efficiency by capturing and investigating time-points along the patient journey from the preoperative phase to the recovery room. High reliability organizations (HRO’s) examine numerous metrics to increase productivity and diminish cost. One important time-point is anesthesia preparation time (APT), defined as the time elapsed from patient "in-room" ("anesthesia start") to "anesthesia ready". This period includes IV placement, monitor placement, airway management and additional IV access if necessary based on the case. Optimization of APT might be done through actions performed on the patient prior to entering the operating room, for example, preoperative IV placement. There is a lack of literature exploring whether the preoperative placement of IV lines shortens APT or patient-in-to-incision time. However, there have been documented increases in OR efficiency in settings where a regional anesthesia team separate from the OR anesthesia team performs regional blocks in dedicated block rooms prior to patients arrival in OR. The benefits of this workflow can be analyzed similarly to that of preoperative IV placement. The goals of this study are to determine if preoperative IV placement leads to a significant reduction in APT. More specifically, we will examine anesthesia start time to induction time to account for difficulties in airway management. We propose that this specific workflow will ultimately improve OR efficiency. We will also examine a specific cohort of patient to see if this intervention is useful in those cases- namely high turnover cases. We reviewed anonymized quality data of outpatient surgeries during a six-month span (June 2018 to November 2018). Of the 43,000 cases, only about 12,300 documented the time of IV insertion. Two groups were examined, that with IV placement before entering OR (Preop-IV) and placement after entering OR to entering OR (Intraop-IV). We compared median times for “anesthesia start - induction” and “anesthesia start - anesthesia ready.” In the Preop-IV group, the median time for “anesthesia start - induction” was 6 minutes versus 9 minutes in the “Intraop-IV” group. For "anesthesia start - ready," the two groups had median times of 11 minutes versus 14 minutes, respectively. A small cohort of 456 hysteroscopy cases were examined to see the effect on shorter, high turnover rooms. The “Preop-IV” group in this cohort saw an even greater benefit with median time to induction of 5.5 versus 9 minutes in the “Intraop-IV” group. The median anesthesia ready time of 9.5 minutes versus 12 minutes, respectively. Approximately 3-4 minutes of intraoperative time was saved with this variable. In an institution where we preform approximately 310 outpatient procedures daily, this would amount to 1,085 minutes saved. Additional time saved might be best applied to our specific cohort group where 18 - 40 minutes are saved, which might allow for another case to be performed at the end of the day.

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