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Improving Operating Room Efficiency via Reduction and Standardization of Video-Assisted Thoracoscopic Surgery Instrumentation

  • Systems-Level Quality Improvement
  • Published:
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Abstract

Being the economic powerhouses of most large medical centers, operating rooms (ORs) require the highest levels of teamwork, communication, and efficiency in order to optimize patient safety and reduce hospital waste. A major component of OR waste comes from unused surgical instrumentation; instruments that are frequently prepared for procedures but are never touched by the surgical team still require a full reprocessing cycle at the conclusion of the case. Based on our own previous successes in the perioperative domain, in this work we detail an initiative that reduces surgical instrumentation waste of video-assisted thoracoscopic surgery (VATS) procedures by placing thoracotomy conversion instrumentation in a standby location and designing a specific instrument kit to be used solely for VATS cases. Our estimates suggest that this initiative will reduce at least 91,800 pounds of unnecessary surgical instrumentation from cycling through our ORs and reprocessing department annually, resulting in increased OR team communication without sacrificing the highest standard of patient safety.

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Abbreviations

MGH:

Massachusetts General Hospital

AMC:

Academic Medical Center

OR:

Operating Room

CSPS:

Central Sterile Processing & Supplies

VATS:

Video-Assisted Thoracoscopic Surgery

QI:

Quality Improvement

References

  1. Spaner, S. J., and Warnock, G. L., A brief history of endoscopy, laparoscopy, and laparoscopic surgery. J. Laparoendosc. Adv. Surg. Tech. 7:369–373, 1997. https://doi.org/10.1089/lap.1997.7.369.

    Article  CAS  Google Scholar 

  2. Reynolds, Jr., W., The first laparoscopic cholecystectomy. JSLS J. Soc. Laparoendosc. Surg. 5:89–94, 2001.

    Google Scholar 

  3. Eldar, S., Sabo, E., Nash, E. et al., Laparoscopic versus open cholecystectomy in acute cholecystitis. Surg. Laparosc. Endosc. 7:407–414, 1997.

    Article  PubMed  CAS  Google Scholar 

  4. Sauerland, S., Jaschinski, T., and Neugebauer, E. A., Laparoscopic versus open surgery for suspected appendicitis. Cochrane Database Syst. Rev. CD001546. https://doi.org/10.1002/14651858.CD001546.pub3.2010.

  5. Conacher, I. D., Soomro, N. A., and Rix, D., Anaesthesia for laparoscopic urological surgery. Br. J. Anaesth. 93:859–864, 2004.

    Article  PubMed  CAS  Google Scholar 

  6. Powell, F., and Khaund, A., Laparoscopy and laparoscopic surgery. Obstet. Gynaecol. Reprod. Med. 26:297–303, 2016. https://doi.org/10.1016/j.ogrm.2016.07.004.

    Article  Google Scholar 

  7. Gopaldas, R. R., Bakaeen, F. G., Dao, T. K. et al., Video-assisted thoracoscopic versus open thoracotomy lobectomy in a cohort of 13,619 patients. Ann. Thorac. Surg. 89:1563–1570, 2010. https://doi.org/10.1016/j.athoracsur.2010.02.026.

    Article  PubMed  Google Scholar 

  8. McKenna, R. J., Houck, W., and Fuller, C. B., Video-assisted thoracic surgery lobectomy: experience with 1,100 cases. Ann. Thorac. Surg. 81:421–426, 2006. https://doi.org/10.1016/j.athoracsur.2005.07.078.

    Article  PubMed  Google Scholar 

  9. Copenhaver, M. S., Friend, T. H., Fitzgerald-Brown, C. et al., Improving operating room and surgical instrumentation efficiency, safety, and communication via the implementation of emergency laparoscopic cholecystectomy and appendectomy conversion case carts. Perioper Care Oper. Room Manag., 2017. https://doi.org/10.1016/j.pcorm.2017.09.001.

  10. Hanna, J. M., Berry, M. F., and D’Amico, T. A., Contraindications of video-assisted thoracoscopic surgical lobectomy and determinants of conversion to open. J. Thorac. Dis. 5, 2013. https://doi.org/10.3978/j.issn.2072-1439.2013.07.08.

  11. Hansen, H. J., Petersen, R. H., and Christensen, M., Video-assisted thoracoscopic surgery (VATS) lobectomy using a standardized anterior approach. Surg. Endosc. Other Interv. Tech. 25:1263–1269, 2011. https://doi.org/10.1007/s00464-010-1355-9.

    Article  Google Scholar 

  12. Onaitis, M. W., Petersen, R. P., Balderson, S. S. et al., Thoracoscopic lobectomy is a safe and versatile procedure. Trans . Meet. Am. Surg. Assoc. 124:86–91, 2006. https://doi.org/10.1097/01.sla.0000234892.79056.63.

    Article  Google Scholar 

  13. Wormer, B. A., Augenstein, V. A., Carpenter, C. L. et al., The green operating room: Simple changes to reduce cost and our carbon footprint. Am. Surg. 79:666–671, 2013.

    PubMed  Google Scholar 

  14. Farrokhi, F. R., Gunther, M., Williams, B., and Blackmore, C. C., Application of lean methodology for improved quality and efficiency in operating room instrument availability. J. Healthc Qual. 2013.

  15. Blackmore, C. C., Bishop, R., Luker, S., and Williams, B. L., Applying lean methods to improve quality and safety in surgical sterile instrument processing. Jt. Comm. J. Qual. Patient Saf. 39:99–105, 2013. https://doi.org/10.1016/S1553-7250(13)39014-X.

    Article  PubMed  Google Scholar 

  16. Halton, K., Graves, N., and Hall, L., Opportunity cost of unavailable surgical instruments in Australian hospitals. ANZ J. Surg. 84:905–906, 2014. https://doi.org/10.1111/ans.12822.

    Article  PubMed  Google Scholar 

  17. Friend, T. H., Jennings, S. J., Copenhaver, M. S., and Levine, W. C., Implementation of the Vocera communication system in a quaternary perioperative environment. J. Med. Syst. 41. doi:https://doi.org/10.1007/s10916-016-0652-9. 2017.

  18. Divisi, D., Zaccagna, G., Gabriele, F., and Crisci, R., Role and utility of the national registers of VATS major procedures. Video-Assist. Thorac. Surg. 2:3, 2017. https://doi.org/10.21037/vats.2017.01.01.

    Article  Google Scholar 

  19. Augustin, F., Maier, H. T., Weissenbacher, A. et al., Causes, predictors and consequences of conversion from VATS to open lung lobectomy. Surg. Endosc. Other Interv. Tech. 30:2415–2421, 2016. https://doi.org/10.1007/s00464-015-4492-3.

    Article  Google Scholar 

  20. Smith, D. E., Dietrich, A., Nicolas, M. et al., Conversion during thoracoscopic lobectomy: Related factors and learning curve impact. Updates Surg. 67:427–432, 2015. https://doi.org/10.1007/s13304-015-0334-z.

    Article  PubMed  Google Scholar 

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Acknowledgements

We would like to thank all members of the MGH Division of Thoracic Surgery for their help and patience in the implementation of this QI initiative. THF thanks Denise Gee, M.D., for her help in preparing the history of laparoscopy globally and at MGH, and Martin Copenhaver for his help with historical procedural data capture and organization. Vocera® is a trademark of Vocera Communications, Inc. registered in the United States and other jurisdictions. All other trademarks appearing in this article are the property of their respective owners.

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Massachusetts General Hospital, 55 Fruit Street, WHT 400, Boston, MA, 02114, USA

    Tynan H. Friend, Ashley Paula, Jason Klemm, Mark Rosa & Wilton Levine

Authors
  1. Tynan H. Friend
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  2. Ashley Paula
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  3. Jason Klemm
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  4. Mark Rosa
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  5. Wilton Levine
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Correspondence to Wilton Levine.

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Conflict of Interest

Dr. Wilton Levine receives royalties for intellectual property licensed to Codonics, Inc., and Western Enterprises, Inc. The other authors declare that they have no conflict of interest.

Ethical Approval

This article does not contain any studies with human participants or animals performed by any of the authors.

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This article is part of the Topical Collection on Systems-Level Quality Improvement

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Friend, T.H., Paula, A., Klemm, J. et al. Improving Operating Room Efficiency via Reduction and Standardization of Video-Assisted Thoracoscopic Surgery Instrumentation. J Med Syst 42, 116 (2018). https://doi.org/10.1007/s10916-018-0976-8

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