A mobile, web-based rounding tool is allowing the perioperative leadership team at Vail Valley Medical Center (VVMC) in Vail, Colorado, to collect, analyze, and report on information gathered from surgeons, staff, and patients to improve quality of care and move toward high reliability. Software designed by MyRounding Solutions in Littleton,…

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Efforts to increase patient safety have been successful in some areas, but less so in others—notably, postoperative outcomes—according to a recent study. Researchers who analyzed Medicare Patient Safety Monitoring System data for the period 2005 through 2011 found declines in adverse event rates for patients hospitalized because of acute myocardial…

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Obstructive sleep apnea is a major clinical and economic challenge in the postoperative period, affecting up to one-fourth of patients undergoing elective surgical procedures. The prevalence among orthopedic patients having joint arthroplasty may be especially high because obesity is a widespread comorbidity in this patient population. Obesity is 1 of…

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Sacred Heart Medical Center RiverBend in Springfield, Oregon, began OR optimization efforts soon after moving to a new facility in August 2008. Because of the US economic downturn around that same time, the hospital launched several initiatives to make the most of available resources, including a Lean process to improve…

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Surgical case delays have been found to last an average of nearly 17 minutes. Not only do such delays make surgeons dissatisfied, they also reduce case volume and related revenues, and they may lead to additional time under anesthesia for patients. The root causes of instrument-based delays are seldom simple,…

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Although immediate-use steam sterilization (IUSS) is a safe method to sterilize emergently contaminated instruments, inappropriate use may lead to an increased risk for surgical site infection, according to a study in the American Journal of Infection Control. This study stated the only acceptable indicator for use of IUSS based on…

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Many OR directors struggle with designing effective nurse compensation systems. The ideal system would achieve department goals while maintaining nurse satisfaction. Unfortunately, a compensation plan that links these 2 objectives is often elusive. In 2012, OR leadership at a small Pennsylvania hospital developed a compensation system that effectively aligns nursing…

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The primary function of an ambulatory surgery center (ASC) is simple and easily described: to perform surgery for which patients can be discharged within 24 hours, to do this efficiently, safely, and cost effectively, and to collect adequate, timely payment. The path to achieving these results is not so simple.…

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After a poor handoff from the OR to the postanesthesia care unit (PACU) was identified as the culprit behind a serious adverse event, Nancy Robinson, DNP, MSN, RN, LHRM, CCM, made it her mission to avoid a recurrence. “I’m passionate about safe patient hand-offs,” says Robinson. “I didn’t want this…

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With the expansion of Medicare readmission penalties to elective total-knee and total-hip arthroplasty patients in 2014 comes an increasing demand for OR leaders to ensure better postdischarge care. To avoid readmissions, OR management will have to be more proactive about reducing length of stay and complications and providing for care…

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In 2011, fewer than half of all first cases at Dartmouth Hitchcock Medical Center in Lebanon, New Hampshire, were starting on time. That meant subsequent cases were also delayed, with overtime costs exceeding $500,000 a year. “People were unhappy with that for a lot of different reasons. It was a…

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By 2020, 80% of RNs should have a bachelor of science in nursing (BSN) degree, according to recommendations made by the Institute of Medicine (IOM) in 2010. Responses to the 2013 OR Manager Annual Salary/Career Survey showed that almost half of OR directors and managers have a master’s degree and…

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More than $150 billion is spent annually on medical devices in the United States, with orthopedic and cardiac procedures accounting for almost all of Medicare’s device-related expenditures. Most of the recent increases in such expenditures have been related to the wider use of orthopedic devices, which is expected to grow…

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What would you do if you had more than 50 open positions and 40 travel nurses in your OR? If you were part of the team at University of Virginia Medical Center (UVAMC) in Charlottesville, you would get busy recruiting and retaining staff. “We knew we couldn’t continue down that…

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Like most OR leaders, Doug Robinson, BSN, RN, CNOR, manager of the Roberts Operating Rooms at Baylor University Medical Center at Dallas, wants a steady supply of OR nurses. Robinson has reached back to his own student experience to develop a program that gives students OR exposure, with the intent…

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In the days after the Boston Marathon bombing on April 15, 2013, many praised the way the city’s hospitals responded to the attack. But clinicians in those hospitals aren’t resting on their laurels. They have examined what worked well (and not so well) after the event and continue to plan…

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Surgical checklist compliance among 4 Canadian hospitals was around 60% in a large, retrospective study of acute care operations performed in 2010 and 2011. Although Alberta Health Services in Calgary, Alberta, Canada, had mandated checklist use starting in 2009, limitations such as instructional misuse, lack of perceived benefit, and lack…

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Among the challenges facing OR leaders everywhere are declining payment in tandem with rising costs, increased quality and patient satisfaction requirements, and the ongoing struggle to manage relations with surgeons. When it comes to tackling these issues, many OR directors do not realize they have a powerful natural ally—the anesthesiology…

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How to identify the most common problems that occur in the OR and then find ways to prevent them is a trick most OR leaders would love to learn. A solution that shows some promise is a web-based debriefing questionnaire, judging by the experience of a multidisciplinary safety team at…

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The Patient Protection and Affordable Care Act (ACA) is affecting every part of the healthcare system, including ambulatory surgery centers (ASCs). Whether it will help or hinder ASCs, however, will depend on how adept they are at managing changes in the way they are paid and how they interact with…

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