The Best in OR Business Award is presented annually at the OR Business Management Conference to recognize an outstanding leader who has saved on costs, increased OR utilization, improved patient safety, or otherwise streamlined the surgical services department. The 2020 award will be presented to Vikram Tiwari, PhD, associate professor…

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At Virginia Commonwealth University (VCU) Health System in Richmond, implementation of Enhanced Recovery After Surgery (ERAS) incorporates principles of Lean thinking, a management methodology that emphasizes “…maximize[ing] customer value while minimizing waste. Simply, lean means creating more value for customers with fewer resources,” according to the Lean Enterprise Institute.1 Several…

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Of the approximately 57 million surgical procedures performed annually in the US, it is estimated that hospital inpatient procedures (overnight admissions) account for less than 20% of cases. Many procedures once performed in hospital outpatient surgery departments (HOPDs) have moved to ambulatory surgery centers (ASCs) over the past 15 years,…

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Starting the first cases of the day on time is key for maintaining the OR schedule. A delay in first case on-time starts (FCOTS) can lead to less OR utilization, greater facility costs, and dissatisfaction among physicians, OR staff, and patients. It’s a problem in many surgical suites, but when…

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Editor's Note In this study from Washington University School of Medicine, St Louis, a first case on-time starts (FCOTS) improvement initiative was linked to a higher frequency of FCOTS, which was independently associated with last case on-time ends (LCOTE) and decreased OR overtime costs. Of 12,073 cases (6,095 pre- vs…

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Malignant hyperthermia (MH) is a rare but life-threatening surgical complication that seems to turn the effects of general anesthesia upside down. Instead of relaxing, muscles become rigid, releasing large amounts of acid and potassium into the blood. Instead of a normal slowing of breathing, respirations quicken, and end-tidal CO2 rises.…

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A care transition poses a danger point for patients—failing to “hand off” needed information from one clinician to another can lead to significant morbidity and mortality. The Joint Commission was so concerned about handoffs that in 2017 it issued a sentinel event alert on the topic. “Handoffs are a safety…

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In 2017, the Joint Commission issued a Sentinel Alert Event on the problem of inadequate handoff communication, focusing attention on this vital aspect of care. (See related story, p 22.) Clinicians and leaders agree that handoffs are important, but implementing them effectively can be challenging, particularly in the fast-paced perioperative…

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Enhanced Recovery After Surgery The implementation of Enhanced Recovery After Surgery (ERAS) is based on the concept of organizing care around the patient, addressing medical condition needs to optimize readiness for surgery and reducing the likelihood of postoperative complications. Efficacy is measured by how well we perform according to these…

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Editor's Note Though patient and personnel factors affect the order of case induction, induction time is most dependent on patient factors, this study finds. Of 15,823 cases analyzed, predictors of later patient induction included add-on case, ASA class 3 or more, neuraxial anesthesia, and CRNA staffing. In 11,093 (70.1%) cases,…

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