Journal of perioperative practice
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The concept of 'lean thinking' first originated in the manufacturing industry as a means of improving productivity whilst maintaining quality through eliminating wasteful processes. The purpose of this article is to demonstrate how the principles of 'lean thinking' are relevant to healthcare and the operating theatre, with reference to our own institutional experience.
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Carbohydrate loading is an important component of enhanced recovery pathways. Some practitioners argue that patients' low acceptance for drinking such solutions could hamper the implementation of a full protocol. The aim of this study was to assess patients' actual acceptance of drinking carbohydrate solutions. ⋯ Finally 16 patients (54%) responded that they would be willing to take it again if indicated. We concluded that patient-related factors were not sufficient to hamper the implementation of carbohydrate loading before major surgery. The lack of implementation is probably related more to the attitude of the practitioner.
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Preoperative fasting is recognised as an important factor in perioperative patient care. Implementation of guidelines on preoperative fasting remains sub-optimal. ⋯ The manner in which information is presented to patients impacts behavior and adherence to recommendations. Improving this domain of clinical practice requires thorough and conscious effort and repeated reassessment.
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Patients who had arthroscopic shoulder surgery with the provision of an inter-scalene nerve block (ISB) at Blackpool Teaching Hospitals, were previously required to remain in hospital overnight. We introduced a new protocol that allowed same day discharge following arthroscopic shoulder surgery under general anaesthesia and ISB. The aim of this study was to review the outcome of this change in practice. Our results indicated that providing a discharge protocol for patients having arthroscopic shoulder surgery with the inclusion of ISB can avoid unnecessary overnight stay and enable significant cost savings, without detriment to patient safety or satisfaction.