The Journal of medical practice management : MPM
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The operating room (OR) turnover is a critical period in patient care and OR management. Turnover time (TOT) is a traditional quantitative measure of OR efficiency but is lacking when used to describe the TOT process. ⋯ Interview data of OR staff can supplement quantitative efficiency measures and identify areas of opportunity in OR management and patient safety.
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Traditionally, the operating room (OR) in an academic medical center has faced numerous challenges to effective clinical productivity, including additional missions of teaching and research. Level 1 trauma poses more challenges related to the need for additional specialized personnel in anesthesia, surgery, and nursing. The present investigation explores lessons learned in efficiency, teamwork, and data evaluation at a level 1 academic teaching facility. ⋯ These results are remarkable in comparison to the greater-than 20% cancellation rate recorded in 2005 when the current OR leadership team first assessed OR efficiency. An increase in the number of cases completed per month likely can be attributed to a reduction in the number of case cancellations. Increased efficiency allows for more operations to be performed, leading to increased profitability and an increased ability of hospitals to continue caring for patients. We advocate the implementation of a comprehensive multidisciplinary strategy for sustained improvement in OR efficiency and utilization.
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All physicians have mentors, role models, and even historical figures in medicine to whom they turn for advice on everything from treating their patients to running their practices. To be sure, many physicians have learned valuable lessons from Osler, Halstead, Fleming, Pasteur, and a long list of former professors, supervisors, and practice partners. In this article, however, we suggest that modern physicians can turn to a most unlikely source of wisdom and knowledge. ⋯ It may be hard to believe, but modern physicians can learn much about the care of patients and the business of running their practices from the very same books they are reading with their children and grandchildren. The idea that well-trained and sophisticated physicians can learn from Dr. Seuss is not as far-fetched as it may seem initially.
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When an unexpected perioperative crisis arises, simulation studies have suggested that the use of an emergency manual (EM) may offset the large cognitive load involved in crisis management, facilitating the efficient performance of key steps in treatment. However, little is known about how well EMs will translate into actual practice and what is required to use them optimally. ⋯ In the interim, cautious use of these cognitive aids is recommended, especially when the diagnosis is not straightforward, falls "in between" sections of the EM, or falls outside of the EM itself. Further research should focus on the efficacy of EMs as measured by the percentage of critical steps correctly performed by their users in scenarios that do not closely mirror one of the listed EM scenarios from the beginning or as the situation evolves.
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Performing a peer review of an article under consideration for publication requires not only an understanding of the subject matter, but also a systematic approach that includes screening for conflicts of interest; determining whether the manuscript is within or outside the reviewer's area of expertise; properly classifying the manuscript; and writing a detailed, organized review. Although some journals may provide guidelines for the reviewers, the guidelines usually are not detailed and do not take into consideration the variability in reviewer experience. This article is meant to serve as a guideline for peer reviewers and provide concrete information on how to write a comprehensive, unbiased review that will serve both the author and the journal well.