The idea of ​​streamlining the operating room makes patients undergo surgery faster

The pandemic exacerbates waiting lists for non-urgent surgeries. An alternative model London hospital

When a surgeon sees a patient stuck waiting for orthopedic surgery, he designs a better operating room – one that is publicly funded and can perform procedures faster and more efficiently. Now, this is another hospital model I'm interested in emulating.

Dr. Abdel-Rahman Lawendy, chief and medical director of the outpatient surgery center at the London Health Sciences Centre, reorganized the OR — one of the most resource-intensive places in the hospital — for select orthopedic surgeries.

His "Surgery Center" idea took certain patients away from large standard operating theaters full of staff and equipment, reducing them to just what was needed to operate on an outpatient — one who could walk after surgery and go home the same day. . Examples of surgeries performed include repairing a torn ACL in the knee, a common sports injury. And the operation is performed in an operating room outside the hospital, even though it is managed by the institution.

In comparison, a standard hospital operating room needs to be prepared for a complex operation that requires about six staff per room and a full set of sterilized instruments, just in case if needed.

"By cutting all that stuff, you're essentially lowering costs significantly and then increasing efficiency, which in our system doesn't necessarily mean saving more money," says Lawendy. "This means treating more patients."

Treating more patients is critical now that the COVID-19 pandemic is extending long waiting lists for non-urgent surgeries, hospital officials said. The average waiting time in Canada last year for a hip replacement was about 25 weeks, according to the Canadian Institute of Health Information.

But Mary Curry only waited 14 weeks for forefoot reconstruction. Arthritis has resulted in months of leg pain that has limited the mobility of patients in Denfield, Ontario and left him psychologically exhausted.

Strong team adds efficiency

He and other patients at the Nazem Kadri Surgery Center went home on the day of their surgery. Since Curry's pain is not life-threatening, without Lawendy's innovation, he may have to wait longer for surgery to resume walking on his heels, given the average waiting time.

Patients are eligible for the outpatient surgery option at a London hospital if they are relatively healthy and undergo minor foot, ankle or hernia surgery that requires minimal equipment.

"The crew is amazing," Curry said as he was pushed out of the smaller, high-efficiency OR. "Stayed awake until I started to feel the push and pull."

Jillian Holbrough, clinical manager of the surgical center, said staff were at least 30 percent faster than in a standard hospital operating room. They perform between 10 and 15 operations a day in two operating theaters. "It was a little scary at first, thought, because it's so innovative," Holbrough said of the initial hesitation. Then the culture changed and the staff joined in.

"We have a very strong team here and we all work together," said Holbrough, who is also manager at Victoria's OR Hospital, also in London, Ontario. "And that, by itself, creates a lot of efficiency." Same quality, lower cost.

Holbrough said the outpatient center also offers a great patient experience because people receive pre- and post-operative care at the same place by the same nurses.

Lawendy graduate student Moaz Bin Yunus Chohan wrote a thesis about a surgical center based on data that tested the approach on more than 1,000 patients.

Instead of the standard minimum of six staff in the OR, smaller operating rooms have exactly what is needed for a given patient — be it surgical, anesthetic and nursing personnel and equipment, says Lawendy. "Basically it shows that we can cut costs while maintaining quality," said Lawendy, who is also head of orthopedic trauma services.

The researchers found that the cost in a conventional operating room or hospital was about $469 per patient. In high-efficiency or outpatient centers, the cost drops to $172 per patient. And patients treated in regulated outpatient centers also tend to have fewer postoperative complications, resulting in further cost savings. The Ontario government sees Lawendy's public system model as a way to safely speed up operations.

"We have people who come to tour here almost every week to see what models from all over Ontario look like," she said.

Dr Danny Goel, a clinical professor in orthopedic surgery at the University of British Columbia, was not involved in Lawendy's model, which he calls the big shift. "As more and more procedures shift to this method of delivering care, opportunities to invest in a surgical center should be encouraged to reduce the burden on traditional hospital settings," Goel said in an email.

"While there may be some initial infrastructure and implementation challenges, the long-term benefits to patient care and the Canadian healthcare system in general will be significant."

For its part, the London Center for Health Sciences plans to increase to four more outpatient ORs.

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