Association of Reduced Delay in Care With a Dedicated Operating Room in Pediatric Otolaryngology | Otolaryngology | JAMA Otolaryngology–Head & Neck Surgery | JAMA Network
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Original Investigation
April 2018

Association of Reduced Delay in Care With a Dedicated Operating Room in Pediatric Otolaryngology

Author Affiliations
  • 1Department of Otolaryngology–Head and Neck Surgery, University Cincinnati, Cincinnati, Ohio
  • 2Department of Otolaryngology–Head and Neck Surgery, St Johns Providence Health System, Madison Heights, Michigan
  • 3Division of Pediatric Otolaryngology–Head and Neck Surgery, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
JAMA Otolaryngol Head Neck Surg. 2018;144(4):330-334. doi:10.1001/jamaoto.2017.3165
Key Points

Question  Could a dedicated block of operating room time help reduce the time from inpatient consult to operating room, and would it be adequately utilized?

Findings  In this review of 316 cases, the institution of a dedicated block of operating room time was associated with decreased time of 3 days from consult to operating room and had an adjusted utilization rate of 86%.

Meaning  Institution of a dedicated block of operating room time to triage inpatient consults is highly utilized and is associated with decreased time to operating room for consult patients.

Abstract

Importance  Obtaining sufficient operating room time for inpatient consults requiring an operative intervention is a persistent challenge for otolaryngologists.

Objective  To examine the institution of an otolaryngology-specific operating room (OR) for unscheduled (add-on) cases for its association with time from initial consultation to surgery and, secondarily, to determine utilization of a dedicated block of time.

Design, Setting, and Participants  Retrospective review of medical records of a tertiary care pediatric hospital for patients treated between January 1, 2015, and March 31, 2016; analysis was concluded by June 2016. Included were all patients undergoing inpatient otolaryngology consultations who required nonemergency operative procedures.

Interventions  In August 2015, a once-weekly 5-hour block of OR time dedicated to inpatient otolaryngology consults was instituted. Prior to this, cases were placed on an add-on list shared between all surgical services.

Main Outcomes and Measures  It was hypothesized that institution of a dedicated block of OR time would decrease the time from initial consultation to operative intervention and would be utilized at a high rate. Operating room utilization was calculated by dividing scheduled OR time by actual OR time utilized. Time from initial consultation to OR intervention was compared before and after the institution of the dedicated OR block.

Results  A total of 316 inpatient add-on pediatric cases (including 108 patients from the intensive care unit [ICU]) were scheduled during the study period. The most common cases were microlaryngoscopy/bronchoscopy (79%) and tracheostomy (8%). Mean (SD) time between consultation and OR intervention was 7.8 (1.6) days prior to establishing the add-on OR and 4.4 (1.3) days after it was established (absolute difference of 3.4 days; 95% CI, 3.1-3.7 days). Mean (SD) time between consultation and OR intervention was 7.4 (5.0) days for ICU patients prior to intervention and 5.6 (3.0) days after intervention (absolute difference of 1.8 days; 95% CI, 1.6-2.0 days). Total utilization of the OR block time was 74%, and adjusted utilization was 86%. There was a 15% drop in the number of unscheduled add-on cases after the intervention (from 10 cases/mo to 8.5 cases/mo; absolute difference of 1.5 cases; 95% CI, 1.1-1.9 cases).

Conclusions and Relevance  Instituting a dedicated otolaryngology add-on OR was associated with significantly reduced time between initial consultation and operative care, by approximately 3 days, decreased the number of unscheduled add-on cases, and was utilized at a high level.

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