The Experts below are selected from a list of 129975 Experts worldwide ranked by ideXlab platform
Franklin Dexter - One of the best experts on this subject based on the ideXlab platform.
-
caseload is increased by resequencing cases before and on the Day of Surgery at ambulatory Surgery centers where initial patient recovery is in operating rooms and cleanup times are longer than typical
Journal of Clinical Anesthesia, 2020Co-Authors: Zhengli Wang, Franklin Dexter, Stefanos A ZeniosAbstract:Abstract Study objective The coronavirus disease 2019 (COVID-19) pandemic impacts operating room (OR) management in regions with high prevalence (e.g., >1.0% of asymptomatic patients testing positive). Cases with aerosol producing procedures are isolated to a few ORs, initial phase I recovery of those patients is in the ORs, and multimodal environmental decontamination applied. We quantified the potential increase in productivity from also resequencing these cases among those 2 or 3 ORs. Design Computer simulation provided sample sizes requiring >100 years experimentally. Resequencing was limited to changes in the start times of surgeons' lists of cases. Setting Ambulatory Surgery center or hospital outpatient department. Main results With case resequencing applied before and on the Day of Surgery, there were 5.6% and 5.5% more cases per OR per Day for the 2 ORs and 3 ORs, respectively, both standard errors (SE) 90% probability of each OR finishing within the prespecified 12-h shift. Thus, the additional cases were all scheduled before the Day of Surgery. The greater allocated time also resulted in less overutilized time, a mean of 4.2 min per OR per Day for 2 ORs (SE 0.5) and 6.3 min per OR per Day for 3 ORs (SE 0.4). The benefit could be achieved while limiting application of resequencing to Days when the OR with the fewest estimated hours of cases has ≤8 h. Conclusions Some ambulatory Surgery ORs have unusually long OR times and/or room cleanup times (e.g., infection control efforts because of the pandemic). Resequencing cases before and on the Day of Surgery should be considered, because moving 1 or 2 cases occasionally has little to no cost with substantive benefit.
-
with directed study before a 4 Day operating room management course trust in the content did not change progressively during the classroom time
Journal of Clinical Anesthesia, 2017Co-Authors: Franklin Dexter, Richard H Epstein, Brenda G Fahy, Lyn M Van SwolAbstract:Abstract Study objective A 4-Day course in operating room (OR) management is sufficient to provide anesthesiologists with the knowledge and problem solving skills needed to participate in projects of the systems-based-practice competency. Anesthesiologists may need to learn fewer topics when the objective is, instead, limited to comprehension of decision-making on the Day of Surgery, We tested the hypothesis that trust in course content would not increase further after completion of topics related to OR decision-making on the Day of Surgery. Design Panel survey. Setting A 4-Day 35hour course in OR management. Mandatory assignments before classes were: 1) review of statistics at a level slightly less than required of anesthesiology residents by the American Board of Anesthesiology; and 2) reading of peer-reviewed published articles while learning the scientific vocabulary. Subjects N=31 course participants who each attended 1 of 4 identical courses. Measurements At the end of each of the 4Days, course participants completed a 9-item scale assessing trust in the course content, namely, its quality, usefulness, and reliability. Main results Cronbach alpha for the 1 to 7 trust scale was 0.94. The means±SD of scores were 5.86±0.80 after Day #1, 5.81±0.76 after Day #2, 5.80±0.77 after Day #3, and 5.97±0.76 after Day #4. Multiple methods of statistical analysis all found that there was no significant effect of the number of Days of the course on trust in the content (all P≥0.30). Conclusions Trust in the course content did not increase after the end of the 1st Day. Therefore, statistics review, reading, and the 1st Day of the course appear sufficient when the objective of teaching OR management is not that participants will learn how to make the decisions, but will comprehend them and trust in the information underlying knowledgeable decision-making.
-
the limited value of sequencing cases based on their probability of cancellation
Anesthesia & Analgesia, 2010Co-Authors: Avery Tung, Franklin Dexter, Sharon Jakubczyk, David B GlickAbstract:BACKGROUND:Case cancellations on the Day of Surgery reduce operating room (OR) and anesthesia group productivity. One strategy to reduce the impact of case cancellations on productivity is to assign high-risk cases to start last in the OR workDay. To evaluate the utility of this intervention, we use
-
influence of procedure classification on process variability and parameter uncertainty of surgical case durations
Anesthesia & Analgesia, 2010Co-Authors: Franklin Dexter, Elisabeth U Dexter, Johannes LedolterAbstract:BACKGROUND:Predictive variability of operating room (OR) times influences decision making on the Day of Surgery including when to start add-on cases, whether to move a case from one OR to another, and where to assign relief staff. One contributor to predictive variability is process variability, whi
-
operating room managerial decision making on the Day of Surgery with and without computer recommendations and status displays
Anesthesia & Analgesia, 2007Co-Authors: Franklin Dexter, Ann WillemsendunlapAbstract:BACKGROUND: There are three basic types of decision aids to facilitate operating room (OR) management decision-making on the Day of Surgery. Decision makers can rely on passive status displays (e.g., big screens or whiteboards), active status displays (e.g., text pager notification), and/or command displays (e.g., text recommendations about what to do). METHODS: Anesthesiologists, OR nurses, and housekeepers were given nine simulated scenarios (vignettes) involving multiple ORs to study their decision-making. Participants were randomized to one of four groups, all with an updated paper OR schedule: with/without command display and with/without passive status display. RESULTS: Participants making decisions without command displays performed no better than random chance in terms of increasing the predictability of work hours, reducing over-utilized OR time, and increasing OR efficiency. Status displays had no effect on these end-points, whereas command displays improved the quality of decisions. In the scenarios for which the command displays provided recommendations that adversely affected safety, participants appropriately ignored advice. CONCLUSIONS: Anesthesia providers and nursing staff made decisions that increased clinical work per unit time in each OR, even when doing so resulted in an increase in over-utilized OR time, higher staffing costs, unpredictable work hours, and/or mandatory overtime. Organizational culture and socialization during clinical training may be a cause. Command displays showed promise in mitigating this tendency. Additional investigations are in our companion paper.
David O Warner - One of the best experts on this subject based on the ideXlab platform.
-
association between smoking status preoperative exhaled carbon monoxide levels and postoperative surgical site infection in patients undergoing elective Surgery
JAMA Surgery, 2017Co-Authors: Margaret B Nolan, David P Martin, Rodney L Thompson, Darrell R Schroeder, Andrew C Hanson, David O WarnerAbstract:Importance Cigarette smoking is a risk factor for many perioperative complications, including surgical site infection (SSI). The duration of abstinence from smoking required to reduce this risk is unknown. Objectives To evaluate if abstinence from smoking on the Day of Surgery is associated with a decreased frequency of SSI in patients who smoke cigarettes and to confirm that smoking is significantly independently associated with SSI when adjustment is made for potentially relevant covariates, such as body mass index. Design, Setting, and Participants In this observational, nested, matched case-control study, 2 analyses were performed at an academic referral center in the upper Midwest. Cases included all patients undergoing elective surgical procedures at Mayo Clinic, Rochester, Minnesota, between January 1, 2009, and July 31, 2014 (inclusive) who subsequently developed an SSI. Controls for both analyses were matched on age, sex, and type of Surgery. Exposures Smoking status and preoperative exhaled carbon monoxide level, assessed by nurses in the preoperative holding area. Patients were classified as smoking on the Day of Surgery if they self-reported smoking or if their preoperative exhaled carbon monoxide level was 10 ppm or higher. Main Outcomes and Measures Surgical site infection after a surgical procedure at Mayo Clinic, Rochester, as identified by routine clinical surveillance using National Healthcare Safety Network criteria. Results of the 6919 patients in the first analysis, 3282 (47%) were men and 3637 (53%) were women; median age (interquartile range) for control and SSI cases was 60 (48-70). of the 392 patients in the second analysis, 182 (46%) were men and 210 (54%) were women; median age (interquartile range) for controls was 53 (45-49) and for SSI cases was 51 (45-60). During the study period, approximately 2% of surgical patients developed SSI annually. Available for the first analysis (evaluating the influence of current smoking status) were 2452 SSI cases matched to 4467 controls. The odds ratio for smoking and SSI was 1.51 (95% CI, 1.20-1.90; P P Conclusions and Relevance Current smoking is associated with the development of SSI, and smoking on the Day of Surgery is independently associated with the development of SSI. These data cannot distinguish whether abstinence per se reduces risk or whether it is associated with other factors that may be causative.
-
association between smoking status preoperative exhaled carbon monoxide levels and postoperative surgical site infection in patients undergoing elective Surgery
JAMA Surgery, 2017Co-Authors: Margaret B Nolan, David P Martin, Rodney L Thompson, Darrell R Schroeder, Andrew C Hanson, David O WarnerAbstract:Importance Cigarette smoking is a risk factor for many perioperative complications, including surgical site infection (SSI). The duration of abstinence from smoking required to reduce this risk is unknown. Objectives To evaluate if abstinence from smoking on the Day of Surgery is associated with a decreased frequency of SSI in patients who smoke cigarettes and to confirm that smoking is significantly independently associated with SSI when adjustment is made for potentially relevant covariates, such as body mass index. Design, Setting, and Participants In this observational, nested, matched case-control study, 2 analyses were performed at an academic referral center in the upper Midwest. Cases included all patients undergoing elective surgical procedures at Mayo Clinic, Rochester, Minnesota, between January 1, 2009, and July 31, 2014 (inclusive) who subsequently developed an SSI. Controls for both analyses were matched on age, sex, and type of Surgery. Exposures Smoking status and preoperative exhaled carbon monoxide level, assessed by nurses in the preoperative holding area. Patients were classified as smoking on the Day of Surgery if they self-reported smoking or if their preoperative exhaled carbon monoxide level was 10 ppm or higher. Main Outcomes and Measures Surgical site infection after a surgical procedure at Mayo Clinic, Rochester, as identified by routine clinical surveillance using National Healthcare Safety Network criteria. Results of the 6919 patients in the first analysis, 3282 (47%) were men and 3637 (53%) were women; median age (interquartile range) for control and SSI cases was 60 (48-70). of the 392 patients in the second analysis, 182 (46%) were men and 210 (54%) were women; median age (interquartile range) for controls was 53 (45-49) and for SSI cases was 51 (45-60). During the study period, approximately 2% of surgical patients developed SSI annually. Available for the first analysis (evaluating the influence of current smoking status) were 2452 SSI cases matched to 4467 controls. The odds ratio for smoking and SSI was 1.51 (95% CI, 1.20-1.90; P P Conclusions and Relevance Current smoking is associated with the development of SSI, and smoking on the Day of Surgery is independently associated with the development of SSI. These data cannot distinguish whether abstinence per se reduces risk or whether it is associated with other factors that may be causative.
Margaret B Nolan - One of the best experts on this subject based on the ideXlab platform.
-
association between smoking status preoperative exhaled carbon monoxide levels and postoperative surgical site infection in patients undergoing elective Surgery
JAMA Surgery, 2017Co-Authors: Margaret B Nolan, David P Martin, Rodney L Thompson, Darrell R Schroeder, Andrew C Hanson, David O WarnerAbstract:Importance Cigarette smoking is a risk factor for many perioperative complications, including surgical site infection (SSI). The duration of abstinence from smoking required to reduce this risk is unknown. Objectives To evaluate if abstinence from smoking on the Day of Surgery is associated with a decreased frequency of SSI in patients who smoke cigarettes and to confirm that smoking is significantly independently associated with SSI when adjustment is made for potentially relevant covariates, such as body mass index. Design, Setting, and Participants In this observational, nested, matched case-control study, 2 analyses were performed at an academic referral center in the upper Midwest. Cases included all patients undergoing elective surgical procedures at Mayo Clinic, Rochester, Minnesota, between January 1, 2009, and July 31, 2014 (inclusive) who subsequently developed an SSI. Controls for both analyses were matched on age, sex, and type of Surgery. Exposures Smoking status and preoperative exhaled carbon monoxide level, assessed by nurses in the preoperative holding area. Patients were classified as smoking on the Day of Surgery if they self-reported smoking or if their preoperative exhaled carbon monoxide level was 10 ppm or higher. Main Outcomes and Measures Surgical site infection after a surgical procedure at Mayo Clinic, Rochester, as identified by routine clinical surveillance using National Healthcare Safety Network criteria. Results of the 6919 patients in the first analysis, 3282 (47%) were men and 3637 (53%) were women; median age (interquartile range) for control and SSI cases was 60 (48-70). of the 392 patients in the second analysis, 182 (46%) were men and 210 (54%) were women; median age (interquartile range) for controls was 53 (45-49) and for SSI cases was 51 (45-60). During the study period, approximately 2% of surgical patients developed SSI annually. Available for the first analysis (evaluating the influence of current smoking status) were 2452 SSI cases matched to 4467 controls. The odds ratio for smoking and SSI was 1.51 (95% CI, 1.20-1.90; P P Conclusions and Relevance Current smoking is associated with the development of SSI, and smoking on the Day of Surgery is independently associated with the development of SSI. These data cannot distinguish whether abstinence per se reduces risk or whether it is associated with other factors that may be causative.
-
association between smoking status preoperative exhaled carbon monoxide levels and postoperative surgical site infection in patients undergoing elective Surgery
JAMA Surgery, 2017Co-Authors: Margaret B Nolan, David P Martin, Rodney L Thompson, Darrell R Schroeder, Andrew C Hanson, David O WarnerAbstract:Importance Cigarette smoking is a risk factor for many perioperative complications, including surgical site infection (SSI). The duration of abstinence from smoking required to reduce this risk is unknown. Objectives To evaluate if abstinence from smoking on the Day of Surgery is associated with a decreased frequency of SSI in patients who smoke cigarettes and to confirm that smoking is significantly independently associated with SSI when adjustment is made for potentially relevant covariates, such as body mass index. Design, Setting, and Participants In this observational, nested, matched case-control study, 2 analyses were performed at an academic referral center in the upper Midwest. Cases included all patients undergoing elective surgical procedures at Mayo Clinic, Rochester, Minnesota, between January 1, 2009, and July 31, 2014 (inclusive) who subsequently developed an SSI. Controls for both analyses were matched on age, sex, and type of Surgery. Exposures Smoking status and preoperative exhaled carbon monoxide level, assessed by nurses in the preoperative holding area. Patients were classified as smoking on the Day of Surgery if they self-reported smoking or if their preoperative exhaled carbon monoxide level was 10 ppm or higher. Main Outcomes and Measures Surgical site infection after a surgical procedure at Mayo Clinic, Rochester, as identified by routine clinical surveillance using National Healthcare Safety Network criteria. Results of the 6919 patients in the first analysis, 3282 (47%) were men and 3637 (53%) were women; median age (interquartile range) for control and SSI cases was 60 (48-70). of the 392 patients in the second analysis, 182 (46%) were men and 210 (54%) were women; median age (interquartile range) for controls was 53 (45-49) and for SSI cases was 51 (45-60). During the study period, approximately 2% of surgical patients developed SSI annually. Available for the first analysis (evaluating the influence of current smoking status) were 2452 SSI cases matched to 4467 controls. The odds ratio for smoking and SSI was 1.51 (95% CI, 1.20-1.90; P P Conclusions and Relevance Current smoking is associated with the development of SSI, and smoking on the Day of Surgery is independently associated with the development of SSI. These data cannot distinguish whether abstinence per se reduces risk or whether it is associated with other factors that may be causative.
Darrell R Schroeder - One of the best experts on this subject based on the ideXlab platform.
-
association between smoking status preoperative exhaled carbon monoxide levels and postoperative surgical site infection in patients undergoing elective Surgery
JAMA Surgery, 2017Co-Authors: Margaret B Nolan, David P Martin, Rodney L Thompson, Darrell R Schroeder, Andrew C Hanson, David O WarnerAbstract:Importance Cigarette smoking is a risk factor for many perioperative complications, including surgical site infection (SSI). The duration of abstinence from smoking required to reduce this risk is unknown. Objectives To evaluate if abstinence from smoking on the Day of Surgery is associated with a decreased frequency of SSI in patients who smoke cigarettes and to confirm that smoking is significantly independently associated with SSI when adjustment is made for potentially relevant covariates, such as body mass index. Design, Setting, and Participants In this observational, nested, matched case-control study, 2 analyses were performed at an academic referral center in the upper Midwest. Cases included all patients undergoing elective surgical procedures at Mayo Clinic, Rochester, Minnesota, between January 1, 2009, and July 31, 2014 (inclusive) who subsequently developed an SSI. Controls for both analyses were matched on age, sex, and type of Surgery. Exposures Smoking status and preoperative exhaled carbon monoxide level, assessed by nurses in the preoperative holding area. Patients were classified as smoking on the Day of Surgery if they self-reported smoking or if their preoperative exhaled carbon monoxide level was 10 ppm or higher. Main Outcomes and Measures Surgical site infection after a surgical procedure at Mayo Clinic, Rochester, as identified by routine clinical surveillance using National Healthcare Safety Network criteria. Results of the 6919 patients in the first analysis, 3282 (47%) were men and 3637 (53%) were women; median age (interquartile range) for control and SSI cases was 60 (48-70). of the 392 patients in the second analysis, 182 (46%) were men and 210 (54%) were women; median age (interquartile range) for controls was 53 (45-49) and for SSI cases was 51 (45-60). During the study period, approximately 2% of surgical patients developed SSI annually. Available for the first analysis (evaluating the influence of current smoking status) were 2452 SSI cases matched to 4467 controls. The odds ratio for smoking and SSI was 1.51 (95% CI, 1.20-1.90; P P Conclusions and Relevance Current smoking is associated with the development of SSI, and smoking on the Day of Surgery is independently associated with the development of SSI. These data cannot distinguish whether abstinence per se reduces risk or whether it is associated with other factors that may be causative.
-
association between smoking status preoperative exhaled carbon monoxide levels and postoperative surgical site infection in patients undergoing elective Surgery
JAMA Surgery, 2017Co-Authors: Margaret B Nolan, David P Martin, Rodney L Thompson, Darrell R Schroeder, Andrew C Hanson, David O WarnerAbstract:Importance Cigarette smoking is a risk factor for many perioperative complications, including surgical site infection (SSI). The duration of abstinence from smoking required to reduce this risk is unknown. Objectives To evaluate if abstinence from smoking on the Day of Surgery is associated with a decreased frequency of SSI in patients who smoke cigarettes and to confirm that smoking is significantly independently associated with SSI when adjustment is made for potentially relevant covariates, such as body mass index. Design, Setting, and Participants In this observational, nested, matched case-control study, 2 analyses were performed at an academic referral center in the upper Midwest. Cases included all patients undergoing elective surgical procedures at Mayo Clinic, Rochester, Minnesota, between January 1, 2009, and July 31, 2014 (inclusive) who subsequently developed an SSI. Controls for both analyses were matched on age, sex, and type of Surgery. Exposures Smoking status and preoperative exhaled carbon monoxide level, assessed by nurses in the preoperative holding area. Patients were classified as smoking on the Day of Surgery if they self-reported smoking or if their preoperative exhaled carbon monoxide level was 10 ppm or higher. Main Outcomes and Measures Surgical site infection after a surgical procedure at Mayo Clinic, Rochester, as identified by routine clinical surveillance using National Healthcare Safety Network criteria. Results of the 6919 patients in the first analysis, 3282 (47%) were men and 3637 (53%) were women; median age (interquartile range) for control and SSI cases was 60 (48-70). of the 392 patients in the second analysis, 182 (46%) were men and 210 (54%) were women; median age (interquartile range) for controls was 53 (45-49) and for SSI cases was 51 (45-60). During the study period, approximately 2% of surgical patients developed SSI annually. Available for the first analysis (evaluating the influence of current smoking status) were 2452 SSI cases matched to 4467 controls. The odds ratio for smoking and SSI was 1.51 (95% CI, 1.20-1.90; P P Conclusions and Relevance Current smoking is associated with the development of SSI, and smoking on the Day of Surgery is independently associated with the development of SSI. These data cannot distinguish whether abstinence per se reduces risk or whether it is associated with other factors that may be causative.
David P Martin - One of the best experts on this subject based on the ideXlab platform.
-
association between smoking status preoperative exhaled carbon monoxide levels and postoperative surgical site infection in patients undergoing elective Surgery
JAMA Surgery, 2017Co-Authors: Margaret B Nolan, David P Martin, Rodney L Thompson, Darrell R Schroeder, Andrew C Hanson, David O WarnerAbstract:Importance Cigarette smoking is a risk factor for many perioperative complications, including surgical site infection (SSI). The duration of abstinence from smoking required to reduce this risk is unknown. Objectives To evaluate if abstinence from smoking on the Day of Surgery is associated with a decreased frequency of SSI in patients who smoke cigarettes and to confirm that smoking is significantly independently associated with SSI when adjustment is made for potentially relevant covariates, such as body mass index. Design, Setting, and Participants In this observational, nested, matched case-control study, 2 analyses were performed at an academic referral center in the upper Midwest. Cases included all patients undergoing elective surgical procedures at Mayo Clinic, Rochester, Minnesota, between January 1, 2009, and July 31, 2014 (inclusive) who subsequently developed an SSI. Controls for both analyses were matched on age, sex, and type of Surgery. Exposures Smoking status and preoperative exhaled carbon monoxide level, assessed by nurses in the preoperative holding area. Patients were classified as smoking on the Day of Surgery if they self-reported smoking or if their preoperative exhaled carbon monoxide level was 10 ppm or higher. Main Outcomes and Measures Surgical site infection after a surgical procedure at Mayo Clinic, Rochester, as identified by routine clinical surveillance using National Healthcare Safety Network criteria. Results of the 6919 patients in the first analysis, 3282 (47%) were men and 3637 (53%) were women; median age (interquartile range) for control and SSI cases was 60 (48-70). of the 392 patients in the second analysis, 182 (46%) were men and 210 (54%) were women; median age (interquartile range) for controls was 53 (45-49) and for SSI cases was 51 (45-60). During the study period, approximately 2% of surgical patients developed SSI annually. Available for the first analysis (evaluating the influence of current smoking status) were 2452 SSI cases matched to 4467 controls. The odds ratio for smoking and SSI was 1.51 (95% CI, 1.20-1.90; P P Conclusions and Relevance Current smoking is associated with the development of SSI, and smoking on the Day of Surgery is independently associated with the development of SSI. These data cannot distinguish whether abstinence per se reduces risk or whether it is associated with other factors that may be causative.
-
association between smoking status preoperative exhaled carbon monoxide levels and postoperative surgical site infection in patients undergoing elective Surgery
JAMA Surgery, 2017Co-Authors: Margaret B Nolan, David P Martin, Rodney L Thompson, Darrell R Schroeder, Andrew C Hanson, David O WarnerAbstract:Importance Cigarette smoking is a risk factor for many perioperative complications, including surgical site infection (SSI). The duration of abstinence from smoking required to reduce this risk is unknown. Objectives To evaluate if abstinence from smoking on the Day of Surgery is associated with a decreased frequency of SSI in patients who smoke cigarettes and to confirm that smoking is significantly independently associated with SSI when adjustment is made for potentially relevant covariates, such as body mass index. Design, Setting, and Participants In this observational, nested, matched case-control study, 2 analyses were performed at an academic referral center in the upper Midwest. Cases included all patients undergoing elective surgical procedures at Mayo Clinic, Rochester, Minnesota, between January 1, 2009, and July 31, 2014 (inclusive) who subsequently developed an SSI. Controls for both analyses were matched on age, sex, and type of Surgery. Exposures Smoking status and preoperative exhaled carbon monoxide level, assessed by nurses in the preoperative holding area. Patients were classified as smoking on the Day of Surgery if they self-reported smoking or if their preoperative exhaled carbon monoxide level was 10 ppm or higher. Main Outcomes and Measures Surgical site infection after a surgical procedure at Mayo Clinic, Rochester, as identified by routine clinical surveillance using National Healthcare Safety Network criteria. Results of the 6919 patients in the first analysis, 3282 (47%) were men and 3637 (53%) were women; median age (interquartile range) for control and SSI cases was 60 (48-70). of the 392 patients in the second analysis, 182 (46%) were men and 210 (54%) were women; median age (interquartile range) for controls was 53 (45-49) and for SSI cases was 51 (45-60). During the study period, approximately 2% of surgical patients developed SSI annually. Available for the first analysis (evaluating the influence of current smoking status) were 2452 SSI cases matched to 4467 controls. The odds ratio for smoking and SSI was 1.51 (95% CI, 1.20-1.90; P P Conclusions and Relevance Current smoking is associated with the development of SSI, and smoking on the Day of Surgery is independently associated with the development of SSI. These data cannot distinguish whether abstinence per se reduces risk or whether it is associated with other factors that may be causative.
