Adapting to a new system of surgical technologies and perioperative processes among clinicians.
Adapting to a new system of surgical technologies and perioperative processes among clinicians.
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适应临床医生的新的外科技术和围手术期流程系统。
DOI：
10.1016/j.jss.2006.08.030
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发表时间：
2007
期刊：
影响因子：
--
通讯作者：
Gazelle,GScott
中科院分区：
文献类型：
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作者：
Stahl,JamesE;Goldman,JulianM;Rattner,DavidW;Gazelle,GScott
目的了解新系统的外科技术和围手术期流程的学习和适应。方法记录实验手术室（“未来手术室”或ORF）和对照手术室第一年的患者等待时间、流程时间和手术程序时间。回归方法用于检验假设影响性能的因素。结果ORF患者的血流时间、等待时间和手术时间均显著缩短。ORF性能表现为初始超调，随后在组均值周围振荡30-40 d。如果外科医生手术间隔≥2周，平均病例量超过2.1例/周，则观察到类似的行为。使用假设学习因素的回归模型预测流时间（R2= 0.33）和等待时间（R2= 0.36）；将过程类型添加到这些模型中，r2分别提高到0.7和0.57。结论：引入新技术后对系统性能的客观观察可以为适应性提供见解，并可能对手术室的调度、培训和成本效益评估具有重要意义。
PURPOSETo understand learning and adaptation to a new system of surgical technologies and perioperative processes.METHODSPatient wait time, flow time, and surgery procedure time were recorded in the experimental (“Operating room of the future” or ORF) and control ORs over the first year of the ORF’s operation. Regression methods were used to examine factors hypothesized to influence performance.RESULTSFlow time, wait time, and surgery procedure time for each case decreased significantly in the ORF. The ORF performance demonstrated an initial overshoot followed by oscillation with 30–40 d period around the group mean. Similar behavior was observed for surgeons if they had ≥2-week hiatus from operating and had an average caseload more than 2.1 cases/week. Regression models using hypothesized learning factors predicted flow time (R2= 0.33) and wait time (R2= 0.36); adding procedure type to these models raised R2to 0.7 and 0.57, respectively.CONCLUSIONSObjective observation of system performance in which a new technology is introduced can provide insights into adaptation and may have significant implications for OR scheduling, training, and cost-effectiveness evaluations.