Intraoperative Scrub Nurse Handoffs Are Associated with Increased Operative Times for Lower Extremity Orthopaedic Sports Procedures.
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ABSTRACT: Purpose
The purpose of this study was to evaluate the effect of intraoperative scrub nurse handoffs on surgical times for arthroscopically-assisted anterior cruciate ligament (ACL) reconstructions and hip arthroscopies.Methods
A retrospective chart review was done at a major, urban academic medical center for all patients who underwent arthroscopically-assisted ACL reconstructions and hip arthroscopies for femoroacetabular impingement syndrome between May 2014 and May 2020. All ACL reconstructions were performed by 1 of 6 sports medicine fellowship-trained surgeons, and all hip arthroscopies were performed by a single surgeon. Operative times, number of scrub nurse handoffs, surgeon, patient demographics, and procedure-specific information were recorded. The association between patient characteristics and the number of handoffs, as well as the association between patient characteristics and operative times, stratified by scrub nurse handoffs, were calculated. A multivariable linear regression was performed to assess the association between intra-operative handoffs and operative times.Results
Eight hundred twenty ACL reconstructions and 269 hip arthroscopies were identified. Multivariable linear regression demonstrated increasing intraoperative scrub nurse handoffs were associated with increased operative times for all patients. For ACL reconstructions, when including all possible covariates, 1 scrub nurse handoff increased operative times by 21.1 minutes (95% confidence interval [CI]: 15.36 to 26.89; P < .001), and 2+ handoffs increased operative times by 34.2 minutes (95% CI: 26.28 to 42.15; P < .001). For hip arthroscopies, 1 scrub nurse handoff increased operative times by 7.0 minutes (95% CI: 0.31 to 13.74; P = .04).Conclusion
Although a causal link cannot be made, intraoperative scrub nurse handoffs were associated with statistically significant increase in operative times for both ACL reconstructions and hip arthroscopies.Level of evidence
Level III, retrospective cohort study.
SUBMITTER: Hammoor BT
PROVIDER: S-EPMC8365200 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:BackgroundSurgeons typically remain scrubbed in for the duration of a surgical case, while scrub nurses are shift-workers who handoff mid-operation. These handoffs can intuitively create inefficiencies, but currently, no orthopedic research has studied the impact of these handoffs. This study analyzed the effect of intraoperative scrub nurse handoffs on operative times for total joint arthroplasties (TJAs).MethodsA retrospective chart review was performed for primary total hip (THA) and total knee arthroplasties (TKA) performed between May 2014 and May 2018. Operative times, number of scrub nurse handoffs, surgeon, and patient information were collected. A multivariable linear regression was performed to assess the association between patient and surgeon characteristics, intraoperative handoffs, and operative times.ResultsA total of 1109 TKA and 1032 THA patients were identified. Multivariable linear regression demonstrated that for TKAs, 1 handoff was associated with a 3.89-minute longer operative time (P value = .02), and 2+ handoffs were associated with a 15.99-minute longer case (P value < .001). For THA patients, 1 handoff was associated with a 6.20-minute longer operative time (P value < .001), and 2+ handoffs were associated with an 18.52-minute longer case (P value < .001).ConclusionsAlthough causation cannot be established, when controlling for multiple confounders, intraoperative scrub nurse handoffs were associated with statistically significant increases in operative times for TJAs. Optimizing scrub nurse staffing models to decrease intraoperative handoffs could thus have practical ramifications on TJA patients.
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Project description:ObjectiveTo compare nurse preparedness and quality of patient handoff during interfacility transfers from a pretransfer emergency department to a PICU when conducted over telemedicine versus telephone.DesignCross-sectional nurse survey linked with patient electronic medical record data using multivariable, multilevel analysis.SettingTertiary PICU within an academic children's hospital.ParticipantsPICU nurses who received a patient handoff between October 2017 and July 2018.InterventionsNone.Main results and measurementsAmong 239 eligible transfers, 106 surveys were completed by 55 nurses (44% survey response rate). Telemedicine was used for 30 handoffs (28%), and telephone was used for 76 handoffs (72%). Patients were comparable with respect to age, sex, race, primary spoken language, and insurance, but handoffs conducted over telemedicine involved patients with higher illness severity as measured by the Pediatric Risk of Mortality III score (4.4 vs 1.9; p = 0.05). After adjusting for Pediatric Risk of Mortality III score, survey recall time, and residual clustering by nurse, receiving nurses reported higher preparedness (measured on a five-point adjectival scale) following telemedicine handoffs compared with telephone handoffs (3.4 vs 3.1; p = 0.02). There were no statistically significant differences in both bivariable and multivariable analyses of handoff quality as measured by the Handoff Clinical Evaluation Exercise. Handoffs using telemedicine were associated with increased number of Illness severity, Patient summary, Action list, Situation awareness and contingency planning, Synthesis by receiver components (3.3 vs 2.8; p = 0.04), but this difference was not significant in the adjusted analysis (3.1 vs 2.9; p = 0.55).ConclusionsTelemedicine is feasible for nurse-to-nurse handoffs of critically ill patients between pretransfer and receiving facilities and may be associated with increased perceived and objective nurse preparedness upon patient arrival. Additional research is needed to demonstrate that telemedicine during nurse handoffs improves communication, decreases preventable adverse events, and impacts family and provider satisfaction.
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Project description:Purpose The purpose of this study was to report demographic trends in terms of ethnicity/race and gender among the membership and leadership positions of the Arthroscopy Association of North America (AANA) and the American Orthopaedic Society of Sports Medicine (AOSSM). Over the years both AANA and AOSSM will increase in diversity through their committee membership and leadership positions. Methods AANA and AOSSM membership and leadership were reviewed for the years 2010, 2015, and 2020. Race/ethnicity was divided into Caucasian, Asian, African American (AA), Hispanic/Latin/South American (HLSA), and Middle Eastern (ME). Gender was limited to male or female, based on name and photographic depiction. Results Diversity in AANA and AOSSM committee and leadership positions is summarized in Table 1 and Table 2, respectively. In 2010, 166/191 (87%) AANA committee members were Caucasian, as compared with 125/186 (67%) in 2020. Asian committee members were similar in 2010 (13/191, 7%) and 2015 (13/216, 6%) but increased to 17/186 (10%) in 2020. HLSA committee members increased from 5/191 (3%) 2010 to 11/186 (6%) in 2020. AA committee membership increased from 2/191 (1%) in 2010 to 5/186 (3%) in 2020. The diversity of AANA Board of Director leadership positions increased, with Caucasian representation decreasing from 14/14 (100%) 2010 to 11/12 (92%) in 2020 and Asian representation increasing from 0% in 2010 to 1/12 (8%) in 2020, with HLSA, AA and ME remaining the same with 0/12 (0%). In AANA, men comprised 181/191 (95%) committee members in 2010 and 166/186 (89%) in 2020. The percentage of female committee members increased from 10/191 (5%) in 2010 to 20/186 (11%) in 2020. In 2010, 73/79 (92%) AOSSM committee members were Caucasian compared to 62/81 (77%) in 2020 with AA having the largest increase in committee members from 0% in 2010 to 6/81 (7%) in 2020 (Table 2). Within AOSSM, men comprised 73/79 (92%) committee members in 2010 and 70/81 (86%) in 2020. The percentage of female committee members in AOSSM increased from 6/79 (8%) in 2010 to 11/81 (14%) in 2020. Conclusion There has been a progressive trend toward increasing diversity in both committee membership and leadership positions in AANA and AOSSM from 2010 to 2020. Within AANA, there has been a decrease in the Caucasian representation from 87% in 2010 to 67% in 2020 and an increase in the female representation from 5% in 2010 to 11% in 2020. AOSSM demonstrated a similar trend, with Caucasian representation decreasing from 92% in 2010 to 77% in 2020, in addition to female percentage increasing from 8% in 2010 to 14% in 2020. Although there has been an increase in representation of minority and female orthopaedic surgeons within both societies, there is still room for more diversity and inclusion within committee membership and leadership. It is important to progress toward the understanding of the changes that need to be made and work to implement opening the field of orthopaedic sports medicine.
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Project description:PurposeTo identify the factors considered most important by sports medicine fellowship applicants when deciding where to apply and ultimately interview.MethodsAn anonymous, electronic survey was distributed in 2018 via e-mail to orthopaedic surgery residents who applied to a specific orthopaedic sports medicine fellowship program in 2015 and 2016. The survey included questions regarding the number of fellowships applications per respondent and the number of interviews they were offered and accepted. Questions regarding the application process were included. Participants also were asked to rank 9 criteria from most to least important (1 being most important; 9 being least important) when deciding where to apply or accept interviews. Each criterion's score reflects its average ranking among respondents.ResultsAmong the 99 orthopaedic surgery residents applying to this fellowship program, 42 (42.4%) completed the survey. The factors considered most influential included variety and complexity of surgical exposure (2.16), autonomy (3.72), and reputation of faculty members (4.05). The factors considered least important were program size (7.21), job placement of past fellows (7.07), and geographic location (5.68).ConclusionsVariety and complexity of surgical exposure, operative autonomy, and program reputation were valued as the most important factors for orthopaedic surgery residents applying to sports medicine fellowship programs.Clinical relevanceThe information obtained in this study may provide sports medicine fellowship programs and orthopaedic residents with a better understanding of factors that are considered to be important by sports medicine fellowship applicants. This will improve training for future sports medicine specialists, thus improving the care that they provide to their patients.
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Project description:PurposeThe purpose of this study was to assess the price variation of various Medicare severity diagnosis-related group codes for orthopaedic upper extremity procedures for the top 20 orthopaedic hospitals using chargemaster price listings from each hospital.MethodsThe top 20 orthopaedic hospitals in the United States were determined by querying the U.S. News and World Report's 2020 orthopaedic hospital ranking. This report ranks orthopaedic hospitals according to 4 major domains: outcomes, structure, process/expert opinion, and patient experience. Chargemaster data for the top 20 orthopaedic hospitals was compiled from their websites. Five DRG codes that represented orthopaedic upper extremity procedures were selected, and the pricing information for each was extracted from hospital chargemasters. The median income and cost-of-living index were also compiled for the county that each hospital is located in so that pricing data could be compared to economic measures through regression analysis.ResultsOf the top 20 orthopaedic hospitals, 18 had publicly available pricing information in DRG format on their websites. The DRG code with the highest pricing variability was Hand Injury Procedures (DRG 906; range, $12,832-$253,633). The procedure with the least pricing variability was Hand or Wrist Procedures (DRG 514; range, $24,533-$128,403). Additionally, only the cost of living index was a statistically significant predictor of procedure pricing with a weak correlation.ConclusionHospital chargemaster listings are lacking in 2 major areas: true price transparency and standardization/consistency between hospitals. Chargemaster data are often difficult to find, confusing to patients, and inaccurate. Additionally, the price range for a single DRG code can also vary substantially depending on the hospital. It is possible that hospitals located in areas with high costs of living and median incomes would charge higher prices, but these factors were not found to support this hypothesis.
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Project description:There is evidence that systems-based factors influence surgical outcomes of intraoperative and postoperative morbidity. The goal of this study was to provide an exploratory analysis of systems-based variables and their associations with surgical outcomes in gynecologic oncology patients. We merged electronic records from operating room software with billing claims from major surgeries performed from 2011 to 2013, at a tertiary care academic medical center. Univariate and bivariate analyses were performed to evaluate the relationship between baseline demographic and clinical covariates (age, comorbidity, procedure type, and surgeon volume), the main exposure variables (case start time, case order, and personnel handoffs), and the primary outcome of 30-day postoperative complications. Multiple logistic regression models were created to analyze the contributing effect of each systemic variable on postoperative complications. The overall rate of postoperative complications among patients was 31.4% (n = 182). Although traditional risk factors of comorbidity, procedure type, and case length were the strongest primary drivers of complication risk, there was a significant relationship between handoffs among surgical scrub technicians and postoperative complications (odds ratio: 2.12; 95% CI: 1.00-4.47). As a novel finding in surgical quality and safety research, this supports greater efforts into integrating key staffing information into studies of systemic variables and surgical outcomes.
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Project description:IntroductionInterns must be able to give and receive handoffs and use handoff information to respond to calls from nursing staff regarding patient concerns. Medical students may not receive adequate instruction in these tasks and often feel unprepared in this aspect of transitioning to residency. This program simulated an overnight call experience for fourth-year medical students emphasizing handoffs, nurse calls, and medical emergency response.MethodsThe program utilized a combination of traditional didactics and simulated handoffs, nurse calls, and patient scenarios to allow groups of fourth-year medical students to independently manage a simulated overnight call. The program was designed for students as part of a larger Transition to Residency capstone course.ResultsWe ran four sessions over 3 years, with a total of 105 medical student participants. All students reported increased confidence or comfort in their ability to manage handoffs and respond to nurse calls. Students reported that the sessions were helpful and realistic.DiscussionThis program provided fourth-year medical students with a realistic and useful opportunity to simulate handoffs and response to nurse calls, which increased their confidence and comfort. Minor changes were made between iterations of the course with continued positive feedback from medical students. The course is generalizable and can be adapted to the needs and resources of different institutions.
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Project description:Purpose To evaluate the gender composition of fellows, faculty, and leaders within orthopaedic sports medicine fellowship programs to provide a more complete description of gender diversity within this subspecialty. Methods Official program websites of orthopaedic sports medicine fellowships listed on the Arthroscopy Association of North America fellowship directory were examined. Data collected for analysis included the gender of program directors, fellowship faculty, orthopaedic surgery department faculty, current sports medicine fellows, and fellows who graduated within the last 5 years. Results Of the 132 orthopaedic sports medicine fellows in training in the United States in the 2021 to 2022 academic year, 113 (85.6%) were men and 19 (14.4%) were women (P < .001). Within the past 5 years, 419 fellows were listed as completing a sports medicine fellowship, with 375 (89.5%) being men, and 44 (10.5%) being women (P < .001). There was no significant difference in the gender composition of current fellows compared with the composition of fellows within the last 5 years (P = .74). When we examined gender trends in sports medicine faculty, 639 (86.6%) were men and 99 (13.4%) were women (P < .001). There were 14 women (14.4%) orthopaedic sports medicine faculty in leadership positions (i.e., program director or assistant program director) compared with 83 men in such positions (85.6%) (P < .001). Conclusions Orthopaedic sports medicine fellowships remain heavily male-dominated on all levels, including fellows, faculty, and leadership. There were no differences in the gender composition of current fellows when compared with those who graduated in the last 5 years, suggesting persistent gender disparity and the need for novel initiatives to enhance gender diversity in sports medicine. Level of Evidence IV, descriptive study.
| S-EPMC10461135 | biostudies-literature
Project description:We investigated the proportion of orthopaedic procedures supported by evidence from randomised controlled trials comparing operative procedures to a non-operative alternative. Orthopaedic procedures conducted in 2009, 2010 and 2011 across three metropolitan teaching hospitals were identified, grouped and ranked according to frequency. Searches of the Cochrane Central Register of Controlled Trials (CENTRAL), the Cochrane Database of Systematic Reviews (CDSR) and the Database of Abstracts of Reviews of Effects (DARE) were performed to identify RCTs evaluating the most commonly performed orthopaedic procedures. Included studies were categorised as "supportive" or "not supportive" of operative treatment. A risk of bias analysis was conducted for included studies using the Cochrane Collaboration's Risk of Bias tool. A total of 9,392 orthopaedic procedures were performed across the index period. 94.6% (8886 procedures) of the total volume, representing the 32 most common operative procedure categories, were used for this analysis. Of the 83 included RCTs, 22.9% (19/83) were classified as supportive of operative intervention. 36.9% (3279/8886) of the total volume of procedures performed were supported by at least one RCT showing surgery to be superior to a non-operative alternative. 19.6% (1743/8886) of the total volume of procedures performed were supported by at least one low risk of bias RCT showing surgery to be superior to a non-operative alternative. The level of RCT support for common orthopaedic procedures compares unfavourably with other fields of medicine.
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Project description:BackgroundWithin surgery, assistive robotic devices (ARD) have reported improved patient outcomes. ARD can offer the surgical team a "third hand" to perform wider tasks and more degrees of motion in comparison with conventional laparoscopy. We test an eye-tracking based robotic scrub nurse (RSN) in a simulated operating room based on a novel real-time framework for theatre-wide 3D gaze localization in a mobile fashion.MethodsSurgeons performed segmental resection of pig colon and handsewn end-to-end anastomosis while wearing eye-tracking glasses (ETG) assisted by distributed RGB-D motion sensors. To select instruments, surgeons (ST) fixed their gaze on a screen, initiating the RSN to pick up and transfer the item. Comparison was made between the task with the assistance of a human scrub nurse (HSNt) versus the task with the assistance of robotic and human scrub nurse (R&HSNt). Task load (NASA-TLX), technology acceptance (Van der Laan's), metric data on performance and team communication were measured.ResultsOverall, 10 ST participated. NASA-TLX feedback for ST on HSNt vs R&HSNt usage revealed no significant difference in mental, physical or temporal demands and no change in task performance. ST reported significantly higher frustration score with R&HSNt. Van der Laan's scores showed positive usefulness and satisfaction scores in using the RSN. No significant difference in operating time was observed.ConclusionsWe report initial findings of our eye-tracking based RSN. This enables mobile, unrestricted hands-free human-robot interaction intra-operatively. Importantly, this platform is deemed non-inferior to HSNt and accepted by ST and HSN test users.
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