ortho efficiency

[Gas you down]

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anyone have their hospital involved in this Marshall Steele program for improving total joint OR efficiency?
as an overview...develop guidelines to prevent delays/cancellations, work fast and on time, use block/induction rooms, address ponv.
not exactly anything ground breaking ...anyone have anything good to say about the program?

 

[jwk]

I stopped reading their website when I saw Dr. Steele, MD.

 

[sevoflurane]

anyone have their hospital involved in this Marshall Steele program for improving total joint OR efficiency?
as an overview...develop guidelines to prevent delays/cancellations, work fast and on time, use block/induction rooms, address ponv.
not exactly anything ground breaking ...anyone have anything good to say about the program?

Yes. Our hospital threw money at them.

They didn't do anything that really added any value. He has become very rich off of his enterprise (I think Stryker bought him out). He knows how to speak administration talk.
IMO...A waste of time and resources. Steele is a class A douche-bag. He is soooo full of himself: "I did this and I did that" type. Ohh and he knows very little regarding regional anesthesia... exparel is his best friend.

 

[sevoflurane]

Don't buy into the hype.

 

[BuzzPhreed]

I looked at his website. We are already doing 95% of what he advocates. Minus the score cards (and some other minor things). Score cards are dangerous territory in my humble opinion.

We don't need to pay anyone to tell us what we already know. There is planning. And there is execution. The first part is easy. The second not so much. At least in our practice's case we've already got both pretty much down pat.

 

[pjl]

This stuff is simple, and any anesthesiologist with half a brain should be able to come up with a similar plan AND be able to help ortho guy with quicker discharges. Just takes time and some extra resources on our end and nursing/support side, so you need a motivated hospital. I would bet most places are already doing >2/3 of his plan.

 

[Gas you down]

now I think it's just a PR move. admin just loves having more things to advertise. they really love certificates of excellence in whatever fields etc. I think this is an extension of that. also it makes surgeons happy

 

[sevoflurane]

now I think it's just a PR move. admin just loves having more things to advertise. they really love certificates of excellence in whatever fields etc. I think this is an extension of that. also it makes surgeons happy

Yeah... always looks good on the highway billboards.

 

[seinfeld]

Forget about whoever this guy is but how many Total joints are you able to accomplish per surgeon per day? We are able to complete 15. First is in room at 7am last is out at 5-530pm.

 

[jwk]

Forget about whoever this guy is but how many Total joints are you able to accomplish per surgeon per day? We are able to complete 15. First is in room at 7am last is out at 5-530pm.

How many OR's for the one surgeon? Residents, assistants, or PA's to open or close?

 

[nimbus]

Forget about whoever this guy is but how many Total joints are you able to accomplish per surgeon per day? We are able to complete 15. First is in room at 7am last is out at 5-530pm.

That is excellent! Would love to hear more about how you do it.

I used to work at a place where we did 5 from 7am to 3-4pm and I thought that was pretty good. We had 1 room/1 team. At my current place we can only do 3-4 in that time. Slower surgeons and slower turnovers.

 

[seinfeld]

1. Need to have a surgeon who can perform a joint replacement ( skin to facial closure) in 20-30 minutes.
2. Two rooms with an ortho PA in each who is responsible for draping at the start of the case and closing the skin at the end
3. One Attending anesthesiologist and 2 CRNAs
4. An "induction" room, staffed with dedicated nurses, where patient arrive, Pre op interview conducted, monitors applied and Spinal placed
5. Parellel processing instead of serial processing by surgeons, circulating nurses, housekeeping and surgeons

Surgeons flow
a. Consent and sign cases 1 and 2 first thing in am
b. Go into room A start operation
C. Leave room A once facial layer is closed go to induction room and sign/consent patient number 3
D. Go to room B
E. Leave room B once facial layer is closed go to induction room and sign/consent patient number 4
F. Go to Room A
G. Cont to repeat

Anesthesia flow
A. Patient 1 arrives in induction room, interview conducted, monitors applied by nursing.
B. Patient 2 Arrives in induction room
C. spinal placed in patient 1
B, CRNA X takes over managing sedation and transports patient 1 from induction room to OR
C. Patient 2 interviewed, spinal placed (15-20min from the time patient 1 left the room)
D. CRNA Y takes over managing sedation and transports patient 2 from induction room to OR
E. Patient 3 arrives in induction room, interview conducted
F. CRNA X drops patient 1 off in PACU and then comes to induction room
G. Spinal placed in patient 3 (by the time the CRNA signs out of PACU, the spinal and foley are placed the room has been cleaned and setup by nursing)
H. CRNA X takes over managing sedation and transports patient 3 from induction room to OR
I. Patient 4 arrive in induction room, interview conducted
J. CRNA Y drops patient 2 off in PACU and then comes to induction room
K. Spinal placed in patient 4 (by the time the CRNA signs out of PACU, the spinal and foley are placed the room has been cleaned and setup by nursing)

rinse and repeat

For me it is actually one of the most relaxing days. I place a spinal every 15-20 minutes,I am in my "own" room

 

[nimbus]

1. Need to have a surgeon who can perform a joint replacement ( skin to facial closure) in 20-30 minutes.
2. Two rooms with an ortho PA in each who is responsible for draping at the start of the case and closing the skin at the end
3. One Attending anesthesiologist and 2 CRNAs
4. An "induction" room, staffed with dedicated nurses, where patient arrive, Pre op interview conducted, monitors applied and Spinal placed
5. Parellel processing instead of serial processing by surgeons, circulating nurses, housekeeping and surgeons

Surgeons flow
a. Consent and sign cases 1 and 2 first thing in am
b. Go into room A start operation
C. Leave room A once facial layer is closed go to induction room and sign/consent patient number 3
D. Go to room B
E. Leave room B once facial layer is closed go to induction room and sign/consent patient number 4
F. Go to Room A
G. Cont to repeat

Anesthesia flow
A. Patient 1 arrives in induction room, interview conducted, monitors applied by nursing.
B. Patient 2 Arrives in induction room
C. spinal placed in patient 1
B, CRNA X takes over managing sedation and transports patient 1 from induction room to OR
C. Patient 2 interviewed, spinal placed (15-20min from the time patient 1 left the room)
D. CRNA Y takes over managing sedation and transports patient 2 from induction room to OR
E. Patient 3 arrives in induction room, interview conducted
F. CRNA X drops patient 1 off in PACU and then comes to induction room
G. Spinal placed in patient 3 (by the time the CRNA signs out of PACU, the spinal and foley are placed the room has been cleaned and setup by nursing)
H. CRNA X takes over managing sedation and transports patient 3 from induction room to OR
I. Patient 4 arrive in induction room, interview conducted
J. CRNA Y drops patient 2 off in PACU and then comes to induction room
K. Spinal placed in patient 4 (by the time the CRNA signs out of PACU, the spinal and foley are placed the room has been cleaned and setup by nursing)

rinse and repeat

For me it is actually one of the most relaxing days. I place a spinal every 15-20 minutes,I am in my "own" room

That is a baller day. Very surgeon and anesthesia centric. I can only wish.

 

[dhb]

So the surgeon does every joint in 30min or less and never encounters any unexpected difficulties?

 

[ChiDO]

So the surgeon does every joint in 30min or less and never encounters any unexpected difficulties?

Our total joint guys in our residency run 2 rooms in a very similar manner. 6-8 totals for the day followed by 2-3 scopes. Totals done by 1-2 with 8 am start time. They do this for 2 OR days.

As for "unexpected difficulties;" most of these cases are straight forward THA/TKA. Very rarely do you encounter a balancing problem with knees or something unexpecting occuring. If anything, its dropping a piece of equipment that they don't have sterile and waiting to reflash it...lol