ABSTRACT
Introduction: Operating room [OR] is a key department in any institution and it runs with heavy resources. Improper running carries not only loss of revenue but it also effects patient care. Delays in operating room are deleterious and methods to decrease these delays are important not only for patient care, but to maximize operating room resource utilization
Objective: To determine the causes effecting the OR utilization and efficiency and to find out ways to overcome it. Study Design: Observational Study. Period: 15-01-2011 to 08-06-2011. Setting: King Khalid Hospital, KSA
Patients and Methods: Operating room baseline data was collected for one month and it was compared with historical data of the last six month. Operating room utilization was found to be 41% overall and 34% for elective cases [benchmark 85%]. In patient pathway, on average 17 min were required from call to ward to enter in operating room. First incision time was 11%=8-8:30, 31% = 8:30-9 and 58%= 9+. Cancelation was 9%. Various improvement projects were started including surgical list management, OR rescheduling, start on time dashboard, pre-anesthesia clinic and reinforcement of day surgery program
Results: The results showed 47% improvement in elective OR utilization and OR utilization reaching 69%. There was 76% improvement in emergency case booking and 18% improvement in pre/ post-op process time. There was 64% improvement in 1[st] cases before 9 am
Conclusion: Integrated management working can improve the working and outcome of the operating room resulting in high efficiency and best patient satisfaction
Subject(s)
Quality Improvement , EfficiencyABSTRACT
To treat or not to treat Giardia lamblia infection during pregnancy is a debatable issue since, at occasions, it may be advisable to withhold antiparasitic therapy till after delivery. There is no justification for a prescription simply because Giardia lamblia was detected on routine stool microscopy. There is convincing evidence that Giardiasis fits into the category of infectious diseases, which become more severe in pregnancy. The increased nutritional requirements, lowered immunological status and decreased gastric acidity may predispose the already existing Giardial infection to symptomatic Giardiasis which may cause intestinal mucosal injury resulting in disruption of the digestive and absorptive capacity of gut. Three cases of pregnancy associated Giardiasis, in a suburban setting in Punjab [Pakistan], are being reported. The severity of the disease in these patients, impending damage to their foetuses- and public health significance necessitated immediate intervention in the form of specific anti-giardial therapy. The choice of the drug was based on the clinical evaluation and obstetric status. The first patient [23 weeks gestation] was given Intravenous Metronidazole and the third one [30 weeks gestation] oral Secnidazole. Paromomycin [very poorly absorbed from gastrointestinal tract] was selected for the second case [11 weeks gestation]. Regular clinical, parasitological and ultrasonic follow ups of the cases, till term, were carried out. They had uneventful deliveries with normal healthy looking babies. Screening for Giardia lamblia in the family contacts of these patients revealed 11[8 children, 3 adults] parasitologically proven cases [linked to the index cases]. They were successfully treated. It was justifiably concluded that treating the pregnant ladies with acute symptomatic Giardiasis and search for index cases in their family contacts [and their management] were very well rewarding