Measures of walkability in the pediatric population: a qualitative review of the literature.

CONTEXT: Sedentary lifestyle is spreading among children living in urban settings. Recent studies in urban health investigated the effects of built environment on children's physical activity, focusing on the concept of "walkability", an index of how much an area is conducive to walking and active transportation. We decided to browse the literature in order to review all possible tools and methods by which walkability has been evaluated and measured. METHODS: We conducted a qualitative review of the literature in agreement with PRISMA guidelines, searching three medical databases for papers published between January 1994 and July 2017. Inclusion criteria were: primary studies, population ≤18 years and exposure variable as an assessment of walkability or built environment. RESULTS: We retrieved 1,702 articles and included 195 of them in the final review. Most of the studies were cross-sectional (n=188, 96.4%). We identified two possible approaches and four main tools to address walkability measurement. A subjective method approach was used in 71 studies (36.4%), an objective method in 87 (44.6%). Only 37 studies (19.0%) used both. Main tools were survey (n=70, 35.9%), Geographic Information System (GIS) (n=64, 32.8%), street audits (n=11, 5.6%) and Walk-score™ (n=3, 1.5%). Forty-six studies (23.4%) used mixed methods. Environmental variables' assessment and definition was found to vary greatly by method of choice. CONCLUSIONS: We found a high degree of heterogeneity regarding methods and measurements of walkability. A standard approach regarding tools and environmental variables' choice and definition will be advisable in order to allow comparisons among studies. Also, more longitudinal studies are needed.

Operating Room Efficiency measurement made simple by a single metric.

Operating room (OR) efficiency is a hot topic in OR management studies. Benefits of OR efficiency maximization include financial savings, improved patient safety, greater satisfaction for patients and health workers, and increased productivity. However, how to measure the efficiency of an OR suite still remains a pending question. Many performance indicators have been developed (1) and one of the most frequent approaches consists of choosing a set of indicators to create a dashboard for the monitoring of surgical activities. Macario proposed a scoring system based on eight performance indicators (2). A similar approach was used in The Canadian Paediatric Surgical Wait Times Project (3). Although the use of dashboards and scoring systems allows for a wide and in-depth understanding of the numerous factors that contribute to efficiency, it may also raise problems. The use of multiple indicators involves gathering large amounts of data that are not routinely available in every context and are subject to different interpretations if metrics show divergent trends. Moreover, it is not possible to properly establish relative weights among metrics. We propose a different approach, based on a single and overall indicator that can be used as a proxy for OR efficiency. We considered four elements as a minimum set for composing our indicator: raw utilization (RU), turn-over time (TT), preparation time (PT) and case cancellation (CC) (4). RU formed the basis for our considerations, as it is one of the most common and widespread performance indicators. RU represents the percent of time that patients spend in OR during resource hours.

Restructuring the surgical process after regional reform in Emilia-Romagna: an action-research project at Rizzoli Orthopedic Institute.

BACKGROUND: Hospitals performing surgery in Italy underwent important transformations in recent years, with decreasing economic resources and higher expected standards of care. Regional authorities acted differently across the country to adapt to the new scenario, generating heterogeneous outcomes. The Rizzoli Orthopedic Institute (ROI) in the Emilia-Romagna region started its reorganization in 2017, after the issue of new regional regulations about surgical activity. Aim of this paper is to describe the actions taken at ROI and discuss their outcomes. STUDY DESIGN: Action-research. METHODS: From 2017 to 2019 an action-research project was developed to introduce organizational changes within ROI and close the existing gaps between regional requirements and actual features of the Institute. Four areas of intervention were identified: surgical scheduling, appropriateness of surgical setting, monitoring and management of the surgical path and accountability. Progress was monitored through the collection of performance indicators and qualitative investigation of the organizational culture. RESULTS: Changes were implemented in all areas of intervention. Key features were the introduction of Operating Room Management (ORM) skills and the establishment of multiprofessional teams to drive the changes. Performance indicators showed a positive trend in the comparison between 2017 and 2018. Improvements were observed in terms of productivity, scheduling, and respect of standard waiting time, while case-mix did not significantly change. CONCLUSIONS: Effective ORM and collaborative practices can successfully drive the change towards a more efficient surgical process without increasing resources consumption.