Analysis of Operating Room Efficiency in a Burn Center.

Many operating room (OR) processes can limit productivity. Surprisingly, little has been done to identify which OR processes limit downstream activities. Here, the authors aimed to review their burn OR procedures to determine if and where inefficiencies exist. Data for all operations performed in a dedicated burn OR from January 1, 2015, to July 31, 2016 were reviewed in the electronic medical records of our public, teaching hospital. The total time spent was allocated into the following components: induction (patient in room to end of induction), preparation (end of induction to procedure start), procedure (procedure start to procedure end), exit (procedure end to patient out of room), and turnover (patient out of room to next patient in room). Operative times and work relative value units generated were summarized. A total of 1033 cases were performed. Mean ± SD times for each component in minutes were induction (12.4 ± 7.4), preparation (32.1 ± 15.4), procedure (68.21 ± 42.0), exit (14.7 ± 11.0), turnover (50.5 ± 30.0), and total aggregation of components (155.8 ± 65.4). Procedure, turnover, and preparation were the 3 largest time components of an operation in decreasing order (39, 29, and 18%). Mean work relative value units per month was 1749.4 ± 411.9. Average work relative value units per OR hour was 11.7 ± 8.5. The time spent doing procedures comprises about 40% of the total operational time in a burn OR. Other than the procedure itself, the second and third largest component of an operation were turnover and preparation time, respectively.

Pre-burn center management of the burned airway: do we know enough?

Despite the traditional teaching of early and aggressive airway management in thermally injured patients, paramedics and medical providers outside of burn centers receive little formal training in this difficult skill set. However, the initial airway management of these patients is often performed by these preburn center providers (PBCPs). The purpose of this study was to evaluate the authors' experience with patients intubated by PBCPs and subsequently managed at the authors' center. A retrospective review of a level I burn center database was undertaken. All records of patients arriving intubated were reviewed. From January 1982 to June 2005, 11,143 patients were admitted to the regional burn center; 11.4% (n = 1,272) were intubated before arrival. In this group, mean age was 37.1 years, mean burn size was 35.3% TBSA, and mean length of hospital stay was 27.0 days. Approximately 26.3% were suspected of having an inhalation injury, and this was confirmed by either bronchoscopy or clinical course in 88.6% of this subgroup. Mortality in patients arriving intubated was 30.8%, and these were excluded from the rest of the analysis. In the surviving 879 intubated patients, reasons reported by PBCPs for intubation included "airway swelling" in 34.1%, "prophylaxis" in 27.9%, and "ventilation or oxygenation needs" in 13.2%. Of these patients, 16.3% arrived directly from the scene, with the remainder arriving from another hospital facility. Of all survivors who arrived intubated, 11.9% were extubated on the day of admission, 21.3% were extubated on the first postburn day (PBD), and 8.2% were extubated on the second PBD. No patients who were extubated on PBD1 or PBD2 had to be reintubated. A significant number of burn patients have their initial airway management by PBCPs. Of these, a significant number are extubated soon after arrival at the burn center without adverse sequelae. Rationale for their initial intubation varies, but education is warranted in the prehospital community to reduce unnecessary intubation of the burn patient.