Same Day Allocation

In the case listed here Dr. Loren J. Borud was scheduled to perform surgery on Mr. Michael Hicks early on a Friday morning. The surgery was liposuction and a scar repair procedure. Dr. Loren informed the patient the procedure would take approximately ninety minutes, but

This clinical rotation I was assigned to observe at the operating room, where they conduct various surgical procedures. The night prior to the clinical, I have to admit, was every bit unnerving. Especially, the fear of not knowing what to expect was daunting. There must have been a thousand scenario of what to expect or what might possibly go wrong playing through my head that night. However, after being introduced to the nurse I would be following, and meeting the surgeon and the rest of the team; my nerves settled down. The surgery scheduled was for a ventral hernia, which seemed routine, but complicated by a previous bowel realignment previously. The whole operation, from beginning to end, lasted a little over four hours. Although, the procedure lasted that long, it did not bother me even bit. In spite of standing for the whole duration of the observation, I never felt tired nor gotten bored. Notably, watching the surgical team working cohesively is like watching an artists who have

The implications and effects on patients waiting long hours to be seen in the ED are immense. In a recent study done over five years in Ontario hospitals showed the risk of adverse events and even deaths increased with the length of stay in the ED (Science Daily, 2011). When EDs become overcrowded the quality of care changes and declines; which is extremely dangerous. Authors of the study calculated that if ED length of stay was cut by only an hour that 150 fewer Ontarians would die each year (Science Daily, 2011). Wait times can also negatively affect patients financially, untreated medical conditions can lead to reduced productivity and inability to work leading to increased financial strains (Fraser Institute, 2014). As well as delayed access to care can result in more complex interventions needed. Therefore an initiative is needed to provide patients with timely, efficient care when accessing

The entire hospital holds a total of 90 beds, 5 operating rooms, 6 examination rooms, and a laboratory. Despite the size of the hospital, they average 150 operations per week and 7000 to 7500 operations annually. Also, it is important to note that there are only 12 full-time surgeons and 7 assistant part-time surgeons that handle all operations in 5 day a week period. The last thing to take into consideration is that each patient stays 3 days out of a week starting the day they arrive. Although Shouldice’s operations seems to be functioning just fine, there is a debate of effectiveness of whether or not they are fully utilizing their full potential in relation to surgeries performed and beds being

Before the patients leave the clinic, the primary care nurse will give them a simple instruction such as doing the blood work, EKG and chest x-ray prior to pre-operative appointments. This is the end of primary care responsibility for the pre-operative process of patients undergoing surgical procedures. The accountability of making sure the patient is ready for the surgery is then handed over to the pre-operative management nurses. Cancellation of operations in hospitals is a significant problem with far reaching consequences (Kumar & Gandhi, 2012). One of the factors contributing to this cancelation is the pre-operative process itself.

Canada’s health care system assures universality, portability, and accessibility; disappointingly, not all Canadians have access to specialists and facilities. Many patients face long wait times or do not have access to anesthetic and surgical care because the inadequate supply of anaesthesiologists for demand of Canada’s aging population. For instance, a woman experiencing severe pain in her right lower abdomen may endure excessive wait time to receive pain relief and life-saving care. However, surgical or other medical procedures can only be performed if patients have access to an anaesthesiologist. Despite government promises, and the billions of dollars funnelled into the Canadian healthcare system, the average wait time for surgeries in Ontario is approximately 14.3 weeks (Barua, Rovere & Skinner, 2011).

Yet, with all of this positive marketing for new surgical procedures, the lack of knowledge of potential patients is being taken advantage of on a routine basis. Hospital administrators are now trying to find more ways to get their physicians to get more work in order to add to the hospital's bottom line. Physicians are feeling the pressure from management to get as much work done as possible and they are burning themselves out (Health Care Fraud 1).

B. Experiment with new ways of carrying out a function: Incorporate Time-Out into Electronic Medical Records (EMR).

The additional revenues that were collected due to increase in ICU capacity by 20 beds enhanced the total ED revenues by 10%.4 The efficiency of care delivery is decreased when patients are diverted to other hospitals, they have to wait for long period to receive care or if they are placed on the floors where they do not belong. This is seen often due to delay in discharging patients.3 These delays and inefficiencies are the primary cause of decreased satisfaction among patients, their families, hospital employees, and physicians. They also result in avoidable increases in patient length-of-stay, reduced quality of care, and lost or diminished hospital revenue.3

This vastly effects the patient’s decision to have surgery performed, because the procedure could affect their normal way of living. This can cause a tremendous amount of anxiety in patients that prevents them from wanting to have surgery. If someone is close to dying and has a chance of being saved from surgery, they should have the surgery performed regardless of the possible side effects. To establish a faction of satisfied patients, neurosurgeons should start putting the impact of the treatment on the patient’s quality of life before the actual surgical procedure.

“Did-Not-Attends” (DNAs) occur when a patient unexpectedly without notifying the radiology department fails to attend an appointment (Hallsworth et al., 2015). DNAs lead to worse care for patients by delaying in diagnosis and appropriate treatment for the non-attending patient (Gurol-Urganci et al., 2013). Also, DNAs results in wasted resources, disturbs the planned work schedules which leads to frustration for both staff and patients, and increased in the waiting time for appointments (Hasvold and Wootton, 2011). Hospitals may also engage in complex compensating behaviors, such as overbooking, which introduce problems of their own (Hallsworth et al., 2015).

Postoperative pain is the most undesired sequence of surgery, and if not treated properly, can lead to increased hospital stay and delayed return to daily activities (10).

Wrong site surgery remains the most frequently reported sentinel event, with 908 wrong site surgeries reported since 1995 (AORN, 2010). During the late 1990’s and early 2000’s there was a tremendous public concern and lack of trust for the medical profession, especially within surgical services. We as healthcare professionals needed to step up to the plate, slow down, and take responsibility to improve the quality of care we provide for our patients. Although there still is some resistance from surgeons and other healthcare professionals, overall there has been a general acceptance to universal protocol.

One might think of surgery as simple as going to the hospital and receiving a complex operation that saves ones life or improves their quality of life. What most people do not realize is the hardships that those people go through unless they had surgery performed on them themselves, and same thing for the surgeons it is not easy for them as well, even though they are professional and highly trained.

Gilmartin, J. (2003). Day surgery: Patients’ perceptions of a nurse-led preadmission clinic. Journal of Clinical Nursing 13, 243-250.