Medicine and Health Sciences Commons^™

Increasing First Case On Time Starts In An Ambulatory Surgery Center, Diane Fecteau, Shannan Reid, Sydney Green, Ruth Hanselman, Suneela Nayak, Stephen Tyzik, Amy Sparks

Operational Transformation

In an ambulatory surgical center, first case on-time starts directly affects the patient experience. In addition, in order to treat as many patients as possible, delays of first case on-time starts negatively impacts the rest of scheduled surgical patients and increases staff overtime expenditures. An ambulatory surgical team within a large urban health care system initiated a performance improvement initiative to enhance the patient experience, increase staff accountability and care team well-being.

The goal of this project was to start 70% or more first cases on time. Baseline metrics demonstrated that patients and surgeons were the largest cause of delay. …

Changing The Surgical Residency: A Mixed-Methods Study Of Residents’ And Faculty Experiences One Year After Implementation, Sarah B. Cairo, Wendy Craig, Caitlin Gutheil, Paul K. J. Han, Kristiina Hyrkas, Lynda Macken, Jim Whiting

Journal of Maine Medical Center

Objective: To evaluate a reformed surgical residency curriculum aimed at addressing emerging practice models, enhancing residents’ educational experience, and improving the quality/continuity of patient care by reducing the service size and enhancing attending-resident interactions.

Methods: A mixed-methods study of the surgical training program following curriculum reform including: 1) focus group and individual qualitative interviews with residents, attendings, nurses, and advanced practice providers to explore stakeholder perspectives on curriculum reform, 2) time study of surgical resident activities, and 3) quantitative assessment of surgical case logs.

Results: Qualitative interviews demonstrated disparate knowledge and attitudes regarding the goals of the curriculum with emergence …

Predictors For Discharge After Robotic Hysterectomy – A Retrospective Analysis, Heidi Fox, Kristiina Hyrkas

Maine Medical Center

Introduction:

Hysterectomy is one of the most common surgeries performed in the United States with more than 600,000 procedures annually . It has been estimated that in 2011, there were more than 64,000 surgeries performed in an outpatient setting. The highest rate of 0.46% (464/100,000 adult women) has been reported in Maine. The average length of stay was 0.65 days for laparoscopic and 0.79 days for vaginal hysterectomies [1]. Traditionally, hysterectomies have been performed as an inpatient procedure to manage postoperative pain and monitor complications such as bleeding, anemia and return of bowel function. Development of minimally invasive surgery techniques …

Potential Of Vascular Endothelial Growth Factor As A Biomarker Of Coronary Artery Disease In Subjects Undergoing Cabg Surgery, Teaka Jackson, Sarah Peterson, Amanda Favreau-Lessard, Joanne Burgess, Susan Bosworth-Farrell, Robert S. Kramer, Douglas B. Sawyer, Sergey Ryzhov, Michael P. Robich

Maine Medical Center

Introduction:

• Coronary artery disease (CAD) causes local hypoxia due to reduced blood flow

• Hypoxic conditions are known to induce vascular endothelial growth factor (VEGF) production, a key contributor to angiogenesis

• The purpose of this study was to determine the potential of VEGF as a marker of myocardial stress in subjects with CAD undergoing coronary artery bypass grafting (CABG) surgery

Prions To Pathways: Safeguarding Against Creutzfeldt-Jakob Disease In The Operating Room, Jessica Mary Adams Atkinson, Sonja Carol Orff

Maine Medical Center

Introduction:

As defined by the Center for Disease Control (CDC, 2018), Creutzfeldt-Jakob Disease (CJD) is a rapidly progressive, rare, transmissible, and fatal illness. Miscoiling of healthy proteins caused by an abnormal isoform of cellular glycoprotein resulting in protein folding has been found to be the molecular mechanism during the pathological process of this malady (Figure 1), (Castle, Gill, 2017). The current problem is that few recommendations are available for organizations to consider how to manage potential CJD patient cases, and institutions are left to compile and develop their own guidelines and/or protocols for clinical practice. The standards of care for …

Reducing Catheter Associated Urinary Tract Infections (Cauti) By Decreasing Use Of Indwelling Catheters, Joanne Chapman, Brenda Clark, Brian Jumper, Carrie Strick

Maine Medical Center

Background:

Catheter Associated Urinary Tract Infections (CAUTI) are considered a preventable hospital-acquired infection [2]. Centers for Medicaid and Medicare no longer reimburse hospitals for preventable CAUTIs [2]. A concerted effort to decrease our indwelling urinary catheter (IUC) rate has led to a decrease in the number of infections related to these catheters at Maine Medical Center (MMC) in Portland, Maine. Starting in 2012 as a result of The Joint Commission National Patient Safety Goal, the inter-professional CAUTI committee focus has been on decreasing utilization of IUC[1]. After an initial large decrease in utilization, the rates have flattened. The effort over …

Increasing Doses Of Intraoperative Hydromorphone Do Not Reduce Postoperative Pain, Craig S. Curry, Michael B. Henry, Wendy Craig, Janelle M. Richard, Denham S. Ward

Maine Medical Center

Introduction:

• Intermediate and long acting opioids are given intraoperatively to reduce pain during emergence from anesthesia.

• Recent evidence suggests that intraoperative opioids have inconsistent effects on nociception and pain in the immediate postoperative period.

• Multiple potent, short-acting opioids such as remifentanil, sufentanil and fentanyl have been shown to produce dose-related increases in pain scores and opioid consumption in the immediate postoperative recovery period.

• Intraoperative doses of longer acting opioids such as morphine and methadone6 have been shown to reduce pain scores and narcotic requirements in the immediate postoperative period.

• Hydromorphone is an intermediate duration narcotic …

Feasibility Of Pre-Operative Mtor Inhibitor Sirolimus In Children And Young Adults With Desmoid Tumor, Stephanie Verwys, Clara Magyar, Kathleen Glick, Douglas Hawkins, Archana Sharma, Brenda Weigel, Katherine Chastain, Joseph Khoury, Michele Manalang, Sarah Dry, Noah Federman, Aaron Weiss

Maine Medical Center

Background:

• Desmoid tumor represents an intermediate grade neoplasm with a striking predilection for locally invasive growth and recurrence following resection

• More effective, well-tolerated non-surgical treatment options are needed

• Current approaches

• If feasible, watchful waiting is the preferred approach

• 20-30% spontaneous regression

• In situations where treatment is indicated, the following approaches are utilized

• Surgery is the primary approach if minimal morbidity is anticipated

• Medical therapies

• Cytotoxic drugs

• Tyrosine kinase inhibitors

• Hydroxyurea

• Gamma secretase inhibitors

• mTOR Inhibitor Rationale

• Desmoid tumor is well-known to be associated with deregulation of …

In Patients Having A Robotic Hysterectomy, How Does The Amount Of Iv Fluids Given Post-Operatively Affect The Patients' Length Of Stay?, Heidi Fox

Interprofessional Research and Innovations Council

In patients having a robotic hysterectomy, how does the amount of IV fluids given post-operatively affect the patients' length of stay?

Heidi Fox, RN III, CAPA, ASU, MMC

Background: Over the last few years, ASU (ambulatory surgery unit) nurses have noted difficulty with discharging patients undergoing robotic hysterectomy in a timely manner due to both nausea and the inability to void. The nurses have also discerned inconsistencies with regards to the post-operative care including pre-operative bowel prep, amount of IV fluid given post-operatively and anti-nausea meds given. This prompted a literature search and a critical appraisal of pertinent research articles …