A comparison of inhalational inductions for children in the operating room vs the induction room.

Department of Anesthesiology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH 45229-3039, USA.
Pediatric Anesthesia (Impact Factor: 2.44). 12/2011; 22(4):327-34. DOI: 10.1111/j.1460-9592.2011.03755.x
Source: PubMed

ABSTRACT There has been debate about the use of an induction room (IR) compared with an operating room (OR) for inhalational induction in children. The quality of the anesthesia induction between these two physical environments has not been studied previously. We sought to compare child distress, OR utilization and efficiency, and parental satisfaction and safety, between an IR and an OR.
In a prospective observational study, we studied 501 developmentally appropriate children ages 1-14 years, American Society of Anesthesiologists (ASA) physical status I-III, presenting for the inhalational induction of anesthesia, undergoing outpatient or outpatient-admit ENT surgery. Inductions were performed in an IR (IR group) or OR (OR group) with parent(s) present. Child behavioral compliance was assessed using the Induction Compliance Checklist (ICC), a validated observational scale from 0 to 10 consisting of 10 behaviors; an ICC score ≥4 was considered poor behavioral compliance. Times for transport, anesthesia start, ready for surgery, surgery finish, out of OR, and total case process times were recorded. OR utilization and OR efficiency was derived using these times. Data on number and experience of clinical providers were also collected. Parent satisfaction with the induction was measured using a satisfaction survey. Safety was measured by recording respiratory complications during induction. The chi-squared test was conducted to determine whether induction location was associated with level of behavioral compliance. A multivariable proportional odds model was used to control for risk factors. OR utilization and efficiency were analyzed using the Wilcoxon-Mann-Whitney test.
There were no significant differences in ICC scores between the groups (P-value = 0.12). Anesthesia, nonoperative, and transport time were statistically less in the OR group when compared with the IR group, although total case process times were similar in both groups. While OR efficiency was significantly higher for the OR group (P-value = 0.0096), OR utilization did not differ between groups (P-value = 0.288). The OR group had a significantly higher number of anesthesia providers and a more experienced surgical team. Parents in the two groups were equally satisfied with their experience during induction, and none of the subjects had respiratory complications during the anesthesia induction.
We found no differences in child distress, parent satisfaction, and respiratory complications between inductions conducted in the IR vs the OR. Differences in utilization, efficiency, and turnover were minimal and not operationally significant. Capital equipment, space, and staffing strategies should be key drivers in considerations for the use of IRs, and in the design of ORs with IRs.

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    ABSTRACT: Objective A quality improvement project to evaluate operating room efficiency and utilization and to identify areas for improvement. Methods A retrospective assessment of a single surgeon's surgical cases over a 6-month period at a tertiary children's hospital. Primary outcomes included case timing defined as T1, T2, T3 and T4. (T1) - Patient Enters OR–to–Procedure Start. (T2) - Procedure Start–to–Procedure End. (T3) - Procedure End–to–Patient Exits OR. (T4) - Patient Exits OR–to–Next Patient Enters OR (Turnover). Comparison to existing literature was performed and results were presented to stakeholders. Results A total of 180 surgical cases were reviewed, 92 Adenotonsillectomies (T&A), 33 Bilateral Pressure Equalization Tube Placement (PET) and 55 Microlaryngoscopies and Bronchoscopies (MLB). All outcomes were calculated by case type, except T4, and compared to available published data. T2 was compared to published benchmarks for otolaryngology demonstrating favorable operative times for T&A and PET. However, T4 was considerably longer at our institution (average 31.09). Overall OR efficiency was 20.58%. Conclusions The operating room represents one of a hospital's most costly resources. Ensuring that this resource is designed, staffed and utilized efficiently is of major importance to both the quality of patient care and financial productivity. Surgeons are key components of operating room efficiency, utilization and other measurements of institutional performance. How surgeons schedule and perform cases directly impacts, and is impacted by, these measurements of performance. For fields dominated by high volume, short duration procedures such as pediatric otolaryngology, T4 may be the most important variable in determining OR efficiency. By utilizing modern electronic medical records, surgeons can easily track OR time points thereby determining the potential causes of and solutions for OR inefficiency.
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