Journal of perioperative practice最新文献

{"title":"Optimising theatre utilisation through Lean Six Sigma: A model for sustainable theatre utilisation improvement.","authors":"Ibrahim Hemaida, Laura Crawley","doi":"10.1177/17504589261418823","DOIUrl":"10.1177/17504589261418823","url":null,"abstract":"<p><strong>Background: </strong>This quality improvement study was undertaken in the ophthalmology theatres at the Western Eye Hospital, Imperial College Healthcare NHS Trust, to address reduced capped theatre utilisation during the COVID-19 recovery period. Baseline utilisation was 75.8%, below the national Getting It Right First Time target of 85% for theatre touchtime utilisation by 2024/25. The aim was to identify the causes of underperformance and implement targeted interventions to improve theatre efficiency.</p><p><strong>Methods: </strong>A Lean Six Sigma DMAIC (Define, Measure, Analyse, Improve, Control) framework was used as the study design. Targeted interventions included increasing pre-assessment capacity to reduce under-booking, improving scheduling processes, reducing early finishes, and carrying out structured daily reviews of implant and equipment availability to minimise on-the-day cancellations. Multiple regression, factorial Design of Experiments, process capability analysis, Plan-Do-Study-Act cycles, and Statistical Process Control were used to analyse variation, test changes, and monitor performance.</p><p><strong>Results: </strong>The Analyse phase showed that early finishes, under-booking, and limited pre-assessment capacity were the main drivers of low utilisation, rather than commonly assumed factors such as late starts. Following the introduction of targeted interventions, capped theatre utilisation improved from 75.8% to 81%. Continuous monitoring through Plan-Do-Study-Act cycles and Statistical Process Control supported stability and informed further refinements.</p><p><strong>Conclusions: </strong>This project shows that combining Lean Six Sigma methodology with advanced statistical analysis can deliver measurable improvements in theatre utilisation. The findings challenged long-held assumptions about the causes of inefficiency and highlight the importance of optimising scheduling processes and pre-assessment capacity. The model offers a transferable, scalable approach for other units aiming to enhance theatre efficiency and achieve sustainable operational improvements.</p>","PeriodicalId":35481,"journal":{"name":"Journal of perioperative practice","volume":" ","pages":"432-441"},"PeriodicalIF":0.9,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146776704","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Obtaining day-of-surgery written surgical consent is associated with first-case delay.","authors":"Victoria Yin, Tsehay B Abebe, Li Ding, Scott M Atay, Takashi Harano, Anthony W Kim, Baddr A Shakhsheer, Sean C Wightman","doi":"10.1177/17504589251377667","DOIUrl":"10.1177/17504589251377667","url":null,"abstract":"<p><strong>Objective: </strong>To assess the relationship between consent signature timing and first-start case delay.</p><p><strong>Study design: </strong>Consecutive first start patients who arrived on day-of-surgery from home at a single centre from 28 days in June 2021 were identified. First-case delay was defined as operating theatre (OT) in-room time greater than 5 minutes after scheduled start time.</p><p><strong>Results: </strong>A total of 289 patients were eligible for the study. Surgical consent signing in the preoperative area and non-English primary language were significantly associated with OT delay; 234 patients (81%) had signed surgical consent on the day of surgery in the preoperative area. Patients who signed surgical consent on day- of- surgery were 3.2 times as likely to experience OT in-room time delay compared to those who signed surgical consent prior to day of surgery, odds ratio (OR) 3.2, 95% confidence interval (CI): 1.2, 8.5, <i>p</i> = 0.02. Patients with non-English primary language had 3.8 times greater risk for case delay (OR 3.8, 95% CI: 2.0, 7.4, <i>p</i> < 0.0001).</p><p><strong>Conclusion: </strong>Same day consent signing among patients arriving for surgery from home may cause significant operating theatre start time delays. In addition to ethical reasons, obtaining consent in the preoperative area should be avoided to improve preoperative efficiency.</p>","PeriodicalId":35481,"journal":{"name":"Journal of perioperative practice","volume":" ","pages":"413-417"},"PeriodicalIF":0.9,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145303684","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fewer cancellations, better care: Supporting patients with diabetes through surgery.","authors":"Phoebe J Cope, Finn Highfield, Elizabeth Camfield, Charlotte Taylor, Aaisha Saqib","doi":"10.1177/17504589261427976","DOIUrl":"10.1177/17504589261427976","url":null,"abstract":"<p><strong>Background: </strong>Every year 15% of all operative procedures take place in people with diabetes. Suboptimal glycaemic control is associated with increased postoperative complications. This study aimed to identify why people with diabetes have their operations cancelled and introduce interventions to reduce the rate of cancellation.</p><p><strong>Methods: </strong>A retrospective review of all adult people with diabetes with cancelled surgery in 2024 was completed in an inner-city teaching hospital. A new perioperative guideline for elective surgery in people with diabetes was implemented and cancellations were re-audited in June 2025.</p><p><strong>Results: </strong>Postintervention 7% of cancellations were due to suboptimal diabetes control, with none occurring within 2 weeks of surgery (previously 10% and 63%). Prior to intervention, only 32% of patients proceeded to surgery within 1 year of initial cancellation.</p><p><strong>Conclusion: </strong>People with diabetes experience significant delays to surgery; however, targeted perioperative guidelines enable early identification of suboptimal glycaemic control and reduced cancellations. This work highlights the importance of locally tailored perioperative pathways.</p>","PeriodicalId":35481,"journal":{"name":"Journal of perioperative practice","volume":" ","pages":"442-448"},"PeriodicalIF":0.9,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147692650","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Martha's Rule and the perioperative team: What changes, and what still needs to.","authors":"Douglas Blackwood","doi":"10.1177/17504589261449155","DOIUrl":"10.1177/17504589261449155","url":null,"abstract":"","PeriodicalId":35481,"journal":{"name":"Journal of perioperative practice","volume":"36 7-8","pages":"399-401"},"PeriodicalIF":0.9,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13276103/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148266283","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Nociceptive and non-nociceptive pain in critical care patients after cardiac surgery.","authors":"Yesim Yaman Aktas, Esra Özkan","doi":"10.1177/17504589251329284","DOIUrl":"10.1177/17504589251329284","url":null,"abstract":"<p><strong>Aim: </strong>To assess pain intensity during nociceptive (endotracheal suctioning) and non-nociceptive (body temperature measurement) procedures in critically ill patients after cardiac surgery.</p><p><strong>Methods: </strong>A descriptive and cross-sectional design was carried out. The study sample consisted of 60 critically ill patients. The study used the Critical Care Pain Observation Scale, the Behavioural Pain Scale, the Ramsey Sedation Scale and Physiological Parameter Form for data collection. Pain was assessed before, during, and 20 min after endotracheal suctioning and body temperature measurement in the study.</p><p><strong>Results: </strong>The pain scores were found to be statistically significant differences during endotracheal suctioning and body temperature measurement (<i>p</i> <i><</i> 0.001). Pain scores were found to be higher during endotracheal suctioning, which is a nociceptive procedure (<i>p</i> < 0.05). Systolic and diastolic blood pressure, heart rate scores were also determined to be statistically higher during endotracheal suctioning (<i>p</i> <i><</i> 0.05).</p><p><strong>Conclusion: </strong>Pain scores and physiological parameters were found to be higher during endotracheal suctioning, a procedure known to be nociceptive. Critical care nurses are recommended to follow pain assessment protocols.</p>","PeriodicalId":35481,"journal":{"name":"Journal of perioperative practice","volume":" ","pages":"405-412"},"PeriodicalIF":0.9,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144000582","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"From incision to discharge: The role of Enhanced Recovery After Surgery (ERAS) in modern surgical care.","authors":"Syed Hassan Ali, Gaaitri Lohano, Govinda Lohano, Areeba Rao, Suhana Hindu Lohana","doi":"10.1177/17504589251378271","DOIUrl":"10.1177/17504589251378271","url":null,"abstract":"","PeriodicalId":35481,"journal":{"name":"Journal of perioperative practice","volume":" ","pages":"430-431"},"PeriodicalIF":0.9,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145453019","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Preventing postoperative deterioration: The promise of wearable biosensors in rural settings.","authors":"Josh Andrews, Brandon Stretton, Georgina Lewis, Christina Gao, Cecile van der Westhuizen, Alasdair Leslie","doi":"10.1177/17504589251401167","DOIUrl":"10.1177/17504589251401167","url":null,"abstract":"<p><p>Postoperative deterioration remains a challenge, particularly in rural and remote hospitals. Early recognition of complications is critical, yet intermittent ward monitoring may fail to detect subtle physiological changes. Wearable biosensors offer a promising strategy to extend high-dependency surveillance beyond intensive care. These devices can provide continuous, real-time monitoring, enabling earlier intervention, supporting clinical decision-making, and reducing reliance on limited rural health care staff. Evidence suggests these devices are feasible and well tolerated. This viewpoint examines their potential to enhance postoperative surveillance in resource-limited settings and highlights the need for targeted evaluation in rural Australian hospitals to assess effectiveness, cost-benefit, and integration into perioperative practice.</p>","PeriodicalId":35481,"journal":{"name":"Journal of perioperative practice","volume":" ","pages":"402-404"},"PeriodicalIF":0.9,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145702150","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The EPIC SANDPO lettering system and decreased operating room efficiency.","authors":"Lahari Kolli, Richard J Banchs, Steven Roth","doi":"10.1177/17504589251363009","DOIUrl":"10.1177/17504589251363009","url":null,"abstract":"<p><strong>Background: </strong>A new preoperative system (SANDPO) was incorporated into our electronic medical record to improve turnover time and patient safety. SANDPO requires the completion of specific tasks by Surgeons (S), Anaesthetists (A) and Nursing staff (N), completion of Documents (D), Patient consent and identification (P) and Operating Room (O, for OR) staff verifications before patients can be taken for surgery. The system was implemented at the same time in our main operating room and the Specialty Care Building, our new outpatient surgical area.</p><p><strong>Aim: </strong>Identify the impact of SANDPO on turnover time as a measure of operating room efficiency.</p><p><strong>Methods: </strong>Pre- and Post-SANDPO data from our Main (1 October 2021 to 26 August 2023) and Specialty Care Operating Rooms (26 September 2022 to 26 August 2023) were analysed to assess turnover time.</p><p><strong>Results: </strong>Compared to Pre-SANDPO, turnover time increased 24.1% in the main operating room and was significantly lower in the Specialty Care versus the main operating room. Adult cases experienced more delays versus paediatric. Simple setup cases showed the largest increases in turnover time.</p><p><strong>Conclusion: </strong>SANDPO, introduced by hospital administration to enhance safety, significantly and unexpectedly decreased operating room efficiency.</p>","PeriodicalId":35481,"journal":{"name":"Journal of perioperative practice","volume":" ","pages":"424-429"},"PeriodicalIF":0.9,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144971644","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Technologies and management strategies for improving operational efficiency in operating theatres: A scoping review.","authors":"Cristina S Sousa, Rita de Cassia B de Oliveira","doi":"10.1177/17504589261458963","DOIUrl":"https://doi.org/10.1177/17504589261458963","url":null,"abstract":"<p><strong>Objective: </strong>To map strategies, technologies and management practices reported in the literature that contribute to improving operational efficiency in operating theatres.</p><p><strong>Method: </strong>A scoping review conducted according to the Joanna Briggs Institute methodology and reported following the PRISMA Extension for Scoping Reviews (PRISMA-ScR). Searches were conducted in March 2025 in PubMed, ScienceDirect, Scopus, Embase, CINAHL and the Virtual Health Library, as well as grey literature sources including Google Scholar and the CAPES. Studies published within the last 5 years addressing technologies to improve operational efficiency were included.</p><p><strong>Results: </strong>Fifteen studies were included (11 articles and 4 theses/dissertations), most of which were conducted in the United States (40%). Identified strategies included Lean Six Sigma, scheduling automation, digital communication platforms and artificial intelligence, demonstrating improvements in indicators such as turnover time, surgical delays and theatre room idle time.</p><p><strong>Conclusion: </strong>Technological and process-improvement strategies show potential to optimise operating theatre performance and support safer, more efficient use of health care resources.</p>","PeriodicalId":35481,"journal":{"name":"Journal of perioperative practice","volume":" ","pages":"17504589261458963"},"PeriodicalIF":0.9,"publicationDate":"2026-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148353928","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Wound healing in orthopaedic surgery for people living with HIV: Physiologic, surgical, and social determinants of health.","authors":"Jocelyn Hunt, Kaela Williams, Vinay Patel, Setareh Khani, Samantha Monteiro, Emmanuela Beliard, Janae Rasmussen","doi":"10.1177/17504589261453048","DOIUrl":"https://doi.org/10.1177/17504589261453048","url":null,"abstract":"<p><p>Current surgical literature on wound healing often excludes immunosuppressed individuals, such as those with HIV, due to their clinical complexity. Underlying disease processes can negatively influence perioperative outcomes through prolonged wound healing and increased infection risk. This review summarises factors that influence wound healing in patients with HIV undergoing orthopaedic surgery and highlights literature gaps in HIV-specific outcomes that inform intervention timing, duration, and surveillance.</p>","PeriodicalId":35481,"journal":{"name":"Journal of perioperative practice","volume":" ","pages":"17504589261453048"},"PeriodicalIF":0.9,"publicationDate":"2026-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148309562","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}