An idea to streamline the operating room got patients into surgery sooner


When a surgeon noticed patients caught ready for orthopedic surgical procedures, he designed a greater operating room — one which’s publicly funded and may do the procedures sooner and extra effectively. 

Now, it is a model different hospitals are thinking about copying.

Dr. Abdel-Rahman Lawendy, chief and medical director of the ambulatory surgical centre at London Health Sciences Centre, reimagined the OR — one among the most resource-intensive locations in a hospital — for choose orthopedic surgical procedures.

His “Surgi-centre” idea takes sure patients away from the giant, normal operating rooms filled with employees and gear, paring that down to simply what is required to function on ambulatory patients — individuals who can stroll after surgery and go residence the identical day. Examples of the surgical procedures carried out embrace repairing a torn ACL in the knee, a standard sports activities harm. And the surgical procedures are performed at ORs exterior of the hospital, although they’re managed by the establishment.

In comparability, normal hospital operating rooms want to be ready for advanced surgical procedures that require about six employees per room and a full set of sterilized devices, simply in case they’re wanted.

“By reducing all of that stuff out, you primarily drive the price down considerably after which improve the effectivity, which in our system would not essentially translate to saving more cash,” Lawendy stated. “It interprets into treating extra patients.”

Dr. Abdel-Rahman Lawendy discovered methods to lower prices of sure surgical procedures whereas sustaining high quality. (CBC)

Treating extra patients is especially vital now as the COVID-19 pandemic lengthened an already lengthy wait-list for non-urgent surgical procedures, hospital officers say.

The common wait time in Canada final 12 months for hip replacements was about 25 weeks, in accordance to the Canadian Institute of Health Information

But Mary Curry waited solely 14 weeks for a forefoot reconstruction. Arthritis had already resulted in months of foot ache that restricted the Denfield, Ont., affected person’s mobility and left her psychologically exhausted.

Strong workforce provides to efficiencies

She and different patients at the Nazem Kadri Surgical Centre go residence the day of their operation.

Since Curry’s ache was not life-threatening, with out Lawendy’s innovation, she seemingly would’ve had to wait longer for the surgery to resume strolling on her heel, given the common wait occasions.

Patients qualify for the ambulatory surgery possibility at the London hospital in the event that they’re comparatively wholesome and are having minor foot, ankle or hernia surgical procedures that require minimal gear.

A smiling, blonde woman wearing scrubs.
Jillian Holbrough, the centre’s medical supervisor, initially hesitated at the idea of a stripped-down operating room. Then, she says she and the remainder of the workforce got on board. (CBC)

“The crew was wonderful,” Curry stated as she was wheeled out of the smaller, high-efficiency OR. “Stayed awake till I began feeling the pushing and pulling.”

Jillian Holbrough, the surgical centre’s medical supervisor, stated employees are a minimum of 30 per cent sooner than in the hospital’s normal ORs. They carry out between 10 and 15 surgical procedures a day in two operating rooms. “It was a bit scary at first, the thought, as a result of it was so progressive,” Holbrough stated of the preliminary hesitation.

Then the tradition modified and employees got here on board.

“We have a really sturdy workforce right here and all of us work collectively,” stated Holbrough, who can also be the supervisor at  Victoria Hospital’s OR, additionally in London, Ont. “And that, in and of itself, creates quite a lot of efficiencies.”

Same high quality, decrease price

Holbrough stated the ambulatory centre additionally presents an important affected person expertise since individuals obtain care earlier than and after the surgery at the identical spot by the identical nurse.

Lawendy’s graduate scholar, Moaz Bin Yunus Chohan, wrote a thesis about the Surgi-centre based mostly on information testing the strategy in additional than 1,000 patients.

Instead of the normal minimal of six employees in the OR, the smaller operating theatres have precisely what’s wanted for that individual affected person — be it surgical, anesthesia and nursing personnel and gear, Lawendy stated.

“Essentially it demonstrates that we are able to lower prices whereas sustaining high quality,” stated Lawendy, who can also be chief of the orthopedic trauma service.

The researchers discovered that prices in the typical or hospital operating rooms ran about $469 per affected person.

In the high-efficiency or ambulatory centre, the price fell to $172 per affected person. And patients handled in regulated ambulatory centres additionally have a tendency to have fewer post-surgery problems, which ends up in additional cost-savings.

The Ontario authorities is taking a look at Lawendy’s public system model as a means to safely pace up surgical procedures.

“We have individuals coming to tour right here practically each week to see what the model is like from throughout Ontario,” he stated.

Dr. Danny Goel, a medical professor in orthopedic surgery at the University of British Columbia, shouldn’t be concerned in Lawendy’s model, which he referred to as a significant shift.

“As extra procedures are shifting to this method-of-care supply, the alternative to spend money on surgical centres ought to be strongly inspired to lower the burden on a standard hospital setting,” Goel stated in an e mail.

“While there could also be some preliminary infrastructure and implementation challenges, the long-term advantages to affected person care and the Canadian health-care system basically could be vital.”

For its half, London Health Sciences Centre plans to scale up to 4 extra ambulatory ORs.


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