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Operating Room Efficiency and Postoperative Recovery after Major Abdominal Surgery: The Surgical Team’s Efficiency and the Early Postoperative Recovery of Patients with Peritoneal Carcinomatosis
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences. (PC)
2011 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

In selected patients, surgical treatments such as cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) have enabled curative treatment options for previously incurable diseases, such as peritoneal carcinomatosis (PC). The introduction of resource demanding surgery could affect the work process, efficiency, and productivity within a surgical department and factors influencing patient postoperative recovery processes may have an impact on the efficiency of patient care after major surgery.

The aim of this thesis was to investigate operating room efficiency from the perspective of both staff and leaders’ in two different settings (Papers I and II) and the early postoperative recovery of patients with peritoneal carcinomatosis (Papers III and IV).

Interviews were held with 21 people in a county hospital and 11 members of the PC team in a university hospital, and a phenomenographic approach was used to analysis the data (Papers I and II). The patients’ postoperative recovery and pulmonary adverse events (AE) were determined from data retrieved from the electronic health records of 76 patients (Papers III and IV).

The concept of efficiency was understood in different ways by staff members and their leaders (Paper I). However, when working in a team, the team members had both organisation-oriented and individual-oriented understanding of efficiency at work that focused on the patients and the quality of care (Paper II).

The patients with PC regained gastrointestinal functions and could be mobilised during early postoperative recovery phase, although many patients suffered from psychological disturbances, sleep deprivation, and nausea (Paper III). Postoperative clinical and radiological pulmonary AE were common, but did not affect the early recovery process (Paper IV).

In conclusion, leaders who are aware of the variation in understanding the concept of efficiency are better able to create the same platform for staff members by defining the concept of efficiency within the organisation. In a team organisation, the team members have a wider understanding of the concept of efficiency with more focus on the patients. The factors affecting postoperative recovery and pulmonary AE should be considered when designing individualised patient care plans in order to attain a more efficient recovery.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis , 2011. , 79 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 713
Keyword [en]
efficiency, operating room, postoperative recovery, peritoneal carcinomatos, cytoreductive surgery, HIPEC
National Category
Surgery
Identifiers
URN: urn:nbn:se:uu:diva-160045ISBN: 978-91-554-8190-2 (print)OAI: oai:DiVA.org:uu-160045DiVA: diva2:448408
Public defence
2011-12-02, Auditorium minus, Museum Gustavianum, Akademigatan 3, 753 10 Uppsala, 09:15 (Swedish)
Opponent
Supervisors
Available from: 2011-11-11 Created: 2011-10-13 Last updated: 2011-11-23Bibliographically approved
List of papers
1. Job satisfaction or production? How staff and leadership understand operating room efficiency: a qualitative study
Open this publication in new window or tab >>Job satisfaction or production? How staff and leadership understand operating room efficiency: a qualitative study
2008 (English)In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 52, no 10, 1423-1428 p.Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: How to increase efficiency in operating departments has been widely studied. However, there is no overall definition of efficiency. Supervisors urging staff to work efficiently may meet strong reactions due to staff believing that demands for efficiency means just stress at work. Differences in how efficiency is understood may constitute an obstacle to supervisors' efforts to promote it. This study aimed to explore how staff and leadership understand operating room efficiency. METHODS: Twenty-one members of staff and supervisors in an operating department in a Swedish county hospital were interviewed. The analysis was performed with a phenomenographic approach that aims to discover the variations in how a phenomenon is understood by a group of people. RESULTS: Six categories were found in the understanding of operation room efficiency: (A) having the right qualifications; (B) enjoying work; (C) planning and having good control and overview; (D) each professional performing the correct tasks; (E) completing a work assignment; and (F) producing as much as possible per time unit. The most significant finding was that most of the nurses and assistant nurses understood efficiency as individual knowledge and experience emphasizing the importance of the work process, whereas the supervisors and physicians understood efficiency in terms of production per time unit or completing an assignment. CONCLUSIONS: The concept 'operating room efficiency' is understood in different ways by leadership and staff members. Supervisors who are aware of this variation will have better prerequisites for defining the concept and for creating a common platform towards becoming efficient.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-87825 (URN)10.1111/j.1399-6576.2008.01781.x (DOI)000260131000019 ()19025537 (PubMedID)
Available from: 2009-01-14 Created: 2009-01-14 Last updated: 2017-12-14Bibliographically approved
2. How operating room efficiency is understood in a surgical team: a qualitative study
Open this publication in new window or tab >>How operating room efficiency is understood in a surgical team: a qualitative study
2011 (English)In: International Journal for Quality in Health Care, ISSN 1353-4505, E-ISSN 1464-3677, Vol. 23, no 1, 100-106 p.Article in journal (Refereed) Published
Abstract [en]

Objective. Building surgical teams is one attempt to ensure the health-care system becomes more efficient, but how is 'efficiency'understood or interpreted? The aim was to study how organized surgical team members and their leaders understood operating room efficiency.

Design. Qualitative study.

Settings. A 1100-bed Swedish university hospital.

Participants. Eleven participants, nine team members from the same team and their two leaders were interviewed.

Methods. The analysis was performed according to phenomenography, a research approach that aims to discover variationsin peoples' understanding of a henomenon.

Results. Seven ways of understanding operating room efficiency were identified: doing one's best from one's prerequisites,enjoying work and adjusting it to the situation, interacting group performing parallel tasks, working with minimal resources to produce desired results, fast work with preserved quality, long-term effects for patient care and a relative concept. When talking about the quality and benefits of delivered care, most team members invoked the patient as the central focus. Despite seven ways of understanding efficiency between the team members, they described their team as efficient. The nurses and assistant nurses were involved in the production and discussed working in a timely manner more than the leaders.

Conclusions. The seven ways of understanding operating room efficiency appear to represent both organization-oriented andindividual-oriented understanding of that concept in surgical teams. The patient is in focus and efficiency is understood as maintaining quality of care and measuring benefits of care for the patients.

Keyword
Leadership, quality management, qualitative methods, general methodology, teamwork, human resources
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-138784 (URN)10.1093/intqhc/mzq063 (DOI)000286474000012 ()21098628 (PubMedID)
Available from: 2010-12-20 Created: 2010-12-20 Last updated: 2017-12-11Bibliographically approved
3. Factors influencing early postoperative recovery after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy
Open this publication in new window or tab >>Factors influencing early postoperative recovery after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy
Show others...
2011 (English)In: European Journal of Surgical Oncology, ISSN 0748-7983, E-ISSN 1532-2157, Vol. 37, no 10, 897-903 p.Article in journal (Refereed) Published
Abstract [en]

BACKGROUND:

Cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC) can prolong survival in selected patients with peritoneal carcinomatosis (PC). However, there is little data on patients' recovery process after this complex treatment. This study aimed to describe the in-hospital postoperative recovery and factors related to the recovery of patients who undergo CRS and HIPEC.

METHOD:

A retrospective audit of the electronic health record (EHR) was undertaken for 76 PC patients (42 women, 34 men) treated primarily with CRS and HIPEC between 2005 and 2006 in Sweden.

RESULTS:

Oral intake, regaining bowel functions and mobilisation usually occurred between 7 and 11 days postoperatively. Patients experienced nausea for up to 13 days postoperatively. Forty-two patients were satisfied with their pain management, which usually took the form of epidural anaesthesia and which continued for about one week post-surgery. Sleep disturbance was observed in 51 patients and psychological problems in 49 patients during the first three postoperative weeks. Tumour burden, stoma formation, use of CPAP, primary diagnosis, and the length of stay in the ICU were factors related to an early recovery process.

CONCLUSION:

Drinking, eating, regaining bowel functions and mobilisation were re-established within 11 days of CRS and HIPEC. Tumour burden, stoma formation, use of CPAP, primary diagnosis and the length of stay in the ICU all had an impact on postoperative recovery, and should be discussed with the patients preoperatively and taken into consideration in designing an individualised patient care plan, in order to attain a more efficient recovery.

National Category
Surgery
Identifiers
urn:nbn:se:uu:diva-159496 (URN)10.1016/j.ejso.2011.06.003 (DOI)000295894900010 ()21783337 (PubMedID)
Available from: 2011-10-03 Created: 2011-10-03 Last updated: 2017-12-08Bibliographically approved
4. Pulmonary influences on early postoperative recovery in patients after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy treatment
Open this publication in new window or tab >>Pulmonary influences on early postoperative recovery in patients after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy treatment
Show others...
2011 (English)In: Anesthesia and Analgesia, ISSN 0003-2999, E-ISSN 1526-7598Article in journal (Other academic) Submitted
National Category
Surgery
Identifiers
urn:nbn:se:uu:diva-159497 (URN)
Available from: 2011-10-03 Created: 2011-10-03 Last updated: 2017-12-08Bibliographically approved

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