DOI
https://doi.org/10.18849/ve.v10i2.706Abstract
Aims and objectives: The aim of this clinical audit was to reduce nonoperative anaesthesia time from 131 minutes to 102 minutes while maintaining surgical site infection rates below 10% for canine tibial plateau osteotomy procedures. Data collected from anaesthesia records and electronic medical records provided the data to measure these aims.
Background: Increased anaesthesia time increases the risk for perianaesthetic complications including surgical site infections. Through anaesthesia record analysis we recognised that nonoperative anaesthesia time was a variable that could be targeted for improvement. Nonoperative anaesthesia time is defined as total anaesthetic time minus surgical time.
Methods: Review of 40 total anaesthetic records (24 initial audit, 16 re-audit) and electronic medical records provided the data we recorded to determine anaesthesia time information and surgical site infection information. Manual audits were conducted to create a value stream map and nonoperative anaesthesia times were analysed for special cause variation utilising statistical process control.
Results: Nonoperative anaesthesia time was 131 minutes, roughly half of total anaesthesia time (270 minutes), while surgical site infection rate was 8.3%.
Implementation of changes (team discussion & changes made): A new communication protocol was trialed between anaesthesia and surgical teams.
Re-audit: The same procedure and analysis were used for the initial audit and re-audit. During the re-audit nonoperative anesthesia time was reduced to 109 minutes and surgical site infection rate was 6.3%.
Application: The communication protocol trialed during the re-audit is still in practice. This audit can be applied to other practices looking to better analyse their anaesthetic time variables and to re-evaluate communication procedures for better patient outcomes.
References
Benneyan, J.C., Lloyd, R.C. & Plsek, P.E. (2003). Statistical process control as a tool for research and healthcare improvement. BMJ Quality & Safety in Health Care. 12(6), 458–464. DOI: https://doi.org/10.1136/qhc.12.6.458
Centers for Disease Control and Prevention. (2024). National Healthcare Safety Network Surgical Site Infection Event. [online]. Available from: https://www.cdc.gov/nhsn/pdfs/pscmanual/9pscssicurrent.pdf
Cook, J.L., Luther, J.K., Beetem, J., Karnes, J. & Cook, C.R. (2010). Clinical Comparison of a Novel Extracapsular Stabilization Procedure and Tibial Plateau Leveling Osteotomy for Treatment of Cranial Cruciate Ligament Deficiency in Dogs. Veterinary Surgery. 39(3), 315–323. DOI: https://doi.org/10.1111/j.1532-950X.2010.00658.x
Gruenheid, M., Aarnes, T.K., McLoughlin, M.A., Simpson, E.M., Mathys, D.A., Mollenkopf, D.F. &Wittum, T.E. (2018). Risk of anesthesia-related complications in brachycephalic dogs. Journal of the American Veterinary Medical Association. 253(3), 301–306. DOI: https://doi.org/10.2460/javma.253.3.301
McCambridge, J., Witton, J. & Elbourne, D.R. (2014). Systematic review of the Hawthorne Effect: new concepts are needed to study research participation effects. Journal of Clinical Epidemiology. 67(3), 267–277. DOI: https://doi.org/10.1016/j.jclinepi.2013.08.015
Nagpal, K., Vats, A., Lamb, B., Ashrafian, H., Sevdalis, N., Vincent, C. & Moorthy, K. (2010). Information Transfer and Communication in Surgery: A Systematic Review. Annals of Surgery. 252(2), 225–239. DOI: https://doi.org/10.1097/sla.0b013e3181e495c2
Nazarali, A., Singh, A. & Weese, J.S. (2014). Perioperative Administration of Antimicrobials During Tibial Plateau Leveling Osteotomy. Veterinary Surgery. 43(8), 966–971. DOI: https://doi.org/10.1111/j.1532-950X.2014.12269.x
Russ, S., Rout, S., Sevdalis, N., Moorthy, K., Darzi, A. & Vincent, C. (2013). Do Safety Checklists Improve Teamwork and Communication in the Operating Room? A Systematic Review. Annals of Surgery. 258 (6), 856-871. DOI: https://doi.org/10.1097/sla.0000000000000206
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