Retrospective Cohort Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. Jul 18, 2023; 14(7): 516-525
Published online Jul 18, 2023. doi: 10.5312/wjo.v14.i7.516
Effectiveness of an early operating room start time in managing pediatric trauma
Dan Kym, Japsimran Kaur, Nicole Segovia Pham, Eric Klein, Joanna Lind Langner, Ellen Wang, John Schoeneman Vorhies
Dan Kym, Japsimran Kaur, Nicole Segovia Pham, Joanna Lind Langner, John Schoeneman Vorhies, Department of Orthopaedic Surgery, Stanford University School of Medicine, Palo Alto, CA 94304, United States
Eric Klein, Lucile Packard Children’s Hospital, Palo Alto, CA 94304, United States
Ellen Wang, Department of Anesthesiology, Pain and Perioperative Medicine, Stanford University School of Medicine, Palo Alto, CA 94304, United States
Author contributions: Kym D, Kaur J, Pham NS, Klein E, Langner JL, Wang E, and Vorhies JS contributed to the research, writing, and revision of the manuscript.
Institutional review board statement: This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted an IRB waiver by the Ethics Committee of Stanford University (IRB No. 46989).
Informed consent statement: This project is not a randomized clinical trial. Per our Institutional Review Board, this study did not need signed consent from participants.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: John Schoeneman Vorhies, MD, Assistant Professor, Department of Orthopaedic Surgery, Stanford University School of Medicine, 453 Quarry Rd, 3rd Floor, MC 5658, Palo Alto, CA 94304, United States. john.vorhies@stanford.edu
Received: February 22, 2023
Peer-review started: February 22, 2023
First decision: April 13, 2023
Revised: May 10, 2023
Accepted: June 6, 2023
Article in press: June 6, 2023
Published online: July 18, 2023
ARTICLE HIGHLIGHTS
Research background

This study describes the effect of a program allowing an early operating room (OR) start for uncomplicated trauma prior to an elective day of surgery to decrease wait times for surgery for urgent fractures admitted overnight.

Research motivation

The timing of operative treatment for pediatric supracondylar humerus fractures (SCHF) and femoral shaft fractures (FSF) remains controversial.

Research objectives

We present the impact of the quality improvement program initiated at a suburban level I trauma center, aiming to enhance the efficiency of care and adhere to United States News and World Report’s standard for timely management. The program specifically focuses on reducing wait times for urgent trauma cases and mitigating surgeon fatigue by implementing a 6 AM start.

Research methods

From October 2017 onwards, patients admitted between 21:00 the previous night and 05:00 were considered for the early slot in the OR, subject to the surgeon’s judgment. To evaluate the effects of this change, we analyzed the demographic characteristics and treatment timelines of patients with SCHF and FSF, comparing data from one year before and one year after the implementation. Additionally, we gathered survey responses from the surgical team for further insights.

Research results

Out of the 44 SCHF cases that met the inclusion criteria, 16 underwent treatment prior to the program’s implementation, while 28 received treatment afterward. Following the implementation, the average wait time for surgery decreased by 4.8 h or 35.4% (from 13.4 h to 8.7 h; P = 0.001). However, no significant differences were observed in operative duration, post anesthesia care unit stay, or discharge wait time. Survey responses indicated a decline in the program’s popularity among nurses and anesthesiologists compared to surgeons. While 57% of surgeons believed the program was effective, only 9% of anesthesiologists and 16% of nurses shared the same opinion. Due to the overall dissatisfaction, the program was eventually discontinued.

Research conclusions

The results of our study highlight a significant decrease in surgery wait times for uncomplicated SCHF cases admitted overnight. Additionally, we emphasize the significance of engaging stakeholders in shared decision-making. While the program yielded promising outcomes, it also gave rise to conflicts among the OR staff, ultimately leading to its discontinuation at our institution. Moving forward, it is essential to involve stakeholders early on during the planning phase of similar programs to effectively address the OR staff’s requirements and concerns.

Research perspectives

Surgeons and hospital administrators engaging in quality improvement initiatives to improve the timeliness of care can find value in this information. It is recommended that future implementations of such programs involve stakeholders from the outset of the planning process to ensure better alignment with the needs of the OR staff.