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A Standardized Web-based Operating Room Module for Urological Procedures Improves Efficiency, Reduces Cost as a Platform for Continuous Process Improvement: A Pilot Study
Katie H. Willihnganz-Lawson, MD, Ardavan Akhavan, MD, Renelle Risley, MA, Carla Brannen, RN, Paul A. Merguerian, MD, MS.
Seattle Children's Hospital, Seattle, WA, USA.

BACKGROUND: Current operating room practices are not standardized and involve the use of individualized preference cards that are often out-dated and lack visual aids for operating room staff. We hypothesize that a standardized web-based operating room module will minimize operating room redundancy, improve efficiency, reduce cost and provide a platform for continuous improvement.
METHODS: All patients aged between 6 months and 5 years of age undergoing unilateral orchiopexy, unilateral inguinal hernia repair and distal hypospadias repair were included in the study. This excludes any patient who underwent bilateral or multiple other procedures. These three operative procedures were standardized by creating web-based templates that defined steps of the operation including visual aids of mayo stand and room setup. These templates were displayed in the operating room throughout the procedures and made available to all surgical staff. Variables evaluated include total procedure time, extra supplies utilized, number of nursing trips outside the room to deliver supplies not available, and total charges. Baseline data was collected 3 months prior to and 3 months after implementation. We also conducted a validated 10-item usability survey to physicians and staff on the current preference card system before implementation, and then on the standardized web-based template after implementation. Statistical analysis of the data was performed using Student t test and Wilcoxon-Mann-Whitney test for nonparametric data.
RESULTS: A total of 59 patients were evaluated, 29 patients in the baseline group (12 orchiopexy, 9 hypospadias, 8 hernia) and 30 patients in the comparison group (13 orchiopexy, 8 hypospadias, 9 hernia). After implementation of the CEVL module, the system usability scale scores improved from below 10th percentile to above average 80th percentile ( from 52.9 to 75.3 +/- 20, p<0.05). Total in room times were not significantly different after implementation of the platform for all three procedures. There was a decrease in number of extra supplies used following implementation of the template. Total charges were decreased by a mean of $2015 per case, but this did not reach statistical significance.
CONCLUSIONS: A standardized surgical module even for common urological cases improves operating room efficiency, shows a trend to decrease cost, is preferred to current preference card system, and is user-friendly promoting resident education. Further studies are needed to determine the efficacy of such a standardized system, especially for longer and more complex procedures.

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