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During the postoperative period, it is crucial to focus on maintaining circulation, identifying and managing potential complications, and planning for discharge.Nursing AssessmentVital signs monitoring: Regularly monitor vital signs, including blood pressure, heart rate, respiratory rate, and temperature, to detect early signs of complications such as bleeding and infection.Circulation assessment: Monitor pulses, perform Doppler assessments, and check capillary refill, color, temperature, and...
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Patients with hypertrophic cardiomyopathy (HCM) and left ventricular outflow tract (LVOT) obstruction who remain symptomatic despite optimal medical therapy may undergo a septal myectomy (Morrow procedure). This procedure involves excising a portion of the hypertrophied septum below the aortic valve using a heart-lung machine to improve blood flow through the LVOT. Effective preoperative and postoperative nursing management ensures successful patient outcomes, minimizes complications, and...
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Asepsis is the practice of preventing or breaking the chain of infection. The nurse employs aseptic techniques to prevent the spread of microorganisms and reduce the risk of diseases. Hand hygiene is the cornerstone of aseptic techniques and is classified into medical and surgical asepsis. Medical asepsis includes hand hygiene and the use of gloves. Surgical asepsis, or the sterile technique, refers to practices that render and keep objects and areas free of microorganisms.
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Optimizing the Use of Operating Rooms by Transitioning Common Hand Surgeries Into the Office Setting.

Brian W Starr1, Ryan O Davenport2, Derek Granzow2

  • 1Division of Plastic Surgery, Cincinnati Children's Hospital, Cincinnati, OH; Section of Plastic, Reconstructive & Hand Surgery, University of Cincinnati, Cincinnati, OH.

The Journal of Hand Surgery
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Summary

Moving simple hand surgeries to office settings significantly cuts costs and frees up operating room time. This shift improves patient access and validates the financial viability of wide-awake local anesthesia no tourniquet surgery.

Keywords:
CostWALANThand surgeryoffice surgeryutilization

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Area of Science:

  • Health Economics
  • Surgical Innovation
  • Ambulatory Care

Background:

  • Ambulatory surgery centers (ASCs) are widely used for simple hand procedures.
  • Wide-awake local anesthesia no tourniquet (WALANT) surgery offers a minimally invasive approach.
  • Evaluating the financial implications of shifting surgical settings is crucial for healthcare systems.

Purpose of the Study:

  • To determine the financial impact of relocating simple hand procedures from ASCs to office-based settings.
  • To assess the cost savings and operational efficiencies gained by this transition.
  • To evaluate the sustainability of WALANT surgery in an office setting from a health system perspective.

Main Methods:

  • Analysis of costs, revenues, case times, and patient demographics for procedures in ASCs versus office settings over two years.
  • Calculation of mean margin per minute for key hand procedures.
  • Quantification of operating room/ASC time gained and potential for treating additional patients.

Main Results:

  • Simple hand procedures in the office setting resulted in an 82% cost saving per case ($1,137 vs $206).
  • The transition freed up 821 hours of ASC time over two years.
  • The net margin per minute was significantly lower in the office setting ($5.63/min) compared to ASC ($25.01/min), but the overall financial benefit was substantial due to increased volume potential.

Conclusions:

  • Transitioning simple hand operations to the office setting significantly reduces healthcare costs.
  • This shift enhances operating room availability for other procedures and patients.
  • The study validates the financial sustainability and benefits of WALANT surgery in an office environment.