Evidence map›Paper›PMID 36596585›Full record

ArticleCanadian journal of surgery. Journal canadien de chirurgie

Use of multidisciplinary positive deviance seminars to improve efficiency in a high-volume arthroplasty practice: a pilot study.

Richard Gold, Farid Al Zoubi, Julia Brillinger, Cheryl Kreviazuk, Dennis Garvin, David Schramm, Pascal Fallavollita, Andrew J E Seely, Paul E Beaulé

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PubMed Full text at PMC Publisher
In one paragraph

Article in Canadian journal of surgery. Journal canadien de chirurgie. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers.

0numbers the graph read from it
0cells of the map it votes in
6citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

6 citing papers in PubMed.

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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

9 authors.

Richard GoldFrom the Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Ont. (Gold, Brillinger, Kreviazuk, Beaulé); the Faculty of Medicine, McGill University, Montréal, Que. (Gold); the Interdisciplinary School of Health Sciences, University of Ottawa, Ottawa, Ont. (Al Zoubi, Fallavollita); the School of Electrical Engineering and Computer Science, University of Ottawa, Ottawa, Ont. (Al Zoubi, Fallavollita); Clinical Operations, The Ottawa Hospital, Ottawa, Ont. (Garvin); the Department of Otolaryngology - Head and Neck Surgery, The Ottawa Hospital, Ottawa, Ont. (Schramm); and the Department of Thoracic Surgery, The Ottawa Hospital, Ottawa, Ont. (Seely).
Farid Al ZoubiFrom the Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Ont. (Gold, Brillinger, Kreviazuk, Beaulé); the Faculty of Medicine, McGill University, Montréal, Que. (Gold); the Interdisciplinary School of Health Sciences, University of Ottawa, Ottawa, Ont. (Al Zoubi, Fallavollita); the School of Electrical Engineering and Computer Science, University of Ottawa, Ottawa, Ont. (Al Zoubi, Fallavollita); Clinical Operations, The Ottawa Hospital, Ottawa, Ont. (Garvin); the Department of Otolaryngology - Head and Neck Surgery, The Ottawa Hospital, Ottawa, Ont. (Schramm); and the Department of Thoracic Surgery, The Ottawa Hospital, Ottawa, Ont. (Seely).
Julia BrillingerFrom the Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Ont. (Gold, Brillinger, Kreviazuk, Beaulé); the Faculty of Medicine, McGill University, Montréal, Que. (Gold); the Interdisciplinary School of Health Sciences, University of Ottawa, Ottawa, Ont. (Al Zoubi, Fallavollita); the School of Electrical Engineering and Computer Science, University of Ottawa, Ottawa, Ont. (Al Zoubi, Fallavollita); Clinical Operations, The Ottawa Hospital, Ottawa, Ont. (Garvin); the Department of Otolaryngology - Head and Neck Surgery, The Ottawa Hospital, Ottawa, Ont. (Schramm); and the Department of Thoracic Surgery, The Ottawa Hospital, Ottawa, Ont. (Seely).
Cheryl KreviazukFrom the Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Ont. (Gold, Brillinger, Kreviazuk, Beaulé); the Faculty of Medicine, McGill University, Montréal, Que. (Gold); the Interdisciplinary School of Health Sciences, University of Ottawa, Ottawa, Ont. (Al Zoubi, Fallavollita); the School of Electrical Engineering and Computer Science, University of Ottawa, Ottawa, Ont. (Al Zoubi, Fallavollita); Clinical Operations, The Ottawa Hospital, Ottawa, Ont. (Garvin); the Department of Otolaryngology - Head and Neck Surgery, The Ottawa Hospital, Ottawa, Ont. (Schramm); and the Department of Thoracic Surgery, The Ottawa Hospital, Ottawa, Ont. (Seely).
Dennis GarvinFrom the Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Ont. (Gold, Brillinger, Kreviazuk, Beaulé); the Faculty of Medicine, McGill University, Montréal, Que. (Gold); the Interdisciplinary School of Health Sciences, University of Ottawa, Ottawa, Ont. (Al Zoubi, Fallavollita); the School of Electrical Engineering and Computer Science, University of Ottawa, Ottawa, Ont. (Al Zoubi, Fallavollita); Clinical Operations, The Ottawa Hospital, Ottawa, Ont. (Garvin); the Department of Otolaryngology - Head and Neck Surgery, The Ottawa Hospital, Ottawa, Ont. (Schramm); and the Department of Thoracic Surgery, The Ottawa Hospital, Ottawa, Ont. (Seely).
David SchrammFrom the Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Ont. (Gold, Brillinger, Kreviazuk, Beaulé); the Faculty of Medicine, McGill University, Montréal, Que. (Gold); the Interdisciplinary School of Health Sciences, University of Ottawa, Ottawa, Ont. (Al Zoubi, Fallavollita); the School of Electrical Engineering and Computer Science, University of Ottawa, Ottawa, Ont. (Al Zoubi, Fallavollita); Clinical Operations, The Ottawa Hospital, Ottawa, Ont. (Garvin); the Department of Otolaryngology - Head and Neck Surgery, The Ottawa Hospital, Ottawa, Ont. (Schramm); and the Department of Thoracic Surgery, The Ottawa Hospital, Ottawa, Ont. (Seely).
Pascal FallavollitaFrom the Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Ont. (Gold, Brillinger, Kreviazuk, Beaulé); the Faculty of Medicine, McGill University, Montréal, Que. (Gold); the Interdisciplinary School of Health Sciences, University of Ottawa, Ottawa, Ont. (Al Zoubi, Fallavollita); the School of Electrical Engineering and Computer Science, University of Ottawa, Ottawa, Ont. (Al Zoubi, Fallavollita); Clinical Operations, The Ottawa Hospital, Ottawa, Ont. (Garvin); the Department of Otolaryngology - Head and Neck Surgery, The Ottawa Hospital, Ottawa, Ont. (Schramm); and the Department of Thoracic Surgery, The Ottawa Hospital, Ottawa, Ont. (Seely).
Andrew J E SeelyFrom the Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Ont. (Gold, Brillinger, Kreviazuk, Beaulé); the Faculty of Medicine, McGill University, Montréal, Que. (Gold); the Interdisciplinary School of Health Sciences, University of Ottawa, Ottawa, Ont. (Al Zoubi, Fallavollita); the School of Electrical Engineering and Computer Science, University of Ottawa, Ottawa, Ont. (Al Zoubi, Fallavollita); Clinical Operations, The Ottawa Hospital, Ottawa, Ont. (Garvin); the Department of Otolaryngology - Head and Neck Surgery, The Ottawa Hospital, Ottawa, Ont. (Schramm); and the Department of Thoracic Surgery, The Ottawa Hospital, Ottawa, Ont. (Seely).
Paul E BeauléFrom the Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Ont. (Gold, Brillinger, Kreviazuk, Beaulé); the Faculty of Medicine, McGill University, Montréal, Que. (Gold); the Interdisciplinary School of Health Sciences, University of Ottawa, Ottawa, Ont. (Al Zoubi, Fallavollita); the School of Electrical Engineering and Computer Science, University of Ottawa, Ottawa, Ont. (Al Zoubi, Fallavollita); Clinical Operations, The Ottawa Hospital, Ottawa, Ont. (Garvin); the Department of Otolaryngology - Head and Neck Surgery, The Ottawa Hospital, Ottawa, Ont. (Schramm); and the Department of Thoracic Surgery, The Ottawa Hospital, Ottawa, Ont. (Seely) pbeaule@toh.ca.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundPositive deviance (PD) seminars, which have shown excellent results in improving the quality of surgical practices, use individual performance feedback to identify team members who outperform their peers; the strategies from those with exemplary performance are used to improve team members' practices. Our study aimed to use the PD approach with arthroplasty surgeons and nurses to identify multidisciplinary strategies and recommendations to improve operating room (OR) efficiency.

methodsWe recruited 5 surgeons who performed high-volume primary arthroplasty and had participated in 4-joint rooms since 2012, and 29 nurses who had participated in 4-joint rooms and in at least 16 cases in our data set. Three 1-hour PD sessions were held in February and March 2021: 1 with surgeons, 1 with nurses, and 1 with both surgeons and nurses to select recommendations for implementation. The sessions were led by a member of the nonorthopedic surgical faculty who was familiar with the subjects discussed and with PD seminars. To determine the success of the recommendations, we compared OR efficiency before and after implementation. We defined success as performance of 4 joint procedures within 8 hours.

resultsEleven recommendations were recorded from the session with nurses and 7 from the session with surgeons, of which 11 were selected for implementation. During the month after implementation, there were great improvements across all time intervals of surgical procedures, with the greatest improvements seen in mean anesthesia preparation time in the room (4.51 min [26.3%]), mean procedure duration (9.75 min [14.0%]) and mean anesthesia finish time (5.78 min [44.0%]) (all

conclusionThe recommendations and increased motivation owing to the individualized feedback reduced time spent per case, allowing more days to finish on time. Positive deviance seminars offer an inexpensive, efficient and collegial means for process improvement in the OR.

Indexed as

SurgeonsArthroplastyEfficiencyHumansOperating RoomsPilot Projects

Identifiers

PMID36596585
PMCPMC9829057

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.