Applying the Recipe to Perioperative Systems Design

Perioperative systems design describes a rational approach to managing the convergent flow of patients having procedures from disparate physical and temporal starting points, through the operating room and then to such a place where future events pertaining to the patient have no further impact on operating room operations (Fig 8.3). This process for an individual patient can be envisioned as a nested set of timelines: a coarse-grained timeline beginning with the decision to perform an operation and ending when the patient definitively leaves the postoperative occurrence, and a fine-grained timeline encompassing the immediate pre-, intra-, and postoperative course. At each point, physical infrastructure and work processes affect the progress of patients along these timelines. Starting from this construct, perioperative systems design can be conceptualized, studied, and optimized like any industrial process in which many materials, actors, and processes are brought together in a coordinated workflow to achieve a designed goal. Figure 8.3 shows nested, interactive timelines around the preoperative period, the intraoperative period, and the postoperative period. Of interest, is that there are as more activities before and after surgery than during surgery.

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