PDF(Pubmed)
Abstract：
Operating theatres and surgical resource consumption comprise a significant proportion of healthcare costs. Inefficiencies in theatre lists remain an important focus for cost management, along with reducing patient morbidity and mortality. With the emergence of the coronavirus disease 2019 (COVID-19) pandemic, the number of patients on theatre waiting lists has surged. Hence, there is a pressing need to utilise the already limited theatre time and fraught resources with innovative methods. In this systematic review, we discuss the Golden Patient Initiative (GPI), in which the first patient on the operating list is pre-assessed the day prior to surgery, and we aim to assess its impact and overall efficacy. A literature search using the following four databases was conducted to identify and select all clinical research concerning the GPI: Medical Literature Analysis and Retrieval System Online (MEDLINE), Cumulative Index to Nursing and Allied Health Literature (CINAHL), Excerpta Medica Database (EMBASE), and the Cochrane library. Two independent authors screened articles against the eligibility criteria, using a process adapted from the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Data extracted included outcomes measured, follow-up period, and study design. The results showed significant heterogeneity, and hence a narrative review was conducted; 13 of the 73 eligible articles were included for analysis. Outcomes included delay in theatre start time, number of surgical case cancellations, and changes to total case numbers. Across the studies, a 19-30-minute improvement in theatre start time was reported (p<0.05), as well as a statistically significant decrease in case cancellations. Our analysis provides encouraging conclusions with regard to greater theatre efficiency following the application of GPI, a low-cost solution that can easily be implemented to help improve patient safety and lead to cost savings. However, at present, it is largely implemented among local trusts, and hence larger multi-centre studies are required to gather conclusive evidence about the efficacy of the initiative.
摘要：
手术室和手术资源消耗占医疗保健成本的很大一部分。剧院清单的低效率仍然是成本管理的重要重点，同时降低患者发病率和死亡率。随着2019年冠状病毒病(COVID-19)大流行的出现，手术室等候名单上的病人人数激增。因此，迫切需要利用已经有限的戏剧时间和充满创新方法的资源。在这次系统审查中，我们讨论了黄金患者倡议(GPI)，其中手术清单上的第一位患者在手术前一天进行了预先评估，我们的目标是评估其影响和整体疗效。使用以下四个数据库进行文献检索，以识别和选择有关GPI的所有临床研究：在线医学文献分析和检索系统（MEDLINE），护理和相关健康文献累积指数(CINAHL)，摘录医学数据库（EMBASE），还有Cochrane图书馆.两名独立作者根据资格标准筛选了文章，使用改编自系统审查和荟萃分析(PRISMA)指南的首选报告项目的流程。提取的数据包括测量的结果，随访期,和研究设计。结果显示了显著的异质性,因此进行了叙述性审查；73篇合格文章中有13篇被纳入分析。结果包括剧院开始时间的延迟，手术取消的数量，以及案件总数的变化。在整个研究中，据报道，剧院开始时间改善了19-30分钟(p<0.05)，以及病例取消的统计学显着下降。我们的分析提供了关于GPI应用后提高剧院效率的令人鼓舞的结论，一个低成本的解决方案，可以很容易地实施，以帮助提高患者的安全和导致节省成本。然而,目前,它主要在本地信托中实施，因此，需要更大的多中心研究来收集有关该计划有效性的确凿证据。
