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Nowadays, there are, surprisingly, many opportunities for research in the field of radiology, and these are accessible at any level. Thanks to radiological information systems and picture archiving and communication systems (PACS), a huge number of images and cases are available. Nevertheless, the daily workload and the lack of resources sometimes limit the advance of radiologic research. One of the routes of access is doctoral programs. The Bologna process has resulted in significant changes in the organization and in the prerequisites for doctoral theses. The new situation can be confusing for those who are further removed from the university. Given that many radiologists undertake their doctoral theses once their careers are well established, unfamiliarity with the new system can represent an added difficulty. This article aims to review the basic regulations that govern doctoral programs nowadays and to provide some useful advice for potential doctoral students., (Copyright © 2020 SERAM. Publicado por Elsevier España, S.L.U. All rights reserved.)

Background: Time management practice can facilitate productivity and success, contributing to work effectiveness, maintaining balance and job satisfaction. Thus, this study aimed to assess time management practices and associated factors among employees of primary hospitals in north Gondar., Methods: An Institutional based cross-sectional study among primary hospital employees in north Gondar was conducted from March to April 2018. A structured and pre-tested questionnaire was used to collect the data. Simple random sampling technique was utilized to select 422 employees. Bivariate and multivariate logistic regression model were done to identify factors associated with time management practice. Adjusted odds ratio (AOR) with a 95% confidence interval (CI) was ascertained to show the strength and direction of association., Result: In this study, the prevalence of time management practice was 56.4% (95%CI: 49.3, 61.7). Being satisfied with organizational policies (AOR = 2.16; 95%CI: 1.02-4.68), performance appraisals (AOR: 2.11; 95%CI: 1.32-4.66), compensation and benefits (AOR: 4.18; 95%CI: 2.18-7.99), and planning (AOR: 2.86; 95% CI: 1.42-5.75) were statistically significant factors associated with time management practice., Conclusion and Recommendation: The overall time management practice among the primary hospital employees was low. Planning, organizational policy, compensation and benefit, performance appraisal, and residence were factors significantly associated with hospital employee's time management practice. Thus managers and employees need to carry out interventions on significant factors to improve the employees' time management practice., Competing Interests: The authors have declared that no competing interests exist.

Objectives: Work-time control is associated with lower sickness absence rates, but it remains unclear whether this association differs by type of diagnosis and sub-dimension of work-time control (control over daily hours and control over time off) and whether certain vulnerable groups benefit more from higher levels of work-time control., Methods: Survey data from the Finnish 10-town study in 2004 were used to examine if baseline levels of work-time control were associated with register data on diagnose-specific sickness absence for 7 consecutive years (n = 22 599). Cox proportional hazard models were conducted, adjusted for age, sex, education, occupational status, shift work including nights, and physical/mental workload., Results: During follow-up, 2,818 individuals were on sick leave (≥10 days) due to musculoskeletal disorders and 1724 due to mental disorders. Employees with high (HR = 0.80, 95% CI 0.74-0.87; HR = 0.76, 95% CI 0.70-0.82, respectively) and moderate (HR = 0.83, 95% CI 0.77-0.90; HR = 0.85, 95% CI 0.79-0.91, respectively) levels of control over daily hours/control over time off had a decreased risk of sickness absence due to musculoskeletal disorders. Sub-group analyses revealed that especially workers who were older benefitted the most from higher levels of work-time control. Neither sub-dimension of work-time control was related to sickness absence due to mental disorders., Conclusions: Over a 7-year period of follow-up, high and moderate levels of work-time control were related to lower rates of sickness absence due to musculoskeletal disorders, but not due to mental disorders., (© 2020 The Authors. Journal of Occupational Health published by John Wiley & Sons Australia, Ltd on behalf of The Japan Society for Occupational Health.)

Adrian Nelson-Pratt explains how an understanding of the way in which you are spending your time makes it possible to claw back wasted hours and secure a better balance in your life., (British Veterinary Association.)

Aim: To assess whether elderly patients are prioritized under the emergency triage system in Guangzhou, China., Methods: This was a cross-sectional survey of clinical data from adult visitors to the emergency department of the Third Affiliated Hospital of Sun Yat-sen University between 1 August 2015 and 31 December 2017. The primary end-point was receiving the first medical service within the target waiting time, which varied according to the triage level of the patient. Multivariate logistic regression was used to determine whether age was an independent predictor of a shorter waiting time., Results: Data from 262 282 emergency patients were analyzed. The mean age of patients was 35.97 years, and 7.5% were aged ≥65 years. In total, 88.3% of patients received medical service within the target waiting time, and 87.4% of elderly patients received medical service within the target waiting time. Multivariate logistic regression analysis showed that advanced age was independently associated with receiving medical service within the target waiting time (adjusted odds ratio 1.258, 95% confidence interval 1.198-1.321; P < 0.001). The triage level, type of emergency subdivision, availability of outpatient services and time of day were also associated with receiving medical service within the target waiting time., Conclusion: Under the emergency triage system of the hospital, older adults are more likely to receive medical service within the target waiting time than younger patients. Geriatr Gerontol Int 2019; 19: 786-791., (© 2019 Japan Geriatrics Society.)

Objective: To evaluate the implementation of an intensive care unit (ICU) intervention designed to establish rules for making ICU decisions about postsurgery beds., Design: Preintervention/postintervention case study using a multimethod approach, involving two phases of staff interviews, process mapping and collection of administrative data., Setting: ICU in a 700-bed regional tertiary care hospital in Australia., Participants: 31 interview participants. Phases 1 and 2 participants drawn from three groups of staff: bedside nursing staff in the ICU, ICU specialist doctors and senior management staff involved in oversight of ICU operations. Phase 2 included an additional participant group: staff from surgery and emergency departments., Intervention: Implementation of an ICU escalation plan and introduction of a multidisciplinary morning meeting to determine ICU bed status in accordance with the plan., Main Outcome Measures: Interview data consisted of preintervention staff perceptions of ICU workplace cohesiveness with bed pressure, and postintervention staff perceptions of the escalation plan and ICU performance. Administrative data consisted of bed status (red, amber or green), monthly number of planned elective surgeries requiring an ICU bed and monthly number of elective surgeries cancelled due to unavailability of ICU beds., Results: Improved internal communication, decision making and cohesion within the ICU and better coordination between ICU and other hospital departments. Significant reduction in elective surgeries cancelled due to unavailability of ICU beds, χ 2 1 =24.9, p<0.0001., Conclusions: By establishing rules for decision making around ICU bed allocation, the intervention improved internal professional relationships within the ICU as well as between the ICU and external departments and reduced the number of elective surgeries cancelled., Competing Interests: Competing interests: PL, SS and AJ were involved in development of the intervention; however, they were not interviewed as part of the study and were not involved in data collection or analysis. The authors have no other competing interests to declare., (© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Operating room (OR) metrics are frequently cited when optimizing cost efficacy and quality of care (Weiss et al, Characteristics of operating room procedures in U.S. hospitals, 2011: Statistical brief #170, 2013; Macario A, Anesthesiology 105:237-240, 2006; Childers et al, JAMA Surg 153:e176233, 2018). Little has been reported to evaluate how anesthesia trainees change anesthesia-related efficiencies in the OR. Statistical correlation may demonstrate awareness and implementation of efficient systems-based practice., Methods: Utilizing computerized OR information systems, specific data regarding anesthesia controlled turnover times were collected (546 data points) over the course of 4 months. The type of surgery performed, patient's American Society of Anesthesiologists (ASA) physical status and OR turnover times were compared for clinical anesthesia (CA) trainee levels CA1, CA2, CA3 and CRNAs. Standard descriptive statistics were computed. Analysis of variance (ANOVA) was performed to compare the average turnover time., Results: Average OR turnover time was 31 min ranging from 8 to 60 min. There was a significant difference between the OR turnover time of CA-1 (32 min) compared to CA-3 (29 min) (p = 0.017) and CA-1 compared to CRNA (30 min) (p = 0.016). OR turnover time was significantly shorter in CA-3 and CRNA. The analysis showed no differences between OR turnover time of ASA categories., Conclusions: These findings posit that trainees improve efficiency over time, but that education may for a time come at the expense of productivity. This trend may demonstrate a more profound understanding and mastery of a learner progressing in the graduate medical education system. This interplay plays a key role in clinical and academic shared success.

Objective: To evaluate the indicators duration of anesthesia, operative time and time patients stay in the operating rooms of different surgical specialties at a public university hospital., Methods: It was done by a descriptive cross-sectional study based on the operating room database. The following stages were measured: duration of anesthesia, procedure time and patient length of stay in the room of the various specialties. We included surgeries carried out in sequence in the same room, between 7:00 a.m. and 5 p.m., either elective or emergency. We calculated the 80th percentile of the stages, where 80% of procedures were below this value., Results: The study measured 8,337 operations of 12 surgical specialties performed within one year. The overall mean duration of anesthesia of all specialties was 178.12±110.46 minutes, and the 80th percentile was 252 minutes. The mean operative time was 130.45±97.23 minutes, and the 80th percentile was 195 minutes. The mean total time of the patient in the operating room was 197.30±113.71 minutes, and the 80th percentile was 285 minutes. Thus, the variation of the overall mean compared to the 80th percentile was 41% for anesthesia, 49% for surgeries and 44% for operating room time. In average, anesthesia took up 88% of the operating room period, and surgery, 61%., Conclusion: This study identified patterns in the duration of surgery stages. The mean values of the specialties can assist with operating room planning and reduce delays., Objetivo: Avaliar os indicadores de tempo da anestesia, da operação e da permanência do paciente em sala de diversas especialidades do centro cirúrgico de um hospital universitário., Métodos: Foi realizado em estudo descritivo transversal a partir da base de dados do centro cirúrgico e mensuradas as seguintes etapas: duração de anestesia, tempo do procedimento e tempo de permanência do paciente em sala das diversas especialidades. Foram incluídas as operações realizadas em sequência na mesma sala, das 7h às 17h, eletivas ou de urgências. Realizamos o calculo do percentil 80 da duração das etapas, onde 80% dos procedimentos ficaram abaixo deste valor obtido., Resultados: O estudo incluiu 8.337 operações realizadas no período de 1 ano de 12 especialidades cirúrgicas. A média geral da duração da anestesia de todas as especialidades foi de 178,12±110,46 minutos, e o percentil 80 foi de 252 minutos. A média do tempo operatório foi 130,45±97,23 minutos, e o percentil 80 foi de 195 minutos. A média do tempo total do paciente em sala operatória foi de 197,30±113,71 minutos, e o percentil 80 foi de 285 minutos. A variação da média geral em relação ao percentil 80 foi de 41% na anestesia, 49% nas operações e 44% no tempo de sala. Na média geral, a anestesia ocupou 88% do tempo de sala e a operação, 61%., Conclusão: Este estudo identificou padrões nas durações das etapas das operações. A informação das médias históricas das especialidades pode auxiliar no planejamento do centro cirúrgico e diminuir os atrasos.

Objective: The aim of this study is to increase nurses' time for direct patient care and improve safety via a novel human factors framework for nursing worksystem improvement., Background: Time available for direct patient care influences outcomes, yet worksystem barriers prevent nurses adequate time at the bedside., Methods: A novel human factors framework was developed for worksystem improvement in 3 units at 2 facilities. Objectives included improving nurse efficiency as measured by time-and-motion studies, reducing missing medications and subsequent trips to medication rooms and improving medication safety., Results: Worksystem improvement resulted in time savings of 16% to 32% per nurse per 12-hour shift. Requests for missing medications dropped from 3.2 to 1.3 per day. Nurse medication room trips were reduced by 30% and nurse-reported medication errors fell from a range of 1.2 to 0.8 and 6.3 to 4.0 per month., Conclusions: An innovative human factors framework for nursing worksystem improvement provided practical and high priority targets for interventions that significantly improved the nursing worksystem.

Background: Acute limb ischemia (ALI) continues to pose a significant challenge to clinicians and is associated with an unacceptably high rate of morbidity and mortality. Despite its time critical nature, little is known regarding the delays encountered during the patient pathway. The aim of this study was to identify sources of delay in the patient pathway at our institution., Methods: Sixty-seven cases of ALI of the lower extremities from 66 patients, who had presented to our center between May 2003 and April 2014, were identified for retrospective analysis. Data were retrieved from the patient records, discharge summaries and hospital laboratory, emergency department and radiology databases., Results: Median time from onset of symptom to arrival at our institution was 11.35 hr (interquartile range [IQR] 6.27-72). Median cumulative time taken from arrival to vascular team review was 40 min (22.5-120), to imaging being performed was 4.75 hr (2.42-17.25), and to intervention being performed was 10.2 hr (4-31). There were significantly longer delays to presentation in those transferred from inpatient beds as compared with those transferred from the emergency department of other hospitals (66 hr [10.3-98] vs. 8 hr [5.6-14.9], P = 0.007). In total, 84.6% of patients underwent preoperative arterial imaging. Time taken from arrival to diagnostic arterial imaging was significantly longer in patients presenting out-of-ours (15 hr [6.5-20.75]) as compared with patients presenting in-hours (3.5 hr [2-6.5], P = 0.014) or during the weekend (2 hr [2-3], P = 0.022). Time from presentation to intervention was significantly shorter in patients presenting over the weekend (3.9 hr [2.6-5.1]) as compared with those presenting in-hours (14.2 hr [6.2-29], P = 0.006) and out-of-hours (16 hr [10-33], P = 0.021). Out-of-hours, a significant portion of the delay, was attributable to imaging (median time to imaging 15 hr)., Conclusions: This study demonstrates the systematic nature of delays in the patient pathway from onset of symptoms to treatment. Several factors including time to patient presentation and time to imaging and delays in timely transfer to an appropriate facility contribute to this. Strategies need to be deployed to reduce time to revascularization., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Background: The purpose of this study was to determine the factors that affect hand surgeon operating room (OR) turnover time. We hypothesized that surgeon presence in the OR, decreased American Society of Anesthesiologists (ASA) class, smaller case type, and earlier case time, as well as other factors, decreased OR turnover time. Methods: A total of 685 hand surgery cases performed by 5 attending hand surgeons between September 2013 and December 2014 were identified. Turnover time, patient comorbidities (ASA class), surgeon, prior OR surgical procedure, current OR surgical procedure, location of the surgery (ambulatory surgical center [ASC] vs orthopedic specialty hospital [OSH]), time of surgery, and order of OR cases were recorded. The effect of surgeon routine variables, OR case factors, and patient health status on OR turnover was analyzed. Results: Turnover time was significantly shorter in cases where the surgeon remained in the OR during turnover (27.5 minutes vs 30.4 minutes) and when the surgeon incentivized OR staff (24 minutes vs 29 minutes). The ASC was found to have shorter turnover times than the OSH (27.9 minutes vs 36.4 minutes). In addition, ASA class, type of prior OR procedure, type of current OR procedure, and case order all significantly affected turnover time. Comparison of OR turnover time among the 5 surgeons revealed a statistically significant difference at the OSH but not at the ASC. Conclusion: OR turnover time is significantly affected by surgeon routine, location of surgery, patient ASA class, procedure type, and case order. Interestingly, the effect of hand surgeon routine on OR turnover time may be amplified at an academic OSH versus an ASC., Competing Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: The non-operative time during the process of patient change-over between operating theatre cases is a significant source of delay and overall theatre inefficiency. The aim of this study was to integrate and trial a working strategy to improve this change-over time., Method: This was a single-blinded, randomised controlled intervention study comparing a surgeon-led, team-based model of strategies versus routine patient change-over. This model was trialled by a single surgeon, and the primary outcome was the difference in change-over times compared with 4 other surgeons who were blinded and served as controls. Secondary outcome measures included overall differences in complications between the groups, and the number and differences in operative case cancellations due to inadequate theatre time., Results: 1265 patients were randomised into 5 general surgical lists, and included all major and minor cases. Median number of operative cases were 214 per surgeon, with an overall median change over time of 17.9 ± 3.7 min. Surgeon A in the intervention group had a median change-over time of 12.1 ± 5.4 min (p < 0.001), with a median difference of 8.5 min ± 21.4 min (p < 0.0001), translating to a 58% reduction in median change-over time between the intervention and control groups. There were no differences in complication rates amongst the groups. The intervention group had no cancellations due to lack of time, compared with 37 cancellations in the control group., Conclusion: This study demonstrates a statistically significant improvement in median change-over times using this model. This re-design can be implemented without incurring extra costs, staff, or operating theatres., (Copyright © 2016 IJS Publishing Group Ltd. All rights reserved.)

We used electronic medical record (EMR) analysis to determine errors in operating room (OR) time utilisation. Over a two year period EMR data of 44,503 surgical procedures was analysed for OR duration, on-time, first case, and add-on time performance, within 19 surgical specialties. Maximal OR time utilisation at our institution could have saved over 302,620 min or 5,044 hours of OR efficiency over a two year period. Most specialties (78.95%) had inaccurately scheduled procedure times and therefore used the OR more than their scheduled allotment time. Significant differences occurred between the mean scheduled surgical durations (101.38 ± 87.11 min) and actual durations (108.18 ± 102.27 min; P < 0.001). Significant differences also occurred between the mean scheduled add-on durations (111.4 ± 75.5 min) and the actual add-on scheduled durations (118.6 ± 90.1 minutes; P < 0.001). EMR quality improvement analysis can be used to determine scheduling error and bias, in order to improve efficiency and increase OR time utilisation.

Background: Although much attention has been paid to the role of deliberate practice as a means of achieving expert levels of performance in other medical specialties, little has been published regarding its role in maximizing orthopaedic surgery resident potential. As an initial step in this process, this study seeks to determine how residents and program directors (PDs) feel current time spent in training is allocated compared with a theoretical ideal distribution of time., Questions/purposes: According to residents and PDs, (1) how do resident responsibilities change by level of training as perceived and idealized by residents and PDs? (2) How do resident and PD perceptions of current and ideal time distributions compare with one another? (3) Do the current training structures described by residents and PDs differ from what they feel represents an ideal time allocation construct that maximizes the educational value of residency training?, Methods: A survey was sent to orthopaedic surgery resident and PD members of the Midwest Orthopedic Surgical Skills Consortium asking how they felt residents' time spent in training was distributed across 10 domains and four operating room (OR) roles and what they felt would be an ideal distribution of that time. Responses were compared between residents and PDs and between current schedules and ideal schedules., Results: Both residents and PDs agreed that time currently spent in training differs by postgraduate year with senior-level residents spending more time in the OR (33.7% ± 8.3% versus 17.9% ± 6.2% [interns] and 27.4% ± 10.2% [juniors] according to residents, p < 0.001; and 38.6% ± 8.1% versus 11.8% ± 6.4% [interns] and 26.1% ± 5.7% [juniors] according to PD, p < 0.001). The same holds true for their theoretical ideals. Residents and PDs agree on current resident time allocation across the 10 domains; however, they disagree on multiple components of the ideal program with residents desiring more time spent in the OR than what PDs prefer (residents 40.3% ± 10.3% versus PD 32.6% ± 14.6% [mean difference {MD}, 7.7; 95% confidence interval {CI}, 4.4, 11.0], p < 0.001). Residents would also prefer to have more time spent deliberately practicing surgical skills outside of the OR (current 1.8% ± 2.1% versus ideal 3.7% ± 3.2% [MD, -1.9; 95% CI, -.2.4 to -1.4], p < 0.001). Both residents and PDs want residents to spend less time completing paperwork (current 4.4% ± 4.1% versus ideal 0.8% ± 1.6% [MD, 3.6; 95% CI, 3.0-4.2], p < 0.001 for residents; and current 3.6% ± 4.1% versus ideal 1.5% ± 1.9% [MD, 2.1; 95% CI, 0.9-3.3], p < 0.001 for PDs)., Conclusions: Residents and PDs seem to agree on how time is currently spent in residency training. Some differences of opinions continue to exist regarding how an ideal program should be structured; however, this work identifies a few potential targets for improvement that are agreed on by both residents and PDs. These areas include increasing OR time, finding opportunities for deliberate practice of surgical skills outside of the OR, and decreased clerical burden. This study may serve as a template to allow programs to continue to refine their educational models in an effort to achieve curricula that meet the desired goals of both learners and educators. Additionally, it is an initial step toward more objective identification of the optimal educational structure of an orthopaedic residency program.

The American Association of Critical-Care Nurses (AACN) developed the Clinical Scene Investigator (CSI) Academy for nurses at the bedside to hone leadership and innovation skills to create and sustain lasting change and improve patient outcomes. In this first part of a three-part series, we take a look at how the AACN CSI Academy helps clinical nurses cultivate skills that measurably demonstrate how "nonproductive time" is a misnomer that interferes with achieving optimal patient outcomes.

Clinical Issue and Diagnostic Standards: The management of acute stroke patients suffers from several major problems in the daily clinical routine. In order to achieve optimal treatment a complex diagnostic work-up and rapid initiation of therapy are necessary; however, most patients arrive at hospital too late for any type of acute stroke treatment, although all forms of treatment are highly time-dependent according to the generally accepted "time is brain" concept., Diagnostic Innovations: Recently, two randomized clinical trials demonstrated the feasibility of prehospital stroke diagnostic work-up and treatment. This was accomplished by use of a specialized ambulance, equipped with computed tomography for multimodal imaging and a point-of-care laboratory system., Performance: In both trials the results demonstrated a clear superiority of the prehospital treatment group with a significant reduction of treatment times, significantly increased number of patients treated within the first 60 min after symptom onset and an optimized triage to the correct target hospital., Achievements and Practical Recommendations: Currently, mobile stroke units are in operation in various countries and should lead to an improvement in stroke treatment; nevertheless, intensive research is still needed to analyze the best framework settings for prehospital stroke management.

Background: Mechanical recanalization of proximal arteries of the cerebral arterial circle with stent retrievers provides new therapeutic options for patients with ischemic stroke, in addition to the established method of intravenous (i. v.) thrombolysis; however, as with thrombolysis, the success of these measures is time-dependent. A variety of factors can delay the onset of adequate therapy and thus lead to impaired functional outcome., Objectives: A review of the current literature on time management in the prehospital and in-hospital phases was carried out and the most important practice-relevant measures for a rapid onset of therapy are presented., Material and Methods: A PubMed search and presentation of representative articles on the topic of time management in the therapy of acute ischemic stroke., Results: After alerting emergency medical rescue services, professional assistants have an influence on the optimization of therapy times. Useful steps are advance notification of the hospital for admission by the emergency services, a stroke team that collects the patient directly on arrival at hospital, transfer to a reserved computed tomography (CT) or magnetic resonance imaging (MRI) scanner, a point-of-care laboratory, close proximity to an angiography suite for CT/MRI and clearly formulated standard procedures for anesthesia., Discussion: Measures to optimize therapy times are mostly organizational and cause little or no extra costs. When implemented these measures can lead to a significant improvement in therapy times and functional patient outcome.

Objective: To assess the operative time indicators in a public university hospital., Methods: A descriptive cross-sectional study was conducted using data from operating room database. The sample was obtained from January 2011 to January 2012. The operations performed in sequence in the same operating room, between 7:00 am and 5:00 pm, elective or emergency, were included. The procedures with incomplete data in the system were excluded, as well as the operations performed after 5:00 pm or on weekends or holidays., Results: We measured the operative and non-operative time of 8,420 operations. The operative time (mean and standard deviation) of anesthesias and operations were 177.6 ± 110 and 129.8 ± 97.1 minutes, respectively. The total time of the patient in operative room (mean and standard deviation) was 196.8 ± 113.2. The non-operative time, e.g., between the arrival of the patient and the onset of anesthesia was 14.3 ± 17.3 minutes. The time to set the next patient in operating room was 119.8 ± 79.6 minutes. Our total non-operative time was 155 minutes., Conclusion: Delays frequently occurred in our operating room and had a major effect on patient flow and resource utilization. The non-operative time was longer than the operative time. It is possible to increase the operating room capacity by management and training of the professionals involved. The indicators provided a tool to improve operating room efficiency.

Background: Knowledge about the utilization of the operation theater (OT) is essential to improve its efficiency. This study evaluated the neurosurgical operation theater utilization in a neurosciences teaching hospital., Methods: Data collected included OT start time, delay in start, anesthesia induction time, surgical preparation time, anesthesia recovery time, operating time, time between cases, and theater closing time., Results: Five hundred thirty-seven surgeries were performed during the study period. The percentage of time used for anesthesia induction, actual surgical procedure, recovery from anesthesia, and theater preparation between the two cases were 8%, 70%, 6% and 5%, respectively. Fourteen percent of scheduled cases were cancelled. On 220 occasions (70.51%), theater was over-run. Late start contributed to loss of 8370 minutes (140 hours) of theater time., Conclusions: This study identified the proportion of time spent on each activity in the neurosurgical OT. This knowledge is likely to facilitate better planning of neurosurgical theater schedule and result in optimal utilization., (Copyright © 2015 Elsevier Inc. All rights reserved.)

The American Association of Critical-Care Nurses (AACN) developed the Clinical Scene Investigator (CSI) Academy for nurses at the bedside to hone leadership and innovation skills to create and sustain lasting change and improve positive patient outcomes. In this first part of a three-part series, we take a look at how the AACN CSI Academy helps clinical nurses cultivate skills that measurably demonstrate how nonproductive time is a misnomer that interferes with achieving optimal patient outcomes.

Purpose: To explore the relationship between clinical faculty members' time/effort in four mission areas, their assessment of the distribution of that time/effort, and their intent to leave the institution and academic medicine., Method: Faculty from 14 U.S. medical schools participated in the 2011-2012 Faculty Forward Engagement Survey. The authors conducted multivariate logistic regression analyses to evaluate relationships between clinical faculty members' self-reported time/effort in each mission area, assessment of time/effort, and intent to leave the institution and academic medicine., Results: Of the 13,722 clinical faculty surveyed, 8,349 (60.8%) responded. Respondents reported an average of 54.5% time/effort in patient care. The authors found no relationship between time/effort in patient care and intent to leave one's institution. Respondents who described spending "far too much/too much" time in patient care were more likely to report intent to leave their institution (odds ratio 2.12, P<.001). Those who assessed their time/effort in all mission areas as "about right" were less likely to report intent to leave their institution (64/1,135; 5.6%) than those who reported "far too little/too little" or "far too much/too much" time/effort in one or more mission areas (535/3,671; 14.6%; P<.001)., Conclusions: Although the authors found no relationship between reported time/effort in patient care and intent to leave, the perception of "far too much/too much" time/effort spent in that mission area was correlated with intent to leave the institution. Efforts to align time/effort spent in each mission area with faculty expectations may improve retention.

Purpose: This study aims to asses a cancer fast-track programme (CFP) to shorten the time since a patient with suspicion of cancer is referred by the primary care (PC) physician to the specialized medical team., Methods: Guidelines for main suspected tumours were designed to help PC physicians to detect and rapidly refer cases to the CFP oncology coordinator, who sent them to the appropriate department to accelerate diagnosis, staging and therapy. All patients analysed in this report were referred from June 2009 to July 2012., Results: A total of 897 suspected cancer cases were submitted and finally 705 were studied. In 205 (29 %) a cancer diagnosis was confirmed within 23 days (median). Therapy was initiated within 46 days after referral (median). Early diagnoses with a potential curative approach were made in 166 (82 %)., Conclusions: This CFP decreased the waiting time for cancer diagnosis, by improving communication between PC physician and specialized care teams. Most patients included in this program could get therapy with curative intent.

Current self-quantification systems (SQS) are limited in their ability to support the acquisition of health-related information essential for individuals to make informed decisions based on their health status. They do not offer services such as data handling and data aggregation in a single place, and using multiple types of tools for this purpose complicates data and health self-management for self-quantifiers. An online survey was used to elicit information from self-quantifiers about the methods they used to undertake key activities related to health self-management. This paper provides empirical evidence about self-quantifiers' time spent using different data collection, data handling, data analysis, and data sharing tools and draws implications for health self-management activities.

Current surgical scheduling system has difficulties to handle unpredictable events or uncertainties. Source of uncertainties may come from the patient or the surgery itself, where several cases require immediate changes in data, such as when surgery delays or cancellation occurs on the same day. The study aimed to model the uncertainties for managing identified uncertainties during the continuous scheduling, framed by resilience concept to cope with the system fragility. In order to be able to control and adjust any changes which may affect the surgery schedule of the day, we provide alternatives of solution rather than strictly decide the best valued options. We identified dimensions of uncertainties and categorized them based on the resilience concept, computed the impact value of potentially conflicted resources as a result of schedule change. With the model applied, we would provide a list of most acceptable and less vulnerable alternatives for anesthesiologist as a scheduler to build resilience in the surgical scheduling.

Background: Many patients will require extrication following a motor vehicle collision (MVC). Little information exists on the time taken for the various stages of extrication., Objective: To report the time taken for the various stages of extrication., Methods: A prospective, observational study carried out in the West Midland Fire Service's metropolitan area. Time points related to extrication were collected 'live' by two-way radio broadcast. Any missing data were actively gathered by fire control within 1 h of completion of extrication. This paper reports an interim analysis conducted after 1 year of data collection following a 3-month run-in and training period: data were analysed from 1 January 2011 to 31 December 2011 inclusive., Results: During the study period 228 incidents were identified. Seventy-nine were excluded as they met the predetermined exclusion criteria or had incomplete data collection. This left 158 extrications that were suitable for analysis. The median time for extrication was 30 min, IQR 24-38 min., Conclusions: In patients requiring extrication following an MVC a median time of 8 min is typically required before initial limited patient assessment and intervention. A further 22 min is typically required before full extrication. Prehospital personnel should be aware of these times when planning their approach to a trapped patient., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.)

Operating room (OR) turnover time (TT) has a broad and significant impact on hospital administrators, providers, staff and patients. Our objective was to identify current problems in TT management and implement a consistent, reproducible process to reduce average TT and process variability. Initial observations of TT were made to document the existing process at a 511 bed, 24 OR, academic medical center. Three control groups, including one consisting of Orthopedic and Vascular Surgery, were used to limit potential confounders such as case acuity/duration and equipment needs. A redesigned process based on observed issues, focusing on a horizontally structured, systems-based approach has three major interventions: developing consistent criteria for OR readiness, utilizing parallel processing for patient and room readiness, and enhancing perioperative communication. Process redesign was implemented in Orthopedics and Vascular Surgery. Comparisons of mean and standard deviation of TT were made using an independent 2-tailed t-test. Using all surgical specialties as controls (n = 237), mean TT (hh:mm:ss) was reduced by 0:20:48 min (95 % CI, 0:10:46-0:30:50), from 0:44:23 to 0:23:25, a 46.9 % reduction. Standard deviation of TT was reduced by 0:10:32 min, from 0:16:24 to 0:05:52 and frequency of TT≥30 min was reduced from 72.5to 11.7 %. P < 0.001 for each. Using Vascular and Orthopedic surgical specialties as controls (n = 13), mean TT was reduced by 0:15:16 min (95 % CI, 0:07:18-0:23:14), from 0:38:51 to 0:23:35, a 39.4 % reduction. Standard deviation of TT reduced by 0:08:47, from 0:14:39 to 0:05:52 and frequency of TT≥30 min reduced from 69.2 to 11.7 %. P < 0.001 for each. Reductions in mean TT present major efficiency, quality improvement, and cost-reduction opportunities. An OR redesign process focusing on parallel processing and enhanced communication resulted in greater than 35 % reduction in TT. A systems-based focus should drive OR TT design.

Background: Timely stocking of essential supplies in an emergency department (ED) is crucial to efficient and effective patient care., Objective: The objective of this study was to decrease wasted nursing time in obtaining needed supplies in an ED through the use of Lean process controls., Methods: As part of a Lean project, the team conducted a "before and after" prospective observation study of ED nurses seeking supplies. Nurses were observed for an entire shift for the time spent outside the patient room obtaining supplies at baseline and after implementation of a point-of-use storage system., Results: Before implementation, nurses were leaving patient rooms a median of 11 times per 8-hour shift (interquartile range [IQR], 8 times per 8-hour shift) and 10 times per 12-hour shift (IQR, 23 times per 12-hour shift). After implementation of the new system, the numbers decreased to 2.5 per 8-hour shift (IQR, 2 per 8-hour shift) and 1 per 12-hour shift (IQR, 1 per 12-hour shift)., Conclusion: A redesigned process including a standardized stocking system significantly decreases the number of searches by nurses for supplies.

Rationale and Objectives: Physician staff of academic hospitals today practice in several geographic locations including their main hospital. This is referred to as the extended campus. With extended campuses expanding, the growing complexity of a single division's schedule means that a naive approach to scheduling compromises revenue. Moreover, it may provide an unfair allocation of individual revenue, desirable or burdensome assignments, and the extent to which the preferences of each individual are met. This has adverse consequences on incentivization and employee satisfaction and is simply against business policy., Materials and Methods: We identify the daily scheduling of physicians in this context as an operational problem that incorporates scheduling, revenue management, and fairness. Noting previous success of operations research and optimization in each of these disciplines, we propose a simple unified optimization formulation of this scheduling problem using mixed-integer optimization., Results: Through a study of implementing the approach at the Division of Angiography and Interventional Radiology at the Brigham and Women's Hospital, which is directed by one of the authors, we exemplify the flexibility of the model to adapt to specific applications, the tractability of solving the model in practical settings, and the significant impact of the approach, most notably in increasing revenue by 8.2% over previous operating revenue while adhering strictly to a codified fairness and objectivity., Conclusions: We found that the investment in implementing such a system is far outweighed by the large potential revenue increase and the other benefits outlined., (Copyright © 2014 AUR. Published by Elsevier Inc. All rights reserved.)

Objective: Chronic disease is the main epidemic of the 21st century. It takes up a large part of the social-health budgets that are dedicated to its care. The aim of this study is to analyze if the welfare quality in the management of the chronic patients improves by implementing non-contact care time., Material and Methods: Intervention study conducted in the health care center of Orcasitas (January 2012 - September 2013) in patients with hypertension (357), diabetes (180) and/or ischemic heart disease (60). Health care quality was analyzed through the effectiveness in the program, Tracking Objectives in Primary Care. The intervention group had four physical 10minute consultations/year and three non-physical 10minute consultations/year. The patients in the control group were seen as usual. The data were compared using the McNemar test, chi-square and Cochran's Q test., Results: In the intervention group, the effectiveness increased in the analyzed period by 46%, 54% and 55.9%, respectively, for processes of hypertension, diabetes and dyslipidemia control in ischemic heart disease, whereas in the control group (community of Madrid) it was 2.54%, 1.78%, and 5.44%, respectively, for these processes (statistically significant differences [χ(2)=24.78; χ(2)=39.9 y χ(2)=67.3, P<.0001])., Conclusions: Thirty minutes/year of non-presential care represents a significant change in the level of control of chronic patients. These results should be considered in the approach strategies to chronic diseases., (Copyright © 2014 SECA. Published by Elsevier Espana. All rights reserved.)

Procrastination is a widespread phenomenon that affects everyone's day-to-day life and interferes with the clinical treatment of several psychopathological states. To assess this construct, Steel (2010) developed the Pure Procrastination Scale (PPS), a short scale intended to capture the general notion of dysfunctional delay. The aim of the current study was to present a French version of this questionnaire. To this end, the 12 items of the PPS were translated into French and data were collected from an online survey in a sample of 245 French-speaking individuals from the general population. The results revealed that one item had problematic face validity; it was therefore removed. Exploratory and confirmatory analyses performed on the resulting 11-item version of the French PPS indicated that the scale was composed of two factors ("voluntary delay" and "observed delay") depending on a common, higher-order construct ("general procrastination"). Good internal consistency and test-retest reliability were found. External validity was supported by specific relationships with measures of personality traits, impulsivity, and subjective well-being. The French PPS therefore presents satisfactory psychometric properties and may be considered a reliable and valid instrument for research, teaching and clinical practice., (Copyright © 2014 Elsevier Inc. All rights reserved.)