Prep Time Research Articles

Information Communication Technology & Students’ Discipline

Discipline management is critically important in learning institutions; hence the research article seeks to assess the influence of Information Communication Technology (hereafter, ICT) in enhancing students’ discipline management in Nyandarua North sub-county. Four objectives guided the research study: to establish the influence of ICT on students’ attendance discipline, prep time discipline, students’ class properties discipline and students’ examination discipline. It is anchored on behavioral theory, as guided by Kounin’s model of 1976 ‘with-it-ness,’ which describes the teacher’s alertness on the class ongoing at all times; and Epstein’s theory of 1991 - on overlapping sphere of influence, and which distinguishes an interdependent view of school-family-community influences - from what could be considered as a separate view of influence. The conceptual framework shows application of ICT indicators and the discipline managed, and the intervening variables. The research article employed a mixed method approach. The data was analyzed using thematic analysis techniques and its findings are presented analytically. School principals who had integrated ICT were key targets of the research; and a sample of ten schools was purposefully selected. Its finding is that ICT integration influenced discipline management positively in Nyandarua North Sub-County. The study recommends a further study to be carried out by using inferential statistics.

PO-01-051 EARLY PHYSICIAN ARRIVAL TO ELECTROPHYSIOLOGY LABORATORY INCREASES LAB EFFICIENCY BY DECREASING PREPARATION TIME

Many cardiac arrhythmia patients benefit from interventions performed in the electrophysiology (EP) lab. EP labs are a valuable resource that if not used efficiently may lead to delay in patient care, increased cost to the medical system, and challenges with recruiting and retaining staff. Prep time is defined as the time from when a patient (pt) enters a procedural room until the procedure start. Prep time is affected by many factors, including but not limited to: pt factors, staffing ratios, sedation plan, need for invasive hemodynamic monitoring, and complexity of procedure (proc). Physician arrival to the EP lab is an important component of prep time. To determine if earlier physician arrival to the EP lab shortens prep time. Pt and physician in-room times, proc start times, and proc characteristics were recorded over a 5 month period from 5/22 through 8/22. Quantitative data was divided into subgroups based on proc type – ablation (abl) or device. Means and standard deviation of physician arrival time and proc start time were calculated. A scatter plot of proc start time compared to physician arrival was created and a best-fit polynomial regression was performed (Fig 1). Point of maximum correlation (PMC) was calculated using Pearson’s method and linear regression was applied from that point onward. Cases that were understaffed and VT ablation were highlighted. Of 539 cases, 235 (44%) were device implants and 304 (56%) were abl. The difference between the earliest average physician arrival time compared to the latest average physician arrival time was 17min for device and 16 min for abl. Prep time was 15 minutes shorter for the earliest arriving physician for device, and 28 min shorter for abl. The PMC for abl and device implants were 25mins and 30mins respectively. Every minute of delay after the PMC was directly related to the MD not being present in the lab. For the interval prior to the PMC, there are many factors causing delays in the lab, leading to questionable direct correlation between MD arrival and prep time. The minimum prep time for both abl and implants appears to be 20 mins in this lab with the current staffing and culture. Earlier MD in room times increase lab efficiency by reducing procedure start times.Tabled 1Mean in Room Times to Access (min) +/-SDAblationDevice ImplantMean Pt Room to EP RoomMean Pt Room to AccessMean Pt Room to EP RoomMean Pt Rm to AccessEP115+/-1347+/-1111+/-1246+/-10EP211+/-942+/-1011+/-942+/-10EP318+/-850+/-1213+/-1647+/-16EP425+/-1449+/-1126+/-2149+/-16EP524+/-1660+/-2021+/-1652+/-14EP68+/-1032+/-84+/-837+/-9EP78+/-831+/-107+/-637+/-7 Open table in a new tab

Implementation of a telehealth videoconference to improve hospital-to-skilled nursing care transitions: Preliminary data.

Transition-related patient safety errors are high among patients discharged from hospitals to skilled nursing facilities (SNFs), and interventions are needed to improve communication between hospitals and SNF providers. Our objective was to describe the implementation of a pilot telehealth videoconference program modeled after Extension for Community Health Outcomes-Care Transitions and examine patient safety errors and readmissions. A multidisciplinary telehealth videoconference program was implemented at two academic hospitals for patients discharged to participating SNFs. Process measures, patient safety errors, and hospital readmissions were evaluated retrospectively for patients discussed at weekly conferences between July 2019-January 2020. Results were mapped to the constructs of the Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) model. Descriptive statistics were reported for the conference process measures, patient and index hospitalization characteristics, and patient safety errors. The primary clinical outcome was all-cause 30-day readmissions. An intention-to-treat (ITT) analysis was conducted using logistic regression models fit to compare the probability of 30-day hospital readmission in patients discharged to participating SNFs across 7 months prior to after telehealth project implementation. There were 263 patients (67% of eligible patients) discussed during 26 telehealth videoconferences. Mean discussion time per patient was 7.7min and median prep time per patient was 24.2min for the hospital pharmacist and 10.3min for the hospital clinician. A total of 327 patient safety errors were uncovered, mostly related to communication (54%) and medications (43%). Differences in slopes (program period vs. pre-implementation) of the probability of readmission across the two time periods were not statistically significant (OR 0.95, [95% CI 0.75, 1.19]). A pilot care innovations telehealth videoconference between hospital-based and SNF provider teams was successfully implemented within a large health system and enhanced care transitions by optimizing error-prone transitions. Future work is needed to understand process flow within nursing homes and its impact on clinical outcomes.

Tolerability and Stability of Mask Fixation in Gamma Knife Stereotactic Radiosurgery: Predictors of Treatment Interruptions

Background. Frameless fixation with a thermoplastic mask is an alternative to traditional frame-based immobilization for Gamma-Knife stereotactic radiosurgery (SRS) or fractionated stereotactic radiotherapy (FSRT). However, interruptions during beam-on time can significantly prolong treatment delivery, impacting patient experience and unit workflow. Aim. We investigated clinical and technical predictors of treatment interruptions, and the phases of treatment during which interruptions are most likely to occur. Methods. Patients undergoing frameless Gamma Knife SRS or FSRT in 2020 were retrospectively reviewed. Clinical parameters were extracted from electronic medical records. Dosimetric and treatment interruption data were obtained from Gamma Knife treatment reports. Univariate and multivariate analyses analyzed technical and clinical predictors of treatment interruptions. Results. Our cohort included 84 patients receiving 141 fractions encompassing 255 lesions. 49/84 (58.3%) were female, 79/84 (94.0%) had brain metastases, 49/84 (58.3%) were taking dexamethasone and 30/84 (35.7%) used analgesics. 89/106 (84.0%) courses were single fractions. Mean planned beam-on time was 37.1 minutes (range 7.1-118.8 min) versus a total bed time of 64.9 minutes (range 15-252min) per fraction. 64.5% (91/141) of fractions were interrupted at least once; 12/141 fractions were paused 20 times or more, with a maximum 54 pauses. The mean number of pauses per quartile decreased the further the patient proceeded in beam-on time, and patients receiving first lifetime cranial radiation paused more often than during subsequent fractions. At least one pause occurred in 100% of fractions with a planned beam-on time exceeding 60 minutes. Planned beam-on time, number of gating events and high-definition motion management alarms significantly correlated with total number of pauses on multivariate analysis (all p<0.0001); these three factors, along with prep time and number of operator-initiated pauses, predicted total time on the Gamma Knife couch (all p<0.0001). Clinical factors, medication use, and prior SRS/FSRT were not predictive of pauses. Conclusions. Planned beam-on time, number of gating events and high-definition motion management alarms significantly predicted likelihood of interruptions during frameless Gamma Knife SRS/FSRT. These factors should be considered in selection of immobilization method, especially if exceeding 60 minutes.

776. Reducing Central Line Associated Bloodstream Infections (CLABSI) in a High-Risk Cohort of Patients by Standardizing Skin Preparation Prior to Pulmonary Artery Catheter Insertion

BackgroundCentral line associated bloodstream infections (CLABSI) are a recognized complication of all central venous access devices including pulmonary artery catheters (PAC). At our institution, PACs are utilized frequently, often for prolonged durations, for patients with advanced heart failure in the cardiac care unit (CCU) who are awaiting heart transplant. In early summer 2018, our hospital infection prevention (IP) department detected an uptick in CLABSI attributable to the CCU. After 9 months of zero CLABSI, two CLABSIs attributable to the CCU were identified during a 3 month period from November 2017-January 2018. Four additional CLABSIs were identified between May-July 2018 prompting an investigation by IP. Review of the 9 CLABSIs attributed to the CCU from May 2018 – June 2019 led IP to prioritize improving PAC insertion practices in our cardiac catheterization lab as a mean to reducing CLABSI (see table 1). MethodsIP performed 5 observations of PAC insertion in the cath lab. During the observations of skin preparation, the prep time was performed correctly 40% of the time, correct application 60% of the time and dry time 60% of the time (see table 2, Figure1). Interventions included scheduling a training day for all cath lab staff with the skin prep vendor, performing competency check-offs, and identifying super-users to train future staff. Furthermore, skin antiseptic utilization according the manufacturer's instructions for use was implemented, the coverage area for the applicator was reviewed and a chart for reference was provided.The staff was provided with posters on correct skin prep technique as a visual cue in the procedure room. ResultsSince the project was implemented in September 2019, there has been 1 CLABSI identified that was possibly related to a PAC inserted in the cath lab. During this time 3 CLABSIs were identified in the CCU but were felt to be unrelated to cath lab insertion. ConclusionSince the project was implemented in September 2019, there has been 1 CLABSI identified that was possibly related to a PAC inserted in the cath lab. During this time 3 CLABSIs were identified in the CCU but were felt to be unrelated to cath lab insertion.Disclosures All Authors: No reported disclosures

Pre-exposure Prophylaxis Persistence Among Greek Sexual Minority Men: Results from PrEP for Greece (P4G) Study.

Nearly half the new HIV infections in Greece occur in sexual minority men, yet pre-exposure prophylaxis is not currently supported in the national HIV program. We examined factors associated with PrEP persistence among Greek SMM in PrEP for Greece, the first PrEP study in Greece. Participants (n = 100) were recruited from 2016 to 2018 through respondent-driven sampling among SMM in Athens, receiving supplies for daily PrEP at interval visits over 12-months. PrEP persistence, operationalized as Total PrEP Time, was high, 74% of participants achieving perfect persistence. Higher alcohol risk scores (OR 1.27, 95% CI 1.08-1.49) and adherence to HIV testing guidelines (OR 1.23, 95% CI 1.00-1.51) were associated with persistence. Housing impermanence (OR 0.14, 95% CI 0.04-0.48) and serostatus disclosure concerns (OR 0.77, 95% CI 0.60-0.97) were associated with limited PrEP persistence. While PrEP persistence among Greek SMM is high, socioeconomic factors and societal attitudes may challenge prevention efforts.

MP34-08 INTERPROFESSIONAL PARTNERSHIP USING LEAN/SIX SIGMA METHODOLOGY TO IMPROVE LOCAL PROCEDURES EFFICIENCY

You have accessJournal of UrologyHealth Services Research: Quality Improvement & Patient Safety II (MP34)1 Sep 2021MP34-08 INTERPROFESSIONAL PARTNERSHIP USING LEAN/SIX SIGMA METHODOLOGY TO IMPROVE LOCAL PROCEDURES EFFICIENCY Nicholas Koch, Larry Mandelkehr, Franklin Farmer, Sherry Parker, Shawanda Lang, Matthew Raynor, and Angela Smith Nicholas KochNicholas Koch More articles by this author , Larry MandelkehrLarry Mandelkehr More articles by this author , Franklin FarmerFranklin Farmer More articles by this author , Sherry ParkerSherry Parker More articles by this author , Shawanda LangShawanda Lang More articles by this author , Matthew RaynorMatthew Raynor More articles by this author , and Angela SmithAngela Smith More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002043.08AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Inefficiency of office-based procedures in a busy, tertiary center leads to wasted time, lost revenue and patient and staff frustration. Using Lean/Six Sigma methods, individual process steps were identified, measured, and streamlined through the reduction of redundant or unnecessary steps by maximizing value added time and minimizing non-value-added time. METHODS: Define, Measure, Analyze, Improve and Control (DMAIC) methodology was used to define individual process steps of patient flow and room turnover through collaboration between urology staff and quality improvement experts within the UNC Gillings School of Global Public Health (SPH). Time variables studied include waiting room, triage time, consent time, patient drape and prep time, physician wait time, procedure duration, patient clean-up and dress, patient check-out, and room turnover. Process step order, communication practices and practice variability amongst staff were also recorded. All data were collected by urology staff and provided to SPH team for statistical analysis who provided recommendations to the department. Following implementation of these recommendations, time variables were again collected and analyzed. RESULTS: Baseline results were recorded across 44 procedures over 4 weeks: 29 cystoscopies (Cysto) and 15 prostate biopsies (Pbx). Recommended process changes were identified in order to maximize value-added time (VAT) and minimize non-value-added time (NVAT). Specific changes included: converting wait-room time to VAT by triaging patients with urine sample upon check-in and paging providers prior to patient prep to decrease provider wait time. Following implementation, we noted an average reduction in appointment time of 4 and 10 minutes (cysto and pbx respectively), a reduction of bathroom time from 4:38 to 4:11, with an 80% successful implementation of UA intervention, although only 33% adoption of paging intervention (Table). CONCLUSIONS: Through standardization of process and conversion of NVAT to VAT efficiency, office-based procedural efficiency improved. Partnering with a dedicated QI team maximized resources while demonstrating the importance of interprofessional collaboration. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e619-e619 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Nicholas Koch More articles by this author Larry Mandelkehr More articles by this author Franklin Farmer More articles by this author Sherry Parker More articles by this author Shawanda Lang More articles by this author Matthew Raynor More articles by this author Angela Smith More articles by this author Expand All Advertisement Loading ...

Institutional experience and clinical outcomes of robotic major hepatectomy for liver tumors

The majority of published literature has only reported outcomes of robotic minor non-anatomical hepatectomy. We aim to examine our clinical outcomes, safety, and feasibly with robotic major hepatectomy. We prospectively followed 235 patients who underwent robotic hepatectomy since 2016. Major hepatectomy is defined as a resection of ≥ 3 segments. Data are presented as median (mean ± SD). Of the 235 patients, 142 of the patients underwent a major hepatectomy. Median age was 63 (61 ± 14.0) years, 51% were women, BMI was 28 (29 ± 6.1) kg/m² and ASA Class was 3 (3 ± 0.5). 25% of operations were for metastatic colorectal cancer, 23% for hepatocellular carcinoma, 11% cholangiocarcinoma, and 6% for gallbladder adenocarcinoma. Regarding the type of resection, 15 patients (11%) had central hepatectomy, 30 (21%) had formal right, 41 (29%) had formal left, 31 (22%) had non-anatomical right, 11 (8%) had non-anatomical left, 7 (5%) had extended right, and 7 (5%) had extended left. Prep time (in the room until incision) 64 (74 ± 67.3) minutes, Extraction time (incision until specimen extraction) 138 (159 ± 99.3) minutes, Console time 198 (213 ± 119.8) minutes, Closure time (extraction until dressing placement) 106 (214 ± 271.3) minutes, Operative duration was 288 (305 ± 119.0) minutes and time under anesthesia 359 (369 ± 115.6) minutes. Estimated blood loss was 200 (258 ± 252.1) mL and length of stay was 4 (5 ± 2.7) days. 9 patients experienced postoperative complications (4 ileus, 1 pneumonia, 1 bile leak, 1 gram-negative bacteremia, 1 jaundice, 1 pneumothorax). 22 patients were readmitted within 30 days with one death after readmission, due to aspiration. Application of the robotic platform to major hepatectomy is safe and feasible with excellent perioperative outcomes.

Monitoring Involuntary Muscle Activity in Acute Patients with Upper Motor Neuron Lesion by Wearable Sensors: A Feasibility Study.

Sustained involuntary muscle activity (IMA) is a highly disabling and not completely understood phenomenon that occurs after a central nervous system lesion. We tested the feasibility of in-field IMA measuring at an acute rehabilitation ward. We used wearable probes for single differential surface EMG (sEMG), inclusive of a 3D accelerometer, onboard memory and remote control. We collected 429 h of data from the biceps brachii of 10 patients with arm plegia. Data quality was first verified in the time and frequency domains. Next, IMA was automatically identified based on the steady presence of motor unit action potential (MUAP) trains at rest. Feasibility was excellent in terms of prep time and burden to the clinical staff. A total of 350.5 h of data (81.7%) were reliable. IMA was found in 85.9 h (25%). This was often present in the form of exceedingly long-lasting trains of one or a few MUAPs, with differences among patients and variability, both within and between days in terms of IMA duration, root mean square (RMS) and peak-to-peak amplitude. Our results proved the feasibility of using wearable probes for single differential sEMG to identify and quantify IMA in plegic muscles of bedridden acute neurological patients. Our results also suggest the need for long-lasting acquisitions to properly characterize IMA. The possibility of easily assessing IMA in acute inpatients can have a huge impact on the management of their postures, physiotherapy and treatments.

Methods to increase native warm‐season grass diversity in bermudagrass

AbstractBermudagrass [Cynodon dactylon (L.) Pers.] is the most common warm‐season introduced forage species grown in the southern portion of the United States. Often grown as a monoculture, bermudagrass responds well to fertilizer and intensive management but provides little wildlife or microbial soil community benefits due to the lack of species diversity. A methods study to evaluate methods of increasing diversity of bermudagrass by adding switchgrass (SG) or a native warm‐season grass mixture (NGMIX) was conducted in southern Oklahoma. An established bermudgrass stand was suppressed using either 7, 11, or 19 months of seedbed preparation time (PREP) with either zero, one, two, or three cover crops depending on PREP time and applied to either till or no‐till strips. Initiation of PREP times were staggered so a common date for SG and NGMIX planting was achieved in two consecutive planting years, April 2011 (Year 1) and April 2012 (Year 2). On both soil textures, till establishment increased stand frequency of SG and NGMIX the year of establishment compared to no‐till. Stand frequency was repeated in 2015 (3 and 4 years post planting, respectively). The loam soil, no‐till stand frequency counts in 2015 had improved for SG and NGMIX and were similar to till. The sandy loam site 2015 stand frequency counts of till established SG and NGMIX remained higher than no‐till. No‐till establishment was slower than and not as successful as till but it still achieved plant diversity in bermudagrass at a lower cost compared to till. Cover crops and PREP time had little effect on establishment.

Improved Immunoprecipitation to Mass Spectrometry Method for the Enrichment of Low-Abundant Protein Targets.

Immunoprecipitation (IP) is commonly used upstream of mass spectrometry (MS) as an enrichment tool for low-abundant protein targets. However, several aspects of the classical IP procedure such as nonspecific protein binding to the isolation matrix, detergents or high salt concentrations in wash and elution buffers, and antibody chain contamination in elution fractions render it incompatible with downstream mass spectrometry analysis. Here, we discuss an improved IP-MS workflow that is designed to minimize sample prep time and these contaminants. The method employs biotinylated antibodies to the targets of interest and streptavidin magnetic beads that exhibit low background binding. In addition, alterations in the elution protocol and subsequent MS sample prep were made to reduce time and antibody leaching in the eluent, minimizing potential ion suppression effects and thereby maximizing detection of multiple target antigens and interacting proteins.

671. Same Day Identification of Enterobacteriaceae Directly from Urine Samples

BackgroundUrinary tract infections (UTIs) are one of the most common infections, associated with 10.5 million outpatient visits annually. Fast and accurate identification (ID) of bacteria causing a UTI would allow for immediate targeted therapy, as opposed to conventional methods which take one to three days. The Accelerate Pheno® system (ACC, Accelerate Diagnostics Inc., Tucson, AZ, USA) provides microbial ID and susceptibility (AST) from positive blood cultures. Our objective was to determine ACC’s potential to quickly ID bacterial pathogens directly from urine.MethodsRemnant urine samples with >100K colony forming units (CFU)/mL of gram-negative bacteria as determined by quantitative plating were obtained from the clinical lab. 1.5ml of urine was dispensed into a capsule and loaded onto the Accelerate PhenoPrep™ module. This module automatically performs wash steps to separate bacteria from human cells and other debris. The processed sample was loaded onto ACC for analysis using a custom designed assay which detects the presence of bacteria and employs an Enterobacteriaceae family specific FISH probe. The results were compared to standard of care ID results.ResultsThere were 10 E. coli and 1 C. koseri among the eleven samples tested. Baseline concentration of samples immediately prior to testing ranged from 2.5 x 106 to 1.08 x 1010 CFU/mL (average 4.19 x 109). After specimen processing, average concentration was 2.14 x 109 CFU/mL and average recovery was 42.83%. ACC detected bacteria and identified it as Enterobacteriaceae in 11/11 samples (100%). Average sample prep time was 55 min. Average time to Enterobacteriaceae ID was 8.6 hrs. Average total time to ID, including specimen processing, was 9.5 hrs.Table 1: Results of Direct from Urine Testing ConclusionACC identified Enterobacteriaceae directly from remnant urine specimens in an average of 9.5 hours, approximately 24 to 48 hours faster than conventional methods. ACC was able to be adapted for use in urine samples. Future directions include improving the assay to identify bacteria to the species level and adding AST testing. This shows promise in providing fast actionable UTI diagnosis, allowing for tailored antibiotic therapy.*This information concerns a use that has not been approved or cleared by the Food and Drug Administration.DisclosuresMartin Fuchs, BSEE, MSEE, Accelerate Diagnostics (Employee) Steve Metzger, BA, Accelerate Diagnostics (Employee)

S3400 Recurrent Episodes of Diverticulitis in a Young 28-Year-Old Male: A Rising Trend

INTRODUCTION: Given the current COVID-19 pandemic, social distancing rules have limited in person socialization. Physicians from a variety of specialities, including primary care, endocrinology, rheumatology and more recently gastroenterology, have turned to telemedicine to provide medical care for their patients that can no longer physically visit the hospital due to the COVID-19 pandemic. Telemedicine is defined as providing medical care through a two-way communication between the physician and the patient at a distant site with both audio and video equipment. Although telemedicine has established popularity with most specialities, it has not been fully adopted within the gastroenterology field. We discuss the new era of telemedicine as it pertains to gastroenterology and other aspects of telemedicine such as platform designs, legal, billing and possible challenges in the near future. METHODS: We performed an extensive literature search on currently published data with regards to telemedicine and in particular telemedicine in the field of GI. RESULTS: Below, in Figure 1, we summarize our findings from our literature search with regards to telemedicine platform design, access, legal considerations and billing. CONCLUSION: Providing medical care through telemedicine has significant advantages. Patients describe increased convenience, easier access to medical care, reduced travel burden, improved treatment compliance and outcomes. To date, there has been caution using telemedicine due to expressed concerns regarding strict legislation concerning privacy, platform access, legal ramifications and billing/reimbursement. Due to the COVID-19, legislation has been relaxed in favor of providing more telemedicine visits to patients, in order to encourage safe social distancing and making unnecessary trips to the hospital. In our hospital outpatient clinic setting, telemedicine quickly became popular within the physician staff and patients. Due to the COVID-19 pandemic and to enforce safe social distancing precautions, many patients in our gastroenterology and hepatology outpatient clinics were advised not to come into the clinic. After proper training, our physicians started using telemedicine (either through a webcam on the office computer or by using a smartphone). Given its popularity, many of our gastroenterologists are providing telemedicine visits through their smartphone in between prep time for inpatient endoscopy procedures.Figure 1.: Topics in TelemedicineFigure 2.: Billing in TelemedicineFigure 3.: Telemedicine.

Robotic Major Hepatectomy: An Institutional Experience and Clinical Outcomes.

Most of the literature has only reported outcomes on robotic minor non-anatomical hepatectomy. This study was undertaken to analyze and examine the safety, feasibly, and perioperative outcomes of robotic major hepatectomy at our institution. All patients undergoing robotic major hepatectomy were prospectively followed. Major hepatectomy was defined as a resection of 3 or more segments. Data are expressed as median (mean ± SD). A total of 170 consecutive patients underwent robotic hepatectomies, of which 100 were major resections involving at least 3 segments. The 100 patients were of median 62 (61 ± 13.0) years, and 46% were women. Median BMI was 29 (29 ± 5.9)kg/m2 and median ASA class was 3 (3 ± 0.5). Thirty percent of robotic major hepatectomies were for hepatocellular carcinoma, 28% were for metastatic adenocarcinoma, 9% were for cholangiocarcinoma, and 5% were for metastatic neuroendocrine tumor. Prep time (in the room until incision) was a median 58min (62 ± 18.4), extraction time (incision until specimen extraction) was 124min (146 ± 99.5), console time was 198min (210 ± 123.9), closure time (extraction until dressing placement) was 109min (131 ± 93.8), operative duration was 246min (269 ± 123.2), and time under anesthesia was 330min (353 ± 109.6). Estimated blood loss was 175ml (249 ± 275.9) and length of stay was 4days (5 ± 4.3). Seven patients experienced postoperative complications. Thirteen patients were readmitted within 30days, and one patient died within 30days. Application of the robotic platform to major hepatectomy is safe and feasible. Our early experience shows that this minimally invasive approach results in excellent short-term outcomes.

Making ceramics in a flash

An ultrafast method can drastically reduce the time needed to synthesize ceramics, cutting prep time from several hours to less than a minute (Science 2020, DOI: 10.1126/science.aaz7681). The high-...

547 Increasing Endoscopy Unit Efficiency: It's Time to Take Control

INTRODUCTION: Operational flow is an important factor in relation to efficiency in an endoscopy center. There are opportunities for improvement in efficiency while keeping the standards of quality. We performed a time flow analysis in our outpatient endoscopy center to identify workflow improvement opportunities. METHODS: We evaluated 616 patients who underwent EGD and colonoscopy. We analyzed preop prep time, procedure time, room turnover, recovery room time, total time in unit, and physician arrival time. These times were compared to efficiency benchmarks identified in the limited literature available. A process map was documented to illustrate patient flow and to assess redundancies and non-value added steps (Figure 1). Post-intervention data was collected on 381 patients. RESULTS: Pre-procedure nursing time exceeded benchmark intervals for both EGD and colonoscopy (Table 1). This was due to lack of documentation if the patient could not be reached during precall assessment 5 days prior to procedure requiring the nurse to obtain the information on the day of endoscopy. 2/3 of nurses did not have EMR access to be able to chart the medical history prior to patient arrival. In addition, IV was placed prior to the restroom visit delaying procedure start time while physician was ready to proceed. Doubles were allotted only 30 min block times and progressive delay was noticed increasing pre-procedure wait time. Physician start time was delayed 26% by an average of 12 min (Figure 2). This was due to clerical tasks, staff questions, and operational tasks. Encounter forms were reformatted to be user friendly for nursing documentation. All nurses were given EMR access in the event where patient was not reached prior to procedure. Pre-call assessment changed from 5 to 7 days prior to procedure to increase probability of reaching patients. Patients were offered restroom break prior to IV placement. Block times for doubles were extended from 30 to 45 minute block times . Recovery room delays with EGDs were attributed to oversedation by a single nurse anesthetist who was educated regarding propofol usage. Physician delays remained essentially unchanged (Figure 2). CONCLUSION: With our interventions, we reduced pre-procedure time by 8 mins for EGDs and 7 minutes for colonoscopy. We improved recovery room time. Delays related to physician behavior remain unchanged. Our next step is to address physician arrival times will be to post results of physician start times on a weekly basis at our endocenter.

Operating Room Personnel Determine Efficiency of Pediatric Spinal Fusions for Scoliosis

Study DesignRetrospective chart review. ObjectivesTo investigate the effect of different surgeons, anesthesiologists, and cRNAs individually and in teams on various perioperative and operative time intervals in a large, high-volume children's hospital. Summary of Background DataAlong with individual factors, studies have indicated that team factors play a role in efficiency, with larger teams leading to increased procedure times. An operating room (OR) staff dedicated to orthopedics has been reported to decrease turnover time; however, the characteristics and behaviors of surgical team members, to our knowledge, have not been analyzed as possible factors contributing to pediatric OR efficiency, and limited research has been conducted in the field of orthopedic personnel. MethodsChart review identified consecutive pediatric and adolescent patients who had primary posterior spinal fusion (PSF) of ≥7 levels for correction of spinal deformity. Time intervals and delays were recorded based on previous studies looking at OR efficiency and adjusted to the specific time points available in our perioperative nursing records. ResultsAdjusted for etiology, osteotomy, fusion levels, distance from hospital, staff switch, and body mass index, there was a significant difference in patient wait time among anesthesiologists, surgeon-anesthesiologist, and anesthesiologist-certified registered nurse anesthetist (cRNA) teams; in surgery prep time and total prep among surgeons and SA teams; and in surgery time and total room time among surgeons. There were no significant differences among cRNAs, individually, in any time interval. ConclusionsAnesthesiologists have a significant effect before and surgeons have a significant effect after entry into the OR. Identification of this variability provides an opportunity to study the differences in habits and processes of high- and low-efficiency teams, which can then be applied to all teams with the goal of improving performance of all surgical teams. Level of EvidenceLevel IV, case series.

Prepping for Success: Improving the Communication of Patient Preparatory Instructions for CT Colonography

A CT Colonography (CTC or virtual colonoscopy) is a CT procedure that is designed to specifically examine the large bowel and is a viable alternative for those patients who cannot complete a traditional colonoscopy. CTC requires intensive and very specific patient preparation (prep) that differs significantly from colonoscopy prep. A large cohort of patients arrive at the CTC appointment not properly prepped to complete the exam. This results in frequent delayed, cancelled and rebooked appointments which extends the number of days of prep time required for patients, delays diagnosis, and increases wait times for an already in-demand procedure.

Abstract 1669: Full length transcriptome sequencing of melanoma cell line complements long read sequencing assessment of genomic rearrangements

Abstract Transcriptome sequencing has proven to be an important tool for understanding the biological changes in cancer genomes including the consequences of structural rearrangements. Short read sequencing has been the method of choice, as the high throughput at low cost allows for transcript quantitation and the detection of even rare transcripts. However, the reads are generally too short to reconstruct complete isoforms. Conversely, long-read approaches can provide unambiguous full-length isoforms, but lower throughput has complicated quantitation and high RNA input requirements has made working with cancer samples challenging. Recently, the COLO 829 cell line was sequenced to 50-fold coverage with PacBio SMRT Sequencing. To validate and extend the findings from this effort, we have generated long-read transcriptome data using an updated PacBio Iso-Seq method, the results of which will be shared at the AACR 2019 General Meeting. With this complimentary transcriptome data, we demonstrate how recent innovations in the PacBio Iso-Seq method sample preparation and sequencing chemistry have made long-read sequencing of cancer transcriptomes more practical. In particular, library preparation has been simplified and throughput has increased. The improved protocol has reduced sample prep time from several days to one day while reducing the sample input requirements ten-fold. In addition, the incorporation of unique molecular identifier (UMI) tags into the workflow has improved the bioinformatics analysis. Yield has also increased, with v3 sequencing chemistry typically delivering > 30 Gb per SMRT Cell 1M. By integrating long and short read data, we demonstrate that the Iso-Seq method is a practical tool for annotating cancer genomes with high-quality transcript information. Citation Format: Elizabeth Tseng, Brendan Galvin, Ting Hon, Wigard P. Kloosterman, Meredith Ashby. Full length transcriptome sequencing of melanoma cell line complements long read sequencing assessment of genomic rearrangements [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr 1669.

2139. Improving Peri-Operative Skin Prep Technique at a Large Tertiary Medical Center: A Quality Improvement and Educational Initiative

BackgroundSurgical site infections (SSIs) are the most common cause of healthcare-associated infections. As part of our campaign to reduce SSIs at UT Southwestern Medical Center in Dallas, TX, we sought out to audit skin prep practices with the initial focus on application technique and a secondary focus on choice of product.MethodsInfection Prevention for the University hospitals audited appropriateness of skin prep for compliance with manufacturer’s directions and whether sufficient drying time was allowed. Skin prep was done appropriately less than 50% of the time. BD assessed skin prep practices in May 2017 using a standardized observation tool that evaluated method, prep time, compliance to prep time, dry time and compliance to dry time for ChloraPrep, Duraprep, and other CHG and Iodine solutions. Prep time and dry time were measured and compliance was calculated as a percentage.ResultsA total of 51 cases were observed. ChloraPrep was used most often, followed by two-step PVP Scrub and Paint, CHG and DuraPrep. ChloraPrep was applied correctly 44% of the time and DuraPrep 0% of the time. ChloraPrep prep time was compliant only 6% of the time. Dry time compliance was 45% for ChloraPrep and 50% for DuraPrep. Overall application method was correct 41% of the time, proper prep time 3% (compared with a national average of 44%), proper dry time of 41%. A skin prep task force worked to simplify the products available and clarified instructions for use. Inservice training programs were developed. Nursing educators developed an audit and competency tool for monitoring.ConclusionThe correct application technique, prep time and dry time were adhered to in <50% of the observations. Of interest is that national averages for all of these categories were <50% as well. The results of the assessment at UT Southwestern are not unique and reflect a larger issue in how skin prep is performed across the country. It became clear that doing a deeper dive to understand the barriers in implementing appropriate skin prep practices was necessary. We were able to simplify the various products available to surgical staff, provide consistent recommendations on directions for use and provide hands on teaching to ensure competency. We hope to be able to identify a cost savings in addition to showing a reduction in surgical site infections.Disclosures L. Pearson, BD: Employee, Salary. L. Williams, BD: Employee, Salary.