In hospitals, the duration of surgical procedures is susceptible to a number a factors resulting in varying procedure durations of the same procedure. When these procedure times deviate from the predicted surgical duration, scheduling conflicts arise, leading to patient discomfort and inefficient use of hospital resources. Considering the aging population and the subsequent growing demand for healthcare, hospitals are under constant pressure to provide cost-effective care. Indeed, this is also the case for the interventional cardiology unit, where the expected increase of the prevalence of cardiovascular disease is expected to put a strain on hospital human resources. Improving the efficiency has been an area of focus in many hospitals. In fact, advanced methods such as surgical workflow monitoring have been employed to identify points of improvement especially in procedure scheduling. Up until now, this has not been employed in cardiac catheterization laboratories in the Netherland.
The purpose of this study, therefore is identify primarily the factors influencing variability of the procedure time of procedures of the cardiac catheterization laboratory of the Reinier de Graaf Hospital in Delft and secondarily the possible sources compatible with video-based workflow monitoring for phase segmentation of the procedures.
Retrospective data obtained from DoseWise was used to analyze the procedure times and associating factors of coronary angiograms and pacemaker implantation procedures. In addition, process models of the procedures were created and activity recognition identifiers were studied through observer-based data acquisition.
Analysis showed that in coronary angiograms variations of total procedure times are mostly due to variable preparation times, whereas for pacemaker implantation the lead positioning times were the main source for variability. In addition, more experienced operators were shown to complete the procedure in a shorter time (-4.35%|p=0.007) in comparison to less experienced operator.
Instrument and equipment use were identified as possible sources for activity recognition along with the hand kinematics, however further analysis of reliability is required.
The findings in this study provide a basis for future monitoring of the workflow of these procedures using real-time data acquisition methods to improve the efficiency in cardiac catheterization laboratories.