Otolaryngology - Head & Neck Surgery Supplement - 2020 Official Program Abstracts - P262

P262
Otolaryngology-Head and Neck Surgery 163(1S)
Presentation schedule is subject to change. The Official Program Abstracts supplement does not reflect changes made after August 10, 2020.
Conclusions: The TDABC model allows for analysis of cost
drivers by considering the capacity of each resource. Only
direct costs were considered in our analysis, but future investigation should include indirect costs. Greater transparency in
all costs can provide an accurate understanding of the major
factors that influence procedure costs.
Improving Assessment of Operative
Performance in Residents
Maxwell D. Newby, MD (Presenter); Steven W. Coutras, MD;
Michele M. Carr, MD, DDS, PhD
Objectives: To improve the timeliness and quality of resident surgical skill evaluations with minimal effort for surgeons and adequate value for residents.
Methods: A 4-question smartphone survey was designed for
attendings to rate resident operative proficiency, level of
autonomy, and case complexity. Space for free-text comments
was also provided. Postgraduate year (PGY)-1 and PGY-2
otolaryngology residents were assessed by 6 participating
attending surgeons (of 15 in the department) from January to
March 2019. Feedback to residents was given in real time and
at monthly intervals. This replaced a global rating scale available to attendings on the university website.
Results: A total of 160 (43.6%) cases received an evaluation, compared with none (0%) prior to the intervention.
Residents scored the usefulness of the evaluations as 10/10.
They preferred biweekly feedback reports and valued free text
comments. Attendings scored the process as 1.6/10 for onerousness. They scored the evaluation as 6.75/10 for being useful to the resident and 7.6/10 for being useful to the program.
Conclusions: Overall, attendings believed the evaluation process was valuable with minimal effort. The residents valued
text feedback, particularly when it was timely. The system was
well accepted, but 100% of procedures were not evaluated, in
part because only a fraction of the department was involved,
but also because attendings forgot to complete the evaluations
and residents forgot to ask for them. Despite this, almost half of
their cases had documented evaluations over the study period.
Future effort should focus on improving compliance in providing evaluations of resident operative performance.

PSQI

Improving Inpatient Laryngoscope
Availability: A Systems-Based Approach
Garrett G. Casale, MD (Presenter); Bradley W. Kesser, MD
Objectives: The flexible laryngoscope represents one of the
most commonly used tools in the workup of otolaryngology
consultations in an inpatient setting. We held an A3 meeting at
our institution concerning laryngoscope availability and noted
several systems issues that contributed to lengthy turnover
times that had the potential to affect patient care. We sought to
identify preventable delays in scope processing and address
these sources of delay to increase laryngoscope availability
for use in inpatient consultations.

Methods: Using A3/Lean methodology, we identified
sources of preventable delay in laryngoscope processing.
Once sources of delay had been identified, we pursued a multidepartment approach to address each problem area. In addition, we designated 1 of our laryngoscopes for use only during
emergencies. Residents were surveyed a year following
implementation of our initiatives to assess for improvement.
Results: Our initiatives resulted in significant improvements
in our scope processing workflow. In the year prior to intervention, our department filed more than 20 system complaints concerning lack of scope availability. Since intervention, there have
been no reports of a laryngoscope not being available during an
emergency situation. In addition, residents reported increased
scope availability and increased overall satisfaction on postintervention surveys. Further, postintervention, we have not filed
any system complaints related to scope availability.
Conclusions: By addressing delays in laryngoscope processing using a multilevel systems approach, we were able to identify and address preventable sources of delay. This represents
a systematic effort that had positive changes on our ability to
efficiently provide patient care.
Improving Quality and Safety in Thyroid
Surgery
Lindsey E. Moses (Presenter); Qianhui Shao, MPH;
Mark S. Persky, MD; Michael J. Persky, MD;
Theresa Tuyet-Phuong N. Tran, MD; J. Thomas Roland, MD;
Adam S. Jacobson, MD; Babak Givi, MD
Objectives: Thyroidectomy is one of the most common procedures performed in otolaryngology. Major complications
including recurrent laryngeal nerve injury and severe hypocalcemia have a reported incidence as high as 5% and 8%,
respectively, in national studies. We describe the establishment of a program to monitor and improve the quality and
safety of thyroidectomy.
Methods: All surgeons who perform thyroidectomy participated in establishing standards for postoperative administration of antibiotics and narcotic pain medications. Adverse
events, length of stay, and antibiotic and narcotic prescriptions
were monitored and recorded. Data were collected prospectively from June 2018 to November 2019.
Results: A total of 312 thyroidectomies were performed by
8 surgeons. The average length of stay was less than 24 hours.
Average number of narcotics prescribed was 15 doses, and
postoperative antibiotics were prescribed in 4% of cases. Six
(1.9%) adverse events were identified: 3 (1%) hematomas
requiring operative intervention, 2 readmissions, 1 (0.3%) for
infection, 1 (0.3%) for hypocalcemia, and 1 (0.3%) seroma
managed in the emergency department. No recurrent laryngeal nerve injuries were identified. The average number of
narcotics prescribed declined over the study period from 19 to
11 doses without an increase in the need for refills, and the
percentage of patients prescribed antibiotics declined from
36% to 0% without an increase in infection rates.

Otolaryngology - Head & Neck Surgery Supplement - 2020 Official Program Abstracts

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