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At least 199 records · Page 11Linked to original sources
PubMed2006

A 4-cm thermoactive viscoelastic foam pad on the operating room table to prevent pressure ulcer during cardiac surgery.

AIMS AND OBJECTIVES: In this experimental study, a 4-cm thermoactive viscoelastic foam overlay and a heating source on the operating room table was compared with the standard operating room table with a heating source for the effect on the postoperative pressure ulcer incidence in cardiac surgery patients. BACKGROUND: Pressure ulcer incidence in the cardiac surgery population is reported to be up to 29.5%. The prolonged compressive forces from lying on the operating room table are one source of pressure ulcer development in this population. Pressure-reducing devices on the operating room (OR)-table should reduce the patients' interface pressure and thus the hazard of skin breakdown. METHODS: A randomized controlled trial was performed to test the effect of a 4-cm thermoactive viscoelastic foam overlay with a water-filled warming mattress on the OR-table (test OR-table) compared with the standard OR-table (a water-filled warming mattress, no pressure-reducing device) on the postoperative pressure ulcer incidence in cardiac surgery patients. INSTRUMENTS: The pressure ulcer classification system of the European Pressure Ulcer Advisory Panel (EPUAP) was used for pressure ulcer grading. RESULTS: The results show that patients lying on the 4-cm thermoactive viscoelastic foam overlay suffer slightly more pressure ulcer (17.6%) than patients on the standard OR-table without the foam overlay (11.1%). Because of the clinical relevance of the results, the randomized controlled trial was terminated after 175 patients at the interim analysis although the power calculation stated 350 patients. CONCLUSIONS: The combination of a 4-cm viscoelastic foam overlay and a warming source cannot be recommended for pressure ulcer prevention on the operating room table. RELEVANCE TO CLINICAL PRACTICE: Foam overlays are used to prevent pressure ulcers in patients. It is necessary to use such devices according to patient safety and use of resources.

Adult↗
PubMed1986

The case for using computers in the operating room.

The largest cost center and revenue generator in most hospitals, the operating room is subject to demands for increased cost accountability and quality assurance. Information technology tools can be incorporated into the operating room and have the potential to positively affect practices there through addressing nursing, administrative/financial and medical needs. Microcomputer-based operating room systems now on the market can provide functions from scheduling and case costing to medical records and market analysis. Of 21 functions identified, 10 can be characterized as mandatory and the remaining as optional. Individual systems offer varied configurations, providing from 0 to 21 functions. These enhanced capabilities for data collection, monitoring and analysis enable health care professionals to provide both better and more cost-effective care for surgical patients.

Computers↗
PubMed1999

Early outpatient preoperative anesthesia assessment: does it help to reduce operating room cancellations?

UNLABELLED: Increased understanding of the high cost associated with operating room (OR) cancellations has led to efforts by healthcare providers to decrease case cancellations on the day of surgery. To investigate whether preoperative evaluations within 24 h of surgery were associated with more frequent OR cancellations than those completed 2-30 days before surgery, we prospectively studied OR cancellations for 3 mo. Of the 529 patients in the study, 166 were seen within 24 h of surgery (standard group), and the remaining 363 patients were seen 2-30 days before surgery (early group). There were 70 OR cancellations on the day of surgery, and the largest single group of cancellations was related to administrative problems. The standard group and the early group were similar in terms of gender, age, ASA physical status, and percentage of patients undergoing major surgery. The OR cancellation rates were also comparable between groups: 13.3% for the standard group and 13.2% for the early group. These data suggest that patients can be evaluated in an outpatient preoperative evaluation clinic in a timeframe that is convenient for the patient without adversely affecting the cancellation rate on the day of surgery. IMPLICATIONS: The operating room cancellation rate for outpatients evaluated 2-30 days before surgery was compared with the cancellation rate for outpatients who received their anesthesia evaluation within 24 h of surgery. Because both groups had similar rates, outpatients may be seen at a convenient time without adversely affecting operating room cancellations.

Ambulatory Surgical Procedures↗
PubMed1992

Movement of the i.v. room to the postanesthesia care area: an alternative to an operating room satellite pharmacy.

The Jewish Hospital of St. Louis decided to combine the need for an operating room (OR) satellite pharmacy with the need to upgrade the existing intravenous (IV) room. This decision resulted in the movement of the move not only provided an upgraded IV room but its location allowed for direct access to the OR suites. The IV room can now provide the additional services of an OR satellite pharmacy. Cost savings estimates for a dedicated OR satellite pharmacy did not provide the hospital administration with the financial justification for the project. Only by combining the pharmacy's personnel and physical resources did the proposal become inviting enough for the hospital administration to support. The steps in the creation of the combined IV room/OR satellite pharmacy are presented.

Cost Savings↗
PubMed1985

Air embolism in the operating room.

If left undetected and untreated in the operating room, air embolism can be a potentially lethal event. It is important to be aware of the specific positions and surgical procedures that put a patient at risk for air emboli. This article will define air embolism, discuss its occurrence and effects on the body, review specific monitoring techniques used to detect intravascular air, and present techniques used for prevention and treatment by the operating room staff.

Blood Pressure Determination↗
PubMed2005

Bridging the communication gap in the operating room with medical team training.

BACKGROUND: In the operating room (OR), poor communication among the surgeons, anesthesiologists, and nurses may lead to adverse events that can compromise patient safety. A survey performed at our institution showed low communication ratings from surgeons, anesthesiologists, and OR nursing staff. Our objective was to determine if communication in the operating room could be improved through medical team training (MTT). METHODS: A dedicated training session (didactic instruction, interactive participation, role-play, training films, and clinical vignettes) was offered to the entire surgical service using crew resource management principles. Attendees also were instructed in the principles of change management. A change team was formed to drive the implementation of the principles reviewed through a preoperative briefing conducted among the surgeon, anesthesiologist, and OR nurse. A validated Likert scale survey with questions specific to effective communication was administered to the nurses, anesthesiologists, and surgeons 2 months after the MTT to determine the impact on communication. Data are presented as mean +/- SEM. RESULTS: There was a significant increase in the anesthesiologist and surgeon communication composite score after medical team training (anesthesia pre-MTT = 2.0 +/- .3, anesthesia post-MTT = 4.5 +/- .6, P <.0008; surgeons pre-MTT = 5.2 +/- .2, surgeons post-MTT = 6.6+/-.3, P <.0004; nurses pre-MTT = 4.3 +/- .3, nurses post-MTT = 4.2 +/- .4, P = .7). CONCLUSIONS: Medical team training using crew resource management principles can improve communication in the OR, ensuring a safer environment that leads to decreased adverse events.

Anesthesiology↗
PubMed2005

Rethinking theatre in modern operating rooms.

Metaphor is a means through which a widely accepted meaning of a word is used in a different context to add understanding that would otherwise be difficult to conceive. Through etymological and metaphorical associations, we contend that aspects of "theatre" are still relevant in the modern operating rooms and that the use of dramaturgical metaphors can add another layer of understanding about the social reality in this setting. We begin by exploring the historical roots and derivation of the word theatre as it applied to anatomical dissection and surgery. Briefly, we touch on the work of Erving Goffman and examine how his work has been used by others to explore aspects of operating room nursing. Then, drawing on data from a postmodern ethnographic study that has been used to examine communication in operating room nursing, four dramaturgical metaphors are used to illustrate the argument. They are drama, the script and learning the lines, the show must go on, and changing between back stage and front stage. To conclude, the small amount of previously published literature on this topic is compared and contrasted, and the relevance of using dramaturgical metaphors to understand modern operating rooms is discussed. Being able to distinguish between the inherent drama in operating room work and the dramatic realisation of individuals who work within, can help operating room nurses to think differently about, and perhaps re-evaluate their social situation and how they function within it.

Anthropology, Cultural↗
PubMed1996

[Evaluation of anesthetic activity in the operating room. Use of beta relative cost index].

OBJECTIVE: To evaluate the anaesthetic activity in the operating rooms using the newly reconstructed RCI beta, or relative cost index beta, a specific tool for analysis of anaesthetic activity and the linked cost. STUDY DESIGN: Prospective multicentric survey. METHODS: All scheduled anaesthetic procedures performed in March 1995 were collected. RCI beta items were entered in a standardized data base. Gender, age group, time of admission to the operating room, time of incision, time of exit from the operating room, and the code number of the surgical or radiological procedure were added on request of the steering committee. RESULTS: Complete responses were obtained from 35 out of the 37 contacted departments. A total of 31,391 procedures were analysed. Only 14% of patients were of ASA class over 2. Anaesthetic practices were comparable between institutions. Only the incidence of special circumstances and techniques was higher in University hospitals. General anaesthesia was the most widely used technique (76.58%). A large proportion (19%) of anaesthetics were given for endoscopy and radiology. More than 87% of patients were monitored postoperatively in recovery areas. There was a lower correlation between the theoretical standard duration and median actual duration of the perioperative period than the operative period (r = 0.54 vs r = 0.81). DISCUSSION: Part of our activity could be described with RCI beta. The obtained data allow a comparison of anaesthetic activity in the operating rooms of different hospitals, departments and units. Further analysis of these data will also provide information about the types of surgical procedures and the level of global activity.

Anesthesiology↗
PubMed2002

Impact of the endoscopic sinus surgical simulator on operating room performance.

OBJECTIVES/HYPOTHESIS: The aim of this study is to evaluate an endoscopic sinus surgical simulator (ESS) as a training device and to introduce a methodology to assess its impact on actual operating room performance. STUDY DESIGN: Prospective evaluation of the endoscopic sinus surgical simulator as a trainer. METHODS: Ten junior and senior ear, nose and throat residents served as subjects, some of whom had prior training with the simulator. The evaluation team collected several measures, which were analyzed for a statistical correlation, including simulator scores, operating room performance rating, ratings of videotaped operating room procedures, and surgical competency rating. RESULTS: These findings suggest the ESS simulator positively affects initial operating room performance across all measures as judged by senior surgeons rating anonymous videotapes of those procedures. The two simulation-trained residents were rated consistently better than the other two residents across all measures. These differences approached statistical significance for two items: anterior ethmoidectomy (P =.06; P <.05) and surgical confidence (P =.09; P <.05). In addition, the 3 subjects with the highest overall scores on the competency evaluation also had 3 of the 4 highest cumulative simulation times. CONCLUSIONS: The endoscopic sinus surgical simulator is a valid training device and appears to positively impact operating room performance among junior otolaryngology residents.

Clinical Competence↗
PubMed1996

[Operating room assistance: an innovative practice].

Professional practice changes in the operating room have led to the development of a new role for nurses--as surgical assistants. Essentially, the surgical assistant nurse helps ensure the patient's safety while providing technical and clinical assistance to the surgeon in such areas as exposing and manipulating tissues, suturing fascia and using various specialized instruments. The surgical assistant nurse function is being implemented through a pilot project at the Institut de cardiologie de Montréal. Developed by representatives of the nursing and surgical departments there, the project was approved by the Collège des médecins du Québec in April 1995 and subsequently by the institute's council of physicians, dentists and pharmacists. It has also gained recognition from the Ordre des infirmières et infirmiers du Québec (OIIQ). The pilot project incorporated a 186-hour training program, which was delivered from May to September 1995 according to three distinct learning modules: maintenance of a safe environment for the patient, clinical assistance and technical assistance. A tutorial approach to learning included individual and team work, simulation exercises, technical courses, lab work and practical training in the operating room. At the end of the training program, two surgical assistant nurses began practising in their new role. An evaluation of the project will be performed in September 1996.

Curriculum↗
PubMedDate not supplied

[A ten-year risk evaluation study in Catania hospital operating rooms].

Previous studies conducted in Catania hospitals have revealed a high burden of contamination in the air of operating rooms and have recommended measures to improve air quality. In this study we verified the effectiveness of the undertaken measures. Furthermore we evaluated the possibility of using microclimatic parameters as "markers" of operating room contamination. Changes made to ventilation systems and to waste gas scavenging systems in the monitored operating rooms were remarkably effective. Microclimatic conditions and degree of chemical contamination improved over time; nevertheless airflow velocity values were found to be insufficient and nitrous oxide values, in some cases, remained slightly elevated. A significant correlation was observed only between some nitrous oxide values and relative humidity. Monitoring important marker levels is useful for correctly evaluating operating room thermal, chemical and microbiological air quality.

Air Microbiology↗
PubMed1976

Total hip replacement without deep infection in a standard operating room.

In a consecutive series of 298 total hip-joint replacements performed by a single surgeon using a standard operating room, early deep infection was eliminated by simple inexpensive methods of controlling contamination in the operating room. Settling-plate monitoring revealed an average of 4.8 colonies of bacterial growth per hour of exposure. All patients received prophylactic antibiotics. One patient had a superficial wound infection which was controlled with antibiotic therapy. No deep infections were encountered in the 252 hips followed for two to five years after operation. We conclude that total hip arthroplasty can be performed in the standard operating room without undue risk of infection by consistently employing strict measures of operating-room discipline to limit contamination.

Air Microbiology↗
PubMed1988

Comparison of lead dislodgment and pocket infection rates after pacemaker implantation in the operating room versus the catheterization laboratory.

To assess and compare the rates of lead dislodgment and pocket infection in patients having procedures performed in the operating room versus those performed in the cardiac catheterization laboratory, we reviewed the records of 85 adult patients who underwent 88 procedures, all performed by one surgical team and having complete follow-ups at our institution from October 8, 1979, through November 7, 1986. Forty-five patients underwent 46 procedures in the operating room, and 40 patients underwent 42 procedures in the cardiac catheterization laboratory. There was one instance of ventricular lead dislodgment noted among the 48 leads implanted in the operating room and one instance of ventricular lead dislodgment among the 58 leads implanted in the cardiac catheterization laboratory. No instances of atrial lead dislodgment were noted. No instances of pocket infection were noted among the 46 procedures performed in the operating room or in the 42 procedures performed in the cardiac catheterization laboratory. We conclude that pacemaker implantation can be performed with equivalent safety and effectiveness in the cardiac catheterization laboratory and in the operating room.

Adult↗
PubMed1998

Value of an endovascular suite in the operating room.

The purpose of this study is to describe the advantages and value of an endovascular suite in the operating room from a vascular surgeon's perspective. All endovascular procedures were performed in a specially equipped operating room by vascular surgeons using digital fluoroscopic imaging equipment. Between January 1, 1994 and August 31, 1996, intraoperative balloon angioplasties were attempted by vascular surgeons in 102 patients with insertion of 22 stents. Angioplasties were performed for stenoses in 50 arterial bypasses and 25 iliac, 17 femoral and 10 popliteal arteries proximal or distal to arterial grafts. Sixty-two procedures were performed concomitantly with a surgical bypass and 40 were performed as the sole procedure (30 percutaneous, 10 open) in patients who had previously undergone a bypass. There were five technically unsatisfactory results which were converted to surgical procedures and one postoperative hematoma that required surgical repair. Ninety of the 102 grafts remained patent more than 1 month after the procedure. Establishment of an endovascular operating room suite enables vascular surgeons to perform adjunctive endovascular procedures concomitantly with vascular surgery and treat unexpected findings in the operating room amenable to endovascular intervention without requesting other interventionalists to participate on an emergent basis.

Angiography, Digital Subtraction↗
PubMed1982

Operating room practices for the control of infection in U. S. hospitals, October 1976 to July 1977.

We estimated the frequency of selected infection control practices in the operating room from a nationwide survey of hospitals. Our survey confirmed that, in many hospitals, practices which have not received scientific or budgetary scrutiny have become part of the perioperative routine. Almost half of the hospitals reported using nonrecommended tacky, or disinfectant, mats at the entrance to operating rooms, and more than three-fourths were performing nonrecommended environmental cultures in the operating room at a cost ranging from $2,000 to $20,000 per year. When routine nose and throat cultures were taken of operating room personnel, we found an obvious pecking order, rather than a scientific rationale for culturing. In almost all instances, we found wide variations in practice among hospitals. This nonuniformity may be due to such factors as lack of a convincing scientific basis for evaluating the relative efficacy of alternative practices, the strong influence of industry marketing, the individual preferences of surgeons and operating room supervisors and the lack of completeness and agreement of statements from various scientific and professional organizations.

Bacteriological Techniques↗
PubMedDate not supplied

[Basic structure and function of the operating room committee].

The complicated task of the operating room management is facilitated and supported by an OR multiprofessional committee. The purpose and the task of the OR committee is the effective functioning of the area for the safety surgical treatment of patients. Among the managerial responsibilities of this committee is the development of an organizational policy with the purpose: 1) to safeguard patients and personnel and 2) to face common problems arising in every day practice.

General Surgery↗
PubMed2003

What surgeons want in operating rooms.

The wishes of surgeons for their operating rooms (ORs) are similar in principle to those of other workers for their work place - to be able to do their work accurately, productively, safely, and with satisfaction. To determine these wishes 40 Australian surgeons were asked what changes they would like in their operating rooms. From their responses there were 349 separate comments defined. Each comment was labeled with a keyword which was used to sort them into categories using a spreadsheet. Within each category labels were modified as appropriate and sorting was repeated several times until the groupings appeared stable. Feedback was sought from participants after circulating the collated results by email. Not surprisingly, there were problems in many areas - equipment, lighting and OR planning. Altogether there were 36 different categories of comment, with half of them having six or fewer respondents. The analysis clarified the problems of surgeons, and yielded some that were not expected. The results provide a useful tool for informing equipment designers and administrators of necessary changes. Further research with a larger number of subjects, and perhaps a prompt list, may yield additional significant information.

Journal Article↗
PubMed1990

Designing a state-of-the-art operating room complex.

1. When designing a new operating room complex, it is important to remember that, with a life expectancy of 15 years or more, you must take into account not only your current needs, but also anticipate those of the future. 2. The OR facility needs to be designed both for patients and providers: provide private, comfortable surroundings for your patients that are efficient and conducive to developing an enjoyable work environment for your staff. 3. Be sure to solicit input from various department managers as well as physicians during the initial design phases so that all needs may be met. In addition, ensure that state guidelines are satisfied.

Hospital Design and Construction↗