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At least 235 records · Page 13Linked to original sources
PubMed2006

Resident teaching versus the operating room schedule: an independent observer-based study of 1558 cases.

Efforts to improve operating room efficiency may threaten clinician training. Therefore, we designed a prospective, observational study to determine the actual time spent teaching anesthesiology residents during the interval from patient-on-table to skin incision and to determine whether anesthesia teaching in the peri-induction period increases the time to surgical incision. This study was conducted in an inpatient operating room suite of a tertiary academic medical center. Of 1558 cases examined, 75% had an element of teaching (mean percent teaching per case = 46.4). A 33% decrease in teaching occurs when the attending anesthesiologist concurrently directed care in 2 rooms (P < 0.001). The percent teaching significantly increased as a function of ASA physical status classification and time of day of surgical case (P = 0.001). Teaching accounted for a mean increase of time to incision of 4.5 +/- 3.2 min, but represented only 3% of the mean surgical case length (207 +/- 132 min). We conclude that teaching occurs in the majority of cases in the operating room and although it contributes to increased time to incision, this increase is insignificant compared with the time required to complete the surgical procedure.

Anesthesiology↗
PubMed1949

A consideration of some factors causing death in the operating room.

Some of the causes of deaths in the operating room are related to anesthesia. In some cases death occurs because of lack of understanding of certain factors which are subject to control by the surgeon or the anesthetist. Simple comparisons of the rate of deaths from such causes in one hospital with the rate in another are meaningless because of the many variables involved. A better avenue to the knowledge that may prevent untoward deaths is exposition of the causes in each case. By this means the causative factors may be fully disclosed, emphasized, and guarded against. In this presentation the author has classified the causes of 46 operating room deaths that occurred in the Los Angeles County General Hospital in a period of 21 months, and has discussed the causes individually.

Anesthesia↗
PubMed2001

Ultra-fast-track anesthetic technique facilitates operating room extubation in patients undergoing off-pump coronary revascularization surgery.

OBJECTIVE: To determine if implementation of ultra-fast-track anesthetic (UFTA) technique facilitates operating room extubation in patients undergoing off-pump coronary artery bypass graft (CABG) surgery. DESIGN: Retrospective review. SETTING: Referral center for cardiovascular surgery at a university hospital. PARTICIPANTS: Thirty-seven patients undergoing off-pump CABG surgery. INTERVENTIONS: Two groups represented UFTA (n = 10) and standard anesthetic (controls, n = 27) techniques. Anesthesia was conducted with propofol, remifentanil, vecuronium, and thoracic epidural analgesia in the UFTA group and thiopental, fentanyl, pancuronium, and isoflurane in the control group. Active temperature control was an integral part of the UFTA technique but not the standard technique. The active temperature control included intravenous fluid warmer, prewarmed skin preparation, humidified inspired gases, a circulating water warming blanket, and a forced-air warmer, along with the maintenance of the operating room temperature at 24 degrees C. The control group was managed with an intravenous fluid warmer, and the ambient temperature remained constant (20 degrees C). Patients who did not satisfy extubation criteria within 30 minutes from the end of surgery were sedated and transferred to the intensive care unit (ICU). MEASUREMENTS AND MAIN RESULTS: All patients in the UFTA group and 2 in the control group were extubated in the operating room immediately after surgery. None of the patients required reintubation. There was no significant difference in postextubation PaO(2) and PaCO(2) between the groups. Nasopharyngeal temperature decreased from 36.7 +/- 0.4 degrees C to 36.4 +/- 0.3 degrees C in the UFTA group and from 36.6 +/- 0.5 degrees C to 35.6 +/- 0.4 degrees C in the control group (p < 0.0001). Bradycardia occurred significantly more often in the UFTA group but there was no difference in episodes of hypotension. There were no perioperative deaths. Patients who were extubated in the operating room required lower nurse-to-patient acuity ratio (1:2) in the ICU. No difference was found in ICU and hospital length of stay. CONCLUSIONS: Implementation of UFTA technique provided adequate hemodynamic control and facilitated operating room extubation in all patients. The impact of UFTA on earlier patient discharge and actual cost savings within a fully integrated post-cardiac surgery unit requires further evaluation.

Aged↗
PubMed2004

[Spectrophotometric evaluation of nitrous oxide pollution in the work place of the anesthesiologic personnel in operating rooms].

Chronic exposure to nitrous oxide and volatile anaesthetics can threat the health of the operation theatre personnel. In Poland there are no regulations determining the maximum concentration of anaesthetic gases in the air. The results of measurement of N2O pollution of theatre atmosphere presented in the article exceed European and North American standards. Lack of appropriate technical facilities in operation rooms is aggravated by incompetence of the technical supervision staff and negligence of the anaesthesiological personnel. It is important to enforce European law and standards of work safety in operation rooms. It is of double impact, health protecting and ecological. The authors suggest introducing activities aiming toward the improvement of work conditions in operation rooms and the reduction of uncontrolled release of harmful anaesthetics.

Air Pollutants, Occupational↗
PubMed1984

Bacterial contamination of floors and other surfaces in operating rooms: a five-year survey.

Bacterial contamination of floors and other surfaces in the operating suite has been investigated by contact impression plates during the past five years. Colony counts of the floors of operating rooms, cleaned with disinfectant, were 3.3 c.f.u./10 cm2; on the floors of semi-clean and dirty areas, cleaned with detergent, colony counts were 44.8 and 71.4 c.f.u./10 cm2 respectively. The highest colony counts of 487.4 c.f.u./10 cm2 were found in the dressing rooms, the floors of which were covered with carpets, cleaned with a vacuum cleaner. Mean bacterial numbers on surfaces of various equipment in operating rooms, cleaned with disinfectant, were 2.8 c.f.u./10 cm2. Bacterial numbers on surfaces decreased markedly from 253.2 to 11.9 c.f.u./10 cm2 following the use of disinfectant. Bacterial species found from various surfaces were mainly coagulase-negative staphylococci, derived from human beings. In the light of these findings the regular use of disinfectant for cleaning of the floors and other surfaces in operating rooms is advisable.

Bacteria↗
PubMed2006

Improving operating room efficiency through process redesign.

BACKGROUND: Operating rooms (ORs) are important resources for patient care and revenue, yet a significant portion of OR time is taken up by nonoperative activities. We hypothesized that redesigning the process that occurs between operations would lead to a decrease in nonoperative time (NOT = room turnover time plus anesthesia induction and emergence time). METHODS: Following a 3-month multidisciplinary planning process, a prospective study to reduce NOT was initiated in 2 of 17 ORs at a tertiary care academic medical center. Unlike previous reports, which have limited the number of participants, we constructed a process that was restricted only by case duration. The plan focused on minimizing nonoperative tasks in the OR, effecting parallel performance of activities, and reducing nonclinical disruptions. Eligible cases were those with an estimated operative time of 2 hours or less. A target NOT of 35 minutes was established. Cases of similar duration in the remaining ORs served as a concurrent control group. RESULTS: Twenty-three surgeons, 13 anesthesiologists, and 11 nurses worked in the project ORs over a 3-month period. Residents participated in all cases. There was a significant reduction in NOT (42.2 +/- 12.9 vs 65 +/- 21.7 minutes), turnover time (26.4 +/- 11.2 vs 42.8 +/- 21.7 minutes), and anesthesia-related time (16.9 vs 21.9 minutes, all P < .001) in the project rooms compared with cases of similar duration in control ORs. Process-related delays were identified in 70% of cases when NOT exceeded the 35-minute target. CONCLUSIONS: These results demonstrate that a coordinated multidisciplinary process redesign can significantly reduce NOT. This process is applicable to most ORs and has optimal benefit for cases of 2 hours or less in duration. The high percentage of residual process-related delays suggests that further improvements can be anticipated.

Anesthesiology↗
PubMed1998

Unplanned return to the operating room.

BACKGROUND: Unplanned return to the operating room (OR) has been suggested as one of the indicators that could be used to assess the quality of surgery in a hospital setting. The present study was undertaken in order to try to identify those factors that were important in determining the need for the return to the OR in patients undergoing a series of colorectal surgical procedures. METHODS: All patients who returned to the OR following an index colorectal procedure during a 15-year period on a colorectal service, were identified from the unit's database. The site of original disease, presentation, type of surgery performed, reason for re-operation and post-surgical morbidity and mortality were examined. RESULTS: Overall there were 2011 colorectal surgical admissions, and of these 19 males (61.2 years) and 18 females (67.4 years) underwent an unplanned return to the OR. In 34 patients the index operation was performed by a consultant surgeon. A total of 46% of index operations were performed in an emergency setting. The majority of patients had colorectal cancer. Most lesions were situated in the sigmoid colon or rectum. Postoperative adhesive obstruction was the commonest reason for return to the OR. No patient re-obstructed following re-operation. Overall eight wounds dehisced and five patients suffered anastomotic leakage. Intra-abdominal sepsis was found in 12 patients. Twenty-one patients developed urinary tract infections. Twenty-eight patients were discharged well, two patients were discharged dying with advanced malignancy and there were seven postoperative deaths (18.9%). CONCLUSIONS: Unplanned return to the OR is a function of both the patient's presenting problem and the surgical skill and judgement of the surgeon. It is thus in part determined by the patient casemix in a unit, service or institution.

Colectomy↗
PubMed1979

[Contamination of the operating room with anesthetic gases and vapors. Analytical methods].

An approach for the measurement of the contamination of the operating room air is presented. The measurements were performed in three operating rooms used for general surgery, partly in model experiments and partly while anesthesia was in progress. During anesthesia, the measurements were taken when oxygen 3 l/min containing ethrane 1.0--1.5% was passed into a semi-closed circle and the exhaled gas vented directly to the environmental air with no scavenging system in use. The daily exposure of operating room personnel was determined by adsorption of ethrane on glass tubes containing activated charcoal. The ethrane was subsequently desorbed in toluol and quantified by gas chromatography. The concentration of contaminant was found to be significantly greater in the anesthesiologist's position than in the areas of surgeon and circulating nurse. Some pitfalls in sampling, standardization, and analysis are indicated. Attention is drawn to the numerous factors influencing the extent of contamination.

Air Pollution↗
PubMed1976

Atmospheric derivatives of anaesthetic gases as a possible hazard to operating-room personnel.

During surgical procedures in which nitrous oxide (N2O) anaesthesia was administered there was an increased concentration of both nitric oxide (NO) and nitrogen dioxide (NO2) in operating-room air. Preliminary studies suggest that the use of certain devices (e.g., electric cauteries, X-ray machines) capable of releasing energy in the operating-room produce the oxidation of nitrous oxide. Further evaluation of gas phase reactions of anaesthetic agents within the operating-room appear warranted, particularly in relation to the occupational risks of operating-room personnel.

Abnormalities, Drug-Induced↗
PubMed2006

[Microorganisms in operating room air--selected aspects].

Test results of total number of bacteria and fungi in air of operating rooms were presented. The investigation was performed during "warm season" of the year--from June to September. Concentration of bacteria and fungi in the air of operating rooms with and without air conditioning system are compared, as well between hospitals where continuous inspections and regulations of air conditioning systems are practiced and those where inspections and regulations were done periodically. Results from operating rooms with faulty air conditioning are presented separately.

Air Conditioning↗
PubMed1978

Operating room nurses' psychomotor and driving skills after occupational exposure to halothane and nitrous oxide.

Concentrations of halothane and nitrous oxide were assayed by gas chromatography throughout a working day in three operating theatres and in the end-tidal air of 19 nurses 15 and 60 min after leaving the theatres. Perceptual, psychomotor and driving skills were measured in these nurses and in 11 younger nurses working in the wards of the same hospital. A complicated psychomotor test battery and a driving simulator were used. End-tidal air concentrations of halothane and nitrous oxide were positively correlated with the exposure level of these gases in the operating theatres. Some of the operating room nurses had greater amounts of halothane in their end-tidal air (average 15 to 10 ppm) than student volunteers 4.5 h after 3.5 min of general anaesthesia with a combination of halothanenitrous-oxide oxygen (10 ppm halothane). These volunteers had worse psychomotor and driving performances when measured than controls who had not been anaesthetized. No correlations were found between the concentrations of halothane or nitrous oxide in end-tidal air and psychomotor or driving performance. Despite their higher age and exposure to the operating room environment, the driving skills of the operating room nurses were similar to those of the ward nurses. The results suggest that tolerance to anaesthetic gases develops among operating room personnel. No impairment of driving skills can be expected after daily exposure to halothan and nitrous oxide among long-term employees in operating theatres.

Air Pollutants↗
PubMedDate not supplied

Operating room scheduling by computer.

The surgical operating room schedule has been produced automatically for more than 2 years in our large teaching hospital. In order to apply computer technology to the complex surgical scheduling problem a special programming approach was devised. We discuss this approach under the headings of Expand, Sort, Order and Assign. Consistent, reliable schedules, unaffected by weekends and holidays, are produced by a clerk trained to use a computer terminal. Our program is adapttable to other institutions once the scheduling parameters and operating priorities are delineated.

Anesthesiology↗
PubMed1979

Environmental bacteriology in the unidirectional (vertical) operating room.

An integrated body exhaust/clean air operating room system was evaluated in terms of the microbiologic and particulate contamination control it afforded. The clean air unit was of a vertical unidirectional airflow design and employed high-efficiency particulate air filters to provide air low in both microbes and particulates. The body exhaust portion of the system was composed of an exhaust tube the surgeon's mask, a transparent plastic faceplate, and a microbe-retentive surgical gown and hood. Measurements were made of airborne and surface contamination at the wound site and of microbial burden levels associated with the surgical team. Sampling techniques were designed to parallel those used in a previous study of a horizontal flow/body exhaust system so as to provide comparative data on the effect of airflow configuration on wound site contamination. The data showed the vertical flow room to exhibit significantly lower (P less than .05) contamination levels than the horizontal flow enclosure. Surgical lights, draping techniques, and personnel and material positoning unobstructive to the airstream were judged to the prime factors in reducing wound site contamination.

Air↗
PubMed1975

Applying the nursing process to patient care in the operating room.

Using the nursing process in operating room nursing helps to assure personalized, continuous, and integrated care for the surgical patient. The steps in the nursing process clearly demonstrate the role and functions of the O.R. nurse as a professional member of the surgical team and as a component of the health care system. By this means the patient is assured of protection and quality care.

Nursing Assessment↗
PubMed2004

An experimental operating room project for advanced laparoscopic surgery.

With the challenges that the health sector now faces in accordance with readjustments and demands for increased efficiency, resource utilization, and innovation, we have initiated a project to develop the future operating room for advanced laparoscopic surgery. New hospitals are being built that contain numerous operating room theaters. To share experiences and avoid repeating the same mistakes as others, we find it suitable to build an "experimental" operating room theater where we can try out and study new equipment, logistics, and communications, and operating forms and new technology that both benefit the establishment of our hospital, as well as the establishment of other hospitals and their laparoscopic operating rooms nationally and internationally. The main goals in the project are, through research and development, to reveal information and develop technology and methods to establish more efficient and prospective patient treatment that is focused on quality. The project is deeply rooted in the established research environment in Trondheim, Norway. We will develop new integrated solutions in the laparoscopic operating unit to create a possibility to rapidly implement the results in the form of practical improvements, increased quality, and renovation in patient treatment. The goal is also that this will result in the establishment of new industry nationally.

Hospital Design and Construction↗
PubMed1991

Anger in the operating room.

In the microcosm of the operating room, where all actions and feelings appear intensified, anger can quickly become a significant obstacle to efficient functioning. The ability to therapeutically respond to angry feelings is an important skill for the OR manager. A manager who can respond to another's anger with a cool emotional tone, who can select when and where to express angry feelings, and who can deliberately solve a problem will be respected as a manager as well as a leader whose example should be followed.

Anger↗
PubMed1995

Allocation of surgical procedures to operating rooms.

Reduction of health care costs is of paramount importance in our time. This paper is a part of the research which proposes an expert hospital decision support system for resource scheduling. The proposed system combines mathematical programming, knowledge base, and database technologies, and what is more, its friendly interface is suitable for any novice user. Operating rooms in hospitals represent big investments and must be utilized efficiently. In this paper, first a mathematical model similar to job shop scheduling models is developed. The model loads surgical cases to operating rooms by maximizing room utilization and minimizing overtime in a multiple operating room setting. Then a prototype expert system which replaces the expertise of the operations research analyst for the model, drives the modelbase, database, and manages the user dialog is developed. Finally, an overview of the sequencing procedures for operations within an operating room is also presented.

Artificial Intelligence↗
PubMed1983

Implementing an operating room pharmacy satellite.

Implementation of an operating room (OR) pharmacy satellite is described, and its impact on cost-effectiveness and efficiency of drug distribution is analyzed. The OR satellite provided pharmacy coverage for 30-35 patients per day in 10 centralized surgical suites, 2 obstetric suites, and 1 burn-unit suite in a 401-bed teaching hospital. Objectives of the satellite were to consolidate accountability for drug distribution and control, reduce controlled substance loss and waste, reduce inventory costs, and improve recording of patient charges. Stock on the OR supply cart was reduced, controlled substances were dispensed to anesthesiologists from the satellite, and a system of standardized anesthesiology exchange trays was developed. A new billing form served as both the charging document and replacement list. Reduction in the medication cart stock resulted in smaller discrepancies in patient charges. For the five most commonly used controlled substances, accounting discrepancies were reduced. Inventory turnover increased and inventory dollar value and cost per patient were reduced. The percent of nurses who believed that a pharmacist should work in the area increased from 31% before implementation of the satellite to 95% after. The pilot OR pharmacy satellite was a financial success. Efficiency and effectiveness in drug distribution and control were improved, and communication between pharmacists and other medical personnel working in the OR areas was enhanced.

Anesthesia↗