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PubMedDate not supplied

Learning about teamwork in operating room clinical placement.

The aim of nursing students' operating room (OR) clinical practice is to gain experience of the perioperative nursing process and to develop skills related to the practice within OR teams in a variety of situations. However, it has previously been problematic to get enough practical experience within OR teams because of the general urgency, e.g. rapid turnover and flow of emergency cases, and preceptors' multiple responsibilities related to their simultaneous need to work as team members. This study describes how Finnish, British and American nursing students (n = 30) experienced learning about teamwork during their OR placement period. The critical incident technique was used for data collection, and data were analysed using a descriptive phenomenological method. Three types of teamwork emerged based on the students' perceptions: functional manifestation of OR teamwork, gaining OR team membership and technical orientation of OR teamwork. The findings are discussed in relation to OR practice, education and research on ways to improve teamwork while maintaining a satisfactory OR learning context and stimulating interest in perioperative nursing.

Attitude of Health Personnel↗
PubMed1993

The risk of exposure of third-year surgical clerks to human immunodeficiency virus in the operating room.

The exposure of third-year medical students to blood and blood products in the operating room was assessed with a questionnaire distributed at the end of their clerkship in surgery. Sixty-six (68%) of ninety-seven students reported having been exposed to blood in the operating room during their 3-month rotation in surgery. During the year there was a decrease in the exposure rate that correlated with the students' knowledge of universal precautions (r = .96). Consistent with this observation was a significant decrease in the exposure rate from the first quarter of the year to the last quarter (88% vs 56% of the students). Of the 32 students stuck or cut in the operating room, 21 (66%) were injured by the surgeon. These data underscore the risk to medical students during their clerkships and the important role that universal precautions had in their protection.

Accidents, Occupational↗
PubMed1991

Risk of blood contamination and injury to operating room personnel.

The potential for transmission of deadly viral diseases to health care workers exists when contaminated blood is inoculated through injury or when blood comes in contact with nonintact skin. Operating room personnel are at particularly high risk for injury and blood contamination, but data on the specifics of which personnel are at greater risk and which practices change risk in this environment are almost nonexistent. To define these risk factors, experienced operating room nurses were employed solely to observe and record the injuries and blood contaminations that occurred during 234 operations involving 1763 personnel. Overall 118 of the operations (50%) resulted in at least one person becoming contaminated with blood. Cuts or needlestick injuries occurred in 15% of the operations. Several factors were found to significantly alter the risk of blood contamination or injury: surgical specialty, role of each person, duration of the procedure, amount of blood loss, number of needles used, and volume of irrigation fluid used. Risk calculations that use average values to include all personnel in the operating room or all operations performed substantially underestimate risk for surgeons and first assistants, who accounted for 81% of all body contamination and 65% of the injuries. The area of the body contaminated also changed with the surgical specialty. These data should help define more appropriate protection for individuals in the operating room and should allow refinements of practices and techniques to decrease injury.

Blood↗
PubMed2006

Value of preoperative clinic visits in identifying issues with potential impact on operating room efficiency.

BACKGROUND: Preoperative clinics have been shown to decrease operating room delays and cancellations. One mechanism for this positive economic impact is that medical issues are appropriately identified and necessary information is obtained, so that knowledge of the patients' status is complete before the day of surgery. In this study, the authors describe the identification and management of medical issues in the preoperative clinic. METHODS: All patients coming to the Preoperative Clinic during a 3-month period from November 1, 2003, through January 31, 2004, at the Brigham and Women's Hospital, Boston, Massachusetts, were studied. Data were collected as to the type of issue, information needed to resolve the issue, time to retrieve the information, cancellation and delay rates, and the effect on management. RESULTS: A total of 5,083 patients were seen in the preoperative clinic over the three-month period. A total of 647 patients had a total of 680 medical issues requiring further information or management. Of these issues, 565 were thought to require further information regarding known medical problems, and 115 were new medical problems first identified in the clinic. Most of the new problems required that a new test or consultation be done, whereas most of the old problems required retrieval of information existing from outside medical centers. New problems had a far greater probability of delay (10.7%) or cancellation (6.8%) than old problems (0.6% and 1.8%, respectively). CONCLUSIONS: The preoperative evaluation can identify and resolve a number of medical issues that can impact efficient operating room resource use.

Aged↗
PubMed1992

Ultraviolet radiation and ultra-clean air enclosures in operating rooms. UV-protection, economy, and comfort.

Ultraviolet radiation (UVC), as an air-cleaning method for operating rooms, has received increasing attention, due to its low cost. Recent work shows that UVC can provide ultra-clean air (< 10 CFU/m3) in the operating room. However, the UVC air-cleaning method has been criticized because of the protective clothing needed and the risk of UVC exposure for staff and patients. To evaluate the practicability of the UVC method, the aspects of UV-protection were thoroughly evaluated regarding UVC intensities and the transmission properties of clothing commonly used in the operating room. A comparison between UVC and the Charnley-Howorth enclosure, regarding the aspects of economy and comfort, was performed.

Asepsis↗
PubMed2000

Economic analysis of linking operating room scheduling and hospital material management information systems for just-in-time inventory control.

UNLABELLED: Operating room (OR) scheduling information systems can decrease perioperative labor costs. Material management information systems can decrease perioperative inventory costs. We used computer simulation to investigate whether using the OR schedule to trigger purchasing of perioperative supplies is likely to further decrease perioperative inventory costs, as compared with using sophisticated, stand-alone material management inventory control. Although we designed the simulations to favor financially linking the information systems, we found that this strategy would be expected to decrease inventory costs substantively only for items of high price ($1000 each) and volume (>1000 used each year). Because expensive items typically have different models and sizes, each of which is used by a hospital less often than this, for almost all items there will be no benefit to making daily adjustments to the order volume based on booked cases. We conclude that, in a hospital with a sophisticated material management information system, OR managers will probably achieve greater cost reductions from focusing on negotiating less expensive purchase prices for items than on trying to link the OR information system with the hospital's material management information system to achieve just-in-time inventory control. IMPLICATIONS: In a hospital with a sophisticated material management information system, operating room managers will probably achieve greater cost reductions from focusing on negotiating less expensive purchase prices for items than on trying to link the operating room information system with the hospital's material management information system to achieve just-in-time inventory control.

Computer Simulation↗
PubMed1959

Operating room deaths; an analysis of mortality in a Veterans Administration hospital over a ten-year period.

A study of operating room and recovery room deaths which occurred during a ten-year period from 1948 through 1957 at one hospital revealed that there were 59 deaths associated with 57,132 surgical procedures. Factors which directly influenced the rate of operating room and recovery room death were the age of the patient and the length of operating time. Seventy-five per cent of the deaths occurred in cases in which the operation took longer than one hour. Combined anesthesia techniques may have indirectly contributed to death in some cases. Complications of operation requiring another surgical procedure sometimes occur. In this series, reoperation proved to be more hazardous in terms of mortality rate than did single operations. This is not surprising for most complications occur in the poorer risk patients. The operating room death rate steadily increased during the ten-year period studied. This increasing death rate can largely be attributed to the more intricate operations which are being done on poorer risk patients. The use of the curariform drugs had no influence on the increasing death rate.

Anesthesia↗
PubMed1999

The financial impact of teaching surgical residents in the operating room.

BACKGROUND: There have been no published data regarding the cost of training surgical residents in the operating room. METHODS: At the University of Tennessee Medical Center-Knoxville, in addition to resident-performed teaching cases, some cases are performed without the assistance of residents by the same faculty. RESULTS: Sixty-two case categories involving 14,452 cases were compared for operative times alone. In 46 case categories (10,787 procedures), resident operative times were longer than faculty alone. In 16 case categories, resident operating times were shorter than faculty times. The net incremental operative time cost was 2,050 hours between July 1993 and March 1997. Assuming 4 years of operative training for 11 graduating chief residents, the cost per graduating resident was $47,970. CONCLUSION: Extrapolated to a national annual cost for the 1,014 general surgery residents who completed training in the 1997 academic year, the annual cost of training residents in the operating room is $53 million. This high monetary cost suggests the need for digital skills, selection criteria, the development of training curriculum and resource facilities, the pre-operating room need for suturing and stapling techniques, and perhaps the acquisition of virtual surgery training modules.

Costs and Cost Analysis↗
PubMed2003

Efficiency of the operating room suite.

BACKGROUND: The need to control high costs of running operating rooms while providing for timely patient care led us to assess the time wasted in the operating room (OR). METHODS: OR use by two general surgery and two orthopedic departments in a metropolitan public hospital were analyzed, and the time elapsed when a scheduled OR remained unused or the patient was still awaiting surgery was measured. RESULTS: OR "time-waste" defined as the time in which the scheduled OR was not busy with the scheduled patient amounted to 79 hours over the 30-day study period (15% of total time). It was wasted owing to inappropriately prepared patients (12%), unavailability of surgeons (7%), insufficient nursing staff, anesthesiologists, or OR assignment to emergency surgery (59%), congestion of the postanesthesia care unit (10%), and delay in transport to the OR (2%) Another issue delineated was the frequent occurrence of surgical cases running longer than their scheduled time (termed "spill-over"), outrunning the staffing expectations after 3:00 PM and delaying admission of add-on and emergency procedures, adding 33% to the time wasted. A quality-assurance committee review resulted in implementation of new guidelines, and within 3 months several underlying causes were rectified, and time-waste and spill over time was reduced by 35%. Surgical time predictions were also improved. Shortage of nurses and anesthesiologists, and OR emergency reassignment remained the major causes of OR waste time. CONCLUSIONS: Continuous surveillance on OR suite-patients' prompt care, repeated evaluation, and wise staff deployment-could maximize OR efficiency.

Efficiency, Organizational↗
PubMedDate not supplied

Monitoring the anesthetized patient in the operating room.

In general, monitors used by the anesthesiologist in the operating room provide three basic functions: assessment of machine and patient status to ensure safety; assessment of depth of anesthesia; and determination of physiologic variables. Improved monitoring should reduce risk and improve patient care. Some monitoring techniques are used in only a few specialized procedures, particularly in high-risk patients or for prolonged or difficult surgery. However, many less-sophisticated techniques are used in routine daily practice and require similar philosophies of monitoring. The status of the cardiovascular system is assessed primarily by monitoring the electrocardiogram and blood pressure waveforms. Although desired effects of anesthesia impact the central nervous system, this vital organ system is not routinely monitored. Likewise, widespread monitoring of the respiratory system is not routinely accomplished. Monitoring for anesthesia in the operating room has evolved to some extent in response to what can be accomplished rather than what needs to be done. While the potential for an integrated monitoring system--including all patient and delivery system variables--clearly exists, numerous difficulties preclude its becoming a reality. What is required is the development of an integrated system that can augment the anesthesiologist's sixth sense. Initial efforts toward device interface standardization, configurability, and flexibility must be encouraged to pave the way for the integrated, automated anesthesia delivery system of the future.

Anesthesia↗
PubMed2007

Operating room versus office-based injection laryngoplasty: a comparative analysis of reimbursement.

BACKGROUND: Injection laryngoplasty (IL) continues to evolve as new indications, techniques, approaches, and injection materials are developed. Although historically performed under local or general anesthesia in the operating room suite, IL is now increasingly being performed in an office-based setting. This report presents the results of a reimbursement analysis comparing office-based versus operative IL. OBJECTIVE: The objective of this study was to compare the reimbursement of office-based injection laryngoplasty with the reimbursement of performing the same procedure in the operating room. DESIGN: The authors conducted reimbursement and outcome analysis through retrospective office chart and hospital record review. METHODS: A retrospective review was performed of the hospital records of patients having undergone injection laryngoplasty at the University of Pittsburgh Voice Center from July 1998 through March 2005. Group I included patients who underwent IL in the operating room, whereas group II included those who had office-based IL. A reimbursement analysis for both groups was then performed comparing surgeon fees, anesthesia, and hospital charges and reimbursement. The clinical efficacy of IL performed in either office versus operating room settings was measured by comparing the pre- and postintervention Voice Handicap Index-10 scores for all patients. A predictive model of potential cost savings is developed based on the results of the analysis. RESULTS: Average reimbursement was 2,505 dollars for group I (n = 108) and 496 dollars for group II (n = 50). This reimbursement differential was preserved across the various insurance types examined. There was no significant difference in Voice Handicap Index-10 change after surgery between group I and II. CONCLUSIONS: Office-based IL is both clinically and financially effective, providing patients with a convenient and flexible alternative to operating room-based intervention for glottal insufficiency.

Adolescent↗
PubMed1999

A strategy for deciding operating room assignments for second-shift anesthetists.

UNLABELLED: We developed a relief strategy for assigning second-shift anesthetists to late-running operating rooms. The strategy relies on a statistical method which analyzes historical case durations available from surgical services information systems to estimate the expected (mean) remaining hours in cases after they have begun. We tested our relief strategy by comparing the number of hours that first-shift anesthetists would work overtime if second-shift anesthetists were assigned using our strategy versus if the anesthesia coordinator knew in advance the exact amount of time remaining in each case. Our relief strategy resulted in 3.4% to 4.9% more overtime hours for first-shift anesthetists than the theoretical minimum, as would have been obtained had perfect retrospective knowledge been available. Few additional staff hours would have been saved by supplementing our relief strategy with other methods to monitor case durations (e.g., real-time patient tracking systems or closed circuit cameras in operating rooms). IMPLICATIONS: A relief strategy that relies only on analyzing historical case durations from an operating room information system to predict the time remaining in cases performs well at minimizing anesthetist staffing costs.

Algorithms↗
PubMed1992

Decentralized operating room pharmacy services in a military teaching hospital.

The development, initiation, and evaluation of a decentralized pharmacy satellite within the operating room, requiring neither additional capital funding nor any major construction, is described. The satellite offers numerous programs to aid the operating room staff. Included in this effort is the complete management of all controlled substances within the operating room, post-anesthesia-care unit, and same-day-surgery unit. Pharmacists function as pharmaceutical resources playing a major role in the pain service unit. Success of the satellite is assessed via a number of parameters including staff survey response, quality assurance impact, and inventory management.

California↗
PubMed1979

Nitrous oxide levels in operating room air with various gas flows.

Monitoring of nitrous oxide concentrations in operating rooms disclosed some leaks that had hitherto been unrecognized. Because nitrous oxide concentrations reported before 1967 had been obtained for the most part with high flows of the gas and without information concerning room air exchange, measurements were made of nitrous oxide levels during operations with an infra-red analyzer. after correction of leaks. Measurements were made at six sites in the operating-room suite, with and without scavenging. Flows that varied 0.1 to 2.5 litres of nitrous oxide were used in rooms that had 20 changes per hour of fresh air. Without scavenging, the highest time-weighted average value inhaled by any of the personnel (anaesthetists) was 31 ppm, when flow of 500 ml of nitrous oxide per minute were employed. The lowest reported deleterious concentration (unconfirmed) is 50 ppm. Lower flows produced lower values. With good scavenging, using flows as high as 2.51/min of nitrous oxide, the highest average value (anaesthetist) was 7.2 ppm. A short discussion is given concerning reasons for using low flows, including the cost of wasting agents and pollution of the entire atmosphere.

Air Pollutants↗
PubMed2000

Radiation exposure to the personnel in the operating room and in the pathology due to SLN detection with Tc-99m-nanocolloid in breast cancer patients.

UNLABELLED: AIM of this study was to assess the radiation exposure for the personnel in the operating room and in the pathology laboratories caused by radioguided SLN localization in breast cancer. METHODS: In 15 patients dose rates were measured at various distances from the breast and tumor specimens during operation and pathological work-up at 3-5 h after peritumoral injection of 30 MBq Tc-99m-nanocolloid. RESULTS: The dose rates were 84.1 +/- 46.4 microGy/h at 2.5 cm, 3.57 +/- 2.14 microGy/h at 30 cm, 0.87 +/- 0.51 microGy/h at 100 cm, and 0.40 +/- 0.20 microGy/h at 150 cm in the operating room and 44.4 +/- 27.8 microGy/h at 2.5 cm, and 1.66 +/- 1.34 microGy/h at 30 cm in the pathology laboratories. From these data the radiation exposure was calculated for 250 operations per year assuming a mean exposure time of 30 min for the surgical team members and of 10 min for the pathology staff. Under these conditions the finger dose is 10.5 mGy for the surgeon, and 5.55 mGy for the pathologist. The whole-body doses are 0.45 mSv, 0.11 mSv, 0.05 mSv, and 0.21 mSv for the surgeon, the operating room nurse, the anesthetist, and the pathologist, respectively. CONCLUSION: Since the radiation risk to staff members is low, a classification of the personnel in the operating room and in the pathology laboratories as occupational radiation exposed workers is not necessary.

Breast Neoplasms↗