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At least 415 records · Page 23Linked to original sources
PubMed1996

A comparison of the cost of local versus general anesthesia for laparoscopic sterilization in an operating room setting.

OBJECTIVE: To compare the charges between laparoscopic sterilization performed under either local or general anesthesia in a traditional operating room setting with anesthesia personnel in attendance. DESIGN: A retrospective review of charges. SETTING: The Regional Medical Center, Memphis, Tennessee. PATIENTS: Sixty-five women undergoing laparoscopic sterilization, 33 under local and 32 under general anesthesia. Interventions. Laparoscopic sterilization. MEASUREMENTS AND MAIN RESULTS: Patient demographics, history of pelvic inflammatory disease, and history of previous surgery were similar for both groups. Operating room and recovery room times were shorter for patients whose procedures were performed under local anesthesia. Flat-rate fee schedules reduced the cost savings for cases performed under local anesthesia to $529 dollars per case, with 76% ($402) of the savings related to anesthetic drugs or equipment. CONCLUSION: Although these savings appear minimal on a per case basis, if 50% of the approximately 210,000 laparoscopic sterilizations performed in the United States each year were performed under local anesthesia, a savings of over $55 million could be achieved (105,000 cases X $529 = $55,545,000). This would result in substantial overall monetary savings to the health care system.

Anesthesia, General↗
PubMedDate not supplied

Monitoring in the operating room: current techniques and future requirements.

Review of a recent lawsuit and study of operating room cardiac arrests reveal that ventilatory problems are a major source of intraoperative morbidity and mortality. Tidal volume and airway gas composition are critical to the anesthesiologist who must determine the depth of an inhalation anesthetic. Yet, current instrumentation does not permit these variables to be measured conveniently. In this paper, current techniques for monitoring cardiovascular physiology are review, and considerable attention is focused on the problem of and the requirements for ventilatory monitoring in the operating room. The high dollar cost of infrequent untoward events is discussed, as well as the additional problem this creates because individual anesthesiologists may receive little positive reinforcement in encouraging the development of more sophisticated monitoring techniques.

Anesthesia↗
PubMed2005

Protocol for bedside laparotomy in trauma and emergency general surgery: a low return to the operating room.

Bedside laparotomy (BSL) was introduced as a heroic procedure in trauma patients too unstable for safe transport to the operating room (OR). We hypothesize a BSL protocol would maintain patient safety while reducing OR use. Patients were prospectively entered into a BSL protocol from July 2002 to June 2003 and retrospectively reviewed. Protocol indications for BSL were abdominal compartment syndrome, decompensation due to hemorrhage, washout/closure, and sepsis in a patient too unstable for safe transport to the OR. Primary outcomes were mortality, emergent return to OR, and primary fascial closure (PFC). Trauma operating room charges and OR time were analyzed. One hundred thirty-three BSL were performed on 60 patients with an overall mortality of 23.3 per cent (14/60). There was an average of 2.2 BSL per patient (range 1-8). Indications for BSL were 1) explore/washout (n = 100, 75.2%), 2) decompression (n = 14, 10.5%), 3) infection/abscess (n = 12, 9.0%), 4) hemorrhage (n = 7, 5.3%). Five of 133 BSL (5.8%) were emergently returned to the OR because of perforation or compromised bowel. Trauma OR charges were dollar 5,300 per cases with 2.12 hours per cases. The protocol standardized the conduct of BSL procedure to allow for a low return to OR rate of 5.8 per cent and had an overall in-hospital mortality rate of 23.3 per cent. Primary fascial closure of the abdomen had a significantly reduced hospital stay. BSL allowed trauma OR charges of dollar 5,300 per cases with 2.12 hours per cases savings.

Abdominal Injuries↗
PubMed2001

Intraoperative magnetic resonance imaging: considerations for the operating room of the future.

Recent technological advances have made possible the introduction of the magnetic resonance imaging (MRI) system into the operating room to guide neurosurgical interventions. We review the possibilities and limitations associated with various open-configuration magnet designs, including systems from the Phillips, Siemens, General Electric, Odin and IMRIS designs. This technology has been shown to be a feasible adjunct to current neurosurgical management of intracranial brain tumors for both biopsy and resection procedures and shows significant potential applications for epilepsy surgery, spine surgery and for minimally invasive interventional techniques. Combined with other surgical planning modalities, intra-operative MRI scanners provide an evolutionary influence on the design of today's operating room.

Brain Neoplasms↗
PubMed1989

[HIV occupational risk of surgical specialists and operating room personnel in the Saint Lucas Hospital in Amsterdam].

All instrument and needle accidents, and mucosal exposure to blood involving surgical specialists and operating room personnel were recorded for a seven-month period in a middle-sized Amsterdam hospital, the St. Lucas. Fifty-four accidents were reported, of which 42 were percutaneous wounds and 12, blood splatters in the eyes. The frequency of percutaneous wounds per operation per person ranged from 0 to 0.013. In the same period 3098 patients who had to be operated on were asked to participate in an anonymous study for HIV antibody. One hundred and twenty patients refused participation (3.9%). Of the 2978 participating patients seven were seropositive for anti-HIV (0.23%). The observed percutaneous accident frequency and HIV prevalence were used in combination with reports from the literature on the risk of infection after a single exposure to HIV infected material, to calculate the HIV professional risk for operating room personnel in this hospital. For general surgeons the risk of infection (based on 500 operations per year) was calculated as 0.0012 for an occupational lifespan of 30 years. For the other specialists and functions the risk was the same or less. Considering the low risk our conclusion is that screening of preoperative patients is not necessary in this hospital. The observance of general protective measures provides sufficient protection for the professional group examined.

Accidents↗
PubMed1991

Fighting drug abuse in operating rooms.

A growing problem of drug addicts working in operating rooms is mobilizing hospitals to make it more difficult for staff members to steal drugs for their own use or for sale to others. Monitoring devices and tighter drug distribution security are among measures being used to deter theft by anesthesiologists, technicians or nurses who are addicted to one of many potent narcotics readily available to them.

Drug and Narcotic Control↗
PubMed2005

Aerobiology in the operating room and its implications for working standards.

Two novel operating room (OR) ventilation concepts, i.e. the upward displacement or thermal convection system and the exponential ultra-clean laminar air flow (LAF) designed to function without extra walls, were evaluated from a bacteriological point of view. The thermal convection system (17 air changes/h) was compared with conventional ventilation (16 air changes/h) with an air inlet at the ceiling and evacuation at floor level. The exponential LAF was compared with the vertical ultra-clean LAF and the horizontal ultra-clean LAF, both with extra side walls. The comparison was made using strictly standardized simulated operations and, except for the horizontal LAF, it was performed in the same OR where the type of ventilation was changed. In the different areas important for surgical asepsis, the thermal system resulted in a twofold to threefold increase in bacterial air and surface counts compared to the conventional system (statistical significance = p < 0.05-0.0001). The bacteriological efficiency of the exponential LAF was equal to the horizontal and vertical LAF units with extra walls in the OR, and all three systems easily fulfilled the criteria for ultra-clean air, i.e. bacteria-carrying particles < 10/m3. In the areas important for surgical asepsis the turbulent ventilation systems yielded highly significant correlation between air and surface contamination (p < 0.02-0.0006). No such correlation existed in the LAF systems.

Air Microbiology↗
PubMed2001

[Computer simulation and pharmacoeconomics. Computer simulation as an aid for the analysis of operating room efficiency: an example].

In this study we compared operating room (OR) efficiency of total intravenous anaesthesia (TIVA) with remifentanil and propofol and balanced anaesthesia (BAL) with fentanyl and isoflurane in cataract surgery using computersimulation. We simulated patient flow for one OR and for three ORs. Time intervals of patient flow were randomly generated from the results of a prospective, randomized trial. Both for one and for three ORs, the postanaesthesia care unit (PACU) finished earlier and one additional case per OR and per day could be performed when TIVA was used for the procedures. Overtime in the PACU was less after TIVA. With a workload of 13 or 15 operations per day in three ORs, monitoring equipment for an additional patient in the PACU was required when BAL was used. TIVA with remifentanil and propofol was associated with more OR efficiency than balanced anaesthesia with fentanyl and isoflurane when given for cataract surgery.

Anesthesia, Intravenous↗
PubMed1988

The operating room director: functions and responsibilities.

Do you supervise the operating room (OR) director in your hospital? Are you thinking of applying for an OR director's position? Or are you in the process of clarifying your role as the OR director with your boss? If so, read these authors' analysis of one OR director's role in a large, teaching hospital. Not only will you learn about the functions one OR director performs to lead a 37 million dollar revenue-producing corporate division, but also you will get an appreciation for the pace, complexity, rewards, and dilemmas of such a position.

Administrative Personnel↗
PubMed1996

Recovery of unused operating room supplies for overseas orthopedic surgery.

Recovery of surplus operating room (OR) materials may contribute needed supplies to volunteer overseas surgical efforts. However, recovery often generates supplies that are highly heterogeneous in nature. In order to evaluate the nature and quantity of supplies useful to orthopedic surgical missions, the present investigation evaluated the material generated from 381 consecutive orthopedic cases performed during three 3-month assessment periods over 3 years. The amount of recovered material varied markedly within and among procedure types as well as surgeons. Nevertheless, the long-term, OR-wide recovery program at Yale-New Haven Hospital has provided a highly reliable source of usable materials over the 4-year life of the program.

Equipment and Supplies↗
PubMed1998

Dedicated operating room for trauma: a costly recommendation.

BACKGROUND: A dedicated operating room (OR) for urgent trauma cases is suggested by the American College of Surgeons Committee on Trauma as a necessary component of a Level I or II trauma center. We describe a cost analysis of this recommendation. METHODS: Two models for staffing urgent trauma cases were constructed. Urgent trauma cases were defined as those taken to the OR within 30 minutes of arrival. In one model the OR was available 24 hours a day with in-hospital personnel. The second model used an out-of-hospital call schedule, assuming a patient-ready OR in 30 minutes. Costs and revenue per urgent case were calculated. A break-even analysis shows the number of cases required for costs to equal revenue. RESULTS: In the 24-hour model, the cost/urgent case is $14,288; in the call-schedule model $3,243. The number of cases to break even in the 24-hour model is 1210; in the call-schedule model 375. CONCLUSIONS: A call-schedule model is the least costly way to staff an OR for urgent trauma cases.

Costs and Cost Analysis↗
PubMed1995

Safety of a clean air storage hood for ophthalmic instruments in the operating room.

PURPOSE: Evaluation of the safety of a laminar flow clean air hood for the sterile storage of ophthalmic instruments in an operating room. METHODS: A ten-year retrospective study of 10,524 surgical procedures performed with instruments stored in a clean air hood was conducted at the Mayo Clinic. Cases of postoperative endophthalmitis were identified through review of the diagnostic indices maintained by the ophthalmology department and the institution and through review of individual patient records. RESULTS: The incidence of endophthalmitis in surgical cases in which instruments stored in a clean air hood were used was 0.076% (eight of 10,524 cases). No clusters of infection were identified. CONCLUSIONS: The use of a laminar flow clean air hood provides access to surgical instruments in a high-volume operating room without exposing patients to an increased risk of endophthalmitis.

Endophthalmitis↗
PubMed2001

Paediatric anaesthesia outside the operating room.

Anaesthesiologists are regularly consulted to provide anaesthesia for children in settings other than an operating room. Current debate focuses on the appropriateness of the presence of an anaesthesiologist versus a non-anaesthesiologist. There is mounting evidence that the presence of an anaesthesiologist is safer. We will review the recent literature concerning paediatric anaesthesia outside the operating room and offer recommendations that may impact on efficacy and safety.

Journal Article↗
PubMed2002

Calculating a potential increase in hospital margin for elective surgery by changing operating room time allocations or increasing nursing staffing to permit completion of more cases: a case study.

UNLABELLED: Administrators routinely seek to increase contribution margin (revenue minus variable costs) to better cover fixed costs, provide indigent care, and meet other community service responsibilities. Hospitals with high operating room (OR) utilizations can allocate OR time for elective surgery to surgeons based partly on their contribution margins per hour of OR time. This applies particularly when OR caseload is limited by nursing recruitment. From a hospital's annual accounting data for elective cases, we calculated the following for each surgeon's patients: variable costs for the entire hospitalization or outpatient visit, revenues, hours of OR time, hours of regular ward time, and hours of intensive care unit (ICU) time. The contribution margin per hour of OR time varied more than 1000% among surgeons. Linear programming showed that reallocating OR time among surgeons could increase the overall hospital contribution margin for elective surgery by 7.1%. This was not achieved simply by taking OR time from surgeons with the smallest contribution margins per OR hour and giving it to the surgeons with the largest contribution margins per OR hour because different surgeons used differing amounts of hospital ward and ICU time. We conclude that to achieve substantive improvement in a hospital's perioperative financial performance despite restrictions on available OR, hospital ward, or ICU time, contribution margin per OR hour should be considered (perhaps along with OR utilization) when OR time is allocated. IMPLICATIONS: For hospitals where elective surgery caseload is limited by nursing recruitment, to increase one surgeon's operating room time either another surgeon's time must be decreased, nurses need to be paid a premium for working longer hours, or higher-priced "traveling" nurses can be contracted. Linear programming was performed using Microsoft Excel to estimate the effect of each of these interventions on hospital contribution margin.

Elective Surgical Procedures↗
PubMed1975

The effect of operating-room environment on the infection rate after Charnley low-friction total hip replacement.

After 300 Charnley low-friction arthroplasties done in two hospitals by two surgical teams using clean-air enclosures but no preoperative, operative, or postoperative antibiotics, there were three deep wound infections, two caused by Staphylococcus albus, coagulase negative, and one by Klebsiella. Two of these infections occurred in hips previously operated on and one was in a hip with no previous surgery. These findings suggest that two operating-room environments using the same basic principles without antibiotics can achieve a 1 per cent rate of deep wound infection with no early deep wound infections after total hip replacement, a rate comparable to that reported in other series in which antibiotics were used. However, this study did not answer the questions: Is the environment the primary reason for the low infection rate or is it the discipline required by the environment? Will the rate of late (four to five years) wound infection after operations done in a clean-air enclosure be lower than that after procedures done in a "normal" operating-room environment using preoperative, operative, and postoperative antibiotics?

Air Microbiology↗
PubMed1999

[Use of short wave ultraviolet radiation for disinfection in operating rooms].

Over a number of years, short wave ultraviolet radiation (UVC; 200-280 nm) has been used to disinfect air and surfaces in operating rooms, patient rooms, laboratories and so on, as well as air in ventilation ducts. Despite the well-documented effect of ultraviolet radiation on air quality, thus reducing the occurrence of infections, this technology has been relatively little used. One advantage of this method is that the UVC sources ensure a continuous reduction in the number of airborne microorganisms that are generated all the time. There are, however, some disadvantages with this method. Human exposure to ultraviolet C may cause keratoconjunctivitis and erythema and requires protection of the skin and the eyes of people exposed to levels above recommended exposure limits. However, by enclosing the UVC sources or by irradiating in the absence of human activity, human exposure is eliminated. These and other aspects concerning the use of short wave ultraviolet radiation as a disinfection agent in operating rooms are discussed in this article.

Air Microbiology↗
PubMed1996

Late operating room starts: experience with an education trial.

PURPOSE: This study was undertaken to determine if late starts of first cases in the Operating theatres at the SMBD-Jewish General Hospital remained a problem after identification of the causes of late starts and remedial actions being taken. METHODS: Hospital approval was obtained. A retrospective chart audit analyzed a two week period (10 days with 90 elective surgical cases) in October 1993. The time of entry by the first patient into each Operating Room (OR) was transcribed from the nursing records from each OR. A late start was defined as patient entry into the OR after 0745 hr. This audit revealed 77.8% of patients scheduled' for surgery at 0745 entered the OR late with a cumulative time lost of 1101 min. The reasons for this inefficiency were identified by a follow-up assessment in April 1995 as a result of this audit. Corrective measures included presentation of inpatients for the first case, reorganization of transport personnel schedules to facilitate arrival of patients to the OR, alteration of patient verification procedures prior to entry to the OR, and education of nursing, anaesthesia, and surgical personnel of the scope of the problem of late OR starts. All attending surgeons were notified either by letter or by discussion at departmental rounds. These measures were in effect by July 1995. A second audit, using the same methodology as the first, evaluated a two week period (10 days with 87 elective surgical cases) in October 1995. RESULTS: The second audit showed 65.5% of patients (average of 9 operating rooms daily) scheduled for surgery at 0745 entered the OR late with 601 min lost. The average delay for late starting cases decreased from 15.73 +/- 4.56 to 10.54 +/- 3.92 min (P < 0.05). CONCLUSION: Late OR starts are common and only modest improvements can be achieved without cooperation from anaesthetists and surgeons to arrive on time.

Education↗
PubMed1997

Blood contacts in the operating room after hospital-specific data analysis and action.

BACKGROUND: There has been much work recently to quantify risk of blood exposures among operating room personnel. Little has been done to show the outcome of preventive strategies. Three hospitals implemented a variety of changes after detailed feedback on blood contact data. This report follows those hospitals to document changes in blood contact rates. METHODS: Each hospital reviewed detailed data on blood exposures and developed a range of strategies to reduce contacts. In a second data collection period, uniformly trained circulating nurses sought information during surgical procedures on blood contacts among staff. Data were collected on all blood contacts and surgeries during which they occurred. These data were then compared with data from the previous study period, before changes in practices. RESULTS: All blood contacts combined and in each hospital decreased significantly in the second data collection period. Percutaneous exposures also consistently decreased, but did not reach statistical significance. The distribution of types of contact changed, with percutaneous exposures representing a larger proportion of contacts seen in the second period. Similar anatomic locations, devices, and characteristics of surgeries were associated with blood contacts in both periods. DISCUSSION: Specific data provided to operating room personnel motivated the development of specific strategies, although the influence of feedback alone versus specific interventions can not be separated. Analysis and generation of hospital-specific data on blood exposures among operating personnel may have a positive influence in lowering the risk of blood exposures in this population group.

Blood-Borne Pathogens↗