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At least 541 records · Page 30Linked to original sources
PubMed2005

A procedure for rapid issue of red cells for emergency use.

CONTEXT: A College of American Pathologists Q-Probe revealed that the median turnaround times for emergency requests for red blood cells from the operating room were 30 minutes to release of cells from the blood bank and 34 minutes to delivery to the operating room. These times may not be adequate to permit the red cells to provide sufficiently rapid delivery of oxygen in massively bleeding patients. OBJECTIVE: To improve the time from emergency request for red cells to delivery to the operating room. DESIGN: A new emergency issue program was implemented for only the operating rooms; emergency issue to all other hospital locations remained unchanged. Six units of group O Rh-negative red blood cells (RBCs) are maintained in the blood bank in a separate basket with transfusion forms containing the unit numbers and expiration dates and a bag with one blood tubing segment from each unit. The times to issue and to delivery to the operating room suite were compared with time to issue of 2 group O Rh-negative RBCs for other hospital locations using the older system during the same time period and with the time to issue of 2 units to all other hospital locations during the preceding 2 years. SETTING: A university hospital. MAIN OUTCOME MEASURES: Time between emergency request for red cells and delivery to the operating room. RESULTS: The time between blood bank notification and arrival in the operating room of the 6 units of RBCs was significantly shorter than the time required to just issue (not including delivery time) 2 units of RBCs to other hospital locations. With the new procedure, 82% of units issued reached the operating room within 2 minutes of request, 91% arrived within 3 minutes, and 100% arrived within 4 minutes. These percentages are significantly higher than those for only issue of blood (without delivery) using the older issuing procedure for all hospital locations during the previous 2 years (37%, 49%, and 66%, respectively; P = .007, .009, and .02, respectively) and for other locations during the same 7-month period (29%, 46%, and 73%, respectively; P = .004, .01, and .09, respectively). Time (mean [95% confidence interval]) from blood bank notification to delivery of RBCs to the operating room suite (2.1 [1.6-2.6] minutes, of which approximately 50-60 seconds is attributable to delivery time) was less than issue times (not including delivery times) using the older issuing procedure for other hospital locations during the same period (4.1 [3.1-5.0] minutes; P = .007). CONCLUSIONS: An emergency issue procedure can be used to issue several units of RBCs within 1 minute and have them delivered to the operating room within 2 minutes while maintaining sufficient controls and providing required information to satisfy patient and blood bank requirements.

Blood Banks↗
PubMed1983

Reducing lost drug charges by monitoring computer-generated interdepartmental transfers.

The use of computerized interdepartmental transfer records to identify lost drug charges and a program to capture those charges are described. All charges for medications ordered on floor-stock requisitions for the operating room and various intensive-care units in a 400-bed hospital were entered into the pharmacy's computer. Medications ordered on requisitions that were not stamped with a specific patient's name were charged to the patient-care unit using the computer's interdepartmental transfer program. Computer reports itemizing these charges indicated that over $5100 per month was being lost, approximately half of which originated from the operating room. To reduce lost charges, an improved method of drug-inventory control was implemented in the operating room, and two nurses were hired to coordinate the drug-distribution system in this area. In addition, nurses in other intensive-care units were informed about the liabilities associated with failure to charge for medications, and incentive programs were developed to improve compliance with these procedures. During the first six months after implementation of these measures, monthly lost charges were reduced by a mean of 86%. The use of computerized interdepartmental transfer records to identify lost pharmacy charges may help to justify the cost of computer systems.

Computers↗
PubMedDate not supplied

Impact of a cost containment program on the use of volatile anesthetics and neuromuscular blocking drugs.

STUDY OBJECTIVE: To determine the impact of a cost containment program on the use of volatile anesthetics and neuromuscular blocking drugs. DESIGN: Historical, controlled, retrospective analysis. SETTING: Main operating rooms of an adult general hospital at a university medical center. PATIENTS: All patients undergoing anesthesia between July 1991 and November 1993. MEASUREMENTS AND MAIN RESULTS: Cost per case was determined by dividing the monthly expenditure for each class of drug by the caseload for that month. Cost per case of volatile anesthetic drugs decreased from $19.20 +/- 1.16 to $15.16 +/- 0.39 (p = 0.0034 by unpaired t-test). For neuromuscular blocking drugs, cost per case decreased from $19.67 +/- 1.35 to $12.23 +/- 0.66 (p = 0.003). CONCLUSIONS: Concerted educational efforts can decrease the per case expenditures for both volatile anesthetic drugs and neuromuscular blocking drugs.

Academic Medical Centers↗
PubMed2002

Frameless stereotaxy as an alternative to fluoroscopy for transsphenoidal surgery: use of the InstaTrak-3000 and a novel headset.

Our aim was to evaluate the applicability of an electromagnetic-based frameless stereotactic system for use in transsphenoidal surgery. The system utilizes a novel headset that acts as a replaceable fiducial frame as well as a fixation point for the system's transmitter. It can replace the fluoroscope as a guide to navigation in the sphenoid sinus and sella. The system was used in a consecutive series of 11 patients undergoing transsphenoidal surgery. It was used in conjunction with intraoperative fluoroscopy. We found the Instatrak-3000 to correlate well with lateral fluoroscopic images, and provide additional information in the axial and coronal planes. The InstaTrak-3000 frameless stereotactic system is accurate and obviates the need for intraoperative fluoroscopy during transsphenoidal surgery. Compared to other frameless systems, it avoids the use of fiducial skin markers and head fixation. In common with other frameless stereotactic systems, it provides additional information important for safely approaching the sella and avoids intraoperative radiation exposure for the patient and operating room staff.

Adenoma↗
PubMed1999

The Brigham integrated computing system (BICS): advanced clinical systems in an academic hospital environment.

The Brigham integrated computing system (BICS) provides nearly all clinical, administrative, and financial computing services to Brigham and Women's Hospital, an academic tertiary-care hospital in Boston. The BICS clinical information system includes a very wide range of data and applications, including results review, longitudinal medical records, provider order entry, critical pathway management, operating-room dynamic scheduling, critical-event detection and altering, dynamic coverage lists, automated inpatient summaries, and an online reference library. BICS design emphasizes direct physician interaction and extensive clinical decision support. Impact studies have demonstrated significant value of the system in preventing adverse events and in saving costs, particularly for medications.

Computer Security↗
PubMed2003

Telemedicine in tomorrow's operating room: a natural fit.

The integration of telecommunications and information technologies in medicine, known as telemedicine, has traditionally been outside the operating room. However, with the advent of new technologies, smart systems, and advanced computing, adoption and adaptation of these technologies in the operating room has increased. The operating room has been a place of startling isolation. The operating room is an island within a health system that is only reached by a select few. The application of telemedicine in this inaccessible place offers a huge potential in a variety of ways. These include enhanced education for students, enhanced safety for the patient, enhanced knowledge of the events that occur-a sort of status monitoring of underlying infrastructures-and sharing of the operating environment for collaboration. The Operating Room of the Future will be linked to other islands of expertise by robust telemedicine capabilities, thereby eliminating the isolation. Telemedicine in tomorrow's operating room is a natural fit

Humans↗
PubMed2006

Incident reporting in anesthesia: misidentification of propofol concentrations due to similarities in drug packaging.

We report three cases of misidentification of propofol concentrations due to similarities in drug packaging, which were identified by the incident reporting system. Incident reporting is an approach used to assess the incidence of adverse and potentially adverse events, established to manage the contributing factors and to develop appropriate strategies to prevent errors in anesthesia. Inadvertently, 2% propofol was administered instead of 1%, causing overdosage and prolonged anesthesia in two consecutive patients in the same operating room. The third case was a near-miss that occurred in another operating room of the hospital: a syringe containing 2% propofol instead of 1% was prepared by the nurse, but the anesthesiologist checked the concentration before the induction of anesthesia. The errors occurred due to the presence of similar propofol packaging in the operating rooms. They were the result of both human error because the anesthesia personnel forgot to check the propofol concentration, and system failure, due to the color code of the packaging. In our experience, incident reporting detected the recurrence of drug related errors. Therefore, a preventive strategy was put in place by eliminating 2% propofol packaging from the operating rooms. This paper highlights the need for a cultural shift in the way we collect information on incidents, and it is an example of effective improvement to prevent drug error by reducing the complexity of the system.

Adult↗
PubMed1998

Calibration of tracking systems in a surgical environment.

The purpose of this paper was to assess to what extent an optical tracking system (OTS) used for position determination in computer-aided surgery (CAS) can be enhanced by combining it with a direct current (dc) driven electromagnetic tracking system (EMTS). The main advantage of the EMTS is the fact that it is not dependent on a free line-of-sight. Unfortunately, the accuracy of the EMTS is highly affected by nearby ferromagnetic materials. We have explored to what extent the influence of the metallic equipment in the operating room (OR) can be compensated by collecting precise information on the nonlinear local error in the EMTS by using the OTS for setting up a calibration look-up table. After calibration of the EMTS and registration of the sensor systems in the OR we have found the average euclidean deviation in position readings between the dc tracker and the OTS reduced from 2.9+/-1.0 mm to 2.1+/-0.8 mm within a half-sphere of 530-mm radius around the magnetic field emitter. Furthermore we have found the calibration to be stable after re-registration of the sensors under varying conditions such as different heights of the OR table and varying positions of the OR equipment over a longer time interval. These results encourage the further development of a hybrid magnetooptical tracker for computer-aided surgery where the electromagnetic tracker acts as an auxiliary source of position information for the optical system. Strategies for enhancing the reliability of the proposed hybrid magnetooptic tracker by detecting artifacts induced by mobile ferromagnetic objects such as surgical tools are discussed.

Calibration↗
PubMed2006

Integrating surgical robots into the next medical toolkit.

Surgical robots hold much promise for revolutionizing the field of surgery and improving surgical care. However, despite the potential advantages they offer, there are multiple barriers to adoption and integration into practice that may prevent these systems from realizing their full potential benefit. This study elucidated some of the most salient considerations that need to be addressed for integration of new technologies such as robotic systems into the operating room of the future as it evolves into a complex system of systems. We conducted in-depth interviews with operating room team members and other stakeholders to identify potential barriers in areas of workflow, teamwork, training, clinical acceptance, and human-system interaction. The findings of this study will inform an approach for the design and integration of robotics and related computer-assisted technologies into the next medical toolkit for "computer-enhanced surgery" to improve patient safety and healthcare quality.

Robotics↗
PubMed1998

Asking residents about adverse events in a computer dialogue: how accurate are they?

BACKGROUND: Although retrospective identification of adverse events is time-consuming, whether they are present and/or expected is often readily apparent to providers during the provision of care. METHODS: A computer program to flag admissions with possible adverse events was developed. Readmissions to the hospital within 31 days and admissions including more than one visit to the operating room (OR) were flagged. For surgical site infections, all admissions--including a visit to the OR--were flagged, but only a sample was evaluated in the reliability assessment. Residents in an urban, tertiary care hospital were questioned when inputting computerized discharge orders regarding adverse events among 391 cases sampled from 6,813 admissions for a two-month period. RESULTS: For the 228 readmissions (3.3% of all admissions) identified by the computer program, resident responses had a sensitivity of 57% and a specificity of 73% in detecting an unexpected readmission (nurse responses, 96% and 91%). For the 79 patients with a return to the OR, the residents' responses had a sensitivity of 86% and a specificity of 84% for detecting an unexpected return (versus 75% and 98% for the nurses' responses). For the 209 patients with an OR visit, the sensitivity and specificity for a surgical site infection were 85% and 98% for the residents and 54% and 99% for the nurses. DISCUSSION: Information systems can be used to screen for adverse events and to ask providers whether adverse events are unexpected, although the reliability of this approach is likely to vary by event type.

Boston↗
PubMed2005

Conventional and thermophilic aerobic treatability of high strength oily pet food wastewater using membrane-coupled bioreactors.

Although thermophilic treatment systems have recently gained considerable interest, limited information exists on the comparative performances of membrane-coupled bioreactors (MBR) at thermophilic and conventional conditions. In this study aerobic MBRs operating at room temperature (20 degrees C) and at lower thermophilic range (45 degrees C) were investigated for the treatment of dissolved air flotation (DAF) pretreated pet food wastewater. The particular wastewater is characterized by oil and grease (O & G) concentrations as high as 6 g/L, COD of 51 g/L, BOD of 16 g/L and volatile fatty acid (VFA) of 8.3 g/L. The performances of the two systems in terms of COD, BOD and O & G removal at varying hydraulic retention time (HRT) are compared. COD removal efficiencies in the thermophilic MBR varied from 75% to 98% and remained constant at 94% in the conventional MBR. The O & G removal efficiencies were 66-86% and 98% in the thermophilic and conventional MBR, respectively. Interestingly, high concentrations of VFA were recorded, equivalent to 50-73% of total COD, in the thermophilic MBR effluent. The observed yield in the thermophilic MBR was 40% of that observed in the conventional MBR.

Aerobiosis↗
PubMed2004

Intraoperative Iso-C C-arm navigation in cervical spinal surgery: review of the first 52 cases.

STUDY DESIGN: Fifty-two study participants underwent cervical spine surgery using intraoperative Iso-C imaging with or without spinal navigation. OBJECTIVES: To evaluate prospectively the feasibility, advantages, limitations, and applications of Iso-C in cervical spine surgery. SUMMARY OF BACKGROUND DATA: Existing stereotactic spinal navigational systems images must be acquired before surgery and typically require cumbersome point-to-point registration. Intraoperative computed tomography (CT) and magnetic resonance imaging (MRI) provide real-time information but can restrict access to the patient, preclude the use of traditional operating room tables, and are time-consuming. The Iso-C allows quick, CT-quality, real-time data acquisition without restricting access to the patient. The data acquired can be automatically transferred to navigational systems with the immediate ability to navigate for anterior or posterior cervical spine procedures. METHODS: High-resolution isotropic three-dimensional data sets were acquired using the Iso-C intraoperative fluoroscopy in 52 cervical spine cases. In 30 cases, the data were imported automatically to the StealthStation Treon to support neuronavigation. In 22 cases, a postprocedural intraoperative CT was obtained with the Iso-C primarily to assess the extent of osseous decompression and/or the accuracy of implants or instrumentation. In most cases, a postoperative high-resolution CT image was obtained and compared with the Iso-C data. RESULTS: Successful automated registration suitable for navigation was attained for all anterior and posterior cervical spinal cases. The postprocedural intraoperative Iso-C data were 100% concordant with those of postoperative high-resolution CT as determined by a blinded neuroradiologist. CONCLUSIONS: Iso-C intraoperative fluoroscopy is an accurate and rapid way to perform CT-quality image-guided navigation in cervical spinal surgery. In most cases, it obviates the need for postoperative imaging.

Adolescent↗
PubMed1999

Model-updated image guidance: initial clinical experiences with gravity-induced brain deformation.

Image-guided neurosurgery relies on accurate registration of the patient, the preoperative image series, and the surgical instruments in the same coordinate space. Recent clinical reports have documented the magnitude of gravity-induced brain deformation in the operating room and suggest these levels of tissue motion may compromise the integrity of such systems. We are investigating a model-based strategy which exploits the wealth of readily-available preoperative information in conjunction with intraoperatively acquired data to construct and drive a three dimensional (3-D) computational model which estimates volumetric displacements in order to update the neuronavigational image set. Using model calculations, the preoperative image database can be deformed to generate a more accurate representation of the surgical focus during an operation. In this paper, we present a preliminary study of four patients that experienced substantial brain deformation from gravity and correlate cortical shift measurements with model predictions. Additionally, we illustrate our image deforming algorithm and demonstrate that preoperative image resolution is maintained. Results over the four cases show that the brain shifted, on average, 5.7 mm in the direction of gravity and that model predictions could reduce this misregistration error to an average of 1.2 mm.

Adolescent↗
PubMed1987

[Development of an information system for operations].

The report describes a computer system that provides statistical information on the anesthetic and surgical procedures performed by anesthetists and surgeons, reports on the operative activity of the anesthesia and surgical departments, and assists in daily scheduling of the program. Additional programs can be used for billing, displaying the use of (operating room OR) facilities by the various surgical divisions, and showing the actual stage of on-line operations with monitors. The software system MUMPS has been found to be a low-priced yet efficient and versatile multiuser system. The main features of the program are ease of use, prospective data entry (i.e. during the entire stay of the patient), and the possibility of modifying and expanding the system easily. Missing or inaccurate data are automatically brought to the attention of those who have performed the operation or the anesthesia by a program that is run periodically. The system has been found to be a useful tool for the daily scheduling of the OR program. It provides data for better scheduling of personnel and records can also be kept regarding the professional experience of physicians. The major deficiency of the program at this stage is its lack of a hierarchical structure. For example, it is unable to record multiple operations and/or anesthetic procedures for the same patient. This deficiency will be corrected in a newer version of the program.

Anesthesia↗
PubMed1993

Audit of intensive care unit admissions from the operating room.

An audit of 265 intensive care unit (ICU) admissions from the operating room was performed for the year 1991. In a quality assurance exercise we identified 34 unanticipated ICU admissions (UIAs) by a retrospective peer review of the medical charts. Of these UIAs, 16 were deemed predictable and seven preventable. Five of the seven potentially preventable UIAs were judged to have had inappropriate intravenous fluid management. This has prompted changes in our education programme. In an assessment of our resource management, we evaluated prospectively collected data on the Apache II scores on the day of admission, the incidence of ICU-specific interventions, length of stay in ICU, and outcomes. ICU-specific interventions were not initially required in 36% of admissions and these patients had a low risk (1.1%) of eventually requiring ICU-specific interventions. In comparison with patients requiring ICU-specific interventions, they had lower Apache II scores (10.2 vs 13.1), shorter ICU stays (medians of one vs two days), lower ICU mortality (0 vs 8.2%), P < 0.05, but hospital mortality was not different (7.4 vs 15.3%). This audit has prompted reorganisation of our intensive care services, so that patients not requiring ICU-specific interventions will be managed in an intermediate care area with nurse:patient ratios of 1:3 or 4, in comparison with 1:1 or 2 ratios in the intensive care area.

Ambulatory Surgical Procedures↗
PubMed2003

Characteristics of bariatric surgery in an integrated VA Health Care System: follow-up and outcomes.

BACKGROUND: Since the 1991 NIH consensus conference, obesity surgery has been increasingly accepted as a form of therapy for morbid obesity. Approximately 40% of Veteran patients are obese and would potentially benefit from the operations. METHODS: Records were reviewed for all obesity operations performed at the Veterans Administration Greater Los Angeles Health Care System between January 1997 and April 2002. Morbidity, mortality, weight loss, and extent of follow-up were the outcomes measures assessed. RESULTS: Forty-six [11 Female (24%), 35 Male (76%)] patients underwent Roux-Y gastric bypass during the 63-month period we reviewed. There was one death from pulmonary hypertension unexpectedly encountered in the operating room. There was a single major complication: an anastomotic leak successfully treated with intravenous antibiotics. The Computerized Patient Record System contained extensive weight loss information, with dozens of weight measurements for these patients before and after surgery. Weight loss was sustained in all but 2 patients during the follow-up period. The only patients lost to follow-up were those referred from medical centers outside the boundaries of our integrated health care system. CONCLUSION: (1) The VA population has the opposite male/female ratio of populations reported in most weight loss studies. Because the health risks attributable to obesity are greater in males, the VA represents an important population to study that may benefit significantly from weight loss surgery. (2) Extensive clinical information available in the computerized medical record combined with frequent accession of health care resources by our patients resulted in a database rich in follow-up data for a population where long-term outcomes are traditionally difficult to obtain. (3) There was very low surgical morbidity and mortality in a high-risk population. This contrasts with the results of most volume-outcome studies and occurred in a low-volume hospital by a high-volume surgical and medical team. (4) Distinct patterns of weight loss were observed.

Delivery of Health Care, Integrated↗