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PubMed2005

Team communication in the operating room.

Good communication is vital for safe patient care and good team functioning, not only in the Operating Room but also in all areas of healthcare, as well as in other safety critical industries. Examples from aviation demonstrate both the failures and the successes that can arise from poor and excellent communication. There are six components of effective teamwork: situational awareness, problem identification, decision making, workload distribution, time management and conflict resolution. Practising these, and self-evaluation of team communication, should help to improve team function and contribute to making patient care safer.

Communication↗
PubMed1979

Rhytidectomies in office operating rooms.

We report our experiences in 100 consecutive face lifts done in a well-equipped office operating room, and we believe the results answer the question about the safety of face lifts being done in this manner in a carefully screened population. With the application of our preoperative criteria for patient selection, the complication rate in these outpatients compares favorably with the reported rates in inpatient series of face lifts. Patient satisfaction has been higher, we feel.

Adult↗
PubMed1989

Justification of an operating-room satellite pharmacy.

The pharmacy department's documentation of medication handling and control in a 24-suite operating room (OR) complex to justify implementation of an OR pharmacy satellite is described. At a 937-bed hospital, medication inventory, charge capture, and procedures for handling controlled substances were assessed to justify an OR pharmacy both financially and in terms of patient safety. Actual medication charges to patients using the OR billing system were compared with theoretical pharmacy charges based on medication administration records; results indicated that an OR pharmacy would increase gross revenue by $671,606 annually. New collectible revenue from increased charge capture was projected to be $71,926, considering payer mix, reimbursement rates, and current payment methods. The cost of medication inventory in the OR complex was $75,576; a $55,000 inventory reduction and $50,000 annual decrease in drug wastage was projected. First-year personnel costs associated with an OR pharmacy were estimated at $79,872 and equipment and renovation costs at $5,000. New collectible revenue to the institution, after expenses, was projected at $79,959 from the first year of operation and $277,569 after five years. Controlled-substance documentation was incomplete; 19% of fentanyl and 31% of sufentanil removed from inventory were not recorded as administered, returned, or wasted. The results indicated that, at this institution, approximately three OR complex full-time equivalents could be relieved from medication-related activities. Based on the potential for improved patient safety and new revenue generation, implementation of an OR satellite pharmacy was recommended to the hospital administration.

Cost-Benefit Analysis↗
PubMed2006

The impact of service-specific staffing, case scheduling, turnovers, and first-case starts on anesthesia group and operating room productivity: a tutorial using data from an Australian hospital.

BACKGROUND: In this tutorial, we consider the impact of operating room (OR) management on anesthesia group and OR labor productivity and costs. Most of the tutorial focuses on the steps required for each facility to refine its OR allocations using its own data collected during patient care. METHODS: Data from a hospital in Australia are used throughout to illustrate the methods. OR allocation is a two-stage process. During the initial tactical stage of allocating OR time, OR capacity ("block time") is adjusted. For operational decision-making on a shorter-term basis, the existing workload can be considered fixed. Staffing is matched to that workload based on maximizing the efficiency of use of OR time. RESULTS: Scheduling cases and making decisions on the day of surgery to increase OR efficiency are worthwhile interventions to increase anesthesia group productivity. However, by far, the most important step is the appropriate refinement of OR allocations (i.e., planning service-specific staffing) 2-3 mo before the day of surgery. CONCLUSIONS: Reducing surgical and/or turnover times and delays in first-case-of-the-day starts generally provides small reductions in OR labor costs. Results vary widely because they are highly sensitive both to the OR allocations (i.e., staffing) and to the appropriateness of those OR allocations.

Anesthesiology↗
PubMed2006

Surgical PACS for the digital operating room. Systems engineering and specification of user requirements.

For better integration of surgical assist systems into the operating room, a common communication and processing plattform that is based on the users needs is needed. The development of such a system, a Surgical Picture Aquisition and Communication System (S-PACS), according the systems engineering cycle is oulined in this paper. The first two steps (concept and specification) for the engineering of the S-PACS are discussed.A method for the systematic integration of the users needs', the Quality Function Deployment (QFD), is presented. The properties of QFD for the underlying problem and first results are discussed. Finally, this leads to a first definition of an S-PACS system.

Computer Simulation↗
PubMedDate not supplied

Australian operating room registered nurse education: a national study comparing two types of healthcare technology.

A random sample of operating room registered nurses (N = 258) working in hospitals throughout Australia was surveyed to compare how and what they initially learned about two types of healthcare technology--the count procedure and the electrosurgical unit (ESU)--and the consequences of their use. The most frequently identified method of initially learning to use both technologies was receiving instruction from a staff member on their unit. A comparison of what registered nurses initially learned about the technologies revealed that nurses were significantly more likely to learn more about the count procedure. The count procedure and ESU caused less than one-third of nurses to experience stress; participants were significantly less likely to have had an inaccurate count procedure result in patient harm (10.1%) than to have used an ESU that caused patient harm (17.4%).

Australia↗
PubMed2002

[Perioperative mortality and morbidity in the year 2000 in 520 certified training hospitals of Japanese Society of Anesthesiologists: with a special reference to age--report of Japanese Society of Anesthesiologists Committee on Operating Room Safety].

Perioperative mortality and morbidity in Japan for the year 2000 were studied retrospectively. Committee on Operating Room Safety of Japanese Society of Anesthesiologists (JSA) sent confidential questionnaires to 794 Certified Training Hospitals of JSA and received answers from 67.6% of the hospitals. We analyzed their answers with a special reference to the age group. The total number of anesthetics available for this analysis was 910,757. All cases were divided into 7 age groups; group A (< 1 months), group B (< 12 months), group C (< 5 years), group D (< 18 years), group E (< 65 years), group F (< 85 years), and group G (> 85 years). The incidences of all critical events including cardiac arrest, severe hypotension, and severe hypoxemia were 70.04, 42.06, 17.79, 15.57, 21.14, 39.66, and 44.65 per 10,000 in patients with group A, B, C, D, E, F, and G, respectively. The overall mortality rates (death during anesthesia and within 7th postoperative day) were 26.94, 5.91, 1.88, 2.57, 5.23, 11.98, and 17.50 per 10,000 anesthetics in patients with group A, B, C, D, E, F, and G, respectively. The incidences of cardiac arrest were 28.29, 8.54, 3.56, 2.57, 5.08, 10.27, and 11.47 per 10,000 in patients with group A, B, C, D, E, F, and G, respectively. The mortality rates after cardiac arrest were 18.86, 4.60, 1.26, 1.57, 2.77, 5.50, and 6.64 in patients with group A, B, C, D, E, F, and G, respectively. The incidence of all critical events, the incidence of cardiac arrest, and the overall mortality rate were much higher in group A than in other groups, but much lower than those in 1999. The incidences of all critical events and the mortality rate after cardiac arrest were lowest in group C. Mortality and morbidity due to all kinds of causes including anesthetic management, intraoperative events, co-existing diseases, and operation were as follows. The incidences of all critical events attributable to co-existing disease were the highest in these four groups, and 32.33, 13.80, 5.86, 4.43, 7.50, 15.34, and 21.72 per 10,000 in patients with group A, B, C, D, E, F, and G, respectively. The incidences of all critical events attributable to anesthetic management were 13.47, 16.43, 6.28, 3.86, 4.08, 6.87, and 6.64 per 10,000 in patients with group A, B, C, D, E, F, and G, respectively. The incidence of cardiac arrest in group A was much more attributable to co-existing disease and operation than other causes. The incidences of cardiac arrest attributable to anesthetic management were 0.00, 1.97, 0.63, 0.29, 0.38, 0.74, and 1.81 per 10,000 in patients with group A, B, C, D, E, F, and G, respectively. Its mortality rate in each group was 0.00, 0.00, 0.21, 0.14, 0.06, 0.04, or 0.00. There were eleven cases of death or vegetative state due to anesthetic management, like improper management of airway and overdose of anesthetics. Some of them were preventable with the anesthesiologists' effort in protocol development and skilled assistance.

Adolescent↗
PubMed2002

An Anesthesia Information Management System (AIMS) as a tool for controlling resource management of operating rooms.

OBJECTIVES: In our department, we have been using an Anesthesia Information Management System (AIMS) for five years. In this study, we tested to what extent data extracted from the AIMS could be suitable for the supervision and time-management of operating rooms. METHODS: From 1995 to 1999, all relevant data from 103,264 anesthetic procedures were routinely recorded online with the automatic anesthesia record keeping system NarkoData. The program is designed to record patient related time data, such as the beginning of anesthesia or surgical procedure, on a graphical anesthesia record sheet. The total number of minutes of surgery and anesthesia for each surgical subspecialty per hour/day and day of the year was calculated for each of the more than 40 ORs, amounting to a total of 112 workstations. RESULTS: It was possible to analyze the usage and the utilization of ORs at the hospital for each day of the year since 1997. In addition, annual and monthly evaluations are made available. It is possible to scrutinize data of OR usage from different points of view: queries on the usage of an individual OR, the usage of ORs on certain days or the usage of ORs by a certain surgical subspecialty may be formulated. These data has been used repeatedly in our hospital for decision making in OR management and planning. CONCLUSIONS: In assessing the results of our study, it should be considered that the system used is not a specialized OR management tool. Despite these restrictions, the system contains data which can be used for an exact and relevant presentation of OR utilization.

Anesthesiology↗
PubMed2006

Incidence and nature of adverse events during pediatric sedation/anesthesia for procedures outside the operating room: report from the Pediatric Sedation Research Consortium.

OBJECTIVE: We sought to use a large database of prospectively collected data on pediatric sedation and/or anesthesia for diagnostic and therapeutic procedures to delineate the nature and the frequency of adverse events that are associated with sedation/anesthesia care for procedures that are performed outside the operating room in children. METHODS: Data were collected by the Pediatric Sedation Research Consortium, a collaborative group of 35 institutions that are dedicated to improving sedation/anesthesia care for children internationally. Members prospectively enrolled consecutive patients who were receiving sedation or anesthesia for procedures. Data on demographics, primary illness, coexisting illness, procedure performed, medications used, outcomes, airway interventions, and adverse events were collected and reported on a Web-based data collection tool. RESULTS: A total of 26 institutions submitted data on 30,037 sedation/anesthesia encounters during the study period from July 1, 2004, to November 15, 2005. Serious adverse events were rare in the institutions involved in this study; there were no deaths. Cardiopulmonary resuscitation was required once. Less serious events were more common with O2 desaturation below 90% for > 30 seconds, occurring 157 times per 10000 sedations. Stridor and laryngospasm both occurred in 4.3 per 10,000 sedations. Unexpected apnea, excessive secretions, and vomiting had frequencies of 24, 41.6, and 47.2 per 10,000 encounters, respectively. CONCLUSIONS: Our data indicate that pediatric sedation/anesthesia for procedures outside the operating room is unlikely to yield serious adverse outcomes in a collection of institutions with highly motivated and organized sedation services. However, the safety of this practice depends on the systems' ability to manage less serious events.

Ambulatory Surgical Procedures↗
PubMed1999

Optimal sequencing of urgent surgical cases. Scheduling cases using operating room information systems.

Optimal sequencing of urgent cases (i.e., selecting which urgent case should be performed first and which second) may enhance patient safety, increase patient satisfaction with timeliness of surgery, and minimize surgeons' complaints. Before determining the optimal sequence of urgent cases, an operating room (OR) suite must identify the primary scheduling objective to be satisfied when prioritizing pending urgent cases. These scheduling objectives may include: 1) perform the cases in the sequence that minimizes the average length of time each surgeon and patient waits; 2) perform the cases in the order that they were submitted; or 3) perform the cases based on medical priority, as prioritized by an OR director, or surgeons discussing the cases among themselves. We provide mathematical structure which can be used to program a computerized surgical services information system to assist in optimizing the sequence of urgent cases. We use an example to illustrate that the optimal sequence varies depending on the scheduling objective chosen.

Algorithms↗