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PubMed1983

Surgeons and operating rooms: underutilized resources.

A classification of surgical procedures, based on degree of complexity and the need for facilities and personnel, was applied to all 50,782 surgical interventions performed in the Valle del Cauca, Colombia during 1974. Three-fourths of all operations were of low levels of complexity, and most could be performed on an ambulatory basis with immediate discharge after recovery from anesthesia. Mean numbers of operations per year for surgical specialists and other physicians were 119.7 and 18.1, respectively. The 76 existing operating rooms were utilized only 41.6 per cent of the time. The implications of underutilization of personnel and facilities and low productivity of surgeons are discussed.

Colombia↗
PubMed1998

An examination of the variables associated with the adoption of a computerized innovation (an operating room simulation model).

The purpose of this study was to describe the variables that influenced senior staff to decide to adopt (or reject) a computerized innovation (Operating Room Simulation Model) and to describe the decision process at four hospitals. Rogers' Innovation-Decision Process Model (1983) and Model of the Innovation Process in Organizations (1983) formed the conceptual framework for this study. Five specific variables (relevant advantage, compatibility, complexity, trialability, observability), that were shown in the literature to increase the probability of an innovation to be adopted, were investigated. The results of this study indicated that there was a match between relevant advantage and adoption and no match between compatibility and adoption. There were insufficient data to determine if a match existed between complexity, trialability and observability with adoption of the Model. The links between the organizational variables (agenda setting, matching, decision) and adoption of the OR Simulation Model were not conclusive.

Attitude to Computers↗
PubMed2006

Technologies and solutions for data display in the operating room.

Recent advances in technology have led to the introduction of a variety of innovative devices, each with their own platform for data display, into the operating room (OR). While these innovative applications are expanding the traditional boundaries of the surgical space and enhancing treatment capabilities, the introduction of additional screens and displays is placing an ever-increasing load on the OR team. This review describes the main data display platforms currently available in ORs: computer monitors with CRT (cathode ray tube) or LCD (liquid crystal display) screens, suspended imaging displays, wearable computers (WC), auditory displays and tactile (haptic) displays. The different display platforms are evaluated according to their compatibility with the characteristics of the working environment (OR), the monitoring task, and the users (the surgical team). No single display configuration provides an ultimate solution for presenting patient data in the OR. A multi-sensory data display including visual, acoustic and haptic manipulation is suggested as a promising configuration for data display in the OR.

Biotechnology↗
PubMed1996

The risk of an unplanned return to the operating room in Australian hospitals.

BACKGROUND: The unplanned return of the patient to the operating room (OR) after a previous procedure has implications concerning the quality of surgery, but little has been written on this subject. METHODS: The relationship of bed-size and hospital type (private or public) was studied using data on this clinical indicator submitted to the Australian Council on Healthcare Standards Care Evaluation Program (ACHS CEP) by hospitals presenting voluntarily for accreditation in 1993. RESULTS: The mean rate of an unplanned return to OR was 0.6% (95% confidence interval 0.5-0.7). After adjusting for potential confounders in a logistic model, the risk of unplanned return to OR did not significantly differ by type of hospital (private or public), and location (rural, metropolitan). The risk of unplanned return to OR was higher in large compared with small hospitals. CONCLUSIONS: The finding of the risk of the event being greater in large compared with small hospitals is likely to be a reflection of casemix. An interval review of results (for any facility) is obviously necessary. With some operations a higher incidence of return to the OR may indicate vigilance in peri-operative management.

Australia↗
PubMed1992

Noise pollution in the operating room: a hazard to surgeons, personnel, and patients.

Noise levels up to 118 dB--a level that is potentially damaging to the hearing--were measured in the operating room, notably during the use of high-speed gas turbine bone-cutting drills. Suction tips, which had trapped tissue "whistles" inside, yielded noise levels of up to 96 dB. Surgeons, staff, and patients should be cautioned against such noises and shielded in prolonged cases. We offer a review of acoustical criteria for various practical noises and duration of safe exposure.

Adult↗
PubMed1986

Work practices relating to intubation in operating rooms in Sweden.

A survey into the current usage of tracheal tubes in operating rooms was carried out in Sweden by sending a questionnaire to anaesthetists in charge of anaesthetic departments in 90 acute hospitals, which included seven teaching hospitals. The object was to determine how far the recent advances in tube, cuff design, and material had influenced the attitudes and work practices of anaesthetists. Fifty-eight replies were recorded (a 64.4% response rate). All teaching hospitals and the majority of other hospitals favoured tubes with high-volume, low-pressure cuffs. Most hospitals used size 9 orotracheal tubes in adult male and size 8 in adult female patients. Seventy-one per cent of teaching hospitals used both local anaesthetic jelly for lubricating tubes and topical laryngeal spray prior to intubation. Nasal decongestants were used by only 14.2% of teaching hospitals prior to nasal intubation. Over three-fourths of the hospitals were in favour of inflating the cuff to no-leak ventilation. Just over half of non-teaching hospital and two-thirds of teaching hospital monitored intracuff pressure.

Anesthesia↗
PubMed1996

Zoned vertical ultraclean operating room ventilation. A novel concept making long side walls unnecessary.

We evaluated a novel concept of High Efficiency Particulate Air (HEPA)-filtered vertical Laminar Air Flow (LAF) for operating room ventilation, designed to be used without side-walls. The LAF-unit has a central zone with an airflow of 0.4 m/s and a peripheral zone with an airflow of 0.2 m/s. The design provides an exponential downflow of air resembling an upside-down trumpet mouth and it was claimed to prevent entrainment of peripheral contaminated air. The unit was evaluated with regard to elimination of particles with focus on bacteria-carrying particles (colony-forming units = cfu) during rigidly standardized sham operations. Three different lengths of walls/enclosures (short-ending 2.0 m, medium 1.0 m and long 0.2 m above the floor) were tested. It provided a high degree of bacteriological cleanliness (0.05-4 cfu/m3 of air and 7-64 cfu/m2/h surface contamination) and its efficiency was proved to be independent of the length of the enclosures. We conclude that the novel zoned ultraclean vertical LAF unit is versatile, as it allows for omitting long side-walls, without compromising bacteriological safety.

Air Microbiology↗
PubMed2006

Limited opportunities for paramedic student endotracheal intubation training in the operating room.

BACKGROUND: Paramedics, who often are the first to provide emergency care to critically ill patients, must be proficient in endotracheal intubation (ETI). Training in the controlled operating room (OR) setting is a common method for learning basic ETI technique. OBJECTIVES: To determine the quantity and nature of OR ETI training currently provided to paramedic students. METHODS: The authors surveyed directors of paramedic training programs accredited by the Commission on Accreditation of Allied Health Education Programs. An anonymous 12-question, structured, closed-response survey instrument was used that requested information regarding the duration and nature of OR training provided to paramedic students. The results were analyzed by using descriptive statistics. RESULTS: From 192 programs, 161 completed surveys were received (response rate, 85%). OR training was used at 156 programs (97%) but generally was limited (median, 17-32 hours per student). Half of the programs provided fewer than 16 OR hours per student. Students attempted a limited number of OR ETI (median, 6-10 ETI). Most respondents (61%) reported competition from other health care students for OR ETI. Other identified hindering factors included the increasing OR use of laryngeal mask airways and physicians' medicolegal concerns. Respondents from 52 (33%) programs reported a recent reduction in OR access, and 56 (36%) programs expected future OR opportunities to decrease. CONCLUSIONS: Despite its key role in airway management education, the quantity and nature of OR ETI training that is available to paramedic students is limited in comparison to that available to other ETI providers.

Emergency Medical Technicians↗