Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Operating Room Information Systems”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 811 records · Page 45Linked to original sources
PubMed1994

The anesthesia workstation of the future.

This team's concern is that technology is not the primary limitation to developing the anesthesia workstation to its full potential. In some ways, medical equipment lags far behind other industries in technological sophistication, standardization, miniaturization, and human factors engineering. Real obstacles appear to be economic and conceptual. The anesthetic process has not been reduced to a series of rigorously derived equations; what the user does is still poorly understood. Manufacturers whose design engineers do not spend a significant part of their work week in the operating room seem to be so ignorant of the real needs of the clinician that their products are doomed to fail or to be mediocre. Clinicians need to encourage their industrial counterparts in the development process to become partners in developing the anesthesia systems of the future. Progress can only be made by having clinicians and developers spend time with one another. Can this inconvenient and frustrating process possibly be worse than the everyday torment caused by manufacturers building what the clinicians do not need, because the clinicians cannot tell them?

Anesthesiology↗
PubMed2002

Improving ecological performance of electrical consumer products: the role of design-based measures and user variables.

This research is concerned with the ecological performance of electrical consumer products. It examines the influence of design-based measures on various ecological performance parameters and the relationship of user variables and performance. In the experimental scenario, 40 users were asked to clean a room with a vacuum cleaner under different conditions. In a multi-factorial design, the following independent variables were employed: on-product information, enhanced display-control labelling and proximity of controls. Measures of user variables (environmental concern, knowledge, habits) of ecological behaviour were also taken. The results showed that enhanced display-control labelling improved ecological performance but only when the label was placed close to the user. On-product information only resulted in behavioural change when it was in close spatial proximity to the control device. A positive effect on ecological performance was also observed when controls were in a proximal rather than distal position. Among user variables, habits were found to have an influence on behaviour shown in experimental scenarios. A practical implication of the findings for environmentally friendly design of consumer products is that there should be a stronger focus on system-based measures rather than information-based measures. Finally, the article discusses the theoretical implications of using operational scenarios rather than the information display board paradigm.

Adult↗
PubMed1996

The lifeline of triage.

Most acute hospitals operate a triage system to evaluate and prioritize the care and needs of clients presenting in the Emergency department. The emergency nurse, therefore, employs a variety of cognitive processes to clinically categorize clients in relation to the most acute need. This ability to clinically assess is a combination of knowledge and intuition grounded in experience and formal education. Therefore, the optimal functioning of the Emergency department is dependent upon not only the protocols and policies of hospitals, but the skills, experience and the confidence of individual triage nurses. This paper will reconsider the role of the triage nurse by addressing a literature deficit related to triage and the triage nurse, as the front line mediator, who is in the prime position of being able to rise the professional profile of the emergency nurse by making visible the care provided by nurses in this department and, most significantly, in the triage waiting room. This care extends beyond pointing to the waiting room clock and a sign which informs clients of the purposes of the emergency care department. This paper will also discuss a range of strategies used by the authors to enhance effective triaging to ensure a quality standard in client care.

Clinical Competence↗
PubMed2006

The complexity of measuring interprofessional teamwork in the operating theatre.

Surgery depends on interprofessional teamwork, which is becoming increasingly specialized. If surgery is to become a highly reliable system, it must adapt and professionals must learn from, and share, tested models of interprofessional teamwork. Trainers also need valid measures of teamwork to assess individual and team performance. However, measurement and assessment of interprofessional teamwork is lacking and interprofessional team training is scarce in the surgical domain. This paper addresses the complexity of measuring interprofessional teamwork in the operating theatre. It focuses mainly on the design and properties of observational assessment tools. The report and analysis serves to inform the researcher or clinician of the issues to consider when designing or choosing from alternative measures of team performance for training or assessment.

Humans↗
PubMed1993

Hospital saves with bedside point-of-care system.

Do bedside and point-of-care systems actually deliver on their promise of reducing operating expenses while helping improve the overall quality of healthcare? And how does a healthcare facility quantify associated "productivity" improvements to prove cost savings? These are two critical issues that healthcare providers face in implementing a bedside or point-of-care (POC) system. Barnes Hospital, St. Louis, is a 1,000 bed member facility of the Barnes-Jewish Inc./Christian Health Services integrated health system. Barnes Hospital has indeed seen significant cost savings as a result of a POC project.

Cost Savings↗
PubMed2005

Anesthesia and neurocerebral monitoring for aortic dissection.

Patients presenting to the operating room for repair of aortic dissection are challenging in all aspects of their care. Without exception, they require a multidisciplinary team approach. This article will review some of the specific challenges faced by anesthesiologists and neurologists when confronted with such a diagnosis. Specifically, we will discuss the myriad anesthetic issues that present in the preoperative stage and continue into the postoperative period. Neurologic complications during dissection repair result in increased morbidity and mortality. A variety of neurophysiologic monitoring techniques exist that may reduce this risk and will be discussed in detail. Finally, we will present some "controversies in care," emphasizing that our respective fields continue to grow, learn, and improve what information we have on the morbidity and mortality of aortic dissection.

Anesthesia↗
PubMed1999

Point-of-care and standard laboratory coagulation testing during cardiovascular surgery: balancing reliability and timeliness.

OBJECTIVE: The use of point-of-care technology has increased faster than efforts to validate its effectiveness compared to standard laboratory testing modalities. To address this issue with a current point-of-care coagulation system (HEMOCHRON Jr, International Technidyne Corporation (ITC), Edison, NJ), we designed a study to test the hypothesis that data obtained from point-of-care coagulation equipment correlates with data obtained from standard laboratory coagulation equipment. One of the potential advantages gained using point-of-care testing is the ability to obtain more rapid results. To address this issue, turnaround time, defined as the elapsed time (in minutes) from when the sample was acquired from the patient until the investigators knew the results, was also determined. METHODS: Following Human Investigation Committee approval and informed consent, a prospective study was conducted to compare results obtained from point-of-care coagulation equipment with those results obtained from standard laboratory coagulation equipment. The study was performed in three groups of patients undergoing cardiovascular surgery, each requiring different levels of anticoagulation. RESULTS: Of the 83 patients who met the inclusion criteria, the correlation (combining data from groups 1-3) between results obtained from point-of-care and standard laboratory prothrombin time was r = 0.867, p < 0.001. The correlation (group 3) between point-of-care and standard laboratory international normalized ratio was r = 0.943, p < 0.001. The correlation (combining data from groups 1 & 2) between point-of-care and standard laboratory activated partial thromboplastin time was r = 0.825, p < 0.001. Median turnaround time for the standard laboratory was 90 minutes, with a mean turnaround time of 74 to 78 minutes, depending upon the group. In contrast, the median turnaround time for point-of-care testing was two minutes and 14 seconds. CONCLUSIONS: The results from this study population reveal that data obtained from point-of-care prothrombin time, international normalized ratio and activated partial thromboplastin time results correlate with results obtained from standard laboratory coagulation testing. The value of obtaining reliable results in a timely fashion offers a potential advantage for point-of-care testing in dinical situations, such as in the operating room, where saving time may translate into financial savings.

Aged↗
PubMed1994

The efficiency of preoperative evaluation: a comparison of computerized and paper recording systems.

OBJECTIVE: We designed and implemented a preoperative evaluation record system with seven networked computers for use by physicians and other medical staff. This study compared the efficiency of the new computerized system with that of the paper system. METHODS: We reviewed data from preoperative evaluations completed from November 1990 through December 1992. Data were analyzed automatically (Borland C program) for two intervals: (1) the waiting period, defined as the time the patient entered the waiting room until he or she entered the examination room; and (2) the examination period, defined as the time the patient entered the examination room until an evaluation form was printed. Data were obtained for 2,511 evaluations on paper and 8,342 by computer. RESULTS: The average waiting period with the paper system was 56.1 +/- 44.8 min; the average waiting period with the computerized system was 59.1 +/- 47.0 min. The average examination period was nearly identical for both systems: 27.5 +/- 23.6 min for the paper system; 28.5 +/- 22.7 min for the computerized system. CONCLUSION: The computerized system required no more examination time than the manual system. In addition, we speculate that time is saved at other points of patient care by the legible, instantly retrievable preoperative evaluations that the computerized system produces.

Hospital Information Systems↗
PubMedDate not supplied

Radical nephrectomy performed by open, laparoscopy with or without hand-assistance or robotic methods by the same surgeon produces comparable perioperative results.

PURPOSE: Radical nephrectomy can be performed using open or laparoscopic (with or without hand assistance) methods, and most recently using the da Vinci Surgical Robotic System. We evaluated the perioperative outcomes using a contemporary cohort of patients undergoing radical nephrectomy by one of the above 4 methods performed by the same surgeon. MATERIALS AND METHODS: The relevant clinical information on 57 consecutive patients undergoing radical nephrectomy from September 2000 until July 2004 by a single surgeon was entered in a Microsoft Access Database and queried. Following appropriate statistical analysis, p values < 0.05 were considered significant. RESULTS: Of 57 patients, the open, robotic, laparoscopy with or without hand assistance radical nephrectomy were performed in 18, 6, 21, and 12 patients, respectively. The age, sex, body mass index (BMI), incidence of malignancy, specimen and tumor size, tumor stage, Fuhrman grade, hospital stay, change in postoperative creatinine, drop in hemoglobin, and perioperative complications were not significantly different between the methods. While the estimated median blood loss, postoperative narcotic use for pain control, and hospital stay were significantly higher in the open surgery method (p < 0.05), the median operative time was significantly shorter compared to the robotic method (p = 0.02). Operating room costs were significantly higher in the robotic and laparoscopic groups; however, there was no significant difference in total hospital costs between the 4 groups. CONCLUSIONS: The study demonstrates that radical nephrectomy can be safely performed either by open, robotic, or laparoscopic with or without hand assistance methods without significant difference in perioperative complication rates. A larger cohort and longer follow up are needed to validate our findings and establish oncological outcomes.

Adult↗
PubMed1989

[Evaluation of technical indoor air ventilation systems in operating departments from the health viewpoint].

By means of measurement examples it is shown that the examination of the cfu-concentration in the supply-air is not a sufficient criterion for the hygienic-microbiological evaluation of air-conditioning systems in operation wards. Maximum upper values for cfu-concentration were only exceeded a little in some cases. Particle measurements, carried out simultaneously, gave further information on the hygienic status of the air supplied by the air-conditioning system and permitted an evaluation of the ventilation system (for example an air-supply ceiling with a stabilized air ventilation). An efficient air-ventilation system should have the effect that the air quality in the operation area is of nearly the same quality as the supply-air. On the basis of own measurements maximum upper values and recommended values for cfu- and in particular particle-concentrations in the supply-air of air-conditioning systems with three-step filtration were proposed. The set-up and the carrying out of the measurement is described to standardize a "hygienic evaluation" of air-conditioning systems in operation theatres. Help for the interpretation of measurement results is given by means of measurement examples.

Air Microbiology↗
PubMed1999

Emerging technologies for surgery in the 21st century.

Laparoscopic surgery is a transition technology that marked the beginning of the information age revolution for surgery. Telepresence surgery, robotics, tele-education, and telementoring are the next step in the revolution. Using computer-aided systems such as robotics and image-guided surgery, the next generation of surgical systems will be more sophisticated and will permit surgeons to perform surgical procedures beyond the current limitations of human performance, especially at the microscale or on moving organs. More fundamentally, there will be an increased reliance on 3-dimensional images of the patient, gathered by computed tomography, magnetic resonance imaging, ultrasound, or other scanning techniques, to integrate the entire spectrum of surgical care from diagnosis to preoperative planning to intraoperative navigation to education through simulation. By working through the computer-generated image, first with preoperative planning and then during telepresence or image-guided procedures, new approaches to surgery will be discovered. These technologies are complemented by new educational opportunities, such as tele-education, surgical simulation, and a Web-based curriculum. Telementoring will permit further extension of the educational process directly into the operating room.

Forecasting↗
PubMed1989

The initial clinical evaluation of a transesophageal system with pulsed Doppler, continuous wave Doppler, and color flow imaging based on an annular array technology.

The application of transesophageal echocardiography (TEE) offers access to a great deal of important clinical information regarding cardiovascular anatomy and physiology. Two applications which have not been reported and would appear to be of interest are continuous wave Doppler capabilities and the implementation of higher frequency transducers. A TEE system designed at the Institute of Biomedical Engineering in Trondheim, which is based on an annular array technology, offers these capabilities. We evaluated this instrument in the clinical setting in a series of 30 patients to test the probe function in terms of the tissue and flow imaging quality with a 7.5 MHz carrier frequency, and to report on the implementation of a continuous wave Doppler modality in a TEE probe. We found that the annular array method permitted the use of high frequency probes for tissue and flow imaging which resulted in excellent image resolution, and that shifting the carrier frequency of the transducer to a lower frequency permitted the optimization of the Doppler sensitivity. The continuous wave Doppler was used to measure abnormal blood flow velocities in excess of 5.0 m/s, and was particularly useful in the operating room as velocity measurements could be obtained without compromising the sterile field. The results of our evaluation indicate that high imaging frequencies and continuous wave Doppler can be applied by an annular array TEE transducer.

Adolescent↗
PubMed1996

On line ST-segment analysis for detection of myocardial ischaemia during and after coronary revascularization.

PURPOSE: A paucity of information exists to validate the accuracy and reliability of ECG monitoring in the operating room or ICU. The purpose of this study was to determine the accuracy, sensitivity, specificity, and predictive values of the Marquette ECG monitor for detection of perioperative myocardial ischaemia (PMI) as measured by ST segment changes in a high risk population. METHODS: Monitoring for PMI in 28 patients scheduled for aortocoronary bypass surgery was done with the Cardiodata PR ambulatory continuous electrocardiography (ACECG) monitor lead V5, and compared with lead V5 of the Marquette Series 7000 ECG/Surgical operating room monitor, and ECG/Resp ICU monitor. The Marquette lead V5 was evaluated using current criteria for the assessment of diagnostic tests including concordance, sensitivity, specificity, positive and negative predictive values, false positive and false negative rates and compared with the ACECG monitor which served as the reference or "gold standard." Agreement beyond chance between the two methods was assessed using the Kappa statistic. RESULTS: Of the 53 observation data points, 27 were defined as ischaemic episodes by ACECG. Concordance between lead V5 in each system was 83% (44/53 episodes). Discordance was 17% (9/53 episodes), predominantly in the postbypass interval (77%, 7/9; P = 0.0184). The incidences of false negatives and false positives for Marquette lead V5 was 26% (7/27) and 7.7% (2/26), respectively. The sensitivity and specificity of the Marquette was 0.74 and 0.92. Positive predictive value was 0.91, negative predictive value was 0.77, and Kappa statistic was 66%. CONCLUSION: Automated ST segment analysis with the Marquette Series 7000 monitoring system demonstrates good diagnostic accuracy, moderate sensitivity, and high specificity. However, clinically significant false negative and false positive rates of ischaemia detection are associated with its use, especially in the postoperative period.

Electrocardiography↗
PubMed2006

Robotics in colorectal surgery: telemonitoring and telerobotics.

Surgery has just passed through the laparoscopic surgery revolution, with validation of the advantages for the patient evaluated painstakingly; however, laparoscopy is a transition phase to fully information-based surgery, which only can be accomplished when hand motions are converted to information through robotic surgery systems. The main advantage is using such systems to integrate the entire surgical process. The components that will allow such a transition exist in other industries that use robotics, so it is more a matter of applying these engineering principles to surgery, rather than inventing new technologies. Robotics cannot only improve the performance of surgery, but is providing access to surgical expertise in remote and underserved areas through telementoring, teleconsultation, and telesurgery. Colorectal surgeons should seize the opportunity to begin to use surgical robotic systems in those niche areas and procedures that have proven to be of significant benefit to the patient and are cost-effective. Over time, with the development of even more advanced systems it will become more advantageous to use robotics on a routine basis.

Colon↗
PubMed1998

A computerized reminder for prophylaxis of deep vein thrombosis in surgical patients.

OBJECTIVE: To measure the effect of a computerized reminder system on the rate of deep vein thrombosis (DVT) prophylaxis in surgical patients. DESIGN: A prospective trial to measure change in compliance compared to historic controls. MEASUREMENTS: LDS Hospital surgeons developed local consensus as to which procedures should have DVT prophylaxis. The historic rate of prophylaxis for the procedures was measured through a database search of patient records. A computerized reminder system was then implemented which utilized an expert knowledge base and a time drive mechanism to flag surgical cases for DVT prophylaxis. For eligible patients, a DVT reminder appeared on the operating room schedule; surgical staff used this as a guide to apply prophylaxis. During the 3 month trial the rate of DVT prophylaxis was remeasured and compared to the pre-intervention rate. RESULTS: The pre-intervention rate of DVT prophylaxis over a 3 month period was 85.2% (785 of 921 eligible cases). For the 3 months following the introduction of the computerized reminder, compliance with DVT prophylaxis increased to 99.3% (1084 of 1092 eligible cases). The difference between the historic controls and the study subjects was highly significant (p < 0.001). CONCLUSION: A computerized reminder is an effective method of increasing the rate of DVT prophylaxis in surgical patients.

Anticoagulants↗
PubMed2006

Initial clinical experience with a partly autonomous robotic surgical instrument server.

BACKGROUND: The authors believe it would be useful to have surgical robots capable of some degree of autonomous action in cooperation with the human members of a surgical team. They believe that a starting point for such development would be a system for delivering and retrieving instruments during a surgical procedure. METHODS: The described robot delivers instruments to the surgeon and retrieves the instruments when they are no longer being used. Voice recognition software takes in requests from the surgeon. A mechanical arm with a gripper is used to handle the instruments. Machine-vision cameras locate the instruments after the surgeon puts them down. Artificial intelligence software makes decisions about the best response to the surgeon's requests. RESULTS: A robot was successfully used in surgery for the first time June 16, 2005. The operation involved excision of a benign lipoma. The procedure lasted 31 min, during which time the robot performed 16 instrument deliveries and 13 instrument returns with no significant errors. The average time between verbal request and delivery of an instrument was 12.4 s. CONCLUSIONS: The described robot is capable of delivering instruments to a surgeon at command and can retrieve them independently using machine vision. This robot, termed a "surgical instrument server," represents a new class of information-processing machines that will relieve the operating room team of repetitive tasks and allow the members to focus more attention on the patient.

Adult↗
PubMed2006

Comparison of a flexible laryngoscope with calibrated sizing function to intraoperative measurements.

OBJECTIVES: The objectives were to assess the clinical performance and accuracy of a prototype fiberoptic transnasal laryngeal endoscope with an auxiliary optical system that allows images to be spatially calibrated. METHODS: A novel fiberoptic endoscope was developed that projects green laser beams across the field of view from a separate optical channel. According to the location of the spots in the field of view, the images can be calibrated with a software routine. To assess its performance, we compared measurements of 14 lesions imaged with the calibrated endoscope and during microlaryngoscopy, where a calibration instrument was placed next to the lesions. Four clinicians measured lesion length, width, and area from the collected images. RESULTS: The calibrated endoscope performed as well as current flexible fiberoptic laryngoscopes in terms of image quality and patient comfort. For lesions with well-defined borders, the error ranged from 14% to 23% for length, from 20% to 30% for width, and from 33% to 50% for area across observers. Factors contributing to larger errors in some subjects were identified. CONCLUSIONS: The calibrated endoscope is capable of providing useful sizing information for laryngeal structures, and these measures correspond quite well to more direct measurements in the operating room. Objective sizing of laryngeal lesions is complicated by subjective judgments of lesion boundaries, which can be indistinct in many cases.

Adult↗
PubMedDate not supplied

Electronic data collection options for practice-based research networks.

PURPOSE: We wanted to describe the potential benefits and problems associated with selected electronic methods of collecting data within practice-based research networks (PBRNs). METHODS: We considered a literature review, discussions with PBRN researchers, industry information, and personal experience. This article presents examples of selected PBRNs' use of electronic data collection. RESULTS: Collecting research data in the geographically dispersed PBRN environment requires considerable coordination to ensure completeness, accuracy, and timely transmission of the data, as well as a limited burden on the participants. Electronic data collection, particularly at the point of care, offers some potential solutions. Electronic systems allow use of transparent decision algorithms and improved data entry and data integrity. These systems may improve data transfer to the central office as well as tracking systems for monitoring study progress. PBRNs have available to them a wide variety of electronic data collection options, including notebook computers, tablet PCs, personal digital assistants (PDAs), and browser-based systems that operate independent of or over the Internet. Tablet PCs appear particularly advantageous for direct patient data collection in an office environment. PDAs work well for collecting defined data elements at the point of care. Internet-based systems work well for data collection that can be completed after the patient visit, as most primary care offices do not support Internet connectivity in examination rooms. CONCLUSIONS: When planning to collect data electronically, it is important to match the electronic data collection method to the study design. Focusing an inappropriate electronic data collection method onto users can interfere with accurate data gathering and may also anger PBRN members.

Biomedical Research↗