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PubMedDate not supplied

Recirculation of air in operating rooms.

A study of two neurosurgical operating rooms indicated a low, airborne, microbial population could be maintained by recirculating filtered air during surgical procedures. The commonly used turbulent system of air delivery was employed, and high-efficiency filters were effective in removing airborne bacteria generated within the operating room. Optimal rates and percent of recirculation were determined. The method of exhaust was confirmed to be important. Exhaust ports 40 in. above the floor were more effective in maintaining low airborne microbial populations than baseboard-level ports. The degree of activity of the surgical team and the number of personnel in the operating room correlated with the airborne bacterial counts.

Air Microbiology↗
PubMed2006

Interdisciplinary work flow assessment and redesign decreases operating room turnover time and allows for additional caseload.

HYPOTHESIS: Operating room turnover time (TOT) and daily caseload can be improved by analyzing the routine tasks of the operating team and minimizing inefficiencies. DESIGN: In this prospective study, the assigned tasks and work flow patterns of the anesthesiologist, circulating nurse, and surgical technologist during operations and operating room turnover were studied and changes were implemented where inefficiencies were observed. A brief pilot followed by a broader-scale study was conducted. SETTING: Tertiary care center. PARTICIPANTS: Circulating nurses and surgical technicians were routinely assigned to work with one anesthesiologist and one surgeon during the pilot study; 4 surgeons and 32 anesthesiologists participated in the follow-up study. INTERVENTIONS: The work flow diagram of each individual was redrawn, and changes were implemented. Critical moments were identified, in which brief assistance from other personnel was needed to improve efficiency. MAIN OUTCOME MEASURES: Operative TOT and number of daily operations were the main outcomes. A 2-tailed t test was used to compare the TOTs; chi(2) analysis was used to compare the number of cases completed. Significance was defined as P<.05. RESULTS: A total of 401 operations and 253 turnovers were evaluated. Redesign decreased operating room TOT from 43.7 to 27.7 minutes (P<.001). The mean number of cases completed per day increased from 1.78 to 2.34 (P<.001). CONCLUSION: Interdisciplinary work flow assessment and redesign resulted in decreased operating room TOTs and additional cases being completed each day for 4 different surgeons.

Anesthesiology↗
PubMed2004

Making management decisions on the day of surgery based on operating room efficiency and patient waiting times.

The authors review the scientific literature on operating room management operational decision making on the day of surgery. (1) Some decisions should rely on the expected (mean) duration of the scheduled case. Other decisions should use upper prediction bounds, lower prediction bounds, and other measures reflecting the uncertainty of case duration estimates. One single number cannot be used for good decision making, because durations are uncertain. (2) Operational decisions can be made on the day of surgery based on four ordered priorities. (3) Decisions to reduce overutilized operating room time rely on mean durations. Limited additional data are needed to make these decisions well, specifically, whether a patient is in each operating room and which cases are about to finish. (4) Decisions involving reducing patient (and surgeon) waiting times rely on quantifying uncertainties in case durations, which are affected highly by small sample sizes. Future studies should focus on using real-time display of data to reduce patient waiting.

Appointments and Schedules↗
PubMed1996

How to increase efficiency in the operating room.

The key to increasing operating room efficiency is increasing productivity. Standardizing and streamlining of internal procedures reduce bottlenecks, and computers speed the flow of information so that continuous improvement of the system becomes possible. Patterns and themes can be discovered only when one sits back and listens and watches, shifting the focus from fixing problems to discovering patterns and the structures underlying them. Rethinking the system and evaluating all aspects of the care delivery cycle, abandoning the "sacred cows" of operating room practice, and creating a vision for health care in the future are essential to survival in the managed care environment.

Ambulatory Surgical Procedures↗
PubMed1993

Continued cost justification of an operating room satellite pharmacy.

Cost justification for the establishment and continued operation of an operating room satellite pharmacy is described. Establishment of an operating room satellite pharmacy can be justified based on the need to recover lost revenue, regulate controlled substances, monitor inventory, and enhance communication between operating room personnel and the department of pharmacy. At a 510-bed community hospital, an internal audit performed before the satellite pharmacy was opened revealed an average loss of $14.53 in drug charges per surgical procedure; 16 months after the pharmacy opened, changes in the way drugs are distributed to the departments of surgery and anesthesia has resulted in a decrease in this loss to $9.61, or a 34% improvement. To regulate controlled substances, the pharmacy attaches a drug-use log to each dispensing kit, which has resulted in 98% agreement between recorded administration of controlled substances and actual amounts signed out and ultimately returned. Recommendations made by the department of pharmacy regarding the use of high-cost drugs during surgery has resulted in an annual savings of more than $100,000, and improvements in drug packaging reduced, and in some cases eliminated, wastage. Direct contact between operating room personnel and pharmacists has fostered discussions regarding cost-effective application of pharmacotherapy, and the potential for cost savings is substantial. Although the remaining loss of $9.61 per case must still be addressed, considerable progress has been made in a relatively short period of time. The satellite pharmacy in the operating room has led to increased revenue recovery, improved regulation of controlled substances and monitoring of drug inventory, and better communication among the involved personnel.

Cost-Benefit Analysis↗
PubMed2003

The operating room of the future: observations and commentary.

The Operating Room of the Future is a construct upon which to develop the next generation of operating environments for the patient, surgeon, and operating team. Analysis of the suite of visions for the Operating Room of the Future reveals a broad set of goals, with a clear overall solution to create a safe environment for high-quality healthcare. The vision, although planned for the future, is based upon iteratively improving and integrating current systems, both technology and process. This must become the Operating Room of Today, which will require the enormous efforts described. An alternative future of the operating room, based upon emergence of disruptive technologies, is also presented.

Forecasting↗
PubMed1975

Television in the operating room.

Television serves a number of useful purposes in the operating room. For the operating room supervisor, television surveillance provides an easy, economical method of keeping abreast of surgical and turnaround activities in each operating room. For the surgeon it provides an excellent vehicle for teaching, record keeping, remote viewing, and two way communication with the clinical pathology and x-ray departments, as well as with other consultants.

Education, Medical↗
PubMed2006

Advanced visualization platform for surgical operating room coordination: distributed video board system.

One of the major challenges for day-of-surgery operating room coordination is accurate and timely situation awareness. Distributed and secure real-time status information is key to addressing these challenges. This article reports on the design and implementation of a passive status monitoring system in a 19-room surgical suite of a major academic medical center. Key design requirements considered included integrated real-time operating room status display, access control, security, and network impact. The system used live operating room video images and patient vital signs obtained through monitors to automatically update events and operating room status. Images were presented on a "need-to-know" basis, and access was controlled by identification badge authorization. The system delivered reliable real-time operating room images and status with acceptable network impact. Operating room status was visualized at 4 separate locations and was used continuously by clinicians and operating room service providers to coordinate operating room activities.

Computer Communication Networks↗
PubMed1976

Exposure to anesthetic gases and ethanol during work in operating rooms.

The concentration of halothane and ethanol in operating rooms was measured during 37 routine operations performed in nine different departments of surgery at six different hospitals. The time-weighted halothane concentrations in the respiratory zones of anesthetic and surgical nurses were 0.3--34.0 ppm (time-weighted average 7.2 ppm) and 0.1--9.2 ppm (time-weighted average 2.5 ppm), respectively, in the different operating departments. The corresponding ethanol concentrations were 0.3--36.5 ppm (time-weighted average 12.5 ppm) for anesthetic nurses and 1.5--46.6 ppm (time-weighted average 15.3 ppm) for surgical nurses. The anesthetic technique influences the exposure of the operating staff to anesthetic gases, but it does not affect exposure to ethanol. In controlled experiments volunteers were exposed to low concentrations of halothane or ethanol. About 60% of both substances was retained. The content of ethanol in the end-expired air approached zero within a few minutes after the end of exposure, while low residual concentrations of halothane were demonstrable for more than 1 h. Although exposure to ethanol is insignificant in relation to the metabolic capacity of the body, ethanol indicates the presence of volatile disinfectant components, and its spread through the room atmosphere should be kept in mind when the ventilation of operating rooms is designed. The effective elimination of airborne pollutants in operating rooms calls for good general ventilation in conjunction with local exhaust close to the sources of anesthetic gas leakage. General ventilation mainly affects the concentration of substances well-mixed with the room atmosphere, such as volatile disinfectant components and anesthetic vapor that has spread beyond the actual work zones of the medical staff. For a significant reduction in the concentration of anesthetic gases in the respiratory zones of the medical staff, the gases must be vented at the source of leakage. Since airborne anesthetics occur not only in operating rooms, general ventilation has to meet certain minimum requirements also in anesthetic induction rooms and recovery rooms. Operating rooms and anesthetic induction rooms must also be supplied with local exhaust systems.

Air Conditioning↗
PubMed2003

How much are anesthesiologists exposed to electromagnetic fields in operating rooms?

Numerous electronic devices have been introduced into the operating room. Although little is known about the relationship between exposure to electromagnetic fields (EMF) and health hazards, some authors reported its association with cancer or other diseases. We measured the amount of EMF exposure that an anesthesiologist gets in the operating room. The density of the magnetic field was checked by an extremely low frequency (ELF) field strength measurement system in the 19 operating rooms of our hospital. We measured the magnetic field intensity at a distance of 30 cm, 50 cm, and at the place where the anesthesiologist usually stands from the center of the main monitor. The average exposure quantities of magnetic fields in 19 operating rooms were 2.22 +/- 1.13 mG at 30 cm, 1.29 +/- 0.84 mG at 50 cm and 1.00 +/- 0.78 mG at the anesthesiologist's standing points respectively. Because quantities over 2 or 3 mG were accepted to be high radiation levels of EMF by many reports describing the hazards of EMF, we set 2 mG to be the cutoff value. In some of the 19 operating rooms, the measured EMF density exceeded our cutoff value. Although the health hazards related to EMF exposure are still equivocal, anesthesiologists should consider making an effort to improve their environment and reduce their exposure to EMF.

Anesthesiology↗
PubMed2001

Operating room nurse managers--competence and beyond.

Operating room nurse managers supervise and direct a complex, highly technical, and expensive organization. To be successful, they must possess certain competencies or skills that have not been studied extensively. A replication of one study was conducted to determine which competencies characterize OR nurse managers who are considered competent and superior. The randomly selected, national sample comprised OR nurse managers who completed an Operating Room Nurse Manager Questionnaire. Analysis of 120 useable questionnaires revealed that human and leadership competencies were valued most and conceptual and technical competencies were valued least in OR nurse managers.

Adult↗
PubMed2004

Introduction of anesthesia resident trainees to the operating room does not lead to changes in anesthesia-controlled times for efficiency measures.

BACKGROUND: Operating room efficiency is an important concern in most hospitals today. Little work has been reported to evaluate the contribution of anesthesia residents to changes in anesthesia-controlled time-related efficiencies in the operating room. The goal of this study was to measure the impact of the initiation of new residents to the operating room on anesthesia-related time measures of operating room efficiency. METHODS: Using the computerized operating room information systems, specific data regarding anesthesia-controlled times were extracted over three distinct 2-week periods over the course of 1 academic year. These included the first 2 weeks of July, when most of the operating rooms were staffed by attending physicians working alone; 2 weeks in September when new anesthesia residents were working in a 2:1 ratio with staff; and 2 weeks in May. The induction times, emergence times, and room turnover times were compared over these three periods for first-year anesthesia residents. Standard descriptive statistics were computed. Analysis of variance testing was then conducted comparing each of these time periods. Significance was set at P < 0.05. RESULTS: A total of 3,004 surgical procedures were performed during the 2-week study periods in July, September, and May, respectively. For the July, September, and May groups, the mean anesthesia induction times were 17.3, 19.0, and 20.8 min (P = 0.047); the emergence times were 8.7, 9.7, and 10.0 min, (P = 0.024); and the corresponding mean room turnover times were 47.6, 48.5, and 48.6 min (P = 0.907), respectively. CONCLUSION: Although statistically significant time differences were found, these data strongly suggest that the initiation of anesthesia trainees to the operating room has no clinically or economically meaningful adverse effect on the anesthesia-controlled time component of operating room efficiency.

Anesthesia↗
PubMed2004

Current state of ergonomics of operating rooms of Dutch hospitals in the endoscopic era.

Laparoscopic procedures are mostly performed in operating rooms which have been designed for conventional surgery. The ergonomic layout of these operating rooms is not suited for endoscopic surgery. This study reports on the current state of ergonomics of Dutch operating rooms for laparoscopic surgery. Number of trolleys, presence of ceiling-mounted booms, and number, positioning and size of monitors were recorded. The floor surface of operating rooms and lowest and highest positions of operating tables were documented. Positioning of the surgical team and monitors during laparoscopic surgery were assessed. Twenty-nine hospitals participated in this study. The average number of trolleys per hospital was 2.4. The mean height of the center of the monitors was 163 cm. Average floor surface of operating rooms was 37.45 m 2 . Only one of the 29 hospitals had a ceiling-mounted boom. The height of operating tables varied between 725 and 1215 mm. The floor space of current operating rooms is too small to allow use of space occupying technological systems. Less than 4% of operating rooms are equipped with permanent monitors mounted on booms. Operating tables cannot be lowered to a position which allows an ergonomic posture of the surgical team.

Journal Article↗
PubMed1980

Lack of mutagens in urines of operating room personnel.

Mutagenic activity of urines obtained from operating room personnel was assayed in the Ames Salmonella/mammalian microsome system using three strains of histidine-dependent S. typhimurium, TA1535, TA1538, and TA100. Two procedures were employed. In the first, 100- and 200-microliter aliquots of urine obtained from 28 subjects working in either scavenged or unscavenged operating rooms were tested. In the second, urine samples obtained from 13 physicians before and after starting an anesthesia residency, as well as 250-fold concentrates of these samples, were assayed. There was no statistically significant difference in urinary mutagenic activities between individuals working in scavenged and those working in unscavenged operating rooms. Furthermore, urines of anesthesiologists collected before and after beginning training had similar mutagenic activities. Only heavy smokers had mutagenic urine. It was concluded that the majority of operating room workers do not excrete mutagens in the urine.

Air Pollutants↗
PubMed1994

An ethical framework for operating room infection control.

The operating room nurse has an ethical obligation to provide patients with safe, effective care during surgical intervention. Most basic to this care is surgical asepsis. Bioethics principles of autonomy, beneficence, nonmaleficence, justice, as well as the professional's character in meeting the responsibilities of competence and accountability, are presented as an ethical framework for surgical infection control.

Ethics, Nursing↗
PubMed2002

Contaminated operating room boots: the potential for infection.

BACKGROUND: Dirty operating room boots, often contaminated with blood and other infected material, are not only a source of discontent among surgeons and other surgical personnel, but they also pose a potential risk of transmission of viral or bacterial diseases to the wearer and cleaner of the boots. METHOD: Operating room boots were examined for the presence of blood by visual inspection; the presence or absence of blood was confirmed by a specific biochemical test. Bacterial isolation and quantification from boots were performed with conventional methodology. RESULTS: In this study, a spot check revealed that 44% of all operating room boots tested were contaminated with blood and that the majority were contaminated with bacteria. Sixty-three percent of surgeons using the facility had blood-contaminated boots, and a significant number of boots belonging to other surgical personnel were also contaminated with blood and bacteria normally associated with skin microbiota or the environment. Comfort shoes with perforations on their upper surface and plastic boots commonly found in operating rooms were most heavily contaminated, whereas Wellington boots and clogs had less contamination. CONCLUSION: The present practice of manual cleaning of boots is unsatisfactory, and it is recommended that boots be washed in automatic washing machines.

Blood↗
PubMed1979

Microbiologic environment of the conventional operating room.

Areas of potential contamination of the surgical wound in the conventional operating rooms include the back table, the unsterile suction receptacle, and the lack of a positive pressure relationship between the operating room and adjacent areas. Use of an impermeable hood with a large mask diminished contamination of the instrument table and the the wound from fallout of bacteria from the surgical team. The level of airborne bacterial comtamination in the operating room can be reduced by limiting the traffic and controlling the activity and the number of operating room personnel. Higher rates of postoperatively wound sepsis were noted in older operating rooms, particularly with difficult procedures and those performed later in the day. Conventional operating rooms should be categorized by the level of room air exchange per hour and the level of airborne bacterial contamination.

Air Microbiology↗
PubMed2005

Deliberate perioperative systems design improves operating room throughput.

BACKGROUND: New operating room (OR) design focuses more on the surgical environment than on the process of care. The authors sought to improve OR throughput and reduce time per case by goal-directed design of a demonstration OR and the perioperative processes occurring within and around it. METHODS: The authors constructed a three-room suite including an OR, an induction room, and an early recovery area. Traditionally sequential activities were run in parallel, and nonsurgical activities were moved from the OR to the supporting spaces. The new workflow was supported by additional anesthesia and nursing personnel. The authors used a retrospective, case- and surgeon-matched design to compare the throughput, cost, and revenue performance of the new OR to traditional ORs. RESULTS: For surgeons performing the same case mix in both environments, the new OR processed more cases per day than traditional ORs and used less time per case. Throughput improvement came from superior nonoperative performance. Nonoperative Time was reduced from 67 min (95% confidence interval, 64-70 min) to 38 min (95% confidence interval, 35-40 min) in the new OR. All components of Nonoperative Time were meaningfully reduced. Operative Time decreased by approximately 5%. Hospital and anesthesia costs per case increased, but the increased throughput offset costs and the global net margin was unchanged. CONCLUSIONS: Deliberate OR and perioperative process redesign improved throughput. Performance improvement derived from relocating and reorganizing nonoperative activities. Better OR throughput entailed additional costs but allowed additional patients to be accommodated in the OR while generating revenue that balanced these additional costs.

Anesthesia↗