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At least 1,297 records · Page 72Linked to original sources
PubMed1997

[Ethical conflicts during anesthesia. "Do not resuscitate" orders in the operating room].

Patients have the right to make decisions concerning their health care. The right to consent to or refuse treatment is based on the ethical principle of autonomy. Respecting a patient's autonomy has emerged as one of the leading principle in medical ethics in the last years. In the United States, the Patient Self-Determination Act of 1991 stated that all patients admitted to hospital have to be informed about their right to prepare advance directives and to refuse life-prolonging treatment. Do-not-resuscitate (DNR) orders have been established to provide a mechanism for withholding specific resuscitative therapies in the event of cardiac arrest. Patients may write DNR orders to express in advance their preferences at a time when they are capable of making informed decisions. Terminally ill patients may need palliative surgical interventions to relieve pain or facilitate care. In patients with DNR orders undergoing anaesthesia and surgical procedures, the DNR status in the operating room is increasingly a matter of ethical conflict. Anaesthetic care virtually always implies the provision of resuscitative measures if necessary. Interventions like intubation, mechanical ventilation, or administration of vasoactive drugs may be regarded as a part of resuscitative efforts. There is a remarkable lack of consistency in policies and practices in hospitals regarding interpretation of DNR orders during the perioperative period. Considering policies automatically suspending DNR orders prior to anaesthetic care, the American Society of Anesthesiologists (ASA) in 1993 introduced "Ethical guidelines for the anesthesia care of patients with do not resuscitate orders or other directives that limit treatment". To address a patient's right to self-determination in a responsible and ethical way, the ASA recommends explicitly discussing with the patient all limitations of therapeutic interventions. A list of relevant items that should be considered, like defibrillation and chest compression, but also blood product transfusion or the administration of antibiotics, has been provided by the ASA. These statements can provide some order to an increasing state of the uncertainty, but guidelines might also be regarded as imposing restrictions that compromise the anaesthesiologist's autonomy. I believe that defining accepted and refused interventions in advance is not an appropriate approach to DNR orders during anaesthesia and surgery, as it will be difficult to find a definition of what constitutes resuscitation in this context. Communication with the patient and exchange of information are essential factors promoting ethical decisions. Knowing the individual patient's preferences and fears, a more suitable approach seems to be the perioperative suspension of the DNR order for a limited period of time, with the assurance that therapeutic procedures instituted during surgery will be discontinued postoperatively in reconsideration of the DNR order and if the underlying disease process turns out to be non-reversible.

Anesthesia↗
PubMedDate not supplied

Operating room fires: how to prevent and minimize spread.

To prevent fires, a simple rule to remember is the "fire triangle" of oxygen, heat, and fuel. Minimizing oxygen enrichment will reduce the fire hazard. Proper protocols need to be established for the handling of heat-bearing units, such as electrosurgical pencils, electrocautery units, and lasers.

Equipment Safety↗
PubMedDate not supplied

Practical budgeting for the operating room administrator.

To meet the challenge of an annual budget controlled by revenue projections and cost-containment initiatives, an OR administration reviewed all expenditures, planned new initiatives, evaluated service expansion, and created an environment to encourage new products and services while maintaining quality. This revenue enhancement project maintained the institution's market share and increased revenue.

Budgets↗
PubMed1982

[Bacterial contamination of osteosynthesis material. Comparison between a sterile compartment and the conventional operating room].

This study compares two groups of patients who underwent osteosynthetic operations. The operations of one group were performed in an ultrasterile operating cubicle under laminar flow conditions, those of the other group in a conventional operating theatre. The results of smear tests show that not only the number of bacteria in explants, but also the number of postoperative wound infections was considerably lower in the laminar flow group. During a 4-year observation period, the most frequently isolated organism in 392 explants was staphylococcus aureus, in some cases with additional bacteria. Infection was present only in those cases in which bacteria were detected. The age of the patients, the length of time the explants were stored and the composition of the operating team were all insignificant with regard to the bacterial flora of the extracts. Only the level of sterility in the operating theatre (ultrasterile operating cubicle) at the moment of implantation was of recordable importance.

Air Microbiology↗
PubMed1997

[Air microbiology monitoring in plenum-ventilated operating rooms. Proposed standards].

BACKGROUND: Microbiological standard for air in plenum ventilated operating theatres are not defined. The aim of this study was to analyze the microbiological contamination of air in HUSC theatres and to establish standards of reference. METHODS: 408 air samples (80 l/sample) were taken from air intake and center of the theatres in three surgical areas, throughout five consecutive years (1991-1995). RCS air sampler was used. Media of microbiological counts were compared using the ANOVA and the Kruskall-Wallis tests. Microbiological standards were established based on upper limit of confidence interval of counts, when the degree of contamination was similar in two consecutive years. RESULTS: A falling trend of microbiological counts was observed, with statistical significance between counts found in 1992 and those found in 1994 and 1995 (p < 0.01). There was no difference between results of the three surgical areas, but there was a significant difference between counts from air intake and center of theatres, regardless the year or the surgical area (p < 0.01). During this time a significant decrease in the percentage of samples with presence of fungi (p = 0.001) was produced. The results of years 1994 and 1995 were taken for establish the microbiological standards. CONCLUSIONS: This control program allowed to evaluate and improve the hygienic conditions in the operating theatres and to establish a microbiological standards of reference for plenum ventilated theatres.

Air Microbiology↗
PubMed2005

Creating an optimal operating room schedule.

SCHEDULING IN THE OR suite is a particularly daunting task for many surgical services managers. CREATING AN OPTIMAL OR schedule requires looking at constraining factors as well as historical data. THIS ARTICLE presents one solution to creating an OR schedule that results in increased use of the OR suite and better profitability.

Appointments and Schedules↗
PubMed2001

Weekend operating room on call staffing requirements.

This article describes a statistical method used to determine the minimum number of OR teams that should be on call for urgent procedures, in-house versus on standby from home, to minimize labor costs. The OR manager obtains the number of ORs staffed at each hour of the 24-hour period of interest (e.g., 7 AM Saturday to 7 AM Sunday) from the surgical suite's information system. The minimum number of total staffed hours needed to care for patients is calculated for a prespecified level of the acceptable risk of inadequate staffing. A method used to determine whether each staff member should work in-house or on standby from home then is introduced. This method enumerates all possible combinations of shifts to find the one with the lowest cost, and it ensures a prespecified service level. An example based on 248 weeks of data collected from a large surgical suite is presented, and staffing for emergency procedures is reviewed.

Costs and Cost Analysis↗
PubMed2006

Health promotion in the operating room--a quality improvement project.

Rising health care costs and an aging workforce have led many companies to actively promote wellness in the workplace to help their employees and lower their health care-related costs. A quality improvement initiative examined the health status of perioperative personnel in one facility before and after they took part in an onsite fitness program.

Absenteeism↗
PubMed1999

Designing a laparoscopic operating room.

This article focuses on 4 major aspects in the design of a laparoscopic suite. These areas include: Preliminary overview of the project: Planning, budgeting for CON (certificate of need), and justifying the project. Preconstruction phase and design of the suite: Interpreting blueprints, essential equipment, addressing standards and codes. Construction phase: Developing a project team, life safety, OSHA, JCAH issues, coordination of equipment purchases, infection control. Postconstruction of the project: Certification of gases, inservicing of personnel, addressing policy revisions.

Accreditation↗
PubMed2005

Fire in the operating room during tracheotomy: a case report.

We describe a patient who sustained facial burns during a tracheotomy. The electrosurgical unit indirectly started the fire during monitored anesthesia care when a high inspired oxygen concentration was being delivered to the patient by simple face mask. This case points out the need for prevention strategies, intraoperative vigilance, and quick intervention to prevent further patient injury any time the electrosurgical unit is used in an oxygen-enriched atmosphere.

Accident Prevention↗