WorldWideScience

Sample records for hospital operating rooms

  1. Teamwork in the operating room: frontline perspectives among hospitals and operating room personnel.

    Science.gov (United States)

    Sexton, J Bryan; Makary, Martin A; Tersigni, Anthony R; Pryor, David; Hendrich, Ann; Thomas, Eric J; Holzmueller, Christine G; Knight, Andrew P; Wu, Yun; Pronovost, Peter J

    2006-11-01

    The Joint Commission on Accreditation of Healthcare Organizations is proposing that hospitals measure culture beginning in 2007. However, a reliable and widely used measurement tool for the operating room (OR) setting does not currently exist. OR personnel in 60 US hospitals were surveyed using the Safety Attitudes Questionnaire. The teamwork climate domain of the survey uses six items about difficulty speaking up, conflict resolution, physician-nurse collaboration, feeling supported by others, asking questions, and heeding nurse input. To justify grouping individual-level responses to a single score at each hospital OR level, the authors used a multilevel confirmatory factor analysis, intraclass correlations, within-group interrater reliability, and Cronbach's alpha. To detect differences at the hospital OR level and by caregiver type, the authors used multivariate analysis of variance (items) and analysis of variance (scale). The response rate was 77.1%. There was robust evidence for grouping individual-level respondents to the hospital OR level using the diverse set of statistical tests, e.g., Comparative Fit Index = 0.99, root mean squared error of approximation = 0.05, and acceptable intraclasss correlations, within-group interrater reliability values, and Cronbach's alpha = 0.79. Teamwork climate differed significantly by hospital (F59, 1,911 = 4.06, P teamwork climate is possible using this psychometrically sound teamwork climate scale. This tool and initial benchmarks allow others to compare their teamwork climate to national means, in an effort to focus more on what excellent surgical teams do well.

  2. Flow analysis of airborne particles in a hospital operating room

    Science.gov (United States)

    Faeghi, Shiva; Lennerts, Kunibert

    2016-06-01

    Preventing airborne infections during a surgery has been always an important issue to deliver effective and high quality medical care to the patient. One of the important sources of infection is particles that are distributed through airborne routes. Factors influencing infection rates caused by airborne particles, among others, are efficient ventilation and the arrangement of surgical facilities inside the operating room. The paper studies the ventilation airflow pattern in an operating room in a hospital located in Tehran, Iran, and seeks to find the efficient configurations with respect to the ventilation system and layout of facilities. This study uses computational fluid dynamics (CFD) and investigates the effects of different inflow velocities for inlets, two pressurization scenarios (equal and excess pressure) and two arrangements of surgical facilities in room while the door is completely open. The results show that system does not perform adequately when the door is open in the operating room under the current conditions, and excess pressure adjustments should be employed to achieve efficient results. The findings of this research can be discussed in the context of design and controlling of the ventilation facilities of operating rooms.

  3. Utilization of operating room time in a cancer hospital

    Directory of Open Access Journals (Sweden)

    P Ranganathan

    2013-01-01

    Full Text Available Background: Appropriate usage of operating room (OR time can improve efficiency of utilization of resources and help to decrease surgical waiting lists. Aims: This study was conducted to evaluate the pattern of usage of OR time in a tertiary referral cancer hospital. Setting and Design: This was a prospective audit carried out over 2 months in 11 major ORs in a cancer hospital. Materials and Methods: OR anesthesiologists filled a standard form for all patients undergoing elective surgery and documented the following times: entry into OR, start of anesthesia, handover to surgeon, incision, start of reversal, end of anesthesia, and shifting out of patient. Statistical Analysis: Median time utilized for various OR processes was calculated. Results: An average of two surgeries were performed per OR session (828 surgeries in 407 OR sessions. Anesthesia and surgery-related processes contributed to 17% and 79%, respectively, of total OR time, with turnover time between cases accounting for the remaining 4%. Fifteen percent (60 out of 407 OR sessions started more than 10 min later than the planned start time, and 17% (70 of 407 of OR sessions ended more than 2 h after the scheduled finish time. An anesthesia procedure room was utilized in only 15% of cases where it could potentially have been used. Conclusion: This audit identified patterns of OR usage in a cancer hospital and helped to detect areas of inefficient utilization. Anesthesia-related processes contributed to 17% of the total OR time.

  4. Indoor environmental quality in Hellenic hospital operating rooms

    Energy Technology Data Exchange (ETDEWEB)

    Dascalaki, Elena G.; Gaglia, Athina G.; Balaras, Constantinos A. [Group Energy Conservation, Institute for Environmental Research and Sustainable Development, National Observatory of Athens, I. Metaxa and Vas. Pavlou, GR 152 36 P. Penteli (Greece); Lagoudi, Argyro [Terra Nova Ltd., Environmental Engineering Consultancy, Athens, Kaisareias 39, GR 115 27 Athens (Greece)

    2009-05-15

    Indoor environmental quality (IEQ) in hospital operating rooms (ORs) constitutes a major challenge for the proper design and operation of an energy efficient hospital. A subjective assessment of the indoor environment along with a short monitoring campaign was performed during the audits of 18 ORs at nine major Hellenic hospitals. A total of 557 medical personnel participated in an occupational survey, providing data for a subjective assessment of IEQ in the audited ORs. The OR personnel reported work related health symptoms and an assessment of indoor conditions (thermal, visual and acoustical comfort, and air quality). Overall, personnel reported an average of 2.24 work-related symptoms each, and 67.2% of respondents reported at least one. Women suffer more health symptoms than men. Special dispositions, such as smoking and allergies, increase the number of reported symptoms for male and female personnel. Personnel that perceive satisfactory indoor comfort conditions (temperature, humidity, ventilation, light, and noise) average 1.18 symptoms per person, while for satisfactory indoor air quality the average complaints are 0.99. The perception of satisfactory IEQ (satisfactory comfort conditions and air quality) reduces the average number of health complaints to 0.64 symptoms per person and improves working conditions, even in a demanding OR environment. (author)

  5. A norm utilisation for scarce hospital resources: Evidence from operating rooms in a Dutch university hospital

    NARCIS (Netherlands)

    van Houdenhoven, Mark; Hans, Elias W.; Klein, Jan; Wullink, Gerhard; Kazemier, Geert

    2007-01-01

    Background: Utilisation of operating rooms is high on the agenda of hospital managers and researchers. Many efforts in the area of maximising the utilisation have been focussed on finding the holy grail of 100% utilisation. The utilisation that can be realised, however, depends on the patient mix an

  6. Implementation of a risk management plan in a hospital operating room

    Directory of Open Access Journals (Sweden)

    Li Guo

    2015-12-01

    Full Text Available A risk management program based on AS–NZS4360 risk management standards was developed and implemented in the operating room of Peking University Third Hospital. To accomplish this task, we developed a risk quantification matrix and a risk register form to identify potential risks in the operating room, and then implemented operating room policies designed to reduce or eliminate those risks. We also established a consultation mechanism and risk monitoring system designed to minimize risks to operation room nurses. Finally, we continuously seek to improve our operating room risk management capabilities, so we can continue to improve the quality of service provided and guarantee the safety of surgical patients.

  7. Operating room manager game

    NARCIS (Netherlands)

    Hans, Erwin W.; Nieberg, Tim

    2007-01-01

    The operating room (OR) department of a hospital forms the heart of the organization, where the single largest cost is incurred. This document presents and reports on the “Operating Room Manager Game,” developed to give insight into managing a large hospital's OR department at various levels of cont

  8. Activity-based costing in the operating room at Valley View Hospital.

    Science.gov (United States)

    Baker, J J; Boyd, G F

    1997-01-01

    This article presents an example of how one hospital reports the results of activity-based costing (ABC). It examines the composition and supporting assumptions of an ABC report for a particular procedure in the operating room (OR). It describes management uses of the information generated. It comments upon how the continuous quality improvement (CQI) is synchronized with the ABC reporting.

  9. Improving operating room efficiency in academic children's hospital using Lean Six Sigma methodology.

    Science.gov (United States)

    Tagge, Edward P; Thirumoorthi, Arul S; Lenart, John; Garberoglio, Carlos; Mitchell, Kenneth W

    2017-06-01

    Lean Six Sigma (LSS) is a process improvement methodology that utilizes a collaborative team effort to improve performance by systematically identifying root causes of problems. Our objective was to determine whether application of LSS could improve efficiency when applied simultaneously to all services of an academic children's hospital. In our tertiary academic medical center, a multidisciplinary committee was formed, and the entire perioperative process was mapped, using fishbone diagrams, Pareto analysis, and other process improvement tools. Results for Children's Hospital scheduled main operating room (OR) cases were analyzed, where the surgical attending followed themselves. Six hundred twelve cases were included in the seven Children's Hospital operating rooms (OR) over a 6-month period. Turnover Time (interval between patient OR departure and arrival of the subsequent patient) decreased from a median 41min in the baseline period to 32min in the intervention period (p<0.0001). Turnaround Time (interval between surgical dressing application and subsequent surgical incision) decreased from a median 81.5min in the baseline period to 71min in the intervention period (p<0.0001). These results demonstrate that a coordinated multidisciplinary process improvement redesign can significantly improve efficiency in an academic Children's Hospital without preselecting specific services, removing surgical residents, or incorporating new personnel or technology. Prospective comparative study, Level II. Copyright © 2017 Elsevier Inc. All rights reserved.

  10. Nitrous Oxide Levels In Operating and Recovery Rooms of Iranian Hospitals

    Directory of Open Access Journals (Sweden)

    Sh Sadigh Maroufi

    2011-06-01

    Full Text Available "nBackground: Nitrous oxide (N2O is the oldest anesthetic in routine clinical use and its occupational exposure is under regulation by many countries. As studies are lacking to demonstrate the status of nitrous oxide levels in operating and recovery rooms of Iranian hospitals, we aimed to study its level in teaching hospitals of Tehran University of Medical Sciences."nMethods: During a 6-month period, we have measured the shift-long time weighted average concentration of N2O in 43 op­erating and 12 recovery rooms of teaching hospitals of Tehran University of Medical Sciences."nResults: The results show that the level of nitrous oxide in all hospitals is higher than the limits set by different countries and anesthetists are at higher risk of exposure. In addition, it was shown that installation of air ventilation could reduce not only the overall exposure level, but also the level of exposure of anesthetists in comparison with other personnel."nConclusion: The high nitrous oxide level in Iranian hospitals necessitates improvement of waste gas evacuation systems and regular monitoring to bring the concentration of this gas into the safe level.

  11. Advertised sustainability practices among suppliers to a university hospital operating room.

    Science.gov (United States)

    Schieble, Thomas M

    2008-01-01

    The present study aimed to identify firms supplying products to our university operating room (OR) that promote sustainable manufacturing methods. Results show that 72% of our suppliers, or 152 of 211 companies, do not promote sustainability practices in a salient manner. Multi-national firms document sustainability methods significantly more than U.S. divisions of multi-nationals or U.S. firms with chi-square = 157.93 (p sustainability promotion is an important marketing tool through which purchasers may begin the process of due diligence for product selection. Lack of sustainability information among suppliers in this study suggests that hospital procurement departments likely focus solely on issues like price or quality when making purchase decisions. These results also suggest an opportunity for healthcare administrators to evaluate more fully the products involved in the healthcare supply chain; the intrinsic, intangible value added to hospital products through sustainable manufacturing is consistent with responsible patient care and has the potential to create marketing and public relations value.

  12. Mean sound level in operation rooms in a referral hospital: a brief report

    Directory of Open Access Journals (Sweden)

    Ahmad Joneidi Jafari

    2014-02-01

    Conclusion: Overall total noise dose during all types of surgeries was measured as twice of permitted dose and also orthopedic and general operation rooms experience brief periods of noise exposure in excess.

  13. Associated Roles of Perioperative Medical Directors and Anesthesia: Hospital Agreements for Operating Room Management.

    Science.gov (United States)

    Dexter, Franklin; Epstein, Richard H

    2015-12-01

    As reviewed previously, decision making can be made systematically shortly before the day of surgery based on reducing the hours of overutilized operating room (OR) time and tardiness of case starts (i.e., patient waiting). We subsequently considered in 2008 that such decision making depends on rational anesthesia-hospital agreements specifying anesthesia staffing. Since that prior study, there has been a substantial increase in understanding of the timing of decision making to reduce overutilized OR time. Most decisions substantively influencing overutilized OR time are those made within 1 workday before the day of surgery and on the day of surgery, because only then are ORs sufficiently full that case scheduling and staff assignment decisions affect overutilized OR time. Consequently, anesthesiologists can easily be engaged in such decisions, because generally they must be involved to ensure that the corresponding anesthesia staff assignments are appropriate. Despite this, at hospitals with >8 hours of OR time used daily in each OR, computerized recommendations are superior to intuition because of cognitive biases. Decisions need to be made by a Perioperative Medical Director who has knowledge of the principles of perioperative managerial decision making published in the scientific literature rather than by a committee lacking this competency. Education in the scientific literature, and when different analytical methods should be used, is important. The addition that we make in this article is to show that an agreement between an anesthesia group and a hospital can both reduce overutilized OR time and patient waiting: The anesthesia group and hospital will ensure, hourly, that, when there are case(s) waiting to start, the number of ORs in use for each service will be at least the number that maximizes the efficiency of use of OR time. Neither the anesthesia group nor the hospital will be expected to run more than that number of ORs without mutual agreement

  14. Economic analysis of linking operating room scheduling and hospital material management information systems for just-in-time inventory control.

    Science.gov (United States)

    Epstein, R H; Dexter, F

    2000-08-01

    Operating room (OR) scheduling information systems can decrease perioperative labor costs. Material management information systems can decrease perioperative inventory costs. We used computer simulation to investigate whether using the OR schedule to trigger purchasing of perioperative supplies is likely to further decrease perioperative inventory costs, as compared with using sophisticated, stand-alone material management inventory control. Although we designed the simulations to favor financially linking the information systems, we found that this strategy would be expected to decrease inventory costs substantively only for items of high price ($1000 each) and volume (>1000 used each year). Because expensive items typically have different models and sizes, each of which is used by a hospital less often than this, for almost all items there will be no benefit to making daily adjustments to the order volume based on booked cases. We conclude that, in a hospital with a sophisticated material management information system, OR managers will probably achieve greater cost reductions from focusing on negotiating less expensive purchase prices for items than on trying to link the OR information system with the hospital's material management information system to achieve just-in-time inventory control. In a hospital with a sophisticated material management information system, operating room managers will probably achieve greater cost reductions from focusing on negotiating less expensive purchase prices for items than on trying to link the operating room information system with the hospital's material management information system to achieve just-in-time inventory control.

  15. An Analysis of Operating Room Performance Metrics at Reynolds Army Community Hospital

    Science.gov (United States)

    2009-06-28

    the MTF does not receive any performance earnings from workload generated under the Dental inpatient and outpatient codes (CAA5 and ABFA). Also OR...increasing nursing staffing to permit completion of more cases: A case study. Anesthesia & Analgesia , 94(1), 138 - 142. Dexter, F., & Macario, A. (2002...as possible. Anesthesia & Analgesia , 94(5), 1272 - 1279. OR Metrics 54 Dexter, F., Macario, A., Traub, R.D., & Lubarsky, D.A. (2003). Operating room

  16. Prevalence of Allergy to Natural Rubber Latex and Potential Cross Reacting Food in Operation Room Staff in Shiraz Hospitals -2006

    Directory of Open Access Journals (Sweden)

    H Nabavizade

    2007-07-01

    Full Text Available Introduction & Objective: Allergic reactions to natural rubber latex have increased during past 10 years especially among health care workers and patients with high exposure to latex allergens. Allergic reaction to latex is related to many diseases like occupational asthma. This study was performed to determine the prevalence of allergy to natural rubber latex and potential cross reacting food in operation room staff in Shiraz hospitals. Materials & Methods: In this cross-sectional descriptive study five hundred eighty operation room staff of ten private and state hospitals in Shiraz completed latex allergy questionnaire. They were questioned about personal history and previous history of latex sensitivity, symptoms of latex reactivity and about other allergies particularly to foods that may cross react with latex. Informed consent was obtained and skin prick testing was performed with natural rubber latex. Skin prick tests were done with three potentially cross reacting food (banana, Kiwi, and potato. The obtained data were analyzed with SPSS software and Chi-square test. Results: Among the 580 operation room workers 104 (17.9 % of participants were positive to latex skin test. We found a significant association between positive skin test to latex in operation room staff and atopy, urticaria and food allergy. Positive skin test to latex related to positive kiwi skin test (p<0.05. The prevalence did not vary by sex, age, education, surgical and non surgical glove users, history of contact dermatitis or smoking status. Conclusion: Latex allergy has a high prevalence in personnel of operation room. Evaluation of present symptom and prediction of future disease necessitate screening test in individuals at risk.

  17. Nursing care system development for patients with cleft lip-palate and craniofacial deformities in operating room Srinagarind Hospital.

    Science.gov (United States)

    Riratanapong, Saowaluck; Sroihin, Waranya; Kotepat, Kingkan; Volrathongchai, Kanittha

    2013-09-01

    For a successful surgical outcome for patients with cleft lip/palate (CLP), the attending nurses must continuously develop their potential, knowledge, capacity and skills. The goal is to meet international standards of patient safety and efficiency. To assess and improve the nursing care system for patients with CLP and craniofacial deformities at the operating room (OR), Srinagarind Hospital, Khon Kaen University. Data were collected for two months (between March 1, 2011 and April 30, 2011). Part I was an enquiry regarding the attitude of OR staff on serving patients with CLP; and, Part 2.1) patient and caregiver satisfaction with service from the OR staff and 2.2) patient and caregiver satisfaction with the OR transfer service. The authors interviewed 28 staff in OR unit 2 of the OR nursing division and 30 patients with CLP and his/her caregiver. The respective validity according to the Cronbach's alpha coefficient was 0.87 and 0.93. The OR staff attitude visa-vis service provision for patients with CLP service was middling. Patient and caregiver satisfaction with both OR staff and the transfer service was very satisfactory. Active development of the nursing care system for patients with CLP and craniofacial deformities in the operating room, Srinagarind Hospital improved staff motivation with respect to serving patients with CLP. The operating theater staff was able to co-ordinate the multidisciplinary team through the provision of surgical service for patients with CLP.

  18. Operating room management and operating room productivity: the case of Germany.

    Science.gov (United States)

    Berry, Maresi; Berry-Stölzle, Thomas; Schleppers, Alexander

    2008-09-01

    We examine operating room productivity on the example of hospitals in Germany with independent anesthesiology departments. Linked to anesthesiology group literature, we use the ln(Total Surgical Time/Total Anesthesiologists Salary) as a proxy for operating room productivity. We test the association between operating room productivity and different structural, organizational and management characteristics based on survey data from 87 hospitals. Our empirical analysis links improved operating room productivity to greater operating room capacity, appropriate scheduling behavior and management methods to realign interests. From this analysis, the enforcing jurisdiction and avoiding advance over-scheduling appear to be the implementable tools for improving operating room productivity.

  19. [Who is suited as operation room manager? Evaluation process for hospitals and candidates].

    Science.gov (United States)

    Schüpfer, G; Bauer, M

    2011-03-01

    Operation room (OR) management is not an end in itself. The challenge is more to organize the complex, inhomogeneous and interference-prone machinery of intraoperative service provision according to business objectives. Although business objectives may differ in some details the ultimate consequence is always to assure the quality of medical care along with adhering to the general economic conditions. The narrower the economic framework the smaller the company's tolerance to unprofessional OR management. Consequently, it can be noticed that OR management has become of age. An internal socialization as frontline leader is no longer sufficient for taking over a job profile which, regarding the risks of revenues and costs belongs to the top management of a company. Prior to looking for a future OR manager it is mandatory to develop a profile of qualifications tailored to the company. In the following selection process the important thing is to identify the candidate who fits best to the developed profile. This paper sees itself as an assistance in the development of such a company-specific qualification profile for an OR manager. On the basis of knowledge, skills and characteristics, different manager typologies are developed, facilitating the successful evaluation in a selection process for both the company and the candidate.

  20. An Investigation on the Current Status of the Operation Recovery Rooms in Yazd Hospitals in 2010-2011

    Directory of Open Access Journals (Sweden)

    MR Khajeh Aminian

    2012-08-01

    Full Text Available Introduction: The recovery ward is a vital unit to care patients awaking from anesthesia and is a standard requirement for the operating room. Recovery ward is located adjacent to the operation room and is easily accessible to trained and skilled individuals. The unit must have adequate equipment for surveillance and monitoring of patients and required medication should also be provided. Methods: This study is a cross-sectional conducted in one phase through referring to hospital facilities and equipment. Physical space, personnel and their skill levels and other factors that are involved in the care of patients in the recovery have been investigated. The instruments used in this study were a check list and observe sheet which were completed by the researchers. Data analysis was conducted by SPSS software. Results: The results showed that the standards of buildings and physical space in the researched areas were mostly nonstandard. Equipment standards were to some extent in line with the criteria set by American Association of Anesthesia. Besides, some equipment was blow standard levels. Personnel standards regarding the number of nurses toward the number of recovery beds did not meet the standard criteria in most of the cases. Conclusion: The research shows that building standards in most cases are not in line with mentioned references. Undertaking equipment standards in the hospital recovery wards needs reviewing and providing controlling equipment for preventing the complications of recovery phase of anesthesia in recovery wards.

  1. New heuristics for planning operating rooms.

    NARCIS (Netherlands)

    Molina-Pariente, J.M.; Hans, E.W.; Framinan, J.M.; Gomez-Cia, T.

    2015-01-01

    We tackle the operating room planning problem of the Plastic Surgery and Major Burns Specialty of the University Hospital “Virgen del Rocio” in Seville (Spain). The decision problem is to assign an intervention date and an operating room to a set of surgeries on the waiting list, minimizing access t

  2. An audit of operating room time utilization in a teaching hospital: is there a place for improvement?

    Science.gov (United States)

    Stavrou, George; Panidis, Stavros; Tsouskas, John; Tsaousi, Georgia; Kotzampassi, Katerina

    2014-01-01

    Aim. To perform a thorough and step-by-step assessment of operating room (OR) time utilization, with a view to assess the efficacy of our practice and to identify areas of further improvement. Materials and Methods. We retrospectively analyzed the most ordinary general surgery procedures, in terms of five intervals of OR time utilization: anaesthesia induction, surgery preparation, duration of operation, recovery from anaesthesia, and transfer to postanaesthesia care unit (PACU) or intensive care unit (ICU). According to their surgical impact, the procedures were defined as minor, moderate, and major. Results. A total of 548 operations were analyzed. The mean (SD) time in minutes for anaesthesia induction was 19 (9), for surgery preparation 13 (8), for surgery 115 (64), for recovery from anaesthesia 12 (8), and for transfer to PACU/ICU 12 (9). The time spent in each step presented an ascending escalation pattern proportional to the surgical impact (P = 0.000), which was less pronounced in the transfer to PACU/ICU (P = 0.006). Conclusions. Albeit, our study was conducted in a teaching hospital, the recorded time estimates ranged within acceptable limits. Efficient OR time usage and outliers elimination could be accomplished by a better organized transfer personnel service, greater availability of anaesthesia providers, and interdisciplinary collaboration.

  3. Difficult points and countermeasures for hospital infection control in operating room%手术室医院感染控制的难点及对策

    Institute of Scientific and Technical Information of China (English)

    冯迎辉

    2011-01-01

    Objective:To solve the difficulties of controlling hospital infection in operating room and give some solutions to this problem in order to improve the quality of nursing. Methods: The problems which found in our hospital in daily work were analyzed, improved and summaried, such as the operating room environment, the management of sterile goods, hand hygiene, movement in the surgery. Results: Cut the way caused the operating room infection, make the indicators of the operating room in the normal range, could avoid the occurrence of various surgical infections and improve the quality of health care. Conclusion: The effective implementations of the operating room disinfection and isolation measures were an important way to control hospital infection.%目的:解决手术室医院感染控制的难点并探讨手术室医院感染控制对策,以提高医疗护理质量.方法:通过我院感染管理科在日常工作中发现的问题,如手术室环境、无菌物品的管理、手卫生、手术中人员流动、各项感染措施及各项制度的落实等找出原因进行分析、整改和总结.结果:切断了引起手术室医院感染的途径,使手术室的各项指标在正常范围,避免了各项手术感染的发生,提高了医院的医疗护理质量.结论:有效地落实手术室消毒隔离措施是控制医院感染的重要途径.

  4. Private Hospital La Clinique de La Qiataigneraie Deployed Wi-Fi Network to Optimize the Management of its Operating Rooms

    Institute of Scientific and Technical Information of China (English)

    2006-01-01

    Symbol Technologies, Inc. (NYSE:SBL), The Enterprise Mobility Company, and Ekahau, one of the leading suppliers of Wi-Fi positioning solutions, today announced that the La Chataigneraie private clinic implemented the Ekahau Real Time Location System (RTLS) solution. The wireless solution incorporates two Symbol WS5100 wireless switches and 30 AP300 access ports, and is used to improve communications in and between its 16 operating rooms.

  5. A STUDY OF PRE OPERATION NURSING VISIT ABOUT THE NURSES’ VIEW FROM THE SURGERY ROOM OF A UNIVERSITY HOSPITAL.

    Directory of Open Access Journals (Sweden)

    Izilda Esmenia Muglia Araújo

    2004-08-01

    Full Text Available This study to do an analysis of the PONV`s importance, by nurses from the Daily’s SurgeryRoom of an University Hospital, through forms distributed to them and to apply the written communicationinstrument on the PONV,proposed by NORONHA & ARAÚJO (1995. The results this research were: 92,9% ofthe nurses from the Daily’s Surgery Room think that it is important the performance of the PONV to the patientand Nursing aid, and 85,7% think the PONV is important for the nurse who works in a Surgery Room. Thewritten communication instrument on the PONV was applied with success, being really easy to fill it in with clearquestions , showing so to be a lot of viable but some items of the instrument like blood group and FATOR RHcouldn’t be filled even after the records check. In this way, I think it is worth the suggestion o9f sitting the writtencommunication instrument proposed by ARAÚJO AND NORONHA (1995 at this State University, proposinghowever, inclusion on the patients’ records data about blood group and FATOR RH.

  6. Performance of the Operating Room Personnel in following of the standards of Infection Control in the Educational Hospitals of Yasuj University of Medical Sciences in 2009

    Directory of Open Access Journals (Sweden)

    A Rostaminejad

    2011-04-01

    Full Text Available Introduction & Objective: Surgical wound infection is one of the common nosocomial infections. During operation, members of the surgical team which are in contact with the tissue incision should observe the standards of infection control in the operating room since it has a great role in prevention and control of these infections. The present study aimed to determine the performance of the operating room personnel in observing the standards of infection control in educational hospitals of Yasuj University of Medical Sciences in 2009. Materials & Methods: Forty two operating room personnel participated in this cross-sectional analytic-descriptive study. A check list was used for unnoticeably collecting the data about the performance of personnel in respect of infection control standards at three different times. Their performances were classified into four levels (very weak, weak, moderate and good and the results were shown as absolute and relative frequency distribution. Data were analyzed using Chi-square and Fischer exact test by the SPSS software. Results: Performance of personnel in following the standards of infection control in this study was moderate. Conclusion: The results indicate that the participants of the study do not follow some of the standards of infection control in the operating rooms. Therefore, further activities of the committees of infection control and using of new antiseptic for surgical scrub are recommended.

  7. Using Goal Setting, Task Clarification, and Feedback to Increase the Use of the Hands-Free Technique by Hospital Operating Room Staff

    Science.gov (United States)

    Cunningham, Thomas R; Austin, John

    2007-01-01

    We evaluated the effects of a behavioral treatment on the safe passing of sharp instruments using the hands-free technique among hospital operating room personnel during surgical procedures. Treatment consisted of participative goal setting, task clarification, and feedback. The average percentage of sharp instruments passed safely increased from 32% to 64% and 31% to 70% between baseline and treatment phases in the inpatient and outpatient surgery units, respectively. Five-month follow-up data suggested maintenance of treatment effects. These findings suggest the utility of organizational behavior management strategies in reducing risky behavior in hospital settings. PMID:18189098

  8. Unplanned return to operating room after endovascular repair of abdominal aortic aneurysm (EVAR) is associated with increased risk of hospital readmission.

    Science.gov (United States)

    Aziz, Faisal; Ferranti, Katelynn; Lehman, Erik B

    2017-01-01

    Objectives Hospital readmissions after surgical operations are considered serious events. Centers for Medicare and Medicaid (CMS) consider surgical readmissions as preventable and hold hospitals responsible for them. Endovascular abdominal aortic aneurysm (EVAR) has become the first line modality of treatment for suitable patients with abdominal aortic aneurysm (AAA). The purpose of this study is to retrospectively review the factors associated with hospital readmission after EVAR. Methods The 2013 EVAR targeted American College of Surgeons (ACS-NSQIP) database and generalized 2013 general and vascular surgery ACS-NSQIP participant use files were used for this study. Patient, diagnosis, and procedure characteristics of patients undergoing EVAR surgery were assessed. Multivariate logistic regression analysis was used to determine independent risk factors for hospital readmission within 30 days after surgery. Results A total of 2277 patients (81% males, 19% females) underwent EVAR operations in the year 2013. Indications for operations included: asymptomatic large diameter (79%), symptomatic (5.7%), rupture without hypotension (4.3%), and rupture with hypotension (2.8%). Among these patients, 178 (7.8%) were readmitted to the hospital within 30 days after surgery. About 53% of all readmissions were within two weeks after the discharge. Risk factors, associated with readmission included: body mass index (per 5-units, OR 1.23, CI 1.06-1.42, p return to the operating room (OR 11.29, CI 6.29-20.28, p Risk of readmission for patients with presence of all these seven factors was 99.9%. Conclusions Readmission after EVAR is a serious occurrence. Various factors predispose a patient at a high risk for readmission. Unplanned return to operating room after EVAR is associated with a 11-fold increase in hospital readmission.

  9. Analysis of Bacterial Contamination in Anesthetic Equipments in Operation Room of Vali-E-Asr Hospital of Fasa; Efficiency of Disinfection Methods

    Directory of Open Access Journals (Sweden)

    Abbas Abdollahi

    2011-09-01

    Full Text Available Background & Objectives: Anesthetic equipments could be one of the factors transmitting infection in a surgical operation. We could be prevent infection transmission to a great extend, by providing efficient methods of disinfection of anesthetic equipments. The purpose of the present research is to analyze the bacterial contamination in anesthetic equipment in operation rooms of Vali-e-Asr hospital in Fasa city, Fars province, and evaluate the efficiency of the applied disinfection methods. Materials & Methods: In this cross-sectional & analytical study, sampling from anesthetic equipment was done by sterile swap and culture on nutrient media, irregularly and randomly, before and after using and washing tools. Used anesthetic equipment in such operation rooms have been washed with Betadine 7.5% by experts and technicians of anesthetic section and were prepared for the next operation. Results: Total contamination was 2.3% in 210 samples taken. 5 culture items indicated the existence of bacterial contamination, among which 2 contamination cases were observed in nasal airway (coagulase negative Staphylococcus, non pathogen Neisseria, 2 contamination cases in red rubber endotracheal tube (nonpathogen Neisseria and Klebsiella pneumonia and 1 contamination case in oxygen mask (Escherichia coli. Conclusion: The very low level of contamination (20-85% contamination in anesthetic equipments in our research is probably due to application of a appropriate disinfection method used by educated personnel in operation rooms. This could have a significant role in decreasing the infection rate in one hand and decreasing expenses and time on the other hand.

  10. Type and Concentration of Bioaerosols in the Operating Room of Educational Hospitals of Hamadan University of Medical Sciences and Effectiveness of Ventilation Systems, in Year 2004

    Directory of Open Access Journals (Sweden)

    F. Ghorbani Shahna

    2006-07-01

    Full Text Available Introduction & Objective: The bioaerosol is one of the operating room(OR hazards that can be threaten of personel health and capable to creating of postoperetive infection in the patients. Because of the hospital infection rate has correleted to bioaerosol concentration, therefore, it is important to determine of type and concentration of these microorganisms as the main goal of this study. Materials and Methods: In this research, 23 operation rooms in the 4 educational hospitals of the Hamadan City were studied. 115 air samples were collected in the various locations and conditions according to filtration method suggested by bioaerosol committee of ACGIH. The samples were transported to blood agar and cultivated immediatedly. The type and number of colonies were determined in the laberatory then, the bioaerosol concentration were calculated in terms of cfu/m3. The data of physical conditions of ORs , ventilation specifications and other environmental parameters have been recorded in the work sheet.Results: The results have demonstrated that the mean of total bioaerosol and pathogen bioaerosol concentration were 136 cfu/m3 and 4.01 cfu/m3 respectively. The concentration of 25.3% of the total pathogen samples be exceeded of recommended limit. It is apeared that have been correlation between concentration of bioaerosols and duration of surgry (P<0.05, also the concentration of morninig shift were higher than the other shifts(P<0.05.Conclusion: According to the detected bioaerosols pathogens in the samples, high cleaning class in the operating rooms is necessary. It is necessary to design and administrate the ventilation systems according to standards because of the absence of appropriate ventilation system in the three hospitals of four investigated hospitals.

  11. [Management for the operating room].

    Science.gov (United States)

    Tschudi, O; Schüpfer, G

    2015-03-01

    Business companies, which in the current times also includes hospitals, must create customer benefits and as a prerequisite for this must sustainably generate profits. Management in the world of business means the formation and directing of a company or parts of a company on a permanent basis, whereby management in this context is not exercising power but function. This concept of management is exemplary developed in this article for the important services sector of the operating room (OR) and individual functions, such as resource control, capacity planning and materials administration are presented in detail. Some OR-specific management challenges are worked out. From this it becomes clear that the economic logic of the most efficient implementation possible is not a contradiction of medical ethics, enabling the most effective treatment possible for patients while safeguarding the highest possible levels of safety and quality. The article aims to build a bridge for medical specialists to the language and world of commerce, emphasizing the profession-based competence and hopefully to arouse interest to go into more detail.

  12. Fresh-Frozen Plasma: Ordering Patterns and Utilization in the Operating Rooms of a Tertiary Referral Hospital.

    Science.gov (United States)

    Meyer, Matthew J; Dzik, Walter H; Levine, Wilton C

    2017-02-01

    Blood product transfusion is the most commonly performed hospital procedure. Intraoperative blood product utilization varies between institutions and anesthesiologists. In the United States in 2011, nearly 4 million plasma units were transfused. A retrospective analysis of intraoperative plasma ordering patterns and utilization (thawing and transfusing) was performed at a tertiary, academic hospital between January 2015 and March 2016. Over 15 months, 46,002 operative procedures were performed. In 1540 of them, plasma was thawed or transfused: 8297 plasma units were thawed and 3306 of those units were transfused. These 3306 plasma units were transfused in 749 cases with a median of 2 plasma units (interquartile range, 2-4) transfused. The percentage of average monthly procedures with plasma thawed and none transfused was 51.3% (confidence interval, 49.0%-53.6%). The cardiac surgery service requested the greatest number of plasma units to be thawed (2143) but only transfused 712 (33.2%) of them. Of all plasma units not transfused, 45% were generated by procedures with 1 to 4 units of plasma thawed; 95.7% of these units were thawed as even integers (ie, 2, 4). For operative procedures, far more plasma was thawed than was transfused and this practice occurred across surgical specialties and anesthesiologists. Considering the plasma that was not transfused, 45% occurred in procedures with 4 or fewer units of plasma requested suggesting these low-volume requests were a primary source of potential waste. Further studies are needed to examine associations between plasma utilization and clinical outcomes.

  13. [Comparison of waste anesthetic gases in operating rooms with or without an scavenging system in a Brazilian University Hospital].

    Science.gov (United States)

    Braz, Leandro Gobbo; Braz, José Reinaldo Cerqueira; Cavalcante, Guilherme Aparecido Silva; Souza, Kátina Meneghetti; Lucio, Lorena Mendes de Carvalho; Braz, Mariana Gobbo

    Occupational exposure to waste anesthetic gases in operating room (OR) without active scavenging system has been associated with adverse health effects. Thus, this study aimed to compare the trace concentrations of the inhaled anesthetics isoflurane and sevoflurane in OR with and without central scavenging system. Waste concentrations of isoflurane and sevoflurane were measured by infrared analyzer at different locations (near the respiratory area of the assistant nurse and anesthesiologist and near the anesthesia station) and at two times (30 and 120minutes after the start of surgery) in both OR types. All isoflurane and sevoflurane concentrations in unscavenged OR were higher than the US recommended limit (2 parts per million), regardless of the location and time evaluated. In scavenged OR, the average concentrations of isoflurane were within the limit of exposure, except for the measurements near the anesthesia station, regardless of the measurement times. For sevoflurane, concentrations exceeded the limit value at all measurement locations and at both times. The exposure to both anesthetics exceeded the international limit in unscavenged OR. In scavenged OR, the concentrations of sevoflurane, and to a lesser extent those of isoflurane, exceeded the recommended limit value. Thus, the OR scavenging system analyzed in the present study decreased the anesthetic concentrations, although not to the internationally recommended values. Copyright © 2017 Sociedade Brasileira de Anestesiologia. Publicado por Elsevier Editora Ltda. All rights reserved.

  14. Managing risk and expected financial return from selective expansion of operating room capacity: mean-variance analysis of a hospital's portfolio of surgeons.

    Science.gov (United States)

    Dexter, Franklin; Ledolter, Johannes

    2003-07-01

    Surgeons using the same amount of operating room (OR) time differ in their achieved hospital contribution margins (revenue minus variable costs) by >1000%. Thus, to improve the financial return from perioperative facilities, OR strategic decisions should selectively focus additional OR capacity and capital purchasing on a few surgeons or subspecialties. These decisions use estimates of each surgeon's and/or subspecialty's contribution margin per OR hour. The estimates are subject to uncertainty (e.g., from outliers). We account for the uncertainties by using mean-variance portfolio analysis (i.e., quadratic programming). This method characterizes the problem of selectively expanding OR capacity based on the expected financial return and risk of different portfolios of surgeons. The assessment reveals whether the choices, of which surgeons have their OR capacity expanded, are sensitive to the uncertainties in the surgeons' contribution margins per OR hour. Thus, mean-variance analysis reduces the chance of making strategic decisions based on spurious information. We also assess the financial benefit of using mean-variance portfolio analysis when the planned expansion of OR capacity is well diversified over at least several surgeons or subspecialties. Our results show that, in such circumstances, there may be little benefit from further changing the portfolio to reduce its financial risk. Surgeon and subspecialty specific hospital financial data are uncertain, a fact that should be taken into account when making decisions about expanding operating room capacity. We show that mean-variance portfolio analysis can incorporate this uncertainty, thereby guiding operating room management decision-making and reducing the chance of a strategic decision being made based on spurious information.

  15. The Patient Safety Attitudes among the Operating Room Personnel

    Directory of Open Access Journals (Sweden)

    Cherdsak Iramaneerat

    2016-07-01

    Full Text Available Background: The first step in cultivating the culture of safety in the operating room is the assessment of safety culture among operating room personnel. Objective: To assess the patient safety culture of operating room personnel at the Department of Surgery, Faculty of Medicine Siriraj Hospital, and compare attitudes among different groups of personnel, and compare them with the international standards. Methods: We conducted a cross-sectional survey of safety attitudes among 396 operating room personnel, using a short form of the Safety Attitudes Questionnaire (SAQ. The SAQ employed 30 items to assess safety culture in six dimensions: teamwork climate, safety climate, stress recognition, perception of hospital management, working conditions, and job satisfaction. The subscore of each dimension was calculated and converted to a scale score with a full score of 100, where higher scores indicated better safety attitudes. Results: The response rate was 66.4%. The overall safety culture score of the operating room personnel was 65.02, higher than an international average (61.80. Operating room personnel at Siriraj Hospital had safety attitudes in teamwork climate, safety climate, and stress recognition lower than the international average, but had safety attitudes in the perception of hospital management, working conditions, and job satisfaction higher than the international average. Conclusion: The safety culture attitudes of operating room personnel at the Department of Surgery, Siriraj Hospital were comparable to international standards. The safety dimensions that Siriraj Hospital operating room should try to improve were teamwork climate, safety climate, and stress recognition.

  16. Operating room of the future.

    Science.gov (United States)

    Bharathan, Rasiah; Aggarwal, Rajesh; Darzi, Ara

    2013-06-01

    Development of surgical care in the 21st century is increasingly dependent on demonstrating safety, efficacy and cost effectiveness. Over the past 2 decades, the potential role of simulation in surgery has been explored with encouraging results; this can now be linked to direct improvement in the quality of care provision. Computer-assisted surgical platforms, such as robotic surgery, offer us the versatility to embrace a host of technical and technological developments. Rapid development in nanomedicine will expand the limits of operative performance through improved navigation and surgical precision. Integration of the multiple functions of the future operating room will be essential in optimising resource management. The key to bringing about the necessary paradigm shift in the design and delivery of modern surgical care is to appreciate that we now function in an information age, where the integrity of processes is driven by apt data management.

  17. Operating Room Telephone Microbial Flora

    Science.gov (United States)

    2007-11-02

    beta-lactamase expressing multi-resistant Acinetobacter baumannii transmitted in the operation area. J Hosp Infect, 2004. 57(4): p. 308-15. 63...Goodman, J. E., Volk, H. M., and Sood, R., Direct costs of multidrug-resistant Acinetobacter baumannii in the burn unit of a public teaching hospital...Scerpella, E.G., Wanger, A. R., Armitige, L., Anderlini, P., & Ericsson, C. D., Nosocomial outbreak caused by a multiresistant clone of Acinetobacter

  18. Success of commonly used operating room management tools in reducing tardiness of first case of the day starts: evidence from German hospitals.

    Science.gov (United States)

    Ernst, Christian; Szczesny, Andrea; Soderstrom, Naomi; Siegmund, Frank; Schleppers, Alexander

    2012-09-01

    One of the declared objectives of surgical suite management in Germany is to increase operating room (OR) efficiency by reducing tardiness of first case of the day starts. We analyzed whether the introduction of OR management tools by German hospitals in response to increasing economic pressure was successful in achieving this objective. The OR management tools we considered were the appointment of an OR manager and the development and adoption of a surgical suite governance document (OR charter). We hypothesized that tardiness of first case starts was less in ORs that have adopted one or both of these tools. Using representative 2005 survey data from 107 German anesthesiology departments, we used a Tobit model to estimate the effect of the introduction of an OR manager or OR charter on tardiness of first case starts, while controlling for hospital size and surgical suite complexity. Adoption reduced tardiness of first case starts by at least 7 minutes (mean reduction 15 minutes, 95% confidence interval (CI): 7-22 minutes, P tardiness of first case starts figure prominently the objectives of surgical suite management in Germany. Our results suggest that the appointment of an OR manager or the adoption of an OR charter support this objective. For short-term decision making on the day of surgery, this reduction in tardiness may have economic implications, because it reduced overutilized OR time.

  19. THE MANAGEMENT MEASURES FOR THE OPERATION QUALITY OF LAMINAR FLOW OPERATING ROOM SYSTEMS SECURITY IN OPERATING ROOM OF THE HOSPITAL%医院手术部层流洁净系统运行质量安全管理措施

    Institute of Scientific and Technical Information of China (English)

    林彬; 李文霞; 李晓花

    2012-01-01

    Objective To observe the operation quality of laminar flow clean system in operating room so as to enhance safety management measures. Methods Through the instrumental analysis and detection methods on the field, the running quality of laminar flow clean system in operating room of this hospital was monitored. Results After the laminar flow system of each level of the operating room and ancillary rooms running for 30 min, the average pass rate of micro - climate of all parts of the indoor environment was more than 98% ; that of precipitating bacterial indicators in the surgical area and the surrounding area of one thousand purification surgery air was more than 97% and that of the subsidence bacteria indicators in the 100 000 - 300 000 clean regional area was 100%. Conclusion The operation quality of laminar flow clean system in operating room of this hospital is reliable and the management is normative. The operating manual should be stricdy executed.%目的 观察医院手术部层流洁净系统运行质量,加强安全管理措施.方法 通过现场仪器分析检测方法,对某医院手术部层流洁净系统运行质量进行了监测.结果 各级别手术室和辅助用房在层流洁净系统运行30min后,所有部位室内环境微小气候平均合格率达到98%以上.1000级手术区和周边区空气中沉降菌指标有97%以上达标;10万至30万级洁净区域沉降菌指标合格率均达到100%.结论 该医院手术部层流洁净系统运行质量可靠,管理规范,主要靠严格执行操作规程.

  20. Workplace culture among operating room nurses.

    Science.gov (United States)

    Eskola, Suvi; Roos, Mervi; McCormack, Brendan; Slater, Paul; Hahtela, Nina; Suominen, Tarja

    2016-09-01

    To investigate the workplace culture in the Operating Room (OR) environment and the factors associated with it. In health care, the workplace culture affects the delivery and experience of care. The OR can be a stressful practice environment, where nurses might have occasionally either job stress or job satisfaction based on their competence. A quantitative cross-sectional approach was used. The study consisted of 96 Finnish OR nurses. A Nursing Context Index instrument was used to obtain data by way of an electronic questionnaire. The primary role and working unit of respondents were the main components relating to workplace culture, and especially to job stress. Nurse anaesthetists were found to be slightly more stressed than scrub nurses. In local hospitals, job stress related to workload was perceived less than in university hospitals (P = 0.001). In addition, OR nurses in local hospitals were more satisfied with their profession (P = 0.007), particularly around issues concerning adequate staffing and resources (P = 0.001). It is essential that nurse managers learn to recognise the different expressions of workplace culture. In particular, this study raises a need to recognise the factors that cause job stress to nurse anaesthetists. © 2016 John Wiley & Sons Ltd.

  1. 整形美容科门诊手术室医院感染隐患与防控对策%Security risks and prevention and control measures of the plastic surgery outpatient operating room of hospital infection

    Institute of Scientific and Technical Information of China (English)

    王靖; 杨爱芝; 赵应兰

    2012-01-01

    目的:探讨整形美容门诊手术室医院感染的安全隐患与控制措施.方法:分析发生感染的危险因素,采取相应的感染预防与控制措施,严格遵守感染预防原则,做好布局、流程、监测等环节的管理.结果:通过预防措施,规范了整形美容患者进入门诊手术室手术的流程,降低了医院感染率,提高了医疗护理质量,避免了医疗纠纷.结论:通过分析整形美容门诊手术室医院感染的安全隐患,加强整形美容门诊手术室医院感染的管理,增加了医院的社会及经济效益.%Objective:To explore the security risks and control measures of cosmetic surgery outpatient operating room and hospital infection. Methods:Ana-lyzed of the occurrence of risk factors for infection, and took the appropriate infection prevention and control measures, strict compliance with infection pre-vention principles,good layout,processes, monitoring and other aspects of management. Results:Through preventive measures,standardized the process of cosmetic surgery patients entered the outpatient operating room surgery, reduced hospital infection rates, improved the quality of medical nursing, avoided medical disputes. Conclusion;Through the analyze the security risks of cosmetic surgery clinic operating room hospital infections,to strengthen the manage-ment of cosmetic surgery to the outpatient operating room of hospital infection,and increase the hospital's social and economic benefits.

  2. Disinfection and sterilization monitoring and hospital infection control in operating room%手术室消毒灭菌监测与医院感染控制

    Institute of Scientific and Technical Information of China (English)

    唐香祝; 阮杏菲; 江翠波

    2016-01-01

    目的:探讨加强手术室消毒灭菌监测,对医院感染控制的作用。方法根据《消毒技术规范》中所规定的操作要求对手术室消毒灭菌效果进行监测。研究采用回顾性及现场临床观察方法,观察患者术后伤口情况。结果实施手术室消毒灭菌监测前,空气灭菌合格率、消毒物品灭菌合格率、医护人员手灭菌合格率分别为92.63%、93.75%、88.57%,实施手术室消毒灭菌监测后,空气灭菌合格率、消毒物品灭菌合格率、医护人员手灭菌合格率分别为98.96%、100.00%、100.00%,差异有统计学意义(P<0.05);实施手术室消毒灭菌监测前,手术患者切口感染率为6.41%,Ⅰ类切口感染率、Ⅱ类切口感染率、Ⅲ类切口感染率分别为2.54%、6.22%、11.34%,实施手术室消毒灭菌监测后,手术患者切口感染率为2.57%,Ⅰ类切口感染率、Ⅱ类切口感染率、Ⅲ类切口感染率分别为0.39%、2.21%、5.77%,差异有统计学意义(P<0.05)。结论通过手术室消毒灭菌监测,能够有效提高手术室内空气、设备、器械等灭菌率。此外,还能够有效降低手术患者术后切口感染率,值得推广。%Objective To study the effect of disinfection and sterilization monitoring and hospital infection control in operating room.MethodsTo monitor the effect of disinfection and sterilization in operating room according to the operation requirements stipulate by disinfection technical guidelines.To observe the patients' postoperative wound condition according to the methods of retrospectively study and spot clinical observation.Results The differences of the eligible sterilization rate of air, disinfection materials, hands of medical staff after implementation of disinfection and sterilization monitoring(98.96%,100.00%,100.00%)were statically significant compared with which before implementation of disinfection and sterilization monitoring(92

  3. Rethinking theatre in modern operating rooms.

    Science.gov (United States)

    Riley, Robin; Manias, Elizabeth

    2005-03-01

    Metaphor is a means through which a widely accepted meaning of a word is used in a different context to add understanding that would otherwise be difficult to conceive. Through etymological and metaphorical associations, we contend that aspects of "theatre" are still relevant in the modern operating rooms and that the use of dramaturgical metaphors can add another layer of understanding about the social reality in this setting. We begin by exploring the historical roots and derivation of the word theatre as it applied to anatomical dissection and surgery. Briefly, we touch on the work of Erving Goffman and examine how his work has been used by others to explore aspects of operating room nursing. Then, drawing on data from a postmodern ethnographic study that has been used to examine communication in operating room nursing, four dramaturgical metaphors are used to illustrate the argument. They are drama, the script and learning the lines, the show must go on, and changing between back stage and front stage. To conclude, the small amount of previously published literature on this topic is compared and contrasted, and the relevance of using dramaturgical metaphors to understand modern operating rooms is discussed. Being able to distinguish between the inherent drama in operating room work and the dramatic realisation of individuals who work within, can help operating room nurses to think differently about, and perhaps re-evaluate their social situation and how they function within it.

  4. Facets of operational performance in an emergency room (ER)

    NARCIS (Netherlands)

    van der Vaart, Taco; Vastag, Gyula; Wijngaard, Jacob

    2011-01-01

    This paper, using detailed time measurements of patients complemented by interviews with hospital management and staff, examines three facets of an emergency room's (ER) operational performance: (1) effectiveness of the triage system in rationing patient treatment; (2) factors influencing ER's opera

  5. The vascular hybrid room--operating room of the future.

    Science.gov (United States)

    Hudorović, Narcis; Rogan, Suncica Andreja; Lovricević, Ivo; Zovak, Mario; Schmidt, Sasa

    2010-09-01

    The last two decades have seen a paradigm shift in the treatment of vascular related diseases from once traditional open surgical repairs to the entire vascular tree being amenable to percutaneous interventions. Neither the classic operating room nor the conventional angiography suite is optimal for both open surgery and endovascular procedures. Important issues for the vascular hybrid operating room include quality of the imaging equipment, radiation burden, ease of use of the equipment, need for specially trained personnel, ergonomics, ability to perform both open and percutaneous procedures, sterile environments, as well as quality and efficiency of patient care. The most important feature of working in a dedicated hybrid vascular suite should be the ability to attain best treatment of vascular patients. Whether the interventional radiologist or the vascular surgeon uses the facilities is of less importance. Establishment of an endovascular operating room suite has the benefit of a sterile environment, and the possibility of performing hybrid procedures and conversions when necessary. Moreover, angiography immediately before treatment gives contemporary anatomical information, and after treatment provides quality control. Consequently, better quality and service can be provided to the individual patient. These changes in the treatment of vascular disease require that a new type of vascular specialist, named 'vascular hybrid surgeon', trained to perform both endovascular and open surgical procedures in this highly complex patient group.

  6. Principles of operating room organization.

    Science.gov (United States)

    Watkins, W D

    1997-01-01

    The importance of the changing health care climate has triggered important changes in the management of high-cost components of acute care facilities. By integrating and better managing various elements of the surgical process, health care institutions are able to rationally trim costs while maintaining high-quality services. The leadership that physicians can provide is crucial to the success of this undertaking (1). The importance of the use of primary data related to patient throughput and related resources should be strongly emphasized, for only when such data are converted to INFORMATION of functional value can participating healthcare personnel be reasonably expected to anticipate and respond to varying clinical demands with ever-limited resources. Despite the claims of specific commercial vendors, no single product will likely be sufficient to significantly change the perioperative process to the degree or for the duration demanded by healthcare reform. The most effective approach to achieving safety, cost-effectiveness, and predictable process in the realm of Surgical Services will occur by appropriate application of the "best of breed" contributions of: (a) medical/patient safety practice/oversight; (b) information technology; (c) contemporary management; and (d) innovative and functional cost-accounting methodology. S "modified activity-based cost accounting method" can serve as the basis for acquiring true direct-cost information related to the perioperative process. The proposed overall management strategy emphasizes process and feedback, rather than specific product, and although imposing initial demands and change on the traditional hospital setting, can advance the strongest competitive position in perioperative services. This comprehensive approach comprises a functional basis for important bench-marking activities among multiple surgical services. An active, comparative process of this type is of paramount importance in emphasizing patient care and

  7. Implementing an operating room pharmacy satellite.

    Science.gov (United States)

    Powell, P J; Maland, L; Bair, J N; McCall, J D; Wong, K C

    1983-07-01

    Implementation of an operating room (OR) pharmacy satellite is described, and its impact on cost-effectiveness and efficiency of drug distribution is analyzed. The OR satellite provided pharmacy coverage for 30-35 patients per day in 10 centralized surgical suites, 2 obstetric suites, and 1 burn-unit suite in a 401-bed teaching hospital. Objectives of the satellite were to consolidate accountability for drug distribution and control, reduce controlled substance loss and waste, reduce inventory costs, and improve recording of patient charges. Stock on the OR supply cart was reduced, controlled substances were dispensed to anesthesiologists from the satellite, and a system of standardized anesthesiology exchange trays was developed. A new billing form served as both the charging document and replacement list. Reduction in the medication cart stock resulted in smaller discrepancies in patient charges. For the five most commonly used controlled substances, accounting discrepancies were reduced. Inventory turnover increased and inventory dollar value and cost per patient were reduced. The percent of nurses who believed that a pharmacist should work in the area increased from 31% before implementation of the satellite to 95% after. The pilot OR pharmacy satellite was a financial success. Efficiency and effectiveness in drug distribution and control were improved, and communication between pharmacists and other medical personnel working in the OR areas was enhanced.

  8. Safety status system for operating room devices.

    Science.gov (United States)

    Guédon, Annetje C P; Wauben, Linda S G L; Overvelde, Marlies; Blok, Joleen H; van der Elst, Maarten; Dankelman, Jenny; van den Dobbelsteen, John J

    2014-01-01

    Since the increase of the number of technological aids in the operating room (OR), equipment-related incidents have come to be a common kind of adverse events. This underlines the importance of adequate equipment management to improve the safety in the OR. A system was developed to monitor the safety status (periodic maintenance and registered malfunctions) of OR devices and to facilitate the notification of malfunctions. The objective was to assess whether the system is suitable for use in an busy OR setting and to analyse its effect on the notification of malfunctions. The system checks automatically the safety status of OR devices through constant communication with the technical facility management system, informs the OR staff real-time and facilitates notification of malfunctions. The system was tested for a pilot period of six months in four ORs of a Dutch teaching hospital and 17 users were interviewed on the usability of the system. The users provided positive feedback on the usability. For 86.6% of total time, the localisation of OR devices was accurate. 62 malfunctions of OR devices were reported, an increase of 12 notifications compared to the previous year. The safety status system was suitable for an OR complex, both from a usability and technical point of view, and an increase of reported malfunctions was observed. The system eases monitoring the safety status of equipment and is a promising tool to improve the safety related to OR devices.

  9. Google Glass in the Operating Room: The Plastic Surgeon's Perspective.

    Science.gov (United States)

    Sinkin, Jeremy C; Rahman, Omar F; Nahabedian, Maurice Y

    2016-07-01

    New technologies and innovations are common in the delivery of modern health care. Google Glass is one such device gaining increased attention in medical specialties. The authors surveyed residents and attending physicians in the Department of Plastic Surgery, MedStar Georgetown University Hospital, on their experience using Google Glass in the operating room. Ease of use, quality of images, gaze disruption, and distraction during surgery were measured. Overall, subjects found the device to be comfortable and satisfying to wear and use during surgery to capture images of good quality. Despite some identified weaknesses, Google Glass is a unique technology with a promising plastic surgical application in the operating room.

  10. A model for generating master surgical schedules to allow cyclic scheduling in operating room departments

    NARCIS (Netherlands)

    Oostrum, van J.M.; Houdenhoven, van M.; Hurink, J.L.; Hans, E.W.; Wullink, G.; Kazemier, G.

    2005-01-01

    This paper addresses the problem of operating room scheduling at the tactical level of hospital planning and control. Hospitals repetitively construct operating room schedules, which is a time consuming tedious and complex task. The stochasticity of the durations of surgical procedures complicates t

  11. Analysis of the Effect of Disinfection Management in Operating Room on Hospital Infection Control%手术室消毒对感染控制的效果分析

    Institute of Scientific and Technical Information of China (English)

    程锐; 陈伟丽; 叶旭霞

    2016-01-01

    Objective To explore the effect of disinfection management in operating room on hospital infection control.Methods Disinfection and sterilization monitoring data from January 2013 to December 2014 when traditional operating room management was implemented in our hospital was randomly selected as the control group. Disinfection and sterilization monitoring data from January 2015 to December 2015 when disinfection management in operating room was implemented in our hospital was randomly selected as the treatment group. Comparison of the disinfection effect in operating room and incision infection rate between two groups was made.Results The qualified rate of the air, disinfection articles and hand disinfection of medical staffs in operating room after disinfection management was significantly higher than that in control group with statistically significant difference (P<0.05). The infection rate of surgical patients after the implementation of disinfection management in operating room was lower than that in the control group with statistically significant difference (P<0.05).Conclusion Strengthening the disinfection management in operation room can promote the formation of a good habit for medical personnel in operation room and reduce the incision infection rate.%目的探讨手术室消毒管理对医院感染控制的效果。方法随机抽取2013年1月至2014年12月我院实施传统手术室管理模式期间的消毒灭菌监测资料作为对照组,随机抽取2015年1月至2015年12月我院实施手术室消毒管理模式期间的消毒灭菌监测资料作为观察组,对比两组手术室消毒效果及研究期间手术室收治患者切口感染率。结果实施手术室消毒管理后手术室空气、消毒物品及医护人员手消毒合格率均较传统手术室管理提高,差异有统计学意义(P<0.05);实施手术室消毒管理后各科室手术患者手术部位感染率均较传统手术室管理降低,

  12. Quality of life of nurses in the operating room

    Directory of Open Access Journals (Sweden)

    Raquel Murano Alfaia dos Santos

    2009-03-01

    Full Text Available Objective: To evaluate the quality of life of operating room nurses and collect their opinions as to the influence their professional activity exerts on their quality of life. Methods: This was a cross-sectional study carried out on a sample of 24 nurses that work in the operating room of a large private hospital in the city of São Paulo. Two questionnaires were applied; one was designed by the authors of this research project, and the other was the Quality of Life Questionnaire (WHOQOL-BREF. Rresults: As to quality of life, the environment domain obtained the highest score, while the psychological domain obtained the lowest. When asked if their professional activity in the operating room influenced their quality of life, most responded affirmatively. Regarding the justifications offered by the nurses for the influence of their professional activity on their quality of life, 50% mentioned environment-related stress, responsibilities, duties, risk situations, relationships with the multiprofessional team, and the type of work carried out in the operating room. Cconclusions: The psychological domain obtained the lowest score in the nurse quality of life evaluation, pointing out the need to facilitate and/or encourage nurses to seek psychological support. As to the influence of their professional activity on their quality of life, the nurses mentioned stress related to their work environment and professional activities in the operating room. This highlights the importance of managers in this area, paying greater attention to the individual and collective needs of their employees.

  13. [Performance development of a university operating room after implementation of a central operating room management].

    Science.gov (United States)

    Waeschle, R M; Sliwa, B; Jipp, M; Pütz, H; Hinz, J; Bauer, M

    2016-08-01

    The difficult financial situation in German hospitals requires measures for improvement in process quality. Associated increases in revenues in the high income field "operating room (OR) area" are increasingly the responsibility of OR management but it has not been shown that the introduction of an efficiency-oriented management leads to an increase in process quality and revenues in the operating theatre. Therefore the performance in the operating theatre of the University Medical Center Göttingen was analyzed for working days in the core operating time from 7.45 a.m. to 3.30 p.m. from 2009 to 2014. The achievement of process target times for the morning surgery start time and the turnover times of anesthesia and OR-nurses were calculated as indicators of process quality. The number of operations and cumulative incision-suture time were also analyzed as aggregated performance indicators. In order to assess the development of revenues in the operating theatre, the revenues from diagnosis-related groups (DRG) in all inpatient and occupational accident cases, adjusted for the regional basic case value from 2009, were calculated for each year. The development of revenues was also analyzed after deduction of revenues resulting from altered economic case weighting. It could be shown that the achievement of process target values for the morning surgery start time could be improved by 40 %, the turnover times for anesthesia reduced by 50 % and for the OR-nurses by 36 %. Together with the introduction of central planning for reallocation, an increase in operation numbers of 21 % and cumulative incision-suture times of 12% could be realized. Due to these additional operations the DRG revenues in 2014 could be increased to 132 % compared to 2009 or 127 % if the revenues caused by economic case weighting were excluded. The personnel complement in anesthesia (-1.7 %) and OR-nurses (+2.6 %) as well as anesthetists (+6.7 %) increased less compared to the

  14. Advanced Technologies in Safe and Efficient Operating Rooms

    Science.gov (United States)

    2006-02-01

    area of Informatics, a Meta analysis of commercially available positioning technolgies has been completed. A sampling of these technologies was...intense care provided for many patients. The operating room forms the nucleus of mobile military hospitals. Whether found in civilian or military...encompasses systems consisting of mobile transmitters and fixed or semi-fixed receivers used wirelessly and without human intervention to identify the

  15. How do strategic decisions and operative practices affect operating room productivity?

    Science.gov (United States)

    Peltokorpi, Antti

    2011-12-01

    Surgical operating rooms are cost-intensive parts of health service production. Managing operating units efficiently is essential when hospitals and healthcare systems aim to maximize health outcomes with limited resources. Previous research about operating room management has focused on studying the effect of management practices and decisions on efficiency by utilizing mainly modeling approach or before-after analysis in single hospital case. The purpose of this research is to analyze the synergic effect of strategic decisions and operative management practices on operating room productivity and to use a multiple case study method enabling statistical hypothesis testing with empirical data. 11 hypotheses that propose connections between the use of strategic and operative practices and productivity were tested in a multi-hospital study that included 26 units. The results indicate that operative practices, such as personnel management, case scheduling and performance measurement, affect productivity more remarkably than do strategic decisions that relate to, e.g., units' size, scope or academic status. Units with different strategic positions should apply different operative practices: Focused hospital units benefit most from sophisticated case scheduling and parallel processing whereas central and ambulatory units should apply flexible working hours, incentives and multi-skilled personnel. Operating units should be more active in applying management practices which are adequate for their strategic orientation.

  16. [Comprehensive system integration and networking in operating rooms].

    Science.gov (United States)

    Feußner, H; Ostler, D; Kohn, N; Vogel, T; Wilhelm, D; Koller, S; Kranzfelder, M

    2016-12-01

    A comprehensive surveillance and control system integrating all devices and functions is a precondition for realization of the operating room of the future. Multiple proprietary integrated operation room systems are currently available with a central user interface; however, they only cover a relatively small part of all functionalities. Internationally, there are at least three different initiatives to promote a comprehensive systems integration and networking in the operating room: the Japanese smart cyber operating theater (SCOT), the American medical device plug-and-play interoperability program (MDPnP) and the German secure and dynamic networking in operating room and hospital (OR.NET) project supported by the Federal Ministry of Education and Research. Within the framework of the internationally advanced OR.NET project, prototype solution approaches were realized, which make short-term and mid-term comprehensive data retrieval systems probable. An active and even autonomous control of the medical devices by the surveillance and control system (closed loop) is expected only in the long run due to strict regulatory barriers.

  17. 8S管理在手术室医院感染控制中的应用%The application of 8S management in the control of operating room hospital infection

    Institute of Scientific and Technical Information of China (English)

    姚锦尚; 肖平平; 张梅

    2015-01-01

    目的::探讨通过实施8S精益管理提高手术室医院感染控制水平的有效管理方法。方法:选择2012年1月~2013年12月我院手术室环境卫生学及消毒灭菌监测资料,将2012年1~12月医院感染控制主要实施规范化管理措施分为对照组;2013年1~12月在规范化管理的基础上引入8S管理理念(即整理、整顿、清扫、清洁、素养、安全、学习、节约)分为观察组。查阅同期产科、普外科、骨科手术出院病人病历,分析比较两组手术室环境卫生学和消毒灭菌监测资料数据,以及不同科室手术患者的手术部位感染数据。结果:两组手术室环境卫生学及消毒灭菌合格率比较手术间空气与医务人员手监测数据差异有统计学意义(P<0.05);不同科室手术患者的手术部位感染数据有统计学意义(P<0.05)。结论:手术室实施8S精益管理,可以促进医务人员形成良好的行为习惯,提高专业文化素养,提高手卫生依从性,有效降低手术患者手术部位感染率。%Objective:To investigate the effctive method of improving the control level of operating room hospital infection through the application of 8S man-agement. Methods:In 2012,standardized management measures were mainy applied in the control of operating room management,whose monioring data were classified as the control group. In the year of 2013,on the base of standardized management,8S management ( sort,straighten,sweep,sanitary,sentiment, safety,study and save) were introduced,whose data were classified as the observation group. Applying method of retrospective survey,by inspecting the re-cords of obstetric,general surgery and orthopedic patients who had been discharged in 2012 and 2013,analyzed and compared the data of sterilization and environmental hygiene and the data of surgical site infection of patients of various departments. Results:Comparing the passing rate of sterilization and envi

  18. Improving pharmacy supply-chain management in the operating room.

    Science.gov (United States)

    Thomas, J A; Martin, V; Frank, S

    2000-12-01

    Anesthesia services can account for a significant portion of a healthcare organization's costs. Deaconess Hospital of Evansville, Indiana, used a collaborative, multidisciplinary effort to implement process improvements that yielded significant cost savings while improving patient care. Shifting responsibility for drug distribution from the operating room (OR) nurses to a pharmacist, the hospital established a satellite pharmacy service for the OR. As a result, the hospital was able to improve control of drug distribution and record-keeping, reduce turnaround time for medication preparation, lower its medication charge error rate, and increase the percentage of surgeries that start on time. The success of the OR satellite pharmacy led the hospital to expand satellite pharmacy services to labor and delivery, the cardiac cath laboratory, and the intensive care units.

  19. 长沙市综合医院手术室男护士工作现状调查%Investigation of Working Present Situation of Male Nurses at Operating Room in General Hospital of Changsha City

    Institute of Scientific and Technical Information of China (English)

    余尚昆; 董小文

    2016-01-01

    目的:调查湖南省长沙市二级甲等以上综合医院手术室男护士的工作现状,以帮助他们正确看待自己的专业,解决一些疑惑,以便为改善医院手术室男护士身心健康状况提供依据,从而使他们以良好的状态工作。方法采取双向调查的方法,随机选择长沙市8所二级甲等以上综合手术室男护士和女护士各60人,以及男护士参与过手术的患者、手术医生、女护士各50名,采用自行设计的调查问卷进行调查。结果男护士在手术室中承担着大量有益的工作,与女护士比较男护士在应急、体力、学习、互补等方面具有优势,手术患者、手术室医生、手术室护士对男护士满意度较高,差异有统计学意义(P<0.05)。结论手术室应该根据自身情况,不断加强男护士队伍建设,充分发挥其优势,更好地服务患者。%Objective To investigate the working situation of male nurses at operating room in secondary A or higher general hospitals in Changsha and give them assistance to correctly view their major and solve their problems in order to provide evidence for improving the physical and mental health of operating room male nurses. Thus enable them to work in good condition. Methods Adopted to investigate two-way, 8 secondary hospitals above comprehensive operation room male nurses and nurse of 60 people were randomly selected in Changsha, as well as male nurses in surgery patients, doctors and women nurses 50 cases, using self-designed questionnaire survey. Results Male nurse takes a lot of useful work in the operating room, compared with female nurses male nurses in emergency, physical strength, gender, learning, complementary, have obvious advantages, surgery patients, operating room doctors and nurses on male nurse satisfaction is high, the difference has statistical significance (P<0.05).ConclusionAccording to self-condition, operating rooms should continue to

  20. The radiation dose dilemma in the hybrid operating room

    NARCIS (Netherlands)

    de Ruiter, QMB

    2016-01-01

    The of the hybrid Operation room (an operation room combined with advanced radiological X-ray equipment) is gaining popularity, as it is now the preferred room to perform (complex) endovascular aortic procedures. The fixed C-arms equipped in these rooms make it possible to gain very high image

  1. The radiation dose dilemma in the hybrid operating room

    NARCIS (Netherlands)

    de Ruiter, QMB

    2016-01-01

    The of the hybrid Operation room (an operation room combined with advanced radiological X-ray equipment) is gaining popularity, as it is now the preferred room to perform (complex) endovascular aortic procedures. The fixed C-arms equipped in these rooms make it possible to gain very high image quali

  2. AIR DISINFECTION EFFECT IN THE OPERATING ROOM OF HOSPITAL BY USING THE LOCAL AIR PURIFICATION DEVICE%局部空气净化装置对手术室空气的消毒效果

    Institute of Scientific and Technical Information of China (English)

    陈英

    2012-01-01

    目的 观察空气消毒机对医院手术室空气消毒效果,以评价其实际应用效果.方法 采用平板沉降采样和细菌培养方法,评价该多因子组合空气净化装置对手术室空气中自然菌净化效果,并与紫外线灯照射消毒作平行比较.结果 启动YKX/Y型空气消毒机和紫外线灯作用30 min,5 min后采样,手术室空气中细菌总数<200cfu/m3,随着时间的延长,空气中菌数逐渐增加,15 min后细菌总数逐渐增加到200 cfu/m3以上.在手术室有6人工作的情况下,空气消毒机持续运行,可使空气细菌继续保持在<200 cfu/m3.结论 试验用空气消毒机可以在手术期间持续消毒,可以维持手术室内空气中细菌总数< 200 cfu/m3.%Objective To observe the air disinfection effect in the operating room of hospital by using the local air purification device and evaluate the practical application effect of the device. Methods By using the methods of tablet settlement sampling and bacterial culture, to evaluate and compare the effect of air purification in the operating room by the air purification device and ultraviolet light irradiation. Results 5 mins later after using the air disinfection device of YKX / Y - type and the ultraviolet ray lamp for 30 mins, the total number of bacteria in the air of operating room was less than 200 cfu/m3. As the time prolonged to 15 min, the bacteria number increased to more than 200 cfu/m3. Under the condition of six persons working and the air disinfection device running continuously in the operating room, the bacteria in the air maintained less than 200 cfu/m3. Conclusion The air purification device can continue disinfection during surgical operation and the number of bacteria can maintain less than 200 cfu/m3.

  3. Local anaesthesia outside the operating room.

    Science.gov (United States)

    Chan, S K; Karmakar, M K; Chui, P T

    2002-04-01

    An increasing number of minor surgical procedures are performed under local anaesthesia in clinical settings outside the operating room, where monitoring and resuscitation equipment--as well as personnel skilled in resuscitation--may not be readily available. Serious adverse effects and even fatalities may result from the use of local anaesthetic agents, arising from a variety of causes such as systemic toxicity, allergy, vasovagal syncope, and reaction to additives present in the local anaesthetic. This article briefly reviews the pharmacology of local anaesthetic agents, and describes various techniques commonly used for local anaesthesia, with special emphasis on safety. Clinical features of toxicity, and its differential diagnosis and management, are also discussed.

  4. Prepare to protect: Operating and maintaining a tornado safe room.

    Science.gov (United States)

    Herseth, Andrew; Goldsmith-Grinspoon, Jennifer; Scott, Pataya

    2017-06-01

    Operating and maintaining a tornado safe room can be critical to the effective continuity of business operations because a firm's most valuable asset is its people. This paper describes aspects of operations and maintenance (O&M) for existing tornado safe rooms as well as a few planning and design aspects that affect the ultimate operation of a safe room for situations where a safe room is planned, but not yet constructed. The information is based on several Federal Emergency Management Agency safe room publications that provide guidance on emergency management and operations, as well as the design and construction of tornado safe rooms.

  5. Surgical attire and the operating room: role in infection prevention.

    Science.gov (United States)

    Salassa, Tiare E; Swiontkowski, Marc F

    2014-09-01

    ➤ Although there is some evidence that scrubs, masks, and head coverings reduce bacterial counts in the operating room, there is no evidence that these measures reduce the prevalence of surgical site infection.➤ The use of gloves and impervious surgical gowns in the operating room reduces the prevalence of surgical site infection.➤ Operating-room ventilation plays an unclear role in the prevention of surgical site infection.➤ Exposure of fluids and surgical instruments to the operating-room environment can lead to contamination. Room traffic increases levels of bacteria in the operating room, although the role of this contamination in surgical site infection is unclear.

  6. [Design, equipment, and management for air conditioning in operating room].

    Science.gov (United States)

    Fuji, Kumiko; Mizuno, Ju

    2011-11-01

    In order to maintain air cleanliness in the operating room (OR) permanently, air exchange rate in the OR should be more than 15 times x hr(-1), the laminar air flow should be kept, and the numbers of the persons in the OR and the numbers of opening and closing OR door should be limited. High efficiency particulate air (HEPA) filter is effective in collection and removal of airborne microbes, and is used in the biological clean room. We need to design, equip, and manage the OR environment according to Guideline for Design and Operation of Hospital HVAC Systems HEAS-02-2004 established by Healthcare Engineering Association of Japan and Guideline for Prevention of Surgical Site Infection (SSI) established by the Center for Disease Control and Prevention (CDC) in the USA.

  7. Start time delays in operating room: Different perspectives

    Directory of Open Access Journals (Sweden)

    Babita Gupta

    2011-01-01

    Full Text Available Background: Healthcare expenditure is a serious concern, with escalating costs failing to meet the expectations of quality care. The treatment capacities are limited in a hospital setting and the operating rooms (ORs. Their optimal utilization is vital in efficient hospital management. Starting late means considerable wait time for staff, patients and waste of resources. We planned an audit to assess different perspectives of the residents in surgical specialities and anesthesia and OR staff nurses so as to know the causative factors of operative delay. This can help develop a practical model to decrease start time delays in operating room (ORs. Aims: An audit to assess different perspectives of the Operating room (OR staff with respect to the varied causative factors of operative delay in the OR. To aid in the development of a practical model to decrease start time delays in ORs and facilitate on-time starts at Jai Prakash Narayan Apex Trauma centre (JPNATC, All India Institute of Medical Sciences (AIIMS, New Delhi. Methods: We prepared a questionnaire seeking the five main reasons of delay as per their perspective. Results: The available data was analysed. Analysis of the data demonstrated the common causative factors in start time operative delays as: a lack of proper planning, deficiencies in team work, communication gap and limited availability of trained supporting staff. Conclusions: The preparation of the equipment and required material for the OR cases must be done well in advance. Utilization of newer technology enables timely booking and scheduling of cases. Improved inter-departmental coordination and compliance with preanesthetic instructions needs to be ensured. It is essential that the anesthesiologists perform their work promptly, well in time . and supervise the proceedings as the OR manager. This audit is a step forward in defining the need of effective OR planning for continuous quality improvement.

  8. Human reliability analysis of control room operators

    Energy Technology Data Exchange (ETDEWEB)

    Santos, Isaac J.A.L.; Carvalho, Paulo Victor R.; Grecco, Claudio H.S. [Instituto de Engenharia Nuclear (IEN), Rio de Janeiro, RJ (Brazil)

    2005-07-01

    Human reliability is the probability that a person correctly performs some system required action in a required time period and performs no extraneous action that can degrade the system Human reliability analysis (HRA) is the analysis, prediction and evaluation of work-oriented human performance using some indices as human error likelihood and probability of task accomplishment. Significant progress has been made in the HRA field during the last years, mainly in nuclear area. Some first-generation HRA methods were developed, as THERP (Technique for human error rate prediction). Now, an array of called second-generation methods are emerging as alternatives, for instance ATHEANA (A Technique for human event analysis). The ergonomics approach has as tool the ergonomic work analysis. It focus on the study of operator's activities in physical and mental form, considering at the same time the observed characteristics of operator and the elements of the work environment as they are presented to and perceived by the operators. The aim of this paper is to propose a methodology to analyze the human reliability of the operators of industrial plant control room, using a framework that includes the approach used by ATHEANA, THERP and the work ergonomics analysis. (author)

  9. Physician communication in the operating room.

    Science.gov (United States)

    Kirschbaum, Kristin A; Rask, John P; Fortner, Sally A; Kulesher, Robert; Nelson, Michael T; Yen, Tony; Brennan, Matthew

    2015-01-01

    In this study, communication research was conducted with multidisciplinary groups of operating-room physicians. Theoretical frameworks from intercultural communication and rhetoric were used to (a) measure latent cultural communication variables and (b) conduct communication training with the physicians. A six-step protocol guided the research with teams of physicians from different surgical specialties: anesthesiologists, general surgeons, and obstetrician-gynecologists (n = 85). Latent cultural communication variables were measured by surveys administered to physicians before and after completion of the protocol. The centerpiece of the 2-hour research protocol was an instructional session that informed the surgical physicians about rhetorical choices that support participatory communication. Post-training results demonstrated scores increased on communication variables that contribute to collaborative communication and teamwork among the physicians. This study expands health communication research through application of combined intercultural and rhetorical frameworks, and establishes new ways communication theory can contribute to medical education.

  10. HEMATOLOGIC FINDINGS IN OPERATING ROOM STAFFS

    Directory of Open Access Journals (Sweden)

    H SOLTANI

    2000-03-01

    Full Text Available Introduction. Long term exposure to trace amounts of anesthetic vapors and gases may produce hematologic and hepatic disorders in human. Since operating room (OR staffs are exposed to these agents, we decided to study their hematopoietic and hepatic systems in comparison with ordinary ward staffs. Methods. Seventy staffs from OR were compared with a matched similar number of ward staffs about their hematologic and hepatic laboratory findings in a historical cohort study. Findings. Mean of leukocyte and platelet counts were significantly lower in OR staffs, but in normal range. Mean of monocyte count was significantly higher in OR staffs. No significant differences were found between two groups for other hepatic and hematologic tests. Fatigue and headache were reported in OR staffs more than others. Conclusion. These findings may warn a risk to OR staffs but, it is not clear and requires further controlled studies.

  11. Attitudes and behavior towards patient safety in an operating room

    Directory of Open Access Journals (Sweden)

    María del Pilar Sánchez Moreno

    2013-09-01

    Full Text Available Patient´s safety is a priority line of action in the Quality of Health Care. Adequate patient safety culture is one of the important pillars in the health care. Also the World Health Organization reports that 7 million people, of 234 million of major surgeries, suffer complications and this can be reduced by half with a system that decreases the possibility of error. Objectives: To determinate the attitude and behavior of professionals in the operating room unit in Hospital Virgen de la Salud of Toledo towards patient safety. Material and method: The type of study is a descriptive and transversal. Population: medical and nursing staff of the theatre with over 1 year in service. Measurement of variables will be made by a validated test and adapted to Spanish territory by the Agency for Healthcare Research and Quality of the United States. We intend to identify the strengths and weaknesses in matter of operating room safety, to know the starting point for the implementation of the surgical safety checklist and to develop a safety culture in the operating room with standardized tools and regular quality controls.

  12. Prevention of occupational exposure to nurses in operating room of grass-roots hospitals%基层医院手术室护士职业暴露的预防

    Institute of Scientific and Technical Information of China (English)

    徐秀琴; 谢多希; 谢灵智; 王淑珠; 贾仕林; 胡乐湖; 倪金莲

    2011-01-01

    OBJECTIVE To investigate the factors for occupational exposure to the nurses in hospital operating room,and to adopt intervention measures to reduce the incidence of occupational exposure. METHODS The incidence of occupational exposure to nurses in operating room was analyzed by using questionnaire survey; Efforts was made to develop the training, lectures, establish the management regulations and institute the intervention measures, including the operation guide, to reduce the incidence of occupational exposure. RESULTS After the intervention measures adopted by the target population, the awareness rate of the knowledge about occupational exposure were that before: 36. 8% ~ 89. 5%, after: 88. 2% ~ 100. 0%. The annual rate of occupational exposure were before: 47. 4%, after: 5. 3%. The difference before and after the intervention was statistically significant (P <0. 05 ). CONCLUSION The prevalence of occupational exposure widely occurs to nurses in operating room, the intervention activities related to occupational exposure can be effective in reducing the incidence of occupational exposure.%目的 探讨基层医院手术室护士职业暴露因素之间的关联性,采取干预措施以减少职业暴露发生率.方法 采用问卷调查的方式,统计基层医院手术室护士职业暴露发生情况;开展职业暴露防护培训、讲座、建立管理规章、制定操作防护指南等干预措施,减少职业暴露发生率.结果 职业暴露相关知识知晓率干预前36.8%~89.5%,干预后88.2%~100.0%;年职业暴露率干预前:47.4%,干预后:5.3%;干预前后比较差异有统计学意义(P<0.05).结论 手术室护士发生职业暴露普遍存在,开展职业暴露相关干预活动,可有效减少职业暴露发生率.

  13. Complementing Operating Room Teaching With Video-Based Coaching.

    Science.gov (United States)

    Hu, Yue-Yung; Mazer, Laura M; Yule, Steven J; Arriaga, Alexander F; Greenberg, Caprice C; Lipsitz, Stuart R; Gawande, Atul A; Smink, Douglas S

    2017-04-01

    Surgical expertise demands technical and nontechnical skills. Traditionally, surgical trainees acquired these skills in the operating room; however, operative time for residents has decreased with duty hour restrictions. As in other professions, video analysis may help maximize the learning experience. To develop and evaluate a postoperative video-based coaching intervention for residents. In this mixed methods analysis, 10 senior (postgraduate year 4 and 5) residents were videorecorded operating with an attending surgeon at an academic tertiary care hospital. Each video formed the basis of a 1-hour one-on-one coaching session conducted by the operative attending; although a coaching framework was provided, participants determined the specific content collaboratively. Teaching points were identified in the operating room and the video-based coaching sessions; iterative inductive coding, followed by thematic analysis, was performed. Teaching points made in the operating room were compared with those in the video-based coaching sessions with respect to initiator, content, and teaching technique, adjusting for time. Among 10 cases, surgeons made more teaching points per unit time (63.0 vs 102.7 per hour) while coaching. Teaching in the video-based coaching sessions was more resident centered; attendings were more inquisitive about residents' learning needs (3.30 vs 0.28, P = .04), and residents took more initiative to direct their education (27% [198 of 729 teaching points] vs 17% [331 of 1977 teaching points], P Video-based coaching is a novel and feasible modality for supplementing intraoperative learning. Objective evaluation demonstrates that video-based coaching may be particularly useful for teaching higher-level concepts, such as decision making, and for individualizing instruction and feedback to each resident.

  14. Door Opening Affects Operating Room Pressure During Joint Arthroplasty.

    Science.gov (United States)

    Mears, Simon C; Blanding, Renee; Belkoff, Stephen M

    2015-11-01

    Many resources are expended to ensure a sterile operating room environment. Efforts are made to prevent exposure of patients to personnel and to achieve positive room pressure to keep out airborne contaminants. Foot traffic into and out of the operating room during surgery can undermine these efforts. The authors investigated the number and duration of operating room door openings during hip and knee arthroplasty procedures and the effect of the door openings on room pressure. They tested the hypothesis that door openings defeat positive pressure, permitting air flow into the room. Room pressure and door status were monitored electronically during 191 hip and knee arthroplasty procedures. Operating room staff were unaware that data were being collected. The authors evaluated the data with regression analysis to determine whether the number and duration of door openings had an effect on room pressure. Significance was set at Poperating room. Total time with the door open significantly affected the minimum pressure recorded in the room (Poperating room sterility. The causes of excessive operating room traffic must be evaluated to identify ways to reduce this traffic and the associated risks.

  15. 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.

    Science.gov (United States)

    McIntosh, Catherine; Dexter, Franklin; Epstein, Richard H

    2006-12-01

    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. 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. 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. 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.

  16. Diagnostic hysteroscopy in a procedure room setting compared to diagnostic hysteroscopy in the operating room

    Directory of Open Access Journals (Sweden)

    Ayman Oraif

    2016-12-01

    Conclusions: Diagnostic hysteroscopy is currently considered a valuable investigational tool for endometrial abnormalities and abnormal uterine bleeding. Most of these procedures can be performed in a procedure room setting without I.V. sedation or pre-operative narcotics. In our experience, a utero-sacral block using lidocaine is quite effective in controlling discomfort while passing various instruments through the internal cervical os. These techniques result in good visualization of the endometrial cavity, adequate and appropriate endometrial sampling with tolerable discomfort. The patients spend less time in the hospital, experience a much faster recovery and have less pre-operative restrictions. [Int J Reprod Contracept Obstet Gynecol 2016; 5(12.000: 4164-4173

  17. Effective management strategy for establishing an operating room satellite pharmacy.

    Science.gov (United States)

    Brakebill, J I; Schoeneman, P F; Buchanan, B

    1988-11-01

    The steps involved in justifying and implementing an operating room (OR) pharmacy satellite are described. A hospital administrator's viewpoint on the project is included. Objectives of the satellite were to reduce inventory costs, improve control of distribution, reduce loss of revenue and improve patient charging, improve IV compounding and labeling, and significantly improve narcotic control and accountability. The satellite provides comprehensive services 12 hours a day, five days a week. Effective after-hours procedures have been developed to provide efficient drug distribution when the pharmacy is closed. Achieved benefits of the satellite include decreased drug inventory, improved patient charging, accurate labeling, improved IV compounding, and improved pharmacy/surgery relations. The OR pharmacy satellite is a successful cost-effective operation.

  18. A Learning Needs Assessment of Operating Room Nurses.

    Science.gov (United States)

    Pounds, Elizabeth; Littlefield, John H.

    Operating room nursing is not a formal part of the generic nursing curriculum. A learning needs assessment can serve to identify inservice education needs of operating nurses. In this study, a factor analysis was performed on the responses of 1,201 practicing operating room nurses to a list of 24 behaviorally-stated learning needs. Four factors,…

  19. Foucault could have been an operating room nurse.

    Science.gov (United States)

    Riley, Robin; Manias, Elizabeth

    2002-08-01

    Operating room nursing is an under-researched area of nursing practice. The stereotypical image of operating room nursing is one of task- and technically-orientated aspects of practice, where nurses work in a medical model and are dominated by constraints from outside their sphere of influence. This paper explores the possibility of understanding operating room nursing in a different way. Using the work of Michel Foucault to analyse the work of operating room nursing, this paper argues the relevance of the framework for a more in-depth analysis of this specialty area of practice. The concepts of power, discipline and subjectivity are used to demonstrate how operating room nursing is constructed as a discipline and how operating room nurses act to govern and construct the specialty. Exemplars are drawn from extensive professional experience, from guidelines of professional operating room nursing associations, as well as published texts. The focus is predominantly on the regulation of space and time to maintain the integrity of the sterile surgical field and issues of management, as well as the use of the ethical concept of the 'surgical conscience'. This form of analysis provides a level and depth of inquiry that has rarely been undertaken in operating room nursing. As such, it has the potential to provide a much needed, different view of operation room nursing that can only help to strengthen its professional foundations and development.

  20. Ventilation in the Hospital Operating Room.

    Science.gov (United States)

    1984-10-01

    protocol. a. Give sodium pentothal to make the patient lose consciousness. b. With the patient unconscious, inject a skeletal muscle relaxant . c. In...seconds of flow at 0.1 L/min). (2) The actual time that passes from the intravenous injection of the skeletal muscle relaxant to connection of the...intravenous injection of the skeletal muscle relaxant to connection of the delivery tube is again assumed to be two minutes. Therefore, the one liter

  1. Safety culture in the gynecology robotics operating room.

    Science.gov (United States)

    Zullo, Melissa D; McCarroll, Michele L; Mendise, Thomas M; Ferris, Edward F; Roulette, G D; Zolton, Jessica; Andrews, Stephen J; von Gruenigen, Vivian E

    2014-01-01

    To measure the safety culture in the robotics surgery operating room before and after implementation of the Robotic Operating Room Computerized Checklist (RORCC). Prospective study. Gynecology surgical staff (n = 32). An urban community hospital. The Safety Attitudes Questionnaire domains examined were teamwork, safety, job satisfaction, stress recognition, perceptions of management, and working conditions. Questions and domains were described using percent agreement and the Cronbach alpha. Paired t-tests were used to describe differences before and after implementation of the checklist. Mean (SD) staff age was 46.7 (9.5) years, and most were women (78%) and worked full-time (97%). Twenty respondents (83% of nurses, 80% of surgeons, 66% of surgical technicians, and 33% of certified registered nurse anesthetists) completed the Safety Attitudes Questionnaire; 6 were excluded because of non-matching identifiers. Before RORCC implementation, the highest quality of communication and collaboration was reported by surgeons and surgical technicians (100%). Certified registered nurse anesthetists reported only adequate levels of communication and collaboration with other positions. Most staff reported positive responses for teamwork (48%; α = 0.81), safety (47%; α = 0.75), working conditions (37%; α = 0.55), stress recognition (26%; α = 0.71), and perceptions of management (32%; α = 0.52). No differences were observed after RORCC implementation. Quality of communication and collaboration in the gynecology robotics operating room is high between most positions; however, safety attitude responses are low overall. No differences after RORCC implementation and low response rates may highlight lack of staff support. Copyright © 2014. Published by Elsevier Inc.

  2. Music in the operating room: is it a safety hazard?

    Science.gov (United States)

    Shambo, Lyda; Umadhay, Tony; Pedoto, Alessia

    2015-02-01

    Noise is a health hazard and a source of stress, and it impairs concentration and communication. Since 1960, hospital noise levels have risen around the world. Nowhere in the healthcare setting is noise more prevalent than in the operating room (OR). The genetic makeup of humans does not evolve at the rate of technology. Noise exposure, sensory overload, and the capacity to adapt without physical and psychological consequences are absent from the human condition. The World Health Organization has recognized environmental noise as harmful pollution that causesadverse effects on health. Although noise in the OR is unavoidable, music is a choice. The purpose of this literature review is to provide further insight into the ramifications of the presence of music in the OR, evaluate its appropriateness in relation to care and safety for the patient and staff, and provide information for future research.

  3. Application of an Online Reference for Reviewing Basic Statistical Principles of Operating Room Management

    Science.gov (United States)

    Dexter, Franklin; Masursky, Danielle; Wachtel, Ruth E.; Nussmeier, Nancy A.

    2010-01-01

    Operating room (OR) management differs from clinical anesthesia in that statistical literacy is needed daily to make good decisions. Two of the authors teach a course in operations research for surgical services to anesthesiologists, anesthesia residents, OR nursing directors, hospital administration students, and analysts to provide them with the…

  4. Novel bed integrated ventilation method for hospital patient rooms

    DEFF Research Database (Denmark)

    Bivolarova, Mariya Petrova; Melikov, Arsen Krikor; Kokora, Monika

    2014-01-01

    a mattress having a suction opening from which bio-effluents generated from human body are exhausted. Experiments were conducted in a full-scale two-bed hospital room mock-up, 4.7 x 5.3 x 2.6 m3 (W x L x H). Only one of the patients’ beds was equipped with the ventilated mattress. The room was air......This study presents a novel method for advanced ventilation of hospital wards leading to improved air quality at reduced ventilation rate. The idea is to evacuate the bio-effluents generated from patients’ body by local exhaustion before being spread in the room. This concept was realized by using...... conditioned via mixing total volume ventilation system supplying air through a ceiling mounted diffuser. All experiments were performed at room air temperature of 23ºC. A thermal manikin was used to simulate a polluting patient on the bed equipped with the ventilated mattress. Two heated dummies were used...

  5. Improving operating room turnover time: a systems based approach.

    Science.gov (United States)

    Bhatt, Ankeet S; Carlson, Grant W; Deckers, Peter J

    2014-12-01

    Operating room (OR) turnover time (TT) has a broad and significant impact on hospital administrators, providers, staff and patients. Our objective was to identify current problems in TT management and implement a consistent, reproducible process to reduce average TT and process variability. Initial observations of TT were made to document the existing process at a 511 bed, 24 OR, academic medical center. Three control groups, including one consisting of Orthopedic and Vascular Surgery, were used to limit potential confounders such as case acuity/duration and equipment needs. A redesigned process based on observed issues, focusing on a horizontally structured, systems-based approach has three major interventions: developing consistent criteria for OR readiness, utilizing parallel processing for patient and room readiness, and enhancing perioperative communication. Process redesign was implemented in Orthopedics and Vascular Surgery. Comparisons of mean and standard deviation of TT were made using an independent 2-tailed t-test. Using all surgical specialties as controls (n = 237), mean TT (hh:mm:ss) was reduced by 0:20:48 min (95 % CI, 0:10:46-0:30:50), from 0:44:23 to 0:23:25, a 46.9 % reduction. Standard deviation of TT was reduced by 0:10:32 min, from 0:16:24 to 0:05:52 and frequency of TT≥30 min was reduced from 72.5to 11.7 %. P systems-based focus should drive OR TT design.

  6. Determination of Anger Expression and Anger Management Styles and an Application on Operating Room Nurses

    Directory of Open Access Journals (Sweden)

    Hülya Aslan

    2016-12-01

    Full Text Available This research has been carried out in order to determine anger expression and anger management styles in operating room nurses. By applying an in-depth interview technique on operating room nurses working in a private hospital, a qualitative study has been performed in order to determine anger expression and anger management styles in operating room nurses. The interview consisted of ten questions such as demographic questions addressing the workers’ age, sex, education level and duration of employment in the organization they work, aiming to determine their anger expression and anger management styles. Since operating room environments contain various risk factors, and require active team work in a stressful dynamic setting under excessive workload, , it has been found that operating room nurses display their anger through loud speaking, fail to settle their anger positively, fail to control their anger in a behavioural pattern despite their cognitive awareness in anger management. Thus, it has been suggested that operating room nurses should be trained on anger management methods so that they can manage their anger in a stressful operating room environment.

  7. Influence of disturbances on bacteria level in an operating room

    DEFF Research Database (Denmark)

    Brohus, Henrik; Hyldig, Mikkel; Kamper, Simon

    2008-01-01

    In operating rooms great effort is manifested to reduce the bacteria level in order to decrease the risk of infections. The main source of bacteria is the staff and the patient, thus, the resulting bacteria concentration is roughly speaking a combination of the ventilation system and the emission...... from the occupants. This study investigates the influence of two main disturbances in an operating room namely the door opening during the operation and the activity level of the staff. It is found that the frequent door opening in this case does not cause significant transport of air from outside...... the operating room to the wound area of the patient. However, a significant influence of the activity level on the bacteria emission and concentration is found. Counting the number of persons in an operating room to estimate the bacteria source strength is not sufficient, the corresponding activity level must...

  8. Concentrations of methoxyflurane and nitrous oxide in veterinary operating rooms

    Energy Technology Data Exchange (ETDEWEB)

    Ward, G.S.; Byland, R.R.

    1982-02-01

    The surgical rooms of 14 private veterinary practices were monitored to determined methoxyflurane (MOF) concentrations during surgical procedure under routine working conditions. The average room volume for these 14 rooms was 29 m3. The average MOF value for all rooms was 2.3 ppm, with a range of 0.7 to 7.4 ppm. Four of the 14 rooms exceeded the maximum recommended concentration of 2 ppm. Six rooms which had 6 or more air changes/hr averaged 1.1 ppm, whereas 8 rooms with less than 6 measurable air changes/hr averaged 3.2 ppm. Operating rooms that had oxygen flows of more than 1,000 cm3/min averaged 4.4 ppm, whereas those with flows of less than 1,000 cm3/min averaged 1.5 ppm. The average time spent during a surgical procedure using MOF, for all 14 facilities, was 2 hours. Nitrous oxide (N/sub 2/O) concentrations were determined in 4 veterinary surgical rooms. The average N/sub 2/O concentration for 3 rooms without waste anesthetic gas scavenging was 138 ppm. Concentration of N/sub 2/O in the waste anesthetic gas-scavenged surgical room was 14 ppm, which was below the maximum recommended concentration of 25 ppm.

  9. Operating room waste reduction in plastic and hand surgery

    Science.gov (United States)

    Albert, Mark G; Rothkopf, Douglas M

    2015-01-01

    BACKGROUND: Operating rooms (ORs), combined with labour and delivery suites, account for approximately 70% of hospital waste. Previous studies have reported that recycling can have a considerable financial impact on a hospital-wide basis; however, its importance in the OR has not been demonstrated. OBJECTIVE: To propose a method of decreasing cost through judicious selection of instruments and supplies, and initiation of recycling in plastic and hand surgery. METHODS: The authors identified disposable supplies and instruments that are routinely opened and wasted in common plastic and hand surgery procedures, and calculated the savings that can result from eliminating extraneous items. A cost analysis was performed, which compared the expense of OR waste versus single-stream recycling and the benefit of recycling HIPAA documents and blue wrap. RESULTS: Fifteen total items were removed from disposable plastic packs and seven total items from hand packs. A total of US$17,381.05 could be saved per year from these changes alone. Since initiating single-stream recycling, the authors’ institution has saved, on average, US$3,487 per month at the three campuses. After extrapolating at the current savings rate, one would expect to save a minimum of US$41,844 per year. DISCUSSION: OR waste reduction is an effective method of decreasing cost in the surgical setting. By revising the contents of current disposable packs and instrument sets designated for plastic and hand surgery, hospitals can reduce the amount of opened and unused material. CONCLUSIONS: Significant financial savings and environmental benefit can result from this judicious supply and instrument selection, as well as implementation of recycling. PMID:26665137

  10. Feasibility Assessment of Performing Surgery in a Deployable Medical System Operating Room

    Science.gov (United States)

    2002-05-01

    Nosocomial infections are easily prevented if the hospital and its staff follow well-recognized sanitation and hygiene protocols. The Guidelines for...instance, frequent hand washing has been shown to significantly lessen the incidence of nosocomial infections . In addition, improved operating room...risk management. 26 Criteria included the following: noise exposure, nosocomial infections , environmental controls, air exchanges, and electrical

  11. Assessment on nursing serviceat hospital external consulting rooms

    Directory of Open Access Journals (Sweden)

    Mª Dolores Poyatos Ruiz

    2013-05-01

    Full Text Available The social needs and requests change constantly, so that health care is evolving to a more focused on the users, in order to meet users´ needs and expectations of those who are going to get our assistance. Aim: We have developed a research to evaluate the quality of the assistance received by the patientst in their first encounter in the hospital external consulting rooms of traumathology at Santa Bárbara Hospital, letting us know about the patient´s satisfaction after the consulting has finished. Material and method: A transverse descriptive study on the traumathology consulting room of Santa Bárbara Hospital in Puertollano was developed for two months. The research is formed by the patients who attend this consulting room for their first time. A self made multiple choice questionnaire, which was designe by experts, and patients were asked to answer it once their first consulting at traumathology service had finished. Results: 95.6% of the patients considered as good or very good the nursing kindness (confidence/reliabitity when seeing them; 93.5% of them considered as good or very good the information given to them and 90.6% of them considered as good or very good the medical explanations they got. We also noticed a significant statistical difference among nursing kindness (confidence/reliabitity, enough consultation time and explanations received, with regard to the variant high resolution. Conclusions: The study reveals that more than 90% of the interviewed people considered as good or very good the clinical assistance and service given. The research has allowed us to know the areas that we can work on and improve.

  12. Avaliação da preceptoria na residência médica em cirurgia geral, no centro cirúrgico, comparação entre um hospital universitário e um hospital não universitário Assessment of preceptorship in general surgery residency in the operating room, comparison between a teaching hospital and a non teaching hospital

    Directory of Open Access Journals (Sweden)

    Elizabeth Gomes Santos

    2012-12-01

    Full Text Available OBJETIVO: Avaliar e comparar a preceptoria no programa de residência médica em Cirurgia Geral, no centro cirúrgico, em um hospital universitário e em um hospital não universitário, a partir da ótica dos residentes que ingressaram em 2010 e 2011. MÉTODOS: Questionário aplicado aos residentes, modificado de Sarker SK, Vincent C, e Darzi AW e usando-se a escala de Likert para qualificar o ítem pesquisado sobre as atitudes dos preceptores. A comparação da distribuição das respostas entre os dois hospitais foi analisada pelo teste de c² para tendências. RESULTADOS: No hospital universitário foram avaliados 12 preceptores por sete residentes. No hospital não universitário foram 11 preceptores avaliados por 13 residentes. O hospital não universitário apresentou a tendência de resposta discordante e indiferente (DC, D e I maior que o hospital universitário. Só o resultado de uma pergunta apresentou significância estatística. Não houve diferença significativa na comparação das respostas nas demais perguntas entre os dois hospitais. CONCLUSÃO: Os hospitais apresentaram preceptoria semelhante.BACKGROUND: Medical residency is well known as the best training method after graduation. It is a moment when, in addition to receiving technical guidance, residents should also develop attitudes, ethics, and professionalism. In order for that to occur, preceptors should be prepared for their task. OBJECTIVE: To evaluate and compare the preceptorship in the Medical Residency in General Surgery program, in the operating room of a Teaching Hospital (TH and a Non-teaching Hospital (NTH, from the viewpoint of the residents who entered in 2010 and 2011. METHODS: A questionnaire was applied to the residents, adapted from Sarker, Vincent and Darzi, and the Likert scale was used to qualify the survey items on the preceptors' attitudes. RESULTS: At the TH, 12 preceptors were evaluated by 7 residents. One of the residents did not answer the

  13. Before operating room nursing journals: operating room nursing in the pages of the Canadian Nurse 1940-1960.

    Science.gov (United States)

    Moszczynski, Alice

    2010-09-01

    The Canadian Nurses Association (CNA) values learning from nursing history to provide a contextual perspective in understanding how past events have shaped current nursing practice. Until the publication of operating room nursing journals, Canada's national nursing journal, The Canadian Nurse, served as an educational and professional resource for those nurses working in the operating room and for nurses whose work was related to, or connected with, the operating room. A historical review of early issues of The Canadian Nurse (first published in 1905) reveals a substantial amount of content related to operating room nursing in the twenty year period, beginning in the 1940s, that predated the existence of OR specialty journals. The content was, for the time, both detailed and informative. It was through this journal that operating room nurses, indeed all Canadian nurses, learned about new advances, employment opportunities, educational programs, professional associations, and the achievements of those in the profession. Operating Room Nursing, as an isolated and quickly emerging specialty, was introduced to other nurses via items in The Canadian Nurse journal.

  14. Preoperative planning and designing of a fluorocompatible endourology operating room.

    Science.gov (United States)

    Sabnis, Ravindra B; Mishra, Shashikant; Sharma, Rajan; Desai, Mahesh R

    2009-10-01

    A dedicated fluoroscopic-compatible operating room (OR) for endourologic procedures, such as percutaneous nephrolithotomy and ureteroscopy, is structurally and functionally different from the general OR. Publications with practical details are scarce, imposing a challenge in construction of such an OR. We outline a practical approach for the design and construction of a modern flourocompatible endourology OR. There were no publications related to a dedicated endourology OR in Medline. A search was then performed for English language articles on OR designing, fluoroscopy in the OR, data archiving, and data relay. We also surveyed the existing endourology OR in different hospitals and analyzed the available technology for audiovisual capture and relay in surgery. This article was then prepared, covering the relevant areas on designing a dedicated flourocompatible endourology OR. Close cooperation and interaction between an architect and expert construction manager for designing, development, and construction of an OR are necessary. Strategic equipment placement with booms is essential to increase the efficiency and safety within the surgical space. Distinct features of an endourology OR are thickness of the walls for radiation protection, wide OR gate, central floor water exit drain, flourocompatible rotatable OR table, C-arm unit, minimum three hanging thin-film transistor (TFT) screen monitors, and endoscopic equipment supported on a boom. The anesthetic boom should be retractable and movable from one end of the OR table to other. The OR should have an electronic workstation strategically located at one corner for data capture, archiving, and telementoring. Data relay of the OR procedure is facilitated by a control room located in the vicinity of the OR. Designing the layout of the OR is extremely important, necessitating thoughtful planning to provide hassle-free movement, comfort to the surgeon, and efficient data archiving and transmission during a surgical

  15. Design and Implementation of Air Conditioning System in Operating Room

    Directory of Open Access Journals (Sweden)

    Htet Htet Aung

    2014-10-01

    Full Text Available The system is air conditioning system in operating room. The main objective of the system was implemented to provide air balance and temperature necessary conditions and to control airflow system for ventilation units in operating room. The operation room can be controlled with fuzzy expert system and describes the desired outputs. Input parameters such as temperature, humidity, oxygen and particle are used and output parameters are chosen as air conditioning motor speed and exhaust motor speed. Input parameters of the system are taken into account optimal conditions based on oxygen as medium and other parameters are chosen minimum condition for operating room. The airflow control system is determined the two components: the airflow block and the thermal block for ventilation units in operating room. The mathematical modeling of each such system based on a computational procedure and to combine them together in an efficient manner. Whether it supports to the most suitable control for the system prototype was determined by simulating the operation with varying the number of personnel and duration of time. Finally, according to the combination of temperature and airflow regulations with PI controller, the results of simulation of the entire ventilation unit control system is obtained.

  16. A Miracle That Accelerates Operating Room Functionality: Sugammadex

    Directory of Open Access Journals (Sweden)

    Erdal Dogan

    2014-01-01

    Full Text Available Background. Sugammadex offers a good alternative to the conventional decurarisation process currently performed with cholinesterase inhibitors. Sugammadex, which was developed specifically for the aminosteroid-structured rocuronium and vecuronium neuromuscular blockers, is a modified cyclodextrin made up of 8 glucose monomers arranged in a cylindrical shape. Methods. In this study, the goal was to investigate the efficacy of sugammadex. Sugammadex was used when there was insufficient decurarisation following neostigmine. This study was performed on 14 patients who experienced insufficient decurarisation (TOF <0.9 with neostigmine after general anaesthesia in the operating rooms of a university and a state hospital between June, 2012, and January, 2014. A dose of 2 mg/kg of sugammadex was administered. Results. Time elapsed until sugammadex administration following neostigmine 37 ± 6 min, following sugammadex it took 2.1 ± 0.9 min to reach TOF ≥ 0.9, and the extubation time was 3.2 ± 1.4 min. No statistically significant differences were detected in the hemodynamic parameters before and after sugammadex application. From the time of administration of sugammadex to the second postoperative hour, no side effects or complications occurred. None of the patients experienced acute respiratory failure or residual block during this time period. Conclusion. Sugammadex was successfully used to reverse rocuronium-induced neuromuscular block in patients where neostigmine was insufficient.

  17. 手术室护理管理对手术患者医院感染的干预意义研究%Study on the Significance of Nursing Management in Operation Room to the Hospital Infection of Surgical Patients

    Institute of Scientific and Technical Information of China (English)

    王雪梅

    2016-01-01

    Objective To investigate the significance of nursing management in the operation room for hospital infection.MethodsSelected from May 2014 to February 2016,75 cases of surgical patients admitted to our hospital were randomly divided into group A,group was given routine operation room management,B group line of comprehensive nursing management. Comparison of intervention results of two groups.Results Patients in group B were significantly higher than group A in nursing management,disinfection and isolation, standard hand washing,sterile operation quality was significantly better than that of A group,the incidence of hospital infection was significantly lower than that of A group,P<0.05.Conclusion The effect of operation room nursing management on hospital infection in patients with surgery.%目的:探讨手术室护理管理对手术患者医院感染的干预意义。方法选取2014年5月~2016年2月我院所收治的75例手术患者随机分组,A组给予手术室常规管理;B组行手术室全面护理管理。比较干预结果。结果 B组患者护理管理满意度比A组高,消毒隔离、规范洗手、无菌操作质量显著比A组好,医院感染发生率显著比A组低,P<0.05。结论手术室护理管理对手术患者医院感染的干预效果确切。

  18. LOW ENDOPHTHALMITIS RATES AFTER INTRAVITREAL ANTI-VASCULAR ENDOTHELIAL GROWTH FACTOR INJECTIONS IN AN OPERATION ROOM

    DEFF Research Database (Denmark)

    Freiberg, Florentina J; Brynskov, Troels; Munk, Marion R

    2017-01-01

    PURPOSE: To evaluate the rate of presumed endophthalmitis (EO) after intravitreal anti-vascular endothelial growth factor (anti-VEGF) injections in three European hospitals performed in an operation room (OR) under sterile conditions. METHODS: A retrospective multicenter study between 2003 and 2016...... at three European sites, City Hospital Triemli Zurich, Switzerland (CHT), Zealand University Hospital Roskilde, Denmark (ZUH) and University Clinic Bern, Switzerland (UCB). Intravitreal injection (IVI) database of each department was reviewed. All anti-vascular endothelial growth factor injections were.......0074% per injection (95% CI: 0.0070-0.0078%). Positive cultures were found in 4 out of 10 presumed endophthalmitis cases. CONCLUSION: The standardized sterile technique in an operation room with laminar airflow showed very low rates of endophthalmitis at three European sites....

  19. Cost-benefit analysis of different air change rates in an operating room environment.

    Science.gov (United States)

    Gormley, Thomas; Markel, Troy A; Jones, Howard; Greeley, Damon; Ostojic, John; Clarke, James H; Abkowitz, Mark; Wagner, Jennifer

    2017-09-08

    Hospitals face growing pressure to meet the dual but often competing goals of providing a safe environment while controlling operating costs. Evidence-based data are needed to provide insight for facility management practices to support these goals. The quality of the air in 3 operating rooms was measured at different ventilation rates. The energy cost to provide the heating, ventilation, and air conditioning to the rooms was estimated to provide a cost-benefit comparison of the effectiveness of different ventilation rates currently used in the health care industry. Simply increasing air change rates in the operating rooms tested did not necessarily provide an overall cleaner environment, but did substantially increase energy consumption and costs. Additionally, and unexpectedly, significant differences in microbial load and air velocity were detected between the sterile fields and back instrument tables. Increasing the ventilation rates in operating rooms in an effort to improve clinical outcomes and potentially reduce surgical site infections does not necessarily provide cleaner air, but does typically increase operating costs. Efficient distribution or management of the air can improve quality indicators and potentially reduce the number of air changes required. Measurable environmental quality indicators could be used in lieu of or in addition to air change rate requirements to optimize cost and quality for an operating room and other critical environments. Copyright © 2017 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

  20. [Perioperative mortality and morbidity for the year of 1999 in 466 Japanese Certified Anesthesia-training Hospitals: with special reference to ASA-physical status--report of Committee on Operating Room Safety of Japan Society of Anesthesiologists].

    Science.gov (United States)

    Irita, K; Kawashima, Y; Kobayashi, T; Goto, Y; Morita, K; Iwao, Y; Seo, N; Tsuzaki, K; Dohi, S

    2001-06-01

    Perioperative mortality and morbidity in Japan for the year 1999 were studied retrospectively. Committee on Operating Room Safety of the Japan Society of Anesthesiologists (JSA) sent confidential questionnaires to 774 Certified Training Hospitals of JSA and received answers from 60.2% of the hospitals. We analyzed their answers with special reference to ASA physical status (ASA-PS). The total number of anesthetics analyzed was 655, 644. Mortality and morbidity due to all kinds of causes including anesthetic management, intraoperative events, co-existing diseases, and operation were as follows. The incidence of cardiac arrest (per 10,000 anesthetics) was 0.68, 3.76, 14.37, 67.03, 0.36, 4.68, 27.96, 206.30 in patients with ASA-PS of I, II, III, IV, I E, II E, III E, and IV E, respectively. The incidences of critical events including cardiac arrest, severe hypotension, and severe hypoxemia were 8.93, 26.99, 71.30, 188.52, 8.68, 31.27, 136.16, and 790.92 in patients with ASA-PS of I, II, III, IV, I E, II E, III E, and IV E, respectively. The mortality rates (death during anesthesia and within 7th postoperative day) after cardiac arrest were 0.16, 0.94, 5.71, 33.51, 0.00, 1.46, 16.41 and 167.76 per 10,000 anesthetics in patients with ASA-PS of I, II, III, IV, I E, II E, III E, and IV E, respectively. The overall mortality rates were 0.24, 1.66, 12.16, 67.03, 0.00, 3.51, 34.65 and 417.14 in patients with ASA-PS of I, II, III, IV, I E, II E, III E, and IV E, respectively. Overall mortality and morbidity were higher in emergency anesthetics than in elective anesthetics. ASA-PS correlated well with overall mortality and with morbidity, regardless of etiology. The incidences of cardiac arrest totally attributable to anesthesia were 0.24, 0.45, 1.47, 8.38, 0.36, 1.75, 2.43 and 11.34 in patients with ASA-PS of I, II, III, IV, I E, II E, III E, and IV E, respectively. The incidences of all critical events totally attributable to anesthesia were 4.92, 8.81, 14.74, 20.95, 4

  1. [Design and Implementation of a Mobile Operating Room Information Management System Based on Electronic Medical Record].

    Science.gov (United States)

    Liu, Baozhen; Liu, Zhiguo; Wang, Xianwen

    2015-06-01

    A mobile operating room information management system with electronic medical record (EMR) is designed to improve work efficiency and to enhance the patient information sharing. In the operating room, this system acquires the information from various medical devices through the Client/Server (C/S) pattern, and automatically generates XML-based EMR. Outside the operating room, this system provides information access service by using the Browser/Server (B/S) pattern. Software test shows that this system can correctly collect medical information from equipment and clearly display the real-time waveform. By achieving surgery records with higher quality and sharing the information among mobile medical units, this system can effectively reduce doctors' workload and promote the information construction of the field hospital.

  2. Patient safety in the operating room: an intervention study on latent risk factors

    Directory of Open Access Journals (Sweden)

    van Beuzekom Martie

    2012-06-01

    Full Text Available Abstract Background Patient safety is one of the greatest challenges in healthcare. In the operating room errors are frequent and often consequential. This article describes an approach to a successful implementation of a patient safety program in the operating room, focussing on latent risk factors that influence patient safety. We performed an intervention to improve these latent risk factors (LRFs and increase awareness of patient safety issues amongst OR staff. Methods Latent risk factors were studied using a validated questionnaire applied to the OR staff before and after an intervention. A pre-test/post-test control group design with repeated measures was used to evaluate the effects of the interventions. The staff from one operating room of an university hospital acted as the intervention group. Controls consisted of the staff of the operating room in another university hospital. The outcomes were the changes in LRF scores, perceived incident rate, and changes in incident reports between pre- and post-intervention. Results Based on pre-test scores and participants’ key concerns about organizational factors affecting patient safety in their department the intervention focused on the following LRFs: Material Resources, Training and Staffing Recourses. After the intervention, the intervention operating room - compared to the control operating room - reported significantly fewer problems on Material Resources and Staffing Resources and a significantly lower score on perceived incident rate. The contribution of technical factors to incident causation decreased significantly in the intervention group after the intervention. Conclusion The change of state of latent risk factors can be measured using a patient safety questionnaire aimed at these factors. The change of the relevant risk factors (Material and Staffing resources concurred with a decrease in perceived and reported incident rates in the relevant categories. We conclude that

  3. In-office vs. operating room procedures for recurrent respiratory papillomatosis.

    Science.gov (United States)

    Miller, Anya J; Gardner, Glendon M

    2017-01-01

    We conducted a study to analyze hospital and patient costs, outcomes, and patient satisfaction among adults undergoing in-office and operating room procedures for the treatment of recurrent respiratory papillomatosis. Our final study population was made up of 17 patients-1 man and 16 women, aged 30 to 86 years (mean: 62). The mean number of in-office laser procedures per patient was 4.2, and the mean interval between procedures was 5.4 months (although 10 patients underwent only 1 office procedure); the mean number of operating room procedures was 13.5, and the mean interval between procedures was 14.3 months. An equal number of patients reported complications or adverse events with the two types of procedures-5 each. The difference in cost between the office procedure (mean: $3,413.00) and the operating room procedure (mean: $12,382.59) was almost $9,000, but these savings were offset by the fact that the office procedures needed to be performed three times as often. Patients reported slightly more anxiety and discomfort during the office procedures and, overall, they appeared to prefer the operating room procedure. We conclude that office procedures are significantly more cost-effective than operating room procedures, but their use may be limited by patient tolerance and the increased frequency of the procedure.

  4. Silence, power and communication in the operating room

    Science.gov (United States)

    Gardezi, Fauzia; Lingard, Lorelei; Espin, Sherry; Whyte, Sarah; Orser, Beverley; Baker, G Ross

    2009-01-01

    Title. Silence, power and communication in the operating room Aim This paper is a report of a study conducted to explore whether a 1- to 3-minute preoperative interprofessional team briefing with a structured checklist was an effective way to support communication in the operating room. Background Previous research suggests that nurses often feel constrained in their ability to communicate with physicians. Previous research on silence and power suggests that silence is not only a reflection of powerlessness or passivity, and that silence and speech are not opposites, but closely interrelated. Methods We conducted a retrospective study of silences observed in communication between nurses and surgeons in a multi-site observational study of interprofessional communication in the operating room. Over 700 surgical procedures were observed from 2005–2007. Instances of communication characterized by unresolved or unarticulated issues were identified in field notes and analysed from a critical ethnography perspective. Findings We identified three forms of recurring ‘silences’: absence of communication; not responding to queries or requests; and speaking quietly. These silences may be defensive or strategic, and they may be influenced by larger institutional and structural power dynamics as well as by the immediate situational context. Conclusions There is no single answer to the question of why ‘nobody said anything’. Exploring silences in relation to power suggests that there are multiple and complex ways that constrained communication is produced in the operating room, which are essential to understand in order to improve interprofessional communication and collaboration.

  5. Improving the Interdisciplinary Team Work in the Operating Room

    DEFF Research Database (Denmark)

    Tørring, Birgitte

    2016-01-01

    the black box of teamwork in search for relational elements critical to successful collaboration and communication. Few single studies exists which explore how RC could be observed and improved in this context. The present study examines surgical teams in selected operating rooms (OR) focusing on RC...

  6. Delays in the operating room: signs of an imperfect system.

    Science.gov (United States)

    Wong, Janice; Khu, Kathleen Joy; Kaderali, Zul; Bernstein, Mark

    2010-06-01

    Delays in the operating room have a negative effect on its efficiency and the working environment. In this prospective study, we analyzed data on perioperative system delays. One neurosurgeon prospectively recorded all errors, including perioperative delays, for consecutive patients undergoing elective procedures from May 2000 to February 2009. We analyzed the prevalence, causes and impact of perioperative system delays that occurred in one neurosurgeon's practice. A total of 1531 elective surgical cases were performed during the study period. Delays were the most common type of error (33.6%), and more than half (51.4%) of all cases had at least 1 delay. The most common cause of delay was equipment failure. The first cases of the day and cranial cases had more delays than subsequent cases and spinal cases, respectively. A delay in starting the first case was associated with subsequent delays. Delays frequently occur in the operating room and have a major effect on patient flow and resource utilization. Thorough documentation of perioperative delays provides a basis for the development of solutions for improving operating room efficiency and illustrates the principles underlying the causes of operating room delays across surgical disciplines.

  7. Decision support system for the operating room rescheduling problem

    NARCIS (Netherlands)

    Essen, van J. Theresia; Hurink, J.L.; Hartholt, Woutske; Akker, van den Bernd J.

    2012-01-01

    Due to surgery duration variability and arrivals of emergency surgeries, the planned Operating Room (OR) schedule is disrupted throughout the day which may lead to a change in the start time of the elective surgeries. These changes may result in undesirable situations for patients, wards or other in

  8. Gynaecological surgical training in the operating room : an exploratory study

    NARCIS (Netherlands)

    van der Houwen, Clasien; Boor, Klarke; Essed, Gerard G. M.; Boendermaker, Peter M.; Scherpbier, Albert A. J. J. A.; Scheele, Fedde

    2011-01-01

    Objective: One of the challenging goals of gynaecological education is preparing trainees for independent practice of surgery. Research, however, on how to acquire surgical skills in the operating room safely, effectively and efficiently is scarce. We performed this study to explore trainers' and tr

  9. [Perioperative mortality and morbidity in the year 2000 in 502 Japanese certified anesthesia-training hospitals: with a special reference to ASA-physical status--report of the Japan Society of Anesthesiologists Committee on Operating Room Safety].

    Science.gov (United States)

    Irita, Kazuo; Kawashima, Yasuo; Tsuzaki, Koichi; Iwao, Yasuhide; Kobayashi, Tsutomu; Seo, Norimasa; Goto, Yasuyuki; Morita, Kiyoshi; Shiraishi, Yoshito; Nakao, Yasuo; Tanaka, Yoshifumi; Tosaki, Youko; Dohi, Shuji; Obara, Hidefumi

    2002-01-01

    Perioperative mortality and morbidity in Japan from Jan. 1 to Dec. 31, 2000 were studied retrospectively. Committee on Operating Room Safety in 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 ASA physical status (ASA-PS). The total number of anesthesia available for this analysis was 897,733. The percentages of patients with ASA-PS of I, II, III, IV, I E, II E, III E, and IV E are 38.0, 40.3, 8.5, 0.4, 4.3, 5.3, 2.5, and 0.7%, respectively. Mortality and morbidity from all kinds of causes including anesthetic management, intraoperative events, co-existing diseases, and surgical problems were as follows. The incidences of cardiac arrest (per 10,000 cases of anesthesia) were 1.11, 3.26, 12.25, 54.60, 0.77, 4.46, 21.08 and 217.75 in patients with ASA-PS of I, II, III, IV, I E, II E, III E, and IV E, respectively. The incidences of critical events including cardiac arrest, severe hypotension, and severe hypoxemia were 6.89, 20.22, 62.18, 148.21, 6.71, 20.38, 106.72 and 592.21 in patients with ASA-PS of I, II, III, IV, I E, II E, III E, and IV E, respectively. The mortality rates (death during anesthesia and within 7 postoperative days) after cardiac arrest were 0.26, 0.77, 3.69, 41.60, 0.00, 1.06, 9.42 and 163.31 per 10,000 cases of anesthesia in patients with ASA-PS of I, II, III, IV, I E, II E, III E, and IV E, respectively. The overall mortality rates were 0.32, 1.38, 9.75, 70.20, 0.26, 2.12, 29.15 and 353.02 in patients with ASA-PS of I, II, III, IV, I E, II E, III E, and IV E, respectively. Overall mortality and morbidity were higher in emergency anesthesia than in elective anesthesia. ASA-PS correlated well with overall mortality and morbidity, regardless of etiology. The incidences of cardiac arrest totally attributable to anesthesia were 0.23, 0.50, 1.32, 0.00, 0.00, 0.85, 2.69 and 4

  10. Emotional intelligence in the operating room: analysis from the Boston Marathon bombing.

    Science.gov (United States)

    Chang, Beverly P; Vacanti, Joshua C; Michaud, Yvonne; Flanagan, Hugh; Urman, Richard D

    2014-01-01

    The Boston Marathon terrorist bombing that occurred on April 15, 2013 illustrates the importance of a cohesive, efficient management for the operating room and perioperative services. Conceptually, emotional intelligence (EI) is a form of social intelligence used by individuals in leadership positions to monitor the feelings and emotions of their team while implementing a strategic plan. To describe the experience of caring for victims of the bombing at a large tertiary care center and provide examples demonstrating the importance of EI and its role in the management of patient flow and overall care. A retrospective review of trauma data was performed. Data regarding patient flow, treatment types, treatment times, and outcomes were gathered from the hospital's electronic tracking system and subsequently analyzed. Analyses were performed to aggregate the data, identify trends, and describe the medical care. Immediately following the bombing, a total of 35 patients were brought to the emergency department (ED) with injuries requiring immediate medical attention. 10 of these patients went directly to the operating room on arrival to the hospital. The first victim was in an operating room within 21 minutes after arrival to the ED. The application of EI in managerial decisions helped to ensure smooth transitions for victims throughout all stages of their perioperative care. EI provided the fundamental groundwork that allowed the operating room manager and nurse leaders to establish the calm and coordinated leadership that facilitated patient care and teamwork.

  11. Control of the Environment in the Operating Room.

    Science.gov (United States)

    Katz, Jonathan D

    2016-09-23

    There is a direct relationship between the quality of the environment of a workplace and the productivity and efficiency of the work accomplished. Components such as temperature, humidity, ventilation, drafts, lighting, and noise each contribute to the quality of the overall environment and the sense of well-being of those who work there.The modern operating room is a unique workplace with specific, and frequently conflicting, environmental requirements for each of the inhabitants. Even minor disturbances in the internal environment of the operating room can have serious ramifications on the comfort, effectiveness, and safety of each of the inhabitants. A cool, well-ventilated, and dry climate is optimal for many members of the surgical team. Any significant deviation from these objectives raises the risk of decreased efficiency and productivity and adverse surgical outcomes. A warmer, more humid, and quieter environment is necessary for the patient. If these requirements are not met, the risk of surgical morbidity and mortality is increased. An important task for the surgical team is to find the correct balance between these 2 opposed requirements. Several of the components of the operating room environment, especially room temperature and airflow patterns, are easily manipulated by the members of the surgical team. In the following discussion, we will examine these elements to better understand the clinical ramifications of adjustments and accommodations that are frequently made to meet the requirements of both the surgical staff and the patient.

  12. [Surgery training of gynecologic residents: master and student in the operating room].

    Science.gov (United States)

    Rathat, G; Hoa, D; Gagnayre, R; Hoffet, M; Mares, P

    2008-02-01

    Describe the surgical training of gynecologic residents in the operating room, by collecting the opinion of French gynecologists. A questionnaire investigating this subject was put on a web site. Every French gynecologist could answer the questionnaire from a duration of six months. The data of the inquiry were studied by comparing five groups: residents (group 1), fellows (group 2), seniors of public hospital (group 3), and seniors of private hospitals (group 4), or, groups 2, 3 and 4 together, as Group A. Six hundred and fifty-seven gynecologists answered the inquiry. For the residents, lack of time and senior's weak educational motivation are the explanations most frequently retained in order to explain that residents do not operate. For group A, it is rather the residents' skills which is the most important fact to have residents operate. Residents more often practice surgery in general public hospital that in faculty hospital. For 31% of all the referees, heads of departments do not incite their teams to have residents operate. Nearly 25% of all the investigated believe that a man operates more than a woman in resident curriculum. Besides, by analyzing the answers of groups 1 and 2, we were able to correlate resident seniority at their first practice of 13 surgical operations. For 26% of the group A, residents operate less than they do during their own studies. Finally, all the investigated confirm the lack of surgical assessment in the resident curriculum. Decision to let the resident operate remains too dependent on senior personal appreciation and does not seem to join a strategy of training. Opinions of surgical training in the operating room is different between residents and seniors. Operating time increases when residents operate but there is no effect on quality of care. These results show again the necessity of a formal teaching and assessment, in a resident program with objectives, collecting every resident's surgery volume. These educational

  13. Predicting Correct Body Posture based on Theory of Planned Behavior in Iranian Operating Room Nurses

    OpenAIRE

    BAHAREH ABEDI; RABIOLLAH FARMANBAR1; SAEED OMIDI; MAHDI JAHANGIR BLOURCHIAN

    2015-01-01

    Due to the importance of correct posture for preventing musculoskeletal disorders, the purpose of this study was to evaluate Theory of Planned Behavior in Predicting correct Body Posture in operating room nurses.In this cross-sectional study, participants (n=100) were nurses from five hospitals located in northern Iran. Participants completed demographic data and theory of planned behavior construct Questionnaires. In addition, the researcher checked the Body Posture of nurses by Rapid Entire...

  14. Case Study: Review of Operating Room Utilization at Mayo Clinic Arizona (MCA)

    Science.gov (United States)

    2008-05-01

    offers. The premier programs of the hospital are cancer treatment and solid organ /bone marrow transplant . (Mayo Clinic, 2007) Problem Statement In...improve revenue streams (Overdyl, Harvey, Fishman , & Shippey, 1998). Organizations have seen reduced revenues from operating room care because of lower...TASK NUMBER 5f. WORK UNIT NUMBER 7. PERFORMING ORGANIZATION NAME(S) AND ADDRESS(ES) RESIDENCY SITE ADDRESS Mayo Clinic Arizona 5777 East Mayo

  15. Feasibility of touch-less control of operating room lights.

    Science.gov (United States)

    Hartmann, Florian; Schlaefer, Alexander

    2013-03-01

    Today's highly technical operating rooms lead to fairly complex surgical workflows where the surgeon has to interact with a number of devices, including the operating room light. Hence, ideally, the surgeon could direct the light without major disruption of his work. We studied whether a gesture tracking-based control of an automated operating room light is feasible. So far, there has been little research on control approaches for operating lights. We have implemented an exemplary setup to mimic an automated light controlled by a gesture tracking system. The setup includes a articulated arm to position the light source and an off-the-shelf RGBD camera to detect the user interaction. We assessed the tracking performance using a robot-mounted hand phantom and ran a number of tests with 18 volunteers to evaluate the potential of touch-less light control. All test persons were comfortable with using the gesture-based system and quickly learned how to move a light spot on flat surface. The hand tracking error is direction-dependent and in the range of several centimeters, with a standard deviation of less than 1 mm and up to 3.5 mm orthogonal and parallel to the finger orientation, respectively. However, the subjects had no problems following even more complex paths with a width of less than 10 cm. The average speed was 0.15 m/s, and even initially slow subjects improved over time. Gestures to initiate control can be performed in approximately 2 s. Two-thirds of the subjects considered gesture control to be simple, and a majority considered it to be rather efficient. Implementation of an automated operating room light and touch-less control using an RGBD camera for gesture tracking is feasible. The remaining tracking error does not affect smooth control, and the use of the system is intuitive even for inexperienced users.

  16. Sedation of infants and children outside of the operating room.

    Science.gov (United States)

    Tobias, Joseph D

    2015-08-01

    Although adults may be able to tolerate procedures without sedation, developmental and cognitive issues often mandate the use of sedation in infants and children. There has been a shift in the philosophy regarding sedation with an increasing recognition of the negative psychological and physiological aspects of inadequate sedation. The expansion of our technology continues to result in an increasing number of techniques, which require sedation outside of the operating room environment. These factors have contributed to an ever growing number of pediatric patients presenting themselves for procedural sedation. This chapter will discuss issues regarding the provision of anesthesia outside of the operating room for pediatric patients including current guidelines for patient assessment prior to procedural, monitoring during sedation, and a discussion of some of the more commonly utilized sedative and analgesic agents within the pediatric population.

  17. A Web-Based Operating Room Management Educational Tool.

    Science.gov (United States)

    Tsai, Mitchell H; Haddad, Daniel J; Friend, Alexander F; Bender, S Patrick; Davidson, Melissa L

    2016-08-01

    In 2010, our department instituted a nonclinical, administrative rotation in operating room management for anesthesiology residents. Subsequently, we mandated the rotation for all senior anesthesiology residents in 2013. In 2014, under the auspices of the American Society of Anesthesiologists, we developed a web-based module covering the basics of finance, accounting, and operating room management. A multiple-choice test was given to residents at the beginning and end of the rotation, and we compared the mean scores between residents who took the traditional course and residents who took the web-based module. We found no significant difference between the groups of residents, suggesting that the web-based module is as effective as traditional didactics.

  18. The utilization of magnetic resonance imaging in the operating room.

    Science.gov (United States)

    Ménard, C; Pambrun, J-F; Kadoury, S

    Online image guidance in the operating room using ultrasound imaging led to the resurgence of prostate brachytherapy in the 1980s. Here we describe the evolution of integrating MRI technology in the brachytherapy suite or operating room. Given the complexity, cost, and inherent safety issues associated with MRI system integration, first steps focused on the computational integration of images rather than systems. This approach has broad appeal given minimal infrastructure costs and efficiencies comparable with standard care workflows. However, many concerns remain regarding accuracy of registration through the course of a brachytherapy procedure. In selected academic institutions, MRI systems have been integrated in or near the brachytherapy suite in varied configurations to improve the precision and quality of treatments. Navigation toolsets specifically adapted to prostate brachytherapy are in development and are reviewed. Copyright © 2017 American Brachytherapy Society. Published by Elsevier Inc. All rights reserved.

  19. Development of an operating room pharmacy substation on a restricted budget.

    Science.gov (United States)

    Buchanan, E C; Gaither, M W

    1986-07-01

    Pharmaceutical services implemented in an operating room (OR) pharmacy substation without addition of staff in a 764-bed teaching hospital with 22 operating rooms are described. In 1984 an interdepartmental task force recommended that pharmacy take control of responsibility for controlled drugs used in anesthesia. The anesthesia department contributed space for a pharmacy substation and some of the necessary equipment. Two technicians staff the substation (1.5 full-time equivalent positions); pharmacy contributed 0.5 FTE and the additional FTE was obtained through staffing adjustments in other departments. Anesthesiologists and nurse anesthetists obtain controlled drugs directly from the technicians, and records of drug disposition are compared with inventory twice daily. The substation also handles exchange carts for noncontrolled drugs for anesthesia and for other drugs used in the operating rooms. Total cost (additional cost to pharmacy and other departments) for operating the substation for its first year was +2161, and there were no unresolved discrepancies in controlled drug accounting. Undocumented use of noncontrolled drugs has been reduced by 67%, and cooperation and communication between the pharmacy and anesthesia departments has improved. Substation personnel do not prepare intravenous admixtures or provide clinical services. An operating room substation staffed by technicians 10.5 hours daily Monday through Friday provided cost-effective pharmacy control of drugs used in the OR.

  20. Operating room teamwork among physicians and nurses: teamwork in the eye of the beholder.

    Science.gov (United States)

    Makary, Martin A; Sexton, J Bryan; Freischlag, Julie A; Holzmueller, Christine G; Millman, E Anne; Rowen, Lisa; Pronovost, Peter J

    2006-05-01

    Teamwork is an important component of patient safety. In fact, communication errors are the most common cause of sentinel events and wrong-site operations in the US. Although efforts to improve patient safety through improving teamwork are growing, there is no validated tool to scientifically measure teamwork in the surgical setting. Operating room personnel in 60 hospitals were surveyed using the Safety Attitudes Questionnaire. Surgeons, anesthesiologists, certified registered nurse anesthetists, and operating room nurses rated their own peers and each other using a 5-point Likert scale (1 = very low, 5 = very high). Overall response rate was 77.1% (2,135 of 2,769). Ratings of teamwork differed substantially by operating room caregiver type, with the greatest differences in ratings shown by physicians: surgeons (F[4, 2058] = 41.73, p teamwork exist in the operating room, with physicians rating the teamwork of others as good, but at the same time, nurses perceive teamwork as mediocre. Given the importance of communication and collaboration in patient safety, health care organizations should measure teamwork using a scientifically valid method. The Safety Attitudes Questionnaire can be used to measure teamwork, identify disconnects between or within disciplines, and evaluate interventions aimed at improving patient safety.

  1. Response Times of Operators in a Control Room

    DEFF Research Database (Denmark)

    Platz, O.; Rasmussen, J.; Skanborg, Preben Zacho

    A statistical analysis was made of operator response times recorded in the control room of a research reactor during the years 1972-1974. A homogeneity test revealed that the data consist of a mixture of populations. A small but statistically significant difference is found between day and night ...... response times. Lognormal distributions are found to provide the best fit of the day and the night response times....

  2. Surgical site infection prevention: the operating room environment.

    Science.gov (United States)

    Clyburn, Terry A; Evans, Richard P; Moucha, Calin S; Prokuski, Laura

    2011-01-01

    Surgical site infections can complicate orthopaedic procedures and contribute to morbidity, mortality, and health care costs. Extensive literature has been published on this topic; however, the quality of data using standards of evidence-based medicine is variable with a lack of well-controlled studies. A review of the literature concerning measures to prevent surgical site infections in the operating room environment may be helpful in preventing such infections.

  3. Allocation of surgeries to operating rooms by goal programing.

    Science.gov (United States)

    Ozkarahan, I

    2000-12-01

    High usage rate in a surgical suite is extremely important in meeting the increasing demand for health care services and reducing costs to improve quality of care. In this paper a goal programming model which can produce schedules that best serve the needs of the hospital, i.e., by minimizing idle time and overtime, and increasing satisfaction of surgeons, patients, and staff, is described. The approach involves sorting the requests for a particular day on the basis of block restrictions, room utilization, surgeon preferences and intensive care capabilities. The model is tested using the data obtained during field studies at Dokuz Eylul University Hospital. The model is also tested for alternative achievement functions to examine the model's ability to satisfy abstract goals.

  4. Development of efficiency indicators of operating room management for multi-institutional comparisons.

    Science.gov (United States)

    Tanaka, Masayuki; Lee, Jason; Ikai, Hiroshi; Imanaka, Yuichi

    2013-04-01

    The efficiency of a hospital's operating room (OR) management can affect its overall profitability. However, existing indicators that assess OR management efficiency do not take into account differences in hospital size, manpower and functional characteristics, thereby rendering them unsuitable for multi-institutional comparisons. The aim of this study was to develop indicators of OR management efficiency that would take into account differences in hospital size and manpower, which may then be applied to multi-institutional comparisons. Using administrative data from 224 hospitals in Japan from 2008 to 2010, we performed four multiple linear regression analyses at the hospital level, in which the dependent variables were the number of operations per OR per month, procedural fees per OR per month, total utilization times per OR per month and total fees per OR per month for each of the models. The expected values of these four indicators were produced using multiple regression analysis results, adjusting for differences in hospital size and manpower, which are beyond the control of process owners' management. However, more than half of the variations in three of these four indicators were shown to be explained by differences in hospital size and manpower. Using the ratio of observed to expected values (OE ratio), as well as the difference between the two values (OE difference) allows hospitals to identify weaknesses in efficiency with more validity when compared to unadjusted indicators. The new indicators may support the improvement and sustainment of a high-quality health care system. © 2012 Blackwell Publishing Ltd.

  5. Natural Rubber Latex Hypersensitivity with Skin Prick Test in Operating Room Personnel

    Directory of Open Access Journals (Sweden)

    Seyed Hessamedin Nabavizadeh

    2009-12-01

    Full Text Available Hypersensitivity reactions to natural rubber latex have increased recently, especially among people with high exposure to latex allergens. Hypersensitivity reactions to latex are related to many conditions like occupational asthma. Our study was performed to determine the prevalence of hypersensitivity to natural rubber latex and potential food cross reactions in operation room personnel in Shiraz hospitals. In this cross-sectional, descriptive study, 580 operation room personnel filled out our questionnaire which included data about their personal history, symptoms of latex hypersensitivity, and other related allergies such as food hypersensitivity. An informed consent was obtained and skin prick tests were performed for natural rubber latex and potential food cross reactions (kiwi, banana, and potato. The obtained data were analyzed by SPSS and Chi-square test.Results: 104 (17.9% of the operating room personnel showed positive latex skin tests. We revealed a significant correlation between those with positive skin tests to latex with atopia, urthicaria, and food hypersensitivity. The prevalence did not vary by sex, age, education, surgical and non-surgical gloves users, or history of contact dermatitis. Latex hypersensitivity is common among operation room personnel. Evaluation of symptoms and prediction of future diseases necessitate screening tests in individuals at risk.

  6. Operational Strategy of CBPs for load balancing of Operators in Advanced Main Control Room

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Seunghwan; Kim, Yochan; Jung, Wondea [Korea Atomic Energy Research Institute, Daejeon (Korea, Republic of)

    2014-05-15

    With the using of a computer-based control room in an APR1400 (Advanced Pressurized Reactor-1400), the operators' behaviors in the main control room had changed. However, though the working environment of operators has been changed a great deal, digitalized interfaces can also change the cognitive tasks or activities of operators. First, a shift supervisor (SS) can confirm/check the conduction of the procedures and the execution of actions of board operators (BOs) while confirming directly the operation variables without relying on the BOs. Second, all operators added to their work the use of a new CBP and Soft Controls, increasing their procedural workload. New operational control strategies of CBPs are necessary for load balancing of operator's task load in APR1400. In this paper, we compared the workloads of operators in an APR1400 who work with two different usages of the CBP. They are SS oriented usage and SS-BO collaborative usage. In this research, we evaluated the workloads of operators in an advanced main control room by the COCOA method. Two types of CBP usages were defined and the effects of these usages on the workloads were investigated. The obtained results showed that the workloads between operators in a control room can be balanced according to the CBP usages by assigning control authority to the operators.

  7. Obesity increases operating room time for lobectomy in the society of thoracic surgeons database.

    Science.gov (United States)

    St Julien, Jamii B; Aldrich, Melinda C; Sheng, Shubin; Deppen, Stephen A; Burfeind, William R; Putnam, Joe B; Lambright, Eric S; Nesbitt, Jonathan C; Grogan, Eric L

    2012-12-01

    Obesity has become a major epidemic in the United States. Although research suggests obesity does not increase major morbidity or mortality after thoracic operations, it likely results in greater use of health care resources. We examined all patients in The Society of Thoracic Surgeons General Thoracic Surgery database with primary lung cancer who underwent lobectomy from 2006 to 2010. We investigated the impact of body mass index (BMI) on total operating room time using a linear mixed-effects regression model and multiple imputations to account for missing data. Secondary outcomes included postoperative length of stay and 30-day mortality. Covariates included age, sex, race, forced expiratory volume, smoking status, Zubrod score, prior chemotherapy or radiation, steroid use, number of comorbidities, surgical approach, hospital lobectomy volume, hospital percent obesity, and the addition of mediastinoscopy or wedge resection. A total of 19,337 patients were included. The mean BMI was 27.3 kg/m2, with 4,898 patients (25.3%) having a BMI of 30 kg/m2 or greater. The mean total operating room time, length of stay, and 30-day mortality were 240 minutes, 6.7 days, and 1.8%, respectively. For every 10-unit increase in BMI, mean operating room time increased by 7.2 minutes (range, 4.8 to 8.4 minutes; pobese patients did not affect the association between BMI and operative time. Body mass index was not associated with 30-day mortality or increased length of stay. Increased BMI is associated with increased total operating room time, regardless of institutional experience with obese patients. Copyright © 2012 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  8. Virtual reality in the operating room of the future.

    Science.gov (United States)

    Müller, W; Grosskopf, S; Hildebrand, A; Malkewitz, R; Ziegler, R

    1997-01-01

    In cooperation with the Max-Delbrück-Centrum/Robert-Rössle-Klinik (MDC/RRK) in Berlin, the Fraunhofer Institute for Computer Graphics is currently designing and developing a scenario for the operating room of the future. The goal of this project is to integrate new analysis, visualization and interaction tools in order to optimize and refine tumor diagnostics and therapy in combination with laser technology and remote stereoscopic video transfer. Hence, a human 3-D reference model is reconstructed using CT, MR, and anatomical cryosection images from the National Library of Medicine's Visible Human Project. Applying segmentation algorithms and surface-polygonization methods a 3-D representation is obtained. In addition, a "fly-through" the virtual patient is realized using 3-D input devices (data glove, tracking system, 6-DOF mouse). In this way, the surgeon can experience really new perspectives of the human anatomy. Moreover, using a virtual cutting plane any cut of the CT volume can be interactively placed and visualized in realtime. In conclusion, this project delivers visions for the application of effective visualization and VR systems. Commonly known as Virtual Prototyping and applied by the automotive industry long ago, this project shows, that the use of VR techniques can also prototype an operating room. After evaluating design and functionality of the virtual operating room, MDC plans to build real ORs in the near future. The use of VR techniques provides a more natural interface for the surgeon in the OR (e.g., controlling interactions by voice input). Besides preoperative planning future work will focus on supporting the surgeon in performing surgical interventions. An optimal synthesis of real and synthetic data, and the inclusion of visual, aural, and tactile senses in virtual environments can meet these requirements. This Augmented Reality could represent the environment for the surgeons of tomorrow.

  9. Fire in the Operating Room During Hypospadias Repair.

    Science.gov (United States)

    Boscarelli, Alessandro; Frediani, Simone; Ceccanti, Silvia; Cervellone, Alice; Pesce, Maria Vittoria; Cozzi, Denis A

    2017-11-01

    Fire in the operating room (OR) is a very distressful and shocking occurrence with potential dramatic consequences. Despite safety rules and rigorous recommendations, such unintentional events do occur every so often. Notably, the vast majority of cases have been reported in the adult population, with very few pediatric cases described to date. Herein, we report on a 16-month-old boy undergoing reconstructive surgery for penoscrotal hypospadias, who experienced an OR fire most likely related to the use of alcohol-based solution ignited by monopolar electrocautery.

  10. 高效模式下医院手术室一次性无菌物品的管理%Under Highly Effective Revolution Pattern Hospital Operating Room Disposable Asepsis Goods Management

    Institute of Scientific and Technical Information of China (English)

    吴巧琴; 沈惠青

    2014-01-01

    Objective Discusses this courtyard operating room to the disposable asepsis goods management ef ect and the experience.Methods 2012January January through the application of consumables management team re integration, environment layout improvement, goods supply process restructuring and management tools to regulate the new, improved management of disposable sterile items. Results Low seniority nurses can take the object time; leak charge can find the cor ect; reduce the cost of waste; reduce the nurse not on duty time; improve the staf on the disposable use satisfaction; improve the surgeon on nurses' job satisfaction. Conclusion The standardized management ef ectively ensure the safe use of disposable sterile items, make work more orderly, more ef icient, the medical relations more harmonious, but also ful y embodies the patient centered service tenet.%目的:探讨本院手术室对一次性无菌物品管理的效果及体会。方法2012年1月起通过对耗材管理团队的再整合、环境布局的改进、物品供应流程的重组及新的管理工具的应用来进行规范、改进一次性无菌物品的管理。结果缩短了低年资护士拿取物品的时间;漏收费能及时发现更正;减少了科室成本浪费;降低了巡回护士不在岗时间;提高了科室人员对一次性物品使用的满意度;提高了外科医生对护士工作的满意度(P<0.01)。结论规范化管理有效地保证了一次性无菌物品的安全使用,使工作更有序,效率更高,医护关系更融洽,也充分体现了以患者为中心的服务宗旨。

  11. Psychological and Physical Stress in Surgeons Operating in a Standard or Modern Operating Room

    DEFF Research Database (Denmark)

    Klein, M.; Andersen, L.P.H.; Gögenür, Ismayil

    2010-01-01

    Purpose: There have been no studies examining the effect of optimized ergonomic and technical environment on the psychological and physiological stress of the surgeon. The aim of this study was to examine whether optimized ergonomics and technical aids within a modern operating room (OR) affect...... psychological and physiological stress in experienced laparoscopic surgeons. Methods: This was a prospective case-controlled study including 10 experienced surgeons. Surgery was performed in 2 different ORs: a standard room and a modern room (OR1-suite, Karl Storz). The surgeons filled out questionnaires...

  12. Communication Skill in the Operating Room of Merged Hospital%"收编"医院手术室冲突沟通技巧的探讨舆体会

    Institute of Scientific and Technical Information of China (English)

    鲍菲; 曾英玉; 杨秀霞; 黄惠琼; 刘蔚晴

    2002-01-01

    Zhongshan Medical University merged Huangpu Hospital last year. The staff from different hospital can conflict owning tothe divergence in interests, managernent and concept. As far as the nursing system is concerned, the conflict between the chief nurse andthe nurses, the task and the nursing conduct are the major expression.

  13. Effects of Intervention and Team Culture on Operating Room Traffic.

    Science.gov (United States)

    Pulido, Ricardo W; Kester, Benjamin; Schwarzkopf, Ran

    How changes in the surgical team's culture can potentially reduce operating room (OR) traffic. Excessive OR traffic during surgical procedures can present a risk to the patient's safety and recovery. Data suggest that limiting the number of OR personnel during the intraoperative period can reduce excessive OR traffic. However, it is unclear whether the surgeon's verbal intervention can also successfully reduce intraoperative OR traffic. This study compares traffic rates in hip and knee arthroplasty cases against traffic rates during nonarthroplasty cases to examine the effects of verbal interventions implemented by the surgeon to reduce intraoperative traffic. The study consisted of 16 orthopedic surgeons in a noninterventional group and 1 orthopedic surgeon in the interventional group. The surgeon in the interventional group implemented verbal protocols to OR staff to limit excessive intraoperative traffic. Operating room traffic was monitored for 3 consecutive months (January-March 2015) with the use of infrared automated door counters that tracked door openings when someone entered or left the OR. A total of 50 hip and knee arthroplasties cases and 157 nonarthroplasty cases were tracked during the study period. A total of 134 hours and 4482 movements were collected for the hip and knee arthroplasty cases. A total of 498 hours and 22 902 movements were collected for the nonarthroplasty cases. Comparing the 2 groups, the interventional group averaged 33 movements per hour while the noninterventional group averaged 46 movements per hour (P traffic can be reduced through simple verbal protocols established by the surgical team.

  14. [Patient safety recommendations for out of operating room procedure sedation].

    Science.gov (United States)

    Arnal Velasco, D; Romero García, E; Martínez Palli, G; Muñoz Corsini, L; Rey Martínez, M; Postigo Morales, S

    There is an increasing and more complex demand for sedation for procedures out of the operating room. For different reasons, nowadays the administration of sedation varies considerably. We believe that a patient safety approach rather an approach out of corporate or economic interests is desirable. We created a working group of experts within the Spanish Anaesthesia and Reanimation Incident Reporting System (SENSAR) to prepare a series of recommendations through a non-systematic review. These recommendations were validated by an expert panel of 31 anaesthesiologists through two rounds of an adaptation of the Delphi Method where more than 70% agreement was required. The resulting recommendations include previous evaluation, material and staffing needs for sedation for procedures, post-sedation recommendations and activity and quality control advice. We present patient centred recommendations for the safe use of sedation for out of the operating room procedures from the point of view of the professionals with the most experience in its administration. We believe that these can be used as a guide to reduce variability and increase patient safety in the organisation of healthcare. Copyright © 2016 SECA. Publicado por Elsevier España, S.L.U. All rights reserved.

  15. Patient safety recommendations for out of operating room procedure sedation.

    Science.gov (United States)

    Arnal Velasco, D; Romero García, E; Martínez Palli, G; Muñoz Corsini, L; Rey Martínez, M; Postigo Morales, S

    2016-12-01

    There is an increasing and more complex demand for sedation for procedures out of the operating room. For different reasons, nowadays the administration of sedation varies considerably. We believe that a patient safety approach rather an approach out of corporate or economic interests is desirable. We created a working group of experts within the Spanish Anaesthesia and Reanimation Incident Reporting System (SENSAR) to prepare a series of recommendations through a non-systematic review. These recommendations were validated by an expert panel of 31 anaesthesiologists through two rounds of an adaptation of the Delphi Method where more than 70% agreement was required. The resulting recommendations include previous evaluation, material and staffing needs for sedation for procedures, post-sedation recommendations and activity and quality control advice. We present patient centred recommendations for the safe use of sedation for out of the operating room procedures from the point of view of the professionals with the most experience in its administration. We believe that these can be used as a guide to reduce variability and increase patient safety in the organisation of healthcare. Copyright © 2016 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Publicado por Elsevier España, S.L.U. All rights reserved.

  16. Methodology for analyzing environmental quality indicators in a dynamic operating room environment.

    Science.gov (United States)

    Gormley, Thomas; Markel, Troy A; Jones, Howard W; Wagner, Jennifer; Greeley, Damon; Clarke, James H; Abkowitz, Mark; Ostojic, John

    2017-04-01

    Sufficient quantities of quality air and controlled, unidirectional flow are important elements in providing a safe building environment for operating rooms. To make dynamic assessments of an operating room environment, a validated method of testing the multiple factors influencing the air quality in health care settings needed to be constructed. These include the following: temperature, humidity, particle load, number of microbial contaminants, pressurization, air velocity, and air distribution. The team developed the name environmental quality indicators (EQIs) to describe the overall air quality based on the actual measurements of these properties taken during the mock surgical procedures. These indicators were measured at 3 different hospitals during mock surgical procedures to simulate actual operating room conditions. EQIs included microbial assessments at the operating table and the back instrument table and real-time analysis of particle counts at 9 different defined locations in the operating suites. Air velocities were measured at the face of the supply diffusers, at the sterile field, at the back table, and at a return grille. The testing protocol provided consistent and comparable measurements of air quality indicators between institutions. At 20 air changes per hour (ACH), and an average temperature of 66.3°F, the median of the microbial contaminants for the 3 operating room sites ranged from 3-22 colony forming units (CFU)/m(3) at the sterile field and 5-27 CFU/m(3) at the back table. At 20 ACH, the median levels of the 0.5-µm particles at the 3 sites were 85,079, 85,325, and 912,232 in particles per cubic meter, with a predictable increase in particle load in the non-high-efficiency particulate air-filtered operating room site. Using a comparison with cleanroom standards, the microbial and particle counts in all 3 operating rooms were equivalent to International Organization for Standardization classifications 7 and 8 during the mock surgical

  17. Integrating hospital and physician revenue cycle operations.

    Science.gov (United States)

    Lockett, Kevin M

    2014-03-01

    Standardized revenue cycle processes should be a key component of the coordinated care delivery strategy organizations will require to complete the transition to population health management. Integrating hospital and physician revenue cycle operations can help organizations better navigate new payment models, reduce costs, and improve value. The most comprehensive approach involves integrating patient access and registration, coding operations, and receivables management across different settings.

  18. [Simulation-based analysis of novel therapy principles. Effects on the efficiency of operating room processes].

    Science.gov (United States)

    Baumgart, A; Denz, C; Bender, H; Bauer, M; Hunziker, S; Schüpfer, G; Schleppers, A

    2009-02-01

    The introduction of innovative drugs in anesthesiological treatment has the potential to improve perioperative efficiency. This article examines the impact of the new muscle relaxant encapsulator Bridion on emergence from anesthesia and on the efficiency of the perioperative organization. To analyze the effects of medical innovations, computer simulation was used as an experimental frame. The simulation was based on a realistic model of an operating room setting and used historical data to study the effect of innovation on the operational performance and the economic outcomes. The use of medical innovations in anesthesiological emergence yields new potentials for a hospital under certain conditions. Due to shorter block times and anesthesia-controlled times, additional benefits for the operating room could be realized. This results in an increase of up to 2.4% additional cases during similar working hours and planning periods. The introduction of innovative medicines may reveal more efficient and economical conditions in operating rooms. The overall result depends, for example, on the rate of application of the patient's portfolio or the organization and access rules of the surgical suite. Based on the anesthesia-controlled time no general a priori statement about the economic potentials can be confirmed. Future empirical studies should investigate the impact on quality and economic benefits for the entire patient pathway.

  19. Impact of Chlorine Dioxide Gas Sterilization on Nosocomial Organism Viability in a Hospital Room

    Directory of Open Access Journals (Sweden)

    Angela L. Hewlett

    2013-06-01

    Full Text Available To evaluate the ability of ClO2 to decontaminate pathogens known to cause healthcare-associated infections in a hospital room strains of Acinetobacter baumannii, Escherichia coli, Enterococcus faecalis, Mycobacterium smegmatis, and Staphylococcus aureus were spot placed in duplicate pairs at 10 sites throughout a hospital room and then exposed to ClO2 gas. Organisms were collected and evaluated for reduction in colony forming units following gas exposure. Six sterilization cycles with varied gas concentrations, exposure limits, and relative humidity levels were conducted. Reductions in viable organisms achieved ranged from 7 to 10-log reductions. Two sterilization cycles failed to produce complete inactivation of organisms placed in a bathroom with the door closed. Reductions of organisms in the bathroom ranged from 6-log to 10-log reductions. Gas leakage between hospital floors did not occur; however, some minor gas leakage from the door of hospital room was measured which was subsequently sealed to prevent further leakage. Novel technologies for disinfection of hospital rooms require validation and safety testing in clinical environments. Gaseous ClO2 is effective for sterilizing environmental contamination in a hospital room. Concentrations of ClO2 up to 385 ppm were safely maintained in a hospital room with enhanced environmental controls.

  20. Impact of Chlorine Dioxide Gas Sterilization on Nosocomial Organism Viability in a Hospital Room

    Science.gov (United States)

    Lowe, John J.; Gibbs, Shawn G.; Iwen, Peter C.; Smith, Philip W.; Hewlett, Angela L.

    2013-01-01

    To evaluate the ability of ClO2 to decontaminate pathogens known to cause healthcare-associated infections in a hospital room strains of Acinetobacter baumannii, Escherichia coli, Enterococcus faecalis, Mycobacterium smegmatis, and Staphylococcus aureus were spot placed in duplicate pairs at 10 sites throughout a hospital room and then exposed to ClO2 gas. Organisms were collected and evaluated for reduction in colony forming units following gas exposure. Six sterilization cycles with varied gas concentrations, exposure limits, and relative humidity levels were conducted. Reductions in viable organisms achieved ranged from 7 to 10-log reductions. Two sterilization cycles failed to produce complete inactivation of organisms placed in a bathroom with the door closed. Reductions of organisms in the bathroom ranged from 6-log to 10-log reductions. Gas leakage between hospital floors did not occur; however, some minor gas leakage from the door of hospital room was measured which was subsequently sealed to prevent further leakage. Novel technologies for disinfection of hospital rooms require validation and safety testing in clinical environments. Gaseous ClO2 is effective for sterilizing environmental contamination in a hospital room. Concentrations of ClO2 up to 385 ppm were safely maintained in a hospital room with enhanced environmental controls. PMID:23792697

  1. Evaluation of a pulsed xenon ultraviolet light device for isolation room disinfection in a United Kingdom hospital.

    Science.gov (United States)

    Hosein, Ian; Madeloso, Rosie; Nagaratnam, Wijayaratnam; Villamaria, Frank; Stock, Eileen; Jinadatha, Chetan

    2016-09-01

    Pathogen transmission from contaminated surfaces can cause hospital-associated infections. Although pulsed xenon ultraviolet (PX-UV) light devices have been shown to decrease hospital room bioburden in the United States, their effectiveness in United Kingdom (UK) hospitals is less understood. Forty isolation rooms at the Queens Hospital (700 beds) in North London, UK, were sampled for aerobic bacteria after patient discharge, after manual cleaning with a hypochlorous acid-troclosene sodium solution, and after PX-UV disinfection. PX-UV device efficacy on known organisms was tested by exposing inoculated agar plates in a nonpatient care area. Turnaround times for device usage were recorded, and a survey of hospital staff for perceptions of the device was undertaken. After PX-UV disinfection, the bacterial contamination measured in colony forming units (CFU) decreased by 78.4%, a 91% reduction from initial bioburden levels prior to terminal cleaning. PX-UV exposure resulted in a 5-log CFU reduction for multidrug-resistant organisms (MDROs) on spiked plates. The average device turnaround time was 1 hour, with minimal impact on patient throughput. Ward staff were enthusiastic about device deployment, and device operators reported physical comfort in usage. PX-UV use decreased bioburden in patient discharge rooms and on agar plates spiked with MDROs. The implementation of the PX-UV device was well received by hospital cleaning and ward staff, with minimal disruption to patient flow. Copyright © 2016 Association for Professionals in Infection Control and Epidemiology, Inc. All rights reserved.

  2. Equipment-related incidents in the operating room: an analysis of occurrence, underlying causes and consequences for the clinical process

    NARCIS (Netherlands)

    Wubben, I.; van Manen, Jeanette Gabrielle; van den Akker, B.J.; Vaartjes, S.R.; van Harten, Willem H.

    2010-01-01

    Background: Equipment-related incidents in the operating room (OR) can affect quality of care. In this study, the authors determined the occurrence and effects on the care process in a large teaching hospital. - Methods: During a 4-week period, OR nurses reported equipment-related incidents during

  3. Stress reducing effects of real and artificial nature in a hospital waiting room

    NARCIS (Netherlands)

    Beukeboom, C.J.; Langeveld, D.; Tanja-Dijkstra, K.

    2012-01-01

    Objectives: This field study investigated the potential stress-reducing effects of exposure to real or artificial nature on patients in a hospital waiting room. Additionally, it was investigated whether perceived attractiveness of the room could explain these effects. Design: In this

  4. Gender, patient comfort and the neurosurgical operating room.

    Science.gov (United States)

    Zener, Rebecca; Bernstein, Mark

    2011-01-01

    Neurosurgical patients may be unaware of components of their intra-operative care. The relationship between patient gender and comfort level in the neurosurgical operating room (OR) has not been previously studied. Our objective was to gain insight into patients' perspective of the OR environment, including staffing and observers, the role of medical students, catheterization, exposure, and verbiage, using a qualitative needs assessment. Face-to-face semi-structured interviews were conducted with 20 patients (14 female, six male) who had a neurosurgical operation under general anesthetic within the previous two years. The majority underwent craniotomy for benign tumours. Interviews were transcribed and subjected to modified thematic analysis. Nine themes emerged: 1) perception of the intra-operative environment varies between men and women; 2) lacking awareness about observers is anxiety-provoking for women; 3) being unaware of the hands-on involvement of students is a concern for all patients; 4) disclosure of implantation of foreign and permanent materials into patients is important; 5) catheterization is anxiety provoking for women; 6) pre-operative menstruation screening may minimize embarrassment for women; 7) patients perceive extraneous conversation as a distraction for surgeons; 8) patients trust their surgeon; 9) a relationship exists between interviewer gender and patient comfort in the interview. Although most male and female patients are unaware of OR activities, they are generally not fearful since they trust their surgeon. Women appear to have greater information needs. Patients' information needs must be met without provoking anxiety and yet preserving their personal sense of modesty in the intra-operative environment.

  5. To the point: teaching the obstetrics and gynecology medical student in the operating room.

    Science.gov (United States)

    Hampton, Brittany S; Craig, LaTasha B; Abbott, Jodi F; Buery-Joyner, Samantha D; Dalrymple, John L; Forstein, David A; Hopkins, Laura; McKenzie, Margaret L; Page-Ramsey, Sarah M; Pradhan, Archana; Wolf, Abigail; Graziano, Scott C

    2015-10-01

    This article, from the "To the Point" series that is prepared by the Association of Professors of Gynecology and Obstetrics Undergraduate Medical Education Committee, is a review of considerations for teaching the medical student in the operating room during the obstetrics/gynecology clerkship. The importance of the medical student operating room experience and barriers to learning in the operating room are discussed. Specific considerations for the improvement of medical student learning and operating room experience, which include the development of operating room objectives and specific curricula, an increasing awareness regarding role modeling, and faculty development, are reviewed.

  6. Building a Smooth Medical Service for Operating Room Using RFID Technologies

    Directory of Open Access Journals (Sweden)

    Lun-Ping Hung

    2014-01-01

    Full Text Available Due to the information technology advancement, the feasibility for the establishment of mobile medical environments has been strengthened. Using RFID to facilitate the tracing of patients’ mobile position in hospital has attracted more attentions from researchers due to the demand on advanced features. Traditionally, the management of surgical treatment is generally manually operated and there is no consistent operating procedure for patients transferring among wards, surgery waiting rooms, operating rooms, and recovery rooms, resulting in panicky and urgent transferring work among departments and, thus, leading to delays and errors. In this paper, we propose a new framework using radio frequency identification (RFID technology for a mobilized surgical process monitoring system. Through the active tag, an application management system used before, during, and after the surgical processes has been proposed. The concept of signal level matrix, SLM, was proposed to accurately identify patients and dynamically track patients’ location. By updating patient’s information real-time, the preprocessing time needed for various tasks and incomplete transfers among departments can be reduced, the medical resources can be effectively used, unnecessary medical disputes can be reduced, and more comprehensive health care environment can be provided. The feasibility and effectiveness of our proposed system are demonstrated with a number of experimental results.

  7. The operating room case-mix problem under uncertainty and nurses capacity constraints.

    Science.gov (United States)

    Yahia, Zakaria; Eltawil, Amr B; Harraz, Nermine A

    2016-12-01

    Surgery is one of the key functions in hospitals; it generates significant revenue and admissions to hospitals. In this paper we address the decision of choosing a case-mix for a surgery department. The objective of this study is to generate an optimal case-mix plan of surgery patients with uncertain surgery operations, which includes uncertainty in surgery durations, length of stay, surgery demand and the availability of nurses. In order to obtain an optimal case-mix plan, a stochastic optimization model is proposed and the sample average approximation method is applied. The proposed model is used to determine the number of surgery cases to be weekly served, the amount of operating rooms' time dedicated to each specialty and the number of ward beds dedicated to each specialty. The optimal case-mix selection criterion is based upon a weighted score taking into account both the waiting list and the historical demand of each patient category. The score aims to maximizing the service level of the operating rooms by increasing the total number of surgery cases that could be served. A computational experiment is presented to demonstrate the performance of the proposed method. The results show that the stochastic model solution outperforms the expected value problem solution. Additional analysis is conducted to study the effect of varying the number of ORs and nurses capacity on the overall ORs' performance.

  8. A comprehensive operating room information system using the Kinect sensors and RFID.

    Science.gov (United States)

    Nouei, Mahyar Taghizadeh; Kamyad, Ali Vahidian; Soroush, Ahmad Reza; Ghazalbash, Somayeh

    2015-04-01

    Occasionally, surgeons do need various types of information to be available rapidly, efficiently and safely during surgical procedures. Meanwhile, they need to free up hands throughout the surgery to necessarily access the mouse to control any application in the sterility mode. In addition, they are required to record audio as well as video files, and enter and save some data. This is an attempt to develop a comprehensive operating room information system called "Medinav" to tackle all mentioned issues. An integrated and comprehensive operating room information system is introduced to be compatible with Health Level 7 (HL7) and digital imaging and communications in medicine (DICOM). DICOM is a standard for handling, storing, printing, and transmitting information in medical imaging. Besides, a natural user interface (NUI) is designed specifically for operating rooms where touch-less interactions with finger and hand tracking are in use. Further, the system could both record procedural data automatically, and view acquired information from multiple perspectives graphically. A prototype system is tested in a live operating room environment at an Iranian teaching hospital. There are also contextual interviews and usability satisfaction questionnaires conducted with the "MediNav" system to investigate how useful the proposed system could be. The results reveal that integration of these systems into a complete solution is the key to not only stream up data and workflow but maximize surgical team usefulness as well. It is now possible to comprehensively collect and visualize medical information, and access a management tool with a touch-less NUI in a rather quick, practical, and harmless manner.

  9. Application of Digital Operating Room%浅谈数字化手术室的应用

    Institute of Scientific and Technical Information of China (English)

    韩雪峰; 雍维林

    2012-01-01

    介绍了数字化手术室的概念和具体功能,分析了数字化手术室在安全的手术环境、医院系统集成、教学及学术交流等方面的应用,并从提升医疗安全和质量、提高工作效率、监控医疗过程、提高医院信息化管理水平等方面详细阐述了数字化手术室应用效果,指出了数字化手术室是医院数字化建设的重要组成部分,为医院带来直接的经济效益和社会效益,提高了医院的核心竞争力,是医院数字化的必然趋势.%Hie concept and specific functions of digital operating room are introduced, and the application of digital operating room in safe operation environment, hospital system integration, teaching and academic exchanges is analyzed. The application effect of digital operating room is expounded from upgrading medical security and quality, improving work efficiency, monitoring medical process, and heightening hospital information management level, etc. It is pointed out that the digital operating room is an important part for the construction of digital hospital, which can bring direct economic and social benefits for hospital, enhance the core competitiveness of hospital, and is the inevitable trend of digital hospital. [Chinese Medical Equipment Journal,2012,33(4):101-103

  10. Flexibility in hospital building and application by means of standardized medical room types

    NARCIS (Netherlands)

    Kamp, P.G.; Kooistra, R.L.; Ankersmid, H.A.H.G.; Bonnema, G.M.

    2014-01-01

    This paper presents an approach to standardization of hospital rooms. As hospitals are becoming more complex, the need for quality assurance and validation increases as well. Several sources mention the responsibility of the medical personnel for the quality and safety of the equipment with which pa

  11. Application of special instruments and apparatus of using video in the hospital operating room training%特殊仪器和器械使用视频在专科医院手术室培训中的应用

    Institute of Scientific and Technical Information of China (English)

    唐亚萍; 尤卫红; 何妙东

    2015-01-01

    Objective:To explore the effect of special instruments and apparatus training video used in the hospital operating room. Methods:To surveyed of hospital operating room instruments and equipment usage,according to specialized features identified 15 projects and made into a video,theatre nurses and nursing students for training and learning,To compare the test questions,operation exam and doctor's satisfaction before and after training for nurses and nursing students. Results:After training,the question test,examination results and doctor's satisfaction was higher than before,the difference was statistically significant (P<0. 05). Conclusion:Using special devices and equipment used to record videos for training for new employees and interns and nurses in the operations review and learning can improve nurses perception of special devices and equipment,better with surgery,operational capacity and to improve their own qualities.%目的:探讨在专科医院中对特殊仪器和器械使用视频进行手术室培训的应用效果. 方法:2013年1~12月调查我院手术室的仪器和器械使用情况,根据专科特点确定15项操作项目,并制作成视频,对手术室护士和实习护生进行培训和学习. 比较培训前后护士和实习护生的提问测试及操作考核成绩和医师的满意度. 结果:手术室护士和实习护生使用视频培训学习后,提问测试和操作考核成绩、医师满意度均高于培训前,差异有统计学意义(P<0. 05). 结论:将特殊仪器和器械使用录制成视频用于对新员工和实习生的培训教学及手术室护士的操作复习和学习,能提高护士对特殊仪器和器械的认知程度,更好地配合手术,提高业务能力和自身综合素质.

  12. Surgical team turnover and operative time: An evaluation of operating room efficiency during pulmonary resection.

    Science.gov (United States)

    Azzi, Alain Joe; Shah, Karan; Seely, Andrew; Villeneuve, James Patrick; Sundaresan, Sudhir R; Shamji, Farid M; Maziak, Donna E; Gilbert, Sebastien

    2016-05-01

    Health care resources are costly and should be used judiciously and efficiently. Predicting the duration of surgical procedures is key to optimizing operating room resources. Our objective was to identify factors influencing operative time, particularly surgical team turnover. We performed a single-institution, retrospective review of lobectomy operations. Univariate and multivariate analyses were performed to evaluate the impact of different factors on surgical time (skin-to-skin) and total procedure time. Staff turnover within the nursing component of the surgical team was defined as the number of instances any nurse had to leave the operating room over the total number of nurses involved in the operation. A total of 235 lobectomies were performed by 5 surgeons, most commonly for lung cancer (95%). On multivariate analysis, percent forced expiratory volume in 1 second, surgical approach, and lesion size had a significant effect on surgical time. Nursing turnover was associated with a significant increase in surgical time (53.7 minutes; 95% confidence interval, 6.4-101; P = .026) and total procedure time (83.2 minutes; 95% confidence interval, 30.1-136.2; P = .002). Active management of surgical team turnover may be an opportunity to improve operating room efficiency when the surgical team is engaged in a major pulmonary resection. Copyright © 2016 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

  13. Identifying Patients with Bacteremia in Community-Hospital Emergency Rooms: A Retrospective Cohort Study.

    Science.gov (United States)

    Takeshima, Taro; Yamamoto, Yosuke; Noguchi, Yoshinori; Maki, Nobuyuki; Gibo, Koichiro; Tsugihashi, Yukio; Doi, Asako; Fukuma, Shingo; Yamazaki, Shin; Kajii, Eiji; Fukuhara, Shunichi

    2016-01-01

    (1) To develop a clinical prediction rule to identify patients with bacteremia, using only information that is readily available in the emergency room (ER) of community hospitals, and (2) to test the validity of that rule with a separate, independent set of data. Multicenter retrospective cohort study. To derive the clinical prediction rule we used data from 3 community hospitals in Japan (derivation). We tested the rule using data from one other community hospital (validation), which was not among the three "derivation" hospitals. Adults (age ≥ 16 years old) who had undergone blood-culture testing while in the ER between April 2011 and March 2012. For the derivation data, n = 1515 (randomly sampled from 7026 patients), and for the validation data n = 467 (from 823 patients). We analyzed 28 candidate predictors of bacteremia, including demographic data, signs and symptoms, comorbid conditions, and basic laboratory data. Chi-square tests and multiple logistic regression were used to derive an integer risk score (the "ID-BactER" score). Sensitivity, specificity, likelihood ratios, and the area under the receiver operating characteristic curve (i.e., the AUC) were computed. There were 241 cases of bacteremia in the derivation data. Eleven candidate predictors were used in the ID-BactER score: age, chills, vomiting, mental status, temperature, systolic blood pressure, abdominal sign, white blood-cell count, platelets, blood urea nitrogen, and C-reactive protein. The AUCs was 0.80 (derivation) and 0.74 (validation). For ID-BactER scores ≥ 2, the sensitivities for derivation and validation data were 98% and 97%, and specificities were 20% and 14%, respectively. The ID-BactER score can be computed from information that is readily available in the ERs of community hospitals. Future studies should focus on developing a score with a higher specificity while maintaining the desired sensitivity.

  14. Identifying Patients with Bacteremia in Community-Hospital Emergency Rooms: A Retrospective Cohort Study.

    Directory of Open Access Journals (Sweden)

    Taro Takeshima

    Full Text Available (1 To develop a clinical prediction rule to identify patients with bacteremia, using only information that is readily available in the emergency room (ER of community hospitals, and (2 to test the validity of that rule with a separate, independent set of data.Multicenter retrospective cohort study.To derive the clinical prediction rule we used data from 3 community hospitals in Japan (derivation. We tested the rule using data from one other community hospital (validation, which was not among the three "derivation" hospitals.Adults (age ≥ 16 years old who had undergone blood-culture testing while in the ER between April 2011 and March 2012. For the derivation data, n = 1515 (randomly sampled from 7026 patients, and for the validation data n = 467 (from 823 patients.We analyzed 28 candidate predictors of bacteremia, including demographic data, signs and symptoms, comorbid conditions, and basic laboratory data. Chi-square tests and multiple logistic regression were used to derive an integer risk score (the "ID-BactER" score. Sensitivity, specificity, likelihood ratios, and the area under the receiver operating characteristic curve (i.e., the AUC were computed.There were 241 cases of bacteremia in the derivation data. Eleven candidate predictors were used in the ID-BactER score: age, chills, vomiting, mental status, temperature, systolic blood pressure, abdominal sign, white blood-cell count, platelets, blood urea nitrogen, and C-reactive protein. The AUCs was 0.80 (derivation and 0.74 (validation. For ID-BactER scores ≥ 2, the sensitivities for derivation and validation data were 98% and 97%, and specificities were 20% and 14%, respectively.The ID-BactER score can be computed from information that is readily available in the ERs of community hospitals. Future studies should focus on developing a score with a higher specificity while maintaining the desired sensitivity.

  15. Mission Operations Control Room Activities during STS-2 mission

    Science.gov (United States)

    1981-01-01

    Mission Operations Control Room (MOCR) activities during STS-2 mission. Overall view of the MOCR in the Johnson Space Center's Mission Control Center. At far right is Eugene F. Kranz, Deputy Director of Flight Operations. At the flight director console in front of Kranz's FOD console are Flight Directors M.P. Frank, Neil B. Hutchinson and Donald R. Puddy as well as others (39506); Wide-angle view of flight controllers in the MOCR. Clifford E. Charlesworth, JSC Deputy Director, huddles with several flight directors for STS-2 at the flight director console. Kranz, is at far right of frame (39507); Dr. Christopher C. Kraft, Jr., JSC Director, center, celebrates successful flight and landing of STS-2 with a cigar in the MOCR. He is flanked by Dr. Maxime A Faget, left, Director of Engineering and Development, and Thomas L. Moser, of the Structures and Mechanics Division (39508); Flight Director Donald R. Puddy, near right, holds replica of the STS-2 insignia. Insignias on the opposite wall

  16. OR.NET: multi-perspective qualitative evaluation of an integrated operating room based on IEEE 11073 SDC.

    Science.gov (United States)

    Rockstroh, M; Franke, S; Hofer, M; Will, A; Kasparick, M; Andersen, B; Neumuth, T

    2017-08-01

    Clinical working environments have become very complex imposing many different tasks in diagnosis, medical treatment, and care procedures. During the German flagship project OR.NET, more than 50 partners developed technologies for an open integration of medical devices and IT systems in the operating room. The aim of the present work was to evaluate a large set of the proposed concepts from the perspectives of various stakeholders. The demonstration OR is focused on interventions from the head and neck surgery and was developed in close cooperation with surgeons and numerous colleagues of the project partners. The demonstration OR was qualitatively evaluated including technical as well as clinical aspects. In the evaluation, a questionnaire was used to obtain feedback from hospital operators. The clinical implications were covered by structured interviews with surgeons, anesthesiologists and OR staff. In the present work, we qualitatively evaluate a subset of the proposed concepts from the perspectives of various stakeholders. The feedback of the clinicians indicates that there is a need for a flexible data and control integration. The hospital operators stress the need for tools to simplify risk management in openly integrated operating rooms. The implementation of openly integrated operating rooms will positively affect the surgeons, the anesthesiologists, the surgical nursing staff, as well as the technical personnel and the hospital operators. The evaluation demonstrated the need for OR integration technologies and identified the missing tools to support risk management and approval as the main barriers for future installments.

  17. Improved scores for observed teamwork in the clinical environment following a multidisciplinary operating room simulation intervention.

    Science.gov (United States)

    Weller, Jennifer M; Cumin, David; Civil, Ian D; Torrie, Jane; Garden, Alexander; MacCormick, Andrew D; Gurusinghe, Nishanthi; Boyd, Matthew J; Frampton, Christopher; Cokorilo, Martina; Tranvik, Magnus; Carlsson, Lisa; Lee, Tracey; Ng, Wai Leap; Crossan, Michael; Merry, Alan F

    2016-08-05

    We ran a Multidisciplinary Operating Room Simulation (MORSim) course for 20 complete general surgical teams from two large metropolitan hospitals. Our goal was to improve teamwork and communication in the operating room (OR). We hypothesised that scores for teamwork and communication in the OR would improve back in the workplace following MORSim. We used an extended Behavioural Marker Risk Index (BMRI) to measure teamwork and communication, because a relationship has previously been documented between BMRI scores and surgical patient outcomes. Trained observers scored general surgical teams in the OR at the two study hospitals before and after MORSim, using the BMRI. Analysis of BMRI scores for the 224 general surgical cases before and 213 cases after MORSim showed BMRI scores improved by more than 20% (0.41 v 0.32, pteamwork score would translate into a clinically important reduction in complications and mortality in surgical patients. We demonstrated an improvement in scores for teamwork and communication in general surgical ORs following our intervention. These results support the use of simulation-based multidisciplinary team training for OR staff to promote better teamwork and communication, and potentially improve outcomes for general surgical patients.

  18. Association Between Surgeon Scorecard Use and Operating Room Costs.

    Science.gov (United States)

    Zygourakis, Corinna C; Valencia, Victoria; Moriates, Christopher; Boscardin, Christy K; Catschegn, Sereina; Rajkomar, Alvin; Bozic, Kevin J; Soo Hoo, Kent; Goldberg, Andrew N; Pitts, Lawrence; Lawton, Michael T; Dudley, R Adams; Gonzales, Ralph

    2017-03-01

    Despite the significant contribution of surgical spending to health care costs, most surgeons are unaware of their operating room costs. To examine the association between providing surgeons with individualized cost feedback and surgical supply costs in the operating room. The OR Surgical Cost Reduction (OR SCORE) project was a single-health system, multihospital, multidepartmental prospective controlled study in an urban academic setting. Intervention participants were attending surgeons in orthopedic surgery, otolaryngology-head and neck surgery, and neurological surgery (n = 63). Control participants were attending surgeons in cardiothoracic surgery, general surgery, vascular surgery, pediatric surgery, obstetrics/gynecology, ophthalmology, and urology (n = 186). From January 1 to December 31, 2015, each surgeon in the intervention group received standardized monthly scorecards showing the median surgical supply direct cost for each procedure type performed in the prior month compared with the surgeon's baseline (July 1, 2012, to November 30, 2014) and compared with all surgeons at the institution performing the same procedure at baseline. All surgical departments were eligible for a financial incentive if they met a 5% cost reduction goal. The primary outcome was each group's median surgical supply cost per case. Secondary outcome measures included total departmental surgical supply costs, case mix index-adjusted median surgical supply costs, patient outcomes (30-day readmission, 30-day mortality, and discharge status), and surgeon responses to a postintervention study-specific health care value survey. The median surgical supply direct costs per case decreased 6.54% in the intervention group, from $1398 (interquartile range [IQR], $316-$5181) (10 637 cases) in 2014 to $1307 (IQR, $319-$5037) (11 820 cases) in 2015. In contrast, the median surgical supply direct cost increased 7.42% in the control group, from $712 (IQR, $202-$1602) (16 441 cases

  19. Key facilitators and best practices of hotel-style room service in hospitals.

    Science.gov (United States)

    Sheehan-Smith, Lisa

    2006-04-01

    This qualitative study sought to identify the features, advantages, and disadvantages of hotel-style room service; the barriers to, and facilitators for, implementing the process; and "best practices." The study took place in four heterogeneous hospitals. Participants included hospital administrators, managers, and room-service employees. Data-collection methods included semi-structured interviews, observations, and document analysis. Common features of hotel-style room service were meal delivery within 30 to 45 minutes, a restaurant-style menu, procedures to feed ineligible patients, tray assembly on demand, scripting, and waitstaff uniforms for room-service employees. The major barrier to implementing room service was obtaining nursing support. The key facilitators were the hospital's service-oriented culture, using a multidisciplinary planning team, engaging nursing departments early in the planning stages, and intense customer-service training of room-service employees. The overwhelming advantage was patients' control over their food choices. The main disadvantage was cost. Initial best practices in hotel-style room service include: (a) taking a multidisciplinary team approach for developing and implementing the process, (b) customer-service training, (c) using a customer-driven menu, (d) wearing waitstaff uniforms, and (e) using carts with airpots for dispensing hot beverages.

  20. POST OPERATIVE PROBLEMS IN ORTOPEDICS PATIENTS IN THE RECOVERY ROOM

    Directory of Open Access Journals (Sweden)

    Regiane Aparecida dos Santos Soares Barreto

    2002-12-01

    Full Text Available This study aimed at providing related problems in patients who had undergone orthopedic surgery through theevaluation of the following variables: sex, age, surgery type and anesthesia type. Two hundred and twenty patientswere studied. They had been submitted to an elective orthopedic surgical procedure from July to December 1998and their medical records were used for retrospective data collection. With regard to sex, 58% were males and42% were females. As to age, middle-aged patients - 35 to 65 years old - comprised 48%, young adults - 18 to 35years old - were 38% and elderly adults - over 66 years old - were 14%. The frequency of results were as follows:surgery on the upper limbs/shoulder, 27%, knee/leg, 32%, spinal cord, 17%, femur/hips, 15%, ankle/foot, 9%,regional anesthesia, 48%, general anesthesia, 38%, regional associated with general, 6% and blocking, 8%.Occurred 306 post-operative problems were observed as follows: pain, 45%, nausea/vomiting, 16%, blooding,11%, cardiovascular alterations, 10%, hypothermia, 9%, urinary retention, 5%, respiratory problems, 1% andhiperthermia, 0,6%. In this way, there was an attempt at making a profile of orthopedic surgery patients in POI as asource of data for planning nursing care. It is believed that the study has contributed to nursing care in postanesthesiarecovery room which is based on scientific data and not only on every-day practice.

  1. Decision support system for the operating room rescheduling problem.

    Science.gov (United States)

    van Essen, J Theresia; Hurink, Johann L; Hartholt, Woutske; van den Akker, Bernd J

    2012-12-01

    Due to surgery duration variability and arrivals of emergency surgeries, the planned Operating Room (OR) schedule is disrupted throughout the day which may lead to a change in the start time of the elective surgeries. These changes may result in undesirable situations for patients, wards or other involved departments, and therefore, the OR schedule has to be adjusted. In this paper, we develop a decision support system (DSS) which assists the OR manager in this decision by providing the three best adjusted OR schedules. The system considers the preferences of all involved stakeholders and only evaluates the OR schedules that satisfy the imposed resource constraints. The decision rules used for this system are based on a thorough analysis of the OR rescheduling problem. We model this problem as an Integer Linear Program (ILP) which objective is to minimize the deviation from the preferences of the considered stakeholders. By applying this ILP to instances from practice, we determined that the given preferences mainly lead to (i) shifting a surgery and (ii) scheduling a break between two surgeries. By using these changes in the DSS, the performed simulation study shows that less surgeries are canceled and patients and wards are more satisfied, but also that the perceived workload of several departments increases to compensate this. The system can also be used to judge the acceptability of a proposed initial OR schedule.

  2. Technologies and solutions for data display in the operating room.

    Science.gov (United States)

    Bitterman, Noemi

    2006-06-01

    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.

  3. The operating room: architectural conditions and potential hazards.

    Science.gov (United States)

    Koneczny, Sonja

    2009-01-01

    Ergonomics is still not fully implemented in the design of operation rooms (ORs). The OR staff has to deal with various ergonomic deficiencies which may be associated with potential hazards for the patient and/or the OR team.Three surveys were conducted among German OR staff at major conferences. Two of them dealt with the working conditions in the OR and were conducted among surgeons and OR nurses. The third survey queried OR nurses about the electrical safety in the OR.In addition, a specially developed checklist was used to evaluate the work place OR in five German OR units and the staff of these OR units were queried with questionnaires adapted from the surveys. For this article a few of the deficiencies found in the ORs were chosen to serve as examples for the plethora of results gathered.Findings showed that there was a high potential for ergonomic improvement and therefore an increase in safety and comfort. Many of these deficiencies may be eased by simple means such as the reduction of the number of different devices and mandatory training in the use of the devices since device operation is one of the main causes leading to potential hazards in the OR. Other deficiencies, such as the cable routing in the OR, require more extensive intervention and/or the implementation of new techniques, for example the "wireless" OR. All these deficiencies demonstrate the need for better implementation of ergonomics into the OR and for individual solutions, as there is no such thing as an 'one-size-fits-all' solution for OR units.

  4. Changing Operating Room Culture: Implementation of a Post-Operative Debrief and Improved Safety Culture.

    Science.gov (United States)

    Magill, Stephen T; Wang, Doris D; Rutledge, W Caleb; Lau, Darryl; Berger, Mitchel S; Sankaran, Sujatha; Lau, Catherine Y; Imershein, Sarah G

    2017-08-23

    Patient safety is foundational to neurosurgical care. Post-procedural "debrief" checklists have been proposed to improve patient safety, but there is limited data about their use in neurosurgery. Here, we implemented an initiative to routinely perform post-operative debriefs and evaluated the impact of debriefing on operating room (OR) safety culture. A 10-question safety attitude questionnaire (SAQ) was sent to neurosurgical operating room staff at a major academic medical center before and 18-months after implementation of a post-operative debriefing initiative. Rates of debrief compliance and changes in attitudes before and after the survey were evaluated. The survey utilized a Likert scale and analyzed with standard statistical methods. After the debrief initiative, the rate of debriefing increased from 51% to 86% of cases for the neurosurgery service. Baseline SAQ responses found that neurosurgeons had a more favorable perception of OR safety than anesthesiologists and nurses. Following implementation of the post-operative debriefing process, perceptions of OR safety significantly improved for neurosurgeons, anesthesiologists and nurses. Furthermore, the disparity between nurses and surgeons was no longer significant. After debrief implementation, neurosurgical OR staff had improved perceptions of patient safety compared to surgical services that did not commonly perform debriefing. Debriefing identified OR efficiency concerns in 26.9% of cases and prevention of potential adverse events/near misses were reported in 8% of cases. Post-operative debriefing can be effectively introduced into the operating room and improves the safety culture after implementation. Debriefing is an effective tool to identify OR inefficiencies and potential adverse events. Copyright © 2017 Elsevier Inc. All rights reserved.

  5. Evaluation of the Beneficial Effects of rooming-in care, in icteric hospitalized neonates

    Directory of Open Access Journals (Sweden)

    Mohammad Kazemian

    2016-12-01

    Full Text Available Background: Rooming-in, motivated by World Health Organization (WHO strategies and baby-friendly hospital policies, is a practice followed in many maternity hospitals of Iran. Mother-infant dyad may easily be damaged by the separation caused by medical and surgical problems, which result in hospital stay. Regarding this, the aim of this study was to investigate the effects of the rooming-in practice in icteric newborns admitted to Mofid Children's Hospital of Tehran, Iran. Methods: This study was conducted on 220 neonates admitted to Mofid Children's Hospital with the complaint of jaundice. Out of the 220 newborns, 124 cases were assigned into the intervention group (the rooming-in care and 96 neonates were categorized into the control group (the routine-care. The two groups were compared in terms of the length of hospital stay, maternal satisfaction, nursing care time, and hospital stay complications. The data were collected by some trained mid-wives using a validated questionnaire. Data analysis was performed using paired sample t-test through SPSS version 16. Results: According to the results of the study, about 55% of the neonates were male. The neonatal mean ages of the intervention and control groups were 6.6 ±3.7 and 7 ± 3.8 days, respectively. Maternal satisfaction with neonatal care and maternal comfort during hospital stay were significantly higher in the intervention group (P=0.027. Furthermore, the two groups had no significant difference regarding the complications of hospital stay (P=0.655. Conclusion: As the findings of the present study demonstrated, in spite of the similarities of the health issues, nursery essentials, and hospital stay complications between the two groups, the rooming-in was more favorable according to the mothers’ viewpoints.

  6. A survey of static and dynamic work postures of operating room staff.

    Science.gov (United States)

    Kant, I J; de Jong, L C; van Rijssen-Moll, M; Borm, P J

    1992-01-01

    Work in health care units is associated with considerable physical strain and many musculoskeletal complaints. Most investigations have concentrated on the work of general hospital nurses; little is known about the physical stress load on other health care workers. We therefore carried out an ergonomic study amongst operating room staff in order to (i) determine the work (posture) stress load on this particular group of health care workers and the effect of static posture on this stress, (ii) identify activities involving poor work postures, and (iii) determine differences between specialties in regard to work posture stress load. The work postures and related work activities of four different groups of staff in operating rooms (surgeons, assistant anaesthesists, instrumentation nurses and circulating nurses) were recorded and evaluated using the specified Ovako Working posture Analysing System (OWAS). Observation during the course of 18 daily surgical programmes (total number of observations: 3714) in the specialties general surgery and ear-nose-throat (ENT) surgery revealed that the work-load according to OWAS for circulating nurses and assistant anaesthesists was not harmful. Some work postures seen among instrumentation nurses and surgeons, however, need improvement. The work posture stress load in these groups is mainly due to the high prevalence of static work postures during the activities "surgery" (surgeons) and "assisting surgery" (instrumentation nurses). Significant differences in ergonomic stress load were observed between general surgeons and ENT surgeons. This survey in operating theatres relates work postures to basic activities and can be used as a starting point from which to improve work conditions in order to reduce or eliminate physical complaints among operating room staff.

  7. [Intelligent operating room suite : From passive medical devices to the self-thinking cognitive surgical assistant].

    Science.gov (United States)

    Kenngott, H G; Wagner, M; Preukschas, A A; Müller-Stich, B P

    2016-12-01

    Modern operating room (OR) suites are mostly digitally connected but until now the primary focus was on the presentation, transfer and distribution of images. Device information and processes within the operating theaters are barely considered. Cognitive assistance systems have triggered a fundamental rethinking in the automotive industry as well as in logistics. In principle, tasks in the OR, some of which are highly repetitive, also have great potential to be supported by automated cognitive assistance via a self-thinking system. This includes the coordination of the entire workflow in the perioperative process in both the operating theater and the whole hospital. With corresponding data from hospital information systems, medical devices and appropriate models of the surgical process, intelligent systems could optimize the workflow in the operating theater in the near future and support the surgeon. Preliminary results on the use of device information and automatically controlled OR suites are already available. Such systems include, for example the guidance of laparoscopic camera systems. Nevertheless, cognitive assistance systems that make use of knowledge about patients, processes and other pieces of information to improve surgical treatment are not yet available in the clinical routine but are urgently needed in order to automatically assist the surgeon in situation-related activities and thus substantially improve patient care.

  8. Operating Room Efficiency before and after Entrance in a Benchmarking Program for Surgical Process Data.

    Science.gov (United States)

    Pedron, Sara; Winter, Vera; Oppel, Eva-Maria; Bialas, Enno

    2017-08-23

    Operating room (OR) efficiency continues to be a high priority for hospitals. In this context the concept of benchmarking has gained increasing importance as a means to improve OR performance. The aim of this study was to investigate whether and how participation in a benchmarking and reporting program for surgical process data was associated with a change in OR efficiency, measured through raw utilization, turnover times, and first-case tardiness. The main analysis is based on panel data from 202 surgical departments in German hospitals, which were derived from the largest database for surgical process data in Germany. Panel regression modelling was applied. Results revealed no clear and univocal trend of participation in a benchmarking and reporting program for surgical process data. The largest trend was observed for first-case tardiness. In contrast to expectations, turnover times showed a generally increasing trend during participation. For raw utilization no clear and statistically significant trend could be evidenced. Subgroup analyses revealed differences in effects across different hospital types and department specialties. Participation in a benchmarking and reporting program and thus the availability of reliable, timely and detailed analysis tools to support the OR management seemed to be correlated especially with an increase in the timeliness of staff members regarding first-case starts. The increasing trend in turnover time revealed the absence of effective strategies to improve this aspect of OR efficiency in German hospitals and could have meaningful consequences for the medium- and long-run capacity planning in the OR.

  9. Laparoscopy Using Room Air Insufflation in a Rural African Jungle Hospital: The Bongolo Hospital Experience, January 2006 to December 2013.

    Science.gov (United States)

    O'Connor, Zachary; Faniriko, Marco; Thelander, Keir; O'Connor, Jennifer; Thompson, David; Park, Adrian

    2017-06-01

    Carbon dioxide is the standard insufflation gas for laparoscopy. However, in many areas of the world, bottled carbon dioxide is not available. Laparoscopy offers advantages over open surgery and has been practiced using filtered room air insufflation since 2006 at Bongolo Hospital in Gabon, Africa. Our primary goal was to evaluate the safety of room air insufflation related to intraoperative and postoperative complications. Our secondary aim was to review the types of cases performed laparoscopically at our institution. This retrospective review evaluates laparoscopic cases performed at Bongolo Hospital between January 2006 and December 2013. Demographic and perioperative information for patients undergoing laparoscopic procedures was collected. Insufflation was achieved using a standard, oil-free air compressor using filtered air and a standard insufflation regulator. A total of 368 laparoscopic procedures were identified within the time period. The majority of cases were gynecologic (43%). There was a 2% (8/368) complication rate with one perioperative death. The 2 complications related to insufflation were episodes of hypotension responsive to standard corrective measures. No intracorporeal combustion events were observed in any cases in which the use of diathermy and room air insufflation were combined. The other complications and the death were unrelated to the use of insufflation with air. Insufflation complications with room air occurred in our study. However, the complications related to insufflation with room air in our study were no different than those described in the literature using carbon dioxide. As room air is less costly than carbon dioxide and readily available, confirming the safety of room air insufflation in prospective studies is warranted. Room air appears to be safe for establishing and maintaining pneumoperitoneum, making laparoscopic surgery more accessible to patients in low-resource settings.

  10. [Conflict matrix : Risk management tool in the operating room].

    Science.gov (United States)

    Andel, D; Markstaller, K; Andel, H

    2017-05-01

    In business conflicts have long been known to have a negative effect on costs and team performance. In medicine this aspect has been widely neglected, especially when optimizing processes for operating room (OR) management. In the multidisciplinary setting of OR management, shortcomings in rules for decision making and lack of communication result in members perceiving themselves as competitors in the patient's environment rather than acting as art of a multiprofessional team. This inevitably leads to the emergence and escalation of conflicts. We developed a conflict matrix to provide an inexpensive and objective way for evaluating the level of escalation of conflicts in a multiprofessional working environment, such as an OR. The senior members of all involved disciplines were asked to estimate the level of conflict escalation between the individual professional groups on a scale of 0-9. By aggregating the response data, an overview of the conflict matrix within this OR section was created. No feedback was received from 1 of the 11 contacted occupational groups. By color coding the median, minimum and maximum values of the retrieved data, an intuitive overview of the escalation levels of conflict could be provided. The value range of all feedbacks was between 0 and 6. Estimation of the escalation levels differed widely within one category, showing a range of up to 6 (out of 6) levels. The presented assessment using a conflict matrix is a simple and cost-effective method to assess the conflict landscape, especially in multidisciplinary environments, such as OR management. The chance of conflict prevention or the early recognition of existing conflicts represents an enormous potential for cost and risk saving and might have positive long-term effects by building a culture of conflict prevention at the workplace and a positive influence on interdisciplinary cooperation in this working environment.

  11. Operating room waste: disposable supply utilization in neurosurgical procedures.

    Science.gov (United States)

    Zygourakis, Corinna C; Yoon, Seungwon; Valencia, Victoria; Boscardin, Christy; Moriates, Christopher; Gonzales, Ralph; Lawton, Michael T

    2017-02-01

    OBJECTIVE Disposable supplies constitute a large portion of operating room (OR) costs and are often left over at the end of a surgical case. Despite financial and environmental implications of such waste, there has been little evaluation of OR supply utilization. The goal of this study was to quantify the utilization of disposable supplies and the costs associated with opened but unused items (i.e., "waste") in neurosurgical procedures. METHODS Every disposable supply that was unused at the end of surgery was quantified through direct observation of 58 neurosurgical cases at the University of California, San Francisco, in August 2015. Item costs (in US dollars) were determined from the authors' supply catalog, and statistical analyses were performed. RESULTS Across 58 procedures (36 cranial, 22 spinal), the average cost of unused supplies was $653 (range $89-$3640, median $448, interquartile range $230-$810), or 13.1% of total surgical supply cost. Univariate analyses revealed that case type (cranial versus spinal), case category (vascular, tumor, functional, instrumented, and noninstrumented spine), and surgeon were important predictors of the percentage of unused surgical supply cost. Case length and years of surgical training did not affect the percentage of unused supply cost. Accounting for the different case distribution in the 58 selected cases, the authors estimate approximately $968 of OR waste per case, $242,968 per month, and $2.9 million per year, for their neurosurgical department. CONCLUSIONS This study shows a large variation and significant magnitude of OR waste in neurosurgical procedures. At the authors' institution, they recommend price transparency, education about OR waste to surgeons and nurses, preference card reviews, and clarification of supplies that should be opened versus available as needed to reduce waste.

  12. Evaluation on radiation protective effect of mobile C-arm X-ray equipment reconstruction project in operation room in a hospital%某医院手术室移动C臂X线机改建项目的放射防护效果评价

    Institute of Scientific and Technical Information of China (English)

    裴松; 李有军; 杨勇

    2015-01-01

    [Objective] To evaluate the radiation protective effect of mobile C-arm X-ray equipment reconstruction project in operation room in a hospital,ensure the radiological protection facilities meet the national relevant requirements,and protect the safety of medical staff and patients.[Methods] The field investigation and detection were applied in the comprehensive evaluation for the reconstruction project.The x-ray radiation levels of surgical position and surrounding environment (including observation window,operating board,room door,walls and adjacent rooms) were tested.[Results] X-ray radiation dose of surgical position and surrounding environment was 400 μSv/h and 0.07-0.15 μSv/h respectively,which met the Requirements for radiological protection in medical X-ray diagnosis (GBZ 130-2013).[Conclusion] The protective facilities against radiation hazard in this construction project meet the requirements of relevant laws and regulations.%目的 对某医院移动C臂X线机手术室改建项目放射防护效果进行评价,以确保放射防护设施符合国家有关要求,从而保护医护人员和患者的安全.方法 采用现场调查和检测等方法对改建项目进行综合评价.对手术操作位置和观察窗、操作台、机房门、四周墙体、相邻房间等周围环境X线辐射水平进行检测.结果 手术操作位置X射线辐射剂量<400 μSv/h,周围环境辐射剂量范围为0.07~0.15 μSv/h,其结果符合GBZ 130-2013《医用X射线诊断放射防护要求标准》的规定.结论 该建设项目放射危害的防护设施符合相关法律、法规的要求.

  13. Hospital Readmission Following Emergency Room Visit for Cholelithiasis

    Science.gov (United States)

    Williams, Taylor P.; Dimou, Francesca M.; Adhikari, Deepak; Kimbrough, Thomas D.; Riall, Taylor S.

    2015-01-01

    Background For patients presenting with symptomatic cholelithiasis, cholecystectomy is the definitive treatment modality. Our goal was to evaluate the surgical follow-up and outcomes in patients seen in the Emergency Department (ED) for an episode of symptomatic cholelithiasis and discharged home for elective follow-up. Methods We performed a retrospective review of consecutive patients seen in the ED for cholelithiasis and discharged without hospital admission between August 2009 and May 2014. All patients were followed for two years from the date of initial ED visit. We evaluated outpatient surgeon visits, elective and emergent cholecystectomy rates, and additional ED visits. Cumulative incidence and Kaplan-Meier curves were used to examine the time from the initial ED visit to outpatient surgeon evaluation and the time from initial ED visit to ED readmission. Results Seventy-one patients were discharged from the ED with a diagnosis of symptomatic gallstones. 12.6% of patients had an elective cholecystectomy in the two years after the initial visit. In this group, the mean time from the initial ED visit to outpatient surgeon follow-up was 7.7 days and all elective cholecystectomies occurred within one month of the initial visit. Of the 62 patients who did not have an elective cholecystectomy, only 14.5% of patients in this group had outpatient surgeon follow-up at mean time of 137 days from the initial ED visit for symptomatic gallstones. In addition, 37.1% of patients in this group had additional ED visits for gallstone-related symptoms, with 17.7 % of patients having two or more additional ED visits, and 12.9% required emergent/urgent cholecystectomy. 43.5% of additional ED visits occurred within one month and 60.9% within three months of their initial ED visit. In patients with additional ED visits for symptomatic cholelithiasis, 60.9% had more than one abdominal Ultrasound (US) or Computed Tomography (CT) scan during the course of multiple visits. Conclusion

  14. Hospital readmission after emergency room visit for cholelithiasis.

    Science.gov (United States)

    Williams, Taylor P; Dimou, Francesca M; Adhikari, Deepak; Kimbrough, Thomas D; Riall, Taylor S

    2015-08-01

    For patients presenting with symptomatic cholelithiasis, cholecystectomy is the definitive treatment modality. Our goal was to evaluate the surgical follow-up and outcomes in patients seen in the emergency department (ED) for an episode of symptomatic cholelithiasis and discharged home for elective follow-up. We performed a retrospective review of consecutive patients seen in the ED for cholelithiasis and discharged without hospital admission between August 2009 and May 2014. All patients were followed for 2 y from the date of the initial ED visit. We evaluated outpatient surgeon visits, elective and emergent cholecystectomy rates, and additional ED visits. Cumulative incidence and Kaplan-Meier curves were used to examine the time from the initial ED visit to outpatient surgeon evaluation and the time from the initial ED visit to ED readmission. Seventy-one patients were discharged from the ED with a diagnosis of symptomatic gallstones. Patients who had an elective cholecystectomy in the 2 y after the initial visit were 12.6%. In this group, the mean time from the initial ED visit to outpatient surgeon follow-up was 7.7 d, and all elective cholecystectomies occurred within 1 mo of the initial visit. Of the 62 patients who did not have an elective cholecystectomy, only 14.5% of patients in this group had outpatient surgeon follow-up at mean time of 137 d from the initial ED visit for symptomatic gallstones. In addition, 37.1% of patients in this group had additional ED visits for gallstone-related symptoms, with 17.7% of patients having two or more additional ED visits, and 12.9% required emergent and/or urgent cholecystectomy. Additional ED visits (43.5%) occurred within 1 mo and 60.9% within 3 mo of their initial ED visit. In patients with additional ED visits for symptomatic cholelithiasis, 60.9% had more than one abdominal ultrasound or computed tomography scan during the course of multiple visits. Failure to achieve a timely surgical follow-up leads to multiple

  15. The Use of Operational Excellence Principles in a University Hospital

    Directory of Open Access Journals (Sweden)

    Eric R. Edelman

    2017-07-01

    Full Text Available The introduction of Operational Excellence in the Maastricht University Medical Center (MUMC+ has been the first of its kind and scale for a university hospital. The policy makers of the MUMC+ have combined different elements from various other business, management, and healthcare philosophies and frameworks into a unique mix. This paper summarizes the journey of developing this system and its most important aspects. Special attention is paid to the role of the operating rooms and the improvements that have taken place there, because of their central role in the working of the hospital. The MUMC+ is the leading tertiary healthcare center for the South-East region of The Netherlands and beyond. Regional, national, and international developments encouraged the MUMC+ to start significantly reorganizing its care processes from 2009 onward. First experiments with Lean Six Sigma and Business Modeling were combined with lessons learned from other centers around the world to form the MUMC+’s own type of Operational Excellence. At the time of writing, many improvement projects of different types have been successfully completed. Every single department in the hospital now uses Operational Excellence and design thinking in general as a method to develop new models of care. An evaluation in 2014 revealed several opportunities for improvement. A large number of projects were in progress, but 75% of all projects had not been completed, despite the first projects being initiated back in 2012. This led to a number of policy changes, mainly focusing on more intensive monitoring of projects and trying to do more improvement projects directly under the responsibility of the line manager. Focusing on patient value, continuous improvement, and the reduction of waste have proven to be very fitting principles for healthcare in general and specifically for application in a university hospital. Approaching improvement at a systems level while directly involving the

  16. The Use of Operational Excellence Principles in a University Hospital.

    Science.gov (United States)

    Edelman, Eric R; Hamaekers, Ankie E W; Buhre, Wolfgang F; van Merode, Godefridus G

    2017-01-01

    The introduction of Operational Excellence in the Maastricht University Medical Center (MUMC+) has been the first of its kind and scale for a university hospital. The policy makers of the MUMC+ have combined different elements from various other business, management, and healthcare philosophies and frameworks into a unique mix. This paper summarizes the journey of developing this system and its most important aspects. Special attention is paid to the role of the operating rooms and the improvements that have taken place there, because of their central role in the working of the hospital. The MUMC+ is the leading tertiary healthcare center for the South-East region of The Netherlands and beyond. Regional, national, and international developments encouraged the MUMC+ to start significantly reorganizing its care processes from 2009 onward. First experiments with Lean Six Sigma and Business Modeling were combined with lessons learned from other centers around the world to form the MUMC+'s own type of Operational Excellence. At the time of writing, many improvement projects of different types have been successfully completed. Every single department in the hospital now uses Operational Excellence and design thinking in general as a method to develop new models of care. An evaluation in 2014 revealed several opportunities for improvement. A large number of projects were in progress, but 75% of all projects had not been completed, despite the first projects being initiated back in 2012. This led to a number of policy changes, mainly focusing on more intensive monitoring of projects and trying to do more improvement projects directly under the responsibility of the line manager. Focusing on patient value, continuous improvement, and the reduction of waste have proven to be very fitting principles for healthcare in general and specifically for application in a university hospital. Approaching improvement at a systems level while directly involving the people on the work

  17. The Use of Operational Excellence Principles in a University Hospital

    Science.gov (United States)

    Edelman, Eric R.; Hamaekers, Ankie E. W.; Buhre, Wolfgang F.; van Merode, Godefridus G.

    2017-01-01

    The introduction of Operational Excellence in the Maastricht University Medical Center (MUMC+) has been the first of its kind and scale for a university hospital. The policy makers of the MUMC+ have combined different elements from various other business, management, and healthcare philosophies and frameworks into a unique mix. This paper summarizes the journey of developing this system and its most important aspects. Special attention is paid to the role of the operating rooms and the improvements that have taken place there, because of their central role in the working of the hospital. The MUMC+ is the leading tertiary healthcare center for the South-East region of The Netherlands and beyond. Regional, national, and international developments encouraged the MUMC+ to start significantly reorganizing its care processes from 2009 onward. First experiments with Lean Six Sigma and Business Modeling were combined with lessons learned from other centers around the world to form the MUMC+’s own type of Operational Excellence. At the time of writing, many improvement projects of different types have been successfully completed. Every single department in the hospital now uses Operational Excellence and design thinking in general as a method to develop new models of care. An evaluation in 2014 revealed several opportunities for improvement. A large number of projects were in progress, but 75% of all projects had not been completed, despite the first projects being initiated back in 2012. This led to a number of policy changes, mainly focusing on more intensive monitoring of projects and trying to do more improvement projects directly under the responsibility of the line manager. Focusing on patient value, continuous improvement, and the reduction of waste have proven to be very fitting principles for healthcare in general and specifically for application in a university hospital. Approaching improvement at a systems level while directly involving the people on the work

  18. Operating Room Efficiency: Benefits of an Orthopaedic Traumatologist at a Level II Trauma Center.

    Science.gov (United States)

    Althausen, Peter L; Kauk, Justin R; Shannon, Steven; Lu, Minggen; O'Mara, Timothy J; Bray, Timothy J

    2016-12-01

    Fellowship-trained orthopaedic traumatologists are presumably taught skill sets leading to "best practice" outcomes and more efficient use of hospital resources. This should result in more favorable economic opportunities when compared with general orthopaedic surgeons (GOSs) providing similar clinical services. The purpose of our study was to compare the operating room utilization and financial data of traumatologists versus GOSs at a level II trauma center. Retrospective review. Level II community-based trauma hospital. Patients who presented to the emergency room at our institution with fractures and orthopaedic conditions requiring surgical intervention from January 1, 2010, to December 31, 2011. Operative fracture fixation by members of our orthopaedic trauma panel, including fellowship and nontrauma fellowship-trained orthopaedic surgeons. Our institutional database was queried to determine operative times, surgical supply and implant costs, and surgery labor expenses. Patients were stratified according to those treated by our trauma panel's 3 traumatologists and those treated by the 15 GOSs on our trauma panel. These 2 groups were then compared using standard statistical methods. A total of 6449 orthopedic cases were identified and 2076 of these involved fracture care. One thousand one hundred ninety-nine patients were treated by traumatologists and 877 by GOSs. There was no statistical difference detected in American Society of Anesthesiologists score between trauma and nontrauma groups. Overall, the traumatologist group demonstrated significantly decreased procedure times when compared with the GOS group (55.6 vs. 75.8 minutes, P , 0.0001). In 16 of 18 most common procedure types, traumatologists were more efficient. This led to significantly decreased surgical labor costs ($381.4 vs. $484.8; P Economic Level IV. See Instructions for Authors for a complete description of levels of evidence.

  19. Operator's Manual, Boiler Room Operations and Maintenance. Supplement A, Air Pollution Training Institute Self-Instructional Course SI-466.

    Science.gov (United States)

    Environmental Protection Agency, Research Triangle Park, NC. Air Pollution Training Inst.

    This Operator's Manual is a supplement to a self-instructional course prepared for the United States Environmental Protection Agency. This publication is the Boiler Room Handbook for operating and maintaining the boiler and the boiler room. As the student completes this handbook, he is putting together a manual for running his own boiler. The…

  20. Use of an operating microscope during spine surgery is associated with minor increases in operating room times and no increased risk of infection.

    Science.gov (United States)

    Basques, Bryce A; Golinvaux, Nicholas S; Bohl, Daniel D; Yacob, Alem; Toy, Jason O; Varthi, Arya G; Grauer, Jonathan N

    2014-10-15

    Retrospective database review. To evaluate whether microscope use during spine procedures is associated with increased operating room times or increased risk of infection. Operating microscopes are commonly used in spine procedures. It is debated whether the use of an operating microscope increases operating room time or confers increased risk of infection. The American College of Surgeons National Surgical Quality Improvement Program database, which includes data from more than 370 participating hospitals, was used to identify patients undergoing elective spinal procedures with and without the use of an operating microscope for the years 2011 and 2012. Bivariate and multivariate linear regressions were used to test the association between microscope use and operating room times. Bivariate and multivariate logistic regressions were similarly conducted to test the association between microscope use and infection occurrence within 30 days of surgery. A total of 23,670 elective spine procedures were identified, of which 2226 (9.4%) used an operating microscope. The average patient age was 55.1±14.4 years. The average operative time (incision to closure) was 125.7±82.0 minutes.Microscope use was associated with minor increases in preoperative room time (+2.9 min, P=0.013), operative time (+13.2 min, Pmicroscope and nonmicroscope groups for occurrence of any infection, superficial surgical site infection, deep surgical site infection, organ space infection, or sepsis/septic shock, regardless of surgery type. We did not find operating room times or infection risk to be significant deterrents for use of an operating microscope during spine surgery. 3.

  1. Are the urology operating room personnel aware about the ionizing radiation?

    Directory of Open Access Journals (Sweden)

    Adem Tok

    2015-10-01

    Full Text Available ABSTRACT Purpose: We assessed and evaluated attitudes and knowledge regarding ionizing radiation of urology surgery room staff. Materials and Methods: A questionnaire was sent by e-mail to urology surgery room personnel in Turkey, between June and August 2013. The questionnaire included demographic questions and questions regarding radiation exposure and protection. Results: In total, 127 questionnaires were answered. Of them, 62 (48.8% were nurses, 51 (40.2% were other personnel, and 14 (11% were radiological technicians. In total, 113 (89% participants had some knowledge of radiation, but only 56 (44.1% had received specific education or training regarding the harmful effects of radiation. In total, 92 (72.4% participants indicated that they used a lead apron and a thyroid shield. In the subgroup that had received education about the harmful effects of radiation, the use ratio for all protective procedures was 21.4% (n=12; this ratio was only 2.8% (n=2 for those with no specific training; the difference was statistically significant (p=0.004. Regarding dosimeters, the use rates were 100% for radiology technicians, 46.8% for nurses, and 31.4% for other hospital personnel; these differences were statistically significant (p<0.001. No significant relationship between working period in the surgery room, number of daily fluoroscopy procedures, education, task, and use of radiation protection measures was found. Conclusions: It is clear that operating room-allied health personnel exposed to radiation do not have sufficient knowledge of ionizing radiation and they do not take sufficient protective measures.

  2. Operating Room Traffic: Is There Any Role of Monitoring It?

    Science.gov (United States)

    Parikh, Shital N.; Grice, Salih S.; Schnell, Beverly M.; Salisbury, Shelia R.

    2010-01-01

    Background Operating room (OR) human traffic has been implicated as a cause of surgical site infection. We first observed the normal human traffic pattern in our Pediatric Orthopaedic ORs, then examined the effect of surveillance on that traffic pattern. Methods This study consisted of two phases: phase I sought to observe the OR traffic pattern (number of door swings, maximum and minimum number of OR personnel, number of OR personnel at 30 minute intervals, or changes in nursing, anesthesia or surgeon staff) during surgical cases without OR personnel being notified, and for phase II, the same traffic pattern was monitored with their knowledge. Results 2442 minutes of surgical time were observed in phase I, and 1908 minutes were observed in phase II. There was no difference (p=0.06) in the time between door swings between phase I (1.39 minutes) and phase II (1.70), no difference (p=1.000) in the maximum number of people in the OR between phase I (11.5 people, range: 7–15 people) and phase II (11.5 people, range: 8–20 people), no difference (p=1.000) in the minimum number of people in the OR between phase I (4.67 people, range: 4–6 people) and phase II (4.71 people, range: 3–6 people). There was a difference in the time between door swings (p=0.03) and maximum number of people in the OR (p=0.005) based on length of surgery (less or more than120 minutes). There was no difference in the time between door swings (p=0.11), but there was a difference in the maximum number of people in the OR (p=0.002) based on type of surgery (spine vs. others). Conclusion There was no role of surveillance of human traffic in the OR. To achieve any change in the OR traffic pattern, monitoring alone may not be sufficient; other novel techniques or incentives may need to be considered. PMID:20733430

  3. Operating room clinicians' ratings of workload: a vignette simulation study.

    Science.gov (United States)

    Wallston, Kenneth A; Slagle, Jason M; Speroff, Ted; Nwosu, Sam; Crimin, Kimberly; Feurer, Irene D; Boettcher, Brent; Weinger, Matthew B

    2014-06-01

    Increased clinician workload is associated with medical errors and patient harm. The Quality and Workload Assessment Tool (QWAT) measures anticipated (pre-case) and perceived (post-case) clinical workload during actual surgical procedures using ratings of individual and team case difficulty from every operating room (OR) team member. The purpose of this study was to examine the QWAT ratings of OR clinicians who were not present in the OR but who read vignettes compiled from actual case documentation to assess interrater reliability and agreement with ratings made by clinicians involved in the actual cases. Thirty-six OR clinicians (13 anesthesia providers, 11 surgeons, and 12 nurses) used the QWAT to rate 6 cases varying from easy to moderately difficult based on actual ratings made by clinicians involved with the cases. Cases were presented and rated in random order. Before rating anticipated individual and team difficulty, the raters read prepared clinical vignettes containing case synopses and much of the same written case information that was available to the actual clinicians before the onset of each case. Then, before rating perceived individual and team difficulty, they read part 2 of the vignette consisting of detailed role-specific intraoperative data regarding the anesthetic and surgical course, unusual events, and other relevant contextual factors. Surgeons had higher interrater reliability on the QWAT than did OR nurses or anesthesia providers. For the anticipated individual and team workload ratings, there were no statistically significant differences between the actual ratings and the ratings obtained from the vignettes. There were differences for the 3 provider types in perceived individual workload for the median difficulty cases and in the perceived team workload for the median and more difficult cases. The case difficulty items on the QWAT seem to be sufficiently reliable and valid to be used in other studies of anticipated and perceived clinical

  4. Experimental investigation of performance of a novel ventilation method for hospital patient rooms

    DEFF Research Database (Denmark)

    Melikov, Arsen Krikor; Bolashikov, Zhecho Dimitrov; Brand, Marek

    2010-01-01

    A novel hospital bed integrated ventilation and cleaning unit (HBIVCU) was developed to reduce the exposure of medical staff, visitors, etc. to coughed air from a sick patient. The performance efficiency of the unit was studied in a full-scale mock-up of a hospital room with two beds with patients...... and a doctor. Four HBIVCUs were placed along the two sides of the two beds. The room was ventilated by mixing air distribution (ceiling installed supply air terminals) at room air temperature of 22 °C. The coughing patient and the second exposed patient were simulated by two heated dummies with simplified...... geometry. Thermal manikin with realistic body shape and surface temperature distribution was used to mimic the doctor standing beside the bed of the coughing patient. The doctor and the coughing patient were facing each other. The coughing dummy was equipped with a cough generator. The cough produced...

  5. Student Registered Nurse Anesthetists' Atittudes toward and Perceptions of Teamwork in the Operating Room

    Science.gov (United States)

    Heiner, Jeremy S.

    2013-01-01

    Student registered nurse anesthetists are an important part of an operating room team, yet little research has investigated how they perceive teamwork or approach team related issues specific to the operating room. This mixed methods study evaluated junior and senior student registered nurse anesthetists' attitudes toward and perceptions of…

  6. Student Registered Nurse Anesthetists' Atittudes toward and Perceptions of Teamwork in the Operating Room

    Science.gov (United States)

    Heiner, Jeremy S.

    2013-01-01

    Student registered nurse anesthetists are an important part of an operating room team, yet little research has investigated how they perceive teamwork or approach team related issues specific to the operating room. This mixed methods study evaluated junior and senior student registered nurse anesthetists' attitudes toward and perceptions of…

  7. CdZnTe room-temperature semiconductor operation in liquid scintillator

    CERN Document Server

    Stewart, D Y

    2008-01-01

    We demonstrate the first operation of CdZnTe room-temperature detectors in a liquid scintillator environment. This work follows conceptually the Heusser-type detector method of operating HPGe detectors in liquid nitrogen and liquid argon but instead for a far more practical room-temperature ensemble with the aim of achieving ultra-low background levels for radiation detection.

  8. To provide care and be cared for in a multiple-bed hospital room.

    Science.gov (United States)

    Persson, Eva; Määttä, Sylvia

    2012-12-01

    To illuminate patients' experiences of being cared for and nurses' experiences of caring for patients in a multiple-bed hospital room. Many patients and healthcare personnel seem to prefer single-bed hospital rooms. However, certain advantages of multiple-bed hospital rooms (MBRs) have also been described. Eight men and eight women being cared for in a multiple-bedroom were interviewed, and two focus-group interviews (FGI) with 12 nurses were performed. A qualitative content analysis was used. One theme--Creating a sphere of privacy--and three categories were identified based on the patient interviews. The categories were: Being considerate, Having company and The patients' area. In the FGI, one theme--Integrating individual care with care for all--and two categories emerged: Experiencing a friendly atmosphere and Providing exigent care. Both patients and nurses described the advantages and disadvantages of multiple-bed rooms. The patient culture of taking care of one another and enjoying the company of room-mates were considered positive and gave a sense of security of both patients and nurses. The advantages were slight and could easily become disadvantages if, for example, room-mates were very ill or confused. The patients tried to maintain their privacy and dignity and claimed that there were small problems with room-mates listening to conversations. In contrast, the nurses stressed patient integrity as a main disadvantage and worked to protect the integrity of individual patients. Providing care for all patients simultaneously had the advantage of saving time. The insights gained in the present study could assist nurses in reducing the disadvantages and taking advantage of the positive elements of providing care in MBRs. Health professionals need to be aware of how attitudes towards male and female patients, respectively, could affect care provision. © 2012 The Authors. Scandinavian Journal of Caring Sciences © 2012 Nordic College of Caring Science.

  9. Anesthetic drug wastage in the operation room: A cause for concern

    Directory of Open Access Journals (Sweden)

    Kapil Chaudhary

    2012-01-01

    Full Text Available Context: The cost of anesthetic technique has three main components, i.e., disposable supplies, equipments, and anesthetic drugs. Drug budgets are an easily identifiable area for short-term savings. Aim: To assess and estimate the amount of anesthetic drug wastage in the general surgical operation room. Also, to analyze the financial implications to the hospital due to drug wastage and suggest appropriate steps to prevent or minimize this wastage. Settings and Design: A prospective observational study conducted in the general surgical operation room of a tertiary care hospital. Materials and Methods: Drug wastage was considered as the amount of drug left unutilized in the syringes/vials after completion of a case and any ampoule or vial broken while loading. An estimation of the cost of wasted drug was made. Results: Maximal wastage was associated with adrenaline and lignocaine (100% and 93.63%, respectively. The drugs which accounted for maximum wastage due to not being used after loading into a syringe were adrenaline (95.24%, succinylcholine (92.63%, lignocaine (92.51%, mephentermine (83.80%, and atropine (81.82%. The cost of wasted drugs for the study duration was 46.57% (Rs. 16,044.01 of the total cost of drugs issued/loaded (Rs. 34,449.44. Of this, the cost of wastage of propofol was maximum being 56.27% (Rs. 9028.16 of the total wastage cost, followed by rocuronium 17.80% (Rs. 2856, vecuronium 5.23% (Rs. 840, and neostigmine 4.12% (Rs. 661.50. Conclusions: Drug wastage and the ensuing financial loss can be significant during the anesthetic management of surgical cases. Propofol, rocuronium, vecuronium, and neostigmine are the drugs which contribute maximally to the total wastage cost. Judicious use of these and other drugs and appropriate prudent measures as suggested can effectively decrease this cost.

  10. Global public health impact of recovered supplies from operating rooms: a critical analysis with national implications.

    Science.gov (United States)

    Wan, Eric L; Xie, Li; Barrett, Miceile; Baltodano, Pablo A; Rivadeneira, Andres F; Noboa, Jonathan; Silver, Maya; Zhou, Richard; Cho, Suzy; Tam, Tammie; Yurter, Alp; Gentry, Carol; Palacios, Jorge; Rosson, Gedge D; Redett, Richard J

    2015-01-01

    In modern operating rooms, clean and unused medical supplies are routinely discarded and can be effectively recovered and redistributed abroad to alleviate the environmental burden of donor hospitals and to generate substantial health benefits at resource-poor recipient institutions. We established a recovery and donation program to collect clean and unused supplies for healthcare institutions in developing nations. We analyzed items donated over a 3-year period (September 2010-November 2013) by quantity and weight, and estimated the projected value of the program under potential nationwide participation. To capture the health benefits attributable to the donated supplies at recipient institutions, we partnered with two tertiary-care centers in Guayaquil, Ecuador and conducted a pilot study on the utility of the donated supplies at the recipient institutions (October 2013). We determined the disability-adjusted life years (DALY) averted for all patients undergoing procedures involving donated items and estimated the annual attributable DALY as well as the cost per DALY averted both by supply and by procedure. Approximately, 2 million lbs (907,185 kg) per year of medical supplies are recoverable from large non-rural US academic medical centers. Of these supplies, 19 common categories represent a potential for donation worth US $15 million per year, at a cost-utility of US $2.14 per DALY averted. Hospital operating rooms continue to represent a large source of recoverable surgical supplies that have demonstrable health benefits in the recipient communities. Cost-effective recovery and need-based donation programs can significantly alleviate the global burden of surgical diseases.

  11. Key operating and financial ratios for Alberta hospitals.

    Science.gov (United States)

    Jacobs, P; Hall, E M

    1994-01-01

    Comparative financial and operating ratios in Canadian hospitals are examined to reveal sources of increased efficiency. The study involved 70 Alberta hospitals, which were divided into three groups: teaching hospitals, regional hospitals and smaller rural hospitals. Data were obtained from HS-1 and HS-2 reports. Hospitals across Canada can calculate their own ratios to give them a general idea of how they compare with the hospitals in this report.

  12. [Nursing professionals and health care assistants' perception of patient safety culture in the operating room].

    Science.gov (United States)

    Bernalte-Martí, Vicente; Orts-Cortés, María Isabel; Maciá-Soler, Loreto

    2015-01-01

    To assess nursing professionals and health care assistants' perceptions, opinions and behaviours on patient safety culture in the operating room of a public hospital of the Spanish National Health Service. To describe strengths and weaknesses or opportunities for improvement according to the Agency for Healthcare Research and Quality criteria, as well as to determine the number of events reported. A descriptive, cross-sectional study was conducted using the Spanish version of the questionnaire Hospital Survey on Patient Safety Culture. The sample consisted of nursing professionals, who agreed to participate voluntarily in this study and met the selection criteria. A descriptive and inferential analysis was performed depending on the nature of the variables and the application conditions of statistical tests. Significance if p < .05. In total, 74 nursing professionals responded (63.2%). No strengths were found in the operating theatre, and improvements are needed concerning staffing (64.0%), and hospital management support for patient safety (52.9%). A total of 52.3% (n = 65) gave patient safety a score from 7 to 8.99 (on a 10 point scale); 79.7% (n = 72) reported no events last year. The total variance explained by the regression model was 0.56 for "Frequency of incident reporting" and 0.26 for "Overall perception of safety". There was a more positive perception of patient safety culture at unit level. Weaknesses have been identified, and they can be used to design specific intervention activities to improve patient safety culture in other nearby operating theatres. Copyright © 2014 Elsevier España, S.L.U. All rights reserved.

  13. 手术室巡回护士的护理工作%Operating Room Nurses Tour of Nursing Work

    Institute of Scientific and Technical Information of China (English)

    李安祥

    2015-01-01

    the operating room is the place that provide patients with surgery and rescue,is an important technology of the hospital departments.operating room should have with different surgery department,but also with the guard room,anesthesia recovery room in the blood bank,etc.Pays special attention to the incision infection management of four ways, namely:the operating room air, the items needed for the operation,the ifngers of the doctors and nurses and the patient’s skin,prevent infection,to ensure the success rate of surgery.request reasonable design, equipment is well-found,the nurses work is responsive,quick,efifcient work efifciency.Patients into the operating room nursing work to be done by a visiting nurse.%手术室是为病人提供手术及抢救的场所,是医院的重要技术部门。手术室应与手术科室相接连,还要与血库、临护室、麻醉复苏室等临近。抓好手术切口感染四条途径的环节管理,即:手术室的空气、手术所需的物品、医生护士的手指及病人的皮肤,防止感染,确保手术成功率。要求设计合理,设备齐全,护士工作反应灵敏、快捷,有高效的工作效率。患者进入手术室的护理工作由巡回护士完成。

  14. Shielding hospital rooms for brachytherapy patients: design, regulatory and cost/benefit factors.

    Science.gov (United States)

    Gitterman, M; Webster, E W

    1984-03-01

    The current regulations of the U.S. Nuclear Regulatory Commission (NRC) normally require limitation of radiation exposure in any part of unrestricted occupied areas to 2 mrem in any one hour and to 100 mrem in 7 days. To meet these limits when patients are treated therapeutically with radioactive materials, it is advisable to designate specific rooms in a hospital and often necessary to incorporate substantial costly shielding into one or more walls and the room door. Plans have been formulated for shielding existing hospital rooms housing brachytherapy patients receiving 192Ir and 137Cs therapy in order to meet the above NRC requirements for adjacent corridors and rooms. Typical shielding thicknesses required are 4-6 in. of concrete for certain walls and 1/4 in. of lead in the doors. Shielding costs are approx. $6000 per room for one shielded wall and a shielded door. Applying recent estimates of the cancer risk from low-level gamma radiation, the cost of shielding per cancer fatality averted has been estimated to range from $1.8 million to $10.9 million. Cost/benefit comparisons with many other life-saving activities suggest that these costs and the application of the 2 mrem/hr limit which necessitated them are not justified.

  15. Hacking the hospital environment: young adults designing youth-friendly hospital rooms together with young people with cancer experiences.

    Science.gov (United States)

    Boisen, Kirsten A; Boisen, Anne; Thomsen, Stine Legarth; Matthiesen, Simon Meggers; Hjerming, Maiken; Hertz, Pernille Grarup

    2015-12-09

    There is a need for youth-friendly hospital environments as the ward environment may affect both patient satisfaction and health outcomes. To involve young people in designing youth-friendly ward environment. We arranged a design competition lasting 42 h (Hackathon). Students in architecture, design, engineering, communication and anthropology participated (27 young adults) - forming eight groups. Adolescents and young adults (AYA) with current or former cancer experience participated as sparring partners. We provided workspace and food during the weekend. The groups presented their products to a jury and relevant stakeholders. The groups created eight unique design concepts. The young designers were extremely flexible listening to ideas and experiences from the young patients, which led to common features including individual and flexible design, privacy in two-bed wardrooms and social contact with other hospitalized AYA. The winning project included an integrated concept for both wardrooms and the AYA day room, including logos and names for the rooms and an 'energy wall' in the day room. A hackathon event was an effective mode of youth participation. The design concepts and ideas were in line with current evidence regarding pleasing hospital environment and youth-friendly inpatient facilities and may be applicable to other young patients.

  16. Reduced exposure to coughed air by a novel ventilation method for hospital patient rooms

    DEFF Research Database (Denmark)

    Bolashikov, Zhecho Dimitrov; Melikov, Arsen Krikor; Brand, Marek

    2012-01-01

    A novel hospital bed integrated ventilation and cleaning unit (HBIVCU) for local airflow control and cleansing, limiting the airborne spread of contagious air coughed from a sick patient in a hospital room, was developed. The performance efficiency of the unit, to successfully reduce occupants......’ exposure to coughed air, was studied in a full-scale, two-bed hospital room mock-up, 4.65 m x 4.65 m x 2.60 m (W x L x H), with two patients and a doctor. Four units were placed along the two sides of both beds close to the head. The room was ventilated by overhead mixing air distribution at 22 °C room air...... beside the bed and facing the coughing patient. The generated cough consisted of 100% CO2. The mouth was simulated by a circular opening of 0.021 m diameter. The characteristics of the cough were: peak flow - 10 L/s, cough volume - 2.5 L, duration - 0.5 s and maximum velocity - 28.9 m/s. The performance...

  17. Ge-on-Si laser operating at room temperature.

    Science.gov (United States)

    Liu, Jifeng; Sun, Xiaochen; Camacho-Aguilera, Rodolfo; Kimerling, Lionel C; Michel, Jurgen

    2010-03-01

    Monolithic lasers on Si are ideal for high-volume and large-scale electronic-photonic integration. Ge is an interesting candidate owing to its pseudodirect gap properties and compatibility with Si complementary metal oxide semiconductor technology. Recently we have demonstrated room-temperature photoluminescence, electroluminescence, and optical gain from the direct gap transition of band-engineered Ge-on-Si using tensile strain and n-type doping. Here we report what we believe to be the first experimental observation of lasing from the direct gap transition of Ge-on-Si at room temperature using an edge-emitting waveguide device. The emission exhibited a gain spectrum of 1590-1610 nm, line narrowing and polarization evolution from a mixed TE/TM to predominantly TE with increasing gain, and a clear threshold behavior.

  18. Hand washing in operating room: a procedural comparison

    Directory of Open Access Journals (Sweden)

    Alessia Stilo

    2016-09-01

    Full Text Available BACKGROUND Hand washing has been considered a measure of personal hygiene for centuries and it is known that an improper hand hygiene by healthcare workers is responsible for about 40% of nosocomial infections. Therefore, surgical hand preparation is a critical element for healthcare safety in order to reduce microbial contamination of  surgical wound in case of non detected break of the gloves. The aim of our study is to evaluate the efficacy three antiseptics: Povi-iodine scrub; EPG (Ethanol, Hydrogen Peroxide, Glycerol, recommended by WHO, and common marseille soap type in a liquid formulation. METHODS It was designed a randomized, double-blind, single-center study conducted in the University Hospital of Messina, from January to June 2013. We asked operators to put the fingertips of their right hand (if not left-handed for one minute on the PCA medium, before washing with the three types of antiseptics, and after washing and drying. Drying was made using sterile gauzes or disposable wipes. Then, we measured the number of colony forming units per mL (CFU/mL and calculated the percentage of microbial load reduction. RESULTS 211 samples have been considered for statistical analysis: in 42 samples, in fact, initial microbial load was lower than after washing. Washing with EPG reduced CFU/ml from  a mean of 38,9 to 4,1 (86,5% reduction, washing with povi-iodine scrub from 59,55 to 12,9 (75,9% reduction and washing with Marseille soap from 47,26 to 12,7 (64,3% reduction. CONCLUSIONS Our study shows that washing with EPG has superior efficacy in CFU reduction. Antiseptic hand washing, however, cannot be considered the only measure to reduce infections: the anomaly of some results (initial microbial load lower than after washing  demonstrates that drying is an essential phase in the presurgical preparation. Therefore, hand hygiene must be part of a more complex strategy of surveillance and control of nosocomial infections

  19. Semiconductor terahertz technology devices and systems at room temperature operation

    CERN Document Server

    Carpintero, G; Hartnagel, H; Preu, S; Raisanen, A

    2015-01-01

    Key advances in Semiconductor Terahertz (THz) Technology now promises important new applications enabling scientists and engineers to overcome the challenges of accessing the so-called "terahertz gap".  This pioneering reference explains the fundamental methods and surveys innovative techniques in the generation, detection and processing of THz waves with solid-state devices, as well as illustrating their potential applications in security and telecommunications, among other fields. With contributions from leading experts, Semiconductor Terahertz Technology: Devices and Systems at Room Tempe

  20. Optimization of recirculating laminar air flow in operating room air conditioning systems

    Directory of Open Access Journals (Sweden)

    Enver Yalcin

    2016-04-01

    Full Text Available The laminar flow air-conditioning system with 100% fresh air is used in almost all operating rooms without discrimination in Turkey. The laminar flow device which is working with 100% fresh air should be absolutely used in Type 1A operating rooms. However, there is not mandatory to use of 100% fresh air for Type 1B defined as places performed simpler operation. Compared with recirculating laminar flow, energy needs of the laminar flow with 100 % fresh air has been emerged about 40% more than re-circulated air flow. Therefore, when a recirculating laminar flow device is operated instead of laminar flow system with 100% fresh air in the Type 1B operating room, annual energy consumption will be reduced. In this study, in an operating room with recirculating laminar flow, optimal conditions have been investigated in order to obtain laminar flow form by analyzing velocity distributions at various supply velocities by using computational fluid dynamics method (CFD.

  1. Room transfers and the risk of delirium incidence amongst hospitalized elderly medical patients: a case?control study

    OpenAIRE

    Goldberg, Amanda; Sharon E Straus; Hamid, Jemila S; Wong, Camilla L.

    2015-01-01

    Background Room transfers are suspected to promote the development of delirium in hospitalized elderly patients, but no studies have systematically examined the relationship between room transfers and delirium incidence. We used a case?control study to determine if the number of room transfers per patient days is associated with an increased incidence of delirium amongst hospitalized elderly medical patients, controlling for baseline risk factors. Methods We included patients 70?years of age ...

  2. Decontamination of a hospital room using gaseous chlorine dioxide: Bacillus anthracis, Francisella tularensis, and Yersinia pestis.

    Science.gov (United States)

    Lowe, John J; Gibbs, Shawn G; Iwen, Peter C; Smith, Philip W; Hewlett, Angela L

    2013-01-01

    This study assessed the efficacy of gaseous chlorine dioxide for inactivation of Bacillus anthracis, Francisella tularensis, and Yersinia pestis in a hospital patient care suite. Spore and vegetative cells of Bacillus anthracis Sterne 34F2, spores of Bacillus atrophaeus ATCC 9372 and vegetative cells of both Francisella tularensis ATCC 6223 and Yersinia pestis A1122 were exposed to gaseous chlorine dioxide in a patient care suite. Organism inactivation was then assessed by log reduction in viable organisms postexposure to chlorine dioxide gas compared to non-exposed control organism. Hospital room decontamination protocols utilizing chlorine dioxide gas concentrations of 377 to 385 ppm maintained to exposures of 767 ppm-hours with 65% relative humidity consistently achieved complete inactivation of B. anthracis and B. atrophaeus spores, as well as vegetative cells of B. anthracis, F. tularensis, and Y. pestis. Decrease in exposure (ppm-hours) and relative humidity (8 log reductions in organisms. Up to 10-log reductions were achieved in a hospital room with limited impact on adjacent areas, indicating chlorine dioxide concentrations needed for decontamination of highly concentrated (>6 logs) organisms can be achieved throughout a hospital room. This study translates laboratory chlorine dioxide fumigation studies applied in a complex clinical environment.

  3. The operating room as a clinical learning environment: An exploratory study.

    Science.gov (United States)

    Meyer, Rhoda; Van Schalkwyk, Susan C; Prakaschandra, Rosaley

    2016-05-01

    Students undertake their clinical placement in various clinical settings for the exposure to and acquisition of skills related to that particular context. The operating room is a context that offers the opportunity to develop critical skills related to the perioperative care of the patient. Despite numerous studies that have been undertaken in this field, few have investigated the operating room as a clinical learning environment in the South African private healthcare context. The aim of this study was to determine nursing students' perceptions of the operating room as a clinical learning environment. An exploratory, interpretive and descriptive design generating qualitative data was utilized. Eight nursing students completed an open-ended questionnaire, and twelve nursing students participated in the focus group discussion. Four themes emerged, namely, 'interpersonal factors', 'educational factors', 'private operating room context', and 'recommendations'. The opinion that the operating room offers an opportunity to gain skills unique to this context was expressed. However, despite the potential learning opportunities, the key findings of this study reveal negative perceptions of nursing students regarding learning experiences in the operating room. Exploration into the preparatory needs of students specific to learning outcomes before operating room placement should be considered. It will also be necessary to improve collaboration between lecturers, mentors and theatre managers.

  4. The effects of surgeons and anesthesiologists on operating room efficiency

    Directory of Open Access Journals (Sweden)

    Nessa Timoney

    2016-09-01

    Conclusion: In some procedures types a significant part of the variability in operative time is due to the interaction between the surgeon and anesthesiologist. Reviewing operative records should allow identification of efficient/inefficient combinations.

  5. Workflow in the operating room: review of Arrowhead 2004 seminar on imaging and informatics (Invited Paper)

    Science.gov (United States)

    Lemke, Heinz U.; Ratib, Osman M.; Horii, Steven C.

    2005-04-01

    This review paper is based on the 2004 UCLA Seminar on Imaging and Informatics (http://www.radnet.ucla.edu/Arrowhead2004/) which is a joint endeavour between the UCLA and the CARS organization, focussing on workflow analysis tools and the digital operating room. Eleven specific presentations of the Arrowhead Seminar have been summarized in this review referring to redesigning perioperative care for a high velocity OR, intraoperative ultrasound process and model, surgical workflow and surgical PACS, an integrated view , interactions in the surgical OR, workflow automation strategies and target applications, visualisation solutions for the operating room, navigating the fifth dimension, and design of digital operating rooms and interventional suites

  6. Nursing staff sizing in the emergency room of a university hospital

    Directory of Open Access Journals (Sweden)

    Taís Couto Rego da Paixão

    2015-06-01

    Full Text Available OBJECTIVE To verify the adequacy of the professional nursing staff in the emergency room of a university hospital and to evaluate the association between categories of risk classification triage with the Fugulin Patient Classification System. METHOD The classification of patients admitted into the emergency room was performed for 30 consecutive days through the methodology proposed by Gaidzinski for calculating nursing requirements. RESULTS The calculation determines the need for three registered nurses and four non-registered nursing for each six hour shift. However, only one registered nurse and four non-registered nurse were available per shift. There was no correlation between triage risk classification and classification of care by the Fugulin Patient Classification System. CONCLUSION A deficit in professional staff was identified in the emergency room. The specificity of this unit made it difficult to measure. To find the best strategy to do so, further studies should be performed.

  7. Patient walk detection in hospital room using Microsoft Kinect V2.

    Science.gov (United States)

    Liang Liu; Mehrotra, Sanjay

    2016-08-01

    This paper describes a system using Kinect sensor to detect patient walk automatically in a hospital room setting. The system is especially essential for the case when the patient is alone and the nursing staff is absent. The patient activities are represented by the features extracted from Kinect V2 skeletons. The analysis to the recognized walk could help us to better understand the health situation of the patient and the possible hospital acquired infection (HAI), and provide valuable information to healthcare givers for making a corresponding treatment decision and alteration. The Kinect V2 depth sensor provides the ground truth.

  8. HOSPITAL SOUNDSCAPE: ACOUSTICS EVALUATION IN NEONATAL INTENSIVE CARE UNIT (NICU ROOM OF A NATIONAL HOSPITAL IN JAKARTA, INDONESIA

    Directory of Open Access Journals (Sweden)

    SARWONO R. Sugeng Joko

    2016-12-01

    Full Text Available Acoustics comfort in a room is one of the most important building physics aspect that should be observed. in public spaces like hospital, especially in an intensive care unit such as NICU. Researches on the acoustic conditions of NICU in Indonesia are still limited. The acoustical study conducted in this research is using objective, subjective, and simulation methods based on soundscape concept with the concern on the nurse’s perception. This research was conducted at a national hospital in Jakarta. According to National Standardization Agency of Indonesia (SNI and World Health Organization (WHO, the suitable sound pressure level (SPL for noise in patient’s room is 35 dBA. From the study, it was found that the equivalent SPL value exceeded the standard. Soundscape in NICU can be improve with the addition of curtain on the incubator’s side, installation of glass partition, and ceiling absorber in the nurse station area. The result of simulation showed that the SPL in the room decreased with average value 8.9 dBA for sound source alarm ventilator and 8.2 dBA for sound source medical officer conversations. And the speech transmission index (STI increased from “bad” to “good” range became “fair” to “excellent” range.

  9. Relationship Between Operating Room Teamwork, Contextual Factors, and Safety Checklist Performance.

    Science.gov (United States)

    Singer, Sara J; Molina, George; Li, Zhonghe; Jiang, Wei; Nurudeen, Suliat; Kite, Julia G; Edmondson, Lizabeth; Foster, Richard; Haynes, Alex B; Berry, William R

    2016-10-01

    Studies show that using surgical safety checklists (SSCs) reduces complications. Many believe SSCs accomplish this by enhancing teamwork, but evidence is limited. Our study sought to relate teamwork to checklist performance, understand how they relate, and determine conditions that affect this relationship. Using 2 validated tools for observing and coaching operating room teams, we evaluated the association between checklist performance with surgeon buy-in and 4 domains of surgical teamwork: clinical leadership, communication, coordination, and respect. Hospital staff in 10 South Carolina hospitals observed 207 procedures between April 2011 and January 2013. We calculated levels of checklist performance, buy-in, and measures of teamwork, and evaluated their relationship, controlling for patient and case characteristics. Few teams completed most or all SSC items. Teams more often completed items considered procedural "checks" than conversation "prompts." Surgeon buy-in, clinical leadership, communication, a summary measure of teamwork overall, and observers' teamwork ratings positively related to overall checklist completion (multivariable model estimates from 0.04, p teamwork and surgeon buy-in related positively to completing more conversation prompts; none related significantly to procedural checks (estimates from 0.10, p teamwork characterized by shared clinical leadership, open communication, active coordination, and mutual respect were critical in prompting case-related conversations, but not in completing procedural checks. Findings highlight the importance of surgeon engagement and high-quality, consistent teamwork for promoting checklist use and ensuring a safe surgical environment. Copyright © 2016 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

  10. Association between underweight and hospitalization, emergency room visits, and mortality among patients in community medical homes

    Directory of Open Access Journals (Sweden)

    Takahashi PY

    2013-01-01

    Full Text Available Paul Y Takahashi.1 Jennifer L St Sauver,2 Timothy C Olson,1 Jill M Huber,1 Stephen S Cha,2 Jon O Ebbert11Division of Primary Care Internal Medicine, 2Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USABackground: In older adults, underweight (body mass index [BMI] < 18.5 has been associated with increased mortality. This increased mortality risk may be associated with increased health care utilization. We evaluated the relationship between underweight and hospitalization, emergency room visits, and mortality.Methods: An analysis of a retrospective cohort study was conducted at a multisite academic primary care medical practice in Minnesota. The patients were ≥60 years of age, impaneled within primary care on January 1, 2011, and had a BMI measurement recorded between January 1, 2011, and December 31, 2011. Individuals were excluded if they refused review of their medical record. The primary measurement was BMI, which was categorized as underweight (BMI < 18.5 or normal and obese (BMI ≥ 18.5. The outcomes were hospitalization, emergency room visits, and mortality in the 2011 calendar year. Associations between underweight and each outcome were calculated using logistic regression. Interactions between underweight and gender were assessed in the logistic regression models. The final results were adjusted for age, gender, comorbid health conditions, and single living status.Results: The final cohort included 21,019 patients, of whom 220 (1% were underweight. Underweight patients had a higher likelihood of hospitalization compared with patients with higher BMI (adjusted odds ratio [OR] 1.64; 95% confidence interval [CI] 1.21–2.22. Underweight patients were also more likely to visit the emergency room (adjusted OR 1.70; 95% CI 1.28–2.25 or to die (adjusted OR 3.64; 95% CI 2.33–5.69. Men with a BMI < 18.5 compared with those having a BMI ≥ 18.5 had the highest odds of hospitalization (OR 3.45; 95% CI 1.59–7

  11. Psychological and Physical Stress in Surgeons Operating in a Standard or Modern Operating Room

    DEFF Research Database (Denmark)

    Klein, M.; Andersen, L.P.H.; Alamili, M.

    2010-01-01

    concerning physical and psychological wellbeing before and after surgery and had their heart rate variability registered during surgery. Results: Preoperative to postoperative physical strain and pain measurements revealed a systematical difference with 14 of 15 parameters favoring the modern OR. Two...... of these parameters reached statistical significance. We did not find any significant differences in the subjective parameters of surgeon satisfaction or the measured heart rate variability parameters. Conclusions: Physical strain on the surgeon was reduced when performing laparoscopic cholecystectomy in a modern......Purpose: There have been no studies examining the effect of optimized ergonomic and technical environment on the psychological and physiological stress of the surgeon. The aim of this study was to examine whether optimized ergonomics and technical aids within a modern operating room (OR) affect...

  12. The meaning of care for operating room nursing

    OpenAIRE

    Cléton Salbego; Carla da Silveira Dornelles; Patrícia Bitencourt Toscani Greco; Vânia Marta Pradebon; Gabriela Fávero Alberti

    2016-01-01

    Objective: to understand the meaning of care for nursing technicians who work in the Surgical Center of a general hospital in the western border of Rio Grande do Sul/Brazil. Methods: this is a qualitative research, with an exploratory and descriptive approach. The technique used for data collection was a semi-structured interview and notes from the field diary were available for support. The respondents were eight nursing technicians of the Surgical Center. Results: it can be emphasized that ...

  13. Operating room metrics score card-creating a prototype for individualized feedback.

    Science.gov (United States)

    Gabriel, Rodney A; Gimlich, Robert; Ehrenfeld, Jesse M; Urman, Richard D

    2014-11-01

    The balance between reducing costs and inefficiencies with that of patient safety is a challenging problem faced in the operating room suite. An ongoing challenge is the creation of effective strategies that reduce these inefficiencies and provide real-time personalized metrics and electronic feedback to anesthesia practitioners. We created a sample report card structure, utilizing existing informatics systems. This system allows to gather and analyze operating room metrics for each anesthesia provider and offer personalized feedback. To accomplish this task, we identified key metrics that represented time and quality parameters. We collected these data for individual anesthesiologists and compared performance to the overall group average. Data were presented as an electronic score card and made available to individual clinicians on a real-time basis in an effort to provide effective feedback. These metrics included number of cancelled cases, average turnover time, average time to operating room ready and patient in room, number of delayed first case starts, average induction time, average extubation time, average time to recovery room arrival to discharge, performance feedback from other providers, compliance to various protocols, and total anesthetic costs. The concept we propose can easily be generalized to a variety of operating room settings, types of facilities and OR health care professionals. Such a scorecard can be created using content that is important for operating room efficiency, research, and practice improvement for anesthesia providers.

  14. Predicting Correct Body Posture based on Theory of Planned Behavior in Iranian Operating Room Nurses

    National Research Council Canada - National Science Library

    BAHAREH ABEDI; RABIOLLAH FARMANBAR1; SAEED OMIDI; MAHDI JAHANGIR BLOURCHIAN

    2015-01-01

    Due to the importance of correct posture for preventing musculoskeletal disorders, the purpose of this study was to evaluate Theory of Planned Behavior in Predicting correct Body Posture in operating room...

  15. Science Support Room Operations During Desert RATS 2009

    Science.gov (United States)

    Lofgren, G. E.; Horz, F.; Bell, M. S.; Cohen, B. A.; Eppler,D. B.; Evans, C. a.; Hodges, K. V.; Hynek, B. M.; Gruener, J. E.; Kring, D. A.; hide

    2010-01-01

    NASA's Desert Research and Technology Studies (D-RATS) field test is a demonstration that combines operations development, technology advances and science in analog planetary surface conditions. The focus is testing preliminary operational concepts for extravehicular activity (EVA) systems by providing hands-on experience with simulated surface operations and EVA hardware and procedures. The DRATS activities also develop technical skills and experience for the engineers, scientists, technicians, and astronauts responsible for realizing the goals of the Lunar Surface Systems Program. The 2009 test is the twelfth for the D-RATS team.

  16. Real-time observations of stressful events in the operating room

    Directory of Open Access Journals (Sweden)

    AlNassar Sami

    2012-01-01

    Full Text Available Aim: To identify and quantify factors causing stress in the operating room (OR and evaluate the relationship between these factors and surgeons′ stress level. Methods: This is a prospective observational study from 32 elective surgical procedures conducted in the OR of King Khalid University Hospital, Riyadh, Saudi Arabia. Before each operation, each surgeon was asked of stressors. Two interns observed 16 surgeries each, separately. The interns watched and took notes during the entire surgical procedure. During each operation, the observer recorded anxiety-inducing activities and events that occurred in real time by means of a checklist of 8 potential stressors: technical, patient problems, teamwork problems, time and management issues, distractions and interruptions, equipment problems, personal problems, and teaching. After each operation, surgeons were asked to answer the validated State-Trait Anxiety Inventory questionnaire and self-report on their stress level from the 8 sources using a scale of 1-8 (1: stress free, 8: extremely stressful. The observer also recorded perceived stress levels experienced by the surgeons during the operation. Results: One hundred ten stressors were identified. Technical problems most frequently caused stress (16.4% and personal issues the least often (6.4%. Frequently encountered stressors (teaching and distractions/interruptions caused less stress to the surgeons. Technical factors, teamwork, and equipment problems occurred frequently and were also a major contributor to OR stress. All patients were discharged in good health and within 1 week of surgery. Conclusion: Certain stressful factors do occur among surgeons in the OR and can increase the potential for errors. Further research is required to determine the impact of stress on performance and the outcome of surgery.

  17. Real-time observations of stressful events in the operating room.

    Science.gov (United States)

    Sami, Alnassar; Waseem, Hajjar; Nourah, Alsubaie; Areej, Alhummaid; Afnan, Almarshedi; Ghadeer, Al-Shaikh; Abdulaziz, Alsaif; Arthur, Isnani

    2012-04-01

    To identify and quantify factors causing stress in the operating room (OR) and evaluate the relationship between these factors and surgeons' stress level. This is a prospective observational study from 32 elective surgical procedures conducted in the OR of King Khalid University Hospital, Riyadh, Saudi Arabia. Before each operation, each surgeon was asked of stressors. Two interns observed 16 surgeries each, separately. The interns watched and took notes during the entire surgical procedure. During each operation, the observer recorded anxiety-inducing activities and events that occurred in real time by means of a checklist of 8 potential stressors: technical, patient problems, teamwork problems, time and management issues, distractions and interruptions, equipment problems, personal problems, and teaching. After each operation, surgeons were asked to answer the validated State-Trait Anxiety Inventory questionnaire and self-report on their stress level from the 8 sources using a scale of 1-8 (1: stress free, 8: extremely stressful). The observer also recorded perceived stress levels experienced by the surgeons during the operation. One hundred ten stressors were identified. Technical problems most frequently caused stress (16.4%) and personal issues the least often (6.4%). Frequently encountered stressors (teaching and distractions/interruptions) caused less stress to the surgeons. Technical factors, teamwork, and equipment problems occurred frequently and were also a major contributor to OR stress. All patients were discharged in good health and within 1 week of surgery. Certain stressful factors do occur among surgeons in the OR and can increase the potential for errors. Further research is required to determine the impact of stress on performance and the outcome of surgery.

  18. Structure-oriented versus process-oriented approach to enhance efficiency for emergency room operations: what lessons can we learn?

    Science.gov (United States)

    Hwang, Taik Gun; Lee, Younsuk; Shin, Hojung

    2011-01-01

    The efficiency and quality of a healthcare system can be defined as interactions among the system structure, processes, and outcome. This article examines the effect of structural adjustment (change in floor plan or layout) and process improvement (critical pathway implementation) on performance of emergency room (ER) operations for acute cerebral infarction patients. Two large teaching hospitals participated in this study: Korea University (KU) Guro Hospital and KU Anam Hospital. The administration of Guro adopted a structure-oriented approach in improving its ER operations while the administration of Anam employed a process-oriented approach, facilitating critical pathways and protocols. To calibrate improvements, the data for time interval, length of stay, and hospital charges were collected, before and after the planned changes were implemented at each hospital. In particular, time interval is the most essential measure for handling acute stroke patients because patients' survival and recovery are affected by the promptness of diagnosis and treatment. Statistical analyses indicated that both redesign of layout at Guro and implementation of critical pathways at Anam had a positive influence on most of the performance measures. However, reduction in time interval was not consistent at Guro, demonstrating delays in processing time for a few processes. The adoption of critical pathways at Anam appeared more effective in reducing time intervals than the structural rearrangement at Guro, mainly as a result of the extensive employee training required for a critical pathway implementation. Thus, hospital managers should combine structure-oriented and process-oriented strategies to maximize effectiveness of improvement efforts.

  19. [Interface interconnection and data integration in implementing of digital operating room].

    Science.gov (United States)

    Feng, Jingyi; Chen, Hua; Liu, Jiquan

    2011-10-01

    The digital operating-room, with highly integrated clinical information, is very important for rescuing lives of patients and improving quality of operations. Since equipments in domestic operating-rooms have diversified interface and nonstandard communication protocols, designing and implementing an integrated data sharing program for different kinds of diagnosing, monitoring, and treatment equipments become a key point in construction of digital operating room. This paper addresses interface interconnection and data integration for commonly used clinical equipments from aspects of hardware interface, interface connection and communication protocol, and offers a solution for interconnection and integration of clinical equipments in heterogeneous environment. Based on the solution, a case of an optimal digital operating-room is presented in this paper. Comparing with the international solution for digital operating-room, the solution proposed in this paper is more economical and effective. And finally, this paper provides a proposal for the platform construction of digital perating-room as well as a viewpoint for standardization of domestic clinical equipments.

  20. Rule-based medical device adaptation for the digital operating room.

    Science.gov (United States)

    Franke, Stefan; Neumuth, Thomas

    2015-08-01

    A workflow-driven cooperative operating room needs to be established in order to successfully unburden the surgeon and the operating room staff very time-consuming information-seeking and configuration tasks. We propose an approach towards the integration of intraoperative surgical workflow management and integration technologies. The concept of rule-based behavior is adapted to situation-aware medical devices. A prototype was implemented and experiments with sixty recorded brain tumor removal procedures were conducted to test the proposed approach. An analysis of the recordings indicated numerous applications, such as automatic display configuration, room light adaptation and pre-configuration of medical devices and systems.

  1. Operating room team members' views of workload, case difficulty, and nonroutine events.

    Science.gov (United States)

    Minnick, Ann F; Donaghey, Beth; Slagle, Jason; Weinger, Matthew B

    2012-01-01

    Interventions such as mandatory "time-outs" have contributed to intraoperative safety but improvements are still necessary. We present data provided by 3 professions always present in the intraoperative setting that suggest next steps in the quest for improvements. We describe the differences and similarities in operating room (OR) nurses', anesthesia providers', and surgeons' beliefs about team function, case difficulty, nonroutine event (NRE), and error causation using a qualitative design at 3 Veterans' Administration hospitals. Intraoperative errors are costly in lives, suffering, and dollars. A quality improvement tenet states that workers are a rich information source regarding the context within which quality can be improved. Identifying and describing OR providers' beliefs are necessary steps in devising novel approaches to quality improvement. Intraoperative NRE and error prevention opportunities exist within and outside of the OR. There may be "cascade" and "perfect storm conditions" before and during operative procedures that increase the likelihood of NREs. Confirmation of these phenomena could improve prediction and prevention of NREs. Exploration of differences in team definition and team performance ratings by provider type may also identify avenues for improvement.

  2. The utilization of a paediatric emergency room in a general hospital in Kuwait.

    Science.gov (United States)

    al-Hay, A A; Boresli, M; Shaltout, A A

    1997-12-01

    A descriptive study was conducted in Al-Amiri Hospital, Kuwait to evaluate the use of the paediatric emergency room (PER) by children under 12 years of age over an 11-week period. Socio-demographic data on the families, reasons for the visits, the pattern of referral and the diagnoses were reviewed and analyzed. A total of 277 children were enrolled in the study, the majority of whom (81%) were generally well, only 4% requiring admission to hospital. The paediatrician in the emergency room considered that 64% of visits were not emergencies. Some form of treatment and one to two routine investigations were needed in 21% and 21.6%, respectively. Stated reasons for seeking medical care were: symptoms of the child (34%), unavailability of primary clinic at night (22%) and perceived better services in hospital (20%). The median of parental satisfaction at the end of the visit was 95%. We conclude that most visits to the PER at Al-Amiri Hospital are inappropriate and that intensive health education is required to improve use of the PER and to increase public awareness of the difference between primary care and paediatric emergency facilities.

  3. An Outbreak of SARS in a Diabetes Room of a General Hospital without Infected Medical Staff

    Institute of Scientific and Technical Information of China (English)

    2013-01-01

    Objective To investigate the epidemiologic features of an outbreak of SARS that occurred in a single diabetes room of a general hospital in Beijing in late March 2003. Methods Field investigation was carried out in the ward, the nursing log and the hospitalization medical record of correlative patients were consulted. SARS-CoV in serum specimen from SARS patient was detected by PCR. Results The room where SARS outbreak occurred was on the 13th lfoor of the 16-story main ward building. There were 6 beds in the room, living with 6 female patients (aged 45-67) who were all hospitalized due to type 2 diabetes. On March 24, 2003, Patient 1 began to have a fever and cough, chest X-ray showed pneumonia. Five and six days later, Patient 2 and Patient 3 began to have a fever, respectively. Finally, all of these 3 patients died. Their beds were all at the same side of the room, and the other 3 patients at the opposite side were not infected. Serum SARS CoV-RNA of the Patient 3 was positive by nest-PCR. The daughter-in-law of Patient 1 who accompanied Patient 1 by the bedside several days, mainly near the window, upwind of Patient 1, was not infected. Medical staff, family members and visitors of the 6 patients were not infected. Conclusions This outbreak was not transmitted by aerosol. The distance droplets travels could be up to 3.43 meters. Droplet spread has direction, and the droplets direction of propagation is closely related with the wind direction and speed. Those at the downwind position of SARS patients were susceptible to be infected. Medical staff wore face masks and good natural ventilation of this ward building may be important reasons for the prevention of infection.

  4. Operational experience with room temperature continuous wave accelerator structures

    Science.gov (United States)

    Alimov, A. S.; Ishkhanov, B. S.; Piskarev, I. M.; Shvedunov, V. I.; Tiunov, A. V.

    1993-05-01

    The paper reports the results of the computer simulation of parameters of the on-axis coupled accelerator structure for the continuous wave racetrack microtron. The operational experience with the accelerating sections on the basis of the on-axis coupled structure is described.

  5. Improving the Interdisciplinary Team Work in the Operating Room

    DEFF Research Database (Denmark)

    Tørring, Birgitte

    2016-01-01

    In surgical teams, where health professionals are highly interdependent and work under time pressure, it is of particular importance that the team work is well-functioning to secure treatment quality and patient safety. Using the theory of relational coordination (RC) may be the key to unlocking...... period in 2014 in two orthopedic surgical wards in a university hospital. A directed content analysis on the basis of theory of RC is used to transform the data to show different typologies of interdisciplinary team work. RC was subsequently measured using the RC Survey. Data describe very complex...... with the purpose of identifying different ways of communicating and managing relationship in contexts of variable complexity and to develop an intervention program. An ethnographic field study where data are collected through participant observations (35 teams) and semi-structured interviews (15), over a 10-months...

  6. Preparing children for the operating room: psychological issues.

    Science.gov (United States)

    McGraw, T

    1994-11-01

    Children respond psychologically to the prospect of surgery in a variable and age-dependent manner. This review summarizes the psychoanalytic, cognitive, behavioural and family system models of child development. It then reviews studies of hospitalization and anaesthesia in children. These studies suggest that younger children, children previously anaesthetized, and children who experience turbulent anaesthetic inductions are at particular risk for postoperative behavioural disturbances. Strategies of dealing with children and their parents during the perioperative period are discussed. Such strategies include: allowing a parent to be present during induction of anaesthesia, administering sedative premedication, creating a supportive environment, educating children and parents (verbal descriptions, tours, books, videos), and establishing rapport with children and their parents. Age-specific techniques of establishing rapport with children are discussed. If children are less anxious during the perioperative period, not only will they often exhibit less behavioural disturbances postoperatively, but they may face subsequent medical care more easily.

  7. Ketogenic Diet Decreases Emergency Room Visits and Hospitalizations Related to Epilepsy

    Science.gov (United States)

    Luniova, Anastasia; Abdelmoity, Ahmed

    2016-01-01

    Background. Approximately, one-third of patients with epilepsy are refractory to pharmacological treatment which mandates extensive medical care and imposes significant economic burden on patients and their societies. This study intends to assess the impact of the treatment with ketogenic diet (KD) on reducing seizure-related emergency room visits and hospitalizations in children with refractory epilepsy. Methods. This is a retrospective review of children treated with the KD in one tertiary center. We compared a 12 months' period prior to KD with 12 months after the diet was started in regard to the number of emergency department (ED) visits, hospitalizations, and hospital days as well as their associated charges. Results. 37 patients (57% males) were included. Their ages at time of KD initiation were (4.0 ± 2.78) years. Twelve months after the KD initiation, the total number of ED visits was reduced by 36% with a significant decrease of associated charges (p = 0.038). The number of hospital admissions was reduced by 40% and the number of hospital days was reduced by 39%. The cumulative charges showed net cost savings after 9 months when compared to the prediet baseline. Conclusion. In children with refractory epilepsy, treatment with the ketogenic diet reduces the number of ED visits and hospitalizations and their corresponding costs. PMID:27752367

  8. Ketogenic Diet Decreases Emergency Room Visits and Hospitalizations Related to Epilepsy

    Directory of Open Access Journals (Sweden)

    Husam R. Kayyali

    2016-01-01

    Full Text Available Background. Approximately, one-third of patients with epilepsy are refractory to pharmacological treatment which mandates extensive medical care and imposes significant economic burden on patients and their societies. This study intends to assess the impact of the treatment with ketogenic diet (KD on reducing seizure-related emergency room visits and hospitalizations in children with refractory epilepsy. Methods. This is a retrospective review of children treated with the KD in one tertiary center. We compared a 12 months’ period prior to KD with 12 months after the diet was started in regard to the number of emergency department (ED visits, hospitalizations, and hospital days as well as their associated charges. Results. 37 patients (57% males were included. Their ages at time of KD initiation were (4.0±2.78 years. Twelve months after the KD initiation, the total number of ED visits was reduced by 36% with a significant decrease of associated charges (p=0.038. The number of hospital admissions was reduced by 40% and the number of hospital days was reduced by 39%. The cumulative charges showed net cost savings after 9 months when compared to the prediet baseline. Conclusion. In children with refractory epilepsy, treatment with the ketogenic diet reduces the number of ED visits and hospitalizations and their corresponding costs.

  9. Bed Microenvironment in Hospital Patient Rooms with Natural or Mechanical Ventilation

    DEFF Research Database (Denmark)

    Melikov, Arsen Krikor; Li, Yuguo; Georgiev, Emanuil

    2012-01-01

    We studied how to provide patients in bed with thermally comfortable microenvironment in both naturally and mechanically ventilated hospital rooms for both winter and summer seasons. A climate chamber was used to resemble a hospital room and thermal manikin to simulate a patient lying in a bed....... The °manikin was dressed and covered by a quilt with its head resting on a pillow. The effect of local heating was studied at room air temperature of 10 and 16 °C and of local cooling at 28 and 35 °C. Electrical radiant heater, heated blanket, heated pillow, personalized ventilation (PV) and heated boots were...... temperature of 22 °C. The effect of air movement (0.2, 0.4 and 1 m/s) at the bed vicinity was also studied. Electrical radiant heater in combination with heated bed showed to be the most effective at 10 and 16 °C and the combined use of PV and cooled mattress or ventilated bed was the most effective at 28...

  10. Defining the optimal time to the operating room may salvage early trauma deaths.

    Science.gov (United States)

    Remick, Kyle N; Schwab, C William; Smith, Brian P; Monshizadeh, Amir; Kim, Patrick K; Reilly, Patrick M

    2014-05-01

    Early trauma deaths have the potential for salvage with immediate surgery. We studied time from injury to death in this group to qualify characteristics and quantify time to the operating room, yielding the greatest opportunity for salvage. The Pennsylvania Trauma Outcomes Study (PTOS) is a comprehensive registry including all Pennsylvania trauma centers. PTOS was queried for adult trauma patients from 1999 to 2010 dying within 4 hours of injury. The distribution of time to death (TD) was examined for subgroups according to mechanism of injury, hypotension (defined as systolic blood pressure ≤ 90 mm Hg), and operation required. The 5th percentile (TD5) and the 50th percentile (TD50) were calculated from the distributions and compared using the Mann-Whitney U-test. The PTOS yielded 6,547 deaths within 4 hours of injury. The overall TD5 and TD50 were 0:23 (hour:minute) and 0:59, respectively. Median penetrating injury times were significantly shorter than blunt injury times (TD5/TD50, 0:19/0:43 vs. 0:29/1:10). Median time was significantly shorter for hypotensive versus normotensive patients (TD5/TD50, 0:22/0:52 vs. 0:43/2:18). Operative subgroups had different TD5/TD50 (abdominal surgery [n = 607], 1:07/2:26; thoracic surgery [n = 756] 0:25/1:25; vascular surgery [n = 156], 0:35/2:15; and cranial surgery [n = 18], 1:20/2:42). Early trauma deaths have the potential for salvage with immediate surgery. We found TD to vary based on mechanism of injury, presence of hypotension, and type of surgery needed. With the use of TD5 and TD50 benchmarks in these subgroups, a trauma system may determine if decreased time to the operating room decreases mortality. Trauma systems can use these data to further improve prehospital and initial hospital phases of care for this subset of early death trauma patients. Epidemiologic study, level III.

  11. [Implementation of a rational standard of hygiene for preparation of operating rooms].

    Science.gov (United States)

    Bauer, M; Scheithauer, S; Moerer, O; Pütz, H; Sliwa, B; Schmidt, C E; Russo, S G; Waeschle, R M

    2015-10-01

    The assurance of high standards of care is a major requirement in German hospitals while cost reduction and efficient use of resources are mandatory. These requirements are particularly evident in the high-risk and cost-intensive operating theatre field with multiple process steps. The cleaning of operating rooms (OR) between surgical procedures is of major relevance for patient safety and requires time and human resources. The hygiene procedure plan for OR cleaning between operations at the university hospital in Göttingen was revised and optimized according to the plan-do-check-act principle due to not clearly defined specifications of responsibilities, use of resources, prolonged process times and increased staff engagement. The current status was evaluated in 2012 as part of the first step "plan". The subsequent step "do" included an expert symposium with external consultants, interdisciplinary consensus conferences with an actualization of the former hygiene procedure plan and the implementation process. All staff members involved were integrated into this management change process. The penetration rate of the training and information measures as well as the acceptance and compliance with the new hygiene procedure plan were reviewed within step "check". The rates of positive swabs and air sampling as well as of postoperative wound infections were analyzed for quality control and no evidence for a reduced effectiveness of the new hygiene plan was found. After the successful implementation of these measures the next improvement cycle ("act") was performed in 2014 which led to a simplification of the hygiene plan by reduction of the number of defined cleaning and disinfection programs for preparation of the OR. The reorganization measures described led to a comprehensive commitment of the hygiene procedure plan by distinct specifications for responsibilities, for the course of action and for the use of resources. Furthermore, a simplification of the plan, a

  12. Effects of disruptive surgeon behavior in the operating room.

    Science.gov (United States)

    Cochran, Amalia; Elder, William B

    2015-01-01

    Surgeons are the physician group most commonly identified as "disruptive physicians." The aim of this study was to develop a conceptual model of the results of disruptive surgeon behavior and to identify the coping strategies used by perioperative staff. Perspectives of 19 individuals of diverse occupations in the perioperative setting were drawn together using a grounded theory methodology. Effects of disruptive behavior described by participants included shift in attention from the patient to the surgeon, increased mistakes during procedures, deterrence from careers in surgery, and diminished respect for surgeons. Individual coping strategies employed in the face of intimidation include talking to colleagues, externalizing the behavior, avoidance of perpetrators, and warning others. Using grounded theory analysis, we were able to elucidate the impact of disruptive surgeon behavior in the perioperative environment. This conceptual model may be used to understand and counter the negative effects of manipulation and intimidation of hospital staff and trainees and to build on current programmatic strengths to improve surgical environments and training. Copyright © 2015 Elsevier Inc. All rights reserved.

  13. Room transfers and the risk of delirium incidence amongst hospitalized elderly medical patients: a case-control study.

    Science.gov (United States)

    Goldberg, Amanda; Straus, Sharon E; Hamid, Jemila S; Wong, Camilla L

    2015-06-25

    Room transfers are suspected to promote the development of delirium in hospitalized elderly patients, but no studies have systematically examined the relationship between room transfers and delirium incidence. We used a case-control study to determine if the number of room transfers per patient days is associated with an increased incidence of delirium amongst hospitalized elderly medical patients, controlling for baseline risk factors. We included patients 70 years of age or older who were admitted to the internal medicine or geriatric medicine services at St. Michael's Hospital between October 2009 and September 2010 for more than 24 h. The cases consisted of patients who developed delirium during the first week of hospital stay. The controls consisted of patients who did not develop delirium during the first week of hospital stay. Patients with evidence of delirium at admission were excluded from the analysis. A multivariable logistic regression model was used to determine the relationship between room transfers and delirium development within the first week of hospital stay. 994 patients were included in the study, of which 126 developed delirium during the first week of hospital stay. Using a multivariable logistic regression model which controlled for age, gender, cognitive impairment, vision impairment, dehydration, and severe illness, room transfers per patient days were associated with delirium incidence (OR: 9.69, 95 % CI (6.20 to15.16), P patient days is associated with an increased incidence of delirium amongst hospitalized elderly medical patients. This is an exploratory analysis and needs confirmation with larger studies.

  14. Physician communication in the operating room: expanding application of face-negotiation theory to the health communication context.

    Science.gov (United States)

    Kirschbaum, Kristin

    2012-01-01

    Communication variables that are associated with face-negotiation theory were examined in a sample of operating-room physicians. A survey was administered to anesthesiologists and surgeons at a teaching hospital in the southwestern United States to measure three variables commonly associated with face-negotiation theory: conflict-management style, face concern, and self-construal. The survey instrument that was administered to physicians includes items that measured these three variables in previous face-negotiation research with slight modification of item wording for relevance in the medical setting. The physician data were analyzed using confirmatory factor analysis, Pearson's correlations, and t-tests. Results of this initial investigation showed that variables associated with face-negotiation theory were evident in the sample physician population. In addition, the correlations were similar among variables in the medical sample as those found in previous face-negotiation research. Finally, t-tests suggest variance between anesthesiologists and surgeons on specific communication variables. These findings suggest three implications that warrant further investigation with expanded sample size: (1) An intercultural communication theory and instrument can be utilized for health communication research; (2) as applied in a medical context, face-negotiation theory can be expanded beyond traditional intercultural communication boundaries; and (3) theoretically based communication structures applied in a medical context could help explain physician miscommunication in the operating room to assist future design of communication training programs for operating-room physicians.

  15. Conflicts in operating room: Focus on causes and resolution

    Directory of Open Access Journals (Sweden)

    Joginder Pal Attri

    2015-01-01

    Full Text Available The operation theater (OT environment is the most complex and volatile workplace where two coequal physicians share responsibility of one patient. Difference in information, opinion, values, experience and interests between a surgeon and anesthesiologist may arise while working in high-pressure environments like OT, which may trigger conflict. Quality of patient care depends on effective teamwork for which multidisciplinary communication is an essential part. Troubled relationships leads to conflicts and conflicts leads to stressful work environment which hinders the safe discharge of patient care. Unresolved conflicts can harm the relationship but when handled in a positive way it provides an opportunity for growth and ultimately strengthening the bond between two people. By learning the skills to resolve conflict, we can keep our professional relationship healthy and strong which is an important component of good patient care.

  16. Operating room use of hypertonic solutions: a clinical review

    Directory of Open Access Journals (Sweden)

    Gustavo Azoubel

    2008-01-01

    Full Text Available Hyperosmotic-hyperoncotic solutions have been widely used during prehospital care of trauma patients and have shown positive hemodynamic effects. Recently, there has been a growing interest in intra-operative use of hypertonic solutions. We reviewed 30 clinical studies on the use of hypertonic saline solutions during surgeries, with the majority being cardiac surgeries. Reduced positive fluid balance, increased cardiac index, and decreased systemic vascular resistance were the main beneficial effects of using hypertonic solutions in this population. Well-designed clinical trials are highly needed, particularly in aortic aneurysm repair surgeries, where hypertonic solutions have shown many beneficial effects. Examining the immunomodulatory effects of hypertonic solutions should also be a priority in future studies.

  17. Mobile devices in the operating room: Intended and unintended consequences for nurses' work.

    Science.gov (United States)

    Sergeeva, Anastasia; Aij, Kjeld; van den Hooff, Bart; Huysman, Marleen

    2016-12-01

    This article reports the results of a case study of the consequences of mobile device use for the work practices of operating room nurses. The study identifies different patterns of mobile technology use by operating room nurses, including both work-related and non-work-related use. These patterns have multiple consequences for nurses, such as improvements in information access, e-learning and work-related communication, as well as a perceived increase in distractions from the collaborative work. We conceptualize these consequences in terms of three level effects and explain how we find both positive and negative consequences on the third level. On the positive side, improvements were found in how nurses spent their unoccupied time during the stable parts of operations, contributing to their well-being and job satisfaction. A negative consequence was the perceived increase in distraction from the collaborative operating room work practices.

  18. Modular Robotic System as Multisensory Room in Children’s Hospital

    DEFF Research Database (Denmark)

    Lund, Henrik Hautop; Henningsen, Anders; Nielsen, Rasmus

    2009-01-01

    immediate feedback based upon physical interaction with the system. The modularity, ease of use and the functionality of the devices such as modular robotic tiles and cubic I-BLOCKS suit well into these kinds of scenarios, because they can provide feedback in terms of light, vibration, sound and possibly......We developed a system composed of different modular robotic devices, which can be used e.g. as a multi-sensory room in hospital settings. The system composed of the modular robotic devices engage the user in physical activities, and should motivate to perform physical activities by providing...

  19. Implementation of a preoperative briefing protocol improves accuracy of teamwork assessment in the operating room.

    Science.gov (United States)

    Paige, John T; Aaron, Deborah L; Yang, Tong; Howell, D Shannon; Hilton, Charles W; Cohn, Isidore; Chauvin, Sheila W

    2008-09-01

    This study examined the effect of implementing a new preoperative briefing protocol on self- and peer-assessments of individual operating room (OR) teamwork behaviors. From July 2006 to February 2007, OR teamwork performance at a rural community hospital was evaluated before and after training and implementation of the protocol. After each case, every member on the team completed a 360-degree type teamwork behavior evaluation containing both self- and peer-assessments using a six-point Likert type scale (1 = definitely no to 6 = definitely yes). Individual behavior change was measured using the mean scale score of pre and postprotocol assessments. Statistical analysis included t test for both pre/post and self/peer differences. Data were available for one general surgeon and nine OR staff (pre = 20 cases, post = 16 cases). The preprotocol self-assessment mean score was significantly higher than peer-assessment (5.63 vs 5.29, P teamwork behaviors. No difference was observed in postassessment mean scores for self- and peer-assessments. Individuals overestimated their teamwork behaviors before protocol implementation. Using a preoperative protocol seems to improve OR staff teamwork behaviors and self-assessment accuracy. The use of a 360-degree assessment method targeting specific, observable behaviors may be useful in evaluating team-based interventions and enhancing teamwork effectiveness.

  20. Improving operating room efficiency by applying bin-packing and portfolio techniques to surgical case scheduling.

    Science.gov (United States)

    Van Houdenhoven, Mark; van Oostrum, Jeroen M; Hans, Erwin W; Wullink, Gerhard; Kazemier, Geert

    2007-09-01

    An operating room (OR) department has adopted an efficient business model and subsequently investigated how efficiency could be further improved. The aim of this study is to show the efficiency improvement of lowering organizational barriers and applying advanced mathematical techniques. We applied advanced mathematical algorithms in combination with scenarios that model relaxation of various organizational barriers using prospectively collected data. The setting is the main inpatient OR department of a university hospital, which sets its surgical case schedules 2 wk in advance using a block planning method. The main outcome measures are the number of freed OR blocks and OR utilization. Lowering organizational barriers and applying mathematical algorithms can yield a 4.5% point increase in OR utilization (95% confidence interval 4.0%-5.0%). This is obtained by reducing the total required OR time. Efficient OR departments can further improve their efficiency. The paper shows that a radical cultural change that comprises the use of mathematical algorithms and lowering organizational barriers improves OR utilization.

  1. Acupuncture performed by nurses in the recovery room at a Danish biomedical hospital: how patients experience the effect of acupuncture treatment

    DEFF Research Database (Denmark)

    Larsen, Anne Bolt

    2011-01-01

    The abstract build on a master thesis submitted to Department of Anthropology, Aarhus University, Denmark. The thesis aims at investigating a new trend in Danish hospitals, where acupuncture increasingly is used in treating post-operative nausea and vomiting (PONV) and pain. It is a novelty...... that patients may receive acupuncture treatment in hospital. No scientific research has been completed to examine patients experience when treated with acupuncture at a modern hospital based on technology and natural science. This study took place in the recovery room at a regional hospital in Denmark, where...... acupuncture during the past 3-4 years has been implemented by nurses as an option for patients with PONV and post-operative pain. The purpose is to analyse the encounter between acupuncture and biomedicine, how patients experience the effect of acupuncture treatment and their view of acupuncture...

  2. Ergonomic design in the operating room: information technologies

    Science.gov (United States)

    Morita, Mark M.; Ratib, Osman

    2005-04-01

    The ergonomic design in the Surgical OR of information technology systems has been and continues to be a large problem. Numerous disparate information systems with unique hardware and display configurations create an environment similar to the chaotic environments of air traffic control. Patient information systems tend to show all available statistics making it difficult to isolate the key, relevant vitals for the patient. Interactions in this sterile environment are still being done with the traditional keyboard and mouse designed for cubicle office workflows. This presentation will address the shortcomings of the current design paradigm in the Surgical OR that relate to Information Technology systems. It will offer a perspective that addresses the ergonomic deficiencies and predicts how future technological innovations will integrate into this vision. Part of this vision includes a Surgical OR PACS prototype, developed by GE Healthcare Technologies, that addresses ergonomic challenges of PACS in the OR that include lack of portability, sterile field integrity, and UI targeted for diagnostic radiologists. GWindows (gesture control) developed by Microsoft Research and Voice command will allow for the surgeons to navigate and review diagnostic imagery without using the conventional keyboard and mouse that disrupt the integrity of the sterile field. This prototype also demonstrates how a wireless, battery powered, self contained mobile PACS workstation can be optimally positioned for a surgeon to reference images during an intervention as opposed to the current pre-operative review. Lessons learned from the creation of the Surgical OR PACS Prototype have demonstrated that PACS alone is not the end all solution in the OR. Integration of other disparate information systems and presentation of this information in simple, easy to navigate information packets will enable smoother interactions for the surgeons and other healthcare professionals in the OR. More intuitive

  3. Psychological factors of professional success of nuclear power plant main control room operators

    Directory of Open Access Journals (Sweden)

    Kosenkov A.A.

    2014-12-01

    Full Text Available Aim: to conduct a comparative analysis of the psychological characteristics of the most and least successful main control room operators. Material and Methods. Two NPP staff groups: the most and least successful main control room operators, who worked in routine operating conditions, were surveyed. Expert evaluation method has been applied to identify the groups. The subjects were administered the Minnesota Multiphasic Personality Inventory (MMPI, Cattell's Sixteen Personality Factor Questionnaire (16PF form A and Raven's Progressive Matrices test. Results. Numerous significant psychological differences between the groups of most and least successful control room operators were obtained: the best operators were significantly more introverted and correctly solved more logical tasks with smaller percentage of mistakes under time pressure than worst ones. Conclusions: 1. The psychodiagnostic methods used in the study were adequate to meet research objective 2. Tendency to introversion, as well as developed the ability to solve logic problems undertime pressure, apparently, are important professional qualities for control room operators. These indicators should be considered in the process of psychological selection and professional guidance of nuclear power plant operators.

  4. Review article: review of behavioral operations experimental studies of newsvendor problems for operating room management.

    Science.gov (United States)

    Wachtel, Ruth E; Dexter, Franklin

    2010-06-01

    Operating room (OR) managers must plan staffing in the face of uncertain demand for OR time. Planning too much staffing results in underutilized OR time. Planning too little staffing causes overutilized time, which is approximately twice as expensive as underutilized time. Deciding how much staffing to plan for an OR is analogous to the classic newsvendor problem in operations research. A newsvendor must decide how much product to order based on its cost c and sales price p, plus estimates of the uncertain future demand for the product. The newsvendor problem has a simple mathematical solution. The correct amount of product to order is the (p - c)/p quantile of the demand for the product. This optimal order quantity is analogous mathematically to the number of hours of OR time for which staffing should be planned. We performed a systematic review of the behavioral operations experimental literature on newsvendor problems relevant to OR management. Student volunteers participating in experimental studies have great difficulty knowing how much product to order, given c, p, and the demand distribution. Decision making is only modestly improved by more frequent feedback. Even scores of rounds of ordering are insufficient for much learning to occur. Suboptimal decisions result from innate psychological biases. Students anchor on mean demand, make insufficient adjustments, and rely disproportionately on the most recent demand values. The behavior of OR managers who plan staffing for the OR is analogous to that of students participating in a newsvendor experiment. Month after month, an OR manager will plan too little staffing for the surgeon who consistently ends the day late and too much staffing for the surgeon who consistently does not fill an OR. Experimental studies of the newsvendor problem provide mechanistic insights into the reasons that OR managers make poor decisions when planning OR staffing. The students face no organizational factors or personality issues

  5. Hospital bed ventilation: impact of operation mode on exposure

    DEFF Research Database (Denmark)

    Bolashikov, Zhecho Dimitrov; Melikov, Arsen Krikor; Barova, Mariya

    2014-01-01

    Full-scale measurements were performed in a climate chamber set as a two-bed hospital room with overhead ventilation. Air temperature was kept constant at 22 °C. Two breathing thermal manikins were used to mimic a sick patient lying sideways in one of the beds and a doctor. A thermal dummy mimicked...... a second patient lying in the other bed. The doctor stood up 0.55 m from the bed facing the sick patient. Two pairs of localized ventilation units were attached near the heads of both patients alongside the beds to capture, clean and release the captured exhaled air from the lying patients. When the bed...... and droplet nuclei of less than 3 μm aerodynamic diameter. Two modes of operation of the bed incorporated ventilation unit were tested: releasing the cleaned air upwards (pull mode) or supplying it sideways over the lying patient (“push and pull” mode). The strategy to exhaust pollutants close o release...

  6. Experience of Interview Before and After Operation in Operating Room%手术室术前术后访视体会

    Institute of Scientific and Technical Information of China (English)

    陈保清

    2015-01-01

    Objective: To explore the effect of interview before and after operation on nursing works in operating room. Methods: Full-time interviewing nurses were appointed to the operating room to read the medical records of patients who were going to receive operation on the next day. Preoperative directions were given to the patients according to their conditions. The psychological characteristics of the patients were analyzed and right psychological counselings were given to the patients. Results: The interview before and after operation can improve the nursing quality in operating room and the preoperative psychological condition of the patients. It is good for the performance of the operation and increase the comfort of the patients in hospital.%目的:探讨术前、术后访视在手术室护理工作中的护理体会。方法:手术室指定专职的访视护士,在手术前1 d查阅第2 d需要手术的患者病历,根据情况对患者进行术前指导,了解患者心理特点,及时给患者提供正确的心理疏导。结果:通过术前、术后访视提高了手术室护理质量,有利于患者术前心理状态的改善,有助于手术的顺利进行,提高了患者在医院的舒适度。

  7. Hospital markup and operation outcomes in the United States.

    Science.gov (United States)

    Gani, Faiz; Ejaz, Aslam; Makary, Martin A; Pawlik, Timothy M

    2016-07-01

    Although the price hospitals charge for operations has broad financial implications, hospital pricing is not subject to regulation. We sought to characterize national variation in hospital price markup for major cardiothoracic and gastrointestinal operations and to evaluate perioperative outcomes of hospitals relative to hospital price markup. All hospitals in which a patient underwent a cardiothoracic or gastrointestinal procedure were identified using the Nationwide Inpatient Sample for 2012. Markup ratios (ratio of charges to costs) for the total cost of hospitalization were compared across hospitals. Risk-adjusted morbidity, failure-to-rescue, and mortality were calculated using multivariable, hierarchical logistic regression. Among the 3,498 hospitals identified, markup ratios ranged from 0.5-12.2, with a median markup ratio of 2.8 (interquartile range 2.7-3.9). For the 888 hospitals with extreme markup (greatest markup ratio quartile: markup ratio >3.9), the median markup ratio was 4.9 (interquartile range 4.3-6.0), with 10% of these hospitals billing more than 7 times the Medicare-allowable costs (markup ratio ≥7.25). Extreme markup hospitals were more often large (46.3% vs 33.8%, P markup ratio compared with 19.3% (n = 452) and 6.8% (n = 35) of nonprofit and government hospitals, respectively. Perioperative morbidity (32.7% vs 26.4%, P markup hospitals. There is wide variation in hospital markup for cardiothoracic and gastrointestinal procedures, with approximately a quarter of hospital charges being 4 times greater than the actual cost of hospitalization. Hospitals with an extreme markup had greater perioperative morbidity. Copyright © 2016 Elsevier Inc. All rights reserved.

  8. Method of Evidence-Based Intervention for Nosocomial Infection in Operation Room%手术室医院感染循证干预方法

    Institute of Scientific and Technical Information of China (English)

    张雯璟

    2015-01-01

    目的:降低手术室医院感染的危险,保障医疗护理安全。方法对手术室存在的医院感染危险因素及原因进行分析。结果通过对手术室的空气、物体表面、医护人员的手、麻醉用具进行细菌监测,手术器械集中管理,合理使用抗菌药物及加强职业安全防护等,可有效控制手术室医院感染。结论实施手术室医院感染循证干预,重视每一个环节,实施规范化的综合预防措施,才能保证手术患者及手术人员的安全。%Objective To reduce the risk of operating room of hospital infection,to ensure the safety of medical care.Methods The hospital infection risk factors existing in the operating room and the reasons were analyzed.Results Through to the operating room air,surfaces,medical personnel hand,bacteria monitoring anesthesia equipment,surgical instruments centralized management and rational use of antimicrobial agents and strengthening occupational safety protection,etc.,which can ef ectively control the operating room of hospital infection.Conclusion The implementation of the operating room of hospital infection of evidence-based interventions,at ach importance to every link,the implementation of standardized comprehensive prevention measures,to ensure the safety of surgery patients and staf .

  9. Closed-loop approach for situation awareness of medical devices and operating room infrastructure

    Directory of Open Access Journals (Sweden)

    Rockstroh Max

    2015-09-01

    Full Text Available In recent years, approaches for information and control integration in the digital operating room have emerged. A major step towards an intelligent operating room and a cooperative technical environment would be autonomous adaptation of medical devices and systems to the surgical workflow. The OR staff should be freed from information seeking and maintenance tasks. We propose a closed-loop concept integrating workflow monitoring, processing and (semi-automatic interaction to bridge the gap between OR integration of medical devices and workflow-related information management.

  10. Factors related to teamwork performance and stress of operating room nurses.

    Science.gov (United States)

    Sonoda, Yukio; Onozuka, Daisuke; Hagihara, Akihito

    2017-07-25

    To evaluate operating room nurses' perception of teamwork performance and their level of mental stress and to identify related factors. Little is known about the factors affecting teamwork and the mental stress of surgical nurses, although the performance of the surgical team is essential for patient safety. The questionnaire survey for operation room nurses consisted of simple questions about teamwork performance and mental stress. Multivariate analyses were used to identify factors causing a sense of teamwork performance or mental stress. A large number of surgical nurses had a sense of teamwork performance, but 30-40% of operation room nurses were mentally stressed during surgery. Neither the patient nor the operation factors were related to the sense of teamwork performance in both types of nurses. Among scrub nurses, endoscopic and abdominal surgery, body mass index, blood loss and the American Society of Anesthesiologists physical status class were related to their mental stress. Conversely, circulating nurses were stressed about teamwork performance. The factors related to teamwork performance and mental stress during surgery differed between scrub and circulating nurses. Increased support for operation room nurses is necessary. The increased support leads to safer surgical procedures and better patient outcomes. © 2017 John Wiley & Sons Ltd.

  11. Application of Time Management in Operation Room Nursing%时间管理在手术室护理管理中的应用

    Institute of Scientific and Technical Information of China (English)

    王光明; 陈佐彩

    2015-01-01

    目的:探讨时间管理对提高手术室工作效率的效果。方法我院2013年制定并实施手术室时间管理,通过成立质量管理小组、建立手术室时间质量管理制度、严格控制第一台手术开台时间、缩短手术室台间间隔时间、节假日适当安排择期手术等方式方法,提高手术室工作效率。结果2013年共实施手术2469台,日均手术6.8台,第一台手术准时开台率达83%,高于2012年的27%。2013年各科室人员对手术室护理工作满意度明显提高。结论在手术室实施时间管理,可有效提升手术室工作效率、医护人员工作满意度,而且提高了医院经济效益。%Objective To investigate the effect of time management to improve the work efifciency of the operation room.MethodsIn our hospital in 2013 to develop and implement operation room, time management, through the establishment of quality management team, the establishment of operation room time quality management system, strictly control the ifrst surgery founding time, shorten the operation room table time interval, holidays elective surgery way methods appropriate to improve the working efifciency of the operation room.Results A total of 2469 units in 2013 to implement the operation, the daily operation of 6.8 units. In 2013 the ifrst operation time of founding rate of 83%, higher than the 27% in 2012.In 2013 the Department staff on operation room nursing satisfaction improved signiifcantly.ConclusionThe implementation of time management in the operation room, operation room can effectively improve work efifciency, job satisfaction of medical staff, and improve the economic benefit of hospital.

  12. Shielding considerations for an operating room based intraoperative electron radiotherapy unit.

    Science.gov (United States)

    Mills, M D; Almond, P R; Boyer, A L; Ochran, T G; Madigan, W; Rich, T A; Dally, E B

    1990-05-01

    The leakage radiation characteristics of a dedicated intraoperative radiotherapy linear accelerator have been measured on a machine designed to minimize the shielding required to allow it to be placed in an operating room suite. The scattering foil design was optimized to produce a flat beam for the field sizes employed while generating minimal bremsstrahlung contamination over the available energy range. More lead shielding was used in the treatment head than is used in conventional accelerators. A small amount of borated polyethylene shielding was also employed since neutron production was present at measurable levels. The room shielding installed in the operating room was demonstrated to be adequate to treat at least 20 patients each month to an average dose of 20 Gy. The worst case exposure was found to be 73% maximum permissible exposure. Administrative control was required for adjoining areas when calibrations and maintenance were performed.

  13. Hospitalization in Small-Scale Contingency Operations

    Science.gov (United States)

    2006-05-31

    That Don’t): Creating Conditions for Effective Teamwork . San Francisco: Jossey-Bass Publishers. Hellriegel, Don, John W. Slocum, Jr., and Richard W...General Accounting Office. 1995. GAO. 1996. See United States General Accounting Office. 1996. Hackman , J. Richard, ed. 1990 . Groups That Work (and Those...on the characteristics and capabilities that echelon-III hospital units need in order to deploy and support SSCs under present and emerging conditions

  14. [Importance of material logistics in the interface management of operation departments: is the supply of sterile equipment a new business area of operation room organization?].

    Science.gov (United States)

    Schmeck, J; Schmeck, S B; Kohnen, W; Werner, C; Schäfer, M; Gervais, H

    2008-08-01

    The implementation of diagnosis-related groups (DRGs) sharply increased economic pressure on hospitals. Hence, process optimization was focussed on cost-intensive areas, namely the operation room (OR) departments. Work-flow in the OR is characterized by a mandatory interlocking of the job functions of many different occupational groups and the availability of a variety of different materials. Alternatives for staff assignment optimization have been published in numerous publications dealing with the importance of OR management. In this connection the issue of material logistics in the context of OR management has not been frequently addressed. In order to perform a surgical procedure according to plan, one depends on personnel and on timely availability of the materials needed. Supply of sterilized materials is of utmost importance, because in most hospitals sterilized surgical devices constitute a critical resource. In order to coordinate the OR process with the production flow of sterilized materials, an organizational connection to the OR management makes sense. Hence, in a German university hospital the Department of Hospital Sterile Supplies was integrated into the OR management of the Department of Anesthesiology. This led to a close coordination of work-flow processes, and concomitantly a significant reduction of production costs of sterile supplies could be achieved by direct interaction with the OR. Thus, hospital sterile supplies can reasonably be integrated into an OR management representing a new interesting business area for OR organization.

  15. Improving operating room efficiency by applying bin-packing and portfolio techniques to surgical case scheduling

    NARCIS (Netherlands)

    Houdenhoven, van M.; Oostrum, van J.M.; Hans, E.W.; Wullink, G.; Kazemier, G.

    2013-01-01

    BACKGROUND: An operating room (OR) department has adopted an efficient business model and subsequently investigated how efficiency could be further improved. The aim of this study is to show the efficiency improvement of lowering organizational barriers and applying advanced mathematical techniques.

  16. Are operating room nurses at higher risk of severe persistent asthma? The Nurses' Health Study.

    NARCIS (Netherlands)

    Moual, N. le; Varraso, R.; Zock, J.P.; Henneberger, P.; Speizer, F.E.; Kauffmann, F.; Camargo, C.A.

    2013-01-01

    Objective: To assess the associations between operating room (OR) nursing, a category of health care workers at high risk of exposure to various inhaled agents, and asthma severity/control among women with asthma. Methods: The level of severity/control in nurses with prevalent doctor-diagnosed asthm

  17. Room Temperature Operation of a Buried Heterostructure Photonic Crystal Quantum Cascade Laser

    CERN Document Server

    Peretti, R; Wolf, J M; Bonzon, C; Süess, M J; Lourdudoss, S; Metaferia, W; Beck, M; Faist, J

    2015-01-01

    We demonstrated room temperature operation of deep etched photonic crystal quantum cascade laser emitting around 8.5 micron. We fabricated buried heterostructure photonic crystals, resulting in single mode laser emission on a high order slow Bloch modes of the photonic crystal, between high symmetry points of the Brillouin.

  18. Improving operating room efficiency by applying bin-packing and portfolio techniques to surgical case scheduling

    NARCIS (Netherlands)

    van Houdenhoven, M.; van Oostrum, J.M.; Hans, Elias W.; Wullink, Gerhard; Kazemier, G.

    2013-01-01

    BACKGROUND: An operating room (OR) department has adopted an efficient business model and subsequently investigated how efficiency could be further improved. The aim of this study is to show the efficiency improvement of lowering organizational barriers and applying advanced mathematical techniques.

  19. Exploring perceptions of hospital operations by a modified SERVQUAL approach.

    Science.gov (United States)

    Reidenbach, R E; Sandifer-Smallwood, B

    1990-12-01

    The authors employ a modified SERVQUAL approach to understanding the relationships among patients' perceptions of inpatient, outpatient, and emergency room services and their overall perceptions of service quality, satisfaction with their care, and willingness to recommend the hospital's services to others. Three models of these perceptions and related behavioral variables are developed. Dominating these models is a dimension labeled "patient confidence," which has a significant impact on nearly all measures of patient satisfaction.

  20. The prevention and management of hospital infection in the stomatological consulting room%口腔科诊室医院感染的预防与管理

    Institute of Scientific and Technical Information of China (English)

    郭李柯

    2011-01-01

    目的 加强口腔科诊室医院感染的控制与管理,降低医院感染的发生率。方法 针对口腔科诊室的工作特点,制定并落实各项有效的消毒隔离措施和感染监测制度,严格执行无菌操作规程,创造合格的手术环境。结果 无菌切口感染率为0.19%,特殊感染手术无医院感染发生。结论 加强口腔科诊室医院感染的管理,可有效地防止医院感染的发生,降低无菌切口感染率。%Objective To strengthen the administration the the hospital infection control in the stomatological consulting room for decreasing the incidence rate of the hospital infection.Methods According to the working characteristics of the stomatological consulting room, we enacted and implemented the effective measures of disinfection, isolation and infection monitoring institution, strictly implemented the asepsis operating rules, and created a valid operation environment.Results The infection rate of the incisional wound was 0.19%.The hospital infection was not happened in the special infected operation.Conclusions To strengthen the administration of the hospital infection control in the stomatological consulting room can effectively prevent the hospital infection and reduce the infection rate of the incisional wound.

  1. Crew resource management improved perception of patient safety in the operating room.

    Science.gov (United States)

    Gore, Dennis C; Powell, Jennifer M; Baer, Jennifer G; Sexton, Karen H; Richardson, C Joan; Marshall, David R; Chinkes, David L; Townsend, Courtney M

    2010-01-01

    To improve safety in the operating theater, a company of aviation pilots was employed to guide implementation of preprocedural briefings. A 5-point Likert scale survey that assessed the attitudes of operating room personnel toward patient safety was distributed before and 6 months following implementation of the briefings. Using Mann-Whitney analysis, the survey showed a significant (P perception of patient safety, which was largely demonstrated by nursing personnel.

  2. [The army nurse, from hospital to overseas operations].

    Science.gov (United States)

    Guérot, Françoise; Saliou, Henri; Lefort, Hugues; De Rudnickl, Stéphane

    2014-09-01

    Assigned to French army teaching hospitals, the army nurse can be deployed on overseas operations in support of the armed forces. Experience in the treatment of casualties in life-threatening emergencies is essential, as is the ability to adapt and react. Designated on a voluntary basis, after some two years of working in an army teaching hospital, the hospital nurse receives training in the specificities of the theatre of deployment.

  3. The current status of procedural sedation for pediatric patients in out-of-operating room locations.

    Science.gov (United States)

    Havidich, Jeana E; Cravero, Joseph P

    2012-08-01

    To illustrate the changes that are occurring in the rapidly growing field of pediatric sedation. In the USA and throughout the world, children receive sedation from a multitude of specialists with varying levels of training. The current pediatric sedation literature reflects a growing body of sedation literature by medical specialists other than anesthesiologists. This article will review the controversial use of propofol by nonanesthesiologists and the manner in which this varied group of providers along with government entities, regulatory agencies, and national organizations contribute to the continuing evolution of sedation practices. The number of diagnostic and therapeutic procedures performed on children outside of the operating room continues to increase. The growing body of pediatric sedation literature suggests anesthesiologists are no longer at the forefront of pediatric sedation training, education, and research. Articles published by nonanesthesiologists describe pediatric sedation services, safety, and quality initiatives, drugs, and original sedation research. Medications that were considered under the realm of anesthesiologists are utilized by nonanesthesiologists to provide sedation to children. Regulating and government agencies, including the Joint Commission and the Center for Medicaid and Medicare Services have recently issued statements on the oversight and practice of sedation. The direction of pediatric sedation is no longer solely under the leadership of anesthesiologists. The use of anesthetic agents, including propofol, have been administered by nonanesthesiologists and reported as safe and effective agents. Nonanesthesiologists and governmental and regulatory agencies influence the delivery of sedation services. The future direction of pediatric sedation will ultimately depend upon the ability of anesthesiologists to collaborate with specialists, hospital administrators, credentialing committees, and oversight agencies in order to

  4. Analysis of hospital infection control awareness of ultrasound room office personnel in Busan

    Energy Technology Data Exchange (ETDEWEB)

    Kim, JJung Hoon; Kang, Se Sik; Kim, Chang Soo [Dept. of Radiological Science, College of Health Sciences, Catholic University of Pusan, Pusan (Korea, Republic of)

    2015-06-15

    146 people working in the ultrasound room in Busan were surveyed, and their perception of hospital infection was analyzed. According to the results of the survey, academic background showed the highest number in terms of awareness and performance of personal hygiene management and hand washing management, and the group with experience of infection education showed the highest number in terms of awareness of ultrasound equipment hygiene, and the group with less than college education showed the highest number in terms of performance of ultrasound equipment hygiene. The difference was statistically significant. Based on the results of this study, performance was lower than awareness in general. This result indicates that the degree of performance is inadequate. Therefore, it can be concluded that individuals need to change their perception of personal hygiene and take interest in it through infection education.

  5. Air-conditioning vs. presence of pathogenic fungi in hospital operating theatre environment.

    Science.gov (United States)

    Gniadek, Agnieszka; Macura, Anna B

    2011-01-01

    Infections related to modern surgical procedures present a difficult problem for contemporary medicine. Infections acquired during surgery represent a risk factor related to therapeutical interventions. Eradication of microorganisms from hospital operating theatre environment may contribute to reduction of infections as the laminar flow air-conditioning considerably reduces the number of microorganisms in the hospital environment. The objective of the study was to evaluate the occurrence of fungi in air-conditioned operating theatre rooms. The study was carried out in one of the hospitals in Krak6w during December 2009. Indoor air samples and imprints from the walls were collected from five operating theatre rooms. A total of fifty indoor air samples were collected with a MAS-100 device, and twenty five imprints from the walls were collected using a Count Tact method. Fungal growth was observed in 48 air samples; the average numbers of fungi were within the range of 5-100 c.f.u. in one cubic metre of the air. Fungi were detected only in four samples of the wall imprints; the number of fungi was 0.01 c.f.u. per one square centimetre of the surface. The mould genus Aspergillus was most frequently isolated, and the species A. fumigatus and A. versicolor were the dominating ones. To ensure microbiological cleanness of hospital operating theatre, the air-conditioning system should be properly maintained. Domination of the Aspergillus fungi in indoor air as well as increase in the number of moulds in the samples taken in evenings (p < 0.05) may suggest that the room decontamination procedures were neglected.

  6. An indoor radon survey of the X-ray rooms of Mexico City hospitals

    Energy Technology Data Exchange (ETDEWEB)

    Juarez, Faustino [Facultad de Ciencias, Universidad Autonoma del Estado de Mexico, Instituto Literario No. 100. Estado de Mexico, 50000, Mexico. Instituto de Geofisica, Universidad Nacional Autonoma de Mexico, Circuito (Mexico); Reyes, Pedro G. [Facultad de Ciencias, Universidad Autonoma del Estado de Mexico, Instituto Literario No. 100. Estado de Mexico, 50000 (Mexico); Espinosa, Guillermo [Instituto de Fisica, Universidad Nacional Autonoma de Mexico, Circuito Exterior Ciudad Universitaria, Mexico D.F. Cp.04510 (Mexico)

    2013-07-03

    This paper presents the results of measurements of indoor radon concentrations in the X-ray rooms of a selection of hospitals in the metropolitan area of Mexico City. The metropolitan area of Mexico City is Mexico's largest metropolitan area by population; the number of patients requiring the use of X-rays is also the highest. An understanding of indoor radon concentrations in X-ray rooms is necessary for the estimation of the radiological risk to which patients, radiologists and medical technicians are exposed. The indoor radon concentrations were monitored for a period of six months using nuclear track detectors (NTD) consisting of a closed-end cup system with CR-39 (Lantrack Registered-Sign ) polycarbonate as detector material. The indoor radon concentrations were found to be between 75 and 170 Bq m{sup -3}, below the USEPA-recommended indoor radon action level for working places of 400 Bq m{sup -3}. It is hoped that the results of this study will contribute to the establishment of recommended action levels by the Mexican regulatory authorities responsible for nuclear safety.

  7. An indoor radon survey of the X-ray rooms of Mexico City hospitals

    Science.gov (United States)

    Juárez, Faustino; Reyes, Pedro G.; Espinosa, Guillermo

    2013-07-01

    This paper presents the results of measurements of indoor radon concentrations in the X-ray rooms of a selection of hospitals in the metropolitan area of Mexico City. The metropolitan area of Mexico City is Mexico's largest metropolitan area by population; the number of patients requiring the use of X-rays is also the highest. An understanding of indoor radon concentrations in X-ray rooms is necessary for the estimation of the radiological risk to which patients, radiologists and medical technicians are exposed. The indoor radon concentrations were monitored for a period of six months using nuclear track detectors (NTD) consisting of a closed-end cup system with CR-39 (Lantrack®) polycarbonate as detector material. The indoor radon concentrations were found to be between 75 and 170 Bq m-3, below the USEPA-recommended indoor radon action level for working places of 400 Bq m-3. It is hoped that the results of this study will contribute to the establishment of recommended action levels by the Mexican regulatory authorities responsible for nuclear safety.

  8. Reducing cancelled surgery operations in a hospital: brief report

    Directory of Open Access Journals (Sweden)

    Ali Mohammad Mosadeghrad

    2016-08-01

    Full Text Available Background: Operation theatre in a hospital requires considerable human and physical resources to deliver surgery services on an agreed schedule. However, operation theatres are sometimes underutilized due to avoidable last minute cancellations of operations. Cancellation of operations on the day of intended surgery results in operation theatre planning difficulties, hospital inefficiency and resource wastage. In addition, it causes stress for patients and their relatives and results in unnecessary hospital staying. Cancellation of planned operations could be avoided by applying appropriate management strategies and techniques. Quality management as an organizational strategy helps enhance hospital departments’ productivity. Methods: This study aimed to reduce cancelled surgeries in Shahid Rajaei Hospital in Tehran using a quality management model. A participatory action research was used for the intervention between April 2013 and March 2014. Information on operations cancelled on the day of surgery obtained each day from the operating theatre list. Using a checklist, the reasons for operations cancellation were identified, investigated and an action plan was developed for its reduction. The plan was implemented using the action research cycle. Results: The number of surgeries increased by 4.06 percent and operations cancellation was reduced by 32.4 percent using the quality management strategy. Surgeon and anesthetist related factors, over-running of previous surgery, changes in patient clinical status and lack of intensive care unit beds were the main reasons for cancelling surgeries. Standardization of processes, proper planning and using anesthetics clinic helped reduce the operations cancellation. Conclusion: Last minute surgeries cancellation is potentially avoidable. Implementing an appropriate quality management model helps enhance hospital departments’ productivity and reduce surgical cancellation.

  9. HYBRID ALARM SYSTEMS: COMBINING SPATIAL ALARMS AND ALARM LISTS FOR OPTIMIZED CONTROL ROOM OPERATION

    Energy Technology Data Exchange (ETDEWEB)

    Ronald L. Boring; J.J. Persensky

    2012-07-01

    The US Department of Energy (DOE) is sponsoring research, development, and deployment on Light Water Reactor Sustainability (LWRS), in which the Idaho National Laboratory (INL) is working closely with nuclear utilities to develop technologies and solutions to help ensure the safe operational life extension of current nuclear power plants. One of the main areas of focus is control room modernization. Within control room modernization, alarm system upgrades present opportunities to meet the broader goals of the LWRS project in demonstrating the use and safety of the advanced instrumentation and control (I&C) technologies and the short-term and longer term objectives of the plant. In this paper, we review approaches for and human factors issues behind upgrading alarms in the main control room of nuclear power plants.

  10. Modern approach to the operation of a hospital

    Directory of Open Access Journals (Sweden)

    Christos Karasoulos

    2014-01-01

    Full Text Available The health sector is characterized by diversity due to its singularity but also the many professions associated with it (e.g. doctors, nurses, nursing attendants, managers, suppliers etc.. This kind of diversity has resulted in a dramatic increase of health costs leading hospitals into using business techniques to reduce costs. Purpose: The purpose of the present review was to explore the possibility of operating a hospital standards of operational policy. Material and Method: The methodology followed is based on searching and reviewing research studies and scientific articles abstracted from an international database (Scopus and from the Greek and international literature between the years 1996 to 2012, using keywords such as: hospital, business, health expenditure, supplies, total quality management. Results: The review of literature shows that hospitals suffered from mismanagement, excessive expenses and insufficient health care services. The application of Lean Six Sigma methodologies and TQM helped to reduce costs, the continuous control problems encountered in raising the level of benefits. Conclusions: The hospital cannot be associated with a business, because the hospital is meant to care for the public in general as opposed to businesses that aim at increasing their profits. However, adopting techniques of the business field, the hospitals have the ability to control operating costs and curb costs, therefore, the modern hospital can function as an ‘idiosyncratic’ form of business.

  11. Surgical safety checklist is associated with improved operating room safety culture, reduced wound complications, and unplanned readmissions in a pilot study in neurosurgery.

    Science.gov (United States)

    Lepänluoma, M; Takala, R; Kotkansalo, A; Rahi, M; Ikonen, T S

    2014-03-01

    The World Health Organization's surgical safety checklist is designed to improve adherence to operating room safety standards, and its use has been shown to reduce complications among surgical patients. The objective of our study was to assess the impact of the implementation of the checklist on safety-related issues in the operating room and on postoperative adverse events in neurosurgery. From structured questionnaires delivered to operating room personnel, answers were analyzed to evaluate communication and safety-related issues during 89 and 73 neurosurgical operations before and after the checklist implementation, respectively. From the analyzed operations, 83 and 67 patients, respectively, were included in a retrospective analysis of electronic patient records to compare the length of hospital stay, reported adverse events, and readmissions. In addition, the consistency of operating room documentation and patient records was assessed. Communication between the surgeon and the anesthesiologist was enhanced, and safety-related issues were better covered when the checklist was used. Unplanned readmissions fell from 25% to 10% after the checklist implementation (p = 0.02). Wound complications decreased from 19% to 8% (p = 0.04). The consistency of documentation of the diagnosis and the procedure improved. The use of the checklist improved safety-related performance and, contemporarily, reduced numbers of wound complications, and readmissions were observed.

  12. Physician-patient communication in single-bedded versus four-bedded hospital rooms.

    NARCIS (Netherlands)

    Glind, I. van de; Dulmen, S. van; Goossensen, A.

    2008-01-01

    Objective: To examine whether physician-patient communication in multi-bedded rooms differs from communication in single rooms during ward rounds. Methods: Ward rounds in single bedded patient rooms and ward rounds in four bedded rooms were audiotaped and analyzed with an adapted version of MIARS.

  13. Tactical increases in operating room block time based on financial data and market growth estimates from data envelopment analysis.

    Science.gov (United States)

    O'Neill, Liam; Dexter, Franklin

    2007-02-01

    Data envelopment analysis (DEA) is an established technique that hospitals and anesthesia groups can use to understand their potential to grow different specialties of inpatient surgery. Often related decisions such as recruitment of new physicians are made promptly. A practical challenge in using DEA in practice for this application has been the time to obtain access to and preprocess discharge data from states. A case study is presented to show how results of DEA are linked to financial analysis for purposes of deciding which surgical specialties should be provided more resources and institutional support, including the allocation of additional operating room (OR) block time on a tactical (1 yr) time course. State discharge abstract databases were used to study how to perform and present the DEA using data from websites of the United States' (US) Healthcare Cost and Utilization Project (HCUPNet) and Census Bureau (American FactFinder). DEA was performed without state discharge data by using census data with federal surgical rates adjusted for age and gender. Validity was assessed based on multiple criteria, including: satisfaction of statistical assumptions, face validity of results for hospitals, differentiation between efficient and inefficient hospitals on other measures of how much surgery is done, and correlation of estimates of each hospital's potential to grow the workload of each of eight specialties with estimates obtained using unrelated statistical methods. A hospital can choose specialties to target for expanded OR capacity based on its financial data, its caseloads for specific specialties, the caseloads from hospitals previously examined, and surgical rates from federal census data.

  14. 在导管室管理中手术室管理模式的可行性探讨%Feasibility study of management mode of operation room in the management of catheter room

    Institute of Scientific and Technical Information of China (English)

    丁小云; 周鹏飞; 王晓玉; 黄永丽

    2015-01-01

    Using operating room management mode gives independent management for catheter room,the department management is more standardized,the resource utilization is efficiency,the work team is professionalization,and the benefit is improved obviously.The catheter room is constructed into the second operation room of hospital,as an open and comprehensive platform which is characterized by interventional operation to manage.It is a kind of effective management mode.%目的:运用手术室管理模式对导管室进行独立管理,科室管理更加规范化,资源利用高效化,工作队伍专业化,效益明显提高。将导管室建设成医院的第二手术室,作为一个以介入手术为特色的开放性、综合性平台来管理,是一种行之有效的管理模式。

  15. Comparison of hospital room surface disinfection using a novel ultraviolet germicidal irradiation (UVGI) generator.

    Science.gov (United States)

    Jelden, Katelyn C; Gibbs, Shawn G; Smith, Philip W; Hewlett, Angela L; Iwen, Peter C; Schmid, Kendra K; Lowe, John J

    2016-09-01

    The estimated 721,800 hospital acquired infections per year in the United States have necessitated development of novel environmental decontamination technologies such as ultraviolet germicidal irradiation (UVGI). This study evaluated the efficacy of a novel, portable UVGI generator (the TORCH, ChlorDiSys Solutions, Inc., Lebanon, NJ) to disinfect surface coupons composed of plastic from a bedrail, stainless steel, chrome-plated light switch cover, and a porcelain tile that were inoculated with methicillin-resistant Staphylococcus aureus (MRSA) or vancomycin-resistant Enterococcus faecalis (VRE). Each surface type was placed at 6 different sites within a hospital room and treated by 10-min ultraviolet-C (UVC) exposures using the TORCH with doses ranging from 0-688 mJ/cm(2) between sites. Organism reductions were compared with untreated surface coupons as controls. Overall, UVGI significantly reduced MRSA by an average of 4.6 log10 (GSD: 1.7 log10, 77% inactivation, p < 0.0001) and VRE by an average of 3.9 log10 (GSD: 1.7 log10, 65% inactivation, p < 0.0001). MRSA on bedrail was reduced significantly (p < 0.0001) less than on other surfaces, while VRE was reduced significantly less on chrome (p = 0.0004) and stainless steel (p = 0.0012) than porcelain tile. Organisms out of direct line of sight of the UVC generator were reduced significantly less (p < 0.0001) than those directly in line of sight. UVGI was found an effective method to inactivate nosocomial pathogens on surfaces evaluated within the hospital environment in direct line of sight of UVGI treatment with variation between organism and surface types.

  16. Undergraduate surgical nursing preparation and guided operating room experience: A quantitative analysis.

    Science.gov (United States)

    Foran, Paula

    2016-01-01

    The aim of this research was to determine if guided operating theatre experience in the undergraduate nursing curricula enhanced surgical knowledge and understanding of nursing care provided outside this specialist area in the pre- and post-operative surgical wards. Using quantitative analyses, undergraduate nurses were knowledge tested on areas of pre- and post-operative surgical nursing in their final semester of study. As much learning occurs in nurses' first year of practice, participants were re-tested again after their Graduate Nurse Program/Preceptorship year. Participants' results were compared to the model of operating room education they had participated in to determine if there was a relationship between the type of theatre education they experienced (if any) and their knowledge of surgical ward nursing. Findings revealed undergraduates nurses receiving guided operating theatre experience had a 76% pass rate compared to 56% with non-guided or no experience (p < 0.001). Graduates with guided operating theatre experience as undergraduates or graduate nurses achieved a 100% pass rate compared to 53% with non-guided or no experience (p < 0.001). The research informs us that undergraduate nurses achieve greater learning about surgical ward nursing via guided operating room experience as opposed to surgical ward nursing experience alone.

  17. A Scheduling Problem for Hospital Operating Theatre

    CERN Document Server

    Sufahani, Suliadi F; Ismail, Zuhaimy

    2012-01-01

    This paper provides a classification of real scheduling problems. Various ways have been examined and described on the problem. Scheduling problem faces a tremendous challenges and difficulties in order to meet the preferences of the consumer. Dealing with scheduling problem is complicated, inefficient and time-consuming. This study aims to develop a mathematical model for scheduling the operating theatre during peak and off peak time. Scheduling problem is a well known optimization problem and the goal is to find the best possible optimal solution. In this paper, we used integer linear programming technique for scheduling problem in a high level of synthesis. In addition, time and resource constrained scheduling was used. An optimal result was fully obtained by using the software GLPK/AMPL. This model can be adopted to solve other scheduling problems, such as the Lecture Theatre, Cinemas and Work Shift.

  18. High-density magnetoresistive random access memory operating at ultralow voltage at room temperature.

    Science.gov (United States)

    Hu, Jia-Mian; Li, Zheng; Chen, Long-Qing; Nan, Ce-Wen

    2011-11-22

    The main bottlenecks limiting the practical applications of current magnetoresistive random access memory (MRAM) technology are its low storage density and high writing energy consumption. Although a number of proposals have been reported for voltage-controlled memory device in recent years, none of them simultaneously satisfy the important device attributes: high storage capacity, low power consumption and room temperature operation. Here we present, using phase-field simulations, a simple and new pathway towards high-performance MRAMs that display significant improvements over existing MRAM technologies or proposed concepts. The proposed nanoscale MRAM device simultaneously exhibits ultrahigh storage capacity of up to 88 Gb inch(-2), ultralow power dissipation as low as 0.16 fJ per bit and room temperature high-speed operation below 10 ns.

  19. Single-use surgical clothing system for reduction of airborne bacteria in the operating room.

    Science.gov (United States)

    Tammelin, A; Ljungqvist, B; Reinmüller, B

    2013-07-01

    It is desirable to maintain a low bacterial count in the operating room air to prevent surgical site infection. This can be achieved by ventilation or by all staff in the operating room wearing clothes made from low-permeable material (i.e. clean air suits). We investigated whether there was a difference in protective efficacy between a single-use clothing system made of polypropylene and a reusable clothing system made of a mixed material (cotton/polyester) by testing both in a dispersal chamber and during surgical procedures. Counts of colony-forming units (cfu)/m(3) air were significantly lower when using the single-use clothing system in both settings. Copyright © 2013 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.

  20. [Design of an anesthesia and micro-environment information management system in mobile operating room].

    Science.gov (United States)

    Wang, Xianwen; Liu, Zhiguo; Zhang, Wenchang; Wu, Qingfu; Tan, Shulin

    2013-08-01

    We have designed a mobile operating room information management system. The system is composed of a client and a server. A client, consisting of a PC, medical equipments, PLC and sensors, provides the acquisition and processing of anesthesia and micro-environment data. A server is a powerful computer that stores the data of the system. The client gathers the medical device data by using the C/S mode, and analyzes the obtained HL7 messages through the class library call. The client collects the micro-environment information with PLC, and finishes the data reading with the OPC technology. Experiment results showed that the designed system could manage the patient anesthesia and micro-environment information well, and improve the efficiency of the doctors' works and the digital level of the mobile operating room.

  1. Implications of Surgical Training on Operating Room Throughput at Wilford Hall Medical Center

    Science.gov (United States)

    2008-06-26

    its physician specialists, 85 percent of dental specialists, and a full spectrum of other training. The medical center’s fourth mission is clinical...dedicated to training dental officers of the three services in one facility. The medical center’s support of San Antonio’s emergency medicine structure...P. (2006). Resident teaching versus the operating room schedule: An independent observer- based study of 1558 cases. Anesthesia and Analgesia , 103

  2. Continuous-wave operation of a room-temperature Tm: YAP-pumped Ho: YAG laser

    Institute of Scientific and Technical Information of China (English)

    2008-01-01

    We report a continuous-wave (CW) 2.1-μm Ho:YAG laser operating at room temperature pumped by a diode-pumped 1.94-?m Tm:YAP laser.The maximum output power of 1.5 W is obtained from Ho:YAG laser,corresponding to Tm-to-Ho slope efficiency of 17.9% and diode-to-He conversion efficiency of 5.6%.

  3. Mirror thermal noise in laser interferometer gravitational wave detectors operating at room and cryogenic temperature

    CERN Document Server

    Franc, Janyce; Flaminio, Raffaele; Nawrodt, Ronny; Martin, Iain; Cunningham, Liam; Cumming, Alan; Rowan, Sheila; Hough, James

    2009-01-01

    Mirror thermal noise is and will remain one of the main limitations to the sensitivity of gravitational wave detectors based on laser interferometers. We report about projected mirror thermal noise due to losses in the mirror coatings and substrates. The evaluation includes all kind of thermal noises presently known. Several of the envisaged substrate and coating materials are considered. The results for mirrors operated at room temperature and at cryogenic temperature are reported.

  4. The effects of Chamomile tea on antioxidative biomarkers in operating room staff

    Directory of Open Access Journals (Sweden)

    Sami Ghazal

    2015-07-01

    Full Text Available Introduction: Chamomile tea (CT is an herbal tea and is served as a beneficial herbal infusion all over the world. Its major polyphenols constituents and tea-catechins have been shown to have health benefits. Operating room staff are commonly exposed to damaging factors, such as radiation, waste anesthetic gases and psychological stress. One of the most important qualities of CT is its antioxidant property. The aim of this study was to evaluate the effects of CT in reducing the oxidative stress of operative room staff that are chronically exposed to damaging factors. Methods: In this study we approached to 20 operating room personnel. The subjects drank 2 cups of CT (every cup contained 1.8730 g of chamomile and 300 ml of water daily, one cup in the morning and another in the afternoon for 21 days. A questionnaire that contained personal information was filled by each subject. Oxidative stress parameters such as total antioxidant capacity (TAC, catalase (CAT and total thiol molecules (TTG were measured 2 times: first before drinking CT at the first day and the next time after the 21st day. Results: Consumption of CT by subjects caused a significant induction in TAC (6.62 ± 0.77 vs 4.81± 0.39 ųmol/ml, P < .05 of saliva. There was not any statistically significant change in saliva TTG and CAT after 21 days of drinking CT. Conclusion: In the end we came to conclusion that CT can be a useful additional food to remove the oxidative damage that happens to operating room staff.

  5. Assessment of nursing students' stress levels and coping strategies in operating room practice.

    Science.gov (United States)

    Yildiz Findik, Ummu; Ozbas, Ayfer; Cavdar, Ikbal; Yildizeli Topcu, Sacide; Onler, Ebru

    2015-05-01

    The aim of this study was to evaluate the stress levels and stress coping strategies of nursing students in their first operating room experience. This descriptive study was done with 126 nursing students who were having an experience in an operating room for the first time. Data were collected by using Personal Information Form, Clinical Stress Questionnaire, and Styles of Coping Inventory. The nursing students mostly had low clinical stress levels (M = 27.56, SD = 10.76) and adopted a self-confident approach in coping with stress (M = 14.3, SD = 3.58). The nursing students generally employed a helpless/self-accusatory approach among passive patterns as their clinical stress levels increased, used a self-confident and optimistic approach among active patterns as their average age increased, and those who had never been to an operating room previously used a submissive approach among passive patterns. The results showed that low levels of stress caused the nursing students to use active patterns in coping with stress, whereas increasing levels of stress resulted in employing passive patterns in stress coping. The nursing students should be ensured to maintain low levels of stress and use active patterns in stress coping.

  6. Alcoholics and drug addicts at the emergency room of the hospital. Analysis of the staff behavior and patients' progressions.

    Science.gov (United States)

    Corten, P; Pelc, I

    1986-01-01

    The statistical analysis of a large sample (1.707 cases) was carried out using objective variables. These variables consist of the key points in the progression of alcoholics and drug addicts within two emergency departments situated in general hospitals. This study pinpoints a lack of therapeutic work at the emergency room where neither medical diagnoses nor psychopathological analyses seem to be done.

  7. Use of operating room information system data to predict the impact of reducing turnover times on staffing costs.

    Science.gov (United States)

    Dexter, Franklin; Abouleish, Amr E; Epstein, Richard H; Whitten, Charles W; Lubarsky, David A

    2003-10-01

    Potential benefits to reducing turnover times are both quantitative (e.g., complete more cases and reduce staffing costs) and qualitative (e.g., improve professional satisfaction). Analyses have shown the quantitative arguments to be unsound except for reducing staffing costs. We describe a methodology by which each surgical suite can use its own numbers to calculate its individual potential reduction in staffing costs from reducing its turnover times. Calculations estimate optimal allocated operating room (OR) time (based on maximizing OR efficiency) before and after reducing the maximum and average turnover times. At four academic tertiary hospitals, reductions in average turnover times of 3 to 9 min would result in 0.8% to 1.8% reductions in staffing cost. Reductions in average turnover times of 10 to 19 min would result in 2.5% to 4.0% reductions in staffing costs. These reductions in staffing cost are achieved predominantly by reducing allocated OR time, not by reducing the hours that staff work late. Heads of anesthesiology groups often serve on OR committees that are fixated on turnover times. Rather than having to argue based on scientific studies, this methodology provides the ability to show the specific quantitative effects (small decreases in staffing costs and allocated OR time) of reducing turnover time using a surgical suite's own data. Many anesthesiologists work at hospitals where surgeons and/or operating room (OR) committees focus repeatedly on turnover time reduction. We developed a methodology by which the reductions in staffing cost as a result of turnover time reduction can be calculated for each facility using its own data. Staffing cost reductions are generally very small and would be achieved predominantly by reducing allocated OR time to the surgeons.

  8. Economic assessment of aseptic compounding rooms in hospital pharmacies in five European countries.

    Science.gov (United States)

    Dekyndt, Bérengère; Décaudin, Bertrand; Lannoy, Damien; Odou, Pascal

    2015-04-01

    The aims of the study are to make an inventory of fixtures of aseptic compounding structures, to compare, using real examples, the design and operating costs of controlled atmosphere area (CAA) with isolators and CAA with laminar flow biological safety cabinets (BSCs) in order to determine the most economical scheme in hospitals and to give a final facilities cost calculated for one workstation. Forty-three hospitals were interviewed (21 French and 22 from four European countries) over seven months. Hospital pharmacists completed a form with 390 items. Hospitals are compared according to their workstation type: BSCII or BSCIII (group B) and isolator (group I), using Mann and Whitney's statistical test and Monte-Carlo modeling. Twenty-one hospitals responded (11 French and 10 from other European countries). All European compounding unit organizations are not significantly different. The study compared items such as infrastructure cost, equipment cost, staff cost, consumable cost, cleaning cost and control cost. A synthesis of all costs has been drafted to calculate an estimated preparation cost which seemed to be higher for group B than for group I when staff costs were included ($46 and $31, respectively, in study conditions). The different costs studied have revealed little significant difference between group B and I. The preparation cost in group B appears higher than in group I. This pilot study has resulted in the calculation of an estimated manufactured preparation cost but this work should be completed to help optimize resources and save money. © The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

  9. Operational Auditing in, Hospitality Businesses via Data Envelopment Analysis

    Directory of Open Access Journals (Sweden)

    Süleyman Uyar

    2014-12-01

    Full Text Available In today's world, as in almost all sectors, there is intense competition in the tourism sector. Activity levels of accommodation establishments in the tourism sector have a very important place because of competitive market conditions. When it comes to efficiency measurem ent, control activities come to mind. Data Envelopment Analysis (DEA can be used in operational auditing as a tool for performance measurement The purpose of this study is to make the operational auditing activities of accommodation establishments in Alanya with the DEA. In this study, data for the year 2013 of 37 accommodation establishments were evaluated. As input variables, number of rooms, number of beds, the annual average number of employees, annual energy costs and annual food and beverage expenses were used. As output variables; customer satisfaction, the annual number of overnight stays, occupancy rates and room revenues are used. The obtained results show that the accommodation establishments of five are active.

  10. Room-temperature operation of mid-infrared surface-plasmon quantum cascade lasers

    Science.gov (United States)

    Bahriz, M.; Moreau, V.; Palomo, J.; Krysa, A. B.; Austin, D.; Cockburn, J. W.; Roberts, J. S.; Wilson, L. R.; Julien, F.; Colombelli, R.

    2007-04-01

    We report the pulsed, room-temperature operation of an InGaAs/AllnAs quantum cascade laser at an operating wavelength of ≈ 7.5 μm in which the optical mode is a surface-plasmon polariton excitation. The use of a silver-based electrical contact with reduced optical losses at the laser emission wavelength allows for a reduction of the laser threshold current by a factor of two relative to samples with a gold-based contact layer.

  11. Alcohol based surgical prep solution and the risk of fire in the operating room: a case report

    Directory of Open Access Journals (Sweden)

    Gupta Rajiv

    2008-04-01

    Full Text Available Abstract A few cases of fire in the operating room are reported in the literature. The factors that may initiate these fires are many and include alcohol based surgical prep solutions, electrosurgical equipment, flammable drapes etc. We are reporting a case of fire in the operating room while operating on a patient with burst fracture C6 vertebra with quadriplegia. The cause of the fire was due to incomplete drying of the covering drapes with an alcohol based surgical prep solution. This paper discusses potential preventive measures to minimize the incidence of fire in the operating room.

  12. Thinking in three's: Changing surgical patient safety practices in the complex modern operating room

    Institute of Scientific and Technical Information of China (English)

    Verna C Gibbs

    2012-01-01

    The three surgical patient safety events,wrong site surgery,retained surgical items (RSI) and surgical fires are rare occurrences and thus their effects on the complex modern operating room (OR) are difficult to study.The likelihood of occurrence and the magnitude of risk for each of these surgical safety events are undefined.Many providers may never have a personal experience with one of these events and training and education on these topics are sparse.These circumstances lead to faulty thinking that a provider won't ever have an event or if one does occur the provider will intuitively know what to do.Surgeons are not preoccupied with failure and tend to usually consider good outcomes,which leads them to ignore or diminish the importance of implementing and following simple safety practices.These circumstances contribute to the persistent low level occurrence of these three events and to the difficulty in generating sufficient interest to resource solutions.Individual facilities rarely have the time or talent to understand these events and develop lasting solutions.More often than not,even the most well meaning internal review results in a new line to a policy and some rigorous enforcement mandate.This approach routinely fails and is another reason why these problems are so persistent.Vigilance actions alone have been unsuccessful so hospitals now have to take a systematic approach to implementing safer processes and providing the resources for surgeons and other stakeholders to optimize the OR environment.This article discusses standardized processes of care for mitigation of injury or outright prevention of wrong site surgery,RSI and surgical fires in an action-oriented framework illustrating the strategic elements important in each event and focusing on the responsibilities for each of the three major OR agents-anesthesiologists,surgeons and nurses.A Surgical Patient Safety Checklist is discussed that incorporates the necessary elements to bring these team

  13. Achieving hospital operating objectives in the light of patient preferences.

    Science.gov (United States)

    Ramirez Valdivia, M T; Crowe, T J

    1997-01-01

    Patient satisfaction is becoming increasingly important for the successful operation of private and public hospitals. The quality of the service provided can be improved if internal and external customers' opinions are taken into account during the definition of hospital operating objectives. This research presents a new methodology, called the simulation service quality system (SSQS), developed to improve operating performance measures in the light of customer preferences. The motivation for the development of the SSQS methodology arose from the need to achieve timeliness standards at United States Veterans' Hospitals. The Harry S. Truman Memorial Veterans' Hospital in Columbia Missouri served as the validation and initial application site for the SSQS methodology. Details one such project: the objective of reducing customer waiting times to 30 minutes or less at an outpatient treatment clinic. Through the identification of relationships and interactions, discrete-event simulation techniques are applied to model and experiment with the system to ultimately arrive at recommended changes in hospital operating policies which achieve the objective.

  14. AN IMPACT OF THE EFFICIENT FUNCTIONING OF THE VENTILATION AND AIR-CONDITIONING SYSTEM ON THERMAL COMFORT OF THE MEDICAL STAFF IN THE OPERATING ROOM

    Directory of Open Access Journals (Sweden)

    Tomasz Jankowski

    2016-11-01

    Full Text Available Ventilation and air conditioning systems are necessary for developing proper parameters of indoor envi-ronment in operating rooms. The main task of ventilation and air conditioning in those specific areas consists in creating desirable temperature, reducing the number of microorganisms and the concen-trations of hazardous gases and substances in the air, as well as ensuring the proper direction of airflow. In Poland, indoor environment in operating rooms has to comply with the requirements set out in three regulations (Journal of Laws of 2002 No. 75, item 690, as amended, Journal of Laws of 2002 No. 217, item 1833, Journal of Laws of 2011 No. 31, item 158, as amended and the document entitled "Guidelines for the design of general hospitals". Given insufficient accuracy of the abovementioned national documents, it is a common practice to use foreign standards, i.e. ASHRAE Standard 170-2013, DIN 1946-4: 2008 and FprCEN TR 16244: 2011. When considering the conditions for thermal comfort, it is important to bear in mind a close link between air flow velocity and air temperature. Air in the zone occupied by patients and medical staff must not cause the sensation of draft. Furthermore, air velocity should be sufficient to eliminate interference caused by the presence of people and other sources of heat. It should also reduce the turbulence level in the air in the operating room. Efficient functioning of ventilation and air conditioning was tested during treatments and operations carried out on three wards of a Warsaw hospital. Tests were performed with the participation of medical staff from various surgical units. They were asked to perform minor manual tasks to simulate work on the op-erating table, and to complete a questionnaire on subjective thermal sensation. The applied methodology is widely used during testing of general and local ventilation in public buildings. Air temperature, relative humidity, air flow supply and exhaust air from the

  15. [Air conditioning units and warm air blankets in the operating room].

    Science.gov (United States)

    Kerwat, Klaus; Piechowiak, Karolin; Wulf, Hinnerk

    2013-01-01

    Nowadays almost all operating rooms are equipped with air conditioning (AC units). Their main purpose is climatization, like ventilation, moisturizing, cooling and also the warming of the room in large buildings. In operating rooms they have an additional function in the prevention of infections, especially the avoidance of postoperative wound infections. This is achieved by special filtration systems and by the creation of specific air currents. Since hypothermia is known to be an unambiguous factor for the development of postoperative wound infections, patients are often actively warmed intraoperatively using warm air blankets (forced-air warming units). In such cases it is frequently discussed whether such warm air blankets affect the performance of AC units by changing the air currents or whether, in contrast, have exactly the opposite effect. However, it has been demonstrated in numerous studies that warm air blankets do not have any relevant effect on the functioning of AC units. Also there are no indications that their use increases the rate of postoperative wound infections. By preventing the patient from experiencing hypothermia, the rate of postoperative wound infections can even be decreased thereby. © Georg Thieme Verlag Stuttgart · New York.

  16. Assessment of operative times of multiple surgical specialties in a public university hospital.

    Science.gov (United States)

    Costa, Altair da Silva

    2017-01-01

    To evaluate the indicators duration of anesthesia, operative time and time patients stay in the operating rooms of different surgical specialties at a public university hospital. It was done by a descriptive cross-sectional study based on the operating room database. The following stages were measured: duration of anesthesia, procedure time and patient length of stay in the room of the various specialties. We included surgeries carried out in sequence in the same room, between 7:00 a.m. and 5 p.m., either elective or emergency. We calculated the 80th percentile of the stages, where 80% of procedures were below this value. The study measured 8,337 operations of 12 surgical specialties performed within one year. The overall mean duration of anesthesia of all specialties was 178.12±110.46 minutes, and the 80th percentile was 252 minutes. The mean operative time was 130.45±97.23 minutes, and the 80th percentile was 195 minutes. The mean total time of the patient in the operating room was 197.30±113.71 minutes, and the 80th percentile was 285 minutes. Thus, the variation of the overall mean compared to the 80th percentile was 41% for anesthesia, 49% for surgeries and 44% for operating room time. In average, anesthesia took up 88% of the operating room period, and surgery, 61%. This study identified patterns in the duration of surgery stages. The mean values of the specialties can assist with operating room planning and reduce delays. Avaliar os indicadores de tempo da anestesia, da operação e da permanência do paciente em sala de diversas especialidades do centro cirúrgico de um hospital universitário. Foi realizado em estudo descritivo transversal a partir da base de dados do centro cirúrgico e mensuradas as seguintes etapas: duração de anestesia, tempo do procedimento e tempo de permanência do paciente em sala das diversas especialidades. Foram incluídas as operações realizadas em sequência na mesma sala, das 7h às 17h, eletivas ou de urg

  17. Green monolithic II-VI vertical-cavity surface-emitting laser operating at room temperature

    Science.gov (United States)

    Kruse, C.; Ulrich, S. M.; Alexe, G.; Roventa, E.; Kröger, R.; Brendemühl, B.; Michler, P.; Gutowski, J.; Hommel, D.

    2004-02-01

    The realization of a monolithic all II-VI-based vertical cavity surface emitting laser (VCSEL) for the green spectral region is reported. Optically pumped lasing operation was achieved up to room temperature using a planar VCSEL structure. Taking advantage of distributed Bragg-reflectors based on MgS/Zn(Cd)Se superlattices as the low-refractive index material and ZnS0.06Se0.94 layers as the high-index material with a refractive index contrast of n = 0.6, a quality factor exceeding Q = 2000 is reached by using only 18 Bragg periods for the bottom DBR and 15 Bragg periods for the top DBR. The threshold power density is 0.32 MW/cm2 at a temperature of 10 K (emission wavelength 498.5 nm) and 1.9 MW/cm2 at room temperature (emission wavelength 502.3 nm).

  18. Effects of redecoration of a hospital isolation room with natural materials on stress levels of denizens in cold season

    Science.gov (United States)

    Ohta, Hiromi; Maruyama, Megumi; Tanabe, Yoko; Hara, Toshiko; Nishino, Yoshihiko; Tsujino, Yoshio; Morita, Eishin; Kobayashi, Shotai; Shido, Osamu

    2008-05-01

    We investigated the effects of redecoration of a hospital isolation room with natural materials on thermoregulatory, cardiovascular and hormonal parameters of healthy subjects staying in the room. Two isolation rooms with almost bilaterally-symmetrical arrangements were used. One room (RD) was redecorated with wood paneling and Japanese paper, while the other (CN) was unchanged (with concrete walls). Seven healthy male subjects stayed in each room for over 24 h in the cold season. Their rectal temperature (Tre) and heart rate, and the room temperature (Ta) and relative humidity were continuously measured. Arterial blood pressures, arterial vascular compliance, thermal sensation and thermal comfort were measured every 4 h except during sleeping. Blood was sampled after the stay in the rooms. In RD, Ta was significantly higher by about 0.4°C and relative humidity was lower by about 5% than in CN. Diurnal Tre levels of subjects in RD significantly differed from those in CN, i.e., Tres were significantly higher in RD than in CN especially in the evening. In RD, the subjects felt more thermally-comfortable than in CN. Redecoration had minimal effects on cardiovascular parameters. Plasma levels of catecholamines and antidiuretic hormone did not differ, while plasma cortisol level was significantly lower after staying in RD than in CN by nearly 20%. The results indicate that, in the cold season, redecoration with natural materials improves the thermal environment of the room and contributes to maintaining core temperature of denizens at preferable levels. It also seems that redecoration of room could attenuate stress levels of isolated subjects.

  19. Virtual Visual Effect of Hospital Waiting Room on Pain Modulation in Healthy Subjects and Patients with Chronic Migraine

    Directory of Open Access Journals (Sweden)

    Marina de Tommaso

    2013-01-01

    Full Text Available Environmental context has an important impact on health and well being. We aimed to test the effects of a visual distraction induced by classical hospital waiting room (RH versus an ideal room with a sea view (IH, both represented in virtual reality (VR, on subjective sensation and cortical responses induced by painful laser stimuli (LEPs in healthy volunteers and patients with chronic migraine (CM. Sixteen CM and 16 controls underwent 62 channels LEPs from the right hand, during a fully immersive VR experience, where two types of waiting rooms were simulated. The RH simulated a classical hospital waiting room while the IH represented a room with sea viewing. CM patients showed a reduction of laser pain rating and vertex LEPs during the IH vision. The sLORETA analysis confirmed that in CM patients the two VR simulations induced a different modulation of bilateral parietal cortical areas (precuneus and superior parietal lobe, and superior frontal and cingulate girus, in respect to controls. The architectural context may interfere with pain perception, depending upon the status of subject. Many variables may change patients’ outcome and support the use of VR technology to test the best conditions for their management.

  20. Tracheotomy in Pediatric Patients: In Operating Room or Intensive Care Unit?

    Directory of Open Access Journals (Sweden)

    Umut Kaygusuz

    2014-08-01

    Full Text Available Introduction: The morbidity and mortality rates of tracheotomy are higher in the pediatric population because the incision is small and the trachea is more prone to surgical trauma. Tracheotomy procedure is mostly performed in operating room in most institutions. The aim of the study is to compare the outcomes of tracheotomy procedures between intensive care unit (ICU and operating room (OR in terms of pitfalls, complications and family preferences. Materials and Methods: In between June 2012 and July 2013, at a single institution, 39 patients were prospectively analyzed for age, gender, primary pathology, tracheotomy indications, location of operation, the duration of family consent, perioperative complications and presence of decanulation. Results: Male/female ratio was 20/19. Mean age was 49.9±52.5 (4-204 months. Tracheotomy procedure was performed in OR in 19 patients (45% and in ICU in 20 (54.5% patients. There was no statistically significant difference between groups in terms of complications (OR-48.7%, ICU-51.3%. The time of informed consent was significantly shorter in ICU patients. Conclusions: There is no significant difference in terms of safety for tracheotomy procedure in ICU or OR. Parents give approval to a bedside invasive procedure faster. The words ‘Surgery’ and ‘Operating room’ can easily confuse the parents, extend the duration for endolaryngeal intubation, and increase the cost and labour loss.

  1. Dry lab practice leads to improved laparoscopic performance in the operating room.

    Science.gov (United States)

    Stelzer, Marie K; Abdel, Matthew P; Sloan, Michael P; Gould, Jon C

    2009-06-01

    Research has demonstrated that practice in surgical simulators leads to improved performance in that simulator. Our hypothesis is that skills acquired in simulators are transferable to the operating room. Twenty-three laparoscopically naïve surgical interns performed two standardized tasks in a simulator: pegboard transfer and intracorporeal knot tying. Performance was measured using a validated scoring system. On the same day as this initial assessment, subjects were videotaped performing two tasks in a live porcine model: running the small bowel and intracorporeal knot tying. Performance in the porcine model was measured using a modified version of a validated skills assessment tool by two blinded experts. Following a 6-wk proficiency-based dry lab laparoscopic training course, task performance was re-evaluated. No interval live operative laparoscopic experience occurred between the first and second assessment. After training, mean pegboard transfer scores increased from 118.7 to 181.8 (theoretical maximum = 300; P operative model. We believe that this is evidence that laparoscopic skills developed in a dry laboratory setting are transferable to the operating room.

  2. A System-Wide Approach to Physician Efficiency and Utilization Rates for Non-Operating Room Anesthesia Sites.

    Science.gov (United States)

    Tsai, Mitchell H; Huynh, Tinh T; Breidenstein, Max W; O'Donnell, Stephen E; Ehrenfeld, Jesse M; Urman, Richard D

    2017-07-01

    There has been little in the development or application of operating room (OR) management metrics to non-operating room anesthesia (NORA) sites. This is in contrast to the well-developed management framework for the OR management. We hypothesized that by adopting the concept of physician efficiency, we could determine the applicability of this clinical productivity benchmark for physicians providing services for NORA cases at a tertiary care center. We conducted a retrospective data analysis of NORA sites at an academic, rural hospital, including both adult and pediatric patients. Using the time stamps from WiseOR® (Palo Alto, CA), we calculated site utilization and physician efficiency for each day. We defined scheduling efficiency (SE) as the number of staffed anesthesiologists divided by the number of staffed sites and stratified the data into three categories (SE 1). The mean physician efficiency was 0.293 (95% CI, [0.281, 0.305]), and the mean site utilization was 0.328 (95% CI, [0.314, 0.343]). When days were stratified by scheduling efficiency (SE 1), we found differences between physician efficiency and site utilization. On days where scheduling efficiency was less than 1, that is, there are more sites than physicians, mean physician efficiency (95% CI, [0.326, 0.402]) was higher than mean site utilization (95% CI, [0.250, 0.296]). We demonstrate that scheduling efficiency vis-à-vis physician efficiency as an OR management metric diverge when anesthesiologists travel between NORA sites. When the opportunity to scale operational efficiencies is limited, increasing scheduling efficiency by incorporating different NORA sites into a "block" allocation on any given day may be the only suitable tactical alternative.

  3. Analysis of verbal communication during teaching in the operating room and the potentials for surgical training.

    Science.gov (United States)

    Blom, E M; Verdaasdonk, E G G; Stassen, L P S; Stassen, H G; Wieringa, P A; Dankelman, J

    2007-09-01

    Verbal communication in the operating room during surgical procedures affects team performance, reflects individual skills, and is related to the complexity of the operation process. During the procedural training of surgeons (residents), feedback and guidance is given through verbal communication. A classification method based on structural analysis of the contents was developed to analyze verbal communication. This study aimed to evaluate whether a classification method for the contents of verbal communication in the operating room could provide insight into the teaching processes. Eight laparoscopic cholecystectomies were videotaped. Two entire cholecystectomies and the dissection phase of six additional procedures were analyzed by categorization of the communication in terms of type (4 categories: commanding, explaining, questioning, and miscellaneous) and content (9 categories: operation method, location, direction, instrument handling, visualization, anatomy and pathology, general, private, undefinable). The operation was divided into six phases: start, dissection, clipping, separating, control, closing. Classification of the communication during two entire procedures showed that each phase of the operation was dominated by different kinds of communication. A high percentage of explaining anatomy and pathology was found throughout the whole procedure except for the control and closing phases. In the dissection phases, 60% of verbal communication concerned explaining. These explaining communication events were divided as follows: 27% operation method, 19% anatomy and pathology, 25% location (positioning of the instrument-tissue interaction), 15% direction (direction of tissue manipulation), 11% instrument handling, and 3% other nonclassified instructions. The proposed classification method is feasible for analyzing verbal communication during surgical procedures. Communication content objectively reflects the interaction between surgeon and resident. This

  4. 浅谈手术室的整体护理%Operating Room Holistic Nursing

    Institute of Scientific and Technical Information of China (English)

    王丽娜

    2015-01-01

    This paper discusses the operation room nursing work not only with technical operation, simple operation, should also pay attention to humanistic care operation patients. Master the communication skills. In the process of nursing operation should take the patient as the center to respect the rights of people to serve patients. Caring patients is all care as the starting point and destination, to realize the whole process of operation of holistic nursing. The effective implementation of holistic nursing operation room will improve patient's satisfaction to our work to change from passive to active nursing care.%本文论述了手术室的护理工作不能仅限于配合手术等单纯的技术操作,也应该注重手术患者的人文关怀,掌握沟通技巧。在进行各项护理操作过程中,都要以患者为中心开展,尊重患者的权利,服务于患者。把对患者的关怀作为一切护理工作的出发点和归宿,真正实现手术全过程整体化护理。手术室整体护理模式的有效实施将会提高患者就医满意度,把我们的工作由被动护理转变为主动护理。

  5. Factors predicting the increased risk for return to the operating room in bariatric patients: a NSQIP database study.

    Science.gov (United States)

    Nandipati, Kalyana; Lin, Edward; Husain, Farah; Perez, Sebastian; Srinivasan, Jahnavi; Sweeney, John F; Davis, S Scott

    2013-04-01

    The objective of the study was to assess the risk factors associated with return to the operating room in bariatric surgery patients. Using the American College of Surgeons-National Surgical Quality Improvement Project's participant-use file, patients who underwent laparoscopic gastric bypass (LRYGB) and adjustable gastric band (LAGB) procedures for morbid obesity were identified. Several pre-, peri-, and postoperative variables, including 30 day morbidity and mortality, were collected. The study population was divided into two groups: patients returning to the operating room (group 1), and patients not returning to the operating room (group 2). Variables analyzed included postoperative complications, overall morbidity, and mortality. Relationships between preoperative and perioperative factors leading to the return to the operating room also were analyzed. Of 28,241 (LRYGB = 18,671, LAGB = 9,570) patients included in the study, 644 (2.3 %) patients returned to the operating room. Of the study population, 30 day mortality rate was 0.13 % (37/28,241) and morbidity was 4.1 % (1,155/28,241). Patients returning to the operating room had a higher mortality [14/644 (2.2 %) vs. 23/27,597 (0.01 %); P return to the operating room. Postoperative complications (superficial wound infection, deep surgical site infection, organ space infection, pneumonia, pulmonary embolism, renal insufficiency, renal failure, septic shock, and length of stay) were significantly higher for patients who required reoperation. On multivariate logistic regression analysis, the bypass operation, bleeding disorder, patients on dialysis, preoperative hematocrit, preoperative low albumin, and length of operation were associated with increased risk of return to the operating room. In the bariatric population, return to the operating room is associated with significantly higher morbidity and mortality. Patients who are on dialysis, have a low preoperative serum albumin, and a history of bleeding disorders

  6. A qualitative study of Western Australian women's perceptions of using a Snoezelen room for breastfeeding during their postpartum hospital stay

    Science.gov (United States)

    Hauck, Yvonne L; Summers, Lisa; White, Ellie; Jones, Cheryl

    2008-01-01

    Background There is limited evidence on the use of the Snoezelen concept for maternity clients. Snoezelen, a Dutch concept, initiated in the 1970s as a leisure activity for severely disabled people, involves creating an indoor environment using controllable stimuli to enhance comfort and relaxation. These specially designed rooms expose the user to multiple sensory stimulations combining vision, touch, sounds and aromas. The aim of this study was to provide insight into breastfeeding women's experience of using a Snoezelen room during hospitalisation. Methods A qualitative exploratory design was chosen to reveal women's perceptions of using the Snoezelen room. Osborne Park Hospital, the study setting is the second largest public provider of obstetric services in Western Australia. A purposive sample was drawn from breastfeeding women who used the Snoezelen room during their postpartum stay from March 2006 to March 2007. Saturation was achieved after eleven breastfeeding women were interviewed six weeks post discharge. Data analysis involved the constant comparison method. Results Participants entered the room feeling tired and emotional with an unsettled baby and breastfeeding issues aggravated by maternal stress and anxiety. All women indicated they were able to achieve relaxation while in the room and would recommend its use to other breastfeeding mothers. Two key themes revealed how the Snoezelen room facilitated maternal relaxation, which ultimately enhanced the breastfeeding experience. The first theme, "Finding Relaxation for the Breastfeeding Mother" incorporates three subthemes: 'Time out' for mother; Control in own personal space; and a Quiet/calm environment with homelike atmosphere. The second theme, "Enabling Focus on Breastfeeding", occurred after relaxation was achieved and involved four subthemes: Able to get one-on-one attention; Not physically exposed to others; Away from prying, judgemental eyes and Able to safely attempt breastfeeding alone

  7. A qualitative study of Western Australian women's perceptions of using a Snoezelen room for breastfeeding during their postpartum hospital stay

    Directory of Open Access Journals (Sweden)

    White Ellie

    2008-08-01

    Full Text Available Abstract Background There is limited evidence on the use of the Snoezelen concept for maternity clients. Snoezelen, a Dutch concept, initiated in the 1970s as a leisure activity for severely disabled people, involves creating an indoor environment using controllable stimuli to enhance comfort and relaxation. These specially designed rooms expose the user to multiple sensory stimulations combining vision, touch, sounds and aromas. The aim of this study was to provide insight into breastfeeding women's experience of using a Snoezelen room during hospitalisation. Methods A qualitative exploratory design was chosen to reveal women's perceptions of using the Snoezelen room. Osborne Park Hospital, the study setting is the second largest public provider of obstetric services in Western Australia. A purposive sample was drawn from breastfeeding women who used the Snoezelen room during their postpartum stay from March 2006 to March 2007. Saturation was achieved after eleven breastfeeding women were interviewed six weeks post discharge. Data analysis involved the constant comparison method. Results Participants entered the room feeling tired and emotional with an unsettled baby and breastfeeding issues aggravated by maternal stress and anxiety. All women indicated they were able to achieve relaxation while in the room and would recommend its use to other breastfeeding mothers. Two key themes revealed how the Snoezelen room facilitated maternal relaxation, which ultimately enhanced the breastfeeding experience. The first theme, "Finding Relaxation for the Breastfeeding Mother" incorporates three subthemes: 'Time out' for mother; Control in own personal space; and a Quiet/calm environment with homelike atmosphere. The second theme, "Enabling Focus on Breastfeeding", occurred after relaxation was achieved and involved four subthemes: Able to get one-on-one attention; Not physically exposed to others; Away from prying, judgemental eyes and Able to safely

  8. A study on scattered dose in operation room by C-arm unit

    Energy Technology Data Exchange (ETDEWEB)

    An, Sung Min; Oh, Jung Hwan; Kim, Sung Chul [Gachon Gil College, Incheon (Korea, Republic of)

    2000-04-15

    This paper studied a C-arm's exposure condition and measured scatter rays by thickness and distance. This study reached the following conclusion. Approximately exposure dose for a patient using fluoroscopy is as follows: Mostly, an operating room was not shielding by lead and operator put on only apron without thyroid and facial part protection. 0.5 mmPb equivalent's apron shielded about 99% of scattered rays at 60 cm from x-ray tube. Scattered rays are depended on distance and thickness so operators are should be careful when using fluoroscopy by C-arm and if possible use high frequency equipment that has a large output.

  9. Forced-air warming: a source of airborne contamination in the operating room?

    Directory of Open Access Journals (Sweden)

    David Leaper

    2009-12-01

    Full Text Available Forced-air-warming (FAW is an effective and widely used means for maintaining surgical normothermia, but FAW also has the potential to generate and mobilize airborne contamination in the operating room. We measured the emission of viable and non-viable forms of airborne contamination from an arbitrary selection of FAW blowers (n=25 in the operating room. A laser particle counter measured particulate concentrations of the air near the intake filter and in the distal hose airstream. Filtration efficiency was calculated as the reduction in particulate concentration in the distal hose airstream relative to that of the intake. Microbial colonization of the FAW blower’s internal hose surfaces was assessed by culturing the microorganisms recovered through swabbing (n=17 and rinsing (n=9 techniques. Particle counting revealed that 24% of FAW blowers were emitting significant levels of internally generated airborne contamination in the 0.5 to 5.0 mm size range, evidenced by a steep decrease in FAW blower filtration efficiency for particles 0.5 to 5.0 mm in size. The particle size-range-specific reduction in efficiency could not be explained by the filtration properties of the intake filter. Instead, the reduction was found to be caused by size-range-specific particle generation within the FAW blowers. Microorganisms were detected on the internal air path surfaces of 94% of FAW blowers. The design of FAW blowers was found to be questionable for preventing the build-up of internal contamination and the emission of airborne contamination into the operating room. Although we did not evaluate the link between FAW and surgical site infection rates, a significant percentage of FAW blowers with positive microbial cultures were emitting internally generated airborne contamination within the size range of free floating bacteria and fungi (<4 mm that could, conceivably, settle onto the surgical site.

  10. Teaching techniques in the operating room: the importance of perceptual motor teaching.

    Science.gov (United States)

    Skoczylas, Laura C; Littleton, Eliza B; Kanter, Steven L; Sutkin, Gary

    2012-03-01

    To identify sucessful teaching techniques in the operating room environment through examining the teaching of the midurethral sling (MUS) surgery. The authors distributed questionnaires with open-ended questions about teaching and learning MUS to 5 urogynecology attendings and 16 obstetrics-gynecology residents in spring 2010. In an effort to identify qualities of an effective sling teacher, the authors used grounded theory to determine common themes and to code participant responses for examples. Of 21 potential respondents, 14 (67%) returned questionnaires. The authors analyzed these and identified seven commonalities among effective sling teachers: they (1) emphasize anatomical landmarks (as determined by 64 total comments); (2) use perceptual-motor teaching (PMT; 38 comments); (3) encourage repetition (28); (4) promote early independence (34); (5) demonstrate confident competence (23); (6) maintain a calm demeanor in the operating room (20); and (7) exhibit a willingness to accept responsibility for mistakes and consequences (9). The second-most common attribute, using PMT, requires the teaching attending to emphasize the motor and tactile aspects of operating and involves incorporating not only what learners see but also what they feel. The authors report seven qualities or techniques fundamental to good teaching practice in a high-stress, high-technology surgical environment, and they have identified the use of PMT, which to their knowledge has not been previously described. Teachers and learners in this study characterized PMT, which is likely generalizable to surgical procedures other than the MUS, as important. Future research should focus on exploring this technique in other surgeries.

  11. Automation inflicted differences on operator performance in nuclear power plant control rooms

    Energy Technology Data Exchange (ETDEWEB)

    Andersson, Jonas; Osvalder, A.L. [Chalmers Univ. of Technology, Dept. of Product and Producton Development (Sweden)

    2007-03-15

    Today it is possible to automate almost any function in a human-machine system. Therefore it is important to find a balance between automation level and the prerequisites for the operator to maintain safe operation. Different human factors evaluation methods can be used to find differences between automatic and manual operations that have an effect on operator performance; e.g. Predictive Human Error Analysis (PHEA), NASA Task Load Index (NASA-TLX), Halden Questionnaire, and Human Error Assessment and Reduction Technique (HEART). Results from an empirical study concerning automation levels, made at Ringhals power plant, showed that factors as time pressure and criticality of the work situation influenced the operator's performance and mental workload more than differences in level of automation. The results indicate that the operator's attention strategies differ between the manual and automatic sequences. Independently of level of automation, it is essential that the operator retains control and situational understanding. When performing a manual task, the operator is 'closer' to the process and in control with sufficient situational understanding. When the level of automation increases, the demands on information presentation increase to ensure safe plant operation. The need for control can be met by introducing 'control gates' where the operator has to accept that the automatic procedures are continuing as expected. Situational understanding can be established by clear information about process status and by continuous feedback. A conclusion of the study was that a collaborative control room environment is important. Rather than allocating functions to either the operator or the system, a complementary strategy should be used. Key parameters to consider when planning the work in the control room are time constraints and task criticality and how they affect the performance of the joint cognitive system.However, the examined working

  12. Don't break the chain: importance of supply chain management in the operating room setting.

    Science.gov (United States)

    Bilyk, Candis

    2008-09-01

    Management of supplies within the operating room (OR) has considerable implications for decreasing healthcare costs while maintaining high-quality patient care. This area of healthcare therefore requires more monitoring by end-users including OR management, physicians, and nursing staff. This article is based on understanding supply chain management in the OR setting. Information provided throughout the article can be applied to small or large health care centers. It defines supply chain management and contains a brief overview of supply chain processes. It reviews the benefits of following these processes. The article also includes recommendations for improving the supply chain in the OR.

  13. Bed-integrated local exhaust ventilation system combined with local air cleaning for improved IAQ in hospital patient rooms

    DEFF Research Database (Denmark)

    Bivolarova, Mariya Petrova; Melikov, Arsen Krikor; Mizutani, Chiyomi;

    2016-01-01

    The performance of a ventilated mattress (VM) used as a bed-integrated local exhaust ventilation system combined with air cleaning fabric (acid-treated activated carbon fibre (ACF) fabric) was developed and studied. The separate and combined effect of the VM and the local air cleaning for reducing...... micro-environment was exhausted. Two modes of operation were studied: 1) the exhausted polluted air was discharged out of the room and 2) the polluted air was cleaned by the ACF material installed inside the mattress and recirculated back into the room. Both modes of operation efficiently reduced...

  14. 精益医疗管理在手术室运营中的应用%Application of Refined Medical Care Management in Operation Room Process

    Institute of Scientific and Technical Information of China (English)

    关兵; 许海文; Juan Amador; Brent Dobsch; Jose Paredes

    2014-01-01

    Objective To understand the current status of operation room process , and find out the reason of the decrease of surgery operation.To propose the improving measures, and achieve continuous quality improve -ment.Method Observing the following items of certain third -level grade -A hospital operation room , including daily work processes, whole process of each operation from preparation to start to the end , all the time of each link. Rendering the value stream map, finding out the efficiency factors which influence the value flow of each link .Put forward some suggestions.Conclusion The main factors affecting the operation quantities of hospital were as fol -lows: the number of beds; the number of operation room; the number of medical personnel (including: the sur-geon, anesthesiologist, operation nurse), etc.%目的:了解手术室流程现状,找出外科手术量下降的原因,实施改进措施,持续监控改进效果。方法观察某三级甲等医院手术室每日工作流程,监测每台手术从准备、开始到结束的全部过程,并详细记录各环节所需时间,应用精益医疗的方法绘制手术室价值流图,找出影响价值流中各环节效率的问题并提出改进建议。结论影响某三甲医院手术量的主要因素为:①床位数量;②手术间数量;③医护人员数量(包括:外科医师、麻醉师、手术护士)等。

  15. The evolution of a purpose designed hybrid trauma operating room from the trauma service perspective: the RAPTOR (Resuscitation with Angiography Percutaneous Treatments and Operative Resuscitations).

    Science.gov (United States)

    Kirkpatrick, Andrew W; Vis, Christine; Dubé, Mirette; Biesbroek, Susan; Ball, Chad G; Laberge, Jason; Shultz, Jonas; Rea, Ken; Sadler, David; Holcomb, John B; Kortbeek, John

    2014-09-01

    Traumatic injury is the leading cause of potentially preventable lost years of life in the Western world and exsanguination is the most potentially preventable cause of post-traumatic death. With mature trauma systems and experienced trauma centres, extra-abdominal sites, such as the pelvis, constitute the most frequent anatomic site of exsanguination. Haemorrhage control for such bleeding often requires surgical adjuncts most notably interventional radiology (IR). With the usual paradigm of surgery conducted within an operating room and IR procedures within distant angiography suites, responsible clinicians are faced with making difficult decisions regarding where to transport the most physiologically unstable patients for haemorrhage control. If such a critical patient is transported to the wrong suite, they may die unnecessarily despite having potentially salvageable injuries. Thus, it seems only logical that the resuscitative operating room of the future would have IR capabilities making it the obvious geographic destination for critically unstable patients, especially those who are exsanguinating. Our trauma programme recently had the opportunity to conceive, design, build, and operationalise a purpose-designed hybrid trauma operating room, designated as the resuscitation with angiographic percutaneous techniques and operative resuscitation (RAPTOR) suite, which we believe to be the first such resource designed primarily to serve the exsanguinating trauma patient. The project was initiated after consultations between the trauma programme and private philanthropists regarding the greatest potential impacts on regional trauma care. The initial capital construction costs were thus privately generated but coincided with a new hospital wing construction allowing the RAPTOR to be purpose-designed for the exsanguinating patient. Many trauma programmes around the world are now starting to navigate the complex process of building new facilities, or else retrofitting

  16. Development of Alarm System link Drawing for Operation Support for APR1400 Digital Main Control Room

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Ki-Hwan [KHNP CRI, Daejeon (Korea, Republic of)

    2016-10-15

    Digitalized MMI(Man-Machine Interface) including Digital Main Control Room(MCR) and digital I and C system was being applied for SKN 3 and 4 Nuclear Power Plant(NPP) and subsequent APR1400 NPP type. But, operators can not easily find instrument for alarm immediately. Therefore, Alarm system is required to easily find instrument for Alarm. For this implementation, we will plan system design considering design feature without affecting network load and CPU load. We have developed Alarm system link drawing for digital MCR. Operators of the digitalized MCR navigates from their consoles to the drawings related to the plant alarms and their instruments or the operation status. Such method gives cognitive load to the operators having to travel to different locations in finding the related information. Screen Sharing System, which is the fundamental technique for Drawing Interconnection Alarm System is close to completion, and it should be functionally tested and verified by the human factor engineering. For the actual application to the operating plants, the drawings to be interconnected to the alarms and the opinions from the operators/maintenance departments for designating alarm number should be surveyed, Also, another function that allows the access to the alarm related drawings not only from the MCR but also from the other offices.

  17. Human Factors Guidance for Control Room and Digital Human-System Interface Design and Modification, Guidelines for Planning, Specification, Design, Licensing, Implementation, Training, Operation and Maintenance

    Energy Technology Data Exchange (ETDEWEB)

    R. Fink, D. Hill, J. O' Hara

    2004-11-30

    Nuclear plant operators face a significant challenge designing and modifying control rooms. This report provides guidance on planning, designing, implementing and operating modernized control rooms and digital human-system interfaces.

  18. Air quality monitoring of the post-operative recovery room and locations surrounding operating theaters in a medical center in Taiwan.

    Science.gov (United States)

    Tang, Chin-Sheng; Wan, Gwo-Hwa

    2013-01-01

    To prevent surgical site infection (SSI), the airborne microbial concentration in operating theaters must be reduced. The air quality in operating theaters and nearby areas is also important to healthcare workers. Therefore, this study assessed air quality in the post-operative recovery room, locations surrounding the operating theater area, and operating theaters in a medical center. Temperature, relative humidity (RH), and carbon dioxide (CO2), suspended particulate matter (PM), and bacterial concentrations were monitored weekly over one year. Measurement results reveal clear differences in air quality in different operating theater areas. The post-operative recovery room had significantly higher CO2 and bacterial concentrations than other locations. Bacillus spp., Micrococcus spp., and Staphylococcus spp. bacteria often existed in the operating theater area. Furthermore, Acinetobacter spp. was the main pathogen in the post-operative recovery room (18%) and traumatic surgery room (8%). The mixed effect models reveal a strong correlation between number of people in a space and high CO2 concentration after adjusting for sampling locations. In conclusion, air quality in the post-operative recovery room and operating theaters warrants attention, and merits long-term surveillance to protect both surgical patients and healthcare workers.

  19. Air quality monitoring of the post-operative recovery room and locations surrounding operating theaters in a medical center in Taiwan.

    Directory of Open Access Journals (Sweden)

    Chin-Sheng Tang

    Full Text Available To prevent surgical site infection (SSI, the airborne microbial concentration in operating theaters must be reduced. The air quality in operating theaters and nearby areas is also important to healthcare workers. Therefore, this study assessed air quality in the post-operative recovery room, locations surrounding the operating theater area, and operating theaters in a medical center. Temperature, relative humidity (RH, and carbon dioxide (CO2, suspended particulate matter (PM, and bacterial concentrations were monitored weekly over one year. Measurement results reveal clear differences in air quality in different operating theater areas. The post-operative recovery room had significantly higher CO2 and bacterial concentrations than other locations. Bacillus spp., Micrococcus spp., and Staphylococcus spp. bacteria often existed in the operating theater area. Furthermore, Acinetobacter spp. was the main pathogen in the post-operative recovery room (18% and traumatic surgery room (8%. The mixed effect models reveal a strong correlation between number of people in a space and high CO2 concentration after adjusting for sampling locations. In conclusion, air quality in the post-operative recovery room and operating theaters warrants attention, and merits long-term surveillance to protect both surgical patients and healthcare workers.

  20. Air Quality Monitoring of the Post-Operative Recovery Room and Locations Surrounding Operating Theaters in a Medical Center in Taiwan

    Science.gov (United States)

    Tang, Chin-Sheng; Wan, Gwo-Hwa

    2013-01-01

    To prevent surgical site infection (SSI), the airborne microbial concentration in operating theaters must be reduced. The air quality in operating theaters and nearby areas is also important to healthcare workers. Therefore, this study assessed air quality in the post-operative recovery room, locations surrounding the operating theater area, and operating theaters in a medical center. Temperature, relative humidity (RH), and carbon dioxide (CO2), suspended particulate matter (PM), and bacterial concentrations were monitored weekly over one year. Measurement results reveal clear differences in air quality in different operating theater areas. The post-operative recovery room had significantly higher CO2 and bacterial concentrations than other locations. Bacillus spp., Micrococcus spp., and Staphylococcus spp. bacteria often existed in the operating theater area. Furthermore, Acinetobacter spp. was the main pathogen in the post-operative recovery room (18%) and traumatic surgery room (8%). The mixed effect models reveal a strong correlation between number of people in a space and high CO2 concentration after adjusting for sampling locations. In conclusion, air quality in the post-operative recovery room and operating theaters warrants attention, and merits long-term surveillance to protect both surgical patients and healthcare workers. PMID:23573296

  1. Consequences for overcrowding in the emergency room of a change in bed management policy on available in-hospital beds.

    Science.gov (United States)

    Claret, Pierre-Géraud; Boudemaghe, Thierry; Bobbia, Xavier; Stowell, Andrew; Miard, Élodie; Sebbane, Mustapha; Landais, Paul; De La Coussaye, Jean-Emmanuel

    2015-10-19

    Objective Emergency rooms play an important role by providing continuous access to healthcare 24 h a day, 7 days a week, but the lack of available hospital beds has become a major difficulty. Changing bed management policy could improve patient flow. The aim of the present study was to evaluate the consequences of a change in patient prioritisation on available beds.Methods The study consisted of a computerised bed management simulation based on day-by-day data collected from 1 to 31 January 2013 in a teaching hospital. Real hospital data were used to power the computer simulation. The scenarios tested were: (1) priority for emergency and surgery; (2) priority for emergency and medicine; (3) priority for planned admissions and surgery; and (4) priority for planned admissions and medicine. The results of these scenarios were compared with each other and to actual data.Results This study included 2347 patients. The scenario that proved to be the least efficient was the one that gave priority to emergency patients presenting with a medical condition. The scenario that exhibited the best efficiency was the one that gave priority to planned admissions and surgery.Conclusions Changing policies for hospital bed management is worth exploring to improve hospital patient flow and length of stay.What is known about the topic? The lack of available hospital beds is a major difficulty in managing patient flow in emergency rooms (ERs). The ER patient flow competes against a flow of planned hospital admissions for the same beds and the lack of a clearly defined policy on either prioritising ER patient flow over planned admissions or vice versa contributes to a disordered system.What does this paper add? We compared several simulated scenarios corresponding to different bed management policies. The scenario that gave priority to planned admissions and surgery gave the most suitable results.What are the implications for practitioners? Postponing scheduled surgical patients was not

  2. The emergency room at the Rotunda Hospital: evidence of an improving service over the past 3 years.

    LENUS (Irish Health Repository)

    Talukdar, S

    2014-12-01

    This is a retrospective review of the Rotunda Hospital Emergency Room (ER) documentation with respect to attendances for a 4-month period (August-November) in both 2009 and 2012. The aim was to quantify the workload and assess the quality of care offered to patients attending the ER over the two time periods and to highlight any improvements in care after changes were implemented following the initial 2009 review.

  3. A professional and cost effective digital video editing and image storage system for the operating room.

    Science.gov (United States)

    Scollato, A; Perrini, P; Benedetto, N; Di Lorenzo, N

    2007-06-01

    We propose an easy-to-construct digital video editing system ideal to produce video documentation and still images. A digital video editing system applicable to many video sources in the operating room is described in detail. The proposed system has proved easy to use and permits one to obtain videography quickly and easily. Mixing different streams of video input from all the devices in use in the operating room, the application of filters and effects produces a final, professional end-product. Recording on a DVD provides an inexpensive, portable and easy-to-use medium to store or re-edit or tape at a later time. From stored videography it is easy to extract high-quality, still images useful for teaching, presentations and publications. In conclusion digital videography and still photography can easily be recorded by the proposed system, producing high-quality video recording. The use of firewire ports provides good compatibility with next-generation hardware and software. The high standard of quality makes the proposed system one of the lowest priced products available today.

  4. Health risks associated with exposure to surgical smoke for surgeons and operation room personnel.

    Science.gov (United States)

    Okoshi, Kae; Kobayashi, Katsutoshi; Kinoshita, Koichi; Tomizawa, Yasuko; Hasegawa, Suguru; Sakai, Yoshiharu

    2015-08-01

    Although surgical smoke contains potentially hazardous substances, such as cellular material, blood fragments, microorganisms, toxic gases and vapors, many operating rooms (ORs) do not provide protection from exposure to it. This article reviews the hazards of surgical smoke and the means of protecting OR personnel. Our objectives are to promote surgeons' acceptance to adopt measures to minimize the hazards. Depending on its components, surgical smoke can increase the risk of acute and chronic pulmonary conditions, cause acute headaches; irritation and soreness of the eyes, nose and throat; dermatitis and colic. Transmission of infectious disease may occur if bacterial or viral fragments present in the smoke are inhaled. The presence of carcinogens in surgical smoke and their mutagenic effects are also of concern. This review summarizes previously published reports and data regarding the toxic components of surgical smoke, the possible adverse effects on the health of operating room personnel and measures that can be used to minimize exposure to prevent respiratory problems. To reduce the hazards, surgical smoke should be removed by an evacuation system. Surgeons should assess the potential dangers of surgical smoke and encourage the use of evacuation devices to minimize potential health hazards to both themselves and other OR personnel.

  5. Outside the operating room: How a robotics program changed resource utilization on the inpatient Ward.

    Science.gov (United States)

    Leung, Annie; Abitbol, Jeremie; Ramana-Kumar, Agnihotram V; Fadlallah, Bassam; Kessous, Roy; Cohen, Sabine; Lau, Susie; Salvador, Shannon; Gotlieb, Walter H

    2017-04-01

    To analyze the changes in the composition of the gynecologic oncology inpatient ward following the implementation of a robotic surgery program and its impact on inpatient resource utilization and costs. Retrospective review of the medical charts of patients admitted onto the gynecologic oncology ward the year prior to and five years after the implementation of robotics. The following variables were collected: patient characteristics, hospitalization details (reason for admission and length of hospital stay), and resource utilization (number of hospitalization days, consultations, and imaging). Following the introduction of robotic surgery, there were more admissions for elective surgery yet these accounted for only 21% of the inpatient ward in terms of number of hospital days, compared to 36% prior to the robotic program. This coincided with a sharp increase in the overall number of patients operated on by a minimally invasive approach (15% to 76%, probotics era. The robotics program contributed to a ward with higher proportion of patients with complex comorbidities (Charlson≥5: RR 1.06), Stage IV disease (RR 1.30), and recurrent disease (RR 1.99). Introduction of robotic surgery allowed for more patients to be treated surgically while simultaneously decreasing inpatient resource use. With more patients with non-surgical oncological issues and greater medical complexity, the gynecologic oncology ward functions more like a medical rather than surgical ward after the introduction of robotics, which has implications for hospital-wide resource planning. Copyright © 2017 Elsevier Inc. All rights reserved.

  6. Room-temperature operation of a titanium supersaturated silicon-based infrared photodetector

    Science.gov (United States)

    García-Hemme, E.; García-Hernansanz, R.; Olea, J.; Pastor, D.; del Prado, A.; Mártil, I.; González-Díaz, G.

    2014-05-01

    We report room-temperature operation of 1 × 1 cm2 infrared photoconductive photodetectors based on silicon supersaturated with titanium. We have fabricated these Si-based infrared photodetectors devices by means of ion implantation followed by a pulsed laser melting process. A high sub-band gap responsivity of 34 mV W-1 has been obtained operating at the useful telecommunication applications wavelength of 1.55 μm (0.8 eV). The sub-band gap responsivity shows a cut-off frequency as high as 1.9 kHz. These Si-based devices exhibit a non-previous reported specific detectivity of 1.7 × 104 cm Hz1/2 W-1 at 660 Hz, under a 1.55 μm wavelength light. This work shows the potential of Ti supersaturated Si as a fully CMOS-compatible material for the infrared photodetection technology.

  7. [The application of operating room quality backward system in instrument place management].

    Science.gov (United States)

    Du, Hui; He, Anjie; Zeng, Leilei

    2010-09-01

    Improvement of the surgery instrument's clean quality, the optimized preparation way, reasonable arrangement in groups, raising the working efficiency. We use the quality backward system into the instrument clean, the pack and the preparation way's question, carry on the analysis and the optimization, and appraise the effect after trying out 6 months. After finally the way optimized, instrument clean quality distinct enhancement; The flaws in the instrument clean, the pack way and the total operating time reduce; the contradictory between nurses and the cleans arising from the unclear connection reduces, the satisfaction degree of nurse and doctor to the instrument enhances. Using of operating room quality backward system in the management of the instrument clean, the pack and the preparation way optimized, may reduce flaws in the work and the waste of human resources, raise the working efficiency.

  8. Which algorithm for scheduling add-on elective cases maximizes operating room utilization? Use of bin packing algorithms and fuzzy constraints in operating room management.

    Science.gov (United States)

    Dexter, F; Macario, A; Traub, R D

    1999-11-01

    The algorithm to schedule add-on elective cases that maximizes operating room (OR) suite utilization is unknown. The goal of this study was to use computer simulation to evaluate 10 scheduling algorithms described in the management sciences literature to determine their relative performance at scheduling as many hours of add-on elective cases as possible into open OR time. From a surgical services information system for two separate surgical suites, the authors collected these data: (1) hours of open OR time available for add-on cases in each OR each day and (2) duration of each add-on case. These empirical data were used in computer simulations of case scheduling to compare algorithms appropriate for "variable-sized bin packing with bounded space." "Variable size" refers to differing amounts of open time in each "bin," or OR. The end point of the simulations was OR utilization (time an OR was used divided by the time the OR was available). Each day there were 0.24 +/- 0.11 and 0.28 +/- 0.23 simulated cases (mean +/- SD) scheduled to each OR in each of the two surgical suites. The algorithm that maximized OR utilization, Best Fit Descending with fuzzy constraints, achieved OR utilizations 4% larger than the algorithm with poorest performance. We identified the algorithm for scheduling add-on elective cases that maximizes OR utilization for surgical suites that usually have zero or one add-on elective case in each OR. The ease of implementation of the algorithm, either manually or in an OR information system, needs to be studied.

  9. Investigation the situation of emergeny preparation for sudden event in operating room%手术室突发事件应急准备现状调查

    Institute of Scientific and Technical Information of China (English)

    张健; 彭文涛

    2012-01-01

    Objective:To understand operation room emergency ready to present situation in third -class hospital in our province,to find in the process of operation, the main problems of to improve and perfect the operating room emergency ready to provide the basis. Methods: A self-designed questionnaire for 20 home province of the 200 of the third class hospitals and operating room medical staff to the operating room for emergency situation investigation. Results: 20 Hospital in tnird-class operation room of the emergency response plan of basic finish, but lack of the revision of the plan, emergency command authority of organization was yet to be strengthening;Emergency training,drill a weak. And emergency supplies reserves management was yet to be standard ,promote emergency work of specialized talents training and capital insufficiency, not enough attention and leadership. Conclusion: Thirs-class hospital operation room must research on emergency plan revision, perfect the construction of emergency command system organization, to carry out the emergency training, drill, evaluation and the basic guarantee emergency rescue, increase emergency funds and leadership support,and to improve the operating room contingency ability.%目的:了解我省三级医院手术室突发事件应急准备现状,以发现运行过程中存在的主要问题,为改进和完善手术室突发事件应急准备提供依据.方法:采用自行设计问卷,对我省20家三级医院的200名手术室医护人员进行手术室突发事件应急准备现状调查.结果:20家三级医院手术室应急预案的编制基本完成,但缺乏对预案的修订;应急组织指挥的权威性尚待加强;应急培训、演练环节薄弱;应急物资储备管理尚待规范;推动突发事件应急工作的专业化人才培训和资金不足以及领导重视不够等.结论:我省三级医院手术室需开展对突发事件应急预案的修订,完善应急组织指挥体系的建设,落实应

  10. Skinner boxes for psychotics: Operant conditioning at Metropolitan state hospital

    OpenAIRE

    Rutherford, Alexandra

    2003-01-01

    Between 1953 and 1965, Ogden Lindsley and his associates conducted free-operant research with psychiatric inpatients and normal volunteers at Metropolitan State Hospital in Waltham, Massachusetts. Their project, originally named “Studies in Behavior Therapy,” was renamed “Harvard Medical School Behavior Research Laboratory” in 1955. This name change and its implications were significant. The role of the laboratory in the history of the relationship between the experimental analysis of behavio...

  11. Multidisciplinary teamwork improves use of the operating room: a multicenter study.

    Science.gov (United States)

    van Veen-Berkx, Elizabeth; Bitter, Justin; Kazemier, Geert; Scheffer, Gert J; Gooszen, Hein G

    2015-06-01

    Poor inter-professional collaboration might negatively influence adequate planning of operative procedures. Interventions capable of improving inter-professional collaboration will positively impact professional practice and health care outcomes. Radboud University Medical Center (UMC) redesigned their operating room (OR) scheduling method by implementing cross-functional teams (CFTs). In this center, positive effects of CFTs were already demonstrated in a mono-center study. This study aims to confirm these effects by comparing the Radboud data with data from 6 other similar centers using a nationwide OR benchmark collaborative. The effect of CFTs was measured by the performance indicator "raw utilization." The Kruskal-Wallis one-way ANOVA was applied to compare OR performance among all 7 centers. The Wilcoxon-Mann-Whitney test was used to determine differences in OR performance between Radboud UMC and the control group. Operating room performance differed significantly among all 7 centers (p<0.0005). Radboud UMC demonstrated the highest median raw utilization of 94% vs 85% in the control group (p<0.0005). Box-and-whisker plots validated the reduced variation during the years, indicating an organizational learning effect. Therefore, not only a better performance than the control group, but also a gradual improvement of this performance during the years. This study shows that multidisciplinary collaboration in CFTs during the perioperative phase has a positive influence on OR scheduling and use of OR time. Other national databases considering mortality rates also support the idea that introducing CFTs is not only an important condition for improving OR performance, but also for improving quality of care. Copyright © 2015 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

  12. Attitudes, risk of infection and behaviours in the operating room (the ARIBO Project): a prospective, cross-sectional study.

    Science.gov (United States)

    Birgand, Gabriel; Azevedo, Christine; Toupet, Gaelle; Pissard-Gibollet, Roger; Grandbastien, Bruno; Fleury, Eric; Lucet, Jean-Christophe

    2014-01-02

    Inappropriate staff behaviours can lead to environmental contamination in the operating room (OR) and subsequent surgical site infection (SSI). This study will focus on the continued assessment of OR staff behaviours using a motion tracking system and their impact on the SSI risk during surgical procedures. This multicentre prospective cross-sectional study will include 10 ORs of cardiac and orthopaedic surgery in 12 healthcare facilities (HCFs). The staff behaviour will be assessed by an objective, continued and prolonged quantification of movements within the OR. A motion tracking system including eight optical cameras (VICON-Bonita) will record the movements of reflective markers placed on the surgical caps/hoods of each person entering the room. Different configurations of markers positioning will be used to distinguish between the staff category. Doors opening will be observed by means of wireless inertial sensors fixed on the doors and synchronised with the motion tracking system. We will collect information on the OR staff, surgical procedures and surgical environment characteristics. The behavioural data obtained will be compared (1) to the 'best behaviour rules' in the OR, pre-established using a Delphi method and (2) to surrogates of the infectious risk represented by microbiological air counts, particle counts, and a bacteriological sample of the wound at closing. Statistics will be performed using univariate and multivariate analysis to adjust on the aerolic and architectural characteristics of the OR. A multilevel model will allow including surgical specialty and HCFs effects. Through this study, we will develop an original approach using high technology tools associated to data processing techniques to evaluate 'automatically' the behavioural dynamics of the OR staff and their impact on the SSI risk. Approbation of the Institutional Review Board of Paris North Hospitals, Paris 7 University, AP-HP (no 11-113, 6 April 2012). The findings will be

  13. Attitudes, risk of infection and behaviours in the operating room (the ARIBO Project): a prospective, cross-sectional study

    Science.gov (United States)

    Birgand, Gabriel; Azevedo, Christine; Toupet, Gaelle; Pissard-Gibollet, Roger; Grandbastien, Bruno; Fleury, Eric; Lucet, Jean-Christophe

    2014-01-01

    Introduction Inappropriate staff behaviours can lead to environmental contamination in the operating room (OR) and subsequent surgical site infection (SSI). This study will focus on the continued assessment of OR staff behaviours using a motion tracking system and their impact on the SSI risk during surgical procedures. Methods and analysis This multicentre prospective cross-sectional study will include 10 ORs of cardiac and orthopaedic surgery in 12 healthcare facilities (HCFs). The staff behaviour will be assessed by an objective, continued and prolonged quantification of movements within the OR. A motion tracking system including eight optical cameras (VICON-Bonita) will record the movements of reflective markers placed on the surgical caps/hoods of each person entering the room. Different configurations of markers positioning will be used to distinguish between the staff category. Doors opening will be observed by means of wireless inertial sensors fixed on the doors and synchronised with the motion tracking system. We will collect information on the OR staff, surgical procedures and surgical environment characteristics. The behavioural data obtained will be compared (1) to the ‘best behaviour rules’ in the OR, pre-established using a Delphi method and (2) to surrogates of the infectious risk represented by microbiological air counts, particle counts, and a bacteriological sample of the wound at closing. Statistics will be performed using univariate and multivariate analysis to adjust on the aerolic and architectural characteristics of the OR. A multilevel model will allow including surgical specialty and HCFs effects. Through this study, we will develop an original approach using high technology tools associated to data processing techniques to evaluate ‘automatically’ the behavioural dynamics of the OR staff and their impact on the SSI risk. Ethics and dissemination Approbation of the Institutional Review Board of Paris North Hospitals, Paris 7

  14. InSb Mid-Infrared Photon Detector for Room-Temperature Operation

    Science.gov (United States)

    Ueno, Koichiro; Gomes Camargo, Edson; Katsumata, Takashi; Goto, Hiromasa; Kuze, Naohiro; Kangawa, Yoshihiro; Kakimoto, Koichi

    2013-09-01

    We developed a small InSb mid-infrared (2-7 µm wavelength range) photon detector that operates at room temperature. The photodiode was made from (hetero epitaxial) InSb layers that were grown on a semi-insulating GaAs substrate by molecular beam epitaxy. To suppress the effects of the diffusion current of the p-i-n photodiode, we used an AlInSb barrier layer that raises the resistance of the photodiode. We also optimized the device's doping concentration and the infrared incidence window structure. These optimization steps realized high photoelectric current output in a room-temperature environment. We also increased the signal-to-noise ratio of the detector by connecting multiple photodiodes in series. The size of this detector is 1.9×2.7×0.4 mm3 and the detectivity is 2.8×108 cm Hz1/2/W at 300 K. This is a practical IR detector that can be used in general signal amplification ICs.

  15. Surgical teams: role perspectives and role dynamics in the operating room.

    Science.gov (United States)

    Leach, Linda Searle; Myrtle, Robert C; Weaver, Fred A

    2011-05-01

    Observations of surgical teams in the operating room (OR) and interviews with surgeons, circulating registered nurses (RNs), anaesthesiologists and surgical technicians reveal the importance of leadership, team member competencies and an enacted environment that encourages feelings of competence and cooperation. Surgical teams are more loosely coupled than intact and bounded. Team members tend to rely on expected role behaviours to bridge lack of familiarity. While members of the surgical team identified technical competence and preparation as critical factors affecting team performance, they had differing views over the role behaviours of other members of the surgical team that lead to surgical team performance. Observations revealed that the work climate in the OR can shape interpersonal relations and begins to be established when the room is being set up for the surgical case, and evolves as the surgical procedure progresses. The leadership and supervisory competencies of the circulating RNs establish the initial work environment. Both influenced the degree of cooperation and support that was observed, which had an effect on the interactions and relationships between other members of the surgical team. As the surgery unfolds, the surgeon's behaviours and interpersonal relations modify this environment and ultimately influence the degree of team work, team satisfaction and team performance.

  16. Fabrication of room temperature continuous-wave operation GaN-based ultraviolet laser diodes

    Science.gov (United States)

    Zhao, Degang; Yang, Jing; Liu, Zongshun; Chen, Ping; Zhu, Jianjun; Jiang, Desheng; Shi, Yongsheng; Wang, Hai; Duan, Lihong; Zhang, Liqun; Yang, Hui

    2017-06-01

    Two kinds of continuous-wave GaN-based ultraviolet laser diodes (LDs) operated at room temperature and with different emission wavelengths are demonstrated. The LDs epitaxial layers are grown on GaN substrate by metalorganic chemical vapor deposition, with a 10 × 600 μm2 ridge waveguide structure. The electrical and optical characteristics of the ultraviolet LDs are investigated under direct-current injection at room temperature. The stimulated emission peak wavelength of first LD is 392.9 nm, the threshold current density and voltage is 1.5 kA/cm2 and 5.0 V, respectively. The output light power is 80 mW under the 4.0 kA/cm2 injection current density. The stimulated emission peak wavelength of second LD is 381.9 nm, the threshold current density the voltage is 2.8 kA/cm2 and 5.5 V, respectively. The output light power is 14 mW under a 4.0 kA/cm2 injection current density. Projects the supported by the National Key R&D Program of China (Nos. 2016YFB0401801, 2016YFB0400803), the National Natural Science Foundation of China (Nos. 61674138, 61674139, 61604145, 61574135, 61574134, 61474142, 61474110, 61377020, 61376089), the Science Challenge Project (No. JCKY2016212A503), and the One Hundred Person Project of the Chinese Academy of Sciences.

  17. Estimation of hospital emergency room data using otc pharmaceutical sales and least mean square filters

    Directory of Open Access Journals (Sweden)

    Magruder SF

    2004-03-01

    Full Text Available Abstract Background Surveillance of Over-the-Counter pharmaceutical (OTC sales as a potential early indicator of developing public health conditions, in particular in cases of interest to Bioterrorism, has been suggested in the literature. The data streams of interest are quite non-stationary and we address this problem from the viewpoint of linear adaptive filter theory: the clinical data is the primary channel which is to be estimated from the OTC data that form the reference channels. Method The OTC data are grouped into a few categories and we estimate the clinical data using each individual category, as well as using a multichannel filter that encompasses all the OTC categories. The estimation (in the least mean square sense is performed using an FIR (Finite Impulse Response filter and the normalized LMS algorithm. Results We show all estimation results and present a table of effectiveness of each OTC category, as well as the effectiveness of the combined filtering operation. Individual group results clearly show the effectiveness of each particular group in estimating the clinical hospital data and serve as a guide as to which groups have sustained correlations with the clinical data. Conclusion Our results indicate that Multichannle adaptive FIR least squares filtering is a viable means of estimating public health conditions from OTC sales, and provide quantitative measures of time dependent correlations between the clinical data and the OTC data channels.

  18. A Review of the Ergonomic Issues in the Laparoscopic Operating Room

    Directory of Open Access Journals (Sweden)

    Sang D. Choi

    2012-01-01

    Full Text Available This review paper discusses the ergonomic challenges associated with laparoscopy in the operating room (OR and summarizes the practical ergonomic solutions. The literature search was conducted in the fields of laparoscopy and applied ergonomics. Findings indicated that laparoscopic OR staff (surgeons, perioperative nurses and technicians commonly experienced physical and mental ergonomic risks while working in prolonged static and awkward body positions. This study highlighted the need for more ergonomic interventions in OR environment in order to improve the efficiency of laparoscopy. Ergonomic solutions included utilizing adjustable equipment, placing computer peripherals in optimal locations, providing ergonomic instruments, and improving communication. Understanding the job- or task-related ergonomic risks and hazards could help identify intervention requirements to meet the challenges associated with increased dependency on advanced high technology in the OR.

  19. Designing User Interfaces for Smart-Applications for Operating Rooms and Intensive Care Units

    Science.gov (United States)

    Kindsmüller, Martin Christof; Haar, Maral; Schulz, Hannes; Herczeg, Michael

    Today’s physicians and nurses working in operating rooms and intensive care units have to deal with an ever increasing amount of data. More and more medical devices are delivering information, which has to be perceived and interpreted in regard to patient status and the necessity to adjust therapy. The combination of high information load and insufficient usability creates a severe challenge for the health personnel with respect to proper monitoring of these devices respective to acknowledging alarms and timely reaction to critical incidents. Smart Applications are a new kind of decision support systems that incorporate medical expertise in order to help health personnel in regard to diagnosis and therapy. By means of a User Centered Design process of two Smart Applications (anaesthesia monitor display, diagnosis display), we illustrate which approach should be followed and which processes and methods have been successfully applied in fostering the design of usable medical devices.

  20. Augmented-reality visualization in iMRI operating room: system description and preclinical testing

    Science.gov (United States)

    Sauer, Frank; Khamene, Ali; Bascle, Benedicte; Vogt, Sebastian; Rubino, Gregory

    2002-05-01

    We developed an augmented reality system targeting image guidance for surgical procedures. The surgeon wears a video- see-through head mounted display that provides him with a stereo video view of the patient. The live video images are augmented with graphical representations of anatomical structures that are segmented from medical image data. The surgeon can see, e.g., a tumor in its actual location inside the patient. This in-situ visualization, where the computer maps the image information onto the patient, promises the most direct, intuitive guidance for surgical procedures. In this paper, we describe technical details of the system and its installation in UCLA's iMRI operating room. We added instrument tracking to the capabilities of our system to prepare it for minimally invasive procedures. We discuss several pre-clinical phantom experiments that support the potential clinical usefulness of augmented reality guidance.

  1. Operating Room Performance Improves after Proficiency-Based Virtual Reality Cataract Surgery Training

    DEFF Research Database (Denmark)

    Thomsen, Ann Sofia Skou; Bach-Holm, Daniella; Kjærbo, Hadi

    2017-01-01

    PURPOSE: To investigate the effect of virtual reality proficiency-based training on actual cataract surgery performance. The secondary purpose of the study was to define which surgeons benefit from virtual reality training. DESIGN: Multicenter masked clinical trial. PARTICIPANTS: Eighteen cataract...... surgeons with different levels of experience. METHODS: Cataract surgical training on a virtual reality simulator (EyeSi) until a proficiency-based test was passed. MAIN OUTCOME MEASURES: Technical performance in the operating room (OR) assessed by 3 independent, masked raters using a previously validated...... task-specific assessment tool for cataract surgery (Objective Structured Assessment of Cataract Surgical Skill). Three surgeries before and 3 surgeries after the virtual reality training were video-recorded, anonymized, and presented to the raters in random order. RESULTS: Novices (non...

  2. Impact of computerized information systems on workload in operating room and intensive care unit.

    Science.gov (United States)

    Bosman, R J

    2009-03-01

    The number of operating rooms and intensive care departments equipped with a clinical information system (CIS) is rapidly expanding. Amongst the putative advantages of such an installation, reduction in workload for the clinician is one of the most appealing. The scarce studies looking at workload variations associated with the implementation of a CIS, only focus on direct workload discarding indirect changes in workload. Descriptions of the various methods to quantify workload are provided. The hypothesis that a third generation CIS can reduce documentation time for ICU nurses and increase time they spend on patient care, is supported by recent literature. Though it seems obvious to extrapolate these advantages of a CIS to the anesthesiology department or physicians in the intensive care, studies examining this assumption are scarce.

  3. Risk Factors for Return to the Operating Room after Resident-Performed Cataract Surgery.

    Science.gov (United States)

    Menda, Shivali A; Driver, Todd H; Neiman, Alexandra E; Blumberg, Seth; Naseri, Ayman; Stewart, Jay M

    2016-09-29

    Investigate risk factors for unplanned return to the operating room after resident-performed cataract surgery. Retrospective case-control study. Institutional. Study population: All patients with reoperation within 90 days of resident-performed phacoemulsification were matched to four control eyes which had surgery within 30 days of the reoperation at the same institution. Billing codes were used to identify all patients who underwent resident-performed intended phacoemulsification with intraocular lens placement from January 2005 to December 2010. Investigated risk factors for reoperation included cataract characteristics and preexisting ocular co-morbidities, including diabetic retinopathy, retinal detachment history, glaucoma, corneal pathology, and uveitis. Additional preoperative risk factors studied included resident training year, history of tamsulosin use, phacodonesis, pupillary dilation, presence of pseudoexfoliation, myopia, history of trauma, visual acuity, and monocular status. Intraoperative variables were the use of iris expansion devices, use of capsular stain, attending type, incision type, use of sutures, vitreous loss, anesthesia type, and phacoemulsification technique. There were 67 returns to the operating room (i.e., cases) over five years that were assigned to 268 control eyes. In preoperative multivariate analysis, phacoemulsification done by a first- or second-year resident (OR 3.2, 95% CI: 1.7-6.0, p risk of reoperation. In postoperative multivariate analysis, only the use of the divide-and-conquer technique (OR 4.0, 95% CI:1.7-9.2, p = 0.001) was associated with an increased risk of reoperation. Phacoemulsification done by a junior resident or using the divide-and-conquer technique had the highest risk of reoperation.

  4. Wearing lead aprons in surgical operating rooms: ergonomic injuries evidenced by infrared thermography.

    Science.gov (United States)

    Alexandre, Dominique; Prieto, Marc; Beaumont, Fabien; Taiar, Redha; Polidori, Guillaume

    2017-03-01

    The purpose of this study is to quantify the impact of the weight of radiation protection lead aprons on the discomfort and the fatigue of the medical staff within an operating room of interventional gastroenterology. To quantify this fatigue, we analyzed variations of the physiological parameters, including heart rate, blood pressure, and cutaneous temperature; we compared two situations: the first within the classic endoscopy department (without apron) and the second within the operating room with apron. A follow-up study with lighter lead aprons was also conducted. We used infrared thermography as the principal method of analysis in our study. This technique permits us to obtain data, without body contact, of the spatial and temporal orientation of temperatures on subject skin. This method proves to be beneficial in the evaluation of the posture of users. The symmetry of the temperature evolution among the different body zones can contribute to the body balance analysis. Our results of the cutaneous temperatures obtained by infrared camera show significant differences in the muscular activity. All the muscular groups studied were revealed significant temperature increases. The temperature curve T2-T1 reveals the actual influence of carrying heavy apron loads. Regardless of the muscular group, this temperature increase varies on the range between 0.55°C and 0.95°C. The muscular groups most recruited are the trapezoids and pectorals. The muscles least recruited are those of the lower limbs. The study shows the impact of load bearing on the body mechanics of medical staff during work. It will be beneficial to develop this study to predict changes in skin temperature because of the various types of aprons and to determine the possible correlation between the thermal distribution and users' sense of comfort. Copyright © 2016 Elsevier Inc. All rights reserved.

  5. Influence of the operating room schedule on tardiness from scheduled start times.

    Science.gov (United States)

    Wachtel, Ruth E; Dexter, Franklin

    2009-06-01

    Tardiness from scheduled start times in a surgical suite is a common source of frustration for both operating room personnel and patients. Data from two surgical suites were used to investigate the relative importance of various factors that contribute to tardiness, including average case duration, time of day, prolonged turnovers, whether a surgeon follows himself or another surgeon, the potential for starting cases early, concurrency (e.g., number of residents supervised simultaneously), expected under-utilized or over-utilized time, and case duration bias. Average tardiness per case did not depend on the individual durations of preceding cases or on the relative numbers of long and short cases. In contrast, the total duration of preceding cases was important in determining tardiness. Tardiness per case grew larger as the day progressed because the total duration of preceding cases increased, but began to decline for cases scheduled to commence 6 h after the start of the workday. Tardiness was not affected by prolonged turnovers, differences in average case duration among services, or whether a surgeon followed himself or another surgeon in the same operating room. Tardiness was affected by expected under-utilized or over-utilized time at the end of the workday and by case duration bias. Factors associated with the largest numbers of cases had the biggest influence on tardiness. Greater understanding of these factors aided in the development of several mathematical interventions to reduce tardiness in the two surgical suites. These interventions and their applicability for reducing tardiness are described in a companion article. At two surgical suites, tardiness from scheduled start times did not depend on average case duration or prolonged turnovers. Tardiness did depend on the total duration of preceding cases, expected under-utilized or over-utilized time at the end of the day, and case duration bias.

  6. Operating room fire prevention: creating an electrosurgical unit fire safety device.

    Science.gov (United States)

    Culp, William C; Kimbrough, Bradly A; Luna, Sarah; Maguddayao, Aris J

    2014-08-01

    To reduce the incidence of surgical fires. Operating room fires represent a potentially life-threatening hazard and are triggered by the electrosurgical unit (ESU) pencil. Carbon dioxide is a fire suppressant and is a routinely used medical gas. We hypothesize that a shroud of protective carbon dioxide covering the tip of the ESU pencil displaces oxygen, thereby preventing fire ignition. Using 3-dimensional modeling techniques, a polymer sleeve was created and attached to an ESU pencil. This sleeve was connected to a carbon dioxide source and directed the gas through multiple precisely angled ports, generating a cone of fire-suppressive carbon dioxide surrounding the active pencil tip. This device was evaluated in a flammability test chamber containing 21%, 50%, and 100% oxygen with sustained ESU activation. The sleeve was tested with and without carbon dioxide (control) until a fuel was ignited or 30 seconds elapsed. Time to ignition was measured by high-speed videography. Fires were ignited with each control trial (15/15 trials). The control group median ± SD ignition time in 21% oxygen was 3.0 ± 2.4 seconds, in 50% oxygen was 0.1 ± 1.8 seconds, and in 100% oxygen was 0.03 ± 0.1 seconds. No fire was observed when the fire safety device was used in all concentrations of oxygen (0/15 trials; P fire ignition was 76% to 100%. A sleeve creating a cone of protective carbon dioxide gas enshrouding the sparks from an ESU pencil effectively prevents fire in a high-flammability model. Clinical application of this device may reduce the incidence of operating room fires.

  7. Operating Room Time Savings with the Use of Splint Packs: A Randomized Controlled Trial

    Directory of Open Access Journals (Sweden)

    Tyler Gonzalez

    2016-01-01

    Full Text Available Background: The most expensive variable in the operating room (OR is time. Lean Process Management is being used in the medical field to improve efficiency in the OR. Streamlining individual processes within the OR is crucial to a comprehensive time saving and cost-cutting health care strategy. At our institution, one hour of OR time costs approximately $500, exclusive of supply and personnel costs. Commercially prepared splint packs (SP contain all components necessary for plaster-of-Paris short-leg splint application and have the potential to decrease splint application time and overall costs by making it a more lean process. We conducted a randomized controlled trial comparing OR time savings between SP use and bulk supply (BS splint application. Methods: Fifty consecutive adult operative patients on whom post-operative short-leg splint immobilization was indicated were randomized to either a control group using BS or an experimental group using SP. One orthopaedic surgeon (EMB prepared and applied all of the splints in a standardized fashion. Retrieval time, preparation time, splint application time, and total splinting time for both groups were measured and statistically analyzed. Results: The retrieval time, preparation time and total splinting time were significantly less (p

  8. Creating impact with operations research in health: making room for practice in academia.

    Science.gov (United States)

    Brandeau, Margaret L

    2016-12-01

    Operations research (OR)-based analyses have the potential to improve decision making for many important, real-world health care problems. However, junior scholars often avoid working on practical applications in health because promotion and tenure processes tend to value theoretical studies more highly than applied studies. This paper discusses the author's experiences in using OR to inform and influence decisions in health and provides a blueprint for junior researchers who wish to find success by taking a similar path. This involves selecting good problems to study, forming productive collaborations with domain experts, developing appropriate models, identifying the most salient results from an analysis, and effectively disseminating findings to decision makers. The paper then suggests how journals, funding agencies, and senior academics can encourage such work by taking a broader and more informed view of the potential role and contributions of OR to solving health care problems. Making room in academia for the application of OR in health follows in the tradition begun by the founders of operations research: to work on important real-world problems where operations research can contribute to better decision making.

  9. Augmented reality in neurovascular surgery: feasibility and first uses in the operating room.

    Science.gov (United States)

    Kersten-Oertel, Marta; Gerard, Ian; Drouin, Simon; Mok, Kelvin; Sirhan, Denis; Sinclair, David S; Collins, D Louis

    2015-11-01

    The aim of this report is to present a prototype augmented reality (AR) intra-operative brain imaging system. We present our experience of using this new neuronavigation system in neurovascular surgery and discuss the feasibility of this technology for aneurysms, arteriovenous malformations (AVMs), and arteriovenous fistulae (AVFs). We developed an augmented reality system that uses an external camera to capture the live view of the patient on the operating room table and to merge this view with pre-operative volume-rendered vessels. We have extensively tested the system in the laboratory and have used the system in four surgical cases: one aneurysm, two AVMs and one AVF case. The developed AR neuronavigation system allows for precise patient-to-image registration and calibration of the camera, resulting in a well-aligned augmented reality view. Initial results suggest that augmented reality is useful for tailoring craniotomies, localizing vessels of interest, and planning resection corridors. Augmented reality is a promising technology for neurovascular surgery. However, for more complex anomalies such as AVMs and AVFs, better visualization techniques that allow one to distinguish between arteries and veins and determine the absolute depth of a vessel of interest are needed.

  10. Room-temperature continuous-wave operation of Ti:sapphire buried channel-waveguide lasers fabricated via proton implantation

    NARCIS (Netherlands)

    Grivas, C.; Shepherd, D.P.; Eason, R.W.; Laversenne, L.; Moretti, P.; Borca, C.N.; Pollnau, M.

    2006-01-01

    Fabrication and laser operation of proton-implanted Ti:sapphire buried channel waveguides is reported for the first time to our knowledge. Without any postimplantation annealing of the structures, continuous laser operation near 780 nm was demonstrated at room temperature at an absorbed pump power t

  11. Impact and Challenges of a Policy Change to Early Track Extubation in the Operating Room for Fontan.

    Science.gov (United States)

    Kawaguchi, Atsushi; Liu, Qi; Coquet, Sean; Yasui, Yutaka; Cave, Dominic

    2016-08-01

    While policy changes toward early extubation in the operating room (OR) have been commonly seen in palliative surgeries in single ventricle anatomy, no systematic assessment of their impact on patient outcome has been reported. All patients aged 0-17 years admitted to a PICU in a quaternary children's hospital for post-operative management following a primary Fontan procedure between 2005 and 2011 were included. Patients for revision of Fontan or patients admitted to adult Cardiovascular Intensive Care Unit were excluded. Practice policy was changed from routine extubation in the PICU to early extubation in OR in January 2008. Data were compared between the pre-policy-change era (2005-2007) and the post-policy-change era (2008-2011) to assess the impact of the change on patient outcomes. Generalized linear regression (GLM) and interrupted time series (ITS) analysis were used to access the effect of policy change on PICU length of stay and post-operative fluid balance, adjusting for potential confounders using propensity scores. Root cause analysis (RCA) was conducted to describe causes of failed extubation and challenges of this policy change. One hundred twenty-seven children met inclusion criteria. Average body weight was 14.7 kg [standard deviation (SD) 3.9], and age was 3.5 years (SD 1.9). A clear change in extubation practice occurred between the pre- versus post-policy-change eras: 97.5 % were extubated in the PICU in the pre-policy-change era, as compared to 15.0 % in the post-policy-change era. The average PICU length of stay was shortened by 4.1 days from the pre-policy-change era to the post-policy-change era [95 % CI -1.2 to -6.9, p extubation in the current practice.

  12. A STUDY OF MICROBIOLOGICAL CONTAMINATION OF MOBILE PHONES IN OPERATING ROOM PERSONNEL AND EFFICACY OF DECONTAMINATION WITH 2% ISOPROPYL ALCOHOL

    Directory of Open Access Journals (Sweden)

    Shivakumar M

    2016-02-01

    Full Text Available BACKGROUND The objective of this study was to determine the contamination rate of the healthcare workers’ (HCWs’ mobile phones in operating room and identify strategies for their safe use within clinical areas. This study also to determine whether a standardized disinfecting protocol decreased the rate of bacterial contamination. METHODS This is a cross-sectional study that included all Health care workers with mobile phones in operation theatre. Samples for culture were collected from mobile phones with swab stick before and after disinfection of mobile phones with 2% isopropyl alcohol swab and transported for microbiological identification using Amies medium. Quantification of bacteria was performed using both surface spread isolated bacterial agents were identified using standard microbiological methods. RESULTS Total of 92 samples studied from 46 mobiles, out of 46 mobile phones tested (89% 41 were contaminated with either single or mixed bacterial agents. The most prevalent bacterial contaminants were Coagulase-Negative Staphylococci (CONS and E. coli representing 36% and 23%, respectively. After cleaning of mobile phone with 2% isopropyl alcohol decreases contamination to 50%. The mean bacterial count was 357 CFU/ml, while the median was 13 CFU/ml using the pour plate method. The corresponding figures were 2,192 and 1,720 organisms/phone using the surface spread method. CONCLUSION It is important to be conscious of the fact that mobile phone usage in Operation Theater is easily contaminated. Because cleaning with alcohol swabs prevents the contamination of the mobile phones. Mobile communication devices have an invaluable feature of communication within hospital health care providers should take standard precautions to minimize the contamination of mobile phones.

  13. St John's Hospital (Morton House), Launceston, Australia: A history of the hospital and Dr William Russ Pugh's first operations under ether.

    Science.gov (United States)

    Haridas, R P; Paull, J D

    2017-03-01

    On 7 June 1847, William Russ Pugh, MD, performed two operations at the St John's Hospital and Self-Supporting Dispensary, Launceston, Tasmania, while his patients were rendered insensible by the inhalation of sulphuric ether. These operations are the earliest documented surgical operations under ether in Australia. St John's Hospital officially opened on 1 September 1845. The hospital may have closed in late 1853 because of financial difficulties. The two-storey Georgian-style building which served as the hospital was completed c1831-1832. It has served as a residence, school, boarding school, hospital, medical consulting rooms and commercial offices. The building is now known as Morton House. We could not identify the date when the name Morton House was adopted, or explain the origin of the name. The earliest identified use of this name is in May 1873 in a newspaper advertisement for boarders. No person with the surname Morton is known to have been associated with the building as an owner or as a tenant. The name Morton House may honour William T.G. Morton, MD, the Boston dentist who performed the first public demonstration of surgical etherisation on 16 October 1846.

  14. [Optimization of working in the operating room by minimizing losses and improving flow].

    Science.gov (United States)

    Leppikangas, Heli; Puolakka, Pia; Korppi, Anssi; Heikki-Jussi, Laine

    2015-01-01

    The need for development of practices within the Finnish healthcare system is immense. Economic threats will force the system to streamline treatment processes without sacrificing quality. Surgical operations bind resources and represent one of the most expensive units in the hospital. By developing the respective procedures it is possible to achieve significant changes in the patient's entire care pathway. Lean is a practical management philosophy involving fairly expedient and structured methods of work development. On the basis of available research results and practical experiences Lean is very well suited for a method of development of practices within healthcare.

  15. Prevalence of methicillin-resistant Staphylococcus aureus (MRSA among patients visiting the emergency room at a tertiary hospital in Brazil

    Directory of Open Access Journals (Sweden)

    Julival Ribeiro

    2005-02-01

    Full Text Available We surveyed patients seen at the emergency room at a tertiary hospital in Brazil from August to November 1997. All patients' (n = 600 anterior nares were cultured for MRSA; the results were confirmed by oxacillin disk diffusion methods and by detection of the mecA gene with PCR. Bacteria were found in 93.3% (560 of the patients and MRSA in 0.7% (n = 4. One patient had community-acquired MRSA. We concluded that MRSA is uncommon among patients visiting the emergency room. The presence of community-acquired MRSA can lead to serious medical and epidemiological issues, although initial clinical presentation may not differ from that of infections with other staphylococci. The empirical use of vancomycin for suspected community-acquired infections is seldom warranted.

  16. 手术室护理工作量化考核的实施与探讨%To Explore and Implementation of Quantitative Evaluation of Nursing Work in Operating Room

    Institute of Scientific and Technical Information of China (English)

    李瑞云

    2015-01-01

    目的:探讨护理工作量化考核在手术室中的应用价值。方法2011年11月~2012年11月我院手术室未实施护理工作量化考核,了解我院手术室中的护理差错,并将此时期作为对照组。2012年12月~2014年12月我院手术室应用手术室护理工作量化考核,将此时期作为实验组,探讨护理工作量化考核效果。结果手术室常见护理差错包括静脉通道故障处理不及时、给药错误、标本混淆、体腔遗留手术器械。应用工作量化考核措施后,手术室护理差错发生率由6.0%降低至2.0%,患者护理满意度由86.0%提升至97.0%,P<0.05,差异具有统计学意义。结论手术室护理工作量化考核在手术室中具有较高的应用价值。%Objective To explore and implementation of quantitative evaluation of operating room nursing work. Methods The hospital operating room did not implement nursing quantiifcation assessment from November 2011 to November 2012, understand the hospital operating room in the nursing error as the control group. hospital operating room used in the operating room nursing quantitative assessment from December 2012 to December 2014 as the experimental group, to explore nursing effect of quantitative evaluation. Results The operating room nursing error such as venous channel failure were common processing was not timely, specimens of dosing errors, confusion, body cavity legacy surgical instruments. After the application of quantitative assessment measures, the operating room nursing error rate was reduced to 2.0%from 6.0%before the patient care satisfaction increased from 86.0% to 86.0%, P<0.05, had difference statistically significance. Conclusion The operating room nursing quantiifcation assessment has high application value in the operating room.

  17. Establishment of an operating room committee and a training program to improve aseptic techniques for rodent and large animal surgery.

    Science.gov (United States)

    Héon, Hélène; Rousseau, Nathalie; Montgomery, Jane; Beauregard, Gilles; Choiniére, Manon

    2006-11-01

    Investigators of our research facility generally accept the concept of asepsis as an important component of adequate surgical care for animals. However, they experience difficulties putting it into practice, especially in the case of rodents. The reasons for this are inconvenience, cost, and lack of training. To better assist investigators in the implementation of aseptic surgical techniques in their laboratories, we have created an Operating Room (OR) Committee modeled after OR committees found in human hospitals. A reconstructive surgeon, a veterinarian, a research scientist, a nurse involved in the training of OR personnel, interns, graduate students, and an animal health technician were chosen as committee members in light of their OR and animal care expertise. The first task of the OR Committee was to establish institutional guidelines for aseptic surgery, taking into account the costs imposed on research budgets by these procedures. The OR Committee also supports a complete training program in aseptic surgery techniques, which consists of lectures, a training manual, videos, and a practical course. Furthermore, when experimental procedures require specialized equipment, the OR Committee collaborates with researchers to develop strategies to achieve asepsis. This OR Committee and the training program proved to be important tools to promote and improve the quality of animal care during surgery.

  18. Exposure of health care workers and occupants to coughed airborne pathogens in a double-bed hospital patient room with overhead mixing ventilation

    DEFF Research Database (Denmark)

    Bolashikov, Zhecho D.; Melikov, Arsen K.; Brand, Marek;

    2012-01-01

    The exposure of a doctor and a second patient was studied in a simulated two-bed hospital isolation room. The room was ventilated at three air change rates (3h-1, 6h-1, and 12h-1) by mixing air distribution keeping at 22C (71.6F). The effect of the distance between the doctor and the coughing per...

  19. High rates and the risk factors for emergency room visits and hospitalization in Parkinson's disease

    NARCIS (Netherlands)

    Hassan, A.; Wu, S.S.; Schmidt, P.; Dai, Y.; Simuni, T.; Giladi, N.; Bloem, B.R.; Malaty, I.A.; Okun, M.S.; Investigators, N.-Q.

    2013-01-01

    BACKGROUND: Parkinson's disease (PD) patients are hospitalized more frequently than their peers as a result of falls, psychosis, infections and other medical complications. However, patient-specific risk factors for hospitalization are unclear. OBJECTIVE: To identify rates and risk factors for hospi

  20. Coaching Non-technical Skills Improves Surgical Residents' Performance in a Simulated Operating Room.

    Science.gov (United States)

    Yule, Steven; Parker, Sarah Henrickson; Wilkinson, Jill; McKinley, Aileen; MacDonald, Jamie; Neill, Adrian; McAdam, Tim

    2015-01-01

    To investigate the effect of coaching on non-technical skills and performance during laparoscopic cholecystectomy in a simulated operating room (OR). Non-technical skills (situation awareness, decision making, teamwork, and leadership) underpin technical ability and are critical to the success of operations and the safety of patients in the OR. The rate of developing assessment tools in this area has outpaced development of workable interventions to improve non-technical skills in surgical training and beyond. A randomized trial was conducted with senior surgical residents (n = 16). Participants were randomized to receive either non-technical skills coaching (intervention) or to self-reflect (control) after each of 5 simulated operations. Coaching was based on the Non-Technical Skills For Surgeons (NOTSS) behavior observation system. Surgeon-coaches trained in this method coached participants in the intervention group for 10 minutes after each simulation. Primary outcome measure was non-technical skills, assessed from video by a surgeon using the NOTSS system. Secondary outcomes were time to call for help during bleeding, operative time, and path length of laparoscopic instruments. Non-technical skills improved in the intervention group from scenario 1 to scenario 5 compared with those in the control group (p = 0.04). The intervention group was faster to call for help when faced with unstoppable bleeding in the final scenario (no. 5; p = 0.03). Coaching improved residents' non-technical skills in the simulated OR compared with those in the control group. Important next steps are to implement non-technical skills coaching in the real OR and assess effect on clinically important process measures and patient outcomes. Copyright © 2015 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

  1. Post-operative hospitalization in retinal detachment correlation to recurrences

    Directory of Open Access Journals (Sweden)

    Enzo Maria Vingolo

    2013-12-01

    Full Text Available PURPOSE: To evaluate relationships between the incidence of re-detachment and postoperative days of hospitalization in patients with diagnosis of retinal detachment (RD who underwent surgery either through ab-externo approach (scleral buckling and encircling or ab-interno approach (vitrectomy and oil-gas tamponade. METHODS: This retrospective study included 268 patients (268 eyes with diagnosis of primary RD: 127 males (47% and 141 (53% females, mean age of 64.1 ± 17.3 years. 46 patients (17% underwent a surgical ab-externo approach (group A, while 222 patients (83% underwent an ab-interno surgical approach. Each RD was graded according to the "Retinal detachment grading system of Royal College of Ophthalmologists" and treated within 5 days after diagnosis. The redetachment (RT related to a surgical failure was considered within 30 days after first operation. RESULTS: In the group 1 without night hospitalization (day surgery global RT rate was 3.5% (4.17% for ab-interno technique and 0% for ab-externo techniques. In the group 2 with one day of hospitalization global RT rate was 1.33% (1.49% for ab-interno technique and 0% for ab-externo techniques. In the group 3 with 2 days of hospitalization global RT rate was 3.80% (4.62% for ab-interno techniques and 0% for ab-externo techniques. In the group 4 with 3 or more days of hospitalization global RT rate was 12.28% (14.29% for ab-interno techniques for 6.67% ab-externo techniques. The incidence of RT in group 1, day surgery, is comparable to the other groups and it is less compared to group 4 (3 or more days of hospitalization. CONCLUSIONS: The incidence of retinal redetachment (RRD is not increased in day surgery mode. These data support outpatient management of RD patients to reduce medical cost and problems related to the hospitalization. Further studies are needed for patients' security.

  2. [Unexpected atrial fibrillation when monitoring in operating room. Case of the trimester].

    Science.gov (United States)

    2014-05-01

    A real case reported to the SENSAR database of incidents is presented. In a patient scheduled for nose fracture repair surgery an unexpected atrial fibrillation was found when monitored in the operating room. The operation was not delayed. After induction of general anaesthesia heart rate suddenly increased and hemodinamic situation was impaired. Cardioversion was required. Two electric countershocks were given but sinus rhythm was not restored. Heart rate was controlled with amiodarone infusion. Optimal defibrillation characteristics are described in these cases. Increased risk of thromboembolism (1-2%) following cardioversion is present even if atrial thrombi are ruled out. The mainstay therapies of are rhythm and rate control and prevention of thromboembolic complications. We describe recommendations on the management of these critical situations with emphasis in learning through the creation of protocols and training practice in simulation. Copyright © 2013 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Published by Elsevier España. All rights reserved.

  3. Telementoring systems in the operating room: a new approach in medical training

    Directory of Open Access Journals (Sweden)

    Juan P. Wachs

    2013-12-01

    Full Text Available This paper discusses the challenges and innovations related to the use of telementoring systems in the operating room. Most of the systems presented leverage on three types of interaction channels: audio, visual and physical. The audio channel enables the mentor to verbally instruct the trainee, and allows the trainee to ask questions. The visual channel is used to deliver annotations, alerts and other messages graphically to the trainee during the surgery. These visual representations are often displayed through a telestrator. The physical channel has been used in laparoscopic procedures by partially controlling the laparoscope through force-feedback. While in face to face instruction, the mentor produces gestures to convey certain aspects of the surgical instruction, there is not equivalent of this form of physical interaction between the mentor and trainee in open surgical procedures in telementoring systems. Even that the trend is to perform more minimally invasive surgery (MIS, trauma surgeries are still necessary, where initial resuscitation and stabilization of the patient in a timely manner is crucial. This paper presents a preliminary study conducted at the Indiana University Medical School and Purdue University, where initial lexicons of surgical instructive gestures (SIGs were determined through systematic observation when mentor and trainee operate together. The paper concludes with potential ways to convey gestural information through surgical robots.

  4. Operating Room Performance Improves after Proficiency-Based Virtual Reality Cataract Surgery Training.

    Science.gov (United States)

    Thomsen, Ann Sofia Skou; Bach-Holm, Daniella; Kjærbo, Hadi; Højgaard-Olsen, Klavs; Subhi, Yousif; Saleh, George M; Park, Yoon Soo; la Cour, Morten; Konge, Lars

    2017-04-01

    To investigate the effect of virtual reality proficiency-based training on actual cataract surgery performance. The secondary purpose of the study was to define which surgeons benefit from virtual reality training. Multicenter masked clinical trial. Eighteen cataract surgeons with different levels of experience. Cataract surgical training on a virtual reality simulator (EyeSi) until a proficiency-based test was passed. Technical performance in the operating room (OR) assessed by 3 independent, masked raters using a previously validated task-specific assessment tool for cataract surgery (Objective Structured Assessment of Cataract Surgical Skill). Three surgeries before and 3 surgeries after the virtual reality training were video-recorded, anonymized, and presented to the raters in random order. Novices (non-independently operating surgeons) and surgeons having performed fewer than 75 independent cataract surgeries showed significant improvements in the OR-32% and 38%, respectively-after virtual reality training (P = 0.008 and P = 0.018). More experienced cataract surgeons did not benefit from simulator training. The reliability of the assessments was high with a generalizability coefficient of 0.92 and 0.86 before and after the virtual reality training, respectively. Clinically relevant cataract surgical skills can be improved by proficiency-based training on a virtual reality simulator. Novices as well as surgeons with an intermediate level of experience showed improvement in OR performance score. Copyright © 2017 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.

  5. Telementoring systems in the operating room: a new approach in medical training.

    Science.gov (United States)

    Wachs, Juan P; Gomez, Gerardo

    2013-01-01

    This paper discusses the challenges and innovations related to the use of telementoring systems in the operating room. Most of the systems presented leverage on three types of interaction channels: audio, visual and physical. The audio channel enables the mentor to verbally instruct the trainee, and allows the trainee to ask questions. The visual channel is used to deliver annotations, alerts and other messages graphically to the trainee during the surgery. These visual representations are often displayed through a telestrator. The physical channel has been used in laparoscopic procedures by partially controlling the laparoscope through force-feedback. While in face to face instruction, the mentor produces gestures to convey certain aspects of the surgical instruction, there is not equivalent of this form of physical interaction between the mentor and trainee in open surgical procedures in telementoring systems. Even that the trend is to perform more minimally invasive surgery (MIS), trauma surgeries are still necessary, where initial resuscitation and stabilization of the patient in a timely manner is crucial. This paper presents a preliminary study conducted at the Indiana University Medical School and Purdue University, where initial lexicons of surgical instructive gestures (SIGs) were determined through systematic observation when mentor and trainee operate together. The paper concludes with potential ways to convey gestural information through surgical robots.

  6. Application Analysis of Evidence-based Operation Room Nursing in the Operation Room Emergency Patient Care%循证手术室护理在手术室急诊患者护理中的应用分析

    Institute of Scientific and Technical Information of China (English)

    张梅; 喻瑛; 龚俊仙

    2015-01-01

    Objective:To investigate the clinical application effect of evidence-based operation room nursing in the operation room emergency patient care,and provide a theoretical basis for improving the level of care for emergency patients.Method:100 emergency surgical patients in operation room of our hospital from February 2013 to March 2014 were retrospectively analyzed,they were randomly divided into the control group and the experimental group according to the different ways of surgical care,50 cases in each group.The patients in the control group were treated with routine care,while the patients in the experimental group were treated with routine care added evidence-based care.The clinical effects of the two groups were compared and analyzed.Result:The operative time and postoperative recovery time of the experimental group were (50.65±3.48)min,(5.47±1.62)d,which were significantly shorter than (69.47±3.62)min and (8.26±1.48)d of the control group,the differences were statistically significant(P<0.05).The nursing satisfaction of the experimental group was 96.0%(48/50),which was significantly higher than 72.0%(36/50) of the control group, the incidence of adverse reactions in the experimental group was 4.0%(2/50),which significantly lower than 26.0%(13/50) in the control group,the differences were statistically significant(P<0.05).The scores of depression,anxiety, hostility,fear in the experimental group were significantly lower than those in the control group,the differences were statistically significant(P<0.05).Conclusion:Application of evidence-based operation room nursing in the operation room emergency patient care can improve the quality of nursing care,decrease the postoperative recovery time,increase the satisfaction of emergency surgical patients,lower the incidence of adverse reactions,with obvious clinical practice value,it is worthy of further promotion and application.%目的:探讨循证手术护理在手术室急诊患者护理中的临床应用

  7. Above room temperature continuous wave operation of a broad-area quantum-cascade laser

    Science.gov (United States)

    Semtsiv, M. P.; Masselink, W. T.

    2016-11-01

    We describe the design and implementation of a broad-area (w ≈ 30 μm) quantum-cascade laser operating in a continuous wave mode up to heat-sink temperatures beyond +100 °C. The room-temperature emission wavelength is 4.6 μm. The temperature gradient in the active region of such a wide laser stripe is essentially perpendicular to the epitaxial layers and the resulting steady-state active region temperature offset scales approximately with the square of the number of cascades. With only 10 cascades in the active region, the threshold electrical power density in the current quantum-cascade laser in the continuous-wave mode is as low as Vth × Ith = 3.8 V × 0.9 kA/cm2 = 3.4 kW/cm2 at room temperature for 2 mm-long two-side high-reflectivity coated laser stripe. A 4 mm-long one-side high-reflectivity coated laser stripe delivers in continuous-wave mode above 0.6 W at +20 °C and above 1.3 W at -27 °C (cooled with a single-stage Peltier element). A 2 mm-long two-side high-reflectivity coated laser stripe demonstrates continuous-wave lasing up to at least +102 °C (375 K). The thermal conductance, Gth, ranges between 235 W/K cm2 and 140 W/K cm2 for temperatures between -33 °C and +102 °C. This demonstration opens the route for continuous-wave power scaling of quantum-cascade lasers via broad-area laser ridges.

  8. Time-motion analysis of clinical nursing documentation during implementation of an electronic operating room management system for ophthalmic surgery.

    Science.gov (United States)

    Read-Brown, Sarah; Sanders, David S; Brown, Anna S; Yackel, Thomas R; Choi, Dongseok; Tu, Daniel C; Chiang, Michael F

    2013-01-01

    Efficiency and quality of documentation are critical in surgical settings because operating rooms are a major source of revenue, and because adverse events may have enormous consequences. Electronic health records (EHRs) have potential to impact surgical volume, quality, and documentation time. Ophthalmology is an ideal domain to examine these issues because procedures are high-throughput and demand efficient documentation. This time-motion study examines nursing documentation during implementation of an EHR operating room management system in an ophthalmology department. Key findings are: (1) EHR nursing documentation time was significantly worse during early implementation, but improved to a level near but slightly worse than paper baseline, (2) Mean documentation time varied significantly among nurses during early implementation, and (3) There was no decrease in operating room turnover time or surgical volume after implementation. These findings have important implications for ambulatory surgery departments planning EHR implementation, and for research in system design.

  9. Efficacy Assessment of Lemon Peel Aromatherpy Againts Airborne Bacteria Experimental Study in ICU Room of Sultan Agung Islamic Hospital Semarang

    Directory of Open Access Journals (Sweden)

    Merin Awu Sari

    2012-06-01

    Design and Method: This experimental study used post test only control groups design. The number of airborne bacteria colonies obtained from ICU room of Sultan Agung Islamic Hospital Semarang treated with lemon peel aromatherapy at the concentration of 100 % and the control group (-.The data were analyzed for normality using Shapiro Wilk followed by independent T-test Result: independent inT-test Independent showed a significant differences in the number of bacterial colonies between the treated groups receiving 100% concentration of lemon peel aromatherapy and control group (- (p < 0.045. Conclusion: Aromatherapy extracts of lemon peel has effect on reducing the number of airborne bacteria in the ICU of Sultan Agung Islamic Hospital Semarang (Sains Medika, 4(1:71-77.

  10. Surgical outcomes and transfusion of minimal amounts of blood in the operating room.

    Science.gov (United States)

    Ferraris, Victor A; Davenport, Daniel L; Saha, Sibu P; Austin, Peter C; Zwischenberger, Joseph B

    2012-01-01

    To examine outcomes in patients who receive small amounts of intraoperative blood transfusion. Longitudinal, uncontrolled observational study evaluating results of intraoperative transfusion in patients entered into the American College of Surgeons National Surgical Quality Improvement Program database. We made propensity-matched comparisons between patients who received and did not receive intraoperative transfusion to minimize confounding when estimating the effect of intraoperative transfusion on postoperative outcomes. We queried the American College of Surgeons National Surgical Quality Improvement Program database for patients undergoing operations between January 1, 2005, and December 31, 2009. A large sample of surgical patients from 173 hospitals throughout the United States. Operative mortality and serious perioperative morbidity (≥1 of 20 complications). After exclusions, 941,496 operations were analyzed in patients from 173 hospitals. Most patients (893,205 patients [94.9%]) did not receive intraoperative transfusions. Patients who received intraoperative infusion of 1 unit of packed red blood cells (15,186 patients [1.6%]) had higher unadjusted rates of mortality and more serious morbidity. These rates further increased with intraoperative transfusion of more than 1 unit of packed red blood cells in a dose-dependent manner. After propensity matching to adjust for multiple preoperative risks, transfusion of a single unit of packed red blood cells increased the multivariate risk of mortality, wound problems, pulmonary complications, postoperative renal dysfunction, systemic sepsis, composite morbidity, and postoperative length of stay compared with propensity-matched patients who did not receive intraoperative transfusion. There is a dose-dependent adverse effect of intraoperative blood transfusion. It is likely that a small, possibly discretionary amount of intraoperative transfusion leads to increased mortality, morbidity, and resource use

  11. Carbapenem-resistant Enterobacteriaceae: frequency of hospital room contamination and survival on various inoculated surfaces.

    Science.gov (United States)

    Weber, David J; Rutala, William A; Kanamori, Hajime; Gergen, Maria F; Sickbert-Bennett, Emily E

    2015-05-01

    Carbapenem-resistant Enterobacteriaceae (CRE) only contaminated the environmental surfaces of rooms housing CRE colonized/infected patients infrequently (8.4%) and at low levels (average, 5.1 colony-forming units [CFU]/120 cm² per contaminated surface). Three species of CRE (Klebsiella, Enterobacter, and Escherichia) survived poorly (>85% die-off in 24 hours) when ~2 log10 CFU were inoculated onto 5 different environmental surfaces.

  12. Large Eddy Simulation of Air Escape through a Hospital Isolation Room Single Hinged Doorway--Validation by Using Tracer Gases and Simulated Smoke Videos.

    Science.gov (United States)

    Saarinen, Pekka E; Kalliomäki, Petri; Tang, Julian W; Koskela, Hannu

    2015-01-01

    The use of hospital isolation rooms has increased considerably in recent years due to the worldwide outbreaks of various emerging infectious diseases. However, the passage of staff through isolation room doors is suspected to be a cause of containment failure, especially in case of hinged doors. It is therefore important to minimize inadvertent contaminant airflow leakage across the doorway during such movements. To this end, it is essential to investigate the behavior of such airflows, especially the overall volume of air that can potentially leak across the doorway during door-opening and human passage. Experimental measurements using full-scale mock-ups are expensive and labour intensive. A useful alternative approach is the application of Computational Fluid Dynamics (CFD) modelling using a time-resolved Large Eddy Simulation (LES) method. In this study simulated air flow patterns are qualitatively compared with experimental ones, and the simulated total volume of air that escapes is compared with the experimentally measured volume. It is shown that the LES method is able to reproduce, at room scale, the complex transient airflows generated during door-opening/closing motions and the passage of a human figure through the doorway between two rooms. This was a basic test case that was performed in an isothermal environment without ventilation. However, the advantage of the CFD approach is that the addition of ventilation airflows and a temperature difference between the rooms is, in principle, a relatively simple task. A standard method to observe flow structures is dosing smoke into the flow. In this paper we introduce graphical methods to simulate smoke experiments by LES, making it very easy to compare the CFD simulation to the experiments. The results demonstrate that the transient CFD simulation is a promising tool to compare different isolation room scenarios without the need to construct full-scale experimental models. The CFD model is able to reproduce

  13. A RFID specific participatory design approach to support design and implementation of real-time location systems in the operating room.

    Science.gov (United States)

    Guédon, A C P; Wauben, L S G L; de Korne, D F; Overvelde, M; Dankelman, J; van den Dobbelsteen, J J

    2015-01-01

    Information technology, such as real-time location (RTL) systems using Radio Frequency IDentification (RFID) may contribute to overcome patient safety issues and high costs in healthcare. The aim of this work is to study if a RFID specific Participatory Design (PD) approach supports the design and the implementation of RTL systems in the Operating Room (OR). A RFID specific PD approach was used to design and implement two RFID based modules. The Device Module monitors the safety status of OR devices and the Patient Module tracks the patients' locations during their hospital stay. The PD principles 'multidisciplinary team', 'participation users (active involvement)' and 'early adopters' were used to include users from the RFID company, the university and the hospital. The design and implementation process consisted of two 'structured cycles' ('iterations'). The effectiveness of this approach was assessed by the acceptance in terms of level of use, continuity of the project and purchase. The Device Module included eight strategic and twelve tactical actions and the Patient Module included six strategic and twelve tactical actions. Both modules are now used on a daily basis and are purchased by the hospitals for continued use. The RFID specific PD approach was effective in guiding and supporting the design and implementation process of RFID technology in the OR. The multidisciplinary teams and their active participation provided insights in the social and the organizational context of the hospitals making it possible to better fit the technology to the hospitals' (future) needs.

  14. Different types of door-opening motions as contributing factors to containment failures in hospital isolation rooms.

    Science.gov (United States)

    Tang, Julian W; Nicolle, Andre; Pantelic, Jovan; Klettner, Christian A; Su, Ruikun; Kalliomaki, Petri; Saarinen, Pekka; Koskela, Hannu; Reijula, Kari; Mustakallio, Panu; Cheong, David K W; Sekhar, Chandra; Tham, Kwok Wai

    2013-01-01

    Hospital isolation rooms are vital for the containment (when under negative pressure) of patients with, or the protection (when under positive pressure) of patients, from airborne infectious agents. Such facilities were essential for the management of highly contagious patients during the 2003 severe acute respiratory syndrome (SARS) outbreaks and the more recent 2009 A/H1N1 influenza pandemic. Many different types of door designs are used in the construction of such isolation rooms, which may be related to the space available and affordability. Using colored food dye as a tracer, the qualitative effects of door-opening motions on the dissemination of potentially contaminated air into and out of a single isolation room were visualized and filmed using Reynolds-number-equivalent, small-scale, water-tank models fitted with programmable door-opening and moving human figure motions. Careful scaling considerations involved in the design and construction of these water-tank models enabled these results to be accurately extrapolated to the full-scale situation. Four simple types of door design were tested: variable speed single and double, sliding and hinged doors, in combination with the moving human figure. The resulting video footage was edited, synchronized and presented in a series of split-screen formats. From these experiments, it is clear that double-hinged doors pose the greatest risk of leakage into or out of the room, followed by (in order of decreasing risk) single-hinged, double-sliding and single-sliding doors. The relative effect of the moving human figure on spreading any potential contamination was greatest with the sliding doors, as the bulk airflows induced were large relative to those resulting from these door-opening motions. However, with the hinged doors, the airflows induced by these door-opening motions were significantly greater. Further experiments involving a simulated ventilated environment are required, but from these findings alone, it

  15. Different types of door-opening motions as contributing factors to containment failures in hospital isolation rooms.

    Directory of Open Access Journals (Sweden)

    Julian W Tang

    Full Text Available Hospital isolation rooms are vital for the containment (when under negative pressure of patients with, or the protection (when under positive pressure of patients, from airborne infectious agents. Such facilities were essential for the management of highly contagious patients during the 2003 severe acute respiratory syndrome (SARS outbreaks and the more recent 2009 A/H1N1 influenza pandemic. Many different types of door designs are used in the construction of such isolation rooms, which may be related to the space available and affordability. Using colored food dye as a tracer, the qualitative effects of door-opening motions on the dissemination of potentially contaminated air into and out of a single isolation room were visualized and filmed using Reynolds-number-equivalent, small-scale, water-tank models fitted with programmable door-opening and moving human figure motions. Careful scaling considerations involved in the design and construction of these water-tank models enabled these results to be accurately extrapolated to the full-scale situation. Four simple types of door design were tested: variable speed single and double, sliding and hinged doors, in combination with the moving human figure. The resulting video footage was edited, synchronized and presented in a series of split-screen formats. From these experiments, it is clear that double-hinged doors pose the greatest risk of leakage into or out of the room, followed by (in order of decreasing risk single-hinged, double-sliding and single-sliding doors. The relative effect of the moving human figure on spreading any potential contamination was greatest with the sliding doors, as the bulk airflows induced were large relative to those resulting from these door-opening motions. However, with the hinged doors, the airflows induced by these door-opening motions were significantly greater. Further experiments involving a simulated ventilated environment are required, but from these findings

  16. Different Types of Door-Opening Motions as Contributing Factors to Containment Failures in Hospital Isolation Rooms

    Science.gov (United States)

    Tang, Julian W.; Nicolle, Andre; Pantelic, Jovan; Klettner, Christian A.; Su, Ruikun; Kalliomaki, Petri; Saarinen, Pekka; Koskela, Hannu; Reijula, Kari; Mustakallio, Panu; Cheong, David K. W.; Sekhar, Chandra; Tham, Kwok Wai

    2013-01-01

    Hospital isolation rooms are vital for the containment (when under negative pressure) of patients with, or the protection (when under positive pressure) of patients, from airborne infectious agents. Such facilities were essential for the management of highly contagious patients during the 2003 severe acute respiratory syndrome (SARS) outbreaks and the more recent 2009 A/H1N1 influenza pandemic. Many different types of door designs are used in the construction of such isolation rooms, which may be related to the space available and affordability. Using colored food dye as a tracer, the qualitative effects of door-opening motions on the dissemination of potentially contaminated air into and out of a single isolation room were visualized and filmed using Reynolds-number-equivalent, small-scale, water-tank models fitted with programmable door-opening and moving human figure motions. Careful scaling considerations involved in the design and construction of these water-tank models enabled these results to be accurately extrapolated to the full-scale situation. Four simple types of door design were tested: variable speed single and double, sliding and hinged doors, in combination with the moving human figure. The resulting video footage was edited, synchronized and presented in a series of split-screen formats. From these experiments, it is clear that double-hinged doors pose the greatest risk of leakage into or out of the room, followed by (in order of decreasing risk) single-hinged, double-sliding and single-sliding doors. The relative effect of the moving human figure on spreading any potential contamination was greatest with the sliding doors, as the bulk airflows induced were large relative to those resulting from these door-opening motions. However, with the hinged doors, the airflows induced by these door-opening motions were significantly greater. Further experiments involving a simulated ventilated environment are required, but from these findings alone, it

  17. Reducing transfers of psychiatric inpatients to emergency rooms of general hospitals in Singapore: a clinical practice improvement project.

    Science.gov (United States)

    Low, Tchern Kuang Lambert; Tay, Kai Hong; Fang, Tina; Fung, Daniel Shuen Sheng

    2017-03-01

    Patients admitted to a psychiatric hospital commonly suffer from comorbid medical problems which sometimes require urgent medical attention. Twenty-two percent of emergency medical transfers from the Institute of Mental Health (IMH) to the emergency rooms of general hospitals were preventable and could be managed at IMH itself. We undertook a quality improvement project to understand the reasons behind such preventable referrals and implemented changes to address this. Using the model for improvement, we deconstructed our processes and analysed root causes for such preventable referrals. Thereafter changes were implemented with Plan-Do-Study-Act (PDSA) cycles to analyse their outcomes. During the 6-month study period, we achieved a 100% reduction in preventable referrals through strategies aimed at reducing pressure on our on-call physicians in the making of medical decisions, maximising usage of our medical resources, constant education and raising awareness of this issue. Reducing preventable transfer of inpatients from a psychiatric hospital to the emergency departments of general hospitals is a worthwhile endeavour. Such initiatives optimise use of healthcare resources, improve patient care and increase satisfaction.

  18. Is single room hospital accommodation associated with differences in healthcare-associated infection, falls, pressure ulcers or medication errors? A natural experiment with non-equivalent controls

    Science.gov (United States)

    Maben, Jill; Murrells, Trevor; Griffiths, Peter

    2016-01-01

    Objectives A wide range of patient benefits have been attributed to single room hospital accommodation including a reduction in adverse patient safety events. However, studies have been limited to the US with limited evidence from elsewhere. The aim of this study was to assess the impact on safety outcomes of the move to a newly built all single room acute hospital. Methods A natural experiment investigating the move to 100% single room accommodation in acute assessment, surgical and older people’s wards. Move to 100% single room accommodation compared to ‘steady state’ and ‘new build’ control hospitals. Falls, pressure ulcer, medication error, meticillin-resistant Staphylococcus aureus and Clostridium difficile rates from routine data sources were measured over 36 months. Results Five of 15 time series in the wards that moved to single room accommodation revealed changes that coincided with the move to the new all single room hospital: specifically, increased fall, pressure ulcer and Clostridium difficile rates in the older people’s ward, and temporary increases in falls and medication errors in the acute assessment unit. However, because the case mix of the older people’s ward changed, and because the increase in falls and medication errors on the acute assessment ward did not last longer than six months, no clear effect of single rooms on the safety outcomes was demonstrated. There were no changes to safety events coinciding with the move at the new build control site. Conclusion For all changes in patient safety events that coincided with the move to single rooms, we found plausible alternative explanations such as case-mix change or disruption as a result of the re-organization of services after the move. The results provide no evidence of either benefit or harm from all single room accommodation in terms of safety-related outcomes, although there may be short-term risks associated with a move to single rooms. PMID:26811373

  19. Study on the current situation about pressure of nursing staff in operation room%手术室护理人员压力现状调查及解压对策分析

    Institute of Scientific and Technical Information of China (English)

    王辉; 姚芳; 王艳

    2012-01-01

    OBJECTIVE To study the pressure of nursing staff in operation room, to analyze the causes and measures to relief pressure, and then improve the mental health of nursing staff working in a operation room, further improve the quality of nursing. METHODS Randomly selected 20 nursing staff from the operation room in our hospital, carried on the questionnaire survey, analyzed the current status of stress of nursing staff in operation room, and analyzed relationship of work nature, stress, physical and mental health in nursing staff in operation room. RESULTS In our hospital, the working pressure was relatively large in nursing staff in operation room, and the reason was due to heavy workload in operation room. CONCLUSION The nursing staff in operation room have responsibilities and heavy tasks. In order to improve the quality of nursing in operation room, it should often cany out health education for nursing staff, improve the mental health of nurses; reasonable scheduling could reduce the work stress among nursing staff.%目的 研究手术室护理人员的压力,分析其压力产生的原因以及缓解对策,进而提高手术室护理工作人员的心理健康素质,进一步提高手术护理质量.方法 随机选取某院手术室护理人员20名,对其进行问卷调查,分析当前手术室护理工作人员的压力现状,以及分析探讨手术室护理人员工作性质、压力、身心健康之间的关系.结果 就该院手术室护理人员工作实际来看,工作压力相对较大,其原因与手术室手术室护理工作繁重和强度密切相关.结论 手术室护理工作责任大、任务重,为了提高手术室护理质量,应常期对手术室护理工作人员进行心理辅导,提高护理人员心理健康水平;合理排班,减轻护理人员工作压力.

  20. Photodetector development at Fraunhofer IAF: From LWIR to SWIR operating from cryogenic close to room temperature

    Science.gov (United States)

    Daumer, V.; Gramich, V.; Müller, R.; Schmidt, J.; Rutz, F.; Stadelmann, T.; Wörl, A.; Rehm, R.

    2017-02-01

    Photodetectors in the non-visible region of the electromagnetic spectrum are essential for security, defense and space science as well as industrial and scientific applications. The research activities at Fraunhofer IAF cover a broad range in the infrared (IR) regime. Whereas short-wavelength IR (SWIR, <1.7 μm) detectors are realized by InGaAs/InP structures, InAs/GaSb type-II superlattice (T2SL) infrared detectors are developed for the spectral bands from mid- (MWIR, 3-5 μm) to long-wavelength IR (LWIR, 8-12 μm). We report on the extension of the superlattice empirical pseudopotential method (SEPM) to 300 K for the design of LWIR heterostructures for operation near room temperature. Recently, we have also adapted heterostructure concepts to our well established bi-spectral T2SL MWIR detector resulting in a dark current density below 2 × 10-9 A/cm2 for a cut-off wavelength close to 5 μm. Finally, we present first results obtained with a gated viewing system based on our InGaAs/InAlAs/InP avalanche photodiode arrays.

  1. Obesity increases operating room times in patients undergoing primary hip arthroplasty: a retrospective cohort analysis.

    Science.gov (United States)

    Kadry, Bassam; Press, Christopher D; Alosh, Hassan; Opper, Isaac M; Orsini, Joe; Popov, Igor A; Brodsky, Jay B; Macario, Alex

    2014-01-01

    Background. Obesity impacts utilization of healthcare resources. The goal of this study was to measure the relationship between increasing body mass index (BMI) in patients undergoing total hip arthroplasty (THA) with different components of operating room (OR) time. Methods. The Stanford Translational Research Integrated Database Environment (STRIDE) was utilized to identify all ASA PS 2 or 3 patients who underwent primary THA at Stanford Medical Center from February 1, 2008 through January 1, 2013. Patients were divided into five groups based on the BMI weight classification. Regression analysis was used to quantify relationships between BMI and the different components of total OR time. Results. 1,332 patients were included in the study. There were no statistically significant differences in age, gender, height, and ASA PS classification between the BMI groups. Normal-weight patients had a total OR time of 138.9 min compared 167.9 min (P 35 kg/m(2) each incremental BMI unit increase was associated with greater incremental total OR time increases. Conclusion. Morbidly obese patients required significantly more total OR time than normal-weight patients undergoing a THA procedure. This increase in time is relevant when scheduling obese patients for surgery and has an important impact on health resource utilization.

  2. Obesity increases operating room times in patients undergoing primary hip arthroplasty: a retrospective cohort analysis

    Directory of Open Access Journals (Sweden)

    Bassam Kadry

    2014-08-01

    Full Text Available Background. Obesity impacts utilization of healthcare resources. The goal of this study was to measure the relationship between increasing body mass index (BMI in patients undergoing total hip arthroplasty (THA with different components of operating room (OR time. Methods. The Stanford Translational Research Integrated Database Environment (STRIDE was utilized to identify all ASA PS 2 or 3 patients who underwent primary THA at Stanford Medical Center from February 1, 2008 through January 1, 2013. Patients were divided into five groups based on the BMI weight classification. Regression analysis was used to quantify relationships between BMI and the different components of total OR time. Results. 1,332 patients were included in the study. There were no statistically significant differences in age, gender, height, and ASA PS classification between the BMI groups. Normal-weight patients had a total OR time of 138.9 min compared 167.9 min (P 35 kg/m2 each incremental BMI unit increase was associated with greater incremental total OR time increases. Conclusion. Morbidly obese patients required significantly more total OR time than normal-weight patients undergoing a THA procedure. This increase in time is relevant when scheduling obese patients for surgery and has an important impact on health resource utilization.

  3. [Evaluation of Radiation Dose during Stent-graft Treatment Using a Hybrid Operating Room System].

    Science.gov (United States)

    Haga, Yoshihiro; Chida, Kouichi; Kaga, Yuji; Saitou, Kazuhisa; Arai, Takeshi; Suzuki, Shinichi; Iwaya, Yoshimi; Kumasaka, Eriko; Kataoka, Nozomi; Satou, Naoto; Abe, Mitsuya

    2015-12-01

    In recent years, aortic aneurysm treatment with stent graft grafting in the X-ray fluoroscopy is increasing. This is an endovascular therapy, because it is a treatment which includes the risk of radiation damage, having to deal with radiation damage, to know in advance is important. In this study, in order to grasp the trend of exposure stent graft implantation in a hybrid operating room (OR) system, focusing on clinical data (entrance skin dose and fluoroscopy time), was to count the total. In TEVAR and EVAR, fluoroscopy time became 13.40 ± 7.27 minutes, 23.67 ± 11.76 minutes, ESD became 0.87 ± 0.41 mGy, 1.11 ± 0.57 mGy. (fluoroscopy time of EVAR was 2.0 times than TEVAR. DAP of EVAR was 1.2 times than TEVAR.) When using the device, adapted lesions and usage are different. This means that care changes in exposure-related factors. In this study, exposure trends of the stent graft implantation was able to grasp. It can be a helpful way to reduce/optimize the radiation dose in a hybrid OR system.

  4. The effects of general anesthesia legislation on operating room visits by preschool children undergoing dental treatment.

    Science.gov (United States)

    White, Halley R; Lee, Jessica Y; Rozier, R Gary

    2008-01-01

    The purpose of this study was to examine the impact of state-level general anesthesia (GA) legislation on operating room visits for the treatment of dental caries on preschool-aged children. The North Carolina Ambulatory Surgery Discharge Database was used to observe GA visits for fiscal years (FY) 1997 to 2001. A pretest/post-test design with concurrent comparison groups was used for 2 analyses: (1) all children treated for dental caries were compared to those treated for otitis media; and (2) those whose treatment for dental caries was reimbursed by Medicaid were compared to those whose treatment for dental caries was not reimbursed by Medicaid. In the prelegislation period (FY 1997 and 1998), there were 3,857 GA visits for dental core and 21,038 for otitis media. Postlegislation (FY 2000 and 2001) dental visits increased to 5,511(43%), and otitis media visits increased to 22,279 (6%)-a statistically significant difference (Pdental visits and 2,487 Medicaid dental visits. Non-Medicaid and Medicaid dental visits postlegislation increased to 2,195 (60%) and 3,316 (33%), respectively. This difference was significant (Panesthesia legislation resulted in an increase in access to care for children needing dental care in North Carolina.

  5. Learning from Aviation to Improve Safety in the Operating Room - a Systematic Literature Review

    Directory of Open Access Journals (Sweden)

    Linda S. G. L. Wauben

    2012-01-01

    Full Text Available Lessons learned from other high-risk industries could improve patient safety in the operating room (OR. This review describes similarities and differences between high-risk industries and describes current methods and solutions within a system approach to reduce errors in the OR. PubMed and Scopus databases were systematically searched for relevant articles written in the English language published between 2000 and 2011. In total, 25 articles were included, all within the medical domain focusing on the comparison between surgery and aviation. In order to improve safety in the OR, multiple interventions have to be implemented. Additionally, the healthcare organization has to become a ‘learning organization’ and the OR team has to become a team with shared responsibilities and flat hierarchies. Interpersonal and technical skills can be trained by means of simulation and can be supported by implementing team briefings, debriefings and cross-checks. However, further development and research is needed to prove if these solutions are useful, practical, and actually increase safety.

  6. The Effect of Instructional Supervision by an Operating Room Assistant on First-Case Starts.

    Science.gov (United States)

    Pan, Xiaohua; Zhang, Jun; Dai, Chen; Si, Yibing

    2017-02-01

    Delays in starting first cases of the day are a common topic associated with high economic costs. This study aimed to determine if an operating room (OR) assistant using an instructional supervision program could reduce the tardiness of first-case starts. A prospective study was conducted. Data from four ORs were used to compare the effectiveness of an instructional intervention to reduce delays in starting first cases of the day. The first cases in two ORs received instructional supervision by an OR. The primary endpoint was the percentage of first cases that started on time. Other endpoints were the percentage of the team work score of OR staff and the percentage of patient satisfaction score. Over 48 weeks, the effect of instructional supervision was evaluated in 960 first-case starts. In the instructional supervision group (n = 480), the percentage of first cases that started on time increased significantly (92.1% vs 71.7%; P < .001), and there was a higher percentage of the team work score (84.4% vs 76.7%; P < .01) and patient satisfaction score (88.3% vs 79.4%; P < .001). Instructional supervision by an OR assistant can make a potential improvement in our on-time first-case starts per day. Copyright © 2016 American Society of PeriAnesthesia Nurses. Published by Elsevier Inc. All rights reserved.

  7. Music and ambient operating room noise in patients undergoing spinal anesthesia.

    Science.gov (United States)

    Ayoub, Chakib M; Rizk, Laudi B; Yaacoub, Chadi I; Gaal, Dorothy; Kain, Zeev N

    2005-05-01

    Previous studies have indicated that music decreases intraoperative sedative requirements in patients undergoing surgical procedures under regional anesthesia. In this study we sought to determine whether this decrease in sedative requirements results from music or from eliminating operating room (OR) noise. A secondary aim of the study was to examine the relationship of response to intraoperative music and participants' culture (i.e., American versus Lebanese). Eighty adults (36 American and 54 Lebanese) undergoing urological procedures with spinal anesthesia and patient-controlled IV propofol sedation were randomly assigned to intraoperative music, white noise, or OR noise. We found that, controlling for ambient OR noise, intraoperative music decreases propofol requirements (0.004 +/- 0.002 mg . kg(-1) . min(-1) versus 0.014 +/- 0.004 mg . kg(-1) . min(-1) versus 0.012 +/- 0.002 mg . kg(-1) . min(-1); P = 0.026). We also found that, regardless of group assignment, Lebanese patients used less propofol as compared with American patients (0.005 +/- 0.001 mg . kg(-1) . min(-1) versus 0.017 +/- 0.003 mg . kg(-1) . min(-1); P = 0.001) and that, in both sites, patients in the music group required less propofol (P noise, intraoperative music decreases propofol requirements of both Lebanese and American patients who undergo urological surgery under spinal anesthesia.

  8. Surgical clothing systems in laminar airflow operating room: a numerical assessment.

    Science.gov (United States)

    Sadrizadeh, Sasan; Holmberg, Sture

    2014-01-01

    This study compared two different laminar airflow distribution strategies - horizontal and vertical - and investigated the effectiveness of both ventilation systems in terms of reducing the sedimentation and distribution of bacteria-carrying particles. Three different staff clothing systems, which resulted in source strengths of 1.5, 4 and 5 CFU/s per person, were considered. The exploration was conducted numerically using a computational fluid dynamics technique. Active and passive air sampling methods were simulated in addition to recovery tests, and the results were compared. Model validation was performed through comparisons with measurement data from the published literature. The recovery test yielded a value of 8.1 min for the horizontal ventilation scenario and 11.9 min for the vertical ventilation system. Fewer particles were captured by the slit sampler and in sedimentation areas with the horizontal ventilation system. The simulated results revealed that under identical conditions in the examined operating room, the horizontal laminar ventilation system performed better than the vertical option. The internal constellation of lamps, the surgical team and objects could have a serious effect on the movement of infectious particles and therefore on postoperative surgical site infections.

  9. Light Water Reactor Sustainability Program Operator Performance Metrics for Control Room Modernization: A Practical Guide for Early Design Evaluation

    Energy Technology Data Exchange (ETDEWEB)

    Ronald Boring; Roger Lew; Thomas Ulrich; Jeffrey Joe

    2014-03-01

    As control rooms are modernized with new digital systems at nuclear power plants, it is necessary to evaluate the operator performance using these systems as part of a verification and validation process. There are no standard, predefined metrics available for assessing what is satisfactory operator interaction with new systems, especially during the early design stages of a new system. This report identifies the process and metrics for evaluating human system interfaces as part of control room modernization. The report includes background information on design and evaluation, a thorough discussion of human performance measures, and a practical example of how the process and metrics have been used as part of a turbine control system upgrade during the formative stages of design. The process and metrics are geared toward generalizability to other applications and serve as a template for utilities undertaking their own control room modernization activities.

  10. Rapid hospital room decontamination using ultraviolet (UV) light with a nanostructured UV-reflective wall coating.

    Science.gov (United States)

    Rutala, William A; Gergen, Maria F; Tande, Brian M; Weber, David J

    2013-05-01

    We tested the ability of an ultraviolet C (UV-C)-reflective wall coating to reduce the time necessary to decontaminate a room using a UV-C-emitting device (Tru-D SmartUVC). The reflective wall coating provided the following time reductions for decontamination: for methicillin-resistant Staphylococcus aureus, from 25 minutes 13 seconds to 5 minutes 3 seconds ([Formula: see text]), and for Clostridium difficile spores, from 43 minutes 42 seconds to 9 minutes 24 seconds ([Formula: see text]).

  11. A Comparison Study on Operation Room Scheduling Rules by Using Goal Programming%基于目标规划的手术排程规则的比较

    Institute of Scientific and Technical Information of China (English)

    刘子先; 王萍

    2014-01-01

    Operation room is an important medical service department in hospital , and its operations have an important influence on medical service quality .In order to decrease the overwork and balance the work-load, the operation room scheduling rules are selected as the research objects and an operation room sched-uling model is built with the help of the goal programming .With the catheter rooms'data from a cardiovas-cular hospital in Tianjin and Simio software for system simulation , the normal operating room scheduling rules are compared and analyzed .Results show that the shortest queue method can balance operation room work time , shorten overtime , and improve staff satisfaction .%手术室是医院的重要医疗服务部门,其运营管理对医疗服务质量有重要影响。为减少加班时间、平衡医务人员工作负荷,本文以手术排程规则为研究对象,运用目标规划方法构建手术排程模型,利用天津市某心脑血管病医院导管室手术排程的实际数据和Simio软件进行仿真模拟,对常用的手术排程规则进行分析比较。结果表明,最短队列的排程方法能够更好地均衡各手术室的工作时间、减少加班次数、提高医务人员满意度。

  12. Development of an evaluation methodology for operator`s moving distance workload for the assessment of the layout and arrangement of nuclear power plant control rooms

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Jeong Un; Seo, Sang Moon; Lee, Yong Hee; Cheon, Se Woo [Korea Atomic Energy Research Institute, Taejon (Korea, Republic of)

    1995-07-01

    In this report, link analysis is discussed for the assessment of control room layout and arrangement, among the workload assessment methodologies using SACOM. A methodology developed for estimating operator`s moving distances based on modified link analysis is described, including its detail algorithm. This methodology was developed with the type and content of SACOM input information in consideration of not only software aspects but also easiness when the designer use this for control room layout and arrangement. 1 tab., 7 figs., 8 refs. (Author) .new.

  13. Hippi Care Hospital: Towards Proactive Business Processes in Emergency Room Services. Teaching Case

    Science.gov (United States)

    Tan, Kar Way; Shankararaman, Venky

    2014-01-01

    It was 2:35 am on a Saturday morning. Wiki Lim, process specialist from the Process Innovation Centre (PIC) of Hippi Care Hospital (HCH), desperately doodling on her notepad for ideas to improve service delivery at HCH's Emergency Department (ED). HCH has committed to the public that its ED would meet the service quality criterion of serving 90%…

  14. Incidence of ocular emergencies in the emergency room of the University General Hospital of Cienfuegos

    Directory of Open Access Journals (Sweden)

    Armando Rafael Milanés Armengol

    2015-02-01

    Full Text Available Background: There are few international and national studies on the incidence of ocular emergencies though there are frequent complaints. Objective: To determine the incidence and types of emergencies attended by the department of Ophthalmology at the General University Hospital of Cienfuegos. Methods: Case series study of all patients attended in the Emergency Department of Ophthalmology in Cienfuegos Hospital from March 2013 to March 2014. There were analyzed: name of the patient, sex, age, origin, diagnosis emergency, classification code colors, total of patients requiring surgical treatment and hospitalization. Results: Predominated aged 41-60 years (35.8%, males (58.6% and the largest number of cases attended corresponded to patients in the provincial capital. There was a predominance of green code (70.9%; the conditions most represented were inflammations of annexes followed by injuries; 72 patients needed surgery, (0.38% and 59 required hospitalizations, the rest of the patients were on ambulatory treatment with follow up in outpatient department ( 0.31%. Conclusions: The incidence of true ophthalmologic emergencies was low, for inflammatory conditions of Annexes classified as green code, were the most frequent cause of patient care; conditions that can be treated in primary services, indicating to mismanagement of physicians in the treatment of these ophthalmic conditions with consequent social and economic burden involving secondary services.

  15. Reducing tardiness from scheduled start times by making adjustments to the operating room schedule.

    Science.gov (United States)

    Wachtel, Ruth E; Dexter, Franklin

    2009-06-01

    Tardiness from scheduled start times is a common source of frustration for both operating room (OR) personnel and patients. Factors that influence tardiness were quantified in a companion paper and have been used to develop interventions that have the potential for reducing tardiness. Data from two surgical suites were used to compare the effectiveness of several interventions to reduce tardiness, including i) moving cases to different ORs on the afternoon of surgery, ii) recalculating the OR schedule when it is published to correct for average lateness in first cases of the day, iii) recalculating the OR schedule when it is published to correct for average service-specific case duration bias, and iv) scheduling a gap (time buffer) before the cases of a "to follow" surgeon if the day is expected to end early. These last three interventions involve creation of a modified schedule with revised start times that are more accurate for both patient and "to follow" surgeon. The surgeon performing the first case of the day would not be affected. Moving cases to different ORs when a room was running late produced a 50%-70% reduction in the tardiness for those cases that were moved. However, overall tardiness in each suite was reduced by only 6%-9%, because few cases were moved. Scheduling a gap between surgeons if the day was expected to end early reduced tardiness by more than 50% for those cases that were preceded by gaps. However, overall tardiness in each suite was reduced by only 4%-8%, because few gaps could be scheduled. In contrast, correcting for the combination of lateness in first cases of the day and service-specific case duration bias reduced overall tardiness in each suite by 30%-35%. Interventions which involve small numbers of cases have little potential to reduce overall tardiness. Generating a modified or auxiliary OR schedule that compensates for known causes of tardiness can significantly reduce patient and "to follow" surgeon waiting times. Modifying

  16. Practice Brief: Accommodating Deaf and Hard of Hearing Students in Operating Room Environments--A Case Study

    Science.gov (United States)

    Meeks, Lisa M.; Laird-Metke, Elisa; Rollins, Mark; Gandhi, Seema; Stechert, Martin; Jain, Neera R.

    2015-01-01

    Increasing numbers of deaf students in the health professions require accommodations in the clinical setting to ensure effective learning and accurate communication. Although classroom learning barriers have long been identified and addressed, barriers to clinical education have been far less analyzed. Operating room clerkships, which include many…

  17. Risk-sensitive events during laparoscopic cholecystectomy: the influence of the integrated operating room and a preoperative checklist tool

    NARCIS (Netherlands)

    Buzink, S.N.; Van Lier, L.; De Hingh, I.H.J.T.; Jakimowicz, J.J.

    2010-01-01

    Background - Awareness of the relative high rate of adverse events in laparoscopic surgery created a need to safeguard quality and safety of performance better. Technological innovations, such as integrated operating room (OR) systems and checklists, have the potential to improve patient safety, OR

  18. Countermeasures for nursing errors in operation room%手术室护理差错的防范对策

    Institute of Scientific and Technical Information of China (English)

    李淑文

    2015-01-01

    本文分析手术室护理差错的原因及防范对策,最大限度防止护理差错的发生。%this paper analyzes the causes of nursing errors in operation room and its preventive measures,and can prevent the occurrence of nursing errors..

  19. Risk-sensitive events during laparoscopic cholecystectomy: the influence of the integrated operating room and a preoperative checklist tool

    NARCIS (Netherlands)

    Buzink, S.N.; Van Lier, L.; De Hingh, I.H.J.T.; Jakimowicz, J.J.

    2010-01-01

    Background - Awareness of the relative high rate of adverse events in laparoscopic surgery created a need to safeguard quality and safety of performance better. Technological innovations, such as integrated operating room (OR) systems and checklists, have the potential to improve patient safety, OR

  20. Prevalence and risk factors of needlestick injuries, sharps injuries, and blood and body fluid exposures among operating room nurses in Thailand.

    Science.gov (United States)

    Kasatpibal, Nongyao; Whitney, JoAnne D; Katechanok, Sadubporn; Ngamsakulrat, Sukanya; Malairungsakul, Benjawan; Sirikulsathean, Pinyo; Nuntawinit, Chutatip; Muangnart, Thanisara

    2016-01-01

    Operating room nurses are at high risk for occupational exposure to bloodborne pathogens. This study examined the prevalence of and risk factors for needlestick injuries (NSIs), sharps injuries (SIs), and blood and body fluid exposures (BBFEs) among operating room nurses in Thai hospitals. A cross-sectional study was performed in 247 Thai hospitals. Questionnaires eliciting demographic data and information on injury occurrence and risk factors were distributed to 2500 operating room nurses, and 2031 usable questionnaires were returned, for a response rate of 81.2%. Adjusted odds ratios (ORs) and 95% confidence intervals (CIs) were calculated using multiple logistic regression analysis. The prevalence of NSIs, SIs, and BBFEs was 23.7%, 9.8%, and 40.0%, respectively. Risk factors for NSIs were training without practice (OR, 1.67; 95% CI, 1.29-2.17), haste (OR, 4.81; 95% CI, 3.41-6.79), lack of awareness (OR, 1.36; 95% CI, 1.04-1.77), inadequate staffing (OR, 1.60; 95% CI, 1.21-2.11), and outdated guidelines (OR, 1.69; 95% CI, 1.04-2.74). One risk factor was identified for SIs: haste (OR, 2.43; 95% CI, 1.57-3.76). Risk factors for BBFEs were long working hours per week (OR, 2.07; 95% CI, 1.06-4.04), training without practice (OR, 1.55; 95% CI, 1.25-1.91), haste (OR, 1.66; 95% CI, 1.30-2.13), lack of awareness (OR, 1.54; 95% CI, 1.22-1.95), not wearing protective equipment (OR, 1.61; 95% CI, 1.26-2.06), and inadequate staffing (OR, 1.63; 95% CI, 1.26-2.11). This study highlights the high prevalence of NSIs, SIs, and BBFEs among Thai operating room nurses. Preventable risk factors were identified. Appropriate guidelines, adequate staffing, proper training, and self-awareness may reduce these occurrences. Copyright © 2016 Association for Professionals in Infection Control and Epidemiology, Inc. All rights reserved.

  1. Skinner boxes for psychotics: operant conditioning at Metropolitan State Hospital.

    Science.gov (United States)

    Rutherford, Alexandra

    2003-01-01

    Between 1953 and 1965, Ogden Lindsley and his associates conducted free-operant research with psychiatric inpatients and normal volunteers at Metropolitan State Hospital in Waltham, Massachusetts. Their project, originally named "Studies in Behavior Therapy," was renamed "Harvard Medical School Behavior Research Laboratory" in 1955. This name change and its implications were significant. The role of the laboratory in the history of the relationship between the experimental analysis of behavior and applied behavior analysis is discussed. A case is made for viewing Lindsley's early work as foundational for the subfield of the experimental analysis of human behavior that formally coalesced in the early 1980s. The laboratory's work is also contextualized with reference to the psychopharmacological revolution of the 1950s. Finally, a four-stage framework for studying the historical and conceptual development of behavior analysis is proposed.

  2. 手术室护理带教方法的探讨和学习%Discussion and Study on Teaching Methods of Nursing Teaching in Operation Room

    Institute of Scientific and Technical Information of China (English)

    贺俭

    2016-01-01

    Objective To investigate the operating room nursing teaching method and effect. Methods Hospital from January 2015 to December 2015 30 cases of operating room nursing students as research subjects were randomly divided into two groups to take the way, each 15 nursing students were named as the observation group and the control group. For nursing students in the control group using traditional teaching methods with, for the observation group of nursing students use group learning with teaching. Results The nursing students theoretical test scores, test scores as well as the operation of teaching work satisfaction rate was higher nursing students. Conclusion The group learning with teaching applied operating room nursing teaching work significant effect can be widely promoted.%目的探讨手术室护理带教方法及效果。方法将我院2015年1月~12月30例手术室护生作为研究对象,采取随机分成两组的方式,每组15名护生,分别命名为观察组和对照组。对对照组护生采用传统带教法,对观察组护生采用小组学习带教法,对比两组护生带教的效果。结果观察组护生理论考试成绩、操作考试成绩以及对带教工作的满意率均高于对照组护生。结论将小组学习带教法应用于手术室护理带教工作中效果显著,可进行广泛推广。

  3. The classification of users processes and their impact on care in emergency rooms in hospitals

    Directory of Open Access Journals (Sweden)

    Consuelo Cubero Alpízar

    2013-04-01

    Full Text Available This article is a preview of the research entitled "Strategies for addressing and classification of users inemergency departments in hospitals" which generally aims to "assess strategies for user attention in hospitalemergency departments" and develops in the form of evidence-based nursing. The same refers to theimplementation of different strategies for classifying users (as in the Hospital Emergency Services (ED by thenursing staff. Methodology was implemented based nursing practice in the Evidence (PEBE which consists ofthe following steps: formulation of questions that can be answered; comprehensive literature search, criticalreading of the documents obtained, applying the most appropriate intervention, and evaluation of the interventionAmong the main results is that in terms of staging modalities are varied from structured easily replicated byrandomly attention to arrival, the research shows that structured care becomes an essential tool for professionalsnurse, since they become training together with the building blocks for user classification by these professionals.

  4. The Association Between Operating Room Personnel and Turnover With Surgical Site Infection in More Than 12 000 Neurosurgical Cases.

    Science.gov (United States)

    Wathen, Connor; Kshettry, Varun R; Krishnaney, Ajit; Gordon, Steven M; Fraser, Thomas; Benzel, Edward C; Modic, Michael T; Butler, Sam; Machado, Andre G

    2016-12-01

    Surgical site infection (SSI) contributes significantly to postoperative morbidity and mortality and greatly increases the cost of care. To identify the impact of workflow and personnel-related risk factors contributing to the incidence of SSIs in a large sample of neurological surgeries. Data were obtained using an enterprisewide electronic health record system, operating room, and anesthesia records for neurological procedures conducted between January 1, 2009, and November 30, 2012. SSI data were obtained from prospective surveillance by infection preventionists using Centers for Disease Control and Prevention definitions. A multivariate model was constructed and refined using backward elimination logistic regression methods. The analysis included 12 528 procedures. Most cases were elective (94.5%), and the average procedure length was 4.8 hours. The average number of people present in the operating room at any time during the procedure was 10.0. The overall infection rate was 2.3%. Patient body mass index (odds ratio, 1.03; 95% confidence interval [CI], 1.01-1.04) and sex (odds ratio, 1.36; 95% CI, 1.07-1.72) as well as procedure length (odds ratio, 1.19 per additional hour; 95% CI, 1.15-1.23) and nursing staff turnovers (odds ratio, 1.095 per additional turnover; 95% CI, 1.02-1.21) were significantly correlated with the risk of SSI. This study found that patient body mass index and male sex were associated with an increased risk of SSI. Operating room personnel turnover, a modifiable, work flow-related factor, was an independent variable positively correlated with SSI. This study suggests that efforts to reduce operating room turnover may be effective in preventing SSI. OR, operating roomSSI, surgical site infection.

  5. Application Design of 3D Technology in the Digital Operating Room%数字化手术室的3D应用设计

    Institute of Scientific and Technical Information of China (English)

    李昊航; 傅洪; 袁明勇

    2016-01-01

    目的:利用数字化3D视频技术,提升手术室示教功能,进一步完善数字化手术室解决方案。方法针对3D视频信据量大和受网络带宽限制的问题,本方案采用左右格式的3D视频技术,保证系统的兼容性和扩展性;采用双投影机、提升带宽和有效压缩传输算法解决亮度损失及传输速度问题。结果实现了手术室3D视频信号集中采集并传输到会议室展现;中心机房作为数字化手术室的管理单元,存储3D影像资料,同时实现了与医院其他信息系统的集成。结论3D视频技术在数字化手术室建设中具有重要的应用价值,随着高清3D医疗设备的广泛应用,未来3D视频技术将有更广阔的发展空间。%Abstaract: Objective To make use of the 3D video technology in the digital operating room so as to enhance its teaching function and further provide a better solution for the digital operation room. Methods In view of the problems of massive 3D video data and network bandwidth limitation, application of left-and-right-format 3D video technology in digital operation room was realized to ensure the compatibility and scalability of the system, which also used the dual projector, enhanced bandwidth and efifcient compression algorithm to solve the problem of luminance loss and transmission speed. Results The centralized collection and transmission of 3D video signals in the operating room to the conference room were realized. The center room served as a unit of the digital operating room management for storage of 3D image data. At the same time, the integration with other hospital information systems was accomplished. Conclusion 3D video technology was of important value in the construction of digital operation room. With the extensive application of HD 3D medical devices, the future 3D video technology would have a broad development space.

  6. Pre-hospital advanced airway management by anaesthesiologists: is there still room for improvement?

    Science.gov (United States)

    Sollid, Stephen J M; Heltne, Jon Kenneth; Søreide, Eldar; Lossius, Hans Morten

    2008-07-21

    Endotracheal intubation is an important part of pre-hospital advanced life support that requires training and experience, and should only be performed by specially trained personnel. In Norway, anaesthesiologists serve as Helicopter Emergency Medical Service HEMS physicians. However, little is known about how they themselves evaluate the quality and safety of pre-hospital advanced airway management. Using a semi-structured questionnaire, we interviewed anaesthesiologists working in the three HEMS programs covering Western Norway. We compared answers from specialists and non-specialists as well as full- and part-time HEMS physicians. Of the 17 available respondents, most (88%) felt that their continuous exposure to intubations was not sufficient. Additional training was mainly acquired through other clinical practice and mannequin- or cadaver-based skills training. Of the respondents, 77% and 35% reported having experienced difficult and failed intubations, respectively. Further, 59% reported knowledge of airway management-related deaths in their HEMS program. Significantly more full- than part-time HEMS physicians had experienced these problems. All respondents had airway back-up equipment in their service, but 29% were not familiar with all the equipment. The majority of anaesthesiologists working as HEMS physicians view pre-hospital advanced airway management as a high-risk procedure. Relevant airway management competencies for HEMS physicians in Norway seem to be insufficiently trained and maintained. A better-defined level of competence with better training methods and systems seems warranted.

  7. Pre-hospital advanced airway management by anaesthesiologists: Is there still room for improvement?

    Directory of Open Access Journals (Sweden)

    Søreide Eldar

    2008-07-01

    Full Text Available Abstract Background Endotracheal intubation is an important part of pre-hospital advanced life support that requires training and experience, and should only be performed by specially trained personnel. In Norway, anaesthesiologists serve as Helicopter Emergency Medical Service HEMS physicians. However, little is known about how they themselves evaluate the quality and safety of pre-hospital advanced airway management. Method Using a semi-structured questionnaire, we interviewed anaesthesiologists working in the three HEMS programs covering Western Norway. We compared answers from specialists and non-specialists as well as full- and part-time HEMS physicians. Results Of the 17 available respondents, most (88% felt that their continuous exposure to intubations was not sufficient. Additional training was mainly acquired through other clinical practice and mannequin- or cadaver-based skills training. Of the respondents, 77% and 35% reported having experienced difficult and failed intubations, respectively. Further, 59% reported knowledge of airway management-related deaths in their HEMS program. Significantly more full- than part-time HEMS physicians had experienced these problems. All respondents had airway back-up equipment in their service, but 29% were not familiar with all the equipment. Conclusion The majority of anaesthesiologists working as HEMS physicians view pre-hospital advanced airway management as a high-risk procedure. Relevant airway management competencies for HEMS physicians in Norway seem to be insufficiently trained and maintained. A better-defined level of competence with better training methods and systems seems warranted.

  8. Room-temperature cw operation of an efficient miniaturized Nd:YAG laser end-pumped by a superluminescent diode

    Energy Technology Data Exchange (ETDEWEB)

    Washio, K.; Iwamoto, K.; Inoue, K.; Hino, I.; Matsumoto, S.; Saito, F.

    1976-12-01

    A miniaturized Nd:YAG laser is described, in which a 3-mm-diam x 5.4-mm-long laser rod is end-pumped by a single Al/sub x/Ga/sub 1-x/As superluminescent diode (SLD) having 20-..mu..m x 1.4-nm stripe geometry. A 4.5-mW laser power was obtained at room temperature in a 1-ms pulse operation. Emitted power from the SLD was 50 mW with 1.7% external power efficiency. When continuously pumped, a 1.5-mW laser power was obtained at room temperature. (AIP)

  9. The Role of the Operating Room in Medical Student Education: Differing Perspectives of Learners and Educators.

    Science.gov (United States)

    O'Neill, Rebecca; Shapiro, Michael; Merchant, Aziz

    2017-07-13

    The surgical clerkship is an integral part of third-year medical student education. The operating room (OR) is a heavily used setting, but it is unclear whether this setting is as effective as possible. To determine the role of the OR and potential improvements, it is necessary to analyze the perspectives of those involved, including surgeons, residents, and medical students. An electronic survey was distributed to the surgeons, surgical residents, and third-year medical students associated with Rutgers New Jersey Medical School. The questions were a combination of 5-point Likert scale questions and qualitative responses. The questions assessed the role of the OR, the information taught in the OR, the quality of the teaching and environment, and potential improvements. Attending surgeons and residents generally rated the OR more positively than medical students did. Medical students desired more hands-on participation and a greater focus on learning technical skills. In addition, most medical students rated the feedback and direct instruction in the OR as "poor." Furthermore, the attending surgeons and medical students disagreed about the main roles of the OR as well as the effectiveness of teaching in the OR. The medical students reported experiencing anxiety and intimidation in the OR and suggested several improvements, such as decreasing the length of the surgical clerkship. There is significant disagreement between the surgeons and residents and the medical students regarding the roles and effectiveness of learning in the OR. This may help explain the reported medical student dissatisfaction and frustrations with the surgical clerkship. Copyright © 2017 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

  10. Clinical experience with desflurane for paediatric anaesthesia outside the operating room.

    Science.gov (United States)

    Alonso, M; Builes, L; Morán, P; Ortega, A; Fernández, E; Reinoso-Barbero, F

    2017-01-01

    Desflurane has been used in paediatric patients for several surgical indications. This article analyses the efficacy and safety of desflurane for diagnostic-therapeutic procedures in remote areas far from operating room in a group of selected patients with no known associated respiratory disease. A retrospective analysis was performed on 2,072 general anaesthesia procedures stored in a computer database, in which desflurane was used in a Paediatric Pain Unit during the years 2013 and 2014. An analysis was also performed using the patient demographics, type of procedure, anaesthetic technique, type of airway management, patient cooperation, and incidence of anaesthetic complications. The study included 876 patients, with a mean age of 8.8 years. The main procedures were bone marrow aspirates (23%), lumbar punctures (20%), panendoscopies (15%), and colonoscopies (5%). Induction was intravenous with propofol (26%) or inhalation with sevoflurane in the remaining 74%. Maintenance consisted of remifentanil and desflurane at mean end tidal concentrations of 6.2±2.1%. The airway was managed through a nasal cannula or face mask in spontaneous ventilation. The effectiveness was 98%, and the incidence of side effects was 15%, which included agitation (6%), headache (4%), nausea-vomiting (3%), and laryngospasm (2%). The maintenance with desflurane (at concentrations close to the hypnotic-MAC in spontaneous ventilation) was effective, with a rapid recovery, and with a low incidence of adverse effects. Copyright © 2016 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Publicado por Elsevier España, S.L.U. All rights reserved.

  11. Brain Tumor Interface Dissection Technique with Surgical Blade from Laboratory to Neurosurgical Operating Room.

    Science.gov (United States)

    Rai, Survendra Kumar R; Mancarella, Cristina; Goel, Atul H

    2017-04-01

    Ideal tumor resection requires brain/spinal cord tumor interface separation in perfect and precise surgical planes within a few micrometers for radical tumor resection and maximum normal tissue preservation. Despite the availability of several dissection techniques, the search for additional alternatives and an ideal technique continues. We evaluated the feasibility and advantages of dissection using a No. 15-blade scalpel in special brain tumor surgery situations. We developed a leaf model wherein its outer layer is progressively dissected from its inner skeleton using a scalpel. An additional model used was a tomato wherein its skin was peeled off its pulp using the same technique. We developed an inexpensive leaf model. A scalpel knife was used in a microneurosurgical setting, and the leaf's outer layer is peeled off. The technique is then used in an operating room setup where surgery on extra-axial tumors like meningiomas and intra-axial brain and spinal cord tumors is done. A No. 15 scalpel was used for dissection between the layers of the Peltophorum pterocarpum leaf model. This dissection method was compared with other neurosurgical dissecting tools. We dissected 120-μm thick leaves into 2 layers with removal of an 18- to 55-μm thick layer. Leaving behind a transparent layer was possible using a No. 15 blade scalpel. Similarly, it was possible to preserve a 35- to 40-μm thick arachnoid layer that separated a meningioma from the underlying brain parenchyma. A scalpel with a sharp edge could be used to perform precise and fine dissection. The scalpel deserves to occupy a place of pride as a dissecting tool in neurosurgery. Copyright © 2017 Elsevier Inc. All rights reserved.

  12. Evaluation of an ultraviolet room disinfection protocol to decrease nursing home microbial burden, infection and hospitalization rates.

    Science.gov (United States)

    Kovach, Christine R; Taneli, Yavuz; Neiman, Tammy; Dyer, Elaine M; Arzaga, Alvin Jason A; Kelber, Sheryl T

    2017-03-03

    The focus of nursing home infection control procedures has been on decreasing transmission between healthcare workers and residents. Less evidence is available regarding whether decontamination of high-touch environmental surfaces impacts infection rates or resident outcomes. The purpose of this study was to examine if ultraviolet disinfection is associated with changes in: 1) microbial counts and adenosine triphosphate counts on high-touch surfaces; and 2) facility wide nursing home acquired infection rates, and infection-related hospitalization. The study was conducted in one 160-bed long-term care facility. Following discharge of each resident, their room was cleaned and then disinfected using a newly acquired ultraviolet light disinfection device. Shared living spaces received weekly ultraviolet light disinfection. Thirty-six months of pretest infection and hospitalization data were compared with 12 months of posttest data. Pre and posttest cultures were taken from high-touch surfaces, and luminometer readings of adenosine triphosphate were done. Nursing home acquired infection rates were analyzed relative to hospital acquired infection rates using analysis of variance procedures. Wilcoxon signed rank tests, The Cochran's Q, and Chi Square were also used. There were statistically significant decreases in adenosine triphosphate readings on all high-touch surfaces after cleaning and disinfection. Culture results were positive for gram-positive cocci or rods on 33% (n = 30) of the 90 surfaces swabbed at baseline. After disinfectant cleaning, 6 of 90 samples (7.1%) tested positive for a gram-positive bacilli, and after ultraviolet disinfection 4 of the 90 samples (4.4%) were positive. There were significant decreases in nursing home acquired relative to hospital-acquired infection rates for the total infections (p = .004), urinary tract infection rates (p = .014), respiratory system infection rates (p = .017) and for rates of infection of the skin

  13. Event-based knowledge elicitation of operating room management decision-making using scenarios adapted from information systems data

    Directory of Open Access Journals (Sweden)

    Epstein Richard H

    2011-01-01

    Full Text Available Abstract Background No systematic process has previously been described for a needs assessment that identifies the operating room (OR management decisions made by the anesthesiologists and nurse managers at a facility that do not maximize the efficiency of use of OR time. We evaluated whether event-based knowledge elicitation can be used practically for rapid assessment of OR management decision-making at facilities, whether scenarios can be adapted automatically from information systems data, and the usefulness of the approach. Methods A process of event-based knowledge elicitation was developed to assess OR management decision-making that may reduce the efficiency of use of OR time. Hypothetical scenarios addressing every OR management decision influencing OR efficiency were created from published examples. Scenarios are adapted, so that cues about conditions are accurate and appropriate for each facility (e.g., if OR 1 is used as an example in a scenario, the listed procedure is a type of procedure performed at the facility in OR 1. Adaptation is performed automatically using the facility's OR information system or anesthesia information management system (AIMS data for most scenarios (43 of 45. Performing the needs assessment takes approximately 1 hour of local managers' time while they decide if their decisions are consistent with the described scenarios. A table of contents of the indexed scenarios is created automatically, providing a simple version of problem solving using case-based reasoning. For example, a new OR manager wanting to know the best way to decide whether to move a case can look in the chapter on "Moving Cases on the Day of Surgery" to find a scenario that describes the situation being encountered. Results Scenarios have been adapted and used at 22 hospitals. Few changes in decisions were needed to increase the efficiency of use of OR time. The few changes were heterogeneous among hospitals, showing the usefulness of

  14. Evaluating The Operation Of Three Air Cleaners Working Individually In A Clean Room

    DEFF Research Database (Denmark)

    Ardkapan, Siamak Rahimi; Afshari, Alireza; Bergsøe, Niels Christian

    2011-01-01

    The use of portable air cleaners is becoming increasingly popular in many countries including Denmark. Portable air cleaners are known for not only removing but also generating particles and gases. To clarify this, three air cleaning technologies were evaluated. They were nonthermal plasma......, photochemical air purifier and corona discharge ionizer. The concentrations of ultrafine particles, ozone and total volatile organic compounds were measured both in a duct and in a clean room. It was found that the studied air cleaning technologies increased the ozone level in the clean room and the duct....... The increase of ozone level in the clean room was more than that was measured in the duct. Additionally, it was found that the number of ultrafine particles in the room increased due to the generated ozone. The number of generated particles changed with the season. The study leads to the recommendation...

  15. Data-driven spatio-temporal RGBD feature encoding for action recognition in operating rooms.

    Science.gov (United States)

    Twinanda, Andru P; Alkan, Emre O; Gangi, Afshin; de Mathelin, Michel; Padoy, Nicolas

    2015-06-01

    Context-aware systems for the operating room (OR) provide the possibility to significantly improve surgical workflow through various applications such as efficient OR scheduling, context-sensitive user interfaces, and automatic transcription of medical procedures. Being an essential element of such a system, surgical action recognition is thus an important research area. In this paper, we tackle the problem of classifying surgical actions from video clips that capture the activities taking place in the OR. We acquire recordings using a multi-view RGBD camera system mounted on the ceiling of a hybrid OR dedicated to X-ray-based procedures and annotate clips of the recordings with the corresponding actions. To recognize the surgical actions from the video clips, we use a classification pipeline based on the bag-of-words (BoW) approach. We propose a novel feature encoding method that extends the classical BoW approach. Instead of using the typical rigid grid layout to divide the space of the feature locations, we propose to learn the layout from the actual 4D spatio-temporal locations of the visual features. This results in a data-driven and non-rigid layout which retains more spatio-temporal information compared to the rigid counterpart. We classify multi-view video clips from a new dataset generated from 11-day recordings of real operations. This dataset is composed of 1734 video clips of 15 actions. These include generic actions (e.g., moving patient to the OR bed) and actions specific to the vertebroplasty procedure (e.g., hammering). The experiments show that the proposed non-rigid feature encoding method performs better than the rigid encoding one. The classifier's accuracy is increased by over 4 %, from 81.08 to 85.53 %. The combination of both intensity and depth information from the RGBD data provides more discriminative power in carrying out the surgical action recognition task as compared to using either one of them alone. Furthermore, the proposed non

  16. Low-threshold room-temperature continuous-wave operation of a terahertz difference-frequency quantum cascade laser source

    Science.gov (United States)

    Fujita, Kazuue; Ito, Akio; Hitaka, Masahiro; Dougakiuchi, Tatsuo; Edamura, Tadataka

    2017-08-01

    The performance of a room-temperature continuous-wave (CW) terahertz source based on intracavity difference-frequency generation in a mid-infrared (λ ∼ 6.8 µm) quantum cascade laser with a dual-upper-state active region is reported. The fabricated buried heterostructure device, with a two-section buried distributed feedback grating, operates at two mid-infrared wavelengths and demonstrates a terahertz output of 2.92 THz with a very low threshold current density of 0.89 kA/cm2 in pulsed operation. Consequently, despite an epitaxial-side-up mounting configuration, the device achieves CW operation at room temperature in which a low CW threshold current density of 1.3 kA/cm2 is obtained.

  17. Three distinct surgical clothing systems in a turbulent mixing operating room equipped with mobile ultraclean laminar airflow screen

    DEFF Research Database (Denmark)

    Sadrizadeh, Sasan; Holmberg, Sture; Nielsen, Peter Vilhelm

    2016-01-01

    Two types of mobile screens producing ultraclean local laminar airflow were investigated as an addition to turbulent mixing operating room ventilation. The exploration was carried out numerically using computational fluid dynamics. Surface and volumetric particle counts were simulated on the oper......Two types of mobile screens producing ultraclean local laminar airflow were investigated as an addition to turbulent mixing operating room ventilation. The exploration was carried out numerically using computational fluid dynamics. Surface and volumetric particle counts were simulated...... on the operating and instrument tables with and without the additional mobile airflow screen. Three different source strengths (the mean bacteria-carrying particle value emitted from one person per second) due to staff clothing variety were considered. Model validation was performed through result comparisons...... with experimental data from the literature. Results confirmed that the mobile screen units reduced the airborne bacteria to an acceptable level for infection-prone surgeries. No significant particle concentration differences existed in the periphery of the operating room. Lower source strength resulting from...

  18. THE RELATIONSHIP BETWEEN CARING, COMFORT, AND PATIENT SATISFACTION IN THE EMERGENCY ROOM, RATU ZALECHA HOSPITAL, SOUTH KALIMANTAN, INDONESIA

    Directory of Open Access Journals (Sweden)

    Sirajudin Noor

    2016-12-01

    Full Text Available Background: Emergency nursing service system requires the role of nurses who are able to pay attention to the behavior of caring and patient comfort. Caring in an emergency room is an important aspect in lifesaving procedures. It might impact the psychology of patients if nurses are not caring. Caring behavior and comfort given by nurses can also affect to patient satisfaction. Patient satisfaction is considered important as a bridgehead for the treatment of patients. Objective: The purpose of this study is to determine the relationship between caring behavior and comfort with patient satisfaction in the emergency room, Ratu Zalecha Hospital, South Kalimantan, Indonesia. Method: This was an analytic correlational study with cross-sectional approach involved 341 patients in the emergency unit using consecutive sampling. Four questionnaires were used to measure the characteristics of the respondent, the nurse caring behavior, comfort given by the nurses, and patient satisfaction. Data were analyzed using descriptive statistics for respondents’ characteristic, and chi-square to analyze the relationship between variables. Result: There were 285 respondents (92.8% who received nurses’ caring behaviors were satisfied, and 268 respondents (87.3% stated that the nurses were able to provide comfort in nursing care in the emergency room. Conclusion: This study revealed that there was a relationship between caring behavior, and comfort with patient satisfaction. It tells that caring and comfort are very important components that influence the satisfaction of patients. Therefore, the role of nurse to provide caring and comfort for the patients in the future should be developed along with the development of science and technology and society's demands.

  19. Investigation and analysis of job satisfaction of operating room nurses/%手术室护士工作满意度调查分析

    Institute of Scientific and Technical Information of China (English)

    许振丹; 张会敏; 李荣

    2012-01-01

    目的 调查手术室护士的工作满意度,为手术室护理人力资源管理提供依据.方法 应用护士工作满意度量表对新乡地区三级甲等医院102名手术室护士进行问卷调查.结果 手术室护士在工作条件、同事、工作的稳定性3个条目满意度较高;在所承担的职责、护士的收入、工作时数3个条目满意度较低.结论 应根据手术室护士的工作满意程度及影响因素,进行针对性管理,提高护士工作积极性及护理质量.%Objective To investigate the job satisfaction of the operating room nurses,so as to provide references for human resources management of nursing. Methods A total of 102 operating room nurses from 3A - level hospitals in Xinxiang were investigated with the Nurses'Job Satisfaction Scale. Results The overall satisfaction rates were higher in working conditions,colleagues and the stability of work and lower in responsibilities taken,working incomes and working time. Conclusion Managers should carry out specific management to improve the positivity of nurses and nursing quality according to the job satisfaction and influencing factors of operating room nurses.

  20. ATTENTION TO THE EMERGENCY ROOM WITH EMPHASIS ON PRE-HOSPITAL CARE: INTEGRATIVE REVIEW

    Directory of Open Access Journals (Sweden)

    B. S. Santos

    2017-08-01

    Full Text Available The study aims to identify the factors, which influence positively and negatively the implementation of public policies geared to the needs in scope of mobile, found in the publications of brazilian researchers since the implementation of the National Policy of Attention to the Emergency room in Brazil. This is a study of Integrative Literature Review. Composing the basis of methodology, have been used official documents to guide the findings that comprised the conceptual bases of the study and to guide the Integrative Review were used publications that report on the issue in question respecting all steps of the protocol review. The results show the changes in the organizational structure of the Service Mobile Emergency, given the regionalization as something positive for the growth of this service modality and discuss prematurely early articulation between the sectors that make up the public health system in Brazil. In conclusion, the policies of attention to the urgencies, in particular within mobile, have favored beneficially all of the users who require this type of care, in the meantime, make the necessary reflections about this theme in the attempt of a better understanding of the regionalization process and coordination among the municipalities that will offer the mobile care so as to ensure continuity of care through the mechanisms of reference and counter-reference

  1. Suicidality and hospitalization as cause and outcome of pediatric psychiatric emergency room visits.

    Science.gov (United States)

    Grudnikoff, Eugene; Soto, Erin Callahan; Frederickson, Anne; Birnbaum, Michael L; Saito, Ema; Dicker, Robert; Kane, John M; Correll, Christoph U

    2015-07-01

    The aim of this study was to identify predictors of suicidality in youth presenting to a pediatric psychiatric emergency room service (PPERS). To this end, we conducted a retrospective cohort study of youth aged PPERS 01.01.2002-12.31.2002, using a 12-page semi-structured institutional evaluation form and the Columbia Classification Algorithm for Suicide Assessment. Multivariate regression analyses were conducted to identify correlates of suicidal thoughts and attempts/preparation and their relationship to outpatient/inpatient disposition. Of 1,062 youth, 265 (25.0%) presented with suicidal ideation (16.2%) or attempt/preparation (8.8%). Suicidal ideation was associated with female sex, depression, adjustment disorder, absent referral by family/friend/self, school referral, precipitant of peer conflict, and no antipsychotic treatment (p PPERS evaluations. Higher GAF score and school referral distinguished suicidal ideation from suicidal attempt/preparation and was associated with outpatient disposition in both presentations. Increased education of referral sources and establishment of different non-PPERS evaluation systems may improve identification of non-emergent suicidal presentations and encourage more appropriate outpatient referrals.

  2. 层流净化手术室环境管理的研究进展(综述)%Research Progress of Environment Management of Laminar Flow Operation Room

    Institute of Scientific and Technical Information of China (English)

    陈燕芳

    2014-01-01

    3陈小君,冯祖莲,黄焕宜.层流手术室术前开机时间与空气细菌培养达标的研究[J].全科护理,2008,6  (29):2637~2368.  4杜秀华,赵逢玲,冯艳秋,等.层流手术室回风口过滤器清洁除尘时间研究[J].齐鲁护理杂志,2010,16  (9):15~16.  5吉琦,掌孝荣,刘春霞.手术室温度与感染及人体舒适度关系的研究现状[J].中华医院感染学杂志,2012,22%Operation room is one of the high risk department of hospital infection, the vast majority of postopera-tive infection can be traced back to the operation environment. Widely used laminar flow operation room of bacteria in the control operation in concentration, plays an important role in reducing postoperative infection risk. But clean lami-nar flow operation room has the problem of prioritizing"restart"and ignoring effect. It is essential to strengthen the management of three aspects including air, staff and goods, in order to reflect the advantages of laminar flow operation room.

  3. Emergency Room of the Hospital associated with the University of Salerno: acute poisoning registered from April 2009 to September 2011

    Directory of Open Access Journals (Sweden)

    N. M. Vitola

    2012-07-01

    Full Text Available An ever growing number of patients go to the emergency room (ER for toxic exposure to various causal agents. Yet, the actual number of acute poisoning still remains unknown and the epidemic data are only partly available. Cases of acute poisoning in the ER of Salerno Hospital from April 2009 to September 2011 (30 months’ period are reported. Data are divided according to the criteria of gender, age, aetiologic agent, place and reasons of poisoning, and risk evaluation. Out of the total 220,165 patients, the acute poisoning cases were 1,347 (0.61%. Among these, 189 (14.1% patients were admitted to hospital while 3 (0.2% died. Alcool acute poisonings are the most frequent (43.6%, followed by drugs poisonings (30.6%. Acute poisonings are more common among males (59.9% and in people aged 20-50 years. Out of all the acute poisoning cases, 27.8% requested a consult to the Anti-Poisoning Centre. The results aim at contributing to the epidemic research for acute poisoning in ER.

  4. A Boiler Room in a 600-Bed Hospital Complex: Study, Analysis, and Implementation of Energy Efficiency Improvements

    Directory of Open Access Journals (Sweden)

    Juan-Carlos Fraile

    2014-05-01

    Full Text Available The aim of energy efficiency is to use less energy to provide the same service. In hospitals, energy efficiency offers a powerful and cost-effective tool to reduce greenhouse gas emissions, fuel consumption, and also running costs. Over a six-month period, the six gas-fired boilers that provide both a hospital’s heat and hot water were monitored. Analysis of the data obtained led to several actions being implemented in the hospital boiler room control system to improve the efficiency of the heat production system. Comparative studies were conducted, during similar weather periods, of the performance of the hospital’s hot water production system before and after the controls were implemented. Results indicate that the control actions applied proved to be effective. Finally; the paper offers a financial; primary energy saving and CO2 reduction analysis that points to a 3,434.00 €/week savings in natural gas consumption; and a cut in CO2 emissions of 20.3 tons/week; as compared to the reference facility.

  5. Resident Physicians Improve Nontechnical Skills When on Operating Room Management and Leadership Rotation.

    Science.gov (United States)

    Cole, Devon C; Giordano, Christopher R; Vasilopoulos, Terrie; Fahy, Brenda G

    2017-01-01

    Anesthesiology residency primarily emphasizes the development of medical knowledge and technical skills. Yet, nontechnical skills (NTS) are also vital to successful clinical practice. Elements of NTS are communication, teamwork, situational awareness, and decision making. The first 10 consecutive senior residents who chose to participate in this 2-week elective rotation of operating room (OR) management and leadership training were enrolled in this study, which spanned from March 2013 to March 2015. Each resident served as the anesthesiology officer of the day (AOD) and was tasked with coordinating OR assignments, managing care for 2 to 4 ORs, and being on call for the trauma OR; all residents were supervised by an attending AOD. Leadership and NTS techniques were taught via a standardized curriculum consisting of leadership and team training articles, crisis management text, and daily debriefings. Resident self-ratings and attending AOD and charge nurse raters used the Anaesthetists' Non-Technical Skills (ANTS) scoring system, which involved task management, situational awareness, teamwork, and decision making. For each of the 10 residents in their third year of clinical anesthesiology training (CA-3) who participated in this elective rotation, there were 14 items that required feedback from resident self-assessment and OR raters, including the daily attending AOD and charge nurse. Results for each of the items on the questionnaire were compared between the beginning and the end of the rotation with the Wilcoxon signed-rank test for matched samples. Comparisons were run separately for attending AOD and charge nurse assessments and resident self-assessments. Scaled rankings were analyzed for the Kendall coefficient of concordance (ω) for rater agreement with associated χ and P value. Common themes identified by the residents during debriefings were recurrence of challenging situations and the skills residents needed to instruct and manage clinical teams. For

  6. A System Approach to Navy Medical Education and Training. Appendix 36. Competency Curriculum for Operating Room Assistant and Operating Room Technician.

    Science.gov (United States)

    1974-08-31

    101 2. Peripheral-Vascular Procedures . . . .. .. . .102 3. Abdominal-Vascular Procedures . . . . . . . . . . 103 XII : Scrubbing for Cardiac...ORP) Unit XII : Scr’boing fcr Ca- iac Procadures 2MO D𔃼 1: CLOSED C*.". .C Pp-r .... TASYS a. Scrub for naricardiocto:iy b. Scrub for comiissurotomy...dona for and to him, transfar patient to operating tabla and taka any nece3sary naures to pzovida for patie3nt’ 3 aafety und co-mfort (Crit~azia

  7. Animal Bites Cases Presented to a University Hospital Pediatric Emergency Room

    Directory of Open Access Journals (Sweden)

    Okşan Derinöz

    2017-04-01

    Full Text Available Introduction: Rabies is still one of the important public health problems both in the world and in our country. The highest risk of rabies comes from contact with pets, especially dogs. The aim of this study was to evaluate the treatment steps that are used in the management of cases presenting to the pediatric emergency department in a university hospital with a risk of rabies contact. Methods: Data including age, gender, site of bites, kind of animals, tetanus/rabies prophylaxis, antibiotic treatments and forensic case reports were recorded for the animal bite cases between 2009 and 2016. Results: A total of 94 patients [58 males (61.7%] with a mean age of 11.06±4.77 years (range: 2-18 were included in the study. 43.6% of the cases presented to the pediatric emergency department within eight hours after the contact. 73.4% of patients presented due to dog bites, 25.5% for cat bite and one patient was with mice bite. In 34% of cases, the bite was on the hand. 50% of the bites were on torso in the 0-5 age group, 41.7% on upper extremities in the 6-10 age group, 50% on feet in the 11-15 age group, and 53.8% on lower extremities in the 16-18 age group (p<0.05. 56.4% of cases were reported as forensic cases. In 91.5% of cases, the wounds were cleaned and dressed while in the rest, the wounds were cleaned and sutured. 17% of patients were discharged on antibiotherapy. In only one of the cases, the patient was hospitalized for parenteral antibiotherapy. All the other patients were discharged. Conclusion: Although animal bites are very common cases for both adult emergency departments and pediatric emergency department, still many mistakes can be made in the treatment of these cases. In order to prevent these mistakes, the knowledge and skills of the healthcare professionals should be enhanced.

  8. A Novel Grid-Wide Transient Stability Assessment and Visualization Method for Increasing Situation Awareness of Control Room Operators

    DEFF Research Database (Denmark)

    Pertl, Michael; Rezkalla, Michel M.N.; Marinelli, Mattia

    2016-01-01

    The aim of the paper is to introduce a grid-wide assessment method to determine the transient stability margin and visualize it effectively to increase the situation awareness of control room operators. Critical area(s) with insufficient transient stability margin have to be identified in order...... to be able to take appropriate preventive actions. The introduced method evaluates the transient stability margin with a time-domain approach by using the voltage angle of several buses across the power system. Information about the severity of a contingency and the location of the most critical buses...... is derived. Moreover, it is shown that the method facilitates the visual examination of transient stability. It provides control room operators with essential information about the state of the system and enables them to take appropriate preventive actions if insufficient transient stability margins...

  9. The function of Specialist Team Leader in the Management of Operation Room%手术室专科组长在管理中的作用

    Institute of Scientific and Technical Information of China (English)

    张佳明

    2015-01-01

    目的:探讨手术室专科组长在管理中的作用。方法采用回顾性分析法对本院实施手术室专科分组管理情况加以总结和分析,总结专科组长的职责和工作目标,对设立专科组长前后手术备物情况、专科医生对护士的满意度、各指标等加以观察对比。结果相较于设立专科组长前,设立后手术备物情况更加理想、专科医生对护士的满意度更高,护理查房、业务学习等各指标均有明显的改善,前后具有统计学差异(P<0.05)。结论通过设立专科组长协助护士长进行二级管理,可以使手术室的护理管理有很大的提高,不仅可以提高手术配合水平,也可以提高手术室护士整体素质,值得推广和应用。%Objective: to explore the role of specialist team leader of the operation room in management.Methods:a retrospective analysis was used to summarize and analyze the management of specialist in operation room in our hospital, and to sum up the responsibilities and objectives of the specialist team leader.Results: compared to not set up specialist team leader, after the establishment of specialist team leader, surgical preparation items more ideal, a specialist on nurses’ satisfaction higher, nursing rounds, business training and other indexes were significantly improved, with statistical difference (P<0.05).Conclusion: the establishment of specialist team leader to assist the head of the two level management, can make the operation room nursing management has greatly improved, not only can improve the level of operation, but also can improve the overall quality of specialist room nurses, it is worthy of promotion and application.

  10. Comparison of the Effect of Noise Levels on Stress Response in Two Different Operation Groups in an Orthopedic Surgery Room

    Directory of Open Access Journals (Sweden)

    Hasibe Baytan Yildiz

    2016-09-01

    Full Text Available Aim: The aim of this randomized, single-blinded study was to evaluate the effects of noise on hemodynamic and neuroendocrine stress response by measuring the level of noise in the surgery rooms of patients undergoing knee operations under neuroaxial anesthesia. Gerec ve Yontem: We compared patient responses from two groups of patients: those undergoing knee operations in a surgery room where the noise level (measured in decibels is high, and those undergoing meniscus operations in a surgery room with lower noise levels. The STAI, the State-Trait Anxiety Inventory (STAI-1, and the anxiety test (STAI-2wereperformed at preoperative and postoperative periods. 20 ml of blood sample was taken for basal, intraoperative 30th minute, and postoperative 1st hour measurements. Systolic, diastolic, and mean arterial blood pressures were found to be higher in the high noise level group. ACTH levels were increased during the early postoperative period and became normal during the late postoperative period in the high noise level group whereas ACTH levels were significantly decreased in the low-noise level group. Basal cortisol levels were significantly higher in the high noise level group. HCRP, an inflammatory response mediator was found to be decreased in both groups. Early and late blood glucose levels were significantly higher in the high noise group. There was a greater increase in early and late blood glucose levels in the high noise group. In the postoperative period, although the state-trait anxiety inventory (STAI-2 levels being higher in patients subject to noisier environment determines how people feel independent of the conditions and state they are in, this result made us consider that the noise the patients were subjected to in the intraoperative period may cause a stress response. Discussion: As a result we believe that standard noise levels should be achieved by reducing the factors causing high noise levels in the operating room. This will

  11. Contamination of the operating room by anesthetic gases and vapors. II. Gas chromatographic analysis of nitrous oxide

    Energy Technology Data Exchange (ETDEWEB)

    Cattaneo, A.D.; Ferraiolo, G.; Rovatti, M.; Zattoni, J.; Donato, A.

    1981-12-01

    The contamination by nitrous oxide of an operating room atmosphere was studied in a number of experiments, in the absence of personnel and using a gaschromatographic method. The evacuating device of the anesthesia machine proved to be ineffective to overcome the hazard of leaks in the breathing system, whereas the air conditioning flow rates (12 outside air changes per hour) minimized waste anesthetic gas concentrations.

  12. Full scope simulator of a nuclear power plant control room using 3D stereo virtual reality techniques for operators training

    Energy Technology Data Exchange (ETDEWEB)

    Aghina, Mauricio A.C.; Mol, Antonio Carlos A.; Almeida, Adino Americo A.; Pereira, Claudio M.N.A. [Instituto de Engenharia Nuclear (IEN-CNEN/RJ), Rio de Janeiro, RJ (Brazil)]. E-mails: mag@ien.gov.br; mol@ien.gov.br; adino@ien.gov.br; cmnap@ien.gov.br; Varela, Thiago F.B. [Universidade Federal do Rio de Janeiro (UFRJ), RJ (Brazil). Coordenacao dos Programas de Pos-graduacao de Engenharia (COPPE). Programa de Engenharia Eletrica]. E-mail: phillips.rj@terra.com.br; Cunha, Gerson G. [Universidade Federal do Rio de Janeiro (UFRJ), RJ (Brazil). Coordenacao dos Programas de Pos-graduacao de Engenharia (COPPE). Lab. de Metodos Computacionais em Engenharia (LAMCE)]. E-mail: gerson@lance.ufrj.br

    2007-07-01

    Practical training of nuclear power plants operators are partially performed by means of simulators. Usually these simulators are physical copies of the original control roam, needing a large space on a facility being also very expensive. In this way, the proposal of this paper is to implement the use of Virtual Reality techniques to design a full scope control room simulator, in a manner to reduce costs and physical space usage. (author)

  13. The use of a metronome during cardiopulmonary resuscitation in the emergency room of a university hospital.

    Science.gov (United States)

    Botelho, Renata Maria de Oliveira; Campanharo, Cássia Regina Vancini; Lopes, Maria Carolina Barbosa Teixeira; Okuno, Meiry Fernanda Pinto; Góis, Aécio Flávio Teixeira de; Batista, Ruth Ester Assayag

    2016-11-21

    to compare the rate of return of spontaneous circulation (ROSC) and death after cardiac arrest, with and without the use of a metronome during cardiopulmonary resuscitation (CPR). case-control study nested in a cohort study including 285 adults who experienced cardiac arrest and received CPR in an emergency service. Data were collected using In-hospital Utstein Style. The control group (n=60) was selected by matching patients considering their neurological condition before cardiac arrest, the immediate cause, initial arrest rhythm, whether epinephrine was used, and the duration of CPR. The case group (n=51) received conventional CPR guided by a metronome set at 110 beats/min. Chi-square and likelihood ratio were used to compare ROSC rates considering p≤0.05. ROSC occurred in 57.7% of the cases, though 92.8% of these patients died in the following 24 hours. No statistically significant difference was found between groups in regard to ROSC (p=0.2017) or the occurrence of death (p=0.8112). the outcomes of patients after cardiac arrest with and without the use of a metronome during CPR were similar and no differences were found between groups in regard to survival rates and ROSC. comparar a taxa de retorno da circulação espontânea e óbito após parada cardiorrespiratória, com e sem a utilização do metrônomo durante ressuscitação cardiopulmonar. estudo caso-controle aninhado a estudo de coorte, com 285 adultos atendidos em parada cardíaca em um serviço de emergência e submetidos à ressuscitação cardiopulmonar. Os dados foram coletados por meio do In-hospital Utstein Style. O grupo controle (n=60) foi selecionado pelo pareamento dos pacientes considerando-se o estado neurológico pré-parada cardiorrespiratória, causa imediata e ritmo inicial da parada, utilização de epinefrina e duração da ressuscitação. O grupo caso (n=51) foi submetido à ressuscitação cardiopulmonar convencional com a utilização do metrônomo a 110sons/min. Para comparar

  14. Investigation of the impact of main control room digitalization on operators cognitive reliability in nuclear power plants.

    Science.gov (United States)

    Zhou, Yong; Mu, Haiying; Jiang, Jianjun; Zhang, Li

    2012-01-01

    Currently, there is a trend in nuclear power plants (NPPs) toward introducing digital and computer technologies into main control rooms (MCRs). Safe generation of electric power in NPPs requires reliable performance of cognitive tasks such as fault detection, diagnosis, and response planning. The digitalization of MCRs has dramatically changed the whole operating environment, and the ways operators interact with the plant systems. If the design and implementation of the digital technology is incompatible with operators' cognitive characteristics, it may have negative effects on operators' cognitive reliability. Firstly, on the basis of three essential prerequisites for successful cognitive tasks, a causal model is constructed to reveal the typical human performance issues arising from digitalization. The cognitive mechanisms which they impact cognitive reliability are analyzed in detail. Then, Bayesian inference is used to quantify and prioritize the influences of these factors. It suggests that interface management and unbalanced workload distribution have more significant impacts on operators' cognitive reliability.

  15. A methodology for Living Probabilistic Safety Assessment (LPSA) based on Advanced Control Room Operator Support System (ACROSS)

    Energy Technology Data Exchange (ETDEWEB)

    Zubair, Muhammad, E-mail: zubairheu@gmail.com [College of Nuclear Science and Technology, Harbin Engineering University, 145 Nantong Street, Nangang District, Harbin, Heilongjiang 150001 (China); Zhang Zhijian, E-mail: zhangzhijian@hrbeu.edu.cn [College of Nuclear Science and Technology, Harbin Engineering University, 145 Nantong Street, Nangang District, Harbin, Heilongjiang 150001 (China); Khan, Salah Ud-din, E-mail: khanheu@gmail.com [College of Nuclear Science and Technology, Harbin Engineering University, 145 Nantong Street, Nangang District, Harbin, Heilongjiang 150001 (China)

    2011-06-15

    Highlights: > In this study we have introduced a methodology for Living Probabilistic Safety Assessment (LPSA). > Now the paper is focus on LPSA methodology for this purpose we introduced Advanced Control Room Operator Support System (ACROSS). > The ACROSS concept is new technique in LPSA and it's a part of our research project. > Detail is present in Section of paper. > We have also added to provide more detail about methodology. > We have remove Risk monitor portion from our paper and give more attention to LPSA methodology. - Abstract: In Probabilistic Safety Assessment (PSA) all attention is paid to analyze a system which is a time consuming effort so there is a need to develop a system network to support the analyst and to reduce manpower. To handle the physical, operational and organizational changes and to utilize the PSA information effectively the development of living Probabilistic Safety Assessment (LPSA) is essential. This paper presents a detailed methodology for LPSA. One part of this methodology is Advanced Control Room Operator Support System (ACROSS) which is helpful for updating the LPSA model. This methodology also provides help to make the control rooms in Nuclear Power Plants (NPPs) more advanced and user friendly. The study also makes recommendations for further use and development of this technique in the present and future NPPs.

  16. Assessment of Clinical Stressful Factors Among Academic Students of Nursing and Operating Room of Dezful University of Medical Sciences (2015

    Directory of Open Access Journals (Sweden)

    Mojtaba Raji

    2016-07-01

    Full Text Available Background and Objective: Nursing students are exposed to clinical environmental stresses in addition to educational environmental stresses. The aim of this study was to assessment of clinical stressful factors among Academic Students of Nursing and Operating Room of Dezful University of Medical Sciences in 2015.Materials and Methods: This study was a description-analytical study with 234 students of nursing and operation room up to two semesters for enrolled. Data was using a self-made researcher Questionnaire consisted of demographic information and clinical stressful factors. Data analysis was performed by descriptive and inferential statistics using SPSS-PC (v.20.Results: The findings showed that the main stressors in students of nursing and operation room were unpleasant emotions and least stressful areas were interpersonal communication in a clinical environment. The results showed that the average score of the field of education and humiliating experiences using Spearman correlation test (P=0/045 (r=0/16.Conclusion: Study showed, the mean stress is the moderate level. Stressful areas obtained in the four areas of personal communication, clinical practice stressful, unpleasant feelings and humiliating experience that fortunately, in many cases reform and change.

  17. The effects of nature images on pain in a simulated hospital patient room.

    Science.gov (United States)

    Vincent, Ellen; Battisto, Dina; Grimes, Larry; McCubbin, James

    2010-01-01

    Views of nature have been reported to relieve stress and pain, making nature an ideal medium for use in healthcare settings. In hospitals whose design does not allow for a view of nature, virtual and surrogate views of nature may be viable therapeutic options. This study tests the effects of specific nature images, as defined by Appleton's prospect refuge theory of landscape preference, on participants experiencing pain. The hypotheses were: (1) Nature views are variable in their impact on specific psychological and physiological health status indicators; and (2) Prospect and refuge nature scenes are more therapeutic than hazard nature scenes. The research question was (1) Which nature image categories are most therapeutic as evidenced by reduced pain and positive mood? An experiment using mixed methods assessed the effects of four different nature scenes on physiological (blood pressure, heart rate) and psychological (mood) responses when a person was subjected to a pain stressor. Four groups were subjected to a specific nature image category of prospect, refuge, hazard, or mixed prospect and refuge; the fifth group viewed no image. The Short-Form McGill Pain Questionnaire and the Profile of Mood States survey instruments were used to assess pain and mood, respectively. Continuous physiological readings of heart rate and blood pressure were collected. Pain was induced through a cold pressor task, which required participants to immerse their nondominant hand in ice water for up to 120 seconds. The mixed prospect and refuge image treatment showed significantly lower sensory pain responses, and the no-image treatment indicated significantly higher affective pain perception responses. The hazard image treatment had significantly lower diastolic blood pressure readings during the pain treatment, but it also had significantly high total mood disturbance. Although there was no clear "most" therapeutic image, the mixed prospect and refuge image showed significant

  18. The Design and Research of the Operation Status Detector for Marine Engine Room Power Plant Based on Noise

    Directory of Open Access Journals (Sweden)

    Li Hang

    2016-01-01

    Full Text Available Designed in this paper, based on the noise of ship engine room power plant running status of detector, is mainly used in the operation of the power plant of acoustic shell size to determine when the machine running state, this device is composed of signal disposal and alarm display adjustment part of two parts. Detector that can show the size of the voice, if exceed the set limit alarm value, the detector can sound an alarm, to remind staff equipment fails, it shall timely inspection maintenance, improve the safety of the operation of the ship.

  19. Investigation of self-efficacy and countermeasures for the nursing activities of nurses in operation room%手术室护士护理活动自我效能的现状调查及对策分析

    Institute of Scientific and Technical Information of China (English)

    张月玲; 郭金荣; 张洪芬; 马红霞

    2012-01-01

    Objective To investigate the self-efficacy for the nursing activities of nurses in the operation room and explore the ways of improving the self-efficacy of nursing activities of nurses in the operation room.Methods 160 nnrses in the operation rooms of four hospitals in Binzhou city were chosen as the observation group.160 non-operation room nurses in these four hospitals were chosen as the control group.The self-efficacy of nursing activities questionnaires were used to survey the self-efficacy of nurses.According to the analysis of survey results,measures to improve the self-efficacy of nursing activities were discussed.Results The self-efficacy scores for 160 operation room nurses were lower than those non-operation room nurses.Among 5 dimensions,nursing skill was with the lowest score in 160 nurses who had been investigated.The difference of self-efficacy scores of care activities for nurses in operation rooms of different hospitals was significant.Conclusions Nursing activity in the operation room has its own specialty.The self-efficacy of nursing activities was lower than non-operation room nurses generally,especially in nursing skills.Improving leadership and working environment of nurses,giving positive social support and re-education programs are the scientific ways to improve self-efficacy of nursing activities in the operation room.%目的 对手术室护士护理活动自我效能现状进行调查,探讨提高手术室护士护理活动目我效能的对策.方法 选择滨州市4所医院160名手术室护士作为观察组,同时选择该4所医院非手术室护士160名作为对照组.采用自制手术室护理活动自我效能感调查表对其进行自我效能调查;分析调查结果,探讨提高手术室护士护理活动自我效能感的对策.结果 160名手术室护士的自我效能感得分平均分均显著低于非手术室护士护理活动自我效能得分;160名被调杳护士中,5个维度中护理技能得分最低,和其

  20. Air bacterial counts in hundred-level laminar flow operating room under dynamic conditions%百级层流手术室动态条件下空气细菌数量的调查

    Institute of Scientific and Technical Information of China (English)

    张亚莉; 于芳; 周浩; 姚翠军; 汪能平; 孙树梅

    2012-01-01

    目的 探讨医院百级层流手术室在进行手术状态下,空气中沉降细菌数量监测结果,了解影响其因素和探讨改进层流手术室洁净度的措施.方法 测定百级层流手术室在进行手术状态下(即动态条件下)不同时段空气中沉降细菌菌落数.结果 静态条件下不同手术室之间比较,差异无统计学意义,动态条件下不同手术室之间亦差异无统计学意义;同一手术室动态条件下第一台手术开始时与结束前比较,1、3室沉降菌数量随手术时间延长而增加,差异有统计学意义(P<0.01),2室差异无统计学意义;在手术室内5~10人时,空气沉降菌数量为(10.978±7.275)CFU/平板,11~16人时,沉降菌数量为(23.399±17.334)CFU/平板,两组比较差异有统计学意义(P<0.01),即手术室动态条件下空气沉降菌数量与手术室人数呈正相关.结论 人员是层流手术室空气污染的主要因素,应严格限制手术室内人数,是保障手术中空气清净度的一项关键措施.%OBJECTIVE To evaluate results of the bacteria settlement in hundred-level laminar flow operating room of our hospital> and find out factors correlated with the number of bacteria settlement and measures to improve the clean level of the laminar flow operating room. METHODS The number of bacteria settlement in the air during the operation (under dynamic conditions) in the hundred-level laminar flow operating room was determined at different time points. RESULTS There was no significant difference in the number of bacteria settlement between the operating room under static and dynamic conditions; comparing the beginning (incision) and the end (suture) of the first operation in the same operating room under dynamic conditions, the numbers of bacteria settlement of room No. 1 and No, 3 significantly increased (P<0. 01) with operating time, but not in room No. 2. When there were 5-10 persons in the operating room, the number of bacteria settlement

  1. Evaluation of an automated ultraviolet radiation device for decontamination of Clostridium difficile and other healthcare-associated pathogens in hospital rooms

    Directory of Open Access Journals (Sweden)

    Pultz Michael J

    2010-07-01

    Full Text Available Abstract Background Environmental surfaces play an important role in transmission of healthcare-associated pathogens. There is a need for new disinfection methods that are effective against Clostridium difficile spores, but also safe, rapid, and automated. Methods The Tru-D™ Rapid Room Disinfection device is a mobile, fully-automated room decontamination technology that utilizes ultraviolet-C irradiation to kill pathogens. We examined the efficacy of environmental disinfection using the Tru-D device in the laboratory and in rooms of hospitalized patients. Cultures for C. difficile, methicillin-resistant Staphylococcus aureus (MRSA, and vancomycin-resistant Enterococcus (VRE were collected from commonly touched surfaces before and after use of Tru-D. Results On inoculated surfaces, application of Tru-D at a reflected dose of 22,000 μWs/cm2 for ~45 minutes consistently reduced recovery of C. difficile spores and MRSA by >2-3 log10 colony forming units (CFU/cm2 and of VRE by >3-4 log10 CFU/cm2. Similar killing of MRSA and VRE was achieved in ~20 minutes at a reflected dose of 12,000 μWs/cm2, but killing of C. difficile spores was reduced. Disinfection of hospital rooms with Tru-D reduced the frequency of positive MRSA and VRE cultures by 93% and of C. difficile cultures by 80%. After routine hospital cleaning of the rooms of MRSA carriers, 18% of sites under the edges of bedside tables (i.e., a frequently touched site not easily amenable to manual application of disinfectant were contaminated with MRSA, versus 0% after Tru-D (P Conclusions The Tru-D Rapid Room Disinfection device is a novel, automated, and efficient environmental disinfection technology that significantly reduces C. difficile, VRE and MRSA contamination on commonly touched hospital surfaces.

  2. Operation Room Infection Factors and Control%手术室感染因素及控制

    Institute of Scientific and Technical Information of China (English)

    姜丽; 周静

    2014-01-01

    The postoperative infection of patients means that the threat to life, so to prevent postoperative infection has become the guarantee of human life, an important task to promote the rehabilitation of patients and medical development. In order to reduce the infection rate of operation, improve the quality of medical treatment, the operation infection factors analysis. The results show that: the infection factors although many, but in general the main or operation contact and air bacteria through various means of land caused by operation wound infection in operation room, so is the key to control [1] infection, so the scientific management of operation room, take comprehensive measures and dynamic bacteriological monitoring is the fundamental way to reduce operation incision infection. Ensure work quality is the key to operation room infection reduce all kinds of operation after operation.%术后感染对患者意味着生命的威胁,因此防止术后感染已经成为当今保障人类生命,促进患者康复和医学发展的一个重大课题。为降低手术感染率,提高医疗质量,对手术感染因素进行分析。结果表明:感染因素虽然很多,但总的来说主要还是手术的接触传播和空气浮游菌通过各种途径降落于手术创面而引起的感染,所以手术室是控制切口感染的关键[1],因此对手术室进行科学管理,采取综合预防措施和动态细菌学监测是降低手术切口感染的根本途径。保证手术室工作质量是减少各类手术术后感染的关键。

  3. Association between birth order and emergency room visits and acute hospital admissions following pediatric vaccination: a self-controlled study.

    Directory of Open Access Journals (Sweden)

    Steven Hawken

    Full Text Available OBJECTIVE: We investigated the association between a child's birth order and emergency room (ER visits and hospital admissions following 2-,4-,6- and 12-month pediatric vaccinations. METHODS: We included all children born in Ontario between April 1(st, 2006 and March 31(st, 2009 who received a qualifying vaccination. We identified vaccinations, ER visits and admissions using health administrative data housed at the Institute for Clinical Evaluative Sciences. We used the self-controlled case series design to compare the relative incidence (RI of events among 1(st-born and later-born children using relative incidence ratios (RIR. RESULTS: For the 2-month vaccination, the RIR for 1(st-borns versus later-born children was 1.37 (95% CI: 1.19-1.57, which translates to 112 additional events/100,000 vaccinated. For the 4-month vaccination, the RIR for 1(st-borns vs. later-borns was 1.70 (95% CI: 1.45-1.99, representing 157 additional events/100,000 vaccinated. At 6 months, the RIR for 1(st vs. later-borns was 1.27 (95% CI: 1.09-1.48, or 77 excess events/100,000 vaccinated. At the 12-month vaccination, the RIR was 1.11 (95% CI: 1.02-1.21, or 249 excess events/100,000 vaccinated. CONCLUSIONS: Birth order is associated with increased incidence of ER visits and hospitalizations following vaccination in infancy. 1(st-born children had significantly higher relative incidence of events compared to later-born children.

  4. Effects of Air Pollution on Hospital Emergency Room Visits for Respiratory Diseases: Urban-Suburban Differences in Eastern China.

    Science.gov (United States)

    Liu, Peng; Wang, Xining; Fan, Jiayin; Xiao, Wenxin; Wang, Yan

    2016-03-19

    A study on the relationships between ambient air pollutants (PM2.5, SO₂ and NO₂) and hospital emergency room visits (ERVs) for respiratory diseases from 2013 to 2014 was performed in both urban and suburban areas of Jinan, a heavily air-polluted city in Eastern China. This research was analyzed using generalized additive models (GAM) with Poisson regression, which controls for long-time trends, the "day of the week" effect and meteorological parameters. An increase of 10 μg/m³ in PM2.5, SO₂ and NO₂ corresponded to a 1.4% (95% confidence interval (CI): 0.7%, 2.1%), 1.2% (95% CI: 0.5%, 1.9%), and 2.5% (95%: 0.8%, 4.2%) growth in ERVs for the urban population, respectively, and a 1.5% (95%: 0.4%, 2.6%), 0.8% (95%: -0.7%, 2.3%), and 3.1% (95%: 0.5%, 5.7%) rise in ERVs for the suburban population, respectively. It was found that females were more susceptible than males to air pollution in the urban area when the analysis was stratified by gender, and the reverse result was seen in the suburban area. Our results suggest that the increase in ERVs for respiratory illnesses is linked to the levels of air pollutants in Jinan, and there may be some urban-suburban discrepancies in health outcomes from air pollutant exposure.

  5. 医院消毒供应室质量缺陷管理%Quality Defect Management in the Hospital Disinfection Supply Room

    Institute of Scientific and Technical Information of China (English)

    赵明

    2016-01-01

    Objective To study the work quality defect content and management measures in the hospital disinfection sup-ply room. Methods The disinfection supply room quality management group was established, the existing quality defect kinds and causes in the hospital disinfection supply room were analyzed by the fishbone diagram tool and the corresponding management measures were put forwards in order to improve the work quality defect status in the hospital disinfection sup-ply room. Results A series of improvement measures were worked out and implemented by the brainstorm effect of work staff, and the quality defect in the disinfection supply room was effectively improved and managed. Conclusion The disin-fection supply room is an important support department in the hospital work, and its work quality directly concerns the whole management level of hospitals, the application of fishbone diagram in the quality defect management in the disinfec-tion supply room can effectively reduce the incidence rate of management defect in the disinfection supply room and ensure the strictness and safety in the department work.%目的:探讨医院消毒供应室工作质量缺陷内容及管理措施。方法成立消毒供应室质量管理小组,运用鱼骨图等工具对医院消毒供应室存在的质量缺陷种类及原因进行分析,提出相应管理措施,以改善医院消毒供应室工作质量缺陷现状。结果通过工作人员头脑风暴效应,制定并实施一系列改进措施,消毒供应室存在的质量缺陷得到有效改善管理。结论消毒供应室是医院工作的重要保障科室,其工作质量直接关系着医院的整体管理水平,将鱼骨图运用到消毒供应室的质量缺陷管理中,可有效降低消毒供应室管理缺陷发生率,保障科室工作的严谨性和安全性。

  6. 应用术前准备间对手术室工作效率的影响%Application of Preoperative Preparation Between Affect Working Efficiency of the Operating Room

    Institute of Scientific and Technical Information of China (English)

    张晶; 李淑兰

    2013-01-01

    the operating room is to provide patients with surgery and rescue sites, is an important technology division hospital, the hospital operating room al surgical department is directly related to the work ef iciency of the overal work ef iciency. If the operating ef iciency is not high, not only operation team to bring huge pressure, also af ect the quality of medical care security hidden danger, af ects the hospital economic benefit and social benefit. Even the surgery is to improve the work ef iciency, solve, inadequate surgery between key measures to ensure the surgical system running smoothly.%手术室是为患者提供手术及抢救场所,是医院重要技术部门,医院手术室的工作效率直接关系到所有外科科室的整体工作效率。如果手术室工作效率不高,不仅给术组人员带来巨大压力,同时影响医疗护理质量产生安全隐患,影响医院经济效益和社会效益。进行连台手术是提高工作效率、解决手术间不足,保证外科系统顺。运转的关键措施。

  7. Simulation of operational processes in hospital emergency units as lean healthcare tool

    Directory of Open Access Journals (Sweden)

    Andreia Macedo Gomes

    2017-07-01

    Full Text Available Recently, the Lean philosophy is gaining importance due to a competitive environment, which increases the need to reduce costs. Lean practices and tools have been applied to manufacturing, services, supply chain, startups and, the next frontier is healthcare. Most lean techniques can be easily adapted to health organizations. Therefore, this paper intends to summarize Lean practices and tools that are already being applied in health organizations. Among the numerous techniques and lean tools used, this research highlights the Simulation. Therefore, in order to understand the use of Simulation as a Lean Healthcare tool, this research aims to analyze, through the simulation technique, the operational dynamics of the service process of a fictitious hospital emergency unit. Initially a systematic review of the literature on the practices and tools of Lean Healthcare was carried out, in order to identify the main techniques practiced. The research highlighted Simulation as the sixth most cited tool in the literature. Subsequently, a simulation of a service model of an emergency unit was performed through the Arena software. As a main result, it can be highlighted that the attendants of the built model presented a degree of idleness, thus, they are able to atend a greater demand. As a last conclusion, it was verified that the emergency room is the process with longer service time and greater overload.

  8. Crisis Checklists May Substantially Reduce the Likelihood of Critical Missed Steps in the Operating Room

    Science.gov (United States)

    ... Prevención y bienestar Condiciones y enfermedades Atención médica Medicamentos La seguridad del paciente Calidad de atención médica ... hospitalization but are far more resource-intensive New oral anticoagulant has ... cancer screening Odds of receiving a transfusion during major ...

  9. An empirical investigation of the effectiveness of contemporary managerial philosophies in a hospital operational setting.

    Science.gov (United States)

    Yasin, Mahmoud M; Zimmerer, Linda W; Miller, Phillip; Zimmerer, Thomas W

    2002-01-01

    The new realities of the healthcare marketplace are forcing healthcare decision makers to implement innovative operational philosophies, techniques, and tools that were proven in other industries to enhance the effectiveness of their organization. This study examines the acceptance and effectiveness of these philosophies, techniques, and tools in a hospital operational setting. The impact of implementation on operational and strategic outcomes is examined for 108 hospitals. Overall, the results of this study appear to indicate that certain quality improvement philosophies, techniques, and tools have been successful when applied in a hospital operational setting.

  10. Fuel cells using ionic liquids as electrolyte and operating at room temperature; Celulas de combustivel utilizando como eletrolito liquidos ionicos e operando a temperatura ambiente

    Energy Technology Data Exchange (ETDEWEB)

    Botton, Janine Padilha; Souza, Roberto Fernando de; Goncalves, Reinaldo Simoes; Dupont, Jairton [Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS (Brazil). Inst. de Quimica], e-mail: janine@iq.ufrgs.br

    2004-07-01

    The room temperature imidazolium based ionic liquids, such as 1-n-butyl-3-methylimidazolium tetrafluoroborate (BMI.BF4) are outstanding electrolytes for fuel cells. A 67% overall cell efficiency is achieve using these liquids as supporting electrolytes for a commercially available alkaline fuel cell (AFC) at room temperature operating with air and hydrogen at atmospheric pressure. (author)

  11. Simulated versus realistic intra operative radiation therapy (I.O.R.T.) treatment in operating room: from knowledge of stray radiation to action

    Energy Technology Data Exchange (ETDEWEB)

    Andreoli, S.; Moretti, R. [USC Fisica Sanitaria - Ospedali Riuniti di Bergamo (Italy); Catalano, M.; Locatelli, F. [Degli Studi di Milano Univ., Scuola di Specializzazione in Fisica Sanitaria (Italy)

    2006-07-01

    Intra-Operative Radiation Therapy (I.O.R.T.) is carried out with electron beams produced by a Linac (Linear Accelerator) generally used for conventional radiotherapy with external beam, or by dedicated accelerators that can be employed directly into an operating room. I.O.R.T. refers to the application of radiation during a surgical intervention, after the removal of a neoplastic mass. I.O.R.T. uses on the tumour area a direct irradiation, for the possible localisation of sub-clinic illness or macroscopic residue in the case of non-radical resection. Intra-Operative Radiotherapy foresees a single session only, generally preceded or followed by radiotherapy with external beam. It allows the achievement of a selective radiation boost on the tumour volume. In some cases, it can also be used as a one-time/stand alone treatment in initial cancer of small volume, or in unresectable malignancies for palliative purpose. The technical advantages of I.O.R.T. consist in the direct visual control of the target volume, and in the possibility to protect the healthy tissues by moving them away from the path of the radiation beam. The use of electron beams allows the administration of a homogeneous dose to a selected layer of tissues surrounding the tumour. The following professional staff forms the Operative Group: radiation oncologist, surgeon, anaesthetist, medical physicist, radiation technologist, nurse.The choice of a simulation geometry very similar to the clinical situation allows to evaluate radioprotection data very close to the real situation. For a fixed layout, an anthropomorphic phantom was positioned on the operating bed and a breast I.O.R.T. treatment was simulated positioning all the accessories of the operating room in their typical positions. A detailed dose mapping was performed with a Victoreen 450P ionisation chamber and with environment film-dosimeter on the walls of the operating room during the simulation of the clinical treatment. The simulation appears

  12. 加强医院整形美容门诊手术室管理控制医院感染%Improving management of cosmetic surgery outpatient operating room to control nosocomial infection

    Institute of Scientific and Technical Information of China (English)

    王艳; 董薪; 张金凤; 孙建荷

    2011-01-01

    目的 探讨医院整形美容门诊手术室安全有效的管理措施,加强整形美容手术各个环节管理,预防和控制医院感染. 方法 通过加强组织领导,规范手术室环境、手术物品、手术人员等各个环节管理, 建立健全整形美容手术室医院感染控制体系. 结果 加强了整形美容手术室医院感染的管理体系,有效地预防和控制了医院感染,提高了手术室医疗护理质量. 结论 采取严格规范系统的整形美容手术管理措施,可以有效控制医院感染的发生,对加强医院规范化管理,控制医院感染具有积极重要的意义.%OBJECTIVE To discuss the effective measures for the safety of cosmetic surgery in outpatient operating room and strengthen the management of every links of cosmetic surgery to prevent and control the incidence of nosocomial infection. METHODS By means of reinforcing the administrative performance, the links to the operating room management, such as the environment of operating room, supervision of operation materials and surgical staff, were regulated to establish and perfect the control system of hospital infection in cosmetic surgery operating room. RESULTS The administrative system of nosocomial infection, the effective prevention and control of nosocomial infection in cosmetic surgery operation room and the quality of medical care in cosmetic surgery operation room had been improved. CONCLUSION Adopting the strict, standard and systemic management in cosmetic surgery can effectively control the occurrence of hospital infection and improve the quality of medical nursing and ensure the medical security, which has the positive significance to the standardized management and control of nosocomial infection.

  13. 循证护理在手术室的应用%Evidence-based nursing application in operation room

    Institute of Scientific and Technical Information of China (English)

    车南飞

    2011-01-01

    Objective To investigate the model of evidence - based nursing application in operation room. Methods Based on the model of evidence - based nursing, hypothermia, pressure ulcer in perioperative and postoperative cervicobrachialgia pain after laparoscopic operation were all clinically analyzed. Results Following the model of evidence- based nursing, compared with the common practice, hypothermia, pressure ulcer in the perioperative and postoperative cervicobrachialgia after laparoscopic all achieved significant results. Conclusion The model of evidence -based nursing application in operation room could obtain better effects.%目的 探讨循证护理模式在手术室的应用.方法根据循证护理模式,对手术常见的压疮、低体温、腹腔镜手术后引起的颈肩痛进行循证护理研究.结果遵循循证护理模式后,手术常见的压疮、低体温、腹腔镜手术后引起的颈肩痛与既往所采取常规措施比较,均取得良好效果.结论在手术室工作中遵循循证护理模式,可取得良好效果,值得推广.

  14. A fuel cell operating between room temperature and 250 C based on a new phosphoric acid based composite electrolyte

    Energy Technology Data Exchange (ETDEWEB)

    Lan, Rong [Department of Chemistry, Heriot-Watt University, Edinburgh EH14 4AS (United Kingdom); Xu, Xiaoxiang; Irvine, John T.S. [School of Chemistry, University of St Andrews, St Andrews, Fife KY16 9ST (United Kingdom); Tao, Shanwen [Department of Chemistry, Heriot-Watt University, Edinburgh EH14 4AS (United Kingdom); School of Chemistry, University of St Andrews, St Andrews, Fife KY16 9ST (United Kingdom)

    2010-10-15

    A phosphoric acid based composite material with core-shell microstructure has been developed to be used as a new electrolyte for fuel cells. A fuel cell based on this electrolyte can operate at room temperature indicating leaching of H{sub 3}PO{sub 4} with liquid water is insignificant at room temperature. This will help to improve the thermal cyclability of phosphoric acid based electrolyte to make it easier for practical use. The conductivity of this H{sub 3}PO{sub 4}-based electrolyte is stable at 250 C with addition of the hydrophilic inorganic compound BPO{sub 4} forming a core-shell microstructure which makes it possible to run a PAFC at a temperature above 200 C. The core-shell microstructure retains after the fuel cell measurements. A power density of 350 mW/cm{sup 2} for a H{sub 2}/O{sub 2} fuel cell has been achieved at 200 C. The increase in operating temperature does not have significant benefit to the performance of a H{sub 2}/O{sub 2} fuel cell. For the first time, a composite electrolyte material for phosphoric acid fuel cells which can operate in a wide range of temperature has been evaluated but certainly further investigation is required. (author)

  15. Os fios de sutura cirúrgica e a enfermeira de centro cirúrgico: critérios de previsão e provisão segundo a natureza das instituições hospitalares Los hilos de sutura quirúrgicas y la enfermera de centro quirúrgico: criterios de previsión y provisión según la naturaleza de las instituciones hospitalarias Sutures and the operating room nurse: criteria in forecasting the need for sutures and provisioning according to nature of the hospital institution

    Directory of Open Access Journals (Sweden)

    Anita Romano Ribeiro

    2003-12-01

    hospitals are medium in size and privately owned with a general Operation Room and up to 500 surgical procedures performed per month. The procedures, the type and the variety of surgical sutures are related to the nature of hospital management. However, there are no criteria to select surgical sutures and their distribution in the operation rooms. The nurses participate on the procedures for purchasing, distribution and use of the surgical sutures.

  16. Operating Room Efficiency before and after Entrance in a Benchmarking Program for Surgical Process Data

    DEFF Research Database (Denmark)

    Pedron, Sara; Winter, Vera; Oppel, Eva-Maria

    2017-01-01

    a generally increasing trend during participation. For raw utilization no clear and statistically significant trend could be evidenced. Subgroup analyses revealed differences in effects across different hospital types and department specialties. Participation in a benchmarking and reporting program and thus...... program for surgical process data was associated with a change in OR efficiency, measured through raw utilization, turnover times, and first-case tardiness. The main analysis is based on panel data from 202 surgical departments in German hospitals, which were derived from the largest database for surgical...... process data in Germany. Panel regression modelling was applied. Results revealed no clear and univocal trend of participation in a benchmarking and reporting program for surgical process data. The largest trend was observed for first-case tardiness. In contrast to expectations, turnover times showed...

  17. Interprofessional work in operating rooms: a qualitative study from Sri Lanka

    OpenAIRE

    Jayasuriya-Illesinghe, Vathsala; Guruge, Sepali; Gamage, Bawantha; Espin, Sherry

    2016-01-01

    Background A growing body of research shows links between poor teamwork and preventable surgical errors. Similar work has received little attention in the Global South, and in South Asia, in particular. This paper describes surgeons? perception of teamwork, team members? roles, and the team processes in a teaching hospital in Sri Lanka to highlight the nature of interprofessional teamwork and the factors that influence teamwork in this setting. Methods Data gathered from interviews with 15 su...

  18. Prevalence of Visible and Occult Blood on Airway Management Equipment Used Outside the Operating Room

    Science.gov (United States)

    1999-10-01

    did not accept the current germ theory of her time; however, she developed and implemented the idea of asepsis as a means to control infection. She...renown for his work on chemical disinfection and asepsis in hospital settings, developed a classification system which identified appropriate levels...not accept the current germ theory of her time, she developed and implemented the idea of asepsis as a means to control infection and to prevent the

  19. Interprofessional work in operating rooms: a qualitative study from Sri Lanka

    OpenAIRE

    Jayasuriya-Illesinghe, Vathsala; Guruge, Sepali; Gamage, Bawantha; Espin, Sherry

    2016-01-01

    Background A growing body of research shows links between poor teamwork and preventable surgical errors. Similar work has received little attention in the Global South, and in South Asia, in particular. This paper describes surgeons’ perception of teamwork, team members’ roles, and the team processes in a teaching hospital in Sri Lanka to highlight the nature of interprofessional teamwork and the factors that influence teamwork in this setting. Methods Data gathered from interviews with 15 su...

  20. What can foodservice operators do to remedy undernutrition in hospitals?

    DEFF Research Database (Denmark)

    Mikkelsen, Bent Egberg; Beck, Anne Marie; Balknäs, Ulla Nilsson

    2003-01-01

    of clearly defined responsibilities, and a lack of educational possibilities, as well as a lack of cooperation between those groups. Foodservice and nutritional care does not pay sufficient attention to the rights of the patients and their needs for information, and, finally, hospital management seems...

  1. Post-operative Nausea and Vomiting at Mulago Hospital

    African Journals Online (AJOL)

    jen

    1Department of Surgery, 2Dept of Anaesthesia Mulago Hospital, Kampala – Uganda ... problem because it is transient and does not carry mortality implications. .... Breast. Others. 45 (50.0). 4 (10.8). 19 (59.4). 3 (25.0). 3 (27.3). 45 (50.0).

  2. [Anesthetic management of patients with mental retardation during autologous transplantation of peripheral blood mononuclear cells outside the operating room].

    Science.gov (United States)

    Li, Meng-meng; Zhang, Qing-hong; Liu, Ying-hui; Yue, Li; Liu, Zhi-hui; Hao, Jian-hua

    2011-06-01

    To observe the anesthetic effect and safety of differential airway management in patients with mental retardation (MR) during autologous peripheral blood mononuclear cell transplantation (APBMCT) outside the operating room. In this prospective study, 30 uncooperative patients with MR receiving total intravenous anesthesia (TIVA) with propofol for APBMCT were randomized into 3 groups with monitored anesthesia care (MAC group), inserted classic laryngeal mask airway under general anesthesia (LMA group), or endotracheal tube placement (ETT group). The blood pressure (BP), heart rate (HR), SpO(2) and pH, PaCO(2), and HCO(3)(-) were monitored at 5 min and 1 h after anesthesia, before completion of the operation and at 1 h after the operation. The total operative time, dosage of propofol, awake time and body movement during the procedure were recorded. Compared with LMA and ETT groups, the MAC groups showed a significantly increased total dosage of propofol (66.07±5.41, 35.83±5.80, and 34.61±3.68 g·kg(-1)·min(-1), respectively, Pawake time (16.82±7.60, 4.31±1.32, and 3.73±1.33 min, P0.05). At 1 h after anesthesia, the pH in MAC group decreased markedly compared with that in LMA and ETT groups (PMAC group and remained so till the end of the surgery (P<0.05). Endotracheal tube placement is safer than laryngeal mask airway placement and monitored anesthesia care in patients with MR during APBMCT, and allows rapid onset of sedation with minimal cardiovascular responses, body movement and recovery, therefore is more suitable in the setting outside the operating room.

  3. 手术室服务体验问卷量表的研制%Developing a questionnaire scale for experience investigation to operating room service

    Institute of Scientific and Technical Information of China (English)

    易念巡; 谭玉兰

    2016-01-01

    目的 研制适合住院手术患者手术室服务体验的问卷量表.方法 以美国schrmitt战略体验模块为理论框架自制的调查量表,以此对某三甲医院200名住院手术患者进行手术室服务期望与感受调查,检测量表的信度和效度.结果 服务期望和服务感受量表总的Cronbach's α系数分别为0.901和0.912,奇偶分半系数分别为0.814和0.867,各维度的α系数>0.7;量表各条目得分与总体体验得分之间Pearson相关系数为0.487~0.701(P<0.01).结论 自制的住院手术患者手术室服务体验调查量表的信度和效度良好,可用于相关研究.%Objective To design a questionnaire scale for experience investigation of surgical patients to operating room service.Methods Taking Schmitt strategic experience in the United States as the theoretical framework,a selfmade questionnaire scale for experience investigation of surgical patients to operating room service was designed.The reliability and validity of the questionnaire were tested by an investigation of 200 surgical patients in a third class A hospital with the scale.Results The total Cronbach's a coefficient of the scale was 0.901 and 0.912,and its four dimensions coefficient was>0.7.Pearson correlation coefficient of each item score and the overall experience score was 0.487 ~ 0.701 (P<0.01).Conclusion The selfmade questionnaire scale for experience investigatin of surgical patients to operating room service has good reliability and validity and can be used for the relevant investigations.

  4. Sala de emergência em pediatria: casuística de um hospital universitário Pediatric emergency room: experience at a university hospital

    Directory of Open Access Journals (Sweden)

    Adriana Gut L. Riccetto

    2007-06-01

    Full Text Available OBJETIVO: Descrever a casuística de pacientes pediátricos atendidos em sala de emergência pediátrica de um hospital universitário. MÉTODOS: Estudo retrospectivo descritivo de 1º de janeiro até 31 de dezembro de 2004, com crianças de zero a 14 anos, avaliadas quanto a dados epidemiológicos, hipótese diagnóstica, intubação orotraqueal, óbito, destino e duração da internação. Os pacientes foram divididos em quatro grupos: Não Óbitos; Óbitos 24 horas e transferidos para outros hospitais. RESULTADOS: Foram atendidas 203 crianças; 59,1% meninos; média de idade 3,4 anos; 65% previamente hígidos. O diagnóstico mais freqüente foi insuficiência respiratória (31,1%. Dentre os 22 óbitos, 3,5% ocorreram nas primeiras 24 horas e 7,4% após estas primeiras 24 horas; 172 crianças (84,7% evoluíram para alta após período médio de internação de 19,2 dias. Nove (4,4% foram transferidas para outros hospitais. Das 203 crianças atendidas, 50 (24,6% foram intubadas à admissão e 86 (42,4% necessitaram internação em unidade de terapia intensiva pediátrica. CONCLUSÕES: Os pacientes que evoluíram para óbito precoce eram mais jovens e com diagnóstico de choque. Nos pacientes que evoluíram para óbito após 24 horas do atendimento inicial, predominaram meninas, com doenças prévias e insuficiência respiratória. Aqueles que sobreviveram ao atendimento de emergência eram, em maior freqüência, meninos mais velhos e com doenças respiratórias. Houve necessidade significativa de procedimento invasivo (intubação orotraqueal e internação subseqüente em unidade de terapia intensiva, o que reforça a necessidade de equipamentos adequados e profissionais especializados no setor.OBJECTIVE: Describe the clinical course of pediatric patients treated at a pediatric emergency room in a university hospital. METHODS: This retrospective descriptive study was conducted between January 1st and December 31st, 2004. Data retrieved were

  5. Prediction of mortality rate of trauma patients in emergency room at Cipto Mangunkusumo Hospital by several scoring systems

    Directory of Open Access Journals (Sweden)

    Pande M.W. Tirtayasa

    2013-12-01

    Full Text Available Background: Trauma management is well recognized as one of the main challenges in modern health care. Easy-to-use trauma scoring systems inform physicians of the severity of trauma and help them to decide the course of trauma management. The aim of this study was to find the most applicable trauma scoring system which can be used by physicians by comparing prediction of the mortality rate using: 1triage-revised trauma score (T-RTS; 2 mechanism, Glasgow coma scale (GCS, age, and arterial pressure (MGAP; and GCS, age, and systolic blood pressure (GAP scoring system on trauma patients in emergency room (ER at Cipto Mangunkusumo Hospital.Methods: The data were collected retrospectively from medical records of trauma patients who came to the resuscitation area in ER at Cipto Mangunkusumo Hospital throughout 2011. As many as 185 patients were managed. The inclusion criteria were all trauma patients who came to the resuscitation area in ER. All referred patients, patients under eighteen, and uncompleted data were excluded. The data were calculated based on each scoring system. The outcome (death or alive was collected on first 24 hours following admission.Results: There were 124 cases analyzed, with mean of age of 32.4 years and total mortality rate up to 23 cases (18.5%. The mortality rate of low risk group on T-RTS, MGAP, and GAP was 5%, 1.3%, and 1.4% respectively (p = 1.000. The mortality rate of intermediate risk group on T-RTS, MGAP, and GAP was 39.4%, 32.1%, and 36.3%, respectively (p = 0.841. Mortality rate of high risk group on T-RTS, MGAP, and GAP was 100%, 72.2%, and 85.7% respectively (p = 0.782.Conclusion: There was no difference on T-RTS, MGAP, and GAP scoring system in predicting mortality rate. T-RTS is the most applicable trauma scoring system since it does not differ the age and mechanism of trauma. (Med J Indones. 2013;22:227-31. doi: 10.13181/mji.v22i4.603 Keywords: GAP, MGAP, T-RTS, Trauma scoring system

  6. Manejo del cólico renal en urgencias de un hospital de tercer nivel Nephritic colic management in an emergency room of a referral hospital

    Directory of Open Access Journals (Sweden)

    M.A. Aibar-Arregui

    2010-08-01

    management of patients with nephritic colic in a referral hospital, their monitoring and the incidence of alternative diagnoses. Methods. This is a retrospective review of 182 randomly selected patients who presented a clinical diagnosis compatible with nephritic colic in a referral hospital. In these cases initial treatment, monitoring and alternative diagnoses have been evaluated. Results. Fifty-five point four percent of the patients were male, the mean age was 47.7 years and 40% of the cases were in spring. Urinalysis was carried out in every patient (62.7% dipstick and 72% urinary sediment; they were pathological in over 70%. In 26.4% of cases renal function deteriorated, always transiently. Abdominal radiography (81.9% was the most frequently diagnostic test performed, followed by ultrasound (25.8%. Treatment included a serum therapy in 31.3%; metamizol (61% was the most commonly used analgesic followed by ketorolac (44.5%. More than one non-steroidal anti-inflammatory was used by 46.2%. Hospital admission was required by 24 patients, and 5 of them needed emergency surgery. Twenty-four point one percent of patients had relapses during the next six months. Forty-one point six percent were referred to urology discharge on from the emergency room. Eighteen point one percent of patients had alternative diagnoses; acute pyelonephritis was the most frequent of these (55%. Conclusions. In our work we found a significant variation in the diagnostic and therapeutic management of these patients. The use of clinical guidelines could help us to unify the management of patients with nephritic colic, both in the emergency room and on discharge. Due to the high prevalence of alternative diagnoses, we have to systematically exclude more serious diseases.

  7. Multidisciplinary teamwork improves use of the operating room: a multicenter study

    NARCIS (Netherlands)

    Veen-Berkx, E. van; Bitter, J.; Kazemier, G.; Scheffer, G.J.; Gooszen, H.G.

    2015-01-01

    BACKGROUND: Poor inter-professional collaboration might negatively influence adequate planning of operative procedures. Interventions capable of improving inter-professional collaboration will positively impact professional practice and health care outcomes. Radboud University Medical Center (UMC)

  8. Development of an expert system for abnormal operating procedures in a main control room.

    Science.gov (United States)

    Hsieh, Min-Han; Hwang, Sheue-Ling; Liu, Kang-Hong; Liang, Sheau-Farn Max; Chuang, Chang-Fu

    2012-01-01

    The study was conducted from the perspective of human factors engineering in order to compare the process that operators originally used to diagnose potential and actual faults with a process that included an expert system for diagnosing faults. The results of the study indicated that the existence of an expert system for fault diagnosis makes the task of fault diagnosis easier and reduces errors by quickly suggesting likely Abnormal Operating Procedures (AOPs).

  9. AN IMPACT OF THE EFFICIENT FUNCTIONING OF THE VENTILATION AND AIR-CONDITIONING SYSTEM ON THERMAL COMFORT OF THE MEDICAL STAFF IN THE OPERATING R