WorldWideScience

Sample records for integrated operating room

  1. [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.

  2. Sterilization Monitoring management of the integration of the operating room with CSSD

    Directory of Open Access Journals (Sweden)

    Shu-yan XIA

    2014-08-01

    Full Text Available Objective: Explore the Sterilization Monitoring management of the integration of the operating room with CSSD. Methods: Compare sterilization process monitoring with biological monitoring and chemical monitoring. Results: The management in Biological monitoring, chemical monitoring and sterilization process monitoring is crucial. Conclusion: Sterilization monitoring is to ensure the safe use of sterile goods so as to protect the safety of surgical patients.

  3. Improving operating room safety

    Directory of Open Access Journals (Sweden)

    Garrett Jill

    2009-11-01

    Full Text Available Abstract Despite the introduction of the Universal Protocol, patient safety in surgery remains a daily challenge in the operating room. This present study describes one community health system's efforts to improve operating room safety through human factors training and ultimately the development of a surgical checklist. Using a combination of formal training, local studies documenting operating room safety issues and peer to peer mentoring we were able to substantially change the culture of our operating room. Our efforts have prepared us for successfully implementing a standardized checklist to improve operating room safety throughout our entire system. Based on these findings we recommend a multimodal approach to improving operating room safety.

  4. Design concepts for an integrated control room used as a site-wide operations facility

    International Nuclear Information System (INIS)

    Simon, B.H.; Raghavan, R.; Ujita, H.; Utena, S.; Sakuma, A.; Itoh, T.; Fukura, M.; Ono, I.

    1995-01-01

    The concept of an Integrated Main Control Room (IMCR) evolved from surveys conducted by Tokyo Electric Power Company (TEPCO) with plant managers and workers as their existing GE-type boiling water reactors (BWRs) on the need for improved operating conditions in a new generation of reactors being developed for the next century (around 2010). These reactors will be a further enhancement of the advanced boiling water reactors (ABWRs) now being constructed at the Kashiwazaki-Kariwa site in Japan (no.6 and no.7). TEPCO also saw a need for new thinking on control room design because of projected social conditions in Japan for the 21st century. These projections forecast a smaller number of skilled engineering graduates and those graduates less willing to work in nuclear power because such work is seen as unappealing, conducted in remote geographical locations, and requiring extensive night duty. As one solution to reducing operator burden and decreasing the night shift staff, while making nuclear plant operation more interesting for the operators and reducing labor and construction costs, the IMCR was conceived. (author)

  5. Operating room manager game

    NARCIS (Netherlands)

    Hans, Elias W.; Nieberg, T.

    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

  6. 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.

  7. 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

  8. A short-term operating room surgery scheduling problem integrating multiple nurses roster constraints.

    Science.gov (United States)

    Xiang, Wei; Yin, Jiao; Lim, Gino

    2015-02-01

    Operating room (OR) surgery scheduling determines the individual surgery's operation start time and assigns the required resources to each surgery over a schedule period, considering several constraints related to a complete surgery flow and the multiple resources involved. This task plays a decisive role in providing timely treatments for the patients while balancing hospital resource utilization. The originality of the present study is to integrate the surgery scheduling problem with real-life nurse roster constraints such as their role, specialty, qualification and availability. This article proposes a mathematical model and an ant colony optimization (ACO) approach to efficiently solve such surgery scheduling problems. A modified ACO algorithm with a two-level ant graph model is developed to solve such combinatorial optimization problems because of its computational complexity. The outer ant graph represents surgeries, while the inner graph is a dynamic resource graph. Three types of pheromones, i.e. sequence-related, surgery-related, and resource-related pheromone, fitting for a two-level model are defined. The iteration-best and feasible update strategy and local pheromone update rules are adopted to emphasize the information related to the good solution in makespan, and the balanced utilization of resources as well. The performance of the proposed ACO algorithm is then evaluated using the test cases from (1) the published literature data with complete nurse roster constraints, and 2) the real data collected from a hospital in China. The scheduling results using the proposed ACO approach are compared with the test case from both the literature and the real life hospital scheduling. Comparison results with the literature shows that the proposed ACO approach has (1) an 1.5-h reduction in end time; (2) a reduction in variation of resources' working time, i.e. 25% for ORs, 50% for nurses in shift 1 and 86% for nurses in shift 2; (3) an 0.25h reduction in

  9. [Integrate the surgical hand disinfection as a quality indicator in an operating room of urology].

    Science.gov (United States)

    Francois, M; Girard, R; Mauranne, C C; Ruffion, A; Terrier, J E

    2017-12-01

    The surgical hand disinfection by friction (SDF) helps to reduce the risk of surgical site infections. For this purpose and in order to promote good compliance to quality care, the urology service of Centre Hospitalier Lyon Sud achieved a continuous internal audit to improve the quality of the SDF. An internal audit executed by the medical students of urology was established in 2013. The study population was all operators, instrumentalists and operating aids of urology operating room (OR). Each student realized 5-10 random observations, of all types of professionals. The criteria measured by the audit were criteria for friction. The evolution of indicators was positive. Particularly, the increasing duration of the first and second friction was statistically significant during follow-up (P=0.001). The total duration of friction shows a similar trend for all professionals. The surgical hand disinfection by friction in the urology OR of the Centre Hospitalier Lyon Sud has gradually improved over the iterative audits. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

  10. Integrated Practice Improvement Solutions-Practical Steps to Operating Room Management.

    Science.gov (United States)

    Chernov, Mikhail; Pullockaran, Janet; Vick, Angela; Leyvi, Galina; Delphin, Ellise

    2016-10-01

    Perioperative productivity is a vital concern for surgeons, anesthesiologists, and administrators as the OR is a major source of hospital elective admissions and revenue. Based on elements of existing Practice Improvement Methodologies (PIMs), "Integrated Practice Improvement Solutions" (IPIS) is a practical and simple solution incorporating aspects of multiple management approaches into a single open source framework to increase OR efficiency and productivity by better utilization of existing resources. OR efficiency was measured both before and after IPIS implementation using the total number of cases versus room utilization, OR/anesthesia revenue and staff overtime (OT) costs. Other parameters of efficiency, such as the first case on-time start and the turnover time (TOT) were measured in parallel. IPIS implementation resulted in increased numbers of surgical procedures performed by an average of 10.7%, and OR and anesthesia revenue increases of 18.5% and 6.9%, respectively, with a simultaneous decrease in TOT (15%) and OT for anesthesia staff (26%). The number of perioperative adverse events was stable during the two-year study period which involved a total of 20,378 patients. IPIS, an effective and flexible practice improvement model, was designed to quickly, significantly, and sustainably improve OR efficiency by better utilization of existing resources. Success of its implementation directly correlates with the involvement of and acceptance by the entire OR team and hospital administration.

  11. Microscope-Integrated Optical Coherence Tomography Angiography in the Operating Room in Young Children With Retinal Vascular Disease.

    Science.gov (United States)

    Chen, Xi; Viehland, Christian; Carrasco-Zevallos, Oscar M; Keller, Brenton; Vajzovic, Lejla; Izatt, Joseph A; Toth, Cynthia A

    2017-05-01

    Intraoperative optical coherence tomography (OCT) has gained traction as an important adjunct for clinical decision making during vitreoretinal surgery, and OCT angiography (OCTA) has provided novel insights in clinical evaluation of retinal diseases. To date, these two technologies have not been applied in combination to evaluate retinal vascular disease in the operating suite. To conduct microscope-integrated, swept-source OCTA (MIOCTA) in children with retinal vascular disease. In this case report analysis, OCT imaging in pediatric patients, MIOCTA images were obtained during examination under anesthesia from a young boy with a history of idiopathic vitreous hemorrhage and a female infant with familial exudative vitreoretinopathy. Side-by-side comparison of research MIOCT angiograms and clinically indicated fluorescein angiograms. In 2 young children with retinal vascular disease, the MIOCTA images showed more detailed vascular patterns than were visible on the fluorescein angiograms although within a more posterior field of view. The MIOCTA system allowed visualization of small pathological retinal vessels in the retinal periphery that were obscured in the fluorescein angiograms by fluorescein staining from underlying, preexisting laser scars. This is the first report to date of the use of MIOCTA in the operating room for young children with retinal vascular disease. Further optimization of this system may allow noninvasive detailed evaluation of retinal vasculature during surgical procedures and in patients who could not cooperate with in-office examinations.

  12. Revisiting the Operating Room Basics

    Directory of Open Access Journals (Sweden)

    Tushar Chakravorty

    2015-12-01

    Full Text Available Young doctors walking into the operating room are eager to develop their skills to become efficient and knowledgeable professionals in future. But precious little is done to actively develop the basic practical skills of the budding doctors. They remain unaware about the layout of the operating room, the OR etiquette and often do not have sound scientific understanding and importance of meticulous execution of the basic operating room protocols. This article stresses the need to develop the basics of OR protocol and to improve the confidence of the young doctor by strengthening his foundation by showing him that attention to the basics of medical care and empathy for the patient can really make a difference to the outcome of a treatment.

  13. Using an integrative mock-up simulation approach for evidence-based evaluation of operating room design prototypes.

    Science.gov (United States)

    Bayramzadeh, Sara; Joseph, Anjali; Allison, David; Shultz, Jonas; Abernathy, James

    2018-07-01

    This paper describes the process and tools developed as part of a multidisciplinary collaborative simulation-based approach for iterative design and evaluation of operating room (OR) prototypes. Full-scale physical mock-ups of healthcare spaces offer an opportunity to actively communicate with and to engage multidisciplinary stakeholders in the design process. While mock-ups are increasingly being used in healthcare facility design projects, they are rarely evaluated in a manner to support active user feedback and engagement. Researchers and architecture students worked closely with clinicians and architects to develop OR design prototypes and engaged clinical end-users in simulated scenarios. An evaluation toolkit was developed to compare design prototypes. The mock-up evaluation helped the team make key decisions about room size, location of OR table, intra-room zoning, and doors location. Structured simulation based mock-up evaluations conducted in the design process can help stakeholders visualize their future workspace and provide active feedback. Copyright © 2018 Elsevier Ltd. All rights reserved.

  14. Operating Room Utilization at Frederick Memorial Hospital

    National Research Council Canada - National Science Library

    Edwards, Jonathan A

    2007-01-01

    .... A logistical regression analysis was used to identify the impact of variables on operating room utilization rates and therefore help explain how or why some operating rooms incurred higher utilization rates than others...

  15. The operating room of the future: observations and commentary.

    Science.gov (United States)

    Satava, Richard M

    2003-09-01

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

  16. Ergonomics in the operating room.

    Science.gov (United States)

    Janki, Shiromani; Mulder, Evalyn E A P; IJzermans, Jan N M; Tran, T C Khe

    2017-06-01

    Since the introduction of minimally invasive surgery, surgeons appear to be experiencing more occupational musculoskeletal injuries. The aim of this study is to investigate the current frequency and effects of occupational musculoskeletal injuries on work absence. An online questionnaire was conducted among all surgeons affiliated to the Dutch Society for Endoscopic Surgery, Gastrointestinal Surgery, and Surgical Oncology. In addition, this survey was conducted among surgeons, gynaecologists, and urologists of one cluster of training hospitals in the Netherlands. There were 127 respondents. Fifty-six surgeons currently suffer from musculoskeletal complaints, and 30 have previously suffered from musculoskeletal complaints with no current complaints. Frequently reported localizations were the neck (39.5 %), the erector spinae muscle (34.9 %), and the right deltoid muscle (18.6 %). Most of the musculoskeletal complaints were present while operating (41.8 %). Currently, 37.5 % uses medication and/or therapy to reduce complaints. Of surgeons with past complaints, 26.7 % required work leave and 40.0 % made intraoperative adjustments. More surgeons with a medical history of musculoskeletal complaints have current complaints (OR 6.1, 95 % CI 1.9-19.6). There were no significant differences between surgeons of different operating techniques in localizations and frequency of complaints, or work leave. Despite previous various ergonomic recommendations in the operating room, the current study demonstrated that musculoskeletal complaints and subsequent work absence are still present among surgeons, especially among surgeons with a positive medical history for musculoskeletal complaints. Even sick leave was necessary to fully recover. There were no significant differences in reported complaints between surgeons of different operating techniques. Almost half of the respondents with complaints made intraoperative ergonomic adjustments to prevent future complaints. The

  17. [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.

  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. 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. Advanced control room caters for the operator

    International Nuclear Information System (INIS)

    George, C.R.; Rygg, D.E.

    1980-01-01

    In existing control rooms the operators' efficiency is often limited by widely scattered and sometimes illogically arranged controls which tend to increase the potential for outages or equipment damage. The advanced control room described allows instant and ready access to preselected information and control by one or two operators from a seated or standing position. (author)

  1. New heuristics for planning operating rooms.

    NARCIS (Netherlands)

    Molina-Pariente, J.M.; Hans, Elias 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

  2. Operating room fires in periocular surgery.

    Science.gov (United States)

    Connor, Michael A; Menke, Anne M; Vrcek, Ivan; Shore, John W

    2018-06-01

    A survey of ophthalmic plastic and reconstructive surgeons as well as seven-year data regarding claims made to the Ophthalmic Mutual Insurance Company (OMIC) is used to discuss operating room fires in periocular surgery. A retrospective review of all closed claim operating room fires submitted to OMIC was performed. A survey soliciting personal experiences with operating room fires was distributed to all American Society of Oculoplastic and Reconstructive Surgeons. Over the last 2 decades, OMIC managed 7 lawsuits resulting from an operating room fire during periocular surgery. The mean settlement per lawsuit was $145,285 (range $10,000-474,994). All six patients suffered burns to the face, and three required admission to a burn unit. One hundred and sixty-eight surgeons participated in the online survey. Approximately 44% of survey respondents have experienced at least one operating room fire. Supplemental oxygen was administered in 88% of these cases. Most surgical fires reported occurred in a hospital-based operating room (59%) under monitored anesthesia care (79%). Monopolar cautery (41%) and thermal, high-temperature cautery (41%) were most commonly reported as the inciting agents. Almost half of the patients involved in a surgical fire experienced a complication from the fire (48%). Sixty-nine percent of hospital operating rooms and 66% of ambulatory surgery centers maintain an operating room fire prevention policy. An intraoperative fire can be costly for both the patient and the surgeon. Ophthalmic surgeons operate in an oxygen rich and therefore flammable environment. Proactive measures can be undertaken to reduce the incidence of surgical fires periocular surgery; however, a fire can occur at any time and the entire operating room team must be constantly vigilant to prevent and manage operating room fires.

  3. Development and quantitative effect estimation of an integrated decision support system to aid operator's cognitive activities for NPP advanced main control rooms

    International Nuclear Information System (INIS)

    Lee, Seung Jun

    2007-02-01

    As digital and computer technologies have grown, human-machine interfaces (HMIs) have evolved. In safety critical systems, especially in nuclear power plants (NPPs), HMIs are important for reducing operational costs, for reducing the number of necessary operators, and for reducing the probability of accident occurrence. Efforts have been made to improve main control room (MCR) interface design and to develop automation or support systems to ensure convenient operation and maintenance. In this paper, an integrated decision support system to aid the cognitive activities of operators is proposed for advanced MCRs in future NPPs. The proposed system supports not merely a particular task, but also the entire operation process based on a human cognitive process model. It supports the operator's entire cognitive process by integrating decision support systems that support each cognitive activity. In this paper, the operator's operation processes are analyzed based on a human cognitive process model and appropriate support systems that support each activity of the human cognitive process are suggested. Two decision support systems were developed in this paper. The first one is the fault diagnosis advisory system (FDAS) which detects faults and diagnoses them. The FDAS provides a list of possible faults and expected causes to operators. It was implemented using two kinds of neural networks for more reliable diagnosis results. The second system is the multifunctional operator support system for operation guidance, which includes the FDAS and the operation guidance system. The operation guidance system is to prevent operator's commission errors and omission errors. Furthermore, the effect of the proposed system was estimated because to evaluate decision support systems in order to validate their efficiency is as important as to design highly reliable decision support systems. The effect estimations were performed theoretically and experimentally. The Bayesian

  4. Radiation protection in the operating room

    International Nuclear Information System (INIS)

    Kunz, B.; Stargardt, A.

    1978-01-01

    On the basis of legally provided area dose measurements and time records of fluoroscopic examinations during the operation, radiation doses to medical personnel and patients are evaluated. Adequate radiation protection measures and a careful behaviour in the operating room keep the radiation exposure to the personnel below the maximum permissible exposure. Taking into account the continuous personnel radiation monitoring and medical supervision, radiation hazards in the operating room can be considered low

  5. Approaches for the integration of human factors into the upgrading and refurbishment of control rooms - Summary and conclusions - Principal Working Group 1 on Operating Experience and Human Factors

    International Nuclear Information System (INIS)

    2002-01-01

    A modern approach to control room design, be it for upgrading or complete refurbishment, requires the integration of many disciplines and approaches. The integration of human factors into such a process continues to present challenges. How such a process should be conceived, planned, and carried out is of considerable interest to designers, operators and regulators. Many NPPs around the world have been, or will be faced with decisions concerning modernization of their control rooms. Such changes can be driven by a range of issues including; the need to replace outdated control and instrumentation systems; increasing regulatory concern about human performance; or the need to provide a better process control environment for NPPs whose life cycles extend beyond that originally intended. Considering the importance of operator performance for safe and profitable operations, a process for ensuring that human factors issues are properly addressed could be central to the success or failure of such a project. Human factors is of particular importance when a combination of existing and new systems are to be used, resulting in a so-called 'hybrid' control room. The workshop addressed this topical area by providing a forum where a number of important areas could be discussed and experiences and lessons shared. Topics identified before hand as important and worthy of discussion included: - Exploration of how human factors issues can be identified. - Consideration of those processes and techniques necessary to ensure that appropriate requirements are specified, and that suitable data is gathered and analysed. - Identification and discussion of issues related to the above topics together with lessons from utilities, vendors and regulators which have faced, or are currently facing, these challenges. The meeting itself focused on the state of knowledge and current best practices within these areas and provided a forum for the open discussion of the human factors issues, as seen by

  6. 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.

  7. The role of the control room operator

    International Nuclear Information System (INIS)

    Williams, M.C.

    A control room operator at an Ontario Hydro nuclear power plant operates a reactor-turbine unit according to approved procedures within imposed constraints to meet the objectives of the organization. A number of operating and administrative tasks make up this role. Control room operators spend approximately six percent of their time physically operating equipment exclusive of upset conditions, and another one percent operating in upset conditions. Testing occupies five percent of an operator's time. Operators must be trained to recognize the entire spectrum of inputs available to them and use them all effectively. Any change in system or unit state is always made according to an approved procedure. Extensive training is required; operators must be taught and pracised in what to do, and must know the reasons behind their actions. They are expected to memorize emergency procedures, to know when to consult operating procedures, and to have sufficient understanding and practice to perform these procedures reliably

  8. Engineering Process Monitoring for Control Room Operation

    CERN Document Server

    Bätz, M

    2001-01-01

    A major challenge in process operation is to reduce costs and increase system efficiency whereas the complexity of automated process engineering, control and monitoring systems increases continuously. To cope with this challenge the design, implementation and operation of process monitoring systems for control room operation have to be treated as an ensemble. This is only possible if the engineering of the monitoring information is focused on the production objective and is lead in close collaboration of control room teams, exploitation personnel and process specialists. In this paper some principles for the engineering of monitoring information for control room operation are developed at the example of the exploitation of a particle accelerator at the European Laboratory for Nuclear Research (CERN).

  9. Developing control room operator selection procedures

    International Nuclear Information System (INIS)

    Bosshardt, M.J.; Bownas, D.A.

    1979-01-01

    PDRI is performing a two-year study to identify the tasks performed and attributes required in electric power generating plant operating jobs, and focusing on the control room operator position. Approximately 65 investor-owned utilities are participating in the study

  10. Engineering Process Monitoring for Control Room Operation

    OpenAIRE

    Bätz, M

    2001-01-01

    A major challenge in process operation is to reduce costs and increase system efficiency whereas the complexity of automated process engineering, control and monitoring systems increases continuously. To cope with this challenge the design, implementation and operation of process monitoring systems for control room operation have to be treated as an ensemble. This is only possible if the engineering of the monitoring information is focused on the production objective and is lead in close coll...

  11. Clinical Education Environment Experiences of Operating Room Students

    Directory of Open Access Journals (Sweden)

    Tahereh khazaei

    2016-01-01

    Full Text Available Background and purpose: The objective of medical education is to train competent and qualified workforce in order to provide services in various health environments. One of the important objectives of Operating Room students is to train workforce who can involve in patient’s health and recovery. Training these students should cause clinical ability and independent decision making during surgery. Since students during internship face with many problems, this study has been conducted to explore and describe the challenges and experiences.Methods: This qualitative study is a phenomenology that was conducted based on 20 students in the last semester of Operating Room associate’s degree with purposive sampling. Deep and semi-structured interviews were used to collect data and data were analyzed by content analysis method.Results: The findings in 5 main themes: (1 Physical space and equipment in the operating room, (2 The student’s position in operating room, (3 Integrating knowledge and action, (4 Managing education environment and 5- Student’s viewpoint about operating room and working in it.Conclusions: Interviews with students revealed the educational environment challenges with which they are faced during their study. Teachers can provide solutions to overcome the challenges and create a positive atmosphere for students' learning using results of this study and students may continue their interest in education and improve the quality of their education.Keywords: CLINICAL EDUCATION, OPERATING ROOM STUDENTS, CHALLENGE

  12. Review of operating room ventilation standards

    NARCIS (Netherlands)

    Melhado, M.D.A.; Hensen, J.L.M.; Loomans, M.G.L.C.

    2006-01-01

    This article reviews standards applied to operating room ventilation design used by European, South and North American countries. Required environmental parameters are compared with regard to type of surgery, and ventilation system. These requirements as well as their relation to infection control

  13. A Foot Operated Timeout Room Door Latch.

    Science.gov (United States)

    Foxx, R. M.; And Others

    1982-01-01

    This report describes the design and implementation of a foot operated timeout room door latch that permits staff members to maintain a misbehaving retarded individual in timeout without locking the door. Use of the latch also frees the staff member involved to record behavioral observations or reinforce appropriate behavior. (Author)

  14. Anticipating urgent surgery in operating room departments

    NARCIS (Netherlands)

    van der Lans, M.; Hans, Elias W.; Hurink, Johann L.; Wullink, Gerhard; van Houdenhoven, M.; Kazemier, G.

    2005-01-01

    Operating Room (OR) departments need to create robust surgical schedules that anticipate urgent surgery, while minimizing urgent surgery waiting time and overtime, and maximizing utilization. We consider two levels of planning and control to anticipate urgent surgery. At the tactical level, we study

  15. Reducing start time delays in operating rooms

    NARCIS (Netherlands)

    Does, R.J.M.M.; Vermaat, T.M.B.; Verver, J.P.S.; Bisgaard, S.; van den Heuvel, J.

    2009-01-01

    Problem: Health care today is facing serious problems: quality of care does not meet patients’ needs and costs are exploding. Inefficient utilization of expensive operating rooms is one of the major problems in many hospitals worldwide. A benchmark study of 13 hospitals in the Netherlands and

  16. Operating Room Fires and Surgical Skin Preparation.

    Science.gov (United States)

    Jones, Edward L; Overbey, Douglas M; Chapman, Brandon C; Jones, Teresa S; Hilton, Sarah A; Moore, John T; Robinson, Thomas N

    2017-07-01

    Operating room fires are "never events" that remain an under-reported source of devastating complications. One common set-up that promotes fires is the use of surgical skin preparations combined with electrosurgery and oxygen. Limited data exist examining the incidence of fires and surgical skin preparations. A standardized, ex vivo model was created with a 15 × 15 cm section of clipped porcine skin. An electrosurgical "Bovie" pencil was activated for 2 seconds on 30 Watts coagulation mode in 21% oxygen (room air), both immediately and 3 minutes after skin preparation application. Skin preparations with and without alcohol were tested, and were applied with and without pooling. Alcohol-based skin preparations included 70% isopropyl alcohol (IPA) with 2% chlorhexidine gluconate, 74% IPA with 0.7% iodine povacrylex, and plain 70% IPA. No fires occurred with nonalcohol-based preparations (p fires occurred in 38% (23 of 60) at 0 minutes and 27% (16 of 60) at 3 minutes. Alcohol-based skin preparations fuel operating room fires in common clinical scenarios. Following manufacturer guidelines and allowing 3 minutes for drying, surgical fires were still created in 1 in 10 cases without pooling and more than one-quarter of cases with pooling. Surgeons can decrease the risk of an operating room fire by using nonalcohol-based skin preparations or avoiding pooling of the preparation solution. Published by Elsevier Inc.

  17. Stress, performance, and control room operations

    International Nuclear Information System (INIS)

    Fontaine, C.W.

    1990-01-01

    The notion of control room operator performance being detrimentally affected by stress has long been the focus of considerable conjecture. It is important to gain a better understanding of the validity of this concern for the development of effective severe-accident management approaches. This paper illustrates the undeniable negative impact of stress on a wide variety of tasks. A computer-controlled simulated work environment was designed in which both male and female operators were closely monitored during the course of the study for both stress level (using the excretion of the urine catecholamines epinephrine and norepinephrine as an index) and job performance. The experimental parameters employed by the study when coupled with the subsequent statistical analyses of the results allow one to make some rather striking comments with respect to how a given operator might respond to a situation that he or she perceives to be psychologically stressful (whether the stress be externally or internally generated). The findings of this study clearly indicated that stress does impact operator performance on tasks similar in nature to those conducted by control room operators and hence should be seriously considered in the development of severe-accident management strategies

  18. Tritium Room Air Monitor Operating Experience Review

    Energy Technology Data Exchange (ETDEWEB)

    L. C. Cadwallader; B. J. Denny

    2008-09-01

    Monitoring the breathing air in tritium facility rooms for airborne tritium is a radiological safety requirement and a best practice for personnel safety. Besides audible alarms for room evacuation, these monitors often send signals for process shutdown, ventilation isolation, and cleanup system actuation to mitigate releases and prevent tritium spread to the environment. Therefore, these monitors are important not only to personnel safety but also to public safety and environmental protection. This paper presents an operating experience review of tritium monitor performance on demand during small (1 mCi to 1 Ci) operational releases, and intentional airborne inroom tritium release tests. The tritium tests provide monitor operation data to allow calculation of a statistical estimate for the reliability of monitors annunciating in actual tritium gas airborne release situations. The data show a failure to operate rate of 3.5E-06/monitor-hr with an upper bound of 4.7E-06, a failure to alarm on demand rate of 1.4E-02/demand with an upper bound of 4.4E-02, and a spurious alarm rate of 0.1 to 0.2/monitor-yr.

  19. 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

  20. Skill retention and control room operator competency

    International Nuclear Information System (INIS)

    Stammers, R.B.

    1981-12-01

    The problem of skill retention in relation to the competency of control room operators is addressed. Although there are a number of related reviews of the literature, this particular topic has not been examined in detail before. The findings of these reviews are summarised and their implications for the area discussed. The limited research on skill retention in connection with process control is also reviewed. Some topics from cognitive and instructional psychology are also raised. In particular overlearning is tackled and the potential value of learning strategies is assessed. In conclusion the important topic of measurement of performance is introduced and a number of potentially valuable training approaches are outlined. (author)

  1. 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.

  2. Game theoretic approaches to operating room management.

    Science.gov (United States)

    Marco, Alan P

    2002-05-01

    All interactions between people can be considered games with rules and outcomes. However, modern business practices demand that the players in the game go beyond traditional game theory and look at new ways to improve the outcome of the game. Choosing the right strategy is important to a player's success. A new business strategy, "co-opetition," can be used to increase the value of the game ("create a bigger pie") through cooperative behavior, whereas competition is used to divided the "pie." By looking at how the players adopt simultaneous roles such as complementor and competitor the stakeholders in the operating room (managers, surgeons, anesthesiologists, and nursing staff) can apply the principles of co-opetition to improve the overall success of their facility. Such stakeholders can utilize knowledge of how populations act in games to enhance cooperative play. Adopting such a perspective may lead to increases in the satisfaction and morale of those involved with the operating rooms. Increased morale should increase productivity and staff retention and reduce recruiting needs.

  3. [Controlling systems for operating room managers].

    Science.gov (United States)

    Schüpfer, G; Bauer, M; Scherzinger, B; Schleppers, A

    2005-08-01

    Management means developing, shaping and controlling of complex, productive and social systems. Therefore, operating room managers also need to develop basic skills in financial and managerial accounting as a basis for operative and strategic controlling which is an essential part of their work. A good measurement system should include financial and strategic concepts for market position, innovation performance, productivity, attractiveness, liquidity/cash flow and profitability. Since hospitals need to implement a strategy to reach their business objectives, the performance measurement system has to be individually adapted to the strategy of the hospital. In this respect the navigation system developed by Gälweiler is compared to the "balanced score card" system of Kaplan and Norton.

  4. A new remote control room for tokamak operations

    Energy Technology Data Exchange (ETDEWEB)

    Schissel, D.P., E-mail: schissel@fusion.gat.com [General Atomics, P.O. Box 85608, San Diego, CA (United States); Abla, G.; Flanagan, S.; Kim, E.N. [General Atomics, P.O. Box 85608, San Diego, CA (United States)

    2012-12-15

    This paper presents a summary of a new remote tokamak control room constructed near the offices of DIII-D's scientific staff. This integrated system combines hardware, software, data, and control of the room (R-232) into a unified package that has been designed and constructed in a generic fashion so that it can be used with any tokamak operating worldwide. The room is approximately 300 ft{sup 2} and can accommodate up to 12 seated participants. Mounted on the wall facing each scientist are five 52 Double-Prime LCD televisions and mounted to the wall on their right are six 24 Double-Prime LCD monitors. Each seat has associated with it a 24 Double-Prime monitor, network connection, and power and the scientist is either provided with a computer or they can use their own. The room has been used for operation of DIII-D, EAST, and KSTAR. Due to the long distances, data from EAST and KSTAR was brought back to local DIII-D computers in one large parallel network transfer and subsequently served to scientists in the remote control room to other US collaborators. This parallel data transfer allowed the data to be available to US participants between pulses making remote experimental participation highly effective.

  5. 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)

  6. Improving operating room coordination: communication pattern assessment.

    Science.gov (United States)

    Moss, Jacqueline; Xiao, Yan

    2004-02-01

    To capture communication patterns in operating room (OR) management to characterize the information needs of OR coordination. Technological applications can be used to change system processes to improve communication and information access, thereby decreasing errors and adverse events. The successful design of such applications relies on an understanding of communication patterns among healthcare professionals. Charge nurse communication was observed and documented at four OR suites at three tertiary hospitals. The data collection tool allowed rapid coding of communication patterns in terms of duration, mode, target person, and the purpose of each communication episode. Most (69.24%) of the 2074 communication episodes observed occurred face to face. Coordinating equipment was the most frequently occurring purpose of communication (38.7%) in all suites. The frequency of other purposes in decreasing order were coordinating patient preparedness (25.7%), staffing (18.8%), room assignment (10.7%), and scheduling and rescheduling surgery (6.2%). The results of this study suggest that automating aspects of preparing patients for surgery and surgical equipment management has the potential to reduce information exchange, decreasing interruptions to clinicians and diminishing the possibility of adverse events in the clinical setting.

  7. Lean Strategies in the Operating Room.

    Science.gov (United States)

    Robinson, Stephen T; Kirsch, Jeffrey R

    2015-12-01

    Lean strategies can be readily applied to health care in general and operating rooms specifically. The emphasis is on the patient as the customer, respect and engagement of all providers, and leadership from management. The strategy of lean is to use continuous improvement to eliminate waste from the care process, leaving only value-added activities. This iterative process progressively adds the steps of identifying the 7 common forms of waste (transportation, inventory, motion, waiting, overproduction, overprocessing, and defects), 5S (sort, simplify, sweep, standardize, sustain), visual controls, just-in-time processing, level-loaded work, and built-in quality to achieve the highest quality of patient care. Copyright © 2015 Elsevier Inc. All rights reserved.

  8. Operation Aspect of the Main Control Room of NPP

    International Nuclear Information System (INIS)

    Sahala M Lumbanraja

    2009-01-01

    The main control room of Nuclear Power Plant (NPP) is operational centre to control all of the operation activity of NPP. NPP must be operated carefully and safely. Many aspect that contributed to operation of NPP, such as man power whose operated, technology type used, ergonomic of main control room, operational management, etc. The disturbances of communication in control room must be anticipated so the high availability of NPP can be achieved. The ergonomic of the NPP control room that will be used in Indonesia must be designed suitable to anthropometric of Indonesia society. (author)

  9. Evaluation of new control rooms by operator performance analysis

    International Nuclear Information System (INIS)

    Mori, M; Tomizawa, T.; Tai, I.; Monta, K.; Yoshimura, S.; Hattori, Y.

    1987-01-01

    An advanced supervisory and control system called PODIA TM (Plant Operation by Displayed Information and Automation) was developed by Toshiba. Since this system utilizes computer driven CRTs as a main device for information transfer to operators, thorough system integration tests were performed at the factory and evaluations were made of operators' assessment from the initial experience of the system. The PODIA system is currently installed at two BWR power plants. Based on the experiences from the development of PODIA, a more advanced man-machine interface, Advanced-PODIA (A-PODIA), is developed. A-PODIA enhances the capabilities of PODIA in automation, diagnosis, operational guidance and information display. A-PODIA has been validated by carrying out systematic experiments with a full-scope simulator developed for the validation. The results of the experiments have been analyzed by the method of operator performance analysis and applied to further improvement of the A-PODIA system. As a feedback from actual operational experience, operator performance data in simulator training is an important source of information to evaluate human factors of a control room. To facilitate analysis of operator performance, a performance evaluation system has been developed by applying AI techniques. The knowledge contained in the performance evaluation system was elicited from operator training experts and represented as rules. The rules were implemented by employing an object-oriented paradigm to facilitate knowledge management. In conclusion, it is stated that the feedback from new control room operation can be obtained at an early stage by validation tests and also continuously by comprehensive evaluation (with the help of automated tools) of operator performance in simulator training. The results of operator performance analysis can be utilized for improvement of system design as well as operator training. (author)

  10. The Operating Room of the Future Versus the Future of the Operating Room.

    Science.gov (United States)

    Kassam, Amin B; Rovin, Richard A; Walia, Sarika; Chakravarthi, Srikant; Celix, Juanita; Jennings, Jonathan; Khalili, Sammy; Gonen, Lior; Monroy-Sosa, Alejandro; Fukui, Melanie B

    2017-06-01

    Technological advancement in the operating room is evolving into a dynamic system mirroring that of the aeronautics industry. Through data visualization, information is continuously being captured, collected, and stored on a scalable informatics platform for rapid, intuitive, iterative learning. The authors believe this philosophy (paradigm) will feed into an intelligent informatics domain fully accessible to all and geared toward precision, cell-based therapy in which tissue can be targeted and interrogated in situ. In the future, the operating room will be a venue that facilitates this real-time tissue interrogation, which will guide in situ therapeutics to restore the state of health. Copyright © 2017 Elsevier Inc. All rights reserved.

  11. 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.

  12. 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.

  13. Operating room fires: a closed claims analysis.

    Science.gov (United States)

    Mehta, Sonya P; Bhananker, Sanjay M; Posner, Karen L; Domino, Karen B

    2013-05-01

    To assess patterns of injury and liability associated with operating room (OR) fires, closed malpractice claims in the American Society of Anesthesiologists Closed Claims Database since 1985 were reviewed. All claims related to fires in the OR were compared with nonfire-related surgical anesthesia claims. An analysis of fire-related claims was performed to identify causative factors. There were 103 OR fire claims (1.9% of 5,297 surgical claims). Electrocautery was the ignition source in 90% of fire claims. OR fire claims more frequently involved older outpatients compared with other surgical anesthesia claims (P fire claims (P fires (n = 93) increased over time (P fires occurred during head, neck, or upper chest procedures (high-fire-risk procedures). Oxygen served as the oxidizer in 95% of electrocautery-induced OR fires (84% with open delivery system). Most electrocautery-induced fires (n = 75, 81%) occurred during monitored anesthesia care. Oxygen was administered via an open delivery system in all high-risk procedures during monitored anesthesia care. In contrast, alcohol-containing prep solutions and volatile compounds were present in only 15% of OR fires during monitored anesthesia care. Electrocautery-induced fires during monitored anesthesia care were the most common cause of OR fires claims. Recognition of the fire triad (oxidizer, fuel, and ignition source), particularly the critical role of supplemental oxygen by an open delivery system during use of the electrocautery, is crucial to prevent OR fires. Continuing education and communication among OR personnel along with fire prevention protocols in high-fire-risk procedures may reduce the occurrence of OR fires.

  14. Control room human engineering influences on operator performance

    International Nuclear Information System (INIS)

    Finlayson, F.C.

    1977-01-01

    Three general groups of factors influence operator performance in fulfilling their responsibilities in the control room: (1) control room and control system design, informational data displays (operator inputs) as well as control board design (for operator output); (2) operator characteristics, including those skills, mental, physical, and emotional qualities which are functions of operator selection, training, and motivation; (3) job performance guides, the prescribed operating procedures for normal and emergency operations. This paper presents some of the major results of an evaluation of the effect of human engineering on operator performance in the control room. Primary attention is given to discussion of control room and control system design influence on the operator. Brief observations on the influences of operator characteristics and job performance guides (operating procedures) on performance in the control room are also given. Under the objectives of the study, special emphasis was placed on the evaluation of the control room-operator relationships for severe emergency conditions in the power plant. Consequently, this presentation is restricted largely to material related to emergency conditions in the control room, though it is recognized that human engineering of control systems is of equal (or greater) importance for many other aspects of plant operation

  15. The investigation of the design of hybrid operating room

    International Nuclear Information System (INIS)

    Jiang Weihao; Li Jun

    2011-01-01

    Objective: To investigate the design of the interventional operating room that can meet the needs of modern DSA operation, and the overall arrangement of the hybrid operating room should be reasonable, practical and perspective. Methods: The experience and understanding obtained from the designing and planning of the new Building of Radiology and Surgery in authors' hospital were summarized. In order to meet the requirements of aseptic surgical practices and a full-featured hybrid operating room the following factors should be carefully and synthetically taken into account: the room size, the functional sub-areas, the operational procedures, the aseptic specification, etc. Results: The sufficient verification and scientific design were the important link for building a hybrid operating room. It could provide the surgeons and interventional physicians with more alternative operating methods and it could represent the development trend of medical technology. Conclusion: When planning and designing a new DSA operating room, various factors related to the interventional procedures, such as the room size, the functional sub-areas, the operational procedures and the aseptic specification, should be carefully and synthetically taken into account. The standard of aseptic procedure must be strictly complied with and the various functional sub-areas need to be rationally distributed. The design of hybrid operating room, which joins the functions of both open surgery and interventional management together, should be scientific, practical and perspective. (authors)

  16. [Operating Room Nurses' Experiences of Securing for Patient Safety].

    Science.gov (United States)

    Park, Kwang Ok; Kim, Jong Kyung; Kim, Myoung Sook

    2015-10-01

    This study was done to evaluate the experience of securing patient safety in hospital operating rooms. Experiential data were collected from 15 operating room nurses through in-depth interviews. The main question was "Could you describe your experience with patient safety in the operating room?". Qualitative data from the field and transcribed notes were analyzed using Strauss and Corbin's grounded theory methodology. The core category of experience with patient safety in the operating room was 'trying to maintain principles of patient safety during high-risk surgical procedures'. The participants used two interactional strategies: 'attempt continuous improvement', 'immersion in operation with sharing issues of patient safety'. The results indicate that the important factors for ensuring the safety of patients in the operating room are manpower, education, and a system for patient safety. Successful and safe surgery requires communication, teamwork and recognition of the importance of patient safety by the surgical team.

  17. The development of a model of control room operator cognition

    International Nuclear Information System (INIS)

    Harrison, C. Felicity

    1998-01-01

    The nuclear generation station CRO is one of the main contributors to plant performance and safety. In the past, studies of operator behaviour have been made under emergency or abnormal situations, with little consideration being given to the more routine aspects of plant operation. One of the tasks of the operator is to detect the early signs of a problem, and to take steps to prevent a transition to an abnormal plant state. In order to do this CRO must determine that plant indications are no longer in the normal range, and take action to prevent a further move away from normal. This task is made more difficult by the extreme complexity of the control room, and by the may hindrances that the operator must face. It would therefore be of great benefit to understand CRO cognitive performance, especially under normal operating conditions. Through research carried out at several Canadian nuclear facilities we were able to develop a deeper understanding of CRO monitoring of highly automated systems during normal operations, and specifically to investigate the contributions of cognitive skills to monitoring performance. The consultants were asked to develop a deeper understanding of CRO monitoring during normal operations, and specifically to investigate the contributions of cognitive skills to monitoring performance. The overall objective of this research was to develop and validate a model of CRO monitoring. The findings of this research have practical implications for systems integration, training, and interface design. The result of this work was a model of operator monitoring activities. (author)

  18. 9 CFR 590.522 - Breaking room operations.

    Science.gov (United States)

    2010-01-01

    ... personnel. (m) Ingredients and additives used in, or for, processing egg products, shall be handled in a..., Processing, and Facility Requirements § 590.522 Breaking room operations. (a) The breaking room shall be kept... clean and reasonably dry during breaking operations and free of egg meat and shells. (b) All breaking...

  19. 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.

  20. 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.

  1. Ventilation of nuclear rooms and operators' protection

    International Nuclear Information System (INIS)

    Vavasseur, C.

    1985-01-01

    Ventilation systems are designed to guarantee air replacement in rooms so as to evacuate gases, odors and aerosols liable to be produced therein. This air is conditioned, filtered, heated, and the relative humidity checked. At the outlet, a filtration system adapted to the type of effluent prevents the external dispersion of toxic substances. Ventilation is defined by the air change time. A comfort rule recommends reducing the velocities reaching the person present in less than 0.2 m/sec. This reduction is achieved by adjusting the natural property of the jets, induction, by means of diffusers placed at the vents

  2. 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...

  3. [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

  4. GMRES and integral operators

    Energy Technology Data Exchange (ETDEWEB)

    Kelley, C.T.; Xue, Z.Q. [North Carolina State Univ., Raleigh, NC (United States)

    1994-12-31

    Many discretizations of integral equations and compact fixed point problems are collectively compact and strongly convergent in spaces of continuous functions. These properties not only lead to stable and convergent approximations but also can be used in the construction of fast multilevel algorithms. Recently the GMRES algorithm has become a standard coarse mesh solver. The purpose of this paper is to show how the special properties of integral operators and their approximations are reflected in the performance of the GMRES iteration and how these properties can be used to strengthen the norm in which convergence takes place. The authors illustrate these ideas with composite Gauss rules for integral equations on the unit interval.

  5. Game theory: applications for surgeons and the operating room environment.

    Science.gov (United States)

    McFadden, David W; Tsai, Mitchell; Kadry, Bassam; Souba, Wiley W

    2012-11-01

    Game theory is an economic system of strategic behavior, often referred to as the "theory of social situations." Very little has been written in the medical literature about game theory or its applications, yet the practice of surgery and the operating room environment clearly involves multiple social situations with both cooperative and non-cooperative behaviors. A comprehensive review was performed of the medical literature on game theory and its medical applications. Definitive resources on the subject were also examined and applied to surgery and the operating room whenever possible. Applications of game theory and its proposed dilemmas abound in the practicing surgeon's world, especially in the operating room environment. The surgeon with a basic understanding of game theory principles is better prepared for understanding and navigating the complex Operating Room system and optimizing cooperative behaviors for the benefit all stakeholders. Copyright © 2012 Mosby, Inc. All rights reserved.

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

    NARCIS (Netherlands)

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

    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

  7. Operational Amplifer Integrator

    NARCIS (Netherlands)

    van Tuijl, Adrianus Johannes Maria

    2003-01-01

    An integrator circuit comprises an operational amplifier which has a transistor stage (1) with an input terminal (4) and an output terminal (3), a feedback capacitor (2) connected between the input terminal (4) and the output terminal (3), and a resistor (5) connected to the input terminal (4), and

  8. 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.

  9. Intelligent systems supporting the control room operators

    International Nuclear Information System (INIS)

    Berger, E.

    1997-01-01

    The operational experience obtained with the various applications of the systems discussed in this paper shows that more consequent use of the systems will make detection and management of disturbances still more efficient and faster. This holds true both for a low level of process automation and for power plants with a high level of automation. As for conventional power plants, the trend clearly is towards higher degrees of automation and consequent application of supporting systems. Thus, higher availability and rapid failure management are achieved, at low effects on normal operation. These systems are monitoring and process control systems, expert systems, and systems for optimal use of the equipment, or systems for post-incident analyses and computer-assisted on-shift protocols, or operating manuals. (orig./CB) [de

  10. Integrated formal operations plan

    Energy Technology Data Exchange (ETDEWEB)

    Cort, G.; Dearholt, W.; Donahue, S.; Frank, J.; Perkins, B.; Tyler, R.; Wrye, J.

    1994-01-05

    The concept of formal operations (that is, a collection of business practices to assure effective, accountable operations) has vexed the Laboratory for many years. To date most attempts at developing such programs have been based upon rigid, compliance-based interpretations of a veritable mountain of Department of Energy (DOE) orders, directives, notices, and standards. These DOE dictates seldom take the broad view but focus on highly specialized programs isolated from the overall context of formal operations. The result is a confusing array of specific, and often contradictory, requirements that produce a patchwork of overlapping niche programs. This unnecessary duplication wastes precious resources, dramatically increases the complexity of our work processes, and communicates a sense of confusion to our customers and regulators. Coupled with the artificial divisions that have historically existed among the Laboratory`s formal operations organizations (quality assurance, configuration management, records management, training, etc.), this approach has produced layers of increasingly vague and complex formal operations plans, each of which interprets its parent and adds additional requirements of its own. Organizational gridlock ensues whenever an activity attempts to implement these bureaucratic monstrosities. The integrated formal operations plan presented is to establish a set of requirements that must be met by an integrated formal operations program, assign responsibilities for implementation and operation of the program, and specify criteria against which the performance of the program will be measured. The accountable line manager specifies the items, processes, and information (the controlled elements) to which the formal operations program specified applies. The formal operations program is implemented using a graded approach based on the level of importance of the various controlled elements and the scope of the activities in which they are involved.

  11. Operating room nursing directors' influence on anesthesia group operating room productivity.

    Science.gov (United States)

    Masursky, Danielle; Dexter, Franklin; Nussmeier, Nancy A

    2008-12-01

    Implementation of initiatives to increase anesthesia group productivity depends not just on anesthesia groups, but on operating room (OR) nursing administration. OR nursing directors may encourage organizational change based on the needs of their hospitals and nurses. These changes may differ from those that would increase the anesthesia group's productivity. We assessed reward structures using (A) letters of nomination for the "OR Manager of the Year" award offered annually by the publication OR Manager, and (B) data from a salary/career survey of OR directors by the same publication. (A) There were 164 nomination letters submitted from 2004 through 2007 for 45 nominees. The letters contained n = 2659 full sentences and n = 50,821 words. We systematically created a list of 36 terms related to finance, profit, and productivity. We also analyzed the frequency of use of these terms relative to the use of the 15 most common relationship-oriented terms (e.g., compassion, encourage, mentor, and respect). (B) The salary/career survey's questions relevant to anesthesia group productivity had responses from 303 US OR directors, 97% of whom were nurses. We tested the strength of the relationship between the budget responsibility of the OR nursing director and his or her annual salary. (A) 2.6% of sentences in the nomination letters included at least one term related to profit and productivity (95% confidence interval 2.0%-3.2%). Relationship-oriented terms were 9.0 times more prevalent (95% confidence interval 7.1-11.4). (B) There was statistically significant positive proportionality between the OR nursing director's operational budget (including personnel) and his or her salary (Pearson r = 0.64, P time and OR nursing labor costs. Resulting decisions can differ from those that would increase the productivity (profit) of the anesthesia group. Anesthesia groups need to champion initiatives to increase anesthesia productivity, while being sensitive to institutional

  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. Empirical investigation of workloads of operators in advanced control rooms

    International Nuclear Information System (INIS)

    Kim, Yochan; Jung, Wondea; Kim, Seunghwan

    2014-01-01

    This paper compares the workloads of operators in a computer-based control room of an advanced power reactor (APR 1400) nuclear power plant to investigate the effects from the changes in the interfaces in the control room. The cognitive-communicative-operative activity framework was employed to evaluate the workloads of the operator's roles during emergency operations. The related data were obtained by analyzing the tasks written in the procedures and observing the speech and behaviors of the reserved operators in a full-scope dynamic simulator for an APR 1400. The data were analyzed using an F-test and a Duncan test. It was found that the workloads of the shift supervisors (SSs) were larger than other operators and the operative activities of the SSs increased owing to the computer-based procedure. From these findings, methods to reduce the workloads of the SSs that arise from the computer-based procedure are discussed. (author)

  14. [Handling modern imaging procedures in a high-tech operating room].

    Science.gov (United States)

    Hüfner, T; Citak, M; Imrecke, J; Krettek, C; Stübig, T

    2012-03-01

    Operating rooms are the central unit in the hospital network in trauma centers. In this area, high costs but also high revenues are generated. Modern operating theater concepts as an integrated model have been offered by different companies since the early 2000s. Our hypothesis is that integrative concepts for operating rooms, in addition to improved operating room ergonomics, have the potential for measurable time and cost savings. In our clinic, an integrated operating room concept (I-Suite, Stryker, Duisburg) was implemented after analysis of the problems. In addition to the ceiling-mounted arrangement, the system includes an endoscopy unit, a navigation system, and a voice control system. In the first 6 months (9/2005 to 2/2006), 112 procedures were performed in the integrated operating room: 34 total knee arthroplasties, 12 endoscopic spine surgeries, and 66 inpatient arthroscopic procedures (28 shoulder and 38 knee reconstructions). The analysis showed a daily saving of 22-45 min, corresponding to 15-30% of the daily changeover times, calculated to account for potential savings in the internal cost allocation of 225-450 EUR. A commercial operating room concept was evaluated in a pilot phase in terms of hard data, including time and cost factors. Besides the described effects further savings might be achieved through the effective use of voice control and the benefit of the sterile handle on the navigation camera, since waiting times for an additional nurse are minimized. The time of the procedure of intraoperative imaging is also reduced due to the ceiling-mounted concept, as the C-arm can be moved freely in the operating theater without hindering cables. By these measures and ensuing improved efficiency, the initial high costs for the implementation of the system may be cushioned over time.

  15. Space shuttle operations integration plan

    Science.gov (United States)

    1975-01-01

    The Operations Integration Plan is presented, which is to provide functional definition of the activities necessary to develop and integrate shuttle operating plans and facilities to support flight, flight control, and operations. It identifies the major tasks, the organizations responsible, their interrelationships, the sequence of activities and interfaces, and the resultant products related to operations integration.

  16. Evaluating Operating Room Turnaround Times and Cancellations at Dwight D. Eisenhower Army Medical Center

    National Research Council Canada - National Science Library

    Amsink, William L

    2005-01-01

    .... This study describes the inefficient use of the current operating room management software system, and identifies strategies to improve operating room efficiency by analyzing the most common causes...

  17. Psychophysical workload in the operating room: primary surgeon versus assistant.

    Science.gov (United States)

    Rieger, Annika; Fenger, Sebastian; Neubert, Sebastian; Weippert, Matthias; Kreuzfeld, Steffi; Stoll, Regina

    2015-07-01

    Working in the operating room is characterized by high demands and overall workload of the surgical team. Surgeons often report that they feel more stressed when operating as a primary surgeon than in the function as an assistant which has been confirmed in recent studies. In this study, intra-individual workload was assessed in both intraoperative functions using a multidimensional approach that combined objective and subjective measures in a realistic work setting. Surgeons' intraoperative psychophysiologic workload was assessed through a mobile health system. 25 surgeons agreed to take part in the 24-hour monitoring by giving their written informed consent. The mobile health system contained a sensor electronic module integrated in a chest belt and measuring physiological parameters such as heart rate (HR), breathing rate (BR), and skin temperature. Subjective workload was assessed pre- and postoperatively using an electronic version of the NASA-TLX on a smartphone. The smartphone served as a communication unit and transferred objective and subjective measures to a communication server where data were stored and analyzed. Working as a primary surgeon did not result in higher workload. Neither NASA-TLX ratings nor physiological workload indicators were related to intraoperative function. In contrast, length of surgeries had a significant impact on intraoperative physical demands (p NASA-TLX sum score (p < 0.01; η(2) = 0.287). Intra-individual workload differences do not relate to intraoperative role of surgeons when length of surgery is considered as covariate. An intelligent operating management that considers the length of surgeries by implementing short breaks could contribute to the optimization of intraoperative workload and the preservation of surgeons' health, respectively. The value of mobile health systems for continuous psychophysiologic workload assessment was shown.

  18. 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.

  19. Managing rumor and gossip in operating room settings.

    Science.gov (United States)

    Blakeley, J A; Ribeiro, V; Hughes, A

    1996-07-01

    The unique features of the operating room (OR) make it an ideal setting for the proliferation of gossip and rumor. Although not always negative, these "grapevine" communications can reduce productivity and work satisfaction. Hence, OR managers need to understand these forms of communication and prevent or control their negative consequences. The authors offer suggestions for undertaking this challenge.

  20. Response Times of Operators in a Control Room

    DEFF Research Database (Denmark)

    Platz, O.; Rasmussen, Jens; 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...

  1. Risks and health effects in operating room personnel

    NARCIS (Netherlands)

    van den Berg-Dijkmeijer, Marleen L.; Frings-Dresen, Monique H. W.; Sluiter, Judith K.

    2011-01-01

    The objective was to find the factors that pose a possible health risk to OR personnel. Work-related health problems of operating room (OR) personnel were signalled by an occupational physician and preparations for the development of new Worker's Health Surveillance (WHS) were started with a

  2. Effect of Individual Surgeons and Anesthesiologists on Operating Room Time

    NARCIS (Netherlands)

    van Eijk, Ruben P A; van Veen-Berkx, Elizabeth; Kazemier, Geert; Eijkemans, Marinus J C

    BACKGROUND:: Variability in operating room (OR) time causes overutilization and underutilization of the available ORs. There is evidence that for a given type of procedure, the surgeon is the major source of variability in OR time. The primary aim was to quantify the variability between surgeons and

  3. Enhancement opportunities in operating room utilization; with a statistical appendix

    NARCIS (Netherlands)

    van Veen-Berkx, Elizabeth; Elkhuizen, Sylvia G.; van Logten, Sanne; Buhre, Wolfgang F.; Kalkman, Cor J.; Gooszen, Hein G.; Kazemier, Geert; Balm, Ron; Cornelisse, Diederich C. C.; Ackermans, Hub J.; Stolker, Robert Jan; Bezstarosti, Jeanne; Pelger, Rob C. M.; Schaad, Roald R.; Krooneman-Smits, Irmgard; Meyer, Peter; van Dijk-Jager, Mirjam; Broecheler, Simon A. W.; Kroese, A. Christiaan; Kanters, Jeffrey; Krabbendam, Johannes J.; Hans, Erwin W.; Veerman, Derk P.; Aij, Kjeld H.

    2015-01-01

    Background: The purpose of this study was to assess the direct and indirect relationships between first-case tardiness (or "late start"), turnover time, underused operating room (OR) time, and raw utilization, as well as to determine which indicator had the most negative impact on OR utilization to

  4. Enhancement opportunities in operating room utilization; with a statistical appendix

    NARCIS (Netherlands)

    Veen-Berkx, E. van; Elkhuizen, S.G.; Logten, S. van; Buhre, W.F.; Kalkman, C.J.; Gooszen, H.G.; Kazemier, G.

    2015-01-01

    BACKGROUND: The purpose of this study was to assess the direct and indirect relationships between first-case tardiness (or "late start"), turnover time, underused operating room (OR) time, and raw utilization, as well as to determine which indicator had the most negative impact on OR utilization to

  5. 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

    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

  6. Control of the Environment in the Operating Room.

    Science.gov (United States)

    Katz, Jonathan D

    2017-10-01

    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.

  7. Nuclear power plant control room operator control and monitoring tasks

    International Nuclear Information System (INIS)

    Bovell, C.R.; Beck, M.G.; Carter, R.J.

    1998-01-01

    Oak Ridge National Laboratory is conducting a research project the purpose of which is to develop the technical bases for regulatory review criteria for use in evaluating the safety implications of human factors associated with the use of artificial intelligence and expert systems, and with advanced instrumentation and control (I and C) systems in nuclear power plants (NPP). This report documents the results from Task 8 of that project. The primary objectives of the task was to identify the scope and type of control and monitoring tasks now performed by control-room operators. Another purpose was to address the types of controls and safety systems needed to operate the nuclear plant. The final objective of Task 8 was to identify and categorize the type of information and displays/indicators required to monitor the performance of the control and safety systems. This report also discusses state-of-the-art controls and advanced display devices which will be available for use in control-room retrofits and in control room of future plants. The fundamental types of control and monitoring tasks currently conducted by operators can be divided into four classifications: function monitoring tasks, control manipulation tasks, fault diagnostic tasks, and administrative tasks. There are three general types of controls used in today's NPPs, switches, pushbuttons, and analog controllers. Plant I and C systems include components to achieve a number of safety-related functions: measuring critical plant parameters, controlling critical plant parameters within safety limits, and automatically actuating protective devices if safe limits are exceeded. The types of information monitored by the control-room operators consist of the following parameters: pressure, fluid flow and level, neutron flux, temperature, component status, water chemistry, electrical, and process and area radiation. The basic types of monitoring devices common to nearly all NPP control rooms include: analog meters

  8. Qualified operator training in the simulated control room environment

    International Nuclear Information System (INIS)

    Ionescu, Teodor; Studineanu, Emil; Radulescu, Catalina; Bolocan, Gabriel

    2005-01-01

    Full text: Mainly designed for the training of the Cernavoda NPP Unit 2 operators, the virtual simulated environment allows the training of the already qualified operators for Cernavoda NPP Unit 1, adding to the already trained knowledge, the differences which has occurred in the Unit 2 design. Using state-of-the-art computers and displays and qualified software, the virtual simulated panels could offer a viable alternative to classic hardware-based training. This approach allows quick training of the new procedures required by the new configuration of the re-designed operator panels in the main control room of Cernavoda NPP Unit 2. (authors)

  9. Qualified operator training in the simulated control room environment

    International Nuclear Information System (INIS)

    Ionescu, Teodor; Studineanu, Emil; Radulescu, Catalina; Bolocan, Gabriel

    2005-01-01

    Mainly designed for the training of the Cernavoda NPP Unit 2 operators, the virtual simulated environment allows the training of the already qualified operators for Cernavoda NPP Unit 1, adding to the already trained knowledge, the differences which have occurred in the Unit 2 design. Using state-of-the-art computers and displays and qualified software, the virtual simulated panels could offer a viable alternative to classic hardware-based training. This approach allows quick training of the new procedures required by the new configuration of the re-designed operator panels in the main control room of Cernavoda NPP Unit 2. (authors)

  10. Operating Room Delays: Meaningful Use in Electronic Health Record.

    Science.gov (United States)

    Van Winkle, Rachelle A; Champagne, Mary T; Gilman-Mays, Meri; Aucoin, Julia

    2016-06-01

    Perioperative areas are the most costly to operate and account for more than 40% of expenses. The high costs prompted one organization to analyze surgical delays through a retrospective review of their new electronic health record. Electronic health records have made it easier to access and aggregate clinical data; 2123 operating room cases were analyzed. Implementing a new electronic health record system is complex; inaccurate data and poor implementation can introduce new problems. Validating the electronic health record development processes determines the ease of use and the user interface, specifically related to user compliance with the intent of the electronic health record development. The revalidation process after implementation determines if the intent of the design was fulfilled and data can be meaningfully used. In this organization, the data fields completed through automation provided quantifiable, meaningful data. However, data fields completed by staff that required subjective decision making resulted in incomplete data nearly 24% of the time. The ease of use was further complicated by 490 permutations (combinations of delay types and reasons) that were built into the electronic health record. Operating room delay themes emerged notwithstanding the significant complexity of the electronic health record build; however, improved accuracy could improve meaningful data collection and a more accurate root cause analysis of operating room delays. Accurate and meaningful use of data affords a more reliable approach in quality, safety, and cost-effective initiatives.

  11. Can efficient supply management in the operating room save millions?

    Science.gov (United States)

    Park, Kyung W; Dickerson, Cheryl

    2009-04-01

    Supply expenses occupy an ever-increasing portion of the expense budget in today's increasingly technologically complex operating rooms. Yet, little has been studied and published in the anesthesia literature. This review attempts to bring the topic of supply management to anesthesiologists, who play a significant role in operating room management. Little investigative work has been performed on supply management. Anecdotal reports suggest the benefits of a perpetual inventory system over a periodic inventory system. A perpetual inventory system uses utilization data to update inventory on hand continually and this information is linked to purchasing and restocking, whereas a periodic inventory system counts inventory at some regular intervals (such as annually) and uses average utilization to set par levels. On the basis of application of operational management concepts, ways of taking advantage of a perpetual inventory system to achieve savings in supply expenses are outlined. These include linking the operating room scheduling and supply order system, distributor-driven just-in-time delivery of case carts, continual updating of preference lists based on utilization patterns, increasing inventory turnovers, standardizing surgical practices, and vendor consignment of high unit-cost items such as implants. In addition, Lean principles of visual management and elimination of eight wastes may be applicable to supply management.

  12. 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.

  13. The positive impact of structured teaching in the operating room.

    Science.gov (United States)

    Leung, Yee; Salfinger, Stuart; Mercer, Annette

    2015-12-01

    A survey of obstetric and gynaecology trainees in Australia found the trainee's opinion of the consultants' teaching ability for laparoscopic procedures and procedures dealing with complications as 'poor' in 21.2% and 23.4% of responses, respectively (Aust NZ J Obstet Gynaecol 2009; 49: 84). Surgical caseload per trainee is falling for a variety of reasons. Strategies need to be adopted to enhance the surgical learning experience of trainees in the operating room. We describe the use of a structured encounter template to facilitate the teaching of surgery in the operating room and report the response of the trainees to this intervention. Trainees attached to a gynaecologic surgery unit all underwent surgical training using a set format based on the surgical encounter template, including briefing, goal setting and intra-operative teaching aims as well as debriefing. Data on the trainees' experience and perception of their learning experience were then collected and analysed as quantitative and qualitative data sets. The trainees reported satisfaction with the use of a structured encounter template to facilitate the surgical teaching in the operating room. Some trainees had not received such clarity of feedback or the opportunity to complete a procedure independently prior to using the structured encounter template. A structured surgical encounter template based on andragogy principles to focus consultant teaching in the operating room is highly acceptable to obstetric and gynaecology trainees in Australia. Allowing the trainee the opportunity to set objectives and receive feedback empowers the trainee and enhances their educational experience. © 2015 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists.

  14. Response times of operators in a control room

    International Nuclear Information System (INIS)

    Platz, O.; Rasmussen, J.; Skanborg, P.Z.

    1982-12-01

    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. (author)

  15. 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 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.

  16. 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.

  17. Auditing Operating Room Recycling: A Management Case Report.

    Science.gov (United States)

    McGain, Forbes; Jarosz, Katherine Maria; Nguyen, Martin Ngoc Hoai Huong; Bates, Samantha; O'Shea, Catherine Jane

    2015-08-01

    Much waste arises from operating rooms (ORs). We estimated the practical and financial feasibility of an OR recycling program, weighing all waste from 6 ORs in Melbourne, Australia. Over 1 week, 237 operations produced 1265 kg in total: general waste 570 kg (45%), infectious waste 410 kg (32%), and recyclables 285 kg (23%). The achieved recycling had no infectious contamination. The achieved recycling/potential recycling rate was 285 kg/517 kg (55%). The average waste disposal costs were similar for general waste and recycling. OR recycling rates of 20%-25% total waste were achievable without compromising infection control or financial constraints.

  18. Integrated Ground Operations Demonstration Units

    Data.gov (United States)

    National Aeronautics and Space Administration — The overall goal of the AES Integrated Ground Operations Demonstration Units (IGODU) project is to demonstrate cost efficient cryogenic operations on a relevant...

  19. Analysis of the operator's tasks: An aid to control room design

    International Nuclear Information System (INIS)

    Blanc, P.; Guesnier, G.P.; Heilbronn, B.; Monnier, B.

    1983-01-01

    The control room designer usually has no knowledge of the tasks performed by the operator in the control room since an overall picture of the situation only becomes available once the whole facility has been constructed. In order to study and design control rooms for its future PWR units, Electricite de France (EDF) felt it was essential to analyse these tasks: the work was facilitated by the existence of 900 MW PWR units which were already in operation and which are controlled in much the same manner as future units of the same type. Accordingly, by analysing the control procedures of these 900 MW PWR units, a data base describing the control and monitoring tasks performed by operators in normal, incident and accident situations has been built up. The data-base files, which were established from a study of 130 control procedures, record all the commands given and data available in the control room (about 7000), describe the tasks connected with these commands and data, and identify the times at which they are made use of by the operator. Using this data base, the principle of operator-system communication and of data processing in the control room of the future has been established: in such a control room, most controls and data will be accessible through computer communication systems to ensure that control and monitoring systems are closely integrated under normal operating conditions as well as in incident and post-accident situations and to enable the plant to be controlled by one or two operators in a seated position. (author)

  20. LOFT advanced control room operator diagnostic and display system (ODDS)

    International Nuclear Information System (INIS)

    Larsen, D.G.; Robb, T.C.

    1980-01-01

    The Loss-of-Fluid Test (LOFT) Reactor Facility in Idaho includes a highly instrumented nuclear reactor operated by the Department of Energy for the purpose of establishing nuclear safety requirements. The results of the development and installation into LOFT of an Operator Diagnostic and Display System (ODDS) are presented. The ODDS is a computer-based graphics display system centered around a PRIME 550 computer with several RAMTEK color graphic display units located within the control room and available to the reactor operators. Use of computer-based color graphics to aid the reactor operator is discussed. A detailed hardware description of the LOFT data system and the ODDS is presented. Methods and problems of backfitting the ODDS equipment into the LOFT plant are discussed

  1. Resident Autonomy in the Operating Room: Expectations Versus Reality.

    Science.gov (United States)

    Meyerson, Shari L; Sternbach, Joel M; Zwischenberger, Joseph B; Bender, Edward M

    2017-09-01

    There is concern about graduating thoracic trainees' independent operative skills due to limited autonomy in training. This study compared faculty and trainee expected levels of autonomy with intraoperative measurements of autonomy for common cardiothoracic operations. Participants underwent frame-of-reference training on the 4-point Zwisch scale of operative autonomy (show and tell → active help → passive help → supervision only) and evaluated autonomy in actual cases using the Zwisch Me!! mobile application. A separate "expected autonomy" survey elicited faculty and resident perceptions of how much autonomy a resident should have for six common operations: decortication, wedge resection, thoracoscopic lobectomy, coronary artery bypass grafting, aortic valve replacement, and mitral valve repair. Thirty-three trainees from 7 institutions submitted evaluations of 596 cases over 18 months (March 2015 to September 2016). Thirty attendings subsequently provided their evaluation of 476 of those cases (79.9% response rate). Expected autonomy surveys were completed by 21 attendings and 19 trainees from 5 institutions. The six operations included in the survey constituted 47% (226 of 476) of the cases evaluated. Trainee and attending expectations did not differ significantly for senior trainees. Both groups expected significantly higher levels of autonomy than observed in the operating room for all six types of cases. Although faculty and trainees both expect similar levels of autonomy in the operating room, real-time measurements of autonomy show a gap between expectations and reality. Decreasing this gap will require a concerted effort by both faculty and residents to focus on the development of independent operative skills. Copyright © 2017 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  2. The normalized administration of hybrid operating room: its practical application in managing multiple injuries

    International Nuclear Information System (INIS)

    Li Xue; Zhang Weiguo; Zhang Lianyang; Chen Tingjing; Chen Jinhua

    2011-01-01

    Objective: Through carrying out the normalized administration of hybrid operating room the application of the operating room is expanded to the performing of multiple injuries, and, in this way, the operative management become standardized and programmed, the cooperation and efficiency of hybrid operations for multiple injuries are improved and the surgeries can be ensured. Methods: According to the characteristics of hybrid interventional operation for multiple injuries, the basic construction of the hybrid operating room improved, the hybrid operation team was organized, and the administrative system as well as the working program were established. The green channel for rescuing patients with multiple injuries was set up. The cooperative behavior during interventional treatment for multiple injuries was specified. Results: The coordination and working efficiency of physicians, nurses, technicians and anesthetists were well improved. The qualified rate of lamina flow administration reached 100%. The success rate of the rescue of multiple injuries was increased. Conclusion: As one-stop complex interventional operation for multiple injuries is a new technique, there is no integrated administration system. Therefore, the establishment of standardized management of one-stop complex interventional operation is of great significance in guiding clinical practice. (authors)

  3. Operating room sound level hazards for patients and physicians.

    Science.gov (United States)

    Fritsch, Michael H; Chacko, Chris E; Patterson, Emily B

    2010-07-01

    Exposure to certain new surgical instruments and operating room devices during procedures could cause hearing damage to patients and personnel. Surgical instruments and related equipment generate significant sound levels during routine usage. Both patients and physicians are exposed to these levels during the operative cases, many of which can last for hours. The noise loads during cases are cumulative. Occupational Safety and Health Administration (OSHA) and National Institute for Occupational Safety and Health (NIOSH) standards are inconsistent in their appraisals of potential damage. Implications of the newer power instruments are not widely recognized. Bruel and Kjaer sound meter spectral recordings for 20 major instruments from 5 surgical specialties were obtained at the ear levels for the patient and the surgeon between 32 and 20 kHz. Routinely used instruments generated sound levels as high as 131 dB. Patient and operator exposures differed. There were unilateral dominant exposures. Many instruments had levels that became hazardous well within the length of an average surgical procedure. The OSHA and NIOSH systems gave contradicting results when applied to individual instruments and types of cases. Background noise, especially in its intermittent form, was also of significant nature. Some patients and personnel have additional predisposing physiologic factors. Instrument noise levels for average length surgical cases may exceed OSHA and NIOSH recommendations for hearing safety. Specialties such as Otolaryngology, Orthopedics, and Neurosurgery use instruments that regularly exceed limits. General operating room noise also contributes to overall personnel exposures. Innovative countermeasures are suggested.

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

    International Nuclear Information System (INIS)

    Kim, Seunghwan; Kim, Yochan; Jung, Wondea

    2014-01-01

    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

  5. 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.

  6. [The hybrid operating room. Home of high-end intraoperative imaging].

    Science.gov (United States)

    Gebhard, F; Riepl, C; Richter, P; Liebold, A; Gorki, H; Wirtz, R; König, R; Wilde, F; Schramm, A; Kraus, M

    2012-02-01

    A hybrid operating room must serve the medical needs of different highly specialized disciplines. It integrates interventional techniques for cardiovascular procedures and allows operations in the field of orthopaedic surgery, neurosurgery and maxillofacial surgery. The integration of all steps such as planning, documentation and the procedure itself saves time and precious resources. The best available imaging devices and user interfaces reduce the need for extensive personnel in the OR and facilitate new minimally invasive procedures. The immediate possibility of postoperative control images in CT-like quality enables the surgeon to react to problems during the same procedure without the need for later revision.

  7. Numerical simulation of manual operation at MID stand control room

    International Nuclear Information System (INIS)

    Doca, C.; Dobre, A.; Predescu, D.; Mielcioiu, A.

    2003-01-01

    Since 2000 at INR Pitesti a package of software products devoted to numerical simulation of manual operations at fueling machine control room was developed. So far, specified, designed, worked out and implemented was the PUPITRU code. The following issues were solved: graphical aspects of specific computer - human operator interface; functional and graphical simulation of the whole associated equipment of the control desk components; implementation of the main notation as used in the automated schemes of the control desk in view of the fast identification of the switches, lamps, instrumentation, etc.; implementation within PUPITRU code of the entire data base used in the frame of MID tests; implementation of a number of about 1000 numerical simulation equations describing specific operational MID testing situations

  8. A Study of Interpersonal Conflict Among Operating Room Nurses.

    Science.gov (United States)

    Chang, Tsui-Fen; Chen, Chung-Kuang; Chen, Ming-Jia

    2017-12-01

    Team collaboration is an important factor that affects the performance of the operating room (OR). Therefore, the ability of OR nurses to adapt to and manage interpersonal conflict incidents properly is very important. The aims of this study were to investigate the interpersonal conflict management capabilities of OR nursing staffs and to find the relationships among the demographics of OR nurses and the following: work-related variables, interpersonal conflict management style, and target of interpersonal conflict. This study investigated 201 OR nurses who had worked for more than 6 months at the target hospitals, which were located in the three counties of Changhua, Yunlin, and Chiayi. The questionnaire that was used to collect data included three components: a demographic and work-related variables survey, interpersonal conflict management factor analysis scale, and interpersonal conflict parties and frequency scale. Data were analyzed using independent t test, analysis of variance, Scheffe's test, and Pearson's correlation coefficient. The main findings were as follows: (a) Integration and arbitration were the major interpersonal conflict management strategies adopted by the participants; (b) medical doctor, OR nurses, and anesthetists were the primary targets of conflict for the participants; (c) the factors of educational background, job position, experience in other departments, seniority, attending courses in conflict management, and level of hospital significantly affected the strategies that participants used to manage interpersonal conflict; and (d) license level, experience in other departments, seniority, and inclination toward serving in the OR were each found to relate significantly to the target of interpersonal conflict and the frequency of interpersonal conflict incidents. The main implications of this study are as follows: (a) The environment for communication in the OR should be made more friendly to encourage junior OR nurses to adopt

  9. Implications of Perioperative Team Setups for Operating Room Management Decisions.

    Science.gov (United States)

    Doll, Dietrich; Kauf, Peter; Wieferich, Katharina; Schiffer, Ralf; Luedi, Markus M

    2017-01-01

    Team performance has been studied extensively in the perioperative setting, but the managerial impact of interprofessional team performance remains unclear. We hypothesized that the interplay between anesthesiologists and surgeons would affect operating room turnaround times, and teams that worked together over time would become more efficient. We analyzed 13,632 surgical cases at our hospital that involved 64 surgeons and 48 anesthesiologists. We detrended and adjusted the data for potential confounders including age, American Society of Anesthesiologists physical status, and surgical list (scheduled cases of specific surgical specialties). The surgical lists were categorized as ear, nose, and throat surgery; trauma surgery; general surgery; and gynecology. We assessed the relationship between turnaround times and assignment of different anesthesiologists to specific surgeons using a Monte Carlo simulation. We found significant differences in team performances among the different surgical lists but no team learning. We constructed managerial decision tables for the assignment of anesthesiologists to specific surgeons at our hospital. We defined a decision algorithm based on these tables. Our analysis indicated that had this algorithm been used in staffing the operating room for the surgical cases represented in our data, median turnaround times would have a reduction potential of 6.8% (95% confidence interval 6.3% to 7.1%). A surgeon is usually predefined for scheduled surgeries (surgical list). Allocation of the right anesthesiologist to a list and to a surgeon can affect the team performance; thus, this assignment has managerial implications regarding the operating room efficiency affecting turnaround times and thus potentially overutilized time of a list at our hospital.

  10. 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.

  11. Nuclear power plant control room operators' performance research

    International Nuclear Information System (INIS)

    Gray, L.H.; Haas, P.M.

    1984-01-01

    A research program is being conducted to provide information on the performance of nuclear power plant control room operators when responding to abnormal/emergency events in the plants and in full-scope training simulators. The initial impetus for this program was the need for data to assess proposed design criteria for the choice of manual versus automatic action for accomplishing safety-related functions during design basis accidents. The program also included studies of training simulator capabilities, of procedures and data for specifying and verifying simulator performance, and of methods and applications of task analysis

  12. Fire in the Operating Room During Hypospadias Repair

    Directory of Open Access Journals (Sweden)

    Alessandro Boscarelli

    2017-11-01

    Full Text Available 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.

  13. AIS ASM Operational Integration Plan

    Science.gov (United States)

    2013-08-01

    Rack mount computer AIS Radio Interface Ethernet Switch 192.168.0.x Firewall Cable Modem 192.168.0.1 VTS Accred. Boundary AIS ASM Operational... AIS ASM Operational Integration Plan Distribution Statement A: Approved for public release; distribution is unlimited. August 2013 Report No...CD-D-07-15 AIS ASM Operational Integration Plan ii UNCLAS//Public | CG-926 R&DC | I. Gonin, et al. | Public August 2013 N O T I C

  14. Case review analysis of operating room decisions to cancel surgery.

    Science.gov (United States)

    Chang, Ju-Hsin; Chen, Ke-Wei; Chen, Kuen-Bao; Poon, Kin-Shing; Liu, Shih-Kai

    2014-07-23

    Cancellation of surgery close to scheduled time causes a waste of healthcare resources. The current study analyzes surgery cancellations occurring after the patient has been prepared for the operating room, in order to see whether improvements in the surgery planning process may reduce the number of cancellations. In a retrospective chart review of operating room surgery cancellations during the period from 2006 to 2011, cancellations were divided into the following categories: inadequate NPO; medical; surgical; system; airway; incomplete evaluation. The relative use of these reasons in relation to patient age and surgical department was then evaluated. Forty-one percent of cancellations were for other than medical reasons. Among these, 17.7% were due to incomplete evaluation, and 8.2% were due to family issues. Sixty seven percent of cancelled cases eventually received surgery. The relative use of individual reasons for cancellation varied with patient age and surgical department. The difference between cancellations before and after anesthesia was dependent on the causes of cancellation, but not age, sex, ASA status, or follow-up procedures required. Almost half of the cancellations were not due to medical reasons, and these cancellations could be reduced by better administrative and surgical planning and better communication with the patient and/or his family.

  15. Re-envisioning the operator consoles for Dhruva control room

    International Nuclear Information System (INIS)

    Gaur, S.; Sridharan, P.; Nair, P.M.; Diwakar, M.P.; Gohel, N.; Pithawa, C.K.

    2012-01-01

    Control Room design is undergoing rapid changes with the progressive adoption of computerization and Automation. Advances in man-machine interfaces have further accelerated this trend. This paper presents the design and main features of Operator consoles (OC) for Dhruva control room developed using new technologies. The OCs have been designed so as not to burden the operator with information overload but to help him quickly assess the situation and timely take appropriate steps. The consoles provide minimalistic yet intuitive interfaces, context sensitive navigation, display of important information and progressive disclosure of situation based information. The use of animations, 3D graphics, and real time trends with the benefit of hardware acceleration to provide a resolution independent rich user experience. The use of XAML, an XML based Mark-up Language for User Interface definition and C for application logic resulted in complete separation of visual design, content, and logic. This also resulted in a workflow where separate teams could work on the UI and the logic of an application. The introduction of Model View View-Model has led to more testable and maintainable software. (author)

  16. Bacterial burden in the operating room: impact of airflow systems.

    Science.gov (United States)

    Hirsch, Tobias; Hubert, Helmine; Fischer, Sebastian; Lahmer, Armin; Lehnhardt, Marcus; Steinau, Hans-Ulrich; Steinstraesser, Lars; Seipp, Hans-Martin

    2012-09-01

    Wound infections present one of the most prevalent and frequent complications associated with surgical procedures. This study analyzes the impact of currently used ventilation systems in the operating room to reduce bacterial contamination during surgical procedures. Four ventilation systems (window-based ventilation, supported air nozzle canopy, low-turbulence displacement airflow, and low-turbulence displacement airflow with flow stabilizer) were analyzed. Two hundred seventy-seven surgical procedures in 6 operating rooms of 5 different hospitals were analyzed for this study. Window-based ventilation showed the highest intraoperative contamination (13.3 colony-forming units [CFU]/h) followed by supported air nozzle canopy (6.4 CFU/h; P = .001 vs window-based ventilation) and low-turbulence displacement airflow (3.4 and 0.8 CFU/h; P system showed no increase of contamination in prolonged durations of surgical procedures. This study shows that intraoperative contamination can be significantly reduced by the use of adequate ventilation systems. Copyright © 2012 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Mosby, Inc. All rights reserved.

  17. Ergonomics in the operating room: protecting the surgeon.

    Science.gov (United States)

    Rosenblatt, Peter L; McKinney, Jessica; Adams, Sonia R

    2013-01-01

    To review elements of an ergonomic operating room environment and describe common ergonomic errors in surgeon posture during laparoscopic and robotic surgery. Descriptive video based on clinical experience and a review of the literature (Canadian Task Force classification III). Community teaching hospital affiliated with a major teaching hospital. Gynecologic surgeons. Demonstration of surgical ergonomic principles and common errors in surgical ergonomics by a physical therapist and surgeon. The physical nature of surgery necessitates awareness of ergonomic principles. The literature has identified ergonomic awareness to be grossly lacking among practicing surgeons, and video has not been documented as a teaching tool for this population. Taking this into account, we created a video that demonstrates proper positioning of monitors and equipment, and incorrect and correct ergonomic positions during surgery. Also presented are 3 common ergonomic errors in surgeon posture: forward head position, improper shoulder elevation, and pelvic girdle asymmetry. Postural reset and motion strategies are demonstrated to help the surgeon learn techniques to counterbalance the sustained and awkward positions common during surgery that lead to muscle fatigue, pain, and degenerative changes. Correct ergonomics is a learned and practiced behavior. We believe that video is a useful way to facilitate improvement in ergonomic behaviors. We suggest that consideration of operating room setup, proper posture, and practice of postural resets are necessary components for a longer, healthier, and pain-free surgical career. Copyright © 2013 AAGL. Published by Elsevier Inc. All rights reserved.

  18. Towards a model of surgeons' leadership in the operating room.

    Science.gov (United States)

    Henrickson Parker, Sarah; Yule, Steven; Flin, Rhona; McKinley, Aileen

    2011-07-01

    There is widespread recognition that leadership skills are essential for effective performance in the workplace, but the evidence detailing effective leadership behaviours for surgeons during operations is unclear. Boolean searches of four on-line databases and detailed hand search of relevant references were conducted. A four stage screening process was adopted stipulating that articles presented empirical data on surgeons' intraoperative leadership behaviours. Ten relevant articles were identified and organised by method of investigation into (i) observation, (ii) questionnaire and (iii) interview studies. This review summarises the limited literature on surgeons' intraoperative leadership, and proposes a preliminary theoretically based structure for intraoperative leadership behaviours. This structure comprises seven categories with corresponding leadership components and covers two overarching themes related to task- and team-focus. Selected leadership theories which may be applicable to the operating room environment are also discussed. Further research is required to determine effective intraoperative leadership behaviours for safe surgical practice.

  19. Procedure and information displays in advanced nuclear control rooms: experimental evaluation of an integrated design.

    Science.gov (United States)

    Chen, Yue; Gao, Qin; Song, Fei; Li, Zhizhong; Wang, Yufan

    2017-08-01

    In the main control rooms of nuclear power plants, operators frequently have to switch between procedure displays and system information displays. In this study, we proposed an operation-unit-based integrated design, which combines the two displays to facilitate the synthesis of information. We grouped actions that complete a single goal into operation units and showed these operation units on the displays of system states. In addition, we used different levels of visual salience to highlight the current unit and provided a list of execution history records. A laboratory experiment, with 42 students performing a simulated procedure to deal with unexpected high pressuriser level, was conducted to compare this design against an action-based integrated design and the existing separated-displays design. The results indicate that our operation-unit-based integrated design yields the best performance in terms of time and completion rate and helped more participants to detect unexpected system failures. Practitioner Summary: In current nuclear control rooms, operators frequently have to switch between procedure and system information displays. We developed an integrated design that incorporates procedure information into system displays. A laboratory study showed that the proposed design significantly improved participants' performance and increased the probability of detecting unexpected system failures.

  20. Marcoule pilot work-room: process automatic operation

    International Nuclear Information System (INIS)

    Mus, G.; Linger, C.

    1987-01-01

    Commissioned in the early 1960s, the Marcoule Pilot Plant has undergone a series of sweeping transformations. The Research and Development resources concerning irradiated fuel processing have been expanded and modified. Its reprocessing capacity has also been raised from 2 to 5 t/year. Simultaneously, the installation control system was completely remodelled. The control consoles, which were previously positioned locally near the different units, have been grouped together in a centralized control room. To do this, the measurement and operating circuits were replaced by new data acquisition and processing systems requiring the use of numerical algorithms. The management and control of certain units, including mechanical fuel preparation, sampling, and sample transport to the laboratories, have been entrusted to programmable automata. Certain unit operations, such as concentration by evaporation, are set up with complete automation. These new arrangements will expand the resources for analysing the operation of the Pilot Plant, while offering a more overall view of the operations. They have been made possible by a major effort in the development of sensors, and represent the indispensable prerequisite for the installation of expert systems [fr

  1. 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.

  2. Surgical PACS for the digital operating room. Systems engineering and specification of user requirements.

    Science.gov (United States)

    Korb, Werner; Bohn, Stefan; Burgert, Oliver; Dietz, Andreas; Jacobs, Stephan; Falk, Volkmar; Meixensberger, Jürgen; Strauss, Gero; Trantakis, Christos; Lemke, Heinz U

    2006-01-01

    For better integration of surgical assist systems into the operating room, a common communication and processing plattform that is based on the users needs is needed. The development of such a system, a Surgical Picture Aquisition and Communication System (S-PACS), according the systems engineering cycle is oulined in this paper. The first two steps (concept and specification) for the engineering of the S-PACS are discussed.A method for the systematic integration of the users needs', the Quality Function Deployment (QFD), is presented. The properties of QFD for the underlying problem and first results are discussed. Finally, this leads to a first definition of an S-PACS system.

  3. 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.

  4. Variables influencing medical student learning in the operating room.

    Science.gov (United States)

    Schwind, Cathy J; Boehler, Margaret L; Rogers, David A; Williams, Reed G; Dunnington, Gary; Folse, Roland; Markwell, Stephen J

    2004-02-01

    The operating room (OR) is an important venue where surgeons do much of medical student teaching and yet there has been little work evaluating variables that influence learning in this unique environment. We designed this study to identify variables that affected medical student learning in the OR. We developed a questionnaire based on surgery faculty observations of learning in the OR. The medical students completed the questionnaire on 114 learning episodes in the OR. Pearson correlation coefficient was used to establish the strength of association between various variables and the student's overall perception of learning. The students evaluated 27 variables that might impact their learning in the OR. Strong correlations were identified between the attending physician's attitude, interactions and teaching ability in the OR and the environment being conducive to learning. Surgical faculty behavior is a powerful determinant of student perceptions of what provides for a favorable learning environment in the OR.

  5. Ergonomic evaluation model of operational room based on team performance

    Directory of Open Access Journals (Sweden)

    YANG Zhiyi

    2017-05-01

    Full Text Available A theoretical calculation model based on the ergonomic evaluation of team performance was proposed in order to carry out the ergonomic evaluation of the layout design schemes of the action station in a multitasking operational room. This model was constructed in order to calculate and compare the theoretical value of team performance in multiple layout schemes by considering such substantial influential factors as frequency of communication, distance, angle, importance, human cognitive characteristics and so on. An experiment was finally conducted to verify the proposed model under the criteria of completion time and accuracy rating. As illustrated by the experiment results,the proposed approach is conductive to the prediction and ergonomic evaluation of the layout design schemes of the action station during early design stages,and provides a new theoretical method for the ergonomic evaluation,selection and optimization design of layout design schemes.

  6. Improving the Interdisciplinary Team Work in the Operating Room

    DEFF Research Database (Denmark)

    Tørring, Birgitte

    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...... 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...... 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...

  7. Job satisfaction among control room operators of electrical systems.

    Science.gov (United States)

    Macaia, Amanda A Silva; Marqueze, Elaine C; Rotenberg, Lúcia; Fischer, Frida Marina; Moreno, Claudia R C

    2012-01-01

    Shift workers from control centers of electrical systems are a group that has received little attention in Brazil. This study aimed to compare workers' job satisfaction at five control centers of a Brazilian company electrical system, and according to their job titles. The Organization Satisfaction Index (OSI) questionnaire to assess job satisfaction was used. ANOVA was used to compare OSI means, according to job title and control center. The results showed that there is no difference in job satisfaction among job titles, but a significant difference was found according to the control center. A single organizational culture cannot be applied to several branches. It is required to implement actions that would result in job satisfaction improvements among workers of all studied control rooms centers. The high level of education of operators working in all centers might have contributed to the similar values of perceived satisfaction among distinct job titles.

  8. Human-machine interface aspects and use of computer-based operator support systems in control room upgrades and new control room designs for nuclear power plants

    International Nuclear Information System (INIS)

    Berg, O.

    1997-01-01

    At the Halden Project efforts are made to explore the possibilities through design, development and validation of Computer-based Operator Support Systems (COSSes) which can assist the operators in different operational situations, ranging from normal operation to disturbance and accident conditions. The programme comprises four main activities: 1) verification and validation of safety critical software systems; 2) man-machine interaction research emphasizing improvements in man-machine interfaces on the basis of human factors studies; 3) computerized operator support systems assisting the operator in fault detection/diagnosis and planning of control actions; and 4) control room development providing a basis for retrofitting of existing control rooms and for the design of advanced concepts. The paper presents the status of this development programme, including descriptions of specific operator support functions implemented in the simulator-based, experimental control room at Halden (HAMMLAB, HAlden Man-Machine LABoratory). These operator aids comprise advanced alarms systems, diagnostic support functions, electronic procedures, critical safety functions surveillance and accident management support systems. The different operator support systems development at the Halden Project are tested and evaluated in HAMMLAB with operators from the Halden Reactor, and occasionally from commercial NPPs, as test subjects. These evaluations provide data on the merits of different operator support systems in an advanced control room setting, as well as on how such systems should be integrated to enhance operator performance. The paper discusses these aspects and the role of computerized operator support systems in plant operation based on the experience from this work at the Halden Project. 15 refs, 5 figs

  9. Human-machine interface aspects and use of computer-based operator support systems in control room upgrades and new control room designs for nuclear power plants

    Energy Technology Data Exchange (ETDEWEB)

    Berg, O [Institutt for Energiteknikk, OECD Halden Reactor Project (Netherlands)

    1997-07-01

    At the Halden Project efforts are made to explore the possibilities through design, development and validation of Computer-based Operator Support Systems (COSSes) which can assist the operators in different operational situations, ranging from normal operation to disturbance and accident conditions. The programme comprises four main activities: 1) verification and validation of safety critical software systems; 2) man-machine interaction research emphasizing improvements in man-machine interfaces on the basis of human factors studies; 3) computerized operator support systems assisting the operator in fault detection/diagnosis and planning of control actions; and 4) control room development providing a basis for retrofitting of existing control rooms and for the design of advanced concepts. The paper presents the status of this development programme, including descriptions of specific operator support functions implemented in the simulator-based, experimental control room at Halden (HAMMLAB, HAlden Man-Machine LABoratory). These operator aids comprise advanced alarms systems, diagnostic support functions, electronic procedures, critical safety functions surveillance and accident management support systems. The different operator support systems development at the Halden Project are tested and evaluated in HAMMLAB with operators from the Halden Reactor, and occasionally from commercial NPPs, as test subjects. These evaluations provide data on the merits of different operator support systems in an advanced control room setting, as well as on how such systems should be integrated to enhance operator performance. The paper discusses these aspects and the role of computerized operator support systems in plant operation based on the experience from this work at the Halden Project. 15 refs, 5 figs.

  10. Uncovering the History of Operating Room Attire through Photographs.

    Science.gov (United States)

    Adams, Lu Wang; Aschenbrenner, Carol A; Houle, Timothy T; Roy, Raymond C

    2016-01-01

    Although early proponents for each of the four basic articles of operating room clothing--gowns, caps, masks, and gloves--can be identified, it is unclear from historical commentaries when each article achieved general acceptance and was consistently worn by surgeons and by anesthesia providers. Historical photographs were identified from the Web sites of the National Library of Medicine, Google, and the archives of the Wood Library-Museum of Anesthesiology for the 11 decades 1860 to 1970. The presence or absence of each article of clothing was then determined for the surgical and anesthesia providers depicted. Over 1,000 photographs were identified and examined. Photographs were then eliminated for repetition, lack of available dating, questionable dating, and poor quality. In 338 remaining photographs that met inclusion criteria, 640 surgical providers and 219 anesthesia providers were depicted and used in the analysis. Statistical definitions for historical terms general acceptance and routine use were proposed. The probability that a surgeon was wearing nonstreet clothes (gown) was 0.66 (95% CI, 0.22 to 0.93) in 1863. The years (95% lower bound to 95% upper bound) associated with a 0.5 probability for wearing cap, gloves, and mask were 1900 (1896 to 1904), 1907 (1903 to 1910), and 1916 (1913 to 1919), respectively. The years associated with a 0.5 probability that an anesthesia provider would be wearing nonstreet clothes (gown), cap, and mask were 1883 (1863 to 1889), 1905 (1900 to 1911), and 1932 (1929 to 1937), respectively. Timelines for the adoption of each basic article of surgical attire by surgeons and anesthesia providers were determined by analysis of historical operating room photographs from 1863 to 1969.

  11. Factors contributing to airborne particle dispersal in the operating room.

    Science.gov (United States)

    Noguchi, Chieko; Koseki, Hironobu; Horiuchi, Hidehiko; Yonekura, Akihiko; Tomita, Masato; Higuchi, Takashi; Sunagawa, Shinya; Osaki, Makoto

    2017-07-06

    Surgical-site infections due to intraoperative contamination are chiefly ascribable to airborne particles carrying microorganisms. The purpose of this study is to identify the actions that increase the number of airborne particles in the operating room. Two surgeons and two surgical nurses performed three patterns of physical movements to mimic intraoperative actions, such as preparing the instrument table, gowning and donning/doffing gloves, and preparing for total knee arthroplasty. The generation and behavior of airborne particles were filmed using a fine particle visualization system, and the number of airborne particles in 2.83 m 3 of air was counted using a laser particle counter. Each action was repeated five times, and the particle measurements were evaluated through one-way analysis of variance multiple comparison tests followed by Tukey-Kramer and Bonferroni-Dunn multiple comparison tests for post hoc analysis. Statistical significance was defined as a P value ≤ .01. A large number of airborne particles were observed while unfolding the surgical gown, removing gloves, and putting the arms through the sleeves of the gown. Although numerous airborne particles were observed while applying the stockinet and putting on large drapes for preparation of total knee arthroplasty, fewer particles (0.3-2.0 μm in size) were detected at the level of the operating table under laminar airflow compared to actions performed in a non-ventilated preoperative room (P airborne particles near a sterile area and that laminar airflow has the potential to reduce the incidence of bacterial contamination.

  12. Surgeons' Leadership Styles and Team Behavior in the Operating Room.

    Science.gov (United States)

    Hu, Yue-Yung; Parker, Sarah Henrickson; Lipsitz, Stuart R; Arriaga, Alexander F; Peyre, Sarah E; Corso, Katherine A; Roth, Emilie M; Yule, Steven J; Greenberg, Caprice C

    2016-01-01

    The importance of leadership is recognized in surgery, but the specific impact of leadership style on team behavior is not well understood. In other industries, leadership is a well-characterized construct. One dominant theory proposes that transactional (task-focused) leaders achieve minimum standards and transformational (team-oriented) leaders inspire performance beyond expectations. We videorecorded 5 surgeons performing complex operations. Each surgeon was scored on the Multifactor Leadership Questionnaire, a validated method for scoring transformational and transactional leadership style, by an organizational psychologist and a surgeon researcher. Independent coders assessed surgeons' leadership behaviors according to the Surgical Leadership Inventory and team behaviors (information sharing, cooperative, and voice behaviors). All coders were blinded. Leadership style (Multifactor Leadership Questionnaire) was correlated with surgeon behavior (Surgical Leadership Inventory) and team behavior using Poisson regression, controlling for time and the total number of behaviors, respectively. All surgeons scored similarly on transactional leadership (range 2.38 to 2.69), but varied more widely on transformational leadership (range 1.98 to 3.60). Each 1-point increase in transformational score corresponded to 3 times more information-sharing behaviors (p leadership and its impact on team performance in the operating room. As in other fields, our data suggest that transformational leadership is associated with improved team behavior. Surgeon leadership development, therefore, has the potential to improve the efficiency and safety of operative care. Copyright © 2016 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

  13. 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.

  14. Mobility, Context and Cloud – Exploring Integration Issues in a Meeting Room Scenario

    Directory of Open Access Journals (Sweden)

    Tor-Morten Grønli

    2012-04-01

    Full Text Available In this paper we pursue the context-aware paradigm in a distributed mobile environment. Context-awareness plays a significant role in the domain of implicit human computer interaction and we present an intelligent context-aware meeting room application. The distributed mobile application consists of multiple mobile operating system clients, a Google Android based presenter that, through proximity technology, communicates with a server in the meeting room, and a Google Cloud backend server. Over 40 users have evaluated the application. Results show that the context aware meeting room was well received by users who displayed a strong positive bias towards cloud integration and, in particular, automatic meeting-note push. We conclude that our context-aware meeting assistant can provide valuable assistance to end users and that there is promise for such use of heterogeneous mobile context-aware platforms.

  15. 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)

  16. Overutilization and underutilization of operating rooms - insights from behavioral health care operations management.

    Science.gov (United States)

    Fügener, Andreas; Schiffels, Sebastian; Kolisch, Rainer

    2017-03-01

    The planning of surgery durations is crucial for efficient usage of operating theaters. Both planning too long and too short durations for surgeries lead to undesirable consequences, e.g. idle time, overtime, or rescheduling of surgeries. We define these consequences as operating room inefficiency. The overall objective of planning surgery durations is to minimize expected operating room inefficiency, since surgery durations are stochastic. While most health care studies assume economically rational behavior of decision makers, experimental studies have shown that decision makers often do not act according to economic incentives. Based on insights from health care operations management, medical decision making, behavioral operations management, as well as empirical observations, we derive hypotheses that surgeons' behavior deviates from economically rational behavior. To investigate this, we undertake an experimental study where experienced surgeons are asked to plan surgeries with uncertain durations. We discover systematic deviations from optimal decision making and offer behavioral explanations for the observed biases. Our research provides new insights to tackle a major problem in hospitals, i.e. low operating room utilization going along with staff overtime.

  17. 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.

  18. Human factors design of nuclear power plant control rooms including computer-based operator aids

    International Nuclear Information System (INIS)

    Bastl, W.; Felkel, L.; Becker, G.; Bohr, E.

    1983-01-01

    The scientific handling of human factors problems in control rooms began around 1970 on the basis of safety considerations. Some recent research work deals with the development of computerized systems like plant balance calculation, safety parameter display, alarm reduction and disturbance analysis. For disturbance analysis purposes it is necessary to homogenize the information presented to the operator according to the actual plant situation in order to supply the operator with the information he most urgently needs at the time. Different approaches for solving this problem are discussed, and an overview is given on what is being done. Other research projects concentrate on the detailed analysis of operators' diagnosis strategies in unexpected situations, in order to obtain a better understanding of their mental processes and the influences upon them when such situations occur. This project involves the use of a simulator and sophisticated recording and analysis methods. Control rooms are currently designed with the aid of mock-ups. They enable operators to contribute their experience to the optimization of the arrangement of displays and controls. Modern control rooms are characterized by increasing use of process computers and CRT (Cathode Ray Tube) displays. A general concept for the integration of the new computerized system and the conventional control panels is needed. The technical changes modify operators' tasks, and future ergonomic work in nuclear plants will need to consider the re-allocation of function between man and machine, the incorporation of task changes in training programmes, and the optimal design of information presentation using CRTs. Aspects of developments in control room design are detailed, typical research results are dealt with, and a brief forecast of the ergonomic contribution to be made in the Federal Republic of Germany is given

  19. Evaluation of potential distractors in the urology operating room.

    Science.gov (United States)

    Lee, Jason Y; Lantz, Andrea G; McDougall, Elspeth M; Landman, Jaime; Gettman, Matthew; Sweet, Robert; Sundaram, Chandru P; Zorn, Kevin C

    2013-09-01

    Surgical outcomes depend on patient and disease-related factors, as well as the technical skill of the surgeon. Various distractions in the operating room (OR) environment have been shown to negatively impact a surgeon's performance. A survey was conducted with the objective to evaluate and characterize distractions during urologic surgery. An Internet-based survey was distributed to 2057 international urologists via email between April and October 2011; questions focused on a variety of disruptive factors postulated to have a negative impact on surgical performance. Of the 523 (25%) respondents, 58% practiced in North America, 42% were from an academic institution, and 68% had completed a clinical fellowship. In an average year, 83% reported having operated at least once while sleep deprived, 84% when significantly ill, 55% with a musculoskeletal injury, and 65% under significant social stress. Up to 38% reported that on at least one occasion, such "internal distractions" had significantly affected surgical performance and 14% perceived that at least one surgical complication was caused mainly by an internal distraction. Less than 50% had ever cancelled surgery because of an internal distraction. Music was routinely played in the OR by 57% of respondents, >67% reported answering pages and discussing consults while operating, and 25% reported "commonly" working with scrub nurses/techs that were unfamiliar with the procedure and/or instruments. Only 44% had consistent individual(s) assisting, and 27% reported that the scrub nurse/tech would "commonly" scrub out during a critical portion of the procedure. Overall, 14.5% reported that at least one complication had occurred mainly because of such "external" or "interactive" distractions. Urologists face various distractions in the OR that can negatively impact surgical performance, potentially compromising patient outcomes and safety. Further studies are needed to elucidate the true impact of such distractions and to

  20. Improving safety through an integrated approach for advanced control room development

    International Nuclear Information System (INIS)

    Haugset, K.; Berg, O.; Foerdestroemmen, N.T.; Kvalem, J.; Nelson, W.R.

    1990-01-01

    With the fast development of computer technology, the potential exists for improving operational safety of nuclear plants by using advanced operator tools in the control room. Specific systems are being introduced, such as systems for alarm handling, failure detection, disturbance diagnosis, procedural advice and others, often based on process modeling techniques or expert system technology. To ensure a maximum benefit from the new technology, a careful integration of the various systems must, however, take place, resulting in a well coordinated interface between the operator and the process. The OECD Halden Reactor Project has started the development of an Integrated Surveillance And Control System (ISACS). The basis for the activity is the experience at Halden in developing specific Computerized Operator Support Systems (COSSs), and the activity around the experimental control room HAMMLAB where detailed validations of operator tools have been performed for a number of years. The first goal in the ISACS project is to have a first, limited prototype in operation at the end of 1990. Validation experiments will follow

  1. Improving safety through an integrated approach for advanced control room development

    International Nuclear Information System (INIS)

    Haugset, K.; Berg, O.; Bologna, S.; Foerdestroemmen, N.T.; Kvalem, J.; Nelson, W.R.; Yamane, N.

    1992-01-01

    With the fast development of computer technology, the potential exists for improving operational safety of nuclear plants by using advanced operator tools in the control room. Specific systems are being introduced, such as systems for alarm handling, failure detection, disturbance diagnosis, procedural advice and others, often based on process modeling techniques or expert system technology. To ensure a maximum benefit from the new technology, a careful integration of the various systems must, however, take place, resulting in a well coordinated interface between the operator and the process. The OECD Halden Reactor Project has started the development of an Integrated Surveillance And Control System (ISACS). The basis for the activity is the experience at Halden in developing specific Computerized Operator Support Systems (COSSs), and the activity around the experimental control room HAMMLAB where detailed validations of operator tools have been performed for a number of years. The first goal in the ISACS project is to have a first, limited prototype in operation at the end of 1990. Validation experiments will follow. (orig.)

  2. Completely integrable operator evolutionary equations

    International Nuclear Information System (INIS)

    Chudnovsky, D.V.

    1979-01-01

    The authors present natural generalizations of classical completely integrable equations where the functions are replaced by arbitrary operators. Among these equations are the non-linear Schroedinger, the Korteweg-de Vries, and the modified KdV equations. The Lax representation and the Baecklund transformations are presented. (Auth.)

  3. 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.

  4. 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.

  5. Robotic digital subtraction angiography systems within the hybrid operating room.

    Science.gov (United States)

    Murayama, Yuichi; Irie, Koreaki; Saguchi, Takayuki; Ishibashi, Toshihiro; Ebara, Masaki; Nagashima, Hiroyasu; Isoshima, Akira; Arakawa, Hideki; Takao, Hiroyuki; Ohashi, Hiroki; Joki, Tatsuhiro; Kato, Masataka; Tani, Satoshi; Ikeuchi, Satoshi; Abe, Toshiaki

    2011-05-01

    Fully equipped high-end digital subtraction angiography (DSA) within the operating room (OR) environment has emerged as a new trend in the fields of neurosurgery and vascular surgery. To describe initial clinical experience with a robotic DSA system in the hybrid OR. A newly designed robotic DSA system (Artis zeego; Siemens AG, Forchheim, Germany) was installed in the hybrid OR. The system consists of a multiaxis robotic C arm and surgical OR table. In addition to conventional neuroendovascular procedures, the system was used as an intraoperative imaging tool for various neurosurgical procedures such as aneurysm clipping and spine instrumentation. Five hundred one neurosurgical procedures were successfully conducted in the hybrid OR with the robotic DSA. During surgical procedures such as aneurysm clipping and arteriovenous fistula treatment, intraoperative 2-/3-dimensional angiography and C-arm-based computed tomographic images (DynaCT) were easily performed without moving the OR table. Newly developed virtual navigation software (syngo iGuide; Siemens AG) can be used in frameless navigation and in access to deep-seated intracranial lesions or needle placement. This newly developed robotic DSA system provides safe and precise treatment in the fields of endovascular treatment and neurosurgery.

  6. An ethnographic study of differentiated practice in an operating room.

    Science.gov (United States)

    Graff, C; Roberts, K; Thornton, K

    1999-01-01

    An ethnographic study was conducted to investigate implementation of the clinical nurse III or team leader (TL) role as part of a newly executed nursing differentiated practice model. The six TLs studied were employed in the operating room (OR). Through participant observation, interviews, and document analysis, the TL role--as well as perceptions of the role by the TLs and OR staff--were studied. Problems related to performance of the role and its evolutionary process were delineated. Data analysis involved identifying categories and subcategories of data and developing a coding system to identify themes. Salient themes were related to the culture of the OR. Because of the OR's highly technical environment, the TLs defined their roles in relation to the organizational and technical needs of their surgical service. Refinement of surgeon "preference cards" and "instrument count sheets" was considered the initial priority for the TLs. Various controllable and uncontrollable factors were identified that affected implementation of the new TL role. Findings suggest that introduction of the role requires insight into setting and an emphasis on staging and orientation of employees to the new role.

  7. The next step: intelligent digital assistance for clinical operating rooms

    Directory of Open Access Journals (Sweden)

    Miehle Juliana

    2017-08-01

    Full Text Available With the emergence of new technologies, the surgical working environment becomes increasingly complex and comprises many medical devices that have to be taken cared of. However, the goal is to reduce the workload of the surgical team to allow them to fully focus on the actual surgical procedure. Therefore, new strategies are needed to keep the working environment manageable. Existing research projects in the field of intelligent medical environments mostly concentrate on workflow modeling or single smart features rather than building up a complete intelligent environment. In this article, we present the concept of intelligent digital assistance for clinical operating rooms (IDACO, providing the surgeon assistance in many different situations before and during an ongoing procedure using natural spoken language. The speech interface enables the surgeon to concentrate on the surgery and control the technical environment at the same time, without taking care of how to interact with the system. Furthermore, the system observes the context of the surgery and controls several devices autonomously at the appropriate time during the procedure.

  8. [Role-specific targets and teamwork in the operating room].

    Science.gov (United States)

    Hoeper, K; Kriependorf, M; Felix, C; Nyhuis, P; Tecklenburg, A

    2017-12-01

    The primary goal of a surgical team is the successful performance of an operation on a patien; however, this primary goal can show discrepancies from the goals of individual team members. The main causes for differences of interests can be variations in subjective preferences and organizational differences. Subjective preferences are due to the values held by those involved. These values are of an intrinsic nature and therefore difficult to change. Another reason for individual goals is that hospitals and universities are professional bureaucracies. Experts working in professional bureaucracies are known to identify themselves to a greater extent with their respective profession than with their institution; however, teams in the operating room (OR) have to work together in multidisciplinary teams. The main goal of this analysis is to document role-specific targets and motivations within teams. This was a case study at a university hospital with 40 operating rooms. The data collection resulted from the three pillars of the goal documentation instrument, which includes expert interviews, a utility analysis and card placement as a basis for communicative validation. The results were analyzed with a systematic method as a qualitative content analysis. The four-pillar success model, which maps aspects of a successful hospital, was used as a deductive coding scheme. The four pillars represent the level of medical quality (process, structure and outcome quality), economy and efficiency, client satisfaction (patients and referring physicians) and employee satisfaction. At a university hospital an additional focus is on research and teaching. In addition to the four pillar success model as a deductive coding scheme, an inductive coding scheme was introduced. Approximately 10% of the employees from each professional group (surgeons, anesthesiologists, OR nurses, nurse anesthetists) were interviewed resulting in 65 interviews overall. The interviews were conducted

  9. Development of contextual task analysis for NPP control room operators' work

    International Nuclear Information System (INIS)

    Hukki, K.

    1998-01-01

    The paper introduces a contextual approach to task analysis concerning control room operators' tasks and task conditions in nuclear power plants. The approach is based on the ecological concept of the situational appropriateness of activity. The task demands are dependent on the ultimate task of the operators which is to maintain the critical safety functions of the process. The context also sets boundary conditions to the fulfilment of these demands. The conceptualisation of the context affords possibilities to comprehend and make visible the core demands of the operators' work. Characteristic to the approach is that the conceptualisation is made both from the point of the operators who are making interpretations of the situation and from the point of the process to be controlled. The context is described as a world of operators' possibilities and constraints and, at the same time, in relation to the demands set by the nature of the process. The method is under development and has been applied in simulator training, in the evaluation of the control room information and in the integrated development of reliability analysis. The method emphasizes the role of explicit conceptualisation of the task situations. Explicity enhances its role as a conceptual tool and, therefore, promotes common awareness in these domains. (orig.)

  10. Application of Operational Research Techniques in Operating Room Scheduling Problems: Literature Overview

    Directory of Open Access Journals (Sweden)

    Şeyda Gür

    2018-01-01

    Full Text Available Increased healthcare costs are pushing hospitals to reduce costs and increase the quality of care. Operating rooms are the most important source of income and expense for hospitals. Therefore, the hospital management focuses on the effectiveness of schedules and plans. This study includes analyses of recent research on operating room scheduling and planning. Most studies in the literature, from 2000 to the present day, were evaluated according to patient characteristics, performance measures, solution techniques used in the research, the uncertainty of the problem, applicability of the research, and the planning strategy to be dealt within the solution. One hundred seventy studies were examined in detail, after scanning the Emerald, Science Direct, JSTOR, Springer, Taylor and Francis, and Google Scholar databases. To facilitate the identification of these studies, they are grouped according to the different criteria of concern and then, a detailed overview is presented.

  11. Protective lung ventilation in operating room: a systematic review.

    Science.gov (United States)

    Futier, E; Constantin, J M; Jaber, S

    2014-06-01

    Postoperative pulmonary and extrapulmonary complications adversely affect clinical outcomes and healthcare utilization, so that prevention has become a measure of the quality of perioperative care. Mechanical ventilation is an essential support therapy to maintain adequate gas exchange during general anesthesia for surgery. Mechanical ventilation using high tidal volume (VT) (between 10 and 15 mL/kg) has been historically encouraged to prevent hypoxemia and atelectasis formation in anesthetized patients undergoing abdominal and thoracic surgery. However, there is accumulating evidence from both experimental and clinical studies that mechanical ventilation, especially the use of high VT and plateau pressure, may potentially aggravate or even initiate lung injury. Ventilator-associated lung injury can result from cyclic alveolar overdistension of non-dependent lung tissue, and repetitive opening and closing of dependent lung tissue resulting in ultrastructural damage at the junction of closed and open alveoli. Lung-protective ventilation, which refers to the use of lower VT and limited plateau pressure to minimize overdistension, and positive end-expiratory pressure to prevent alveolar collapse at end-expiration, was shown to improve outcome in critically ill patients with acute respiratory distress syndrome (ARDS). It has been recently suggested that this approach might also be beneficial in a broader population, especially in critically ill patients without ARDS at the onset of mechanical ventilation. There is, however, little evidence regarding a potential beneficial effect of lung protective ventilation during surgery, especially in patients with healthy lungs. Although surgical patients are frequently exposed to much shorter periods of mechanical ventilation, this is an important gap in knowledge given the number of patients receiving mechanical ventilation in the operating room. This review developed the benefits of lung protective ventilation during surgery

  12. Operating room waste reduction in plastic and hand surgery.

    Science.gov (United States)

    Albert, Mark G; Rothkopf, Douglas M

    2015-01-01

    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. To propose a method of decreasing cost through judicious selection of instruments and supplies, and initiation of recycling in plastic and hand surgery. 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. 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. 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. Significant financial savings and environmental benefit can result from this judicious supply and instrument selection, as well as implementation of recycling.

  13. [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.

  14. Operating room fires in otolaryngology: risk factors and prevention.

    Science.gov (United States)

    Smith, Lee P; Roy, Soham

    2011-01-01

    The aim of the study was to characterize the causes of operating room (OR) fires in otolaryngology. A questionnaire was designed to elicit the characteristics of OR fires experienced by otolaryngologists. The survey was advertised to 8523 members of the American Academy of Otolaryngology-Head and Neck Surgery. Three hundred forty-nine questionnaires were completed. Eighty-eight surgeons (25.2%) witnessed at least one OR fire in their career, 10 experienced 2 fires each, and 2 reported 5 fires each. Of 106 reported fires, details were available for 100. The most common ignition sources were an electrosurgical unit (59%), a laser (32%), and a light cord (7%). Twenty-seven percent of fires occurred during endoscopic airway surgery, 24% during oropharyngeal surgery, 23% during cutaneous or transcutaneous surgery of the head and neck, and 18% during tracheostomy; 7% were related to a light cord, and 1% was related to an anesthesia machine. Eighty-one percent of fires occurred while supplemental oxygen was in use. Common fuels included an endotracheal tube (31%), OR drapes/towels (18%), and flash fire (where no substrate burned) (11%). Less common fuels included alcohol-based preparation solution, gauze sponges, patient's hair or skin, electrosurgical unit with retrofitted insulation over the tip, tracheostomy tube, tonsil sponge, suction tubing, a cottonoid pledget, and a red rubber catheter. OR fire may occur in a wide variety of clinical settings; endoscopic airway surgery, oropharyngeal surgery, cutaneous surgery, and tracheostomy present the highest risk for otolaryngologists. Electrosurgical devices and lasers are the most likely to produce ignition. Copyright © 2011 Elsevier Inc. All rights reserved.

  15. Integrated solution for field operations

    Energy Technology Data Exchange (ETDEWEB)

    Aubin, Renaud; Dionis, Francois [EDF, Chatou (France)

    2014-08-15

    This document presents our approach to design and to implement mobile applications for field operations. Internal on-field studies yield to the fact that the value added by mobile solutions is correlated with the easiness of their integration with each other and with the underlying information systems. Moreover, the fast-growing mobile market brings new concepts to the mass and industrial applications design can benefit from these. As a consequence, a simple components-based approach has been applied to design and develop mobile applications for field operations and on-site experiments of the resulting applications have been conducted.

  16. Integrated solution for field operations

    International Nuclear Information System (INIS)

    Aubin, Renaud; Dionis, Francois

    2014-01-01

    This document presents our approach to design and to implement mobile applications for field operations. Internal on-field studies yield to the fact that the value added by mobile solutions is correlated with the easiness of their integration with each other and with the underlying information systems. Moreover, the fast-growing mobile market brings new concepts to the mass and industrial applications design can benefit from these. As a consequence, a simple components-based approach has been applied to design and develop mobile applications for field operations and on-site experiments of the resulting applications have been conducted

  17. Integrated solution for field operations

    International Nuclear Information System (INIS)

    Aubin, Renaud; Dionis, Francois

    2014-01-01

    This paper presents the authors' approach to design and to implement mobile applications for field operations. Internal on-field studies can yield the fact that the value-added by mobile solutions is correlated with the easiness of their integration with each other and with the underlying information systems. Moreover, the fast-growing mobile market brings new concepts to the mass and industrial applications design can benefit from these. As a consequence, a simple components-based approach has been applied to design and develop mobile applications for field operations and on-site experiments of the resulting applications have been conducted. (author)

  18. Role Allocations and Communications of Operators during Emergency Operation in Advanced Main Control Rooms

    International Nuclear Information System (INIS)

    Lee, June Seung

    2009-01-01

    The advanced main control room (MCR) in GEN III + nuclear power plants has been designed by adapting modern digital I and C techniques and an advanced man machine interface system (MMIS). Large Display Panels (LDPs) and computer based workstations are installed in the MCR. A Computerized Procedure System (CPS) and Computerized Operation Support System (COSS) with high degrees of automation are supplied to operators. Therefore, it is necessary to set up new operation concepts in advanced MCRs that are different from those applied in conventional MCRs regarding role allocations and communications of operators. The following presents a discussion of the main differences between advanced MCRs and conventional MCRs from the viewpoint of role allocations and communications. Efficient models are then proposed on the basis of a task analysis on a series of emergency operation steps

  19. Improving operating room first start efficiency - value of both checklist and a pre-operative facilitator.

    Science.gov (United States)

    Panni, M K; Shah, S J; Chavarro, C; Rawl, M; Wojnarwsky, P K; Panni, J K

    2013-10-01

    There are multiple components leading to improved operating room efficiency. We undertook a project focusing on first case starts; accounting for each delay component on a global basis. Our hypothesis was there would be a reduction in first start delays after we implemented strategies to address the issues identified through this accounting process. An orange sheet checklist was implemented, with specific items that needed to be clear prior to roll back to the operating room (OR), and an OR facilitator was employed to intervene whenever there were any missing items needed for a specific patient. We present the data from this quality improvement project over an 18-month period. Initially, 10.07 (± 0.73) delayed first starts occurred per day but declined steadily over time to a low of 4.95 (± 0.38) per day after 6 months (-49.2 %, P < 0.001). By the end of the project, the most common reasons for delay still included late surgical attending (19%), schedule changes (14%) as well as 'other reasons' (13%), but with an overall reduction per day of each. Total anaesthesia delay initially totalled 11% of the first start delays, but was negligible (< 1%) at the project's completion. While we have a challenging operating room environment based on our patient population, multiple trainees in both the surgery and anaesthesiology teams: an orange sheet - pre-operative checklist in addition to a dedicated pre-operative facilitator; allowed us to make a substantial improvement in our first start on time starts. © 2013 The Acta Anaesthesiologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.

  20. 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

  1. 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…

  2. Room-temperature-deposited dielectrics and superconductors for integrated photonics.

    Science.gov (United States)

    Shainline, Jeffrey M; Buckley, Sonia M; Nader, Nima; Gentry, Cale M; Cossel, Kevin C; Cleary, Justin W; Popović, Miloš; Newbury, Nathan R; Nam, Sae Woo; Mirin, Richard P

    2017-05-01

    We present an approach to fabrication and packaging of integrated photonic devices that utilizes waveguide and detector layers deposited at near-ambient temperature. All lithography is performed with a 365 nm i-line stepper, facilitating low cost and high scalability. We have shown low-loss SiN waveguides, high-Q ring resonators, critically coupled ring resonators, 50/50 beam splitters, Mach-Zehnder interferometers (MZIs) and a process-agnostic fiber packaging scheme. We have further explored the utility of this process for applications in nonlinear optics and quantum photonics. We demonstrate spectral tailoring and octave-spanning supercontinuum generation as well as the integration of superconducting nanowire single photon detectors with MZIs and channel-dropping filters. The packaging approach is suitable for operation up to 160 °C as well as below 1 K. The process is well suited for augmentation of existing foundry capabilities or as a stand-alone process.

  3. Assessment of operating room air distribution in a mobile hospital: field experiment based on VDI 2167

    NARCIS (Netherlands)

    Forejt, L.; Drkal, F.; Hensen, J.L.M.; Seppänen, O.; Säteri, J.

    2007-01-01

    Air distribution in mobile operating room was assessed according to the recent acceptance test (VDI, 2004 [1]). This standard presents a simple and uniform validation procedure of operating room air distribution systems. Therefore it was applied as an objective method for evaluating performance of

  4. 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…

  5. Mobile devices in the operating rooms: intended and unintended consequences for nurses’ work

    NARCIS (Netherlands)

    Sergeeva, A.; Aij, K.H.; van den Hooff, B.J.; Huysman, M.H.

    2016-01-01

    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

  6. A master surgical scheduling approach for cyclic scheduling in operating room departments

    NARCIS (Netherlands)

    van Oostrum, Jeroen M.; van Houdenhoven, M.; Hurink, Johann L.; Hans, Elias W.; Wullink, Gerhard; Kazemier, G.

    This paper addresses the problem of operating room (OR) 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

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

    NARCIS (Netherlands)

    van Oostrum, J.M.; van Houdenhoven, M.; Hurink, Johann L.; Hans, Elias W.; Wullink, Gerhard; 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

  8. Effect of Resident Involvement on Operative Time and Operating Room Staffing Costs.

    Science.gov (United States)

    Allen, Robert William; Pruitt, Mark; Taaffe, Kevin M

    The operating room (OR) is a major driver of hospital costs; therefore, operative time is an expensive resource. The training of surgical residents must include time spent in the OR, but that experience comes with a cost to the surgeon and hospital. The objective of this article is to determine the effect of surgical resident involvement in the OR on operative time and subsequent hospital labor costs. The Kruskal-Wallis statistical test is used to determine whether or not there is a difference in operative times between 2 groups of cases (with residents and without residents). This difference leads to an increased cost in associated hospital labor costs for the group with the longer operative time. Cases were performed at Greenville Memorial Hospital. Greenville Memorial Hospital is part of the larger healthcare system, Greenville Health System, located in Greenville, SC and is a level 1 trauma center with up to 33 staffed ORs. A total of 84,997 cases were performed at the partnering hospital between January 1st, 2011 and July 31st, 2015. Cases were only chosen for analysis if there was only one CPT code associated with the case and there were more than 5 observations for each group being studied. This article presents a comprehensive retrospective analysis of 29,134 cases covering 246 procedures. The analysis shows that 45 procedures took significantly longer with a resident present in the room. The average increase in operative time was 4.8 minutes and the cost per minute of extra operative time was determined to be $9.57 per minute. OR labor costs at the partnering hospital was found to be $2,257,433, or $492,889 per year. Knowing the affect on operative time and OR costs allows managers to make smart decisions when considering alternative educational and training techniques. In addition, knowing the connection between residents in the room and surgical duration could help provide better estimates of surgical time in the future and increase the predictability of

  9. Integration of analog and digital instrumentation and control systems in hybrid control rooms

    International Nuclear Information System (INIS)

    2010-01-01

    he IAEA's activities in the area of nuclear power plant operating performance and life cycle management are aimed at increasing Member State capabilities in utilizing good engineering and management practices as developed and transferred by the IAEA. In particular, the IAEA supports the improvement of nuclear power plant performance, plant life management, training, power uprating, operational license renewal, and the modernization of instrumentation and control (I and C) systems of plants. The issue of the integration of analog and digital I and C systems in hybrid control rooms was suggested by the IAEA Technical Working Group on Nuclear Power Plant Control and Instrumentation (TWG-NPPCI) at its meetings in 2003 and 2005. The subject was then approved by the IAEA and included in its work programmes for 2006-2009. The purpose of this report is to help nuclear utilities in planning control room and other human system interface (HSI) changes, making appropriate use of modern technologies. These technologies would aid in managing ageing and obsolescence, and facilitate improvements in plant performance and safety. This report covers a broad spectrum of potential changes to the control room ranging from the replacement of a few obsolete components with newer digital devices to a fully computerized control room. New digital technologies offer significant opportunities to improve access to and presentation of information to the user, e.g. operators, maintenance staff and management. However, this technology should be used prudently. In some cases, modernization is undertaken to resolve ageing and obsolescence or to meet regulatory requirements for license renewal. The integration of new technologies during main control room (MCR) modernizations should be performed cautiously and all affected aspects of plant maintenance, and operation should be carefully considered, paying particular attention to the human factors elements of these aspects. This report describes a

  10. Clinical Experience of Auditory Brainstem Response Testing on Pediatric Patients in the Operating Room

    Directory of Open Access Journals (Sweden)

    Guangwei Zhou

    2012-01-01

    Full Text Available Objectives. To review our experience of conducting auditory brainstem response (ABR test on children in the operating room and discuss the benefits versus limitations of this practice. Methods. Retrospective review study conducted in a pediatric tertiary care facility. A total of 267 patients identified with usable data, including ABR results, medical and surgical notes, and follow-up evaluation. Results. Hearing status successfully determined in all patients based on the ABR results form the operating room. The degrees and the types of hearing loss also documented in most of the cases. In addition, multiple factors that may affect the outcomes of ABR in the operating room identified. Conclusions. Hearing loss in children with complicated medical issues can be accurately evaluated via ABR testing in the operating room. Efforts should be made to eliminate adverse factors to ABR recording, and caution should be taken when interpreting ABR results from the operating room.

  11. Time Management in the Operating Room: An Analysis of the Dedicated Minimally Invasive Surgery Suite

    Science.gov (United States)

    Hsiao, Kenneth C.; Machaidze, Zurab

    2004-01-01

    Background: Dedicated minimally invasive surgery suites are available that contain specialized equipment to facilitate endoscopic surgery. Laparoscopy performed in a general operating room is hampered by the multitude of additional equipment that must be transported into the room. The objective of this study was to compare the preparation times between procedures performed in traditional operating rooms versus dedicated minimally invasive surgery suites to see whether operating room efficiency is improved in the specialized room. Methods: The records of 50 patients who underwent laparoscopic procedures between September 2000 and April 2002 were retrospectively reviewed. Twenty-three patients underwent surgery in a general operating room and 18 patients in an minimally invasive surgery suite. Nine patients were excluded because of cystoscopic procedures undergone prior to laparoscopy. Various time points were recorded from which various time intervals were derived, such as preanesthesia time, anesthesia induction time, and total preparation time. A 2-tailed, unpaired Student t test was used for statistical analysis. Results: The mean preanesthesia time was significantly faster in the minimally invasive surgery suite (12.2 minutes) compared with that in the traditional operating room (17.8 minutes) (P=0.013). Mean anesthesia induction time in the minimally invasive surgery suite (47.5 minutes) was similar to time in the traditional operating room (45.7 minutes) (P=0.734). The average total preparation time for the minimally invasive surgery suite (59.6 minutes) was not significantly faster than that in the general operating room (63.5 minutes) (P=0.481). Conclusion: The amount of time that elapses between the patient entering the room and anesthesia induction is statically shorter in a dedicated minimally invasive surgery suite. Laparoscopic surgery is performed more efficiently in a dedicated minimally invasive surgery suite versus a traditional operating room. PMID

  12. Effect of ventilation rate on air cleanliness and energy consumption in operation rooms at rest.

    Science.gov (United States)

    Lee, Shih-Tseng; Liang, Ching-Chieh; Chien, Tsung-Yi; Wu, Feng-Jen; Fan, Kuang-Chung; Wan, Gwo-Hwa

    2018-02-27

    The interrelationships between ventilation rate, indoor air quality, and energy consumption in operation rooms at rest are yet to be understood. We investigate the effect of ventilation rate on indoor air quality indices and energy consumption in ORs at rest. The study investigates the air temperature, relative humidity, concentrations of carbon dioxide, particulate matter (PM), and airborne bacteria at different ventilation rates in operation rooms at rest of a medical center. The energy consumption and cost analysis of the heating, ventilating, and air conditioning (HVAC) system in the operation rooms at rest were also evaluated for all ventilation rates. No air-conditioned operation rooms had very highest PM and airborne bacterial concentrations in the operation areas. The bacterial concentration in the operation areas with 6-30 air changes per hour (ACH) was below the suggested level set by the United Kingdom (UK) for an empty operation room. A 70% of reduction in annual energy cost by reducing the ventilation rate from 30 to 6 ACH was found in the operation rooms at rest. Maintenance of operation rooms at ventilation rate of 6 ACH could save considerable amounts of energy and achieve the goal of air cleanliness.

  13. Attitudes to teamwork and safety among Italian surgeons and operating room nurses.

    Science.gov (United States)

    Prati, Gabriele; Pietrantoni, Luca

    2014-01-01

    Previous studies have shown that surgical team members' attitudes about safety and teamwork in the operating theatre may play a role in patient safety. The aim of this study was to assess attitudes about teamwork and safety among Italian surgeons and operating room nurses. Fifty-five surgeons and 48 operating room nurses working in operating theatres at one hospital in Italy completed the Operating Room Management Attitudes Questionnaire (ORMAQ). Results showed several discrepancies in attitudes about teamwork and safety between surgeons and operating room nurses. Surgeons had more positive views on the quality of surgical leadership, communication, teamwork, and organizational climate in the theatre than operating room nurses. Operating room nurses reported that safety rules and procedures were more frequently disregarded than the surgeons. The results are only partially aligned with previous ORMAQ surveys of surgical teams in other countries. The differences emphasize the influence of national culture, as well as the particular healthcare system. This study shows discrepancies on many aspects in attitudes to teamwork and safety between surgeons and operating room nurses. The findings support implementation and use of team interventions and human factor training. Finally, attitude surveys provide a method for assessing safety culture in surgery, for evaluating the effectiveness of training initiatives, and for collecting data for a hospital's quality assurance programme.

  14. Operator’s cognitive, communicative and operative activities based workload measurement of advanced main control room

    International Nuclear Information System (INIS)

    Kim, Seunghwan; Kim, Yochan; Jung, Wondea

    2014-01-01

    Highlights: • An advanced MMIS in the advanced MCR requires new roles and tasks of operators. • A new workload evaluation framework is needed for a new MMIS environment. • This work suggests a new workload measurement approach (COCOA) for an advanced MCR. • COCOA enables 3-dimensional measurement of cognition, communication and operation. • COCOA workload evaluation of the reference plant through simulation was performed. - Abstract: An advanced man–machine interface system (MMIS) with a computer-based procedure system and high-tech control/alarm system is installed in the advanced main control room (MCR) of a nuclear power plant. Accordingly, though the task of the operators has been changed a great deal, owing to a lack of appropriate guidelines on the role allocation or communication method of the operators, operators should follow the operating strategies of conventional MCR and the problem of an unbalanced workload for each operator can be raised. Thus, it is necessary to enhance the operation capability and improve the plant safety by developing guidelines on the role definition and communication of operators in an advanced MCR. To resolve this problem, however, a method for measuring the workload according to the work execution of the operators is needed, but an applicable method is not available. In this research, we propose a COgnitive, Communicative and Operational Activities measurement approach (COCOA) to measure and evaluate the workload of operators in an advanced MCR. This paper presents the taxonomy for additional operation activities of the operators to use the computerized procedures and soft control added to an advanced MCR, which enables an integrated measurement of the operator workload in various dimensions of cognition, communication, and operation. To check the applicability of COCOA, we evaluated the operator workload of an advanced MCR of a reference power plant through simulation training experiments. As a result, the amount

  15. The development of a mobile CT-scanner gantry for use in the operating room

    International Nuclear Information System (INIS)

    Okudera, Hiroshi; Kobayashi, Shigeaki; Koike, Jouji; Harada, Takanobu; Kanemaru, Kei

    1989-01-01

    We report the development of a mobile CT-scanner gantry which uses a gantry platter. This system has been developed for use in the operating room. We designed a small lift to move the gantry unit of the scanner: the gantry carrier. The scanner gantry is fixed to the gantry carrier. A phantom test with a digitalized operating table worked well in the laboratory, and operating-room use showed that there was no deterioration in image quality. The mobile gantry system has been developed to increase the efficiency of the operating CT-scanner system. This system enables us to obtain CT images during surgery of immediately after surgery in the operating room, i.e., in cases that are not transferable to the radiological department. The operability is basically the same as that of a conventional mobile X-ray unit. Theoretically, this unit could be used with any CT scanner and in any operating room. (author)

  16. Understanding Costs of Care in the Operating Room.

    Science.gov (United States)

    Childers, Christopher P; Maggard-Gibbons, Melinda

    2018-04-18

    Increasing value requires improving quality or decreasing costs. In surgery, estimates for the cost of 1 minute of operating room (OR) time vary widely. No benchmark exists for the cost of OR time, nor has there been a comprehensive assessment of what contributes to OR cost. To calculate the cost of 1 minute of OR time, assess cost by setting and facility characteristics, and ascertain the proportion of costs that are direct and indirect. This cross-sectional and longitudinal analysis examined annual financial disclosure documents from all comparable short-term general and specialty care hospitals in California from fiscal year (FY) 2005 to FY2014 (N = 3044; FY2014, n = 302). The analysis focused on 2 revenue centers: (1) surgery and recovery and (2) ambulatory surgery. Mean cost of 1 minute of OR time, stratified by setting (inpatient vs ambulatory), teaching status, and hospital ownership. The proportion of cost attributable to indirect and direct expenses was identified; direct expenses were further divided into salary, benefits, supplies, and other direct expenses. In FY2014, a total of 175 of 302 facilities (57.9%) were not for profit, 78 (25.8%) were for profit, and 49 (16.2%) were government owned. Thirty facilities (9.9%) were teaching hospitals. The mean (SD) cost for 1 minute of OR time across California hospitals was $37.45 ($16.04) in the inpatient setting and $36.14 ($19.53) in the ambulatory setting (P = .65). There were no differences in mean expenditures when stratifying by ownership or teaching status except that teaching hospitals had lower mean (SD) expenditures than nonteaching hospitals in the inpatient setting ($29.88 [$9.06] vs $38.29 [$16.43]; P = .006). Direct expenses accounted for 54.6% of total expenses ($20.40 of $37.37) in the inpatient setting and 59.1% of total expenses ($20.90 of $35.39) in the ambulatory setting. Wages and benefits accounted for approximately two-thirds of direct expenses (inpatient, $14.00 of $20

  17. 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

  18. Integrated ADIOS-IGENPRO operator advisory support system

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Dong Young; Park, J. H.; Kim, J. T.; Kim, C. H.; Park, W. M.; Hwang, I. K.; Cheon, S. W.; Song, S. J

    2001-05-01

    The I and C systems and control rooms of nuclear power plants have been constructed by using the automatic control concept and changed to computer-based systems in nowadays. For Increase of an automation and CRT, the role of operators is changed to monitor the condition of the nuclear power plants. Therefore, the information that is offered to operators has to integrate in order for operator to understand the hole condition of plants. In commercial nuclear plants, raw data of sensors and components are shown in a control room. So, operators can not diagnose the condition of plants correctly. For a development of an integrated operator aid system which contain an alarm processing system and a fault diagnosis system, we integrated IGENPRO of ANL(Argonne National Lab.) and ADIOS of KAERI (Korea Atomic Energy Institute). IGENPRO is a fault diagnosis system contains three module such as PROTREN, PRODIAG and PROTREN. ADIOS is an alarm processing system that informs operators of important alarms. The integrated operator advisory support system developed in the research is composed of an alarm processing module and a fault diagnosis module. The alarm processing module shows important alarms to operator by using dynamic alarm filtering methods. The fault diagnosis module shows the cause of faults of sensors and hardwares.

  19. Integrated ADIOS-IGENPRO operator advisory support system

    International Nuclear Information System (INIS)

    Lee, Dong Young; Park, J. H.; Kim, J. T.; Kim, C. H.; Park, W. M.; Hwang, I. K.; Cheon, S. W.; Song, S. J.

    2001-05-01

    The I and C systems and control rooms of nuclear power plants have been constructed by using the automatic control concept and changed to computer-based systems in nowadays. For Increase of an automation and CRT, the role of operators is changed to monitor the condition of the nuclear power plants. Therefore, the information that is offered to operators has to integrate in order for operator to understand the hole condition of plants. In commercial nuclear plants, raw data of sensors and components are shown in a control room. So, operators can not diagnose the condition of plants correctly. For a development of an integrated operator aid system which contain an alarm processing system and a fault diagnosis system, we integrated IGENPRO of ANL(Argonne National Lab.) and ADIOS of KAERI (Korea Atomic Energy Institute). IGENPRO is a fault diagnosis system contains three module such as PROTREN, PRODIAG and PROTREN. ADIOS is an alarm processing system that informs operators of important alarms. The integrated operator advisory support system developed in the research is composed of an alarm processing module and a fault diagnosis module. The alarm processing module shows important alarms to operator by using dynamic alarm filtering methods. The fault diagnosis module shows the cause of faults of sensors and hardwares

  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. 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.

  2. Planning of Operating Rooms at the Danish National Hospital

    OpenAIRE

    Taltavull Mercadal, Ignasi

    2016-01-01

    The irnport.ance of t.he rnanagerial aspects of hospitals can be seen in hvo mam aspects. On one hand, healt.h spending has a big irnpact on the budget. of t.he count.ries. For instance, it accounted for 11% of GDP in Demnark dnring 2014. JVloreover, it is estimated that around of 10-30% of thcse expenditures is destined to surgical facilities. Therefore, as expense centres, an cfficient pla.nning of opernting rooms is highly important to reduce costs ancl optimizc rcsou...

  3. Sedation for procedures outside the operating room in children

    International Nuclear Information System (INIS)

    Molina Rodriguez, Ericka

    2014-01-01

    Sedation is defined in the pediatric population. An adequate preoperative assessment is established in patients subjected to a sedation. Fundamental characteristics of drugs used during a sedation are determined. Recommendations about surveillance and monitoring are established in a patient sedated. Principal characteristics of sedation are defined in patients exposed to radiological diagnostic and therapeutic procedures. Considerations in sedation are identified for procedures in the laboratory of digestive endoscopy. Alternatives of sedation are mentioned for oncological patients subjected to invasive procedures. Working conditions and specifications of anesthesia are determined in the cardiac catheterization room [es

  4. Modes of mechanical ventilation for the operating room.

    Science.gov (United States)

    Ball, Lorenzo; Dameri, Maddalena; Pelosi, Paolo

    2015-09-01

    Most patients undergoing surgical procedures need to be mechanically ventilated, because of the impact of several drugs administered at induction and during maintenance of general anaesthesia on respiratory function. Optimization of intraoperative mechanical ventilation can reduce the incidence of post-operative pulmonary complications and improve the patient's outcome. Preoxygenation at induction of general anaesthesia prolongs the time window for safe intubation, reducing the risk of hypoxia and overweighs the potential risk of reabsorption atelectasis. Non-invasive positive pressure ventilation delivered through different interfaces should be considered at the induction of anaesthesia morbidly obese patients. Anaesthesia ventilators are becoming increasingly sophisticated, integrating many functions that were once exclusive to intensive care. Modern anaesthesia machines provide high performances in delivering the desired volumes and pressures accurately and precisely, including assisted ventilation modes. Therefore, the physicians should be familiar with the potential and pitfalls of the most commonly used intraoperative ventilation modes: volume-controlled, pressure-controlled, dual-controlled and assisted ventilation. Although there is no clear evidence to support the advantage of any one of these ventilation modes over the others, protective mechanical ventilation with low tidal volume and low levels of positive end-expiratory pressure (PEEP) should be considered in patients undergoing surgery. The target tidal volume should be calculated based on the predicted or ideal body weight rather than on the actual body weight. To optimize ventilation monitoring, anaesthesia machines should include end-inspiratory and end-expiratory pause as well as flow-volume loop curves. The routine administration of high PEEP levels should be avoided, as this may lead to haemodynamic impairment and fluid overload. Higher PEEP might be considered during surgery longer than 3 h

  5. NKA/KRU project on operator training, control room designing and human reliability. Summary report

    International Nuclear Information System (INIS)

    1981-06-01

    A Nordic integrated project on human reliability in the conditions of new advanced technology seeks to establish: - The actual repertoire of activities and tasks performed by the operating staff of a nuclear power plant and its dependence on the present and future levels of automation. - The knowledge required for these activities and appropriate means for training plant operators and for competence evaluation and retraining in coping with the rare events. - Models of human operator performance; how do operators read information and make decisions under normal and abnormal plant conditions and how does their performance depend upon control room design. - The typical limits of human capabilities and mechanisms of human errors as they are represented in existing records of incidents and accidents in industrial plants. - The use of process computers for improved design of data presentation and operator support systems, especially for disturbance analysis and diagnosis during infrequent plant disturbance. - Development of experimental techniques to validate research results and proposals for improved man/machine interfaces and other computer-based support systems. (EG)

  6. Updated requirements for control room annunciation: an operations perspective

    International Nuclear Information System (INIS)

    Davey, E.; Lane, L.

    2001-01-01

    The purpose of this paper is to describe the results of updating and aligning requirements for annunciation functionality and performance with current expectations for operational excellence. This redefinition of annunciation requirements was undertaken as one component of a project to characterize improvement priorities, establish the operational and economic basis for improvement, and identify preferred implementation options for Ontario Power Generation plants. The updated requirements express the kinds of information support annunciation should provide to Operations staff to support the detection, recognition and response to changes in plant conditions. The updated requirements were developed using several types of information: management and industry expectations for operations excellence, previous definitions of user needs for annunciation, and operational and ergonomic principles. Operations and engineering staff at several stations have helped refine and complete the initial requirements definition. Application of these updated requirements is expected to lead to more effective and task relevant annunciation system improvements that better serve plant operation needs. The paper outlines the project rationale, reviews development objectives, discusses the approaches applied for requirements definition and organization, describes key requirements findings in relation to current operations experience, and discusses the proposed application of these requirements for guiding future annunciation system improvements. (author)

  7. Novel bed integrated ventilation method for hospital patient rooms

    DEFF Research Database (Denmark)

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

    2014-01-01

    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...... 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...... 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...

  8. Leadership: briefing and debriefing in the operating room.

    Science.gov (United States)

    Donnelly, Teresa

    2017-07-01

    Steelman (2014) stated that the concept of briefing and debriefing used in operating theatres derived from the airline industry in the 1970s. There had been a series of devastating air crashes and the airline industry had come under severe public scrutiny. Investigations identified that, while the crews operating these aircrafts were very skilled and knowledgeable, they lacked competence in their ability to perform as part of a team. Copyright the Association for Perioperative Practice.

  9. OR2020: The Operating Room of the Future

    Science.gov (United States)

    2004-05-01

    spectroscopy is being used particularly for certain applications such as identifying cervical neoplasia. However, the integration capabilities of most...visualization for surgical planning. The left and middle images show 3D reconstructions of a patient with a large hiatal hernia (stomach bulging up into chest

  10. Supporting Control Room Operators in Highly Automated Future Power Networks

    DEFF Research Database (Denmark)

    Chen, Minjiang; Catterson, Victoria; Syed, Mazheruddin

    2017-01-01

    Operating power systems is an extremely challenging task, not least because power systems have become highly interconnected, as well as the range of network issues that can occur. It is therefore a necessity to develop decision support systems and visualisation that can effectively support the hu...... the human operators for decisionmaking in the complex and dynamic environment of future highly automated power system. This paper aims to investigate the decision support functions associated with frequency deviation events for the proposed Web of Cells concept....

  11. Discovery of high-level tasks in the operating room

    NARCIS (Netherlands)

    Bouarfa, L.; Jonker, P.P.; Dankelman, J.

    2010-01-01

    Recognizing and understanding surgical high-level tasks from sensor readings is important for surgical workflow analysis. Surgical high-level task recognition is also a challenging task in ubiquitous computing because of the inherent uncertainty of sensor data and the complexity of the operating

  12. [Operating room during natural disaster: lessons from the 2011 Tohoku earthquake].

    Science.gov (United States)

    Fukuda, Ikuo; Hashimoto, Hiroshi; Suzuki, Yasuyuki; Satomi, Susumu; Unno, Michiaki; Ohuchi, Noriaki; Nakaji, Shigeyuki

    2012-03-01

    Objective of this study is to clarify damages in operating rooms after the 2011 Tohoku Earthquake. To survey structural and non-structural damage in operating theaters, we sent questionnaires to 155 acute care hospitals in Tohoku area. Questionnaires were sent back from 105 hospitals (70.3%). Total of 280 patients were undergoing any kinds of operations during the earthquake and severe seismic tremor greater than JMA Seismic Intensity 6 hit 49 hospitals. Operating room staffs experienced life-threatening tremor in 41 hospitals. Blackout occurred but emergency electronic supply unit worked immediately in 81 out of 90 hospitals. However, emergency power plant did not work in 9 hospitals. During earthquake some materials fell from shelves in 44 hospitals and medical instruments fell down in 14 hospitals. In 5 hospitals, they experienced collapse of operating room wall or ceiling causing inability to maintain sterile operative field. Damage in electric power and water supply plus damage in logistics made many operating rooms difficult to perform routine surgery for several days. The 2011 Tohoku earthquake affected medical supply in wide area of Tohoku district and induced dysfunction of operating room. Supply-chain management of medical goods should be reconsidered to prepare severe natural disaster.

  13. Local Exhaust Efficiency in an Operating Room Ventilated by Horizontal Unidirectional Airflow

    DEFF Research Database (Denmark)

    Brohus, Henrik; Balling, K. D.; Jeppesen, D.

    2004-01-01

    The paper examines the efficiency of a local exhaust applied during an orthopaedic surgical operation. During operations performing hip replacements bone cement is sometimes applied to fasten the new metal hip to the existing thighbone, especially in case of elderly patients. The bone cement emits...... harmful VOCs that may influence the operating room personnel and the patient. A local exhaust is applied to reduce the VOC concentration in the operating room air, however, apparently without success. The aim is to assess the efficiency of the existing solution and to provide an alternative and better...

  14. The Effect of Gender on Resident Autonomy in the Operating room.

    Science.gov (United States)

    Meyerson, Shari L; Sternbach, Joel M; Zwischenberger, Joseph B; Bender, Edward M

    Discrimination against women training in medicine and surgery has been subjectively described for decades. This study objectively documents gender differences in the degree of autonomy given to thoracic surgery trainees in the operating room. Thoracic surgery residents and faculty underwent frame of reference training on the use of the 4-point Zwisch scale to measure operative autonomy. Residents and faculty then submitted evaluations of their perception of autonomy granted for individual operations as well as operative difficulty on a real-time basis using the "Zwisch Me!!" mobile application. Differences in autonomy given to male and female residents were elucidated using chi-square analysis and ordered logistic regression. Seven academic medical centers with thoracic surgery training programs. Volunteer thoracic surgery residents in both integrated and traditional training pathways and their affiliated cardiothoracic faculty. Residents (n = 33, female 18%) submitted a total of 596 evaluations to faculty (n = 48, female 12%). Faculty gave less autonomy to female residents with only 56 of 184 evaluations (30.3%) showing meaningful autonomy (passive help or supervision only) compared to 107 of 292 evaluations (36.7%) at those levels for male residents (p = 0.02). Resident perceptions of autonomy showed even more pronounced differences with female residents receiving only 38 of 197 evaluations (19.3%) with meaningful autonomy compared to 133 of 399 evaluations (33.3%) for male residents (p autonomy granted to residents. Evaluations of operative autonomy reveal a significant bias against female residents. Faculty education is needed to encourage allowing female residents more operative autonomy. Copyright © 2017 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

  15. Surgeons' Leadership Styles and Team Behavior in the Operating Room

    Science.gov (United States)

    Hu, Yue-Yung; Parker, Sarah Henrickson; Lipsitz, Stuart R; Arriaga, Alexander F; Peyre, Sarah E; Corso, Katherine A; Roth, Emilie M; Yule, Steven J; Greenberg, Caprice C

    2016-01-01

    Background The importance of leadership is recognized in surgery, but the specific impact of leadership style on team behavior is not well understood. In other industries, leadership is a well-characterized construct. One dominant theory proposes that transactional (task-focused) leaders achieve minimum standards, whereas transformational (team-oriented) leaders inspire performance beyond expectations. Study Design We video-recorded 5 surgeons performing complex operations. Each surgeon was scored on the Multifactor Leadership Questionnaire, a validated method for scoring transformational and transactional leadership style, by an organizational psychologist and a surgeon-researcher. Independent coders assessed surgeons' leadership behaviors according to the Surgical Leadership Inventory and team behaviors (information-sharing, cooperative, and voice behaviors). All coders were blinded. Leadership style (MLQ) was correlated with surgeon behavior (SLI) and team behavior using Poisson regression, controlling for time and the total number of behaviors, respectively. Results All surgeons scored similarly on transactional leadership (2.38-2.69), but varied more widely on transformational leadership (1.98-3.60). Each 1-point increase in transformational score corresponded to 3× more information-sharing behaviors (psupportive behaviors (pleadership and its impact on team performance in the OR. As in other fields, our data suggest that transformational leadership is associated with improved team behavior. Surgeon leadership development therefore has the potential to improve the efficiency and safety of operative care. PMID:26481409

  16. Tactical and operational decisions for operating room planning: efficiency and welfare implications.

    Science.gov (United States)

    Testi, Angela; Tànfani, Elena

    2009-12-01

    In this paper, we evaluate the impact on welfare implications of a 0-1 linear programming model to solve the Operating Room (OR) planning problem, taking a patient perspective. In particular, given a General Surgery Department made up of different surgical sub-specialties sharing a given number of OR block times, the model determines, during a given planning period, the allocation of those blocks to surgical sub-specialties, i.e. the so called Master Surgical Schedule Problem (MSSP), together with the subsets of elective patients to be operated on in each block time, i.e. the so called Surgical Case Assignment Problem (SCAP). The innovation of the model is two-fold. The first is that OR allocation is "optimal" if the available OR blocks are scheduled simultaneously to the proper subspecialty, at the proper time to the proper patient. The second is defining what "proper" means and include that in the objective function. In our approach what is important is not number of patients who can be treated in a given period but how much welfare loss, due to clinical deterioration or other negative consequences related to excessive waiting, can be prevented. In other words we assume a societal perspective in that we focus on "outcome" (health improving or preventing from worsening) rather than on "output" (delivered procedures). The model can be used both to develop weekly OR planning with given resources (operational decision), and to perform "what if" scenario analysis regarding how to increase the amount of OR time available for the entire department (tactical decision). The model performance is verified by applying it to a real scenario, the elective admissions of the General Surgery Department of the San Martino University Hospital in Genova (Italy). Despite the complexity of this NP-hard combinatorial optimization problem, computational results indicate that the model can solve all test problems within 600 s and an average optimality tolerance of less than 0.01%.

  17. Some criteria for two new integral operators

    Directory of Open Access Journals (Sweden)

    Laura Stanciu

    2012-12-01

    Full Text Available Using the Hadamard product, we define two new integral operators. The main object of the present paper is to discuss some univalence conditions for these operators. Several corollaries of the main results are also considered.

  18. 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.

  19. 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.

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

    Science.gov (United States)

    Attri, Joginder Pal; Sandhu, Gagandeep Kaur; Mohan, Brij; Bala, Neeru; Sandhu, Kulwinder Singh; Bansal, Lipsy

    2015-01-01

    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.

  1. Modeling human-machine interactions for operations room layouts

    Science.gov (United States)

    Hendy, Keith C.; Edwards, Jack L.; Beevis, David

    2000-11-01

    The LOCATE layout analysis tool was used to analyze three preliminary configurations for the Integrated Command Environment (ICE) of a future USN platform. LOCATE develops a cost function reflecting the quality of all human-human and human-machine communications within a workspace. This proof- of-concept study showed little difference between the efficacy of the preliminary designs selected for comparison. This was thought to be due to the limitations of the study, which included the assumption of similar size for each layout and a lack of accurate measurement data for various objects in the designs, due largely to their notional nature. Based on these results, the USN offered an opportunity to conduct a LOCATE analysis using more appropriate assumptions. A standard crew was assumed, and subject matter experts agreed on the communications patterns for the analysis. Eight layouts were evaluated with the concepts of coordination and command factored into the analysis. Clear differences between the layouts emerged. The most promising design was refined further by the USN, and a working mock-up built for human-in-the-loop evaluation. LOCATE was applied to this configuration for comparison with the earlier analyses.

  2. Red-light-emitting laser diodes operating CW at room temperature

    Science.gov (United States)

    Kressel, H.; Hawrylo, F. Z.

    1976-01-01

    Heterojunction laser diodes of AlGaAs have been prepared with threshold current densities substantially below those previously achieved at room temperature in the 7200-8000-A spectral range. These devices operate continuously with simple oxide-isolated stripe contacts to 7400 A, which extends CW operation into the visible (red) portion of the spectrum.

  3. Red-light-emitting laser diodes operating cw at room temperature

    International Nuclear Information System (INIS)

    Kressel, H.; Hawrylo, F.Z.

    1976-01-01

    Heterojunction laser diodes of AlGaAs have been prepared with threshold current densities substantially below those previously achieved at room temperature in the 7200 to 8000-A spectral range. These devices operate cw with simple oxide-isolated stripe contacts to 7400 A, which extends cw operation for the first time into the visible (red) portion of the spectrum

  4. The use of virtual reality to simulate room and pillar operations

    Energy Technology Data Exchange (ETDEWEB)

    Crawshaw, S A.M.; Denby, B; McClarnon, D [Long-Airdox International Limited, Ilkeston (United Kingdom)

    1997-01-01

    Virtual Reality systems allow a user to interact with dynamic three-dimensional computer models of real world situations. The authors show how the complexity of room and pillar mining operations may be mirrored in a user-configurable system. Additionally, an understanding is gained of the mining method, and the operation of equipment in the actual working environment. 1 ref., 5 figs.

  5. The design and operation of the THORP central control room: a human factors perspective

    International Nuclear Information System (INIS)

    Reed, Julie.

    1996-01-01

    The new Thermal Oxide Reprocessing Plant (THORP) at British Nuclear Fuels (BNFL) Sellafield Site is now operational. This paper describes the Central Control Room (CCR), focusing on the control system components. Throughout the design, commissioning and operation of THORP, human factors played an important part. (author)

  6. Optimum Operating Room Environment for the Prevention of Surgical Site Infections.

    Science.gov (United States)

    Gaines, Sara; Luo, James N; Gilbert, Jack; Zaborina, Olga; Alverdy, John C

    Surgical site infections (SSI), whether they be incisional or deep, can entail major morbidity and death to patients and additional cost to the healthcare system. A significant amount of effort has gone into optimizing the surgical patient and the operating room environment to reduce SSI. Relevant guidelines and literature were reviewed. The modern practice of surgical antisepsis involves the employment of strict sterile techniques inside the operating room. Extensive guidelines are available regarding the proper operating room antisepsis as well as pre-operative preparation. The use of pre-operative antimicrobial prophylaxis has become increasingly prevalent, which also presents the challenge of opportunistic and nosocomial infections. Ongoing investigative efforts have brought about a greater appreciation of the surgical patient's endogenous microflora, use of non-bactericidal small molecules, and pre-operative microbial screening. Systematic protocols exist for optimizing the surgical sterility of the operating room to prevent SSIs. Ongoing research efforts aim to improve the precision of peri-operative antisepsis measures and personalize these measures to tailor the patient's unique microbial environment.

  7. Towards a performance assessment methodology using computational simulation for air distribution system designs in operating rooms

    NARCIS (Netherlands)

    Melhado, M.D.A.

    2012-01-01

    One of the important performance requirements for an air distribution system for an operating room (OR) is to provide good indoor environmental conditions in which to perform operations. Important conditions in this respect relate to the air quality and to the thermal conditions for the surgical

  8. Modeling of a dependence between human operators in advanced main control rooms

    International Nuclear Information System (INIS)

    Lee, Seung Jun; Kim, Jaewhan; Jang, Seung-Cheol; Shin, Yeong Cheol

    2009-01-01

    For the human reliability analysis of main control room (MCR) operations, not only parameters such as the given situation and capability of the operators but also the dependence between the actions of the operators should be considered because MCR operations are team operations. The dependence between operators might be more prevalent in an advanced MCR in which operators share the same information using a computerized monitoring system or a computerized procedure system. Therefore, this work focused on the computerized operation environment of advanced MCRs and proposed a model to consider the dependence representing the recovery possibility of an operator error by another operator. The proposed model estimates human error probability values by considering adjustment values for a situation and dependence values for operators during the same operation using independent event trees. This work can be used to quantitatively calculate a more reliable operation failure probability for an advanced MCR. (author)

  9. Foundations for teaching surgeons to address the contributions of systems to operating room team conflict.

    Science.gov (United States)

    Rogers, David A; Lingard, Lorelei; Boehler, Margaret L; Espin, Sherry; Schindler, Nancy; Klingensmith, Mary; Mellinger, John D

    2013-09-01

    Prior research has shown that surgeons who effectively manage operating room conflict engage in a problem-solving stage devoted to modifying systems that contribute to team conflict. The purpose of this study was to clarify how systems contributed to operating room team conflict and clarify what surgeons do to modify them. Focus groups of circulating nurses and surgeons were conducted at 5 academic medical centers. Narratives describing the contributions of systems to operating room conflict and behaviors used by surgeons to address those systems were analyzed using the constant comparative approach associated with a constructivist grounded theory approach. Operating room team conflict was affected by 4 systems-related factors: team features, procedural-specific staff training, equipment management systems, and the administrative leadership itself. Effective systems problem solving included advocating for change based on patient safety concerns. The results of this study provide clarity about how systems contribute to operating room conflict and what surgeons can do to effectively modify these systems. This information is foundational material for a conflict management educational program for surgeons. Copyright © 2013 Elsevier Inc. All rights reserved.

  10. Sister chromatid exchanges and structural chromosome aberrations in lymphocytes in operating room personnel

    Energy Technology Data Exchange (ETDEWEB)

    Husum, B; Niebuhr, E; Wulf, H C; Norgaard, I

    1983-06-01

    Information on possible chromosomal damage in humans after long-term exposure to trace concentrations of waste anaesthetic gases is scarce. We examined peripheral lymphocytes in operating room personnel for both chromosome aberrations and sister chromatid exchanges (SCE). Following a standardized procedure of cultivation and staining, 30 cells from each person were scored for SCE and 100 cells from each person were examined for chromosome aberrations. A total of 45 persons were examined, representing anaesthetists (n . 15), operating room nurses assisting the surgeon (n . 10), nurses circulating in the operating room (n . 8) and healthy, unexposed controls (n . 12). The median duration of working in the operating room was 102 months, respectively. Time-weighted concentration levels of 2.5-4.3 p.p.m. of halothane and 25-400 p.p.m. of nitrous oxide were measured in the breathing zones of the anaesthetists during mask anaesthesia. Examination of SCE and chromosome aberrations yielded corresponding qualitative results. With both tests, no statistically significant difference was observed between the four groups of persons. It was concluded that by examination of both SCE and chromosome aberrations in peripheral lymphocytes in operating room personnel, no indication was found of a mutagenic effect of long-term exposure to trace concentrations of waste anaesthetic gases.

  11. The use of operator surveys by the CEGB to evaluate nuclear control room design and initiatives in the design of alarm systems and control room operating procedures

    International Nuclear Information System (INIS)

    Jackson, A.R.G.

    1988-01-01

    This paper reports on the use of operator surveys and trip report analysis methods which the Central Electricity Generating Board has developed to assess the extent and adequacy of operator support systems currently installed on its four twin-reactor, first generation Advanced Gas Cooled Reactor nuclear power plants. The survey consisted of a programme of structured interviews with control room engineers. The scope of the questions addressed; working environment, communications, man-machine interface, procedural information, and the diagnostic and predictive support system. The analysis of trip reports was targetted at identifying aspects of the performance of the operator support systems which might have been contributory to the cause of reactor trip. The results of this work are being used to assist in determining guidelines for the development of operator support systems, computerised controls and the structure of station operating procedures

  12. 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

  13. Completely integrable operator evolution equations. II

    International Nuclear Information System (INIS)

    Chudnovsky, D.V.

    1979-01-01

    The author continues the investigation of operator classical completely integrable systems. The main attention is devoted to the stationary operator non-linear Schroedinger equation. It is shown that this equation can be used for separation of variables for a large class of completely integrable equations. (Auth.)

  14. 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.

  15. Properties of singular integral operators

    Indian Academy of Sciences (India)

    Amit Samanta

    2018-03-22

    Mar 22, 2018 ... the Toeplitz operator. Tφ on H2 is defined by Tφ( f ) = P(φf ) for all f ∈ H2. The following mentioned properties of the Topelitz operator are well-known and can be found in Chapter 3 and. Chapter 1 of [3]. •Tφ = spectral radius of Tφ =φ ∞. • The commutant of the unilateral shift acting on H2 is Tφ such that φ ...

  16. [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.

  17. Towards a Terahertz Room-Temperature Integrated Source

    DEFF Research Database (Denmark)

    Leo, Giuseppe; Gérard, Jean-Michel; Reitzenstein, Stephan

    2011-01-01

    We aim at a radically new continuous-wave, electrically pumped THz emitter. Compared to existing THz sources, this source will bring together several advantages that are far from being simultaneously available in any existing source today: compactness, roomtemperature operation, output power around...

  18. 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

  19. Ergonomic relationship during work in nursing staff of intensive care unit with operating room

    Directory of Open Access Journals (Sweden)

    Yousef Mahmoudifar

    2017-01-01

    Full Text Available Background and Objectives: High prevalence of work-related musculoskeletal disorders, especially in jobs such as nursing which covers tasks like patients' repositioning, has attracted great attentions from occupational healthcare experts to necessitate the knowledge of ergonomic science. Therefore, this study was performed aiming at ergonomic relationship during work in nursing staff of Intensive Care Unit (ICU with operating room. Materials and Methods: In this descriptive-analytical study (cohort, fifty personnel of ICU staff and fifty of operating room staff were selected through a census method and were assessed using tools such as Nordic questionnaire and Rapid Entire Body Assessment (REBA standards in terms of body posture ergonomics. The obtained data were analyzed by SPSS software and Chi-Square test after collection. Results: The most complaints were from the operating room group (68% and ICU staff (60% for the lumbar musculoskeletal system. There was a significant relationship between the total REBA scores of body, legs, neck, arm, force status, load fitting with hands and static or dynamic activities in the operating room and ICU staff groups (P < 0.05. In operating room and ICU groups, most subjects obtained score 11–15 and very high-risk level. Conclusion: Nurses working at operating room and ICU ward are subjected to high-risk levels and occupational injuries which is dramatically resulted from inappropriate body posture or particular conditions of their works. As a result, taking corrective actions along with planning and identifying ways will help prohibiting the prevalence of disorders in the future.

  20. Evaluation of noise pollution level in the operating rooms of hospitals: A study in Iran.

    Science.gov (United States)

    Giv, Masoumeh Dorri; Sani, Karim Ghazikhanlou; Alizadeh, Majid; Valinejadi, Ali; Majdabadi, Hesamedin Askari

    2017-06-01

    Noise pollution in the operating rooms is one of the remaining challenges. Both patients and physicians are exposed to different sound levels during the operative cases, many of which can last for hours. This study aims to evaluate the noise pollution in the operating rooms during different surgical procedures. In this cross-sectional study, sound level in the operating rooms of Hamadan University-affiliated hospitals (totally 10) in Iran during different surgical procedures was measured using B&K sound meter. The gathered data were compared with national and international standards. Statistical analysis was performed using descriptive statistics and one-way ANOVA, t -test, and Pearson's correlation test. Noise pollution level at majority of surgical procedures is higher than national and international documented standards. The highest level of noise pollution is related to orthopedic procedures, and the lowest one related to laparoscopic and heart surgery procedures. The highest and lowest registered sound level during the operation was 93 and 55 dB, respectively. Sound level generated by equipments (69 ± 4.1 dB), trolley movement (66 ± 2.3 dB), and personnel conversations (64 ± 3.9 dB) are the main sources of noise. The noise pollution of operating rooms are higher than available standards. The procedure needs to be corrected for achieving the proper conditions.

  1. Control Room Tasks During Refueling in Ringhals 1 Nuclear Power Plant - Operator performance during refuelling outages

    International Nuclear Information System (INIS)

    Stroebeck, Einar; Olausson, Jesper; Van Gemst, Paul

    1998-01-01

    This paper discusses the performance and tasks of the operators in the control room during refuelling outages. Analyses of such events have, during the last years, shown that the risk for nuclear accidents is not negligible compared with the risk at higher reactor power levels. Some experts have the opinion that, due to mistakes during an outage, the risk for such accidents during the outage and other accidents later on during power operation is higher than in other plant situations. The high risk level is mainly a result of errors at maintenance actions and supervision of lining up of safety systems. Most of the control rooms in existing NPPs were designed more than 10 years ago. At that time the activities and the tasks for the operators were not very well understood. Procedures for refuelling and other activities during the outages were not described very well. Often the utility organisation for refuelling outages was not established at the start of the control room design. Experience from operation during many years has shown that the performance of operators can be improved in existing plant, and thus risks be reduced, by upgrading the control room. These issues have been studied as a part of the modernisation project for Ringhals 1, an ABB Atom BWR owned by Vattenfall AB in Sweden. The paper will describe the working model for upgrading the control room and important issues to take care of with respect to refuelling outages. The identified issues will be used as the input for improving control room philosophy and the individual technical systems. (authors)

  2. A work process and information flow description of control room operations

    International Nuclear Information System (INIS)

    Davey, E.; Matthews, G.

    2007-01-01

    The control room workplace is the location from which all plant operations are supervised and controlled on a shift-to-shift basis. The activities comprising plant operations are structured into a number of work processes, and information is the common currency that is used to convey work requirements, communicate business and operating decisions, specify work practice, and describe the ongoing plant and work status. This paper describes the motivation for and early experience with developing a work process and information flow model of CANDU control room operations, and discusses some of the insights developed from model examination that suggest ways in which changes in control centre work specification, organization of resources, or asset layout could be undertaken to achieve operational improvements. (author)

  3. A novel interactive educational system in the operating room--the IE system.

    Science.gov (United States)

    Nakayama, Takayuki; Numao, Noboru; Yoshida, Soichiro; Ishioka, Junichiro; Matsuoka, Yoh; Saito, Kazutaka; Fujii, Yasuhisa; Kihara, Kazunori

    2016-02-02

    The shortage of surgeon is one of the serious problems in Japan. To solve the problem, various efforts have been undertaken to improve surgical education and training. However, appropriate teaching methods in the operating room have not been well established. The aim of this study is to assess the utility of a novel interactive educational (IE) system for surgical education on urologic surgeries in the operating room. A total of 20 Japanese medical students were educated on urologic surgery using the IE system in the operating room. The IE system consists of two parts. The first is three-dimensional (3D) magnified vision of the operative field using a 3D head-mounted display and a 3D endoscope. The second is interactive educative communication between medical students and surgeons using a small-sized wireless communication device. The satisfaction level with the IE system and the physical burden on medical students was examined via questionnaire. All students utilized the IE system in urologic surgery and responded to the survey. Most students were satisfied with the IE system. They also felt more welcomed by the surgeon when using the IE system than when not using it. No major unpleasant symptoms were observed but five students (25 %) experienced mild eye fatigue as a result of viewing the medical images. The IE system has the potential to motivate students to become interested in surgery and could be an efficient method of surgical education in the operating room.

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

    Science.gov (United States)

    Sonoda, Yukio; Onozuka, Daisuke; Hagihara, Akihito

    2018-01-01

    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.

  5. 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.

  6. The use of shore wave ultraviolet radiation for disinfection in operating rooms

    International Nuclear Information System (INIS)

    Baanrud, H.; Moan, J.

    1999-01-01

    Over a number of years short wave ultraviolet radiation (UVC;200-280 nm) has been used to disinfect air and surfaces in operating rooms, patient rooms and laboratories, as well as air in ventilation ducts. Despite the well-documented effect of ultraviolet radiation on air quality, this technology has been relatively little used. One advantage of this method is that the UVC sources ensure a continuous reduction in the number of airborne microorganisms that are generated all the time. There are, however, some disadvantages with this method. Human exposure to ultraviolet C may cause keratoconjunctivitis and erythema and requires protection of the skin and the eyes of people exposed to levels above recommended exposure limits. However, by enclosing the UVC sources or by irradiation in the absence of human activity, human exposure is eliminated. These and other aspects concerning the use of short wave ultraviolet radiation as a disinfection agent in operating rooms are discussed in this article

  7. Device- and system-independent personal touchless user interface for operating rooms : One personal UI to control all displays in an operating room.

    Science.gov (United States)

    Ma, Meng; Fallavollita, Pascal; Habert, Séverine; Weidert, Simon; Navab, Nassir

    2016-06-01

    In the modern day operating room, the surgeon performs surgeries with the support of different medical systems that showcase patient information, physiological data, and medical images. It is generally accepted that numerous interactions must be performed by the surgical team to control the corresponding medical system to retrieve the desired information. Joysticks and physical keys are still present in the operating room due to the disadvantages of mouses, and surgeons often communicate instructions to the surgical team when requiring information from a specific medical system. In this paper, a novel user interface is developed that allows the surgeon to personally perform touchless interaction with the various medical systems, switch effortlessly among them, all of this without modifying the systems' software and hardware. To achieve this, a wearable RGB-D sensor is mounted on the surgeon's head for inside-out tracking of his/her finger with any of the medical systems' displays. Android devices with a special application are connected to the computers on which the medical systems are running, simulating a normal USB mouse and keyboard. When the surgeon performs interaction using pointing gestures, the desired cursor position in the targeted medical system display, and gestures, are transformed into general events and then sent to the corresponding Android device. Finally, the application running on the Android devices generates the corresponding mouse or keyboard events according to the targeted medical system. To simulate an operating room setting, our unique user interface was tested by seven medical participants who performed several interactions with the visualization of CT, MRI, and fluoroscopy images at varying distances from them. Results from the system usability scale and NASA-TLX workload index indicated a strong acceptance of our proposed user interface.

  8. Traffic flow and microbial air contamination in operating rooms at a major teaching hospital in Ghana

    DEFF Research Database (Denmark)

    Stauning, M. T.; Bediako-Bowan, A.; Andersen, L. P.

    2018-01-01

    . Aim: To assess microbial air contamination in operating rooms at a Ghanaian teaching hospital and the association with door-openings and number of people present. Moreover, we aimed to document reasons for door-opening. Methods: We conducted active air-sampling using an MAS 100® portable impactor...

  9. Laparoscopic assistance by operating room nurses: Results of a virtual-reality study.

    Science.gov (United States)

    Paschold, M; Huber, T; Maedge, S; Zeissig, S R; Lang, H; Kneist, W

    2017-04-01

    Laparoscopic assistance is often entrusted to a less experienced resident, medical student, or operating room nurse. Data regarding laparoscopic training for operating room nurses are not available. The aim of the study was to analyse the initial performance level and learning curves of operating room nurses in basic laparoscopic surgery compared with medical students and surgical residents to determine their ability to assist with this type of procedure. The study was designed to compare the initial virtual reality performance level and learning curves of user groups to analyse competence in laparoscopic assistance. The study subjects were operating room nurses, medical students, and first year residents. Participants performed three validated tasks (camera navigation, peg transfer, fine dissection) on a virtual reality laparoscopic simulator three times in 3 consecutive days. Laparoscopic experts were enrolled as a control group. Participants filled out questionnaires before and after the course. Nurses and students were comparable in their initial performance (p>0.05). Residents performed better in camera navigation than students and nurses and reached the expert level for this task. Residents, students, and nurses had comparable bimanual skills throughout the study; while, experts performed significantly better in bimanual manoeuvres at all times (p<0.05). The included user groups had comparable skills for bimanual tasks. Residents with limited experience reached the expert level in camera navigation. With training, nurses, students, and first year residents are equally capable of assisting in basic laparoscopic procedures. Copyright © 2017 Elsevier Ltd. All rights reserved.

  10. Exposure of hospital operating room personnel to potentially harmful environmental agents

    International Nuclear Information System (INIS)

    Sass-Kortsak, A.M.; Purdham, J.T.; Bozek, P.R.; Murphy, J.H.

    1992-01-01

    Epidemiologic studies of risk to reproductive health arising from the operating room environment have been inconclusive and lack quantitative exposure information. This study was undertaken to quantify exposure of operating room (OR) personnel to anesthetic agents, x-radiation, methyl methacrylate, and ethylene oxide and to determine how exposure varies with different operating room factors. Exposures of anesthetists and nurses to these agents were determined in selected operating rooms over three consecutive days. Each subject was asked to wear an x-radiation dosimeter for 1 month. Exposure to anesthetic agents was found to be influenced by the age of the OR facility, type of surgical service, number of procedures carried out during the day, type of anesthetic circuitry, and method of anesthesia delivery. Anesthetists were found to have significantly greater exposures than OR nurses. Exposure of OR personnel to ethylene oxide, methyl methacrylate, and x-radiation were well within existing standards. Exposure of anesthetists and nurses to anesthetic agents, at times, was in excess of Ontario exposure guidelines, despite improvements in the control of anesthetic pollution

  11. Cost and morbidity analysis of chest port insertion in adults: Outpatient clinic versus operating room placement.

    Science.gov (United States)

    Feo, Claudio F; Ginesu, Giorgio C; Bellini, Alessandro; Cherchi, Giuseppe; Scanu, Antonio M; Cossu, Maria Laura; Fancellu, Alessandro; Porcu, Alberto

    2017-09-01

    Totally implantable venous access devices (TIVADs) represent a convenient way for the administration of medications or nutrients. Traditionally, chest ports have been positioned by surgeons in the operating room, however there has been a transition over the years to port insertion by interventional radiologists in the radiology suite. The optimal method for chest port placement is still under debate. Data on all adult patients undergoing isolated chest port placement at our institution in a 12-year period were retrospectively reviewed. The aim of this cohort study was to compare cost and morbidity for chest port insertion in two different settings: outpatient clinic and operating room. Between 2003 and 2015 a total of 527 chest ports were placed in adult patients. Of them, 262 procedures were performed in the operating room and 265 procedures were undertaken in the outpatient clinic. Patient characteristics were similar and there was no significant difference in early (port was 1270 Euros in the operating room versus 620 Euros in the outpatient clinic. Our results suggest that chest ports can be safely placed in most patients under local anesthesia in the office setting without fluoroscopy or ultrasound guidance. Future randomized controlled studies may evaluate if surgeons or interventional radiologists should routinely perform these procedures in a dedicated office setting and reserve more sophisticated facilities only for patients at high risk of technical failure.

  12. Design of air distribution system in operating rooms -theory versus practice

    NARCIS (Netherlands)

    Melhado, M.A.; Loomans, M.G.L.C.; Hensen, J.L.M.; Lamberts, R.

    2016-01-01

    Air distribution systems need to secure a good indoor air quality in operating rooms (ORs), minimize the risk of surgical site infections, and establish suitable working conditions for the surgical team through the thermal comfort. The paper presents an overview of the design and decision process of

  13. Learning from aviation to improve safety in the operating room - a systematic literature review

    NARCIS (Netherlands)

    L.S.G.L. Wauben; J.F. Lange (Johan); R.H.M. Goossens (Richard)

    2012-01-01

    textabstractLessons 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

  14. Digitized operator evaluation system for main control room of nuclear power plant

    International Nuclear Information System (INIS)

    Chen Yu; Yan Shengyuan; Chen Wenlong

    2014-01-01

    In order to evaluate the human-machine system matching relation of main control room in nuclear power plant accurately and efficiently, the expression and parameters of operator human body model were analyzed, and the evaluation required function of digital operator was determined. Based on the secondary development technology, the digital operator evaluation body model was developed. It could choose generation, gender, operation posture, single/eyes horizon, and left/right hand up to the domain according to the needs of specific evaluation, it was used to evaluate whether display information can be visible and equipment can be touch, and it also has key evaluation functions such as workspace and character visibility at the same time. The examples show that this method can complete the evaluation work of human-machine matching relation for main control room of nuclear power plant accurately, efficiently and quickly, and achieve the most optimal human-machine coordination relationship. (authors)

  15. An analysis of auditory cues for inclusion in a close quarters battle room clearing operation

    OpenAIRE

    Greenwald, Thomas W.

    2002-01-01

    Approved for public release, distribution is unlimited The purpose of this thesis is to examine which auditory cues need to be included in a virtual representation of a Close Quarters Combat Room Clearing Operation. Future missions of the United States Armed Forces, especially those of the Army and Marine Corps, are increasingly likely to be conducted in cities or built-up areas. A critical need exists for MOUT (Military Operations in Urban Terrain) training by our armed forces, and the en...

  16. Factors Affecting Acoustics and Speech Intelligibility in the Operating Room: Size Matters.

    Science.gov (United States)

    McNeer, Richard R; Bennett, Christopher L; Horn, Danielle Bodzin; Dudaryk, Roman

    2017-06-01

    Noise in health care settings has increased since 1960 and represents a significant source of dissatisfaction among staff and patients and risk to patient safety. Operating rooms (ORs) in which effective communication is crucial are particularly noisy. Speech intelligibility is impacted by noise, room architecture, and acoustics. For example, sound reverberation time (RT60) increases with room size, which can negatively impact intelligibility, while room objects are hypothesized to have the opposite effect. We explored these relationships by investigating room construction and acoustics of the surgical suites at our institution. We studied our ORs during times of nonuse. Room dimensions were measured to calculate room volumes (VR). Room content was assessed by estimating size and assigning items into 5 volume categories to arrive at an adjusted room content volume (VC) metric. Psychoacoustic analyses were performed by playing sweep tones from a speaker and recording the impulse responses (ie, resulting sound fields) from 3 locations in each room. The recordings were used to calculate 6 psychoacoustic indices of intelligibility. Multiple linear regression was performed using VR and VC as predictor variables and each intelligibility index as an outcome variable. A total of 40 ORs were studied. The surgical suites were characterized by a large degree of construction and surface finish heterogeneity and varied in size from 71.2 to 196.4 m (average VR = 131.1 [34.2] m). An insignificant correlation was observed between VR and VC (Pearson correlation = 0.223, P = .166). Multiple linear regression model fits and β coefficients for VR were highly significant for each of the intelligibility indices and were best for RT60 (R = 0.666, F(2, 37) = 39.9, P the size and contents of an OR can predict a range of psychoacoustic indices of speech intelligibility. Specifically, increasing OR size correlated with worse speech intelligibility, while increasing amounts of OR contents

  17. Integrating Sustainable Development into Operations Management Courses

    Science.gov (United States)

    Fredriksson, Peter; Persson, Magnus

    2011-01-01

    Purpose: It is widely acknowledged that aspects of sustainable development (SD) should be integrated into higher level operations management (OM) education. The aim of the paper is to outline the experiences gained at Chalmers University of Technology in Sweden from integrating aspects of SD into OM courses. Design/methodology/approach: The paper…

  18. Integration of operational research and environmental management

    NARCIS (Netherlands)

    Bloemhof - Ruwaard, J.M.

    1996-01-01


    The subject of this thesis is the integration of Operational Research and Environmental Management. Both sciences play an important role in the research of environmental issues. Part I describes a framework for the interactions between Operational Research and Environmental Management.

  19. First-Case Operating Room Delays: Patterns Across Urban Hospitals of a Single Health Care System

    Directory of Open Access Journals (Sweden)

    Callie M. Cox Bauer

    2016-08-01

    Full Text Available Purpose: Operating room delays decrease health care system efficiency and increase costs. To improve operating room efficiency in our system, we retrospectively investigated delay frequencies, causes and costs. Methods: We studied all first-of-the-day nonemergent surgical cases performed at three high-volume urban hospitals of a large health system from July 2012 to November 2013. Times for patient flow from arrival to procedure start and documented reasons for delay were obtained from electronic medical records. Delay was defined as patient placement in the operating room later than scheduled surgery time. Effects of patient characteristics, late patient arrival to the hospital, number of planned procedures, years of surgeon experience, service department and hospital facility on odds of delay were examined using logistic regression. Results: Of 5,598 cases examined, 88% were delayed. Patients arrived late to the hospital (surgery in 65% of first cases. Mean time from arrival to scheduled surgery and in-room placement was 104.6 and 127.4 minutes, respectively. Mean delay time was 28.2 minutes. Nearly 60% of delayed cases had no documented reason for delay. For cases with documentation, causes included the physician (52%, anesthesia (15%, patient (13%, staff (9%, other sources (6% and facility (5%. Regression analysis revealed age, late arrival, department and facility as significant predictors of delay. Estimated delay costs, based on published figures and representing lost revenue, were $519,388. Conclusions: To improve operating room efficiency, multidisciplinary strategies are needed for increasing patient adherence to recommended arrival times, documentation of delay by medical staff and consistency in workflow patterns among facilities and departments.

  20. Finite volume method room acoustic simulations integrated into the architectural design process

    DEFF Research Database (Denmark)

    Pind Jörgensson, Finnur Kári; Jeong, Cheol-Ho; Engsig-Karup, Allan Peter

    2017-01-01

    with the architectural design from the earliest design stage, as a part of a holistic design process. A new procedure to integrate room acoustics into architectural design is being developed in a Ph.D. project, with the aim of promoting this early stage holistic design process. This project aims to develop a new hybrid...

  1. Comparison of the inspection practices in relation to the control room operator and shift supervisor licenses

    International Nuclear Information System (INIS)

    Aro, Ilari; Koizumi, Hiroyoshi; Manzella, Pietro

    1998-01-01

    The CNRA believes that safety inspections are a major element in the regulatory authority's efforts to ensure the safe operation of nuclear facilities. Considering the importance of these issues, the Committee has established a special Working Group on Inspection Practices (WGIP). The purpose of WGIP, is to facilitate the exchange of information and experience related to regulatory safety inspections between CNRA Member countries In 1996, members of WGIP discussed various ways in which regulatory inspectors look at and evaluate how licenses are given to control room operators and shift supervisors in the Member countries. As a result of these discussions it was proposed to put together a short comparison report on this issue. The CNRA approved work on this at its annual meeting that year. This CNRA/WGIP study concentrates on the regulatory inspection of control room operator competence and authorisation. As noted in the text, fourteen Member countries supplied input by responding to the questionnaire. This report presents a comparison of inspection practices in participating OECD countries relating to control room operator and shift supervisor licenses. The report has been derived from answers to a questionnaire on the basis of guidance given in Appendix 1.1 with the detailed answers being given in Appendix 1. Key questions for this comparison were 'What are the regulatory or licensee requirements for holding and up-keeping a license or authorisation' and 'How does the regulatory body inspect the training and competence of shift teams and individual operators'. The main conclusion from the comparison is that the general practice within the participating countries for ensuring the competence of operators is broadly similar although regulatory practices differ markedly. For example, the regulatory bodies in some countries are actively involved in the examination and licensing process of individual operators whereas other regulatory bodies

  2. 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.

  3. Job satisfaction or production? How staff and leadership understand operating room efficiency: a qualitative study.

    Science.gov (United States)

    Arakelian, E; Gunningberg, L; Larsson, J

    2008-11-01

    How to increase efficiency in operating departments has been widely studied. However, there is no overall definition of efficiency. Supervisors urging staff to work efficiently may meet strong reactions due to staff believing that demands for efficiency means just stress at work. Differences in how efficiency is understood may constitute an obstacle to supervisors' efforts to promote it. This study aimed to explore how staff and leadership understand operating room efficiency. Twenty-one members of staff and supervisors in an operating department in a Swedish county hospital were interviewed. The analysis was performed with a phenomenographic approach that aims to discover the variations in how a phenomenon is understood by a group of people. Six categories were found in the understanding of operation room efficiency: (A) having the right qualifications; (B) enjoying work; (C) planning and having good control and overview; (D) each professional performing the correct tasks; (E) completing a work assignment; and (F) producing as much as possible per time unit. The most significant finding was that most of the nurses and assistant nurses understood efficiency as individual knowledge and experience emphasizing the importance of the work process, whereas the supervisors and physicians understood efficiency in terms of production per time unit or completing an assignment. The concept 'operating room efficiency' is understood in different ways by leadership and staff members. Supervisors who are aware of this variation will have better prerequisites for defining the concept and for creating a common platform towards becoming efficient.

  4. Operations strategy for workload balancing of crews in an advanced main control room

    International Nuclear Information System (INIS)

    Kim, Seunghwan; Kim, Yochan; Jung, Wondea

    2016-01-01

    The advanced main control room (advanced-MCR) is the one that allows for reactor operations based on digital instrumentation and control (I and C) technology. Thus, the operators of an advanced-MCR operate the plant through digital I and C interfaces, and for this purpose, an additional digital manipulation task for the operating equipment should be performed that cannot be observed in a conventional-MCR. As a prior study proposing the cognitive, communicative, and operational activity measurement approach (COCOA), COCOA enables an evaluation of the operator's workload in an advanced-MCR,which includes newly generated tasks for Man-Machine Interface System based secondary operation under a digital environment, which does not exist in a conventional-MCR. As a result of observations on the workload level by utilizing COCOA for a reference plant with an advanced-MCR when conducting an emergency operating procedure, it was observed that the workload of the shift supervisor is about two times greater than that of other operators. This is because operators therein stuck to the old guidelines customized to a conventional-MCR and failed to accomplish load balancing in consideration of the operation environment that an advanced-MCR provides. In this context, it would be imperative to develop and apply an operations strategy for an advanced-MCR operation. This study proposes an operations strategy in an attempt to make a balanced workload of operators in an advanced-MCR. (author)

  5. Implementation of an operator model with error mechanisms for nuclear power plant control room operation

    International Nuclear Information System (INIS)

    Suh, Sang Moon; Cheon, Se Woo; Lee, Yong Hee; Lee, Jung Woon; Park, Young Taek

    1996-01-01

    SACOM(Simulation Analyser with Cognitive Operator Model) is being developed at Korea Atomic Energy Research Institute to simulate human operator's cognitive characteristics during the emergency situations of nuclear power plans. An operator model with error mechanisms has been developed and combined into SACOM to simulate human operator's cognitive information process based on the Rasmussen's decision ladder model. The operational logic for five different cognitive activities (Agents), operator's attentional control (Controller), short-term memory (Blackboard), and long-term memory (Knowledge Base) have been developed and implemented on blackboard architecture. A trial simulation with a scenario for emergency operation has been performed to verify the operational logic. It was found that the operator model with error mechanisms is suitable for the simulation of operator's cognitive behavior in emergency situation

  6. Wind energy and power system operations: a review of wind integration studies to date

    Energy Technology Data Exchange (ETDEWEB)

    Cesaro, Jennifer de; Porter, Kevin; Milligan, Michael

    2009-12-15

    Wind integration will not be accomplished successfully by doing ''more of the same.'' It will require significant changes in grid planning and operations, continued technical evolution in the design and operation of wind turbines, further adoption and implementation of wind forecasting in the control room, and incorporation of market and policy initiatives to encourage more flexible generation. (author)

  7. Work Analysis of the nuclear power plant control room operators (II): The classes of situation

    International Nuclear Information System (INIS)

    Alengry, P.

    1989-03-01

    This report presents a work analysis of nuclear power plant control room operators focused on the classes of situation they can meet during their job. Each class of situation is first described in terms of the process variables states. We then describe the goals of the operators and the variables they process in each class of situation. We report some of the most representative difficulties encountered by the operators in each class of situation. Finally, we conclude on different topics: the nature of the mental representations, the temporal dimension, the monitoring activity, and the role of the context in the work of controlling a nuclear power plant [fr

  8. Implementation and evaluation of an interprofessional simulation-based education program for undergraduate nursing students in operating room nursing education: a randomized controlled trial.

    Science.gov (United States)

    Wang, Rongmei; Shi, Nianke; Bai, Jinbing; Zheng, Yaguang; Zhao, Yue

    2015-07-09

    The present study was designed to implement an interprofessional simulation-based education program for nursing students and evaluate the influence of this program on nursing students' attitudes toward interprofessional education and knowledge about operating room nursing. Nursing students were randomly assigned to either the interprofessional simulation-based education or traditional course group. A before-and-after study of nursing students' attitudes toward the program was conducted using the Readiness for Interprofessional Learning Scale. Responses to an open-ended question were categorized using thematic content analysis. Nursing students' knowledge about operating room nursing was measured. Nursing students from the interprofessional simulation-based education group showed statistically different responses to four of the nineteen questions in the Readiness for Interprofessional Learning Scale, reflecting a more positive attitude toward interprofessional learning. This was also supported by thematic content analysis of the open-ended responses. Furthermore, nursing students in the simulation-based education group had a significant improvement in knowledge about operating room nursing. The integrated course with interprofessional education and simulation provided a positive impact on undergraduate nursing students' perceptions toward interprofessional learning and knowledge about operating room nursing. Our study demonstrated that this course may be a valuable elective option for undergraduate nursing students in operating room nursing education.

  9. [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.

  10. 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.

  11. 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...... performed using a standardized sterile technique in an operation room. Injection protocols were similar between the three sites. No preinjection antibiotics were given. Postoperative antibiotics varied among sites. RESULTS: A total of 134,701 intravitreal injections were performed at the 3 sites between...

  12. Traffic in the operating room: a review of factors influencing air flow and surgical wound contamination.

    Science.gov (United States)

    Pokrywka, Marian; Byers, Karin

    2013-06-01

    Surgical wound contamination leading to surgical site infection can result from disruption of the intended airflow in the operating room (OR). When personnel enter and exit the OR, or create unnecessary movement and traffic during the procedure, the intended airflow in the vicinity of the open wound becomes disrupted and does not adequately remove airborne contaminants from the sterile field. An increase in the bacterial counts of airborne microorganisms is noted during increased activity levels within the OR. Researchers have studied OR traffic and door openings as a determinant of air contamination. During a surgical procedure the door to the operating room may be open as long as 20 minutes out of each surgical hour during critical procedures involving implants. Interventions into limiting excessive movement and traffic in the OR may lead to reductions in surgical site infections in select populations.

  13. Wearing long sleeves while prepping a patient in the operating room decreases airborne contaminants.

    Science.gov (United States)

    Markel, Troy A; Gormley, Thomas; Greeley, Damon; Ostojic, John; Wagner, Jennifer

    2018-04-01

    The use of long sleeves by nonscrubbed personnel in the operating room has been called into question. We hypothesized that wearing long sleeves and gloves, compared with having bare arms without gloves, while applying the skin preparation solution would decrease particulate and microbial contamination. A mock patient skin prep was performed in 3 different operating rooms. A long-sleeved gown and gloves, or bare arms, were used to perform the procedure. Particle counters were used to assess airborne particulate contamination, and active and passive microbial assessment was achieved through air samplers and settle plate analysis. Data were compared with Student's t-test or Mann-Whitney U, and P airborne contamination while the skin prep is applied, which may lead to decreased surgical site infections. Copyright © 2018 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

  14. Strategies and Decision Support Systems for Integrating Variable Energy Resources in Control Centers for Reliable Grid Operations

    Energy Technology Data Exchange (ETDEWEB)

    Jones, Lawrence E. [Alstom Grid Inc., Washington, DC (United States)

    2011-11-01

    This report provides findings from the field regarding the best ways in which to guide operational strategies, business processes and control room tools to support the integration of renewable energy into electrical grids.

  15. Strategies and Decision Support Systems for Integrating Variable Energy Resources in Control Centers for Reliable Grid Operations. Executive Summary

    Energy Technology Data Exchange (ETDEWEB)

    Jones, Lawrence E. [Alstom Grid, Inc., Washington, DC (United States)

    2011-11-01

    This is the executive summary for a report that provides findings from the field regarding the best ways in which to guide operational strategies, business processes and control room tools to support the integration of renewable energy into electrical grids.

  16. The SmartOR: a distributed sensor network to improve operating room efficiency.

    Science.gov (United States)

    Huang, Albert Y; Joerger, Guillaume; Fikfak, Vid; Salmon, Remi; Dunkin, Brian J; Bass, Barbara L; Garbey, Marc

    2017-09-01

    Despite the significant expense of OR time, best practice achieves only 70% efficiency. Compounding this problem is a lack of real-time data. Most current OR utilization programs require manual data entry. Automated systems require installation and maintenance of expensive tracking hardware throughout the institution. This study developed an inexpensive, automated OR utilization system and analyzed data from multiple operating rooms. OR activity was deconstructed into four room states. A sensor network was then developed to automatically capture these states using only three sensors, a local wireless network, and a data capture computer. Two systems were then installed into two ORs, recordings captured 24/7. The SmartOR recorded the following events: any room activity, patient entry/exit time, anesthesia time, laparoscopy time, room turnover time, and time of preoperative patient identification by the surgeon. From November 2014 to December 2015, data on 1003 cases were collected. The mean turnover time was 36 min, and 38% of cases met the institutional goal of ≤30 min. Data analysis also identified outlier cases (>1 SD from mean) in the domains of time from patient entry into the OR to intubation (11% of cases) and time from extubation to patient exiting the OR (11% of cases). Time from surgeon identification of patient to scheduled procedure start time was 11 min (institution bylaws require 20 min before scheduled start time), yet OR teams required 22 min on average to bring a patient into the room after surgeon identification. The SmartOR automatically and reliably captures data on OR room state and, in real time, identifies outlier cases that may be examined closer to improve efficiency. As no manual entry is required, the data are indisputable and allow OR teams to maintain a patient-centric focus.

  17. Crew resource management: using aviation techniques to improve operating room safety.

    Science.gov (United States)

    Ricci, Michael A; Brumsted, John R

    2012-04-01

    Since the publication of the Institute of Medicine report estimating nearly 100,000 deaths per year from medical errors, hospitals and physicians have a renewed focus upon error reduction. We implemented a surgical crew resource management (CRM) program for all operating room (OR) personnel. In our academic medical center, 19,000 procedures per year are performed in 27 operating rooms. Mandatory CRM training was implemented for all peri-operative personnel. Aviation techniques introduced included a pre-operative checklist and brief, post-operative debrief, read and initial files, and various other aviation-based techniques. Compliance with conduct of the brief/debrief was monitored as well as wrong-site surgeries and retained foreign body events. The malpractice insurance database for claims was also queried for the period prior to and after training. Initial training was accomplished for 517 people, including all anesthesiologists, surgeons, nurses, technicians, and OR assistants. Pre-operative briefing increased from 6.7 to 99% within 4 mo. Wrong site surgeries and retained foreign bodies decreased from a high of seven in 2007 to none in 2008, but, after 14 mo without additional training, these rose to five in 2009. Malpractice expenses (payouts and legal fees) totaled $793,000 (2003-2007), but have been zero since 2008. CRM training and implementation had an impact on reducing the incidence of wrong site surgery and retained foreign bodies in our operating rooms. However, constant reinforcement and refresher training is necessary for sustained results. Though no one technique can prevent all errors, CRM can effect culture change, producing a safer environment.

  18. Assess of the Status of the Karaj Operating Rooms in Comparison with International Standards in 2011

    Directory of Open Access Journals (Sweden)

    M.H. Naseri

    2012-10-01

    Full Text Available Background: Because of making money, the operating room (OR is known as the beating heart of any clinical & health center. The effective and regular activity of the operating room guarantees a sustainable income for the hospital. So, in order to provide high quality treatment and care services, and to save the health and safety of OR staff, exploiting standard equipments and spaces as well as employing professional and skilled personnel is necessary. This study was aimed to assess the status of the Karaj operating rooms from physical, safety, sterilization, staffing and equipment aspects in comparison to the International Standards. Methods: This sectional descriptive study was conducted in Alborz University of Medical Sciences in 2011. Samples were 10 operating room wards from 10 surgical hospitals. Data were collected by a 70 items check-list at 5 fields of physical, safety, sterilization, staffing and equipment conditions and then compared to the international standards. The data were recorded in SPSS software and analyzed by statistical methods. Results: The results showed that compared to the international standards, the physical aspect was 60.5%, safety aspect 66%, sterilization aspect 68%, staffing aspect 63%, and equipment aspect was 80% close to the standard criteria. On the whole, in 10 assessed hospitals, equipment aspect with 80% had the best and the physical aspect with 60.5% had the worst conditions respectively. Conclusion: Due to admission in different medical and paramedical programs in Alborz University of Medical Sciences, renovation of the ORs is essential for training skilled students. Considering the results of this study could help the University authorities to improve the current condition.

  19. Consequences and potential problems of operating room outbursts and temper tantrums by surgeons

    OpenAIRE

    Jacobs, George B.; Wille, Rosanne L.

    2012-01-01

    Background: Anecdotal tales of colorful temper tantrums and outbursts by surgeons directed at operating room nurses and at times other health care providers, like residents and fellows, are part of the history of surgery and include not only verbal abuse but also instrument throwing and real harassment. Our Editor-in-Chief, Dr. Nancy Epstein, has made the literature review of “Are there truly any risks and consequences when spine surgeons mistreat their predominantly female OR nursing staff/c...

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

    Science.gov (United States)

    2009-06-28

    Orthopedic Care NEC Physical Therapy Clinic Occupation Therapy Clinic Hypertension Clinic Physical Medicine Clinic Medical Clinics Cost Pool Medical...high ICU and ward occupancy rates are limited in the number of inpatient surgeries they can perform. On the other hand, hospitals with inefficient... Rheumatology , 9(5), 325 - 327. Mazzei, W.J. (1999). Maximizing operating room utilization: A landmark study. Anesthesia & Analgesia, 89(1), 1 -2. MEPRS

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

    International Nuclear Information System (INIS)

    Andersson, Jonas; Osvalder, A.L.

    2007-03-01

    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 situations were too different

  2. Assessing Nurse Anaesthetists' Non-Technical Skills in the operating room.

    Science.gov (United States)

    Lyk-Jensen, H T; Jepsen, R M H G; Spanager, L; Dieckmann, P; Østergaard, D

    2014-08-01

    Incident reporting and fieldwork in operating rooms have shown that some of the errors that arise in anaesthesia relate to inadequate use of non-technical skills. To provide a tool for training and feedback on nurse anaesthetists' non-technical skills, this study aimed to adapt the Anaesthetists' Non-Technical Skills (ANTS) as a behavioural marker system for the formative assessment of nurse anaesthetists' non-technical skills in the operating room. A qualitative approach with focus group interviews was used to identify the non-technical skills of nurse anaesthetists in the operating room. The interview data were transcribed verbatim. Directed content analysis was used to code and sort data deductively into the ANTS categories: task management, team working, situation awareness and decision making. The prototype named Nurse Anaesthetists' Non-Technical Skills (N-ANTS) was presented and discussed in a group of subject matter experts to ensure face validity. The N-ANTS system consists of the same four categories as ANTS and 15 underlying elements. Three to five good and poor behavioural markers for each element were identified. The headings and definitions of the categories and elements were adjusted to encompass the behavioural markers in N-ANTS. The differences that emerged mainly reflected statements regarding the establishment of role, competence, and task delegation. A behavioural marker system, N-ANTS, for nurse anaesthetists was adapted from a behavioural marker system, ANTS, for anaesthesiologists. © 2014 The Acta Anaesthesiologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.

  3. 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.

  4. Auditory display as feedback for a novel eye-tracking system for sterile operating room interaction.

    Science.gov (United States)

    Black, David; Unger, Michael; Fischer, Nele; Kikinis, Ron; Hahn, Horst; Neumuth, Thomas; Glaser, Bernhard

    2018-01-01

    The growing number of technical systems in the operating room has increased attention on developing touchless interaction methods for sterile conditions. However, touchless interaction paradigms lack the tactile feedback found in common input devices such as mice and keyboards. We propose a novel touchless eye-tracking interaction system with auditory display as a feedback method for completing typical operating room tasks. Auditory display provides feedback concerning the selected input into the eye-tracking system as well as a confirmation of the system response. An eye-tracking system with a novel auditory display using both earcons and parameter-mapping sonification was developed to allow touchless interaction for six typical scrub nurse tasks. An evaluation with novice participants compared auditory display with visual display with respect to reaction time and a series of subjective measures. When using auditory display to substitute for the lost tactile feedback during eye-tracking interaction, participants exhibit reduced reaction time compared to using visual-only display. In addition, the auditory feedback led to lower subjective workload and higher usefulness and system acceptance ratings. Due to the absence of tactile feedback for eye-tracking and other touchless interaction methods, auditory display is shown to be a useful and necessary addition to new interaction concepts for the sterile operating room, reducing reaction times while improving subjective measures, including usefulness, user satisfaction, and cognitive workload.

  5. Use of hands-free technique among operating room nurses in the Republic of Korea.

    Science.gov (United States)

    Jeong, Ihn Sook; Park, Sunmi

    2009-03-01

    The recently introduced concept of hands-free technique (HFT) currently has no recommendations or formal educational program for use in the Republic of Korea. This study evaluated the level of HFT use and investigated factors related to HFT use among Korean operating room nurses. Data were obtained through a self-administered questionnaire from 158 operating room nurses in 7 general hospitals in Busan, Republic of Korea, in April and May 2006. The questionnaire elicited information on demographics, exposure to education on HFT, attitude toward the need for HFT, concerns about exposure to bloodborne pathogens, and experience with HTF use. Multilevel multiple logistic regression analysis with generalized estimating equations was used, and adjusted odds ratios (ORs) and their 95% confidence intervals (CIs) were calculated. We found that 56% of the participants had used HFT, and 50% had received education on HFT. The use of HFT had a significant association with both education on HFT (OR = 12.02; 95% CI = 7.50 to 19.25) and attitude toward the need for HFT (OR = 4.22; 95% CI = 2.43 to 7.35). Increasing education about HFT could be the most important approach to increasing the use of HFT among Korean operating room nurses. Thus, routine teaching about HFT should be provided to these nurses.

  6. What Orthopaedic Operating Room Surfaces Are Contaminated With Bioburden? A Study Using the ATP Bioluminescence Assay.

    Science.gov (United States)

    Richard, Raveesh Daniel; Bowen, Thomas R

    2017-07-01

    Contaminated operating room surfaces can increase the risk of orthopaedic infections, particularly after procedures in which hardware implantation and instrumentation are used. The question arises as to how surgeons can measure surface cleanliness to detect increased levels of bioburden. This study aims to highlight the utility of adenosine triphosphate (ATP) bioluminescence technology as a novel technique in detecting the degree of contamination within the sterile operating room environment. What orthopaedic operating room surfaces are contaminated with bioburden? When energy is required for cellular work, ATP breaks down into adenosine biphosphate (ADP) and phosphate (P) and in that process releases energy. This process is inherent to all living things and can be detected as light emission with the use of bioluminescence assays. On a given day, six different orthopaedic surgery operating rooms (two adult reconstruction, two trauma, two spine) were tested before surgery with an ATP bioluminescence assay kit. All of the cases were considered clean surgery without infection, and this included the previously performed cases in each sampled room. These rooms had been cleaned and prepped for surgery but the patients had not been physically brought into the room. A total of 13 different surfaces were sampled once in each room: the operating room (OR) preparation table (both pre- and postdraping), OR light handles, Bovie machine buttons, supply closet countertops, the inside of the Bair Hugger™ hose, Bair Hugger™ buttons, right side of the OR table headboard, tourniquet machine buttons, the Clark-socket attachment, and patient positioners used for total hip and spine positioning. The relative light units (RLUs) obtained from each sample were recorded and data were compiled and averaged for analysis. These values were compared with previously published ATP benchmark values of 250 to 500 RLUs to define cleanliness in both the hospital and restaurant industries. All

  7. 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 nurses achieved a 100% pass rate compared to 53% with non-guided or no experience (p 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. Copyright © 2015 Elsevier Ltd. All rights reserved.

  8. Control-room operator alertness and performance in nuclear power plants

    International Nuclear Information System (INIS)

    Baker, T.l.; Campbell, S.C.; Linder, K.D.; Moore-Ede, M.C

    1990-02-01

    All industries requiring round-the-clock operation must deal with the potential problem of impaired alertness, especially among those who work night shifts. In the nuclear power industry, maintaining optimal alertness and performance of control room operators at all times of day is critical. Many of the toot causes of reduced alertness are straightforward and can be easily remedied with tangible solutions; this manual both discusses the reasons for the problem and suggests solutions. The manual surveys factors that influence operator alertness and performance, including shift schedules, caffeine and alcohol use, diet and family lifestyle factors, the control room enviornment, staffing and overtime practices, and work task design. Specific recommendations are made in each of these areas. The project team, consisting of experts on managing round-the-clock operations and scientists who study human alertness and performance, prepared this manual using the latest scientific research and direct input from shift supervisors and operators via interviews, on-site observation, and questionnaires distributed to every nuclear power station. The material contained within is relevant to shiftwork managers, shift supervisors, and operators, each of whom plays a vital role in maintaining optimal alertness and performance on the job. 90 refs., 35 figs

  9. Structure determination of an integral membrane protein at room temperature from crystals in situ

    International Nuclear Information System (INIS)

    Axford, Danny; Foadi, James; Hu, Nien-Jen; Choudhury, Hassanul Ghani; Iwata, So; Beis, Konstantinos; Evans, Gwyndaf; Alguel, Yilmaz

    2015-01-01

    The X-ray structure determination of an integral membrane protein using synchrotron diffraction data measured in situ at room temperature is demonstrated. The structure determination of an integral membrane protein using synchrotron X-ray diffraction data collected at room temperature directly in vapour-diffusion crystallization plates (in situ) is demonstrated. Exposing the crystals in situ eliminates manual sample handling and, since it is performed at room temperature, removes the complication of cryoprotection and potential structural anomalies induced by sample cryocooling. Essential to the method is the ability to limit radiation damage by recording a small amount of data per sample from many samples and subsequently assembling the resulting data sets using specialized software. The validity of this procedure is established by the structure determination of Haemophilus influenza TehA at 2.3 Å resolution. The method presented offers an effective protocol for the fast and efficient determination of membrane-protein structures at room temperature using third-generation synchrotron beamlines

  10. Structure determination of an integral membrane protein at room temperature from crystals in situ

    Energy Technology Data Exchange (ETDEWEB)

    Axford, Danny [Diamond Light Source, Harwell Science and Innovation Campus, Oxfordshire OX11 0DE (United Kingdom); Foadi, James [Diamond Light Source, Harwell Science and Innovation Campus, Oxfordshire OX11 0DE (United Kingdom); Imperial College London, London SW7 2AZ (United Kingdom); Hu, Nien-Jen; Choudhury, Hassanul Ghani [Diamond Light Source, Harwell Science and Innovation Campus, Oxfordshire OX11 0DE (United Kingdom); Imperial College London, London SW7 2AZ (United Kingdom); Rutherford Appleton Laboratory, Oxfordshire OX11 0FA (United Kingdom); Iwata, So [Diamond Light Source, Harwell Science and Innovation Campus, Oxfordshire OX11 0DE (United Kingdom); Diamond Light Source, Harwell Science and Innovation Campus, Oxfordshire OX11 0DE (United Kingdom); Imperial College London, London SW7 2AZ (United Kingdom); Rutherford Appleton Laboratory, Oxfordshire OX11 0FA (United Kingdom); Kyoto University, Kyoto 606-8501 (Japan); Beis, Konstantinos [Diamond Light Source, Harwell Science and Innovation Campus, Oxfordshire OX11 0DE (United Kingdom); Imperial College London, London SW7 2AZ (United Kingdom); Rutherford Appleton Laboratory, Oxfordshire OX11 0FA (United Kingdom); Evans, Gwyndaf, E-mail: gwyndaf.evans@diamond.ac.uk [Diamond Light Source, Harwell Science and Innovation Campus, Oxfordshire OX11 0DE (United Kingdom); Alguel, Yilmaz, E-mail: gwyndaf.evans@diamond.ac.uk [Diamond Light Source, Harwell Science and Innovation Campus, Oxfordshire OX11 0DE (United Kingdom); Imperial College London, London SW7 2AZ (United Kingdom); Rutherford Appleton Laboratory, Oxfordshire OX11 0FA (United Kingdom)

    2015-05-14

    The X-ray structure determination of an integral membrane protein using synchrotron diffraction data measured in situ at room temperature is demonstrated. The structure determination of an integral membrane protein using synchrotron X-ray diffraction data collected at room temperature directly in vapour-diffusion crystallization plates (in situ) is demonstrated. Exposing the crystals in situ eliminates manual sample handling and, since it is performed at room temperature, removes the complication of cryoprotection and potential structural anomalies induced by sample cryocooling. Essential to the method is the ability to limit radiation damage by recording a small amount of data per sample from many samples and subsequently assembling the resulting data sets using specialized software. The validity of this procedure is established by the structure determination of Haemophilus influenza TehA at 2.3 Å resolution. The method presented offers an effective protocol for the fast and efficient determination of membrane-protein structures at room temperature using third-generation synchrotron beamlines.

  11. What factors influence attending surgeon decisions about resident autonomy in the operating room?

    Science.gov (United States)

    Williams, Reed G; George, Brian C; Meyerson, Shari L; Bohnen, Jordan D; Dunnington, Gary L; Schuller, Mary C; Torbeck, Laura; Mullen, John T; Auyang, Edward; Chipman, Jeffrey G; Choi, Jennifer; Choti, Michael; Endean, Eric; Foley, Eugene F; Mandell, Samuel; Meier, Andreas; Smink, Douglas S; Terhune, Kyla P; Wise, Paul; DaRosa, Debra; Soper, Nathaniel; Zwischenberger, Joseph B; Lillemoe, Keith D; Fryer, Jonathan P

    2017-12-01

    Educating residents in the operating room requires balancing patient safety, operating room efficiency demands, and resident learning needs. This study explores 4 factors that influence the amount of autonomy supervising surgeons afford to residents. We evaluated 7,297 operations performed by 487 general surgery residents and evaluated by 424 supervising surgeons from 14 training programs. The primary outcome measure was supervising surgeon autonomy granted to the resident during the operative procedure. Predictor variables included resident performance on that case, supervising surgeon history with granting autonomy, resident training level, and case difficulty. Resident performance was the strongest predictor of autonomy granted. Typical autonomy by supervising surgeon was the second most important predictor. Each additional factor led to a smaller but still significant improvement in ability to predict the supervising surgeon's autonomy decision. The 4 factors together accounted for 54% of decision variance (r = 0.74). Residents' operative performance in each case was the strongest predictor of how much autonomy was allowed in that case. Typical autonomy granted by the supervising surgeon, the second most important predictor, is unrelated to resident proficiency and warrants efforts to ensure that residents perform each procedure with many different supervisors. Copyright © 2017 Elsevier Inc. All rights reserved.

  12. 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.

  13. Identities for generalized fractional integral operators associated ...

    African Journals Online (AJOL)

    In this present work an attempt has been made to define two generalized fractional integral operators associated with products of analogues to Dirichlet averages and special functions. Discussions on the different aspects of the obtained results have been followed by utilization in finding out the images of multivariate ...

  14. Hybrid simulation: bringing motivation to the art of teamwork training in the operating room.

    Science.gov (United States)

    Kjellin, A; Hedman, L; Escher, C; Felländer-Tsai, L

    2014-12-01

    Crew resource management-based operating room team training will be an evident part of future surgical training. Hybrid simulation in the operating room enables the opportunity for trainees to perform higher fidelity training of technical and non-technical skills in a realistic context. We focus on situational motivation and self-efficacy, two important factors for optimal learning in light of a prototype course for teams of residents in surgery and anesthesiology and nurses. Authentic operating room teams consisting of residents in anesthesia (n = 2), anesthesia nurses (n = 3), residents in surgery (n = 2), and scrub nurses (n = 6) were, during a one-day course, exposed to four different scenarios. Their situational motivation was self-assessed (ranging from 1 = does not correspond at all to 7 = corresponds exactly) immediately after training, and their self-efficacy (graded from 1 to 7) before and after training. Training was performed in a mock-up operating theater equipped with a hybrid patient simulator (SimMan 3G; Laerdal) and a laparoscopic simulator (Lap Mentor Express; Simbionix). The functionality of the systematic hybrid procedure simulation scenario was evaluated by an exit questionnaire (graded from 1 = disagree entirely to 5 = agree completely). The trainees were mostly intrinsically motivated, engaged for their own sake, and had a rather great degree of self-determination toward the training situation. Self-efficacy among the team members improved significantly from 4 to 6 (median). Overall evaluation showed very good result with a median grading of 5. We conclude that hybrid simulation is feasible and has the possibility to train an authentic operating team in order to improve individual motivation and confidence. © The Finnish Surgical Society 2014.

  15. Human error mode identification for NPP main control room operations using soft controls

    International Nuclear Information System (INIS)

    Lee, Seung Jun; Kim, Jaewhan; Jang, Seung-Cheol

    2011-01-01

    The operation environment of main control rooms (MCRs) in modern nuclear power plants (NPPs) has considerably changed over the years. Advanced MCRs, which have been designed by adapting digital and computer technologies, have simpler interfaces using large display panels, computerized displays, soft controls, computerized procedure systems, and so on. The actions for the NPP operations are performed using soft controls in advanced MCRs. Soft controls have different features from conventional controls. Operators need to navigate the screens to find indicators and controls and manipulate controls using a mouse, touch screens, and so on. Due to these different interfaces, different human errors should be considered in the human reliability analysis (HRA) for advanced MCRs. In this work, human errors that could occur during operation executions using soft controls were analyzed. This work classified the human errors in soft controls into six types, and the reasons that affect the occurrence of the human errors were also analyzed. (author)

  16. An experimental investigation on relationship between PSFs and operator performances in the digital main control room

    International Nuclear Information System (INIS)

    Park, Jooyoung; Lee, Daeil; Jung, Wondea; Kim, Jonghyun

    2017-01-01

    Highlights: • The relationship between performance shaping factors and operator performances are experimentally investigated. • The experiment includes features of digital main control room. • The result indicates that the operator’s experience level is the most effective on the performance. - Abstract: This study designs an experiment to investigate the relationship between performance shaping factors (PSFs) and operator performances. This study involves selecting three PSFs that are controllable in the experiments: (1) experience, (2) complexity, and (3) urgency. Six scenarios are developed to reflect the PSFs. The experiment involves the participation of licensed operators and the use of an APR1400 simulator. During the experiment, operator performances, such as completion time, error, secondary task, workload, and situation awareness, are measured and collected. The experimental result indicates that the operator’s experience is most effective on the overall performances. The task complexity influences the secondary tasks and situation awareness.

  17. Measuring quality indicators in the operating room: cleaning and turnover time.

    Science.gov (United States)

    Jericó, Marli de Carvalho; Perroca, Márcia Galan; da Penha, Vivian Colombo

    2011-01-01

    This exploratory-descriptive study was carried out in the Surgical Center Unit of a university hospital aiming to measure time spent with concurrent cleaning performed by the cleaning service and turnover time and also investigated potential associations between cleaning time and the surgery's magnitude and specialty, period of the day and the room's size. The sample consisted of 101 surgeries, computing cleaning time and 60 surgeries, computing turnover time. The Kaplan-Meier method was used to analyze time and Pearson's correlation to study potential correlations. The time spent in concurrent cleaning was 7.1 minutes and turnover time was 35.6 minutes. No association between cleaning time and the other variables was found. These findings can support nurses in the efficient use of resources thereby speeding up the work process in the operating room.

  18. The BWR [Boiling Water Reactor] Emergency Operating Procedures Tracking System (EOPTS): Evaluation by control-room operating crews

    International Nuclear Information System (INIS)

    Spurgin, A.J.; Orvis, D.D.; Spurgin, J.P.; Luna, C.J.

    1990-05-01

    This report presents the results of a project sponsored by the Electric Power Research Institute (EPRI) and Taiwan Power Company (TPC) and conducted by APG and TPC to perform evaluation of the Emergency Operating Procedures Tracking System (EOPTS). The EOPTS is an expert system employing artificial intelligence techniques developed by EPRI for Boiling Water Reactor (BWR) plants based on emergency operating procedures (EOPs). EOPTS is a computerized decision aid used to assist plant operators in efficient and reliable use of EOPs. The main objective of this project was to evaluate the EOPTS and determine how an operator aid of this type could noticeably improve the response time and the reliability of control room crews to multi-failure scenarios. A secondary objective was to collect data on how crew performance was affected. Experiments results indicate that the EOPTS measurably improves crew performance over crews using the EOP flow charts. Time-comparison measurements indicate that crews using the EOPTS perform required actions more quickly than do those using the flowcharts. The results indicate that crews using the EOPTS are not only faster and more consistent in their actions but make fewer errors. In addition, they have a higher likelihood of recovering from the errors that they do make. Use of the EOPTS in the control room should result in faster termination and mitigation of accidents and reduced risk of power plant operations. Recommendations are made towards possible applications of the EOPTS to operator training and evaluation, and for the applicability of the evaluation methodology developed for this project to the evaluation of similar operator aides. 17 refs., 14 figs., 14 tabs

  19. Human factors in surgery: from Three Mile Island to the operating room.

    Science.gov (United States)

    D'Addessi, Alessandro; Bongiovanni, Luca; Volpe, Andrea; Pinto, Francesco; Bassi, PierFrancesco

    2009-01-01

    Human factors is a definition that includes the science of understanding the properties of human capability, the application of this understanding to the design and development of systems and services, the art of ensuring their successful applications to a program. The field of human factors traces its origins to the Second World War, but Three Mile Island has been the best example of how groups of people react and make decisions under stress: this nuclear accident was exacerbated by wrong decisions made because the operators were overwhelmed with irrelevant, misleading or incorrect information. Errors and their nature are the same in all human activities. The predisposition for error is so intrinsic to human nature that scientifically it is best considered as inherently biologic. The causes of error in medical care may not be easily generalized. Surgery differs in important ways: most errors occur in the operating room and are technical in nature. Commonly, surgical error has been thought of as the consequence of lack of skill or ability, and is the result of thoughtless actions. Moreover the 'operating theatre' has a unique set of team dynamics: professionals from multiple disciplines are required to work in a closely coordinated fashion. This complex environment provides multiple opportunities for unclear communication, clashing motivations, errors arising not from technical incompetence but from poor interpersonal skills. Surgeons have to work closely with human factors specialists in future studies. By improving processes already in place in many operating rooms, safety will be enhanced and quality increased.

  20. Use of face masks by non-scrubbed operating room staff: a randomized controlled trial.

    Science.gov (United States)

    Webster, Joan; Croger, Sarah; Lister, Carolyn; Doidge, Michelle; Terry, Michael J; Jones, Ian

    2010-03-01

    Ambiguity remains about the effectiveness of wearing surgical face masks. The purpose of this study was to assess the impact on surgical site infections (SSIs) when non-scrubbed operating room staff did not wear surgical face masks. Eight hundred twenty-seven participants undergoing elective or emergency obstetric, gynecological, general, orthopaedic, breast or urological surgery in an Australian tertiary hospital were enrolled. Complete follow-up data were available for 811 patients (98.1%). Operating room lists were randomly allocated to a 'Mask group' (all non-scrubbed staff wore a mask) or 'No Mask group' (none of the non-scrubbed staff wore masks). The primary end point, SSI was identified using in-patient surveillance; post discharge follow-up and chart reviews. The patient was followed for up to six weeks. Overall, 83 (10.2%) surgical site infections were recorded; 46/401 (11.5%) in the Masked group and 37/410 (9.0%) in the No Mask group; odds ratio (OR) 0.77 (95% confidence interval (CI) 0.49 to 1.21), p = 0.151. Independent risk factors for surgical site infection included: any pre-operative stay (adjusted odds ratio [aOR], 0.43 (95% CI, 0.20; 0.95), high BMI aOR, 0.38 (95% CI, 0.17; 0.87), and any previous surgical site infection aOR, 0.40 (95% CI, 0.17; 0.89). Surgical site infection rates did not increase when non-scrubbed operating room personnel did not wear a face mask.

  1. Comprehensive Surgical Coaching Enhances Surgical Skill in the Operating Room: A Randomized Controlled Trial.

    Science.gov (United States)

    Bonrath, Esther M; Dedy, Nicolas J; Gordon, Lauren E; Grantcharov, Teodor P

    2015-08-01

    The aim of the study was to determine whether individualized coaching improved surgical technical skill in the operating room to a higher degree than current residency training. Clinical training in the operating room is a valuable opportunity for surgeons to acquire skill and knowledge; however, it often remains underutilized. Coaching has been successfully used in various industries to enhance performance, but its role in surgery has been insufficiently investigated. This randomized controlled trial was conducted at one surgical training program. Trainees undergoing a minimally invasive surgery rotation were randomized to either conventional training (CT) or comprehensive surgical coaching (CSC). CT included ward and operating room duties, and regular departmental teaching sessions. CSC comprised performance analysis, debriefing, feedback, and behavior modeling. Primary outcome measures were technical performance as measured on global and procedure-specific rating scales, and surgical safety parameters, measured by error count. Operative performance was assessed by blinded video analysis of the first and last cases recorded by the participants during their rotation. Twenty residents were randomized and 18 completed the study. At posttraining the CSC group (n = 9) scored significantly higher on a procedure-specific skill scale compared with the CT group (n = 9) [median, 3.90 (interquartile range, 3.68-4.30) vs 3.60 (2.98-3.70), P = 0.017], and made fewer technical errors [10 (7-13) vs 18 (13-21), P = 0.003]. Significant within-group improvements for all skill metrics were only noted in the CSC group. Comprehensive surgical coaching enhances surgical training and results in skill acquisition superior to conventional training.

  2. Realizing improved patient care through human-centered operating room design: a human factors methodology for observing flow disruptions in the cardiothoracic operating room.

    Science.gov (United States)

    Palmer, Gary; Abernathy, James H; Swinton, Greg; Allison, David; Greenstein, Joel; Shappell, Scott; Juang, Kevin; Reeves, Scott T

    2013-11-01

    Human factors engineering has allowed a systematic approach to the evaluation of adverse events in a multitude of high-stake industries. This study sought to develop an initial methodology for identifying and classifying flow disruptions in the cardiac operating room (OR). Two industrial engineers with expertise in human factors workflow disruptions observed 10 cardiac operations from the moment the patient entered the OR to the time they left for the intensive care unit. Each disruption was fully documented on an architectural layout of the OR suite and time-stamped during each phase of surgery (preoperative [before incision], operative [incision to skin closure], and postoperative [skin closure until the patient leaves the OR]) to synchronize flow disruptions between the two observers. These disruptions were then categorized. The two observers made a total of 1,158 observations. After the elimination of duplicate observations, a total of 1,080 observations remained to be analyzed. These disruptions were distributed into six categories such as communication, usability, physical layout, environmental hazards, general interruptions, and equipment failures. They were further organized into 33 subcategories. The most common disruptions were related to OR layout and design (33%). By using the detailed architectural diagrams, the authors were able to clearly demonstrate for the first time the unique role that OR design and equipment layout has on the generation of physical layout flow disruptions. Most importantly, the authors have developed a robust taxonomy to describe the flow disruptions encountered in a cardiac OR, which can be used for future research and patient safety improvements.

  3. Containment long-term operational integrity

    International Nuclear Information System (INIS)

    Sammataro, R.F.

    1990-01-01

    Periodic integrated leak rate tests are required to assure that containments continue to meet allowable leakage limits. Although overall performance has been quite good to date, several major containment aging and degradation mechanisms have been identified. Two pilot plant life extension (PLEX) studies serve as models for extending the operational integrity of present containments for light-water cooled nuclear power plants in the United States. One study is for a Boiling-Water Reactor (BWR) and the second is for a Pressurized-Water Reactor (PWR). Research and testing programs for determining the ultimate pressure capacity and failure mechanisms for containments under severe loading conditions and studies for extending the life of current plants beyond the present 40-year licensed lifetime are under way. This paper presents an overview of containment designs in the United States. Also presented are a discussion of the American Society of Mechanical Engineers Boiler and Pressure Vessel Code (ASME Code) and regulatory authority requirements for the design, construction, inservice inspection, leakage testing and repair of steel and concrete containments. Findings for containments from the pilot PLEX studies and continuing containment integrity research and testing programs are discussed. The ASME Code and regulatory requirements together with recommendations from the PLEX studies and containment integrity research and testing provide a basis for continued containment long-term operational integrity. (orig./GL)

  4. 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

  5. Short communication: Stability and integrity of classical swine fever virus RNA stored at room temperature

    Directory of Open Access Journals (Sweden)

    Damarys Relova

    2017-12-01

    Full Text Available Worldwide cooperation between laboratories working with classical swine fever virus (CSFV requires exchange of virus isolates. For this purpose, shipment of CSFV RNA is a safe alternative to the exchange of infectious material. New techniques using desiccation have been developed to store RNA at room temperature and are reported as effective means of preserving RNA integrity. In this study, we evaluated the stability and integrity of dried CSFV RNA stored at room temperature. First, we determined the stability of CSFV RNA covering CSFV genome regions used typically for the detection of viral RNA in diagnostic samples by reverse transcription-polymerase chain reaction (RT-PCR. To this end, different concentrations of in vitro-transcribed RNAs of the 5’-untranslated region and of the NS5B gene were stored as dried RNA at 4, 20, and 37oC for two months. Aliquots were analyzed every week by CSFV-specific quantitative real-time RT-PCR. Neither the RNA concentration nor the storage temperature did affect CSFV RNA yields at any of the time evaluated until the end of the experiment. Furthermore, it was possible to recover infectious CSFV after transfection of SK-6 cells with dried viral RNA stored at room temperature for one week. The full-length E2 of CSFV was amplified from all the recovered viruses, and nucleotide sequence analysis revealed 100% identity with the corresponding sequence obtained from RNA of the original material. These results show that CSFV RNA stored as dried RNA at room temperature is stable, maintaining its integrity for downstream analyses and applications.

  6. Two loose screws: near-miss fall of a morbidly obese patient after an operating room table failure.

    Science.gov (United States)

    McAllister, Russell K; Booth, Robert T; Bittenbinder, Timothy M

    2016-09-01

    Operating room surgical table failure is a rare event but can lead to a dangerous situation when it does occur. The dangers can be compounded in the presence of obesity, especially in the anesthetized or sedated patient. We present a case of a near-miss fall of a morbidly obese patient while turning the patient in preparation to transfer from the operating room table to the hospital bed when 2 fractured bolts in the tilt cylinder mechanism led to an operating room table failure. Copyright © 2016 Elsevier Inc. All rights reserved.

  7. On the Riesz representation theorem and integral operators ...

    African Journals Online (AJOL)

    We present a Riesz representation theorem in the setting of extended integration theory as introduced in [6]. The result is used to obtain boundedness theorems for integral operators in the more general setting of spaces of vector valued extended integrable functions. Keywords: Vector integral, integral operators, operator ...

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

    Science.gov (United States)

    Albrecht, Mark; Gauthier, Robert; Leaper, David

    2009-10-10

    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 µm size range, evidenced by a steep decrease in FAW blower filtration efficiency for particles 0.5 to 5.0 µm 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 µm) that could, conceivably, settle onto the surgical site.

  9. Traffic flow and microbial air contamination in operating rooms at a major teaching hospital in Ghana.

    Science.gov (United States)

    Stauning, M T; Bediako-Bowan, A; Andersen, L P; Opintan, J A; Labi, A-K; Kurtzhals, J A L; Bjerrum, S

    2018-07-01

    Current literature examining the relationship between door-opening rate, number of people present, and microbial air contamination in the operating room is limited. Studies are especially needed from low- and middle-income countries, where the risk of surgical site infections is high. To assess microbial air contamination in operating rooms at a Ghanaian teaching hospital and the association with door-openings and number of people present. Moreover, we aimed to document reasons for door-opening. We conducted active air-sampling using an MAS 100 ® portable impactor during 124 clean or clean-contaminated elective surgical procedures. The number of people present, door-opening rate and the reasons for each door-opening were recorded by direct observation using pretested structured observation forms. During surgery, the mean number of colony-forming units (cfu) was 328 cfu/m 3 air, and 429 (84%) of 510 samples exceeded a recommended level of 180 cfu/m 3 . Of 6717 door-openings recorded, 77% were considered unnecessary. Levels of cfu/m 3 were strongly correlated with the number of people present (P = 0.001) and with the number of door-openings/h (P = 0.02). In empty operating rooms, the mean cfu count was 39 cfu/m 3 after 1 h of uninterrupted ventilation and 52 (51%) of 102 samples exceeded a recommended level of 35 cfu/m 3 . The study revealed high values of intraoperative airborne cfu exceeding recommended levels. Minimizing the number of door-openings and people present during surgery could be an effective strategy to reduce microbial air contamination in low- and middle-income settings. Copyright © 2017 The Author(s). Published by Elsevier Ltd.. All rights reserved.

  10. Early Extubation in the Operating Room after Congenital Open-Heart Surgery.

    Science.gov (United States)

    Fukunishi, Takuma; Oka, Norihiko; Yoshii, Takeshi; Kobayashi, Kensuke; Inoue, Nobuyuki; Horai, Tetsuya; Kitamura, Tadashi; Okamoto, Hirotsugu; Miyaji, Kagami

    2018-01-27

    Early extubation in the operating room after congenital open-heart surgery is feasible, but extubation in the intensive care unit after the operation remains common practice at many institutions. The purpose of this study was to evaluate retrospectively the adequacy of our early-extubation strategy and exclusion criteria through analysis based on the Risk Adjustment in Congenital Heart Surgery method (RACHS-1).This retrospective analysis included 359 cases requiring cardiopulmonary bypass (male, 195; female, 164; weight > 3.0 kg; aged 1 month to 18 years). Neonates and preoperatively intubated patients were excluded. Other exclusion criteria included severe preoperative pulmonary hypertension, high-dose catecholamine requirement after cardiopulmonary bypass, delayed sternal closure, laryngomalacia, serious bleeding, and delayed awakening. The early-extubation rates were compared between age groups and RACHS-1 classes.Overall, 83% of cases (298/359) were extubated in the operating room, classified by RACHS-1 categories as follows: 1, 59/59 (100%); 2, 164/200 (84%); 3, 61/78 (78%); and 4-6, 10/22 (45%). The early extubation rate in categories 1-3 (86%, 288/337) was significantly higher than for categories 4-6 (45.5%, 10/22) (P open-heart surgery was feasible based on our criteria, especially for patients in the low RACHS-1 categories, and involves a very low rate of re-intubation.

  11. 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.

  12. Team interaction skills evaluation criteria for nuclear power plant control room operators

    International Nuclear Information System (INIS)

    Montgomery, J.C.; Hauth, J.T.

    1991-01-01

    Team interaction skills are an essential aspect of safe nuclear power plant control room operations. Previous research has shown that, when a group works together, rather than as individuals, more effective operations are possible. However, little research has addressed how such team interaction skills can be measured. In this study rating scales were developed specifically for such a measurement purpose. Dimensions of team skill performance were identified from previous research and experience in the area, incorporating the input of Pacific Northwest Laboratory (PNL) contract operator licensing examiners. Rating scales were developed on the basis of these dimensions, incorporating a modified Behaviorally Anchored Rating Scale (BARS) as well as Behavioral Frequency formats. After a pilot-testing/revision process, rating data were collected using 11 control room crews responding to simulator scenarios at a boiling water and a pressurized water reactor. Statistical analyses of the resulting data revealed moderate inter-rater reliability using the Behavioral Frequency scales, relatively low inter-rater reliability using the BARS, and moderate support for convergent and discriminant validity of the scales. It was concluded that the scales show promise psychometrically and in terms of user acceptability, but that additional scale revision is needed before field implementation. Recommendations for scale revision and directions for future research were presented

  13. Shaping the operating room and perioperative systems of the future: innovating for improved competitiveness.

    Science.gov (United States)

    Seim, Andreas R; Sandberg, Warren S

    2010-12-01

    To review the current state of anesthesiology for operative and invasive procedures, with an eye toward possible future states. Anesthesiology is at once a mature specialty and in a crisis--requiring breakthrough to move forward. The cost of care now approaches reimbursement, and outcomes as commonly measured approach perfection. Thus, the cost of further improvements seems ready to topple the field, just as the specialty is realizing that seemingly innocuous anesthetic choices have long-term consequences, and better practice is required. Anesthesiologists must create more headroom between costs and revenues in order to sustain the academic vigor and creativity required to create better clinical practice. We outline three areas in which technological and organizational innovation in anesthesiology can improve competitiveness and become a driving force in collaborative efforts to develop the operating rooms and perioperative systems of the future: increasing the profitability of operating rooms; increasing the efficiency of anesthesia; and technological and organizational innovation to foster improved patient flow, communication, coordination, and organizational learning.

  14. Evaluation of a pulsed xenon ultraviolet disinfection system to decrease bacterial contamination in operating rooms.

    Science.gov (United States)

    El Haddad, Lynn; Ghantoji, Shashank S; Stibich, Mark; Fleming, Jason B; Segal, Cindy; Ware, Kathy M; Chemaly, Roy F

    2017-10-10

    Environmental cleanliness is one of the contributing factors for surgical site infections in the operating rooms (ORs). To decrease environmental contamination, pulsed xenon ultraviolet (PX-UV), an easy and safe no-touch disinfection system, is employed in several hospital environments. The positive effect of this technology on environmental decontamination has been observed in patient rooms and ORs during the end-of-day cleaning but so far, no study explored its feasibility between surgical cases in the OR. In this study, 5 high-touch surfaces in 30 ORs were sampled after manual cleaning and after PX-UV intervention mimicking between-case cleaning to avoid the disruption of the ORs' normal flow. The efficacy of a 1-min, 2-min, and 8-min cycle were tested by measuring the surfaces' contaminants by quantitative cultures using Tryptic Soy Agar contact plates. We showed that combining standard between-case manual cleaning of surfaces with a 2-min cycle of disinfection using a portable xenon pulsed ultraviolet light germicidal device eliminated at least 70% more bacterial load after manual cleaning. This study showed the proof of efficacy of a 2-min cycle of PX-UV in ORs in eliminating bacterial contaminants. This method will allow a short time for room turnover and a potential reduction of pathogen transmission to patients and possibly surgical site infections.

  15. 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.

  16. Implementation and Use of Anesthesia Information Management Systems for Non-operating Room Locations.

    Science.gov (United States)

    Bouhenguel, Jason T; Preiss, David A; Urman, Richard D

    2017-12-01

    Non-operating room anesthesia (NORA) encounters comprise a significant fraction of contemporary anesthesia practice. With the implemention of an aneshtesia information management system (AIMS), anesthesia practitioners can better streamline preoperative assessment, intraoperative automated documentation, real-time decision support, and remote surveillance. Despite the large personal and financial commitments involved in adoption and implementation of AIMS and other electronic health records in these settings, the benefits to safety, efficacy, and efficiency are far too great to be ignored. Continued future innovation of AIMS technology only promises to further improve on our NORA experience and improve care quality and safety. Copyright © 2017 Elsevier Inc. All rights reserved.

  17. Mitigating operating room fires: development of a carbon dioxide fire prevention device.

    Science.gov (United States)

    Culp, William C; Kimbrough, Bradly A; Luna, Sarah; Maguddayao, Aris J

    2014-04-01

    Operating room fires are sentinel events that present a real danger to surgical patients and occur at least as frequently as wrong-sided surgery. For fire to occur, the 3 points of the fire triad must be present: an oxidizer, an ignition source, and fuel source. The electrosurgical unit (ESU) pencil triggers most operating room fires. Carbon dioxide (CO2) is a gas that prevents ignition and suppresses fire by displacing oxygen. We hypothesize that a device can be created to reduce operating room fires by generating a cone of CO2 around the ESU pencil tip. One such device was created by fabricating a divergent nozzle and connecting it to a CO2 source. This device was then placed over the ESU pencil, allowing the tip to be encased in a cone of CO2 gas. The device was then tested in 21%, 50%, and 100% oxygen environments. The ESU was activated at 50 W cut mode while placing the ESU pencil tip on a laparotomy sponge resting on an aluminum test plate for up to 30 seconds or until the sponge ignited. High-speed videography was used to identify time of ignition. Each test was performed in each oxygen environment 5 times with the device activated (CO2 flow 8 L/min) and with the device deactivated (no CO2 flow-control). In addition, 3-dimensional spatial mapping of CO2 concentrations was performed with a CO2 sampling device. The median ± SD [range] ignition time of the control group in 21% oxygen was 2.9 s ± 0.44 [2.3-3.0], in 50% oxygen 0.58 s ± 0.12 [0.47-0.73], and in 100% oxygen 0.48 s ± 0.50 [0.03-1.27]. Fires were ignited with each control trial (15/15); no fires ignited when the device was used (0/15, P fire prevention device can be created by using a divergent nozzle design through which CO2 passes, creating a cone of fire suppressant. This device as demonstrated in a flammability model effectively reduced the risk of fire. CO2 3-dimensional spatial mapping suggests effective fire reduction at least 1 cm away from the tip of the ESU pencil at 8 L/min CO2 flow

  18. Weighted estimates for the averaging integral operator

    Czech Academy of Sciences Publication Activity Database

    Opic, Bohumír; Rákosník, Jiří

    2010-01-01

    Roč. 61, č. 3 (2010), s. 253-262 ISSN 0010-0757 R&D Projects: GA ČR GA201/05/2033; GA ČR GA201/08/0383 Institutional research plan: CEZ:AV0Z10190503 Keywords : averaging integral operator * weighted Lebesgue spaces * weights Subject RIV: BA - General Mathematics Impact factor: 0.474, year: 2010 http://link.springer.com/article/10.1007%2FBF03191231

  19. 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

  20. Integrated application of human factors to a power plant control room information system

    International Nuclear Information System (INIS)

    Fish, H.C. Jr.; Gutierrez, R.

    1988-01-01

    The human factors plan was developed as a methodology to apply human factors from the conceptual design of the EPIC system to the functional verification conducted at the plant. An integral part of the Human Factors Plan was the Functional Verification Plan. Developed in parallel, this second plan and its resultant programs verified functional appropriateness of the SPDS display, NSSS displays, EOP displays, man-machine interfaces (MMI), and workstation designs. The functional verification process was performed at the hardware/software developer's factory and at the JAFNPP, following installation of the EPIC system. Because the EPIC system replaces existing control room equipment, it is important that human factors be applied in a systematic manner consistent with other control room displays and controls. To ensure that this goal was met, a human factors plan was developed

  1. Teamwork and error in the operating room: analysis of skills and roles.

    Science.gov (United States)

    Catchpole, K; Mishra, A; Handa, A; McCulloch, P

    2008-04-01

    To analyze the effects of surgical, anesthetic, and nursing teamwork skills on technical outcomes. The value of team skills in reducing adverse events in the operating room is presently receiving considerable attention. Current work has not yet identified in detail how the teamwork and communication skills of surgeons, anesthetists, and nurses affect the course of an operation. Twenty-six laparoscopic cholecystectomies and 22 carotid endarterectomies were studied using direct observation methods. For each operation, teams' skills were scored for the whole team, and for nursing, surgical, and anesthetic subteams on 4 dimensions (leadership and management [LM]; teamwork and cooperation; problem solving and decision making; and situation awareness). Operating time, errors in surgical technique, and other procedural problems and errors were measured as outcome parameters for each operation. The relationships between teamwork scores and these outcome parameters within each operation were examined using analysis of variance and linear regression. Surgical (F(2,42) = 3.32, P = 0.046) and anesthetic (F(2,42) = 3.26, P = 0.048) LM had significant but opposite relationships with operating time in each operation: operating time increased significantly with higher anesthetic but decreased with higher surgical LM scores. Errors in surgical technique had a strong association with surgical situation awareness (F(2,42) = 7.93, P skills of the nurses (F(5,1) = 3.96, P = 0.027). Detailed analysis of team interactions and dimensions is feasible and valuable, yielding important insights into relationships between nontechnical skills, technical performance, and operative duration. These results support the concept that interventions designed to improve teamwork and communication may have beneficial effects on technical performance and patient outcome.

  2. Measuring Situation Awareness of Operating Team in Different Main Control Room Environments of Nuclear Power Plants

    Directory of Open Access Journals (Sweden)

    Seung Woo Lee

    2016-02-01

    Full Text Available Environments in nuclear power plants (NPPs are changing as the design of instrumentation and control systems for NPPs is rapidly moving toward fully digital instrumentation and control, and modern computer techniques are gradually introduced into main control rooms (MCRs. Within the context of these environmental changes, the level of performance of operators in a digital MCR is a major concern. Situation awareness (SA, which is used within human factors research to explain to what extent operators of safety-critical systems know what is transpiring in the system and the environment, is considered a prerequisite factor to guarantee the safe operation of NPPs. However, the safe operation of NPPs can be guaranteed through a team effort. In this regard, the operating team's SA in a conventional and digital MCR should be measured in order to assess whether the new design features implemented in a digital MCR affect this parameter. This paper explains the team SA measurement method used in this study and the results of applying this measurement method to operating teams in different MCR environments. The paper also discusses several empirical lessons learned from the results.

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

    International Nuclear Information System (INIS)

    Kim, Ki-Hwan

    2016-01-01

    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

  4. 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.

  5. 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.

  6. 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

    International Nuclear Information System (INIS)

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

    2004-01-01

    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

  7. Microbiological evaluation of various parameters in ophthalmic operating rooms. The need to establish guidelines.

    Directory of Open Access Journals (Sweden)

    Kelkar Uday

    2003-01-01

    Full Text Available Purpose: Postoperative infections can be caused by a contaminated environment, unsterile equipment, contaminated surfaces, and infected personnel as well as contaminated disinfectants. In order to establish guidelines for microbiological monitoring, a detailed microbiological surveillance was carried out in an ophthalmic hospital. Method: Over a period of 21 months, we assessed environmental Bacteria Carrying Particle (BCP load and surface samples weekly (n=276; the autoclaving system once a month and repeated whenever the process failed (n= 24; the air conditioning filters for fungal growth once in four months (n = 15, and the disinfectant solution for contamination once in two months (n = 10. Additionally, the personnel involved directly in surgery were screened for potential pathogens such as Staphylococcus aureus and β haemolytic streptococci. Result: On 14 (5.07% occasions the environment in the operating rooms had a significant risk of airborne infections. Sterilisation of instruments in the autoclaves was unsatisfactory on 4 (16.66 % occasions. Samples from the filters of the air-conditioning units yielded potentially pathogenic fungi on 3 (20% occasions. Personnel sampling revealed that 5 (8.77% individuals harboured β haemolytic Streptococci in the throat and 4 (7.01 % harboured S. aureus in the nasal cavity. The samples of disinfectant in use were not contaminated. Conclusion: There is a need to standardise microbiological evaluation protocols for operating rooms.

  8. Threats to safety during sedation outside of the operating room and the death of Michael Jackson.

    Science.gov (United States)

    Webster, Craig S; Mason, Keira P; Shafer, Steven L

    2016-03-01

    From an understanding of human psychology and the reliability of high-technology systems, this review considers critical threats to the safety of patients undergoing sedation outside of the operating room, and will stratify these threats along what we define as the 'Patient Risk Continuum'. We then consider interventions suitable for addressing identified risks. The technology, organization and delivery of healthcare continue to become more complex, highlighting the importance of maintaining the safety of patients. Sedation outside of the operating room is known to be associated with higher rates of adverse events. However, a number of recent safety initiatives have shown benefit in improving patient safety. The following threats to patients undergoing sedation, in increasing order of risk, are discussed: equipment and environmental factors, known patient risks, poor team performance, combinatorial problems and egregious violations. To address these threats, we discuss a number of approaches consistent with the systems approach to safety, namely: encouraging functions, forcing functions, cognitive safety nets, information sharing, recovery strategies and regulatory change. Demonstrating improvement with any safety initiative relies critically on quality data collected on the problem area in question.

  9. Design, operation, and safety of single-room interventional MRI suites: practical experience from two centers.

    Science.gov (United States)

    White, Mark J; Thornton, John S; Hawkes, David J; Hill, Derek L G; Kitchen, Neil; Mancini, Laura; McEvoy, Andrew W; Razavi, Reza; Wilson, Sally; Yousry, Tarek; Keevil, Stephen F

    2015-01-01

    The design and operation of a facility in which a magnetic resonance imaging (MRI) scanner is incorporated into a room used for surgical or endovascular cardiac interventions presents several challenges. MR safety must be maintained in the presence of a much wider variety of equipment than is found in a diagnostic unit, and of staff unfamiliar with the MRI environment, without compromising the safety and practicality of the interventional procedure. Both the MR-guided cardiac interventional unit at Kings College London and the intraoperative imaging suite at the National Hospital for Neurology and Neurosurgery are single-room interventional facilities incorporating 1.5 T cylindrical-bore MRI scanners. The two units employ similar strategies to maintain MR safety, both in original design and day-to-day operational workflows, and between them over a decade of incident-free practice has been accumulated. This article outlines these strategies, highlighting both similarities and differences between the units, as well as some lessons learned and resulting procedural changes made in both units since installation. © 2014 Wiley Periodicals, Inc.

  10. 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.

  11. The influence of personal characteristics on the resilience of operating room nurses: a predictor study.

    Science.gov (United States)

    Gillespie, Brigid M; Chaboyer, Wendy; Wallis, Marianne

    2009-07-01

    Resilience in the workplace has been described as a means of facilitating adaptation in stressful environments, and therefore has application in nursing contexts. However, little research has examined how personal characteristics such as age, nursing experience and education contribute to resilience in clinical environments such as the operating room (OR). First to identify the level of resilience, and second, investigate whether age, experience and education contribute to resilience in an Australian sample of OR nurses. A predictive survey design was used. A random sample of 1430 nurses who were members of the Australian College of Operating Room Nurses association were surveyed. The survey included the 25-item Connor-Davidson Resilience Scale, and demographic questions. A standard regression model tested the hypothesis that age, years of OR experience and education contributed to resilience in OR nurses. A total of 735 (51.4%) completed, usable surveys were returned. Pearson's correlations demonstrated modest but statistically significant associations between age (presilience. In the multiple regression model, only years of OR experience predicted resilience (presilience. In OR nurses, resilience appears to be predicted by other attributes and is not necessarily dependent on an individual's personal characteristics. Thus, recruitment to the OR should not be based on the conventional notion that an older nursing workforce will have greater longevity and hence be more stable. If younger, less experienced nurses are adequately supported, they may thrive in the OR environment.

  12. Nitrous oxide levels in operating and recovery rooms of Iranian hospitals.

    Science.gov (United States)

    Maroufi, Sh Sadigh; Gharavi, Mj; Behnam, M; Samadikuchaksaraei, A

    2011-01-01

    Nitrous oxide (N(2)O) 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. During a 6-month period, we have measured the shift-long time weighted average concentration of N(2)O in 43 operating and 12 recovery rooms of teaching hospitals of Tehran University of Medical Sciences. 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. 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.

  13. Room temperature continuous wave mid-infrared VCSEL operating at 3.35 μm

    Science.gov (United States)

    Jayaraman, V.; Segal, S.; Lascola, K.; Burgner, C.; Towner, F.; Cazabat, A.; Cole, G. D.; Follman, D.; Heu, P.; Deutsch, C.

    2018-02-01

    Tunable vertical cavity surface emitting lasers (VCSELs) offer a potentially low cost tunable optical source in the 3-5 μm range that will enable commercial spectroscopic sensing of numerous environmentally and industrially important gases including methane, ethane, nitrous oxide, and carbon monoxide. Thus far, achieving room temperature continuous wave (RTCW) VCSEL operation at wavelengths beyond 3 μm has remained an elusive goal. In this paper, we introduce a new device structure that has enabled RTCW VCSEL operation near the methane absorption lines at 3.35 μm. This device structure employs two GaAs/AlGaAs mirrors wafer-bonded to an optically pumped active region comprising compressively strained type-I InGaAsSb quantum wells grown on a GaSb substrate. This substrate is removed in processing, as is one of the GaAs mirror substrates. The VCSEL structure is optically pumped at room temperature with a CW 1550 nm laser through the GaAs substrate, while the emitted 3.3 μm light is captured out of the top of the device. Power and spectrum shape measured as a function of pump power exhibit clear threshold behavior and robust singlemode spectra.

  14. 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.

  15. Residents' reluctance to challenge negative hierarchy in the operating room: a qualitative study.

    Science.gov (United States)

    Bould, M Dylan; Sutherland, Stephanie; Sydor, Devin T; Naik, Viren; Friedman, Zeev

    2015-06-01

    Our aim was to clarify how hierarchy influences residents' reluctance to challenge authority with respect to clearly erroneous medical decision-making. After research ethics approval, we recruited 44 anesthesia residents for a high-fidelity simulation scenario at two Ontario universities. During the scenario, an actor, whom the residents were told was an actual new staff anesthesiologist at their university, asked the trainees to give blood to a Jehovah's Witness in contradiction to the patient's explicitly stated wishes. Following the case, the trainees were debriefed and were interviewed for 30-40 min. The interviews were audio recorded and transcribed verbatim, and the text was coded using a qualitative approach informed by grounded theory. Qualitative analysis of the participants' interviews yielded rich descriptive accounts of hierarchical influences often characterized by fear and intimidation. Residents spoke about their coping strategies, which included adaptability, avoiding conflict, using inquiry as a method for patient advocacy, and relying on a diffusion of responsibility within the larger operating room team. Study results showed that hierarchy played a dominant role in the functioning of the operating room. Participants spoke of both the positive and negative effects of such a hierarchical learning environment. The majority of participants described a negative perception of hierarchy as the norm, and they employed many coping strategies. This study provides insight into how a negative hierarchical culture can adversely impact patient safety, resident learning, and team functioning. We propose a theoretical model to describe challenging authority in this context.

  16. Cognitive models and computer aids for nuclear plant control room operators

    International Nuclear Information System (INIS)

    Sheridan, T.B.

    1982-01-01

    This paper reviews what is usually meant by a cognitive model of a control room operator in a nuclear power plant. It emphasizes the idea of internal (that is, mental) representation of external events and the use of such representation for the cognitive steps of attending, recognizing or learning, assessing and deciding. As computers play an increasingly important role in nuclear power plants, especially as cognitive aids to human supervisors of highly automated control systems, it is important that the software and computer interface characteristics be compatible with the operator's internal model. Specific examples discussed in this paper are in the monitoring and prediction of the plant state and in the detection and diagnosis of failures. Current trends in SPDS (safety parameter display system) and failure detection/location systems will be discussed in this regard

  17. 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.

  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. Durable improvements in efficiency, safety, and satisfaction in the operating room.

    Science.gov (United States)

    Heslin, Martin J; Doster, Barbara E; Daily, Sandra L; Waldrum, Michael R; Boudreaux, Arthur M; Smith, A Blair; Peters, Glenn; Ragan, Debbie B; Buchalter, Scott; Bland, Kirby I; Rue, Loring W

    2008-05-01

    Enhanced productivity and efficiency in the operating room must be balanced with patient safety and staff satisfaction. In December 2004, transition to an expanded replacement hospital resulted in mandatory overtime, unpredictable work hours, and poor morale among operating room (OR) staff. A staff-retention crisis resulted, which threatened the viability of the OR and the institution. We report the changes implemented to efficiently deliver safe patient care in a supportive environment for surgeons and OR staff. University of Alabama at Birmingham University Hospital OR data were evaluated for fiscal year 2004 and compared with fiscal years 2005 and 2006. Case volumes, number of operational ORs, and on-time case starts were evaluated. OR adverse events were tabulated. Percentage of registered nurse hires and staff departures served as a proxy for staff satisfaction. Short, intermediate, and longterm strategies were implemented by an engaged OR management committee with the guidance of surgical, anesthesia, and hospital leadership. These included new block time release policies; use of traveling nurses until new staff could be hired and trained; and incentive-based, voluntary, employee-scheduled overtime. Mandatory nursing education time was blocked weekly. Enforcement of the National Patient Safety Goals were implemented and adjudicated with a "surgeon-of-the-day" system providing backup for nurse management. We demonstrated an increase in operations per year, on-time starts, and registered nurse hires in fiscal years 2005 and 2006. During this same time, we were able to markedly decrease the number of adverse events, admitting delays, and staff departures. Change is difficult to accept but essential when vital clinical activities are impaired and at risk. To maintain important clinical environments like the OR in an academic center, we developed and implemented effective, data-driven changes. This allowed us to retain critical human resources and restore a

  20. Statistical process control as a tool for controlling operating room performance: retrospective analysis and benchmarking.

    Science.gov (United States)

    Chen, Tsung-Tai; Chang, Yun-Jau; Ku, Shei-Ling; Chung, Kuo-Piao

    2010-10-01

    There is much research using statistical process control (SPC) to monitor surgical performance, including comparisons among groups to detect small process shifts, but few of these studies have included a stabilization process. This study aimed to analyse the performance of surgeons in operating room (OR) and set a benchmark by SPC after stabilized process. The OR profile of 499 patients who underwent laparoscopic cholecystectomy performed by 16 surgeons at a tertiary hospital in Taiwan during 2005 and 2006 were recorded. SPC was applied to analyse operative and non-operative times using the following five steps: first, the times were divided into two segments; second, they were normalized; third, they were evaluated as individual processes; fourth, the ARL(0) was calculated;, and fifth, the different groups (surgeons) were compared. Outliers were excluded to ensure stability for each group and to facilitate inter-group comparison. The results showed that in the stabilized process, only one surgeon exhibited a significantly shorter total process time (including operative time and non-operative time). In this study, we use five steps to demonstrate how to control surgical and non-surgical time in phase I. There are some measures that can be taken to prevent skew and instability in the process. Also, using SPC, one surgeon can be shown to be a real benchmark. © 2010 Blackwell Publishing Ltd.

  1. Ge-Based Spin-Photodiodes for Room-Temperature Integrated Detection of Photon Helicity

    KAUST Repository

    Rinaldi, Christian

    2012-05-02

    Spin-photodiodes based on Fe/MgO/Ge(001) heterostructures are reported. These devices perform the room-temperature integrated electrical detection of the spin polarization of a photocurrent generated by circularly polarized photons with a wavelength of 1300 nm, for light pulses with intensity I 0 down to 200 μW. A forward and reverse-biased average photocurrent variation of 5.9% is measured for the complete reversal of the incident light helicity. Copyright © 2012 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

  2. Single-Use Energy Sources and Operating Room Time for Laparoscopic Hysterectomy: A Randomized Controlled Trial.

    Science.gov (United States)

    Holloran-Schwartz, M Brigid; Gavard, Jeffrey A; Martin, Jared C; Blaskiewicz, Robert J; Yeung, Patrick P

    2016-01-01

    To compare the intraoperative direct costs of a single-use energy device with reusable energy devices during laparoscopic hysterectomy. A randomized controlled trial (Canadian Task Force Classification I). An academic hospital. Forty-six women who underwent laparoscopic hysterectomy from March 2013 to September 2013. Each patient served as her own control. One side of the uterine attachments was desiccated and transected with the single-use device (Ligasure 5-mm Blunt Tip LF1537 with the Force Triad generator). The other side was desiccated and transected with reusable bipolar forceps (RoBi 5 mm), and transected with monopolar scissors using the same Covidien Force Triad generator. The instrument approach used was randomized to the attending physician who was always on the patient's left side. Resident physicians always operated on the patient's right side and used the converse instruments of the attending physician. Start time was recorded at the utero-ovarian pedicle and end time was recorded after transection of the uterine artery on the same side. Costs included the single-use device; amortized costs of the generator, reusable instruments, and cords; cleaning and packaging of reusable instruments; and disposal of the single-use device. Operating room time was $94.14/min. We estimated that our single use-device cost $630.14 and had a total time savings of 6.7 min per case, or 3.35 min per side, which could justify the expense of the device. The single-use energy device had significant median time savings (-4.7 min per side, p energy device that both desiccates and cuts significantly reduced operating room time to justify its own cost, and it also reduced total intraoperative direct costs during laparoscopic hysterectomy in our institution. Operating room cost per minute varies between institutions and must be considered before generalizing our results. Copyright © 2016 AAGL. Published by Elsevier Inc. All rights reserved.

  3. Cognitive requirements in the redesign of a TRIGA RC-1 control room: The role of the operators' evaluations

    International Nuclear Information System (INIS)

    Visciola, M.; Bagnara, S.; Ruggeri, R.

    1986-01-01

    When a control room undergoes to a redesign process it is of crucial importance to analyze how operators critically review it and which improvements they suggest. This is even more critical when presumably the same people will operate in the new 'redesigned' control room: Consistency in the mental models possessed by the operators of the plant functions and of their control should be emphasized. Consistency in the mental models can be assumed when redesign follows well-established guidelines drawn from experiences and studies carried out in very similar situations. However, this condition is not fulfilled when a nuclear research control room has to be redesigned, since available guidelines (e.g.; NUREG-0700) are based on studies conducted on nuclear power plant control rooms. These two types of facilities are of much difference as for activities performed in the control room, goals to be aimed at, costs and risks. As a consequence, the available guidelines cannot be safely applied to such a situation as the redesign of a TRIGA RC-1 control room. So, data have to be collected in order to allow the operators to efficiently and easily adapt to the new control room by consistently 'updating' their mental models. In the present study, these data have been collected through structured interviews, which consisted of a modified version of EPRI. The results can be summarized as follows: 1) The operators critically reviewed the present control room and underlined the lack of 'transparency' of the control system as for the plant's conditions and for the feedbacks about their own activities. 2) The operators' work analysis showed that they spend much of their time out of the control room. This means that, if the operators have to stay in the control room, they should be allowed to perform more and higher-level activities than those presently required, to prevent understimulation. So, the redesign should or allow and support the central control and maintenance, and other

  4. Design of a wireless, standard-based patient monitoring system for operating rooms

    Energy Technology Data Exchange (ETDEWEB)

    Villalobos Cervantes, A.; Alamo Ramiro, J.M. del

    2016-07-01

    In the last decades, IT has brought several successful innovations into the healthcare field, such as wearable devices or hospital information systems. However, IT adoption in surgical environments has followed a slower pace. In this kind of interventions, the large number of wired monitoring equipment limits the efficiency and movements of surgical staff in the room. Therefore, wireless intercommunication between these devices has become a priority. This paper proposes a solution to these needs, and describes the design of a system that uses wireless technologies to collect data from different monitors and display physicians an integrated vision of the patient’s status. Finally, a functional prototype was developed to validate the proposed design. (Author)

  5. [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.

  6. Thermal comfort and indoor air quality in rooms with integrated personalized ventilation and under-floor air distribution systems

    DEFF Research Database (Denmark)

    Li, Ruixin; Sekhar ., S. C.; Melikov, Arsen Krikor

    2011-01-01

    A comprehensive study comprising physical measurements and human subject experiments was conducted to explore the potential for improving occupants' thermal comfort and indoor air quality (IAQ) using a personalized ventilation (PV) system combined with an under-floor air distribution(UFAD) system....... The integrated PV-UFAD system, when operated at relatively high temperature of the air supplied from the UFAD system, provided comfortable cooling of the facial region, improved inhaled air quality, and decreased the risk of "cold feet," which is often reported in rooms with UFAD alone. This article explores...... and a secondary AHU for 100% recirculated air that is supplied through UFAD outlets. Velocity and temperature distribution in the chamber were measured. A breathing thermal manikin was used to measure the heat loss from 26 body segments and to determine the equivalent temperature. The responses of 30 human...

  7. Mental workload measurement in operator control room using NASA-TLX

    Science.gov (United States)

    Sugarindra, M.; Suryoputro, M. R.; Permana, A. I.

    2017-12-01

    The workload, encountered a combination of physical workload and mental workload, is a consequence of the activities for workers. Central control room is one department in the oil processing company, employees tasked with monitoring the processing unit for 24 hours nonstop with a combination of 3 shifts in 8 hours. NASA-TLX (NASA Task Load Index) is one of the subjective mental workload measurement using six factors, namely the Mental demand (MD), Physical demand (PD), Temporal demand (TD), Performance (OP), Effort (EF), frustration levels (FR). Measurement of a subjective mental workload most widely used because it has a high degree of validity. Based on the calculation of the mental workload, there at 5 units (DTU, NPU, HTU, DIST and OPS) at the control chamber (94; 83.33; 94.67; 81, 33 and 94.67 respectively) that categorize as very high mental workload. The high level of mental workload on the operator in the Central Control Room is a requirement to have high accuracy, alertness and can make decisions quickly

  8. Human Factors methods concerning integrated validation of nuclear power plant control rooms

    International Nuclear Information System (INIS)

    Oskarsson, Per-Anders; Johansson, Bjoern J.E.; Gonzalez, Natalia

    2010-02-01

    The frame of reference for this work was existing recommendations and instructions from the NPP area, experiences from the review of the Turbic Validation and experiences from system validations performed at the Swedish Armed Forces, e.g. concerning military control rooms and fighter pilots. These enterprises are characterized by complex systems in extreme environments, often with high risks, where human error can lead to serious consequences. A focus group has been performed with representatives responsible for Human Factors issues from all Swedish NPP:s. The questions that were discussed were, among other things, for whom an integrated validation (IV) is performed and its purpose, what should be included in an IV, the comparison with baseline measures, the design process, the role of SSM, which methods of measurement should be used, and how the methods are affected of changes in the control room. The report brings different questions to discussion concerning the validation process. Supplementary methods of measurement for integrated validation are discussed, e.g. dynamic, psychophysiological, and qualitative methods for identification of problems. Supplementary methods for statistical analysis are presented. The study points out a number of deficiencies in the validation process, e.g. the need of common guidelines for validation and design, criteria for different types of measurements, clarification of the role of SSM, and recommendations for the responsibility of external participants in the validation process. The authors propose 12 measures for taking care of the identified problems

  9. Human Factors methods concerning integrated validation of nuclear power plant control rooms; Metodutveckling foer integrerad validering

    Energy Technology Data Exchange (ETDEWEB)

    Oskarsson, Per-Anders; Johansson, Bjoern J.E.; Gonzalez, Natalia (Swedish Defence Research Agency, Information Systems, Linkoeping (Sweden))

    2010-02-15

    The frame of reference for this work was existing recommendations and instructions from the NPP area, experiences from the review of the Turbic Validation and experiences from system validations performed at the Swedish Armed Forces, e.g. concerning military control rooms and fighter pilots. These enterprises are characterized by complex systems in extreme environments, often with high risks, where human error can lead to serious consequences. A focus group has been performed with representatives responsible for Human Factors issues from all Swedish NPP:s. The questions that were discussed were, among other things, for whom an integrated validation (IV) is performed and its purpose, what should be included in an IV, the comparison with baseline measures, the design process, the role of SSM, which methods of measurement should be used, and how the methods are affected of changes in the control room. The report brings different questions to discussion concerning the validation process. Supplementary methods of measurement for integrated validation are discussed, e.g. dynamic, psychophysiological, and qualitative methods for identification of problems. Supplementary methods for statistical analysis are presented. The study points out a number of deficiencies in the validation process, e.g. the need of common guidelines for validation and design, criteria for different types of measurements, clarification of the role of SSM, and recommendations for the responsibility of external participants in the validation process. The authors propose 12 measures for taking care of the identified problems

  10. Intelligent cooperation: A framework of pedagogic practice in the operating room.

    Science.gov (United States)

    Sutkin, Gary; Littleton, Eliza B; Kanter, Steven L

    2018-04-01

    Surgeons who work with trainees must address their learning needs without compromising patient safety. We used a constructivist grounded theory approach to examine videos of five teaching surgeries. Attending surgeons were interviewed afterward while watching cued videos of their cases. Codes were iteratively refined into major themes, and then constructed into a larger framework. We present a novel framework, Intelligent Cooperation, which accounts for the highly adaptive, iterative features of surgical teaching in the operating room. Specifically, we define Intelligent Cooperation as a sequence of coordinated exchanges between attending and trainee that accomplishes small surgical steps while simultaneously uncovering the trainee's learning needs. Intelligent Cooperation requires the attending to accurately determine learning needs, perform real-time needs assessment, provide critical scaffolding, and work with the learner to accomplish the next step in the surgery. This is achieved through intense, coordinated verbal and physical cooperation. Copyright © 2017 Elsevier Inc. All rights reserved.

  11. Verbal Communication Quality Analysis of Human Operators in Main Control Room

    International Nuclear Information System (INIS)

    Kim, Seung Hwan; Park, Jin kyun

    2012-01-01

    Verbal communication problems have been one of the major human factors causing serious problems in many industries. The results of existing researches have revealed that keeping good communication quality is essential to ensure the safety of a large-sized and highly advanced industrial process system. Communication Quality is ensured only when both parties involved in a communication process understand and comprehend each other correctly, and it can be decided based on the correctness of the messages communicated between them. In this paper, we suggested a method to measure the quality of communication during off-normal situation in main control room of nuclear power plants. It evaluates the cosine similarity that is a measure of sentence similarity between two operators by finding the cosine of the angle between them

  12. Implementation of an Electronic Checklist to Improve Patient Handover From Ward to Operating Room

    DEFF Research Database (Denmark)

    Münter, Kristine H; Møller, Thea P; Østergaard, Doris

    2017-01-01

    risk factors. The aim of this study was to describe the implementation process and completion rate of a new preoperative, ward-to-OR checklist. Our goal was a 90% fulfillment. METHOD: This study is a prospective, observational study in a Danish University Hospital including all patients undergoing......OBJECTIVE: Research has identified numerous safety risks in perioperative patient handover. In handover from ward to operating room (OR), patients are often transferred by a third person. This adds to the risk of loss of important information and of caregivers in the OR not identifying possible...... surgery in 2013. The checklist was a screen page with 27 checkboxes of information relevant for a safe handover. The checklist should be completed in the ward before handover to the OR and should be checked in the OR before receiving the patient. The Plan-Do-Study-Act (PDSA) cycle method was used...

  13. Teamwork and communication in the operating room: relationship to discrete outcomes and research challenges.

    Science.gov (United States)

    Nurok, Michael; Sundt, Thoralf M; Frankel, Allan

    2011-03-01

    The literature defining and addressing teamwork and communication is abundant; however, few studies have analyzed the relationship between measures of teamwork and communication and quantifiable outcomes. The objectives of this review are: (1) to identify studies addressing teamwork and communication in the operating room in relation to discrete measures of outcome, (2) to create a classification of studies of the relationship between teamwork and communication and outcomes, (3) to assess the implications of these studies, (4) to explore the methodological challenges of teamwork and communication studies in the perioperative setting, and (5) to suggest future research directions.studies in the perioperative setting, and (5) to suggest future research directions. Copyright © 2011 Elsevier Inc. All rights reserved.

  14. Mixed Reality with HoloLens: Where Virtual Reality Meets Augmented Reality in the Operating Room.

    Science.gov (United States)

    Tepper, Oren M; Rudy, Hayeem L; Lefkowitz, Aaron; Weimer, Katie A; Marks, Shelby M; Stern, Carrie S; Garfein, Evan S

    2017-11-01

    Virtual reality and augmented reality devices have recently been described in the surgical literature. The authors have previously explored various iterations of these devices, and although they show promise, it has become clear that virtual reality and/or augmented reality devices alone do not adequately meet the demands of surgeons. The solution may lie in a hybrid technology known as mixed reality, which merges many virtual reality and augmented realty features. Microsoft's HoloLens, the first commercially available mixed reality device, provides surgeons intraoperative hands-free access to complex data, the real environment, and bidirectional communication. This report describes the use of HoloLens in the operating room to improve decision-making and surgical workflow. The pace of mixed reality-related technological development will undoubtedly be rapid in the coming years, and plastic surgeons are ideally suited to both lead and benefit from this advance.

  15. Professional Satisfaction Of Nurses Working In Operating Room Of A Hospital School

    Directory of Open Access Journals (Sweden)

    Jéssica Helena Dantas de Oliveira

    2017-05-01

    Full Text Available Objective: to characterize in a sociodemographic way the nursing staff of the surgical center; Check the degree of importance assigned to each component of satisfaction: autonomy, interaction, professional status, task requirements, organizational policies, and pay; verify job satisfaction perceived by nurses. Method: exploratory, descriptive, quantitative study, consisting of 9 nurses working in the operating room. The research project was approved by the CEP/HULW, CAAE Nº 24597513.2.0000.5183. Data were collected through questionnaires and then analyzed using descriptive statistics in SPSS 20. Results: We found that the standby component was considered the most important for job satisfaction and Professional Status least important. Conclusion: nurses have a low level of job satisfaction, impacting the performance of its activities. Descriptors: Job Satisfaction. Perioperative Nursing. Quality of Life.

  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

    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...... 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...

  17. 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.

  18. Gas sensor based on photoconductive electrospun titania nanofibres operating at room temperature

    Energy Technology Data Exchange (ETDEWEB)

    Zampetti, E., E-mail: emiliano.zampetti@artov.imm.cnr.it; Macagnano, A.; Bearzotti, A. [Consiglio Nazionale delle Ricerche, Istituto per la Microelettronica e Microsistemi (CNR IMM) (Italy)

    2013-04-15

    An important drawback of semiconductor gas sensors is their operating temperature that needs the use of heaters. To overcome this problem a prototyping sensor using titania nanofibres (with an average diameter of 50 nm) as sensitive membrane were fabricated by electrospinning directly on the transducer of the sensor. Exploiting the effect of titania photoconductivity, resistance variations upon gas interaction under continuous irradiation of ultra violet light were measured at room temperature. The resistive sensor response was evaluated towards ammonia, nitrogen dioxide and humidity. The sensor exhibited a higher response to ammonia than to nitrogen dioxide, especially for concentrations larger than 100 ppb. For 200 ppb of ammonia and nitrogen dioxide, the responses were {approx}2.8 and 1.5 %, respectively.

  19. Concept of polymer alloy electrolytes: towards room temperature operation of lithium-polymer batteries

    International Nuclear Information System (INIS)

    Noda, Kazuhiro; Yasuda, Toshikazu; Nishi, Yoshio

    2004-01-01

    Polymer alloy technique is very powerful tool to tune the ionic conductivity and mechanical strength of polymer electrolyte. A semi-interpenetrating polymer network (semi-IPN) polymer alloy electrolyte, composed of non-cross-linkable siloxane-based polymer and cross-linked 3D network polymer, was prepared. Such polymer alloy electrolyte has quite high ionic conductivity (more than 10 -4 Scm -1 at 25 o C and 10 -5 Scm -1 at -10 o C) and mechanical strength as a separator film with a wide electrochemical stability window. A lithium metal/semi-IPN polymer alloy solid state electrolyte/LiCoO 2 cell demonstrated promising cycle performance with room temperature operation of the energy density of 300Wh/L and better rate performance than conventional PEO based lithium polymer battery ever reported

  20. Leadership in Surgery for Public Sector Hospitals in Jamaica: Strategies for the Operating Room

    Science.gov (United States)

    Cawich, Shamir O; Harding, Hyacinth E; Crandon, Ivor W; McGaw, Clarence D; Barnett, Alan T; Tennant, Ingrid; Evans, Necia R; Martin, Allie C; Simpson, Lindberg K; Johnson, Peter

    2013-01-01

    The barriers to health care delivery in developing nations are many: underfunding, limited support services, scarce resources, suboptimal health care worker attitudes, and deficient health care policies are some of the challenges. The literature contains little information about health care leadership in developing nations. This discursive paper examines the impact of leadership on the delivery of operating room (OR) services in public sector hospitals in Jamaica. Delivery of OR services in Jamaica is hindered by many unique cultural, financial, political, and environmental barriers. We identify six leadership goals adapted to this environment to achieve change. Effective leadership must adapt to the environment. Delivery of OR services in Jamaica may be improved by addressing leadership training, workplace safety, interpersonal communication, and work environment and by revising existing policies. Additionally, there should be regular practice audits and quality control surveys. PMID:24355903

  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. Tale of two sites: capillary versus arterial blood glucose testing in the operating room.

    Science.gov (United States)

    Akinbami, Felix; Segal, Scott; Schnipper, Jeffrey L; Stopfkuchen-Evans, Matthias; Mills, Jonathan; Rogers, Selwyn O

    2012-04-01

    Pre- and intraoperative glycemic control has been identified as a putative target to improve outcomes of surgical patients. Glycemic control requires frequent monitoring of blood glucose levels with appropriate adjustments. However, monitoring standards have been called into question, especially in cases in which capillary samples are used. Point-of-care testing (POCT) using capillary samples and glucometers has been noted to give relatively accurate results for critically ill patients. However, the package inserts of most glucometers warn that they should not be used for patients in shock. This has led clinicians to doubt their accuracy in the operating room. The accuracy of capillary samples when tested in patients undergoing surgical procedures has not been proven. This study aims to determine the accuracy of intraoperative blood glucose values using capillary samples relative to arterial samples. A prospective study was conducted by collecting paired capillary and arterial samples of patients undergoing major operations at a tertiary medical center from August 2009 to May 2011. Subjects were a convenience sample of patients who had arterial lines and needed glucose testing while undergoing the procedure. Precision Xceed Pro (Abbott) handheld glucometers were used to obtain the blood glucose values. Our primary outcome of interest was the degree of correlation between capillary and arterial blood glucose values or the degree to which arterial glucose levels can be predicted by capillary glucose samples. We used linear regression and the Student t tests for statistical analyses. Seventy-two-paired samples were collected. Of the cases, 54% were major abdominal operations, whereas 24% were vascular operations. The mean values ± standard deviation for glucose levels were 146 ± 35 mg/dL (capillary) and 147 ± 36 mg/dL (arterial). The mean time ± standard deviation between the collection of both samples was 3.5 ± 1.3 minutes. The regression coefficient showed a

  3. 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.

  4. 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.

  5. Cost and Morbidity Analysis of Chest Port Insertion: Interventional Radiology Suite Versus Operating Room.

    Science.gov (United States)

    LaRoy, Jennifer R; White, Sarah B; Jayakrishnan, Thejus; Dybul, Stephanie; Ungerer, Dirk; Turaga, Kiran; Patel, Parag J

    2015-06-01

    To compare complications and cost, from a hospital perspective, of chest port insertions performed in an interventional radiology (IR) suite versus in surgery in an operating room (OR). This study was approved by an institutional review board and is HIPAA compliant. Medical records were retrospectively searched on consecutive chest port placement procedures, in the IR suite and the OR, between October 22, 2010 and February 26, 2013, to determine patients' demographic information and chest port-related complications and/or infections. A total of 478 charts were reviewed (age range: 21-85 years; 309 women, 169 men). Univariate and bivariate analyses were performed to identify risk factors associated with an increased complication rate. Cost data on 149 consecutive Medicare outpatients (100 treated in the IR suite; 49 treated in the OR) who had isolated chest port insertions between March 2012 and February 2013 were obtained for both the operative services and pharmacy. Nonparametric tests for heterogeneity were performed using the Kruskal-Wallis method. Early complications occurred in 9.2% (22 of 239) of the IR patients versus 13.4% (32 of 239) of the OR patients. Of the 478 implanted chest ports, 9 placed in IR and 18 placed in surgery required early removal. Infections from the ports placed in IR versus the OR were 0.25 versus 0.18 infections per 1000 catheters, respectively. Overall mean costs for chest port insertion were significantly higher in the OR, for both room and pharmacy costs (P chest ports in an OR setting was almost twice that of placement in the IR suite. Hospital costs to place a chest port were significantly lower in the IR suite than in the OR, whereas radiology and surgery patients did not show a significantly different rate of complications and/or infections. Copyright © 2015 American College of Radiology. Published by Elsevier Inc. All rights reserved.

  6. 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.

  7. Direct to Operating Room Trauma Resuscitation Decreases Mortality Among Severely Injured Children.

    Science.gov (United States)

    Wieck, Minna M; Cunningham, Aaron J; Behrens, Brandon; Ohm, Erika T; Maxwell, Bryan G; Hamilton, Nicholas A; Adams, M Christopher; Cole, Frederick J; Jafri, Mubeen A

    2018-03-16

    Expediting evaluation and intervention for severely injured patients has remained a mainstay of advanced trauma care. One technique, direct to operating room (DOR) resuscitation, for selective adult patients has demonstrated decreased mortality. We sought to investigate the application of this protocol in children. All DOR pediatric patients from 2009-2016 at a pediatric Level I Trauma Center were identified. DOR criteria included penetrating injury, chest injuries, amputations, significant blood loss, cardiopulmonary resuscitation, and surgeon discretion. Demographics, injury patterns, interventions, and outcomes were analyzed. Observed mortality was compared to expected mortality, calculated using Trauma Injury Severity Score (TRISS) methodology, with two-tailed t-tests and a p-value 15, 33% had GCS≤8, and 9% were hypotensive. The most commonly injured body regions were external (66%), head (34%), chest (30%), and abdomen (27%). Sixty-seven patients (82%) required emergent procedural intervention, most commonly wound exploration/repair (35%), central venous access (22%), tube thoracostomy (19%) and laparotomy (18%). Predictors of intervention were ISS>15 (odds ratio=14, p=0.013) and GCS<9 (odds ratio=8.5, p=0.044). The survival rate to discharge for DOR patients was 84% compared with an expected survival of 79% (TRISS) (p=0.4). The greatest improvement relative to expected mortality was seen in the subgroup with penetrating trauma (84.5% vs. 74.4%, p=0.002). A selective policy of resuscitating the most severely injured children in the operating room can decrease mortality. Patients suffering penetrating trauma with the highest ISS and diminished GCS have the greatest benefit. Trauma centers with appropriate resources should evaluate implementing similar policies. Level II. Diagnostic tests or criteria.

  8. A cost and time analysis of laryngology procedures in the endoscopy suite versus the operating room.

    Science.gov (United States)

    Hillel, Alexander T; Ochsner, Matthew C; Johns, Michael M; Klein, Adam M

    2016-06-01

    To assess the costs, charges, reimbursement, and efficiency of performing awake laryngology procedures in an endoscopy suite (ES) compared with like procedures performed in the operating room (OR). Retrospective review of billing records. Cost, charges, and reimbursements for the hospital, surgeon, and anesthesiologist were compared between ES injection laryngoplasty and laser excision procedures and matched case controls in the OR. Time spent in 1) the preoperative unit, 2) the operating or endoscopy suite, and 3) recovery unit were compared between OR and ES procedures. Hospital expenses were significantly less for ES procedures when compared to OR procedures. Reimbursement was similar for ES and OR injection laryngoplasty, though greater for OR laser excisions. Net balance (reimbursement-expenses) was greater for ES procedures. A predictive model of payer costs over a 3-year period showed similar costs for ES and OR laser procedures and reduced costs for ES compared to OR injection laryngoplasty. Times spent preoperatively and the procedure were significantly less for ES procedures. For individual laryngology procedures, the ES reduces time and costs compared to the OR, increasing otolaryngologist and hospital efficiency. This reveals cost and time savings of ES injection laryngoplasty, which occurs at a similar frequency as OR injection laryngoplasty. Given the increased frequency for ES laser procedures, total costs are similar for ES and OR laser excision of papilloma, which usually require repeated procedures. When regulated office space is unavailable, endoscopy rooms represent an alternative setting for unsedated laryngology procedures. NA Laryngoscope, 126:1385-1389, 2016. © 2015 The American Laryngological, Rhinological and Otological Society, Inc.

  9. Evaluation of awareness concerning fire prevention and control methods among personnel of operating room in a hospital

    Directory of Open Access Journals (Sweden)

    2012-09-01

    Full Text Available Introduction: There are risk of fire accidents in Operating rooms during surgery. Experts estimate annually around 100 fire accidents occur in the operating rooms of United States’s hospitals. 10 to 20 of these accidents lead to severe injuries and about 1 to 2 lead to death. Despite such accidents rarely happen, but they can lead to serious injury or death of patients. .Material and Method: This Cross-sectional questionnaire based survey was conducted among several hospitals belonged to Shiraz University of Medical Sciences. In this study, all personnel of operating rooms were investigated. Questionnaire were used to collect information and the chi-square test was applied to examine the relationship between the Knowledge of operating room personels on fire prevention and control methods, jobs and work experience. For statistical analysis SPSS14 were used. .Result: In this study from 220 participants, about 19.72% had full awareness, 19.62% had partial knowledge, 19.37% had low awareness and 40.97% had no knowledge on fire prevention methods, concerning fire control methods. However, 76% of the participate had full awareness and 24% had no knowledge. Test result Statistically showed that the relationship between the awareness of operating room personnel to fire control methods and work experience were significant (P-value <0.05. But, the relationship between the knowledge of operating room to fire control methods and the type of jobs were not significant. Also no significant relationship were found between the level of awareness in operating room personnel to fire prevention methods, work experience and job title. .Conclusion: The results indicated that the operating room staff awareness of fire prevention and control methods are low. The results also showed that awareness of fires prevention are lower than the awareness of fire control among the studied personel. Regarding to the potential risk of fire in the operating room, it is suggested

  10. High-integrity databases for helicopter operations

    Science.gov (United States)

    Pschierer, Christian; Schiefele, Jens; Lüthy, Juerg

    2009-05-01

    Helicopter Emergency Medical Service missions (HEMS) impose a high workload on pilots due to short preparation time, operations in low level flight, and landings in unknown areas. The research project PILAS, a cooperation between Eurocopter, Diehl Avionics, DLR, EADS, Euro Telematik, ESG, Jeppesen, the Universities of Darmstadt and Munich, and funded by the German government, approached this problem by researching a pilot assistance system which supports the pilots during all phases of flight. The databases required for the specified helicopter missions include different types of topological and cultural data for graphical display on the SVS system, AMDB data for operations at airports and helipads, and navigation data for IFR segments. The most critical databases for the PILAS system however are highly accurate terrain and obstacle data. While RTCA DO-276 specifies high accuracies and integrities only for the areas around airports, HEMS helicopters typically operate outside of these controlled areas and thus require highly reliable terrain and obstacle data for their designated response areas. This data has been generated by a LIDAR scan of the specified test region. Obstacles have been extracted into a vector format. This paper includes a short overview of the complete PILAS system and then focus on the generation of the required high quality databases.

  11. 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.

  12. Data collection on the unit control room simulator as a method of operator reliability analysis

    International Nuclear Information System (INIS)

    Holy, J.

    1998-01-01

    The report consists of the following chapters: (1) Probabilistic assessment of nuclear power plant operation safety and human factor reliability analysis; (2) Simulators and simulations as human reliability analysis tools; (3) DOE project for using the collection and analysis of data from the unit control room simulator in human factor reliability analysis at the Paks nuclear power plant; (4) General requirements for the organization of the simulator data collection project; (5) Full-scale simulator at the Nuclear Power Plants Research Institute in Trnava, Slovakia, used as a training means for operators of the Dukovany NPP; (6) Assessment of the feasibility of quantification of important human actions modelled within a PSA study by employing simulator data analysis; (7) Assessment of the feasibility of using the various exercise topics for the quantification of the PSA model; (8) Assessment of the feasibility of employing the simulator in the analysis of the individual factors affecting the operator's activity; and (9) Examples of application of statistical methods in the analysis of the human reliability factor. (P.A.)

  13. To compare methods used in our operating room for alleviating tourniquet pain

    International Nuclear Information System (INIS)

    Ali, M. A.; Siddiqui, S.

    2013-01-01

    Objective: To compare the efficacy of different methods used to alleviate tourniquet pain in operating rooms as well as assess their effect on post-operative pain. Methods: The study was conducted at the Aga Khan University Hospital, Karachi from June to August 2010. All patients who came for elective orthopaedic surgery in whom a tourniquet application was planned were included in the study. Information was collected through a pre-designed data form. Qualitative data was expressed as mean standard deviation, while qualitative data was presented as frequency and percentage. Results: In the 106 patients studied, opioids were administered in 90 (85%) cases, paracetamol in 73 (69%) and non-steroidal anti-inflammatory drugs in 11 (10.4%) cases. Efficacy was determined by means of the effect on the blood pressure and heart rate of the patient before and after the drug administration. Intravenous paracetamol was found to be the most effective in reducing both blood pressure and heart rate (p<0.001). The effect on post-operative pain was insignificant. Conclusions: Intravenous paracetamol is a cost-effective and safe analgesic, especially when combined with a multi-modal regimen, and has potential effect on the alleviation of tourniquet pain. (author)

  14. Operating room scheduling and surgeon assignment problem under surgery durations uncertainty.

    Science.gov (United States)

    Liu, Hongwei; Zhang, Tianyi; Luo, Shuai; Xu, Dan

    2017-12-29

    Scientific management methods are urgently needed to balance the demand and supply of heath care services in Chinese hospitals. Operating theatre is the bottleneck and costliest department. Therefore, the surgery scheduling is crucial to hospital management. To increase the utilization and reduce the cost of operating theatre, and to improve surgeons' satisfaction in the meantime, a practical surgery scheduling which could assign the operating room (OR) and surgeon for the surgery and sequence surgeries in each OR was provided for hospital managers. Surgery durations were predicted by fitting the distributions. A two-step mixed integer programming model considering surgery duration uncertainty was proposed, and sample average approximation (SAA) method was applied to solve the model. Durations of various surgeries were log-normal distributed respectively. Numerical experiments showed the model and method could get good solutions with different sample sizes. Real-life constraints and duration uncertainty were considered in the study, and the model was also very applicable in practice. Average overtime of each OR was reducing and tending to be stable with the number of surgeons increasing, which is a discipline for OR management.

  15. Design of the control room of the N4-type PWR: main features and feedback operating experience

    International Nuclear Information System (INIS)

    Peyrouton, J.M.; Guillas, J.; Nougaret, Ch.

    2004-01-01

    This article presents the design, specificities and innovating features of the control room of the N4-type PWR. A brief description of control rooms of previous 900 MW and 1300 MW -type PWR allows us to assess the change. The design of the first control room dates back to 1972, at that time 2 considerations were taken into account: first the design has to be similar to that of control rooms for thermal plants because plant operators were satisfied with it and secondly the normal operating situation has to be privileged to the prejudice of accidental situations just as it was in a thermal plant. The turning point was the TMI accident that showed the weight of human factor in accidental situations in terms of pilot team, training, procedures and the ergonomics of the work station. The impact of TMI can be seen in the design of 1300 MW-type PWR. In the beginning of the eighties EDF decided to launch a study for a complete overhaul of the control room concept, the aim was to continue reducing the human factor risk and to provide a better quality of piloting the plant in any situation. The result is the control room of the N4-type PWR. Today the cumulated feedback experience of N4 control rooms represents more than 20 years over a wide range of situations from normal to incidental, a survey shows that the N4 design has fulfilled its aims. (A.C.)

  16. On Univalence Criteria for a General Integral Operator

    Directory of Open Access Journals (Sweden)

    Vasile Marius Macarie

    2012-01-01

    Full Text Available We consider a new general integral operator, and we give sufficient conditions for the univalence of this integral operator in the open unit disk of the complex plane. Several consequences of the main results are also shown.

  17. Univalence Conditions Related to a General Integral Operator

    Directory of Open Access Journals (Sweden)

    Nicoleta Breaz

    2012-01-01

    Full Text Available We consider a general integral operator based on two types of analytic functions, namely, regular functions and, respectively, functions having a positive real part. Some univalence conditions for this integral operator are obtained.

  18. Use of a Hybrid Operating Room to Improve Reduction of Syndesmotic Injuries in Ankle Fractures: A Case Report.

    Science.gov (United States)

    Cancienne, Jourdan M; Crosen, Matelin P; Yarboro, Seth R

    2016-01-01

    Ankle fractures are one of the most common orthopedic injuries requiring operative treatment, and approximately 1 in 4 ankle fractures will have an associated distal tibiofibular syndesmosis disruption. Syndesmotic reduction is crucial to restoring ankle function and preventing the development of arthritis. The hybrid operating room provides 3-dimensional intraoperative imaging capabilities that can enable the surgeon to ensure the syndesmosis is appropriately reduced, particularly by comparing it with the contralateral ankle. By confirming the syndesmosis reduction intraoperatively, the risk of a return to the operating room for revision surgery is decreased. Copyright © 2015 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

  19. Ergonomic design of an overview display in a nuclear power plant control room. Integrated process status overview

    International Nuclear Information System (INIS)

    Bouwmeester, R.

    1996-03-01

    A major modification of the Borssele Nuclear Power Plant (NPP), scheduled in 1997, includes the installation of a new Integrated Process Status Overview (IPSO) display in the extensively modified control room. The IPSO display is to promote effective communications among all individuals present in the control room with a clear overview of the main process systems. The flexible LCD rear-projection technique is selected for the replacement of the existing IPSO display with engraved process symbols and hard-wired LEDs. The relation between the IPSO display and the CRT based Process Presentation System (PPS) is described after an elaborate introduction to the nuclear technology and the modification project. The followed IPSO design methodology includes interviews with all IPSO user groups to acquire their experience and comment on the current IPSO in order to enhance the functionality and the acceptance of the new IPSO graphics. The ergonomic design requirements for the new IPSO display concern both generic aspects of information presentation on human-machine interfaces, as well as specific issues related to the selected LCD rear-projection technique. Intermediate stages in the design of the IPSO graphics are outlined as well as the results of the concept evaluation by the user groups. For special interest the functionality of a three dimensional (3-D) display was explored. The design study concludes with a 'final' IPSO graphics design to be used for evaluations on the control room simulator. The presentation of one graphic was found to be most appropriate with adjustment of colour (grey) of components and systems which do not need to operate during the current process conditions or plant mode. (orig.)

  20. 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.

  1. Review of the Operability for the Components Under the Loss of the HVAC System of the Pump Room

    International Nuclear Information System (INIS)

    Hwang Mee Jeong; Yoon, Churl; Yang, Joon Eon; Park, Joo Hwan

    2005-01-01

    In this paper, we estimated the temperature of the pump rooms and reviewed the operability of the components under the loss of the HVAC (Heating, Ventilation, and Air Condition) system. The issues relevant to the HVAC system in the PSA (Probabilistic Safety Assessment) FT (Fault Tree) model are as follows: does the loss of the HVAC system bring about a function failure of other components?. Can the operator take action to reduce the temperature of the room in case of a HVAC function failure?. At present we do not know whether a component will lose its function or not under the loss of the HVAC. ASME Standard describes that a recovery action can be credited if the related recovery action is included in the procedure or there are similar recovery experiences in the plant. However, there is no description about the recovery action of the HVAC in the EOP (Emergency Operation Procedure) of the UCN3, 4 under the situation of a loss of the HVAC. Even though we consider this assumption positively, it would be limited to the rooms such as the Switchgear Room, Inverter Room, and Main Control Room etc. where a real recovery action can be performed easily. However, if we consider the HVAC failure in the PSA FT model according to the above background, the problem is that the unavailability induced from the loss of a HVAC is highly unrealistically. From a viewpoint of the PSA, it is not true that the related system always fails even though the HVAC system fails. Therefore, we reviewed the necessity of the HVAC model through the identification of the operable temperature of the components' within the pump room and the change of the temperature of the pump room under the situation of a loss of the HVAC system

  2. Integrated Interface Strategy toward Room Temperature Solid-State Lithium Batteries.

    Science.gov (United States)

    Ju, Jiangwei; Wang, Yantao; Chen, Bingbing; Ma, Jun; Dong, Shanmu; Chai, Jingchao; Qu, Hongtao; Cui, Longfei; Wu, Xiuxiu; Cui, Guanglei

    2018-04-25

    Solid-state lithium batteries have drawn wide attention to address the safety issues of power batteries. However, the development of solid-state lithium batteries is substantially limited by the poor electrochemical performances originating from the rigid interface between solid electrodes and solid-state electrolytes. In this work, a composite of poly(vinyl carbonate) and Li 10 SnP 2 S 12 solid-state electrolyte is fabricated successfully via in situ polymerization to improve the rigid interface issues. The composite electrolyte presents a considerable room temperature conductivity of 0.2 mS cm -1 , an electrochemical window exceeding 4.5 V, and a Li + transport number of 0.6. It is demonstrated that solid-state lithium metal battery of LiFe 0.2 Mn 0.8 PO 4 (LFMP)/composite electrolyte/Li can deliver a high capacity of 130 mA h g -1 with considerable capacity retention of 88% and Coulombic efficiency of exceeding 99% after 140 cycles at the rate of 0.5 C at room temperature. The superior electrochemical performance can be ascribed to the good compatibility of the composite electrolyte with Li metal and the integrated compatible interface between solid electrodes and the composite electrolyte engineered by in situ polymerization, which leads to a significant interfacial impedance decrease from 1292 to 213 Ω cm 2 in solid-state Li-Li symmetrical cells. This work provides vital reference for improving the interface compatibility for room temperature solid-state lithium batteries.

  3. Management of Surgical Instruments Package in the Operating Room%手术室器械包的管理

    Institute of Scientific and Technical Information of China (English)

    刘萍; 张娟; 潘文琴; 戴榕娟

    2017-01-01

    Objective Cleaning, maintenance, disinfection and preoperative preparation of surgical instruments in the past are done by the operation room, but with the development of China's hospitals and national new surgical management practices, certain progress has been achieved in the integrated management of surgical instruments for the operating rooms.Practical experiences in the management were discussed in this article.MethodsIn order to improve work quality and work efficiency and to reduce cost in the management of instruments in operation room, we analyzed the current situation of the management of equipment in the operation room based on the reality and tried to find out the method of surgical instrument package innovation, including the production of classification photo album for the surgical instrument package, paper list of all equipments, and production of marking cards for the instruments that can stand the sterilization under high pressure.Results and Conclusion From the implementation point of view, the total loss rate is reduced from the original 0.43% to 0.14%,and the loss rate of the micro device from 0.725% to 0.23%, effectively reducing the device losses.Great progress has been made in the use of the new methods, the quality of the personnel, in charge of the surgical instruments, classification management and the mapping and marking of cards.%目的 手术器械包的清洗、保养、消毒灭菌和术前准备工作以往均由手术室自行完成,随着我国医院洁净手术室的发展和国家新手术管理规范的实施,手术器械管理实施手供一体化相关工作逐步取得一定的效果.方法 分析手术器械包的管理及成效,改善工作品质,提高工作效率,降低成本等情况;找出手术器械包新的管理方法,包括制作手术器械包分类相册,以及手术器械包中加入纸质的器械清单、制作能够高压灭菌的金属器械牌等手段.结果与结论 从实施后统计数

  4. Integrated safeguards and facility design and operations

    International Nuclear Information System (INIS)

    Tape, J.W.; Coulter, C.A.; Markin, J.T.; Thomas, K.E.

    1987-01-01

    The integration of safeguards functions to deter or detect unauthorized actions by an insider requires the careful communication and management of safeguards-relevant information on a timely basis. The traditional separation of safeguards functions into physical protection, materials control, and materials accounting often inhibits important information flows. Redefining the major safeguards functions as authorization, enforcement, and verification, and careful attention to management of information from acquisition to organization, to analysis, to decision making can result in effective safeguards integration. The careful inclusion of these ideas in facility designs and operations will lead to cost-effective safeguards systems. The safeguards authorization function defines, for example, personnel access requirements, processing activities, and materials movements/locations that are permitted to accomplish the mission of the facility. Minimizing the number of authorized personnel, limiting the processing flexibility, and maintaining up-to-date flow sheets will facilitate the detection of unauthorized activities. Enforcement of the authorized activities can be achieved in part through the use of barriers, access control systems, process sensors, and health and safety information. Consideration of safeguards requirements during facility design can improve the enforcement function. Verification includes the familiar materials accounting activities as well as auditing and testing of the other functions

  5. Integration of a browser based operator manual in the system environment of a process computer system

    International Nuclear Information System (INIS)

    Weber, Andreas; Erfle, Robert; Feinkohl, Dirk

    2012-01-01

    The integration of a browser based operator manual in the system environment of a process computer system is an optimization of the operating procedure in the control room and a safety enhancement due to faster and error-free access to the manual contents. Several requirements by the authorities have to be fulfilled: the operating manual has to be available as hard copy, the format has to be true to original, protection against manipulation has to be provided, the manual content of the browser-based version and the hard copy have to identical, and the display presentation has to be consistent with ergonomic principals. The integration of the on-line manual in the surveillance process computer system provides the operator with the relevant comments to the surveillance signal. The described integration of the on-line manual is an optimization of the operator's everyday job with respect to ergonomics and safety (human performance).

  6. 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.

  7. Reducing Operating Room Turnover Time for Robotic Surgery Using a Motor Racing Pit Stop Model.

    Science.gov (United States)

    Souders, Colby P; Catchpole, Ken R; Wood, Lauren N; Solnik, Jonathon M; Avenido, Raymund M; Strauss, Paul L; Eilber, Karyn S; Anger, Jennifer T

    2017-08-01

    Operating room (OR) turnover time, time taken between one patient leaving the OR and the next entering, is an important determinant of OR utilization, a key value metric for hospital administrators. Surgical robots have increased the complexity and number of tasks required during an OR turnover, resulting in highly variable OR turnover times. We sought to streamline the turnover process and decrease robotic OR turnover times and increase efficiency. Direct observation of 45 pre-intervention robotic OR turnovers was performed. Following a previously successful model for handoffs, we employed concepts from motor racing pit stops, including briefings, leadership, role definition, task allocation and task sequencing. Turnover task cards for staff were developed, and card assignments were distributed for each turnover. Forty-one cases were observed post-intervention. Average total OR turnover time was 99.2 min (95% CI 88.0-110.3) pre-intervention and 53.2 min (95% CI 48.0-58.5) at 3 months post-intervention. Average room ready time from when the patient exited the OR until the surgical technician was ready to receive the next patient was 42.2 min (95% CI 36.7-47.7) before the intervention, which reduced to 27.2 min at 3 months (95% CI 24.7-29.7) post-intervention (p system changes are needed to capitalize on that result. Pit stop and other high-risk industry models may inform approaches to the management of tasks and teams.

  8. Improve and reinforced aspects associated with the behaviour of control-room operators of NNPPS

    International Nuclear Information System (INIS)

    Lucas, A. S.

    2002-01-01

    This article is devoted to explain the training experience carried out in Tecnatom, in order to improve and reinforce aspects associated with the behavior of Control-Room (CR) Operators of Nuclear Power Stations (Reactor Operators/Supervisors) in the training Simulator-setting, centered mainly in aspects of: Team Work, Effective Communications, Use of Procedures, Self checking, Decisions Making, Diagnosis, Leadership, Motivation and other attitudes to promote during the shift. The experience has been positive for everybody and the results welcomed by the participants, who have fed back the process positively. The experienced training cycle is new and it basically consists in developing, in the Simulator setting and, with a specific programme, behaviors in such a way that the participants reflect and, consider as theirs, the expectations and criteria developed on the previously points, where the role of the instructor Assistant, is only to guide, help, observe, challenge, encourage, create possibilities, motivate, suggest and reflect in such a way that the participant may be able to learn by himself. (Author)

  9. 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.

  10. The perceived urgency of auditory warning alarms used in the hospital operating room is inappropriate.

    Science.gov (United States)

    Mondor, Todd A; Finley, G Allen

    2003-03-01

    To examine the perceived urgency of 13 auditory warning alarms commonly occurring in the hospital operating room. Undergraduate students, who were naïve with respect to the clinical situation associated with the alarms, judged perceived urgency of each alarm on a ten-point scale. The perceived urgency of the alarms was not consistent with the actual urgency of the clinical situation that triggers it. In addition, those alarms indicating patient condition were generally perceived as less urgent than those alarms indicating the operation of equipment. Of particular interest were three sets of alarms designed by equipment manufacturers to indicate specific priorities for action. Listeners did not perceive any differences in the urgency of the 'information only', 'medium' and 'high' priority alarms of two of the monitors with all judged as low to moderate in urgency. In contrast, the high priority alarm of the third monitor was judged as significantly more urgent than its low and medium urgency counterparts. The alarms currently in use do not convey the intended sense of urgency to naïve listeners, and this holds even for two sets of alarms designed specifically by manufacturers to convey different levels of urgency.

  11. [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.

  12. 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.

  13. 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.

  14. 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.

  15. J-integral flaw resistance curves of Incoloy 800H at room temperature

    International Nuclear Information System (INIS)

    Krompholz, K.; Ullrich, G.

    1985-08-01

    J-integral experiments at room temperature were performed on three point bend type specimens of the iron-nickel base alloy Incoloy 800H with a/w-ratios of 0.3 and 0.5. These experiments are performed within the frame of a round robin test in cooperation with German- and US-partners. The tests were performed in stroke control as well as in load control. Three different evaluation procedures were applied: -The signal of the dc potential drop technique -The partial unloading procedure and -The multiple specimen technique. Evaluating the dc potential drop technique and the multiple specimen method delivered reasonable results while the partial unloading procedure failed. The different methods are discussed and fractographic results support these results under discussion. (author)

  16. The technology of integrated surveillance and control system for the advanced control room

    International Nuclear Information System (INIS)

    Song, Soon Ja; Kim, Jung Taek; Hwang, Inn Koo; Kwon, Kee Choon; Ham, Chang Sik

    1998-05-01

    The size and complexity of nuclear power plants have increased significantly in recent. It has important to take both operator's experience and plants for maintaining safety. The role of this system is to gather each computerized operating support system (COSS) having the certain functions, to integrate the summary of high level information through COSS and process, and to display information on the MMI. This kind of functions is requested to develop its own modules in Korea as their events and tasks is run through the intelligent coordinator. Therefore, this survey is suggested to develop the prototype which is integrated with several developed subsystems in KAERI even though a standard guideline and requirement is not existed yet, after reviewing the similar system to be implemented and integrated several hetero subsystems. (author). 24 refs., 5 tabs., 22 figs

  17. [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.

  18. BEYOND INTEGRATED SYSTEM VALIDATION: USE OF A CONTROL ROOM TRAINING SIMULATOR FOR PROOF-OF-CONCEPT INTERFACE DEVELOPMENT

    Energy Technology Data Exchange (ETDEWEB)

    Ronald Boring; Vivek Agarwal

    2012-07-01

    This paper provides background on a reconfigurable control room simulator for nuclear power plants. The main control rooms in current nuclear power plants feature analog technology that is growing obsolete. The need to upgrade control rooms serves the practical need of maintainability as well as the opportunity to implement newer digital technologies with added functionality. There currently exists no dedicated research simulator for use in human factors design and evaluation activities for nuclear power plants in the US. The new research simulator discussed in this paper provides a test bed in which operator performance on new control room concepts can be benchmarked against existing control rooms and in which new technologies can be validated for safety and usability prior to deployment.

  19. Dissecting Attending Surgeons' Operating Room Guidance: Factors That Affect Guidance Decision Making.

    Science.gov (United States)

    Chen, Xiaodong Phoenix; Williams, Reed G; Smink, Douglas S

    2015-01-01

    The amount of guidance provided by the attending surgeon in the operating room (OR) is a key element in developing residents' autonomy. The purpose of this study is to explore factors that affect attending surgeons' decision making regarding OR guidance provided to the resident. We used video-stimulated recall interviews (VSRI) throughout this 2-phase study. In Phase 1, 3 attending surgeons were invited to review separately 30 to 45 minute video segments of their prerecorded surgical operations to explore factors that influenced their OR guidance decision making. In Phase 2, 3 attending surgeons were observed and documented in the OR (4 operations, 341min). Each operating surgeon reviewed their videotaped surgical performance within 5 days of the operation to reflect on factors that affected their decision making during the targeted guidance events. All VSRI were recorded. Thematic analysis and manual coding were used to synthesize and analyze data from VSRI transcripts, OR observation documents, and field notes. A total of 255 minutes of VSRI involving 6 surgeons and 7 surgical operations from 5 different procedures were conducted. A total of 13 guidance decision-making influence factors from 4 categories were identified (Cohen's κ = 0.674): Setting (case schedule and patient morbidity), content (procedure attributes and case progress), resident (current competency level, trustworthiness, self-confidence, and personal traits), and attending surgeon (level of experience, level of comfort, preferred surgical technique, OR training philosophy, and responsibility as surgeon). A total of 5 factors (case schedule, patient morbidity, procedure attributes, resident current competency level, and trustworthiness) influenced attending surgeons' pre-OR guidance plans. "OR training philosophy" and "responsibility as surgeon" were anchor factors that affected attending surgeons' OR guidance decision-making patterns. Surgeons' OR guidance decision making is a dynamic process

  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. [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.

  2. Consequences and potential problems of operating room outbursts and temper tantrums by surgeons.

    Science.gov (United States)

    Jacobs, George B; Wille, Rosanne L

    2012-01-01

    Anecdotal tales of colorful temper tantrums and outbursts by surgeons directed at operating room nurses and at times other health care providers, like residents and fellows, are part of the history of surgery and include not only verbal abuse but also instrument throwing and real harassment. Our Editor-in-Chief, Dr. Nancy Epstein, has made the literature review of "Are there truly any risks and consequences when spine surgeons mistreat their predominantly female OR nursing staff/colleagues, and what can we do about it?," an assigned topic for members of the editorial board as part of a new category entitled Ethical Note for our journal. This is a topic long overdue and I chose to research it. There is no medical literature to review dealing with nurse abuse. To research this topic, one has to involve business, industry, educational institutions, compliance standards and practices, and existing state and federal laws. I asked Dr. Rosanne Wille to co-author this paper since, as the former Dean of Nursing and then Provost and Senior Vice President for Academic Affairs at a major higher educational institution, she had personal experience with compliance regulations and both sexual harassment and employment discrimination complaints, to make this review meaningful. A review of the existing business practices and both state and federal laws strongly suggests that although there has not been any specific legal complaint that is part of the public record, any surgeon who chooses to act out his or her frustration and nervous energy demands by abusing co-workers on the health care team, and in this case specifically operating room personnel, is taking a chance of making legal history with financial outcomes which only an actual trial can predict or determine. Even more serious outcomes of an out-of-control temper tantrum and disruptive behavior can terminate, after multiple hearings and appeals, in adverse decisions affecting hospital privileges. Surgeons who abuse other

  3. Integrating Solar PV in Utility System Operations

    Energy Technology Data Exchange (ETDEWEB)

    Mills, A.; Botterud, A.; Wu, J.; Zhou, Z.; Hodge, B-M.; Heany, M.

    2013-10-31

    This study develops a systematic framework for estimating the increase in operating costs due to uncertainty and variability in renewable resources, uses the framework to quantify the integration costs associated with sub-hourly solar power variability and uncertainty, and shows how changes in system operations may affect these costs. Toward this end, we present a statistical method for estimating the required balancing reserves to maintain system reliability along with a model for commitment and dispatch of the portfolio of thermal and renewable resources at different stages of system operations. We estimate the costs of sub-hourly solar variability, short-term forecast errors, and day-ahead (DA) forecast errors as the difference in production costs between a case with “realistic” PV (i.e., subhourly solar variability and uncertainty are fully included in the modeling) and a case with “well behaved” PV (i.e., PV is assumed to have no sub-hourly variability and can be perfectly forecasted). In addition, we highlight current practices that allow utilities to compensate for the issues encountered at the sub-hourly time frame with increased levels of PV penetration. In this analysis we use the analytical framework to simulate utility operations with increasing deployment of PV in a case study of Arizona Public Service Company (APS), a utility in the southwestern United States. In our analysis, we focus on three processes that are important in understanding the management of PV variability and uncertainty in power system operations. First, we represent the decisions made the day before the operating day through a DA commitment model that relies on imperfect DA forecasts of load and wind as well as PV generation. Second, we represent the decisions made by schedulers in the operating day through hour-ahead (HA) scheduling. Peaking units can be committed or decommitted in the HA schedules and online units can be redispatched using forecasts that are improved

  4. Operative outcomes of conventional specimen radiography versus in-operating room specimen radiography in radioactive seed-localized segmental mastectomies.

    Science.gov (United States)

    Rhee, Daniel; Pockaj, Barbara; Wasif, Nabil; Stucky, Chee-Chee; Pizzitola, Victor; Giurescu, Marina; Patel, Bhavika; McCarthy, Janice; Gray, Richard

    2018-01-01

    In-operating room specimen radiography (ORSR) has not been studied among women undergoing radioactive seed localization (RSL) for breast cancer surgery and had the potential to decrease operative time and perhaps improve intraoperative margin management. One hundred consecutive RSL segmental mastectomies among 98 patients using ORSR were compared to 100 consecutive segmental mastectomies among 98 patients utilizing conventional radiography (CSR) prior to the initiation of ORSR from December 2013 to January 2015 after radioactive seed localization. Final pathologic margins were considered to be 10 mm for all cases of no residual disease after biopsy or neoadjuvant therapy, but such patients were excluded from analyses involving tumor size. All patients' specimens were subjected to intraoperative pathologic consultation in addition to ORSR or CSR. The median age of the cohort was 65 years (range 36-97), and the median tumor size was 1 cm. There were no differences between the ORSR and CSR groups in age, tumor size, percentage of cases with only DCIS, and percentage of cases with microcalcifications. The ORSR group had a statistically significant lower BMI. Mean operative time from cut-to-close was not significantly different (ORSR 77 min, SD 24.8 vs CSR 76 min, SD 24.8, p = 0.75). There was no statistical difference in mean closest final pathologic margin (4.99 mm, SD 3.3 vs 4.88 mm, SD 3.5, p = 0.9). The percentage undergoing intraoperative margin re-excision (ORSR 40%, CR 47%, p = 0.31) and the mean total number of margins excised intraoperatively (ORSR 0.9, CR 1.0 p = 0.65) were similar. The rate of any margin CSR; this difference was not statistically significant (p = 0.25). The mean ratio of segmental mastectomy volume to maximum tumor diameter was less for ORSR (82.7cm2 vs 139.4cm2, p = 0.014). ORSR for RSL breast surgery, in the setting of routine intraoperative pathology consultation, does not significantly impact operative time, the rate or

  5. Assessment of safety levels in operation rooms at two major tertiary care public hospitals of Karachi. Safe surgery saves life

    International Nuclear Information System (INIS)

    Minhas, M.S.; Muzzammil, M.; Effendi, J.

    2017-01-01

    The objectives of this study are to determine the knowledge and attitude towards surgical safety among the health care professionals including surgeons, anaesthetist, hospital administrators, and operation room personnel and raise awareness towards the importance of safe surgery. Method: A pilot cross- sectional study of 543 healthcare providers working in the operating rooms and the surgical intensive care units was conducted in two tertiary care hospitals, within a study period of one month. A structured questionnaire was constructed and an informed verbal consent was taken. The questionnaire was then distributed; data collected and analysed on SPSS 20.0. Results: A total of 543 respondents participated in the study out of which there were 375 (69%) men and 168 (31%) women. The ages ranged between 23-58 years, mean 40.5+-24.74. There were 110 (20.25%) surgeons, 58 (10.68%) anaesthetist, 132 (24.30%) trainees, 125 (23.02%) technicians, and were 118 (21.73%) nurses. The question regarding briefing operation room personnel is important for patient safety was agreed by 532 (98%) respondents. Amongst the respondents, 239 (44%) did not feel safe to be operated in their own setup. Team communication improvement through the check list implementation was agreed by 483 (89%) respondents. 514 (94.7%) opted for the checklist to be used while they are being operated. That operation room personnel frequently disregard established protocols was agreed by 374 (69%) respondents. 193 (35.54%) of the respondents stated that it is difficult for them to speak up in the or if they perceive a problem with patient care. Conclusion: Operation room personnel were not aware of several important areas related to briefing, communication, safety attitude, following standard protocols and use of WHO Surgical Safety check list. A pre-post intervention study should be conducted after formal introduction of the Checklist. Successful implementation will require taking all stake holders on board

  6. Risk and safety of pediatric sedation/anesthesia for procedures outside the operating room.

    Science.gov (United States)

    Cravero, Joseph P

    2009-08-01

    Sedation and anesthesia outside the operating room represents a rapidly growing field of practice that involves a number of different specialty providers including anesthesiology. The literature surrounding this work is found in a variety of journals - many outside anesthesiology. This review is intended to inform readers about the current status of risk and safety involving sedation/anesthesia for tests and minor procedures utilizing a wide range of sources. Two large database studies have helped to define the frequency and nature of adverse events in pediatric sedation/anesthesia practice from a multispecialty perspective. A number of papers describing respiratory and hemodynamic aspects of dexmedetomidine sedation have also been published. Finally, a number of studies relating to training sedation providers, reporting of sedation adverse events, sedation for vulnerable populations, and (in particular) ketamine sedation adverse respiratory events have also come to light. The latest publications continue to document a relatively low risk to pediatric sedation yet also warn us about the potential adverse events in this field. The results help to define competencies required to deliver pediatric sedation and make this practice even safer. Particularly interesting are new jargon and methodologies for defining adverse events and the use of new methods for training sedation providers.

  7. Using human factors engineering to improve patient safety in the cardiovascular operating room.

    Science.gov (United States)

    Gurses, Ayse P; Martinez, Elizabeth A; Bauer, Laura; Kim, George; Lubomski, Lisa H; Marsteller, Jill A; Pennathur, Priyadarshini R; Goeschel, Chris; Pronovost, Peter J; Thompson, David

    2012-01-01

    Despite significant medical advances, cardiac surgery remains a high risk procedure. Sub-optimal work system design characteristics can contribute to the risks associated with cardiac surgery. However, hazards due to work system characteristics have not been identified in the cardiovascular operating room (CVOR) in sufficient detail to guide improvement efforts. The purpose of this study was to identify and categorize hazards (anything that has the potential to cause a preventable adverse patient safety event) in the CVOR. An interdisciplinary research team used prospective hazard identification methods including direct observations, contextual inquiry, and photographing to collect data in 5 hospitals for a total 22 cardiac surgeries. We performed thematic analysis of the qualitative data guided by a work system model. 60 categories of hazards such as practice variations, high workload, non-compliance with evidence-based guidelines, not including clinicians' in medical device purchasing decisions were found. Results indicated that hazards are common in cardiac surgery and should be eliminated or mitigated to improve patient safety. To improve patient safety in the CVOR, efforts should focus on creating a culture of safety, increasing compliance with evidence based infection control practices, improving communication and teamwork, and designing better tools and technologies through partnership among all stakeholders.

  8. [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.

  9. Attending Surgeons' Leadership Style in the Operating Room: Comparing Junior Residents' Experiences and Preferences.

    Science.gov (United States)

    Kissane-Lee, Nicole A; Yule, Steven; Pozner, Charles N; Smink, Douglas S

    2016-01-01

    Recent studies have focused on surgeons' nontechnical skills in the operating room (OR), especially leadership. In an attempt to identify trainee preferences, we explored junior residents' opinions about the OR leadership style of teaching faculty. Overall, 20 interns and 20 mid-level residents completed a previously validated survey on the style of leadership they encountered, the style they preferred to receive, and the style they personally employed in the OR. In all, 4 styles were explored; authoritative: leader makes decisions and communicates them firmly; explanatory: leader makes decisions promptly, but explains them fully; consultative: leader consults with trainees when important decisions are made, and delegative: leader puts the problem before the group and makes decisions by majority opinion. Comparisons were completed using chi-square analysis. Junior resident preference for leadership style of attending surgeons in the OR differed from what they encountered. Overall, 62% of residents encountered an authoritative leadership style; however, only 9% preferred this (p styles (41%). Preferences differed by postgraduate year. Although 40% of interns preferred a consultative style, 50% of mid-level residents preferred explanatory leadership. Junior resident preference of leadership style in the OR differs from what they actually encounter. This has the potential to create unwanted tension and may erode team performance. Awareness of this difference provides an opportunity for an educational intervention directed at both attendings and trainees. Copyright © 2015 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

  10. 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.

  11. Applied patent RFID systems for building reacting HEPA air ventilation system in hospital operation rooms.

    Science.gov (United States)

    Lin, Jesun; Pai, Jar-Yuan; Chen, Chih-Cheng

    2012-12-01

    RFID technology, an automatic identification and data capture technology to provide identification, tracing, security and so on, was widely applied to healthcare industry in these years. Employing HEPA ventilation system in hospital is a way to ensure healthful indoor air quality to protect patients and healthcare workers against hospital-acquired infections. However, the system consumes lots of electricity which cost a lot. This study aims to apply the RFID technology to offer a unique medical staff and patient identification, and reacting HEPA air ventilation system in order to reduce the cost, save energy and prevent the prevalence of hospital-acquired infection. The system, reacting HEPA air ventilation system, contains RFID tags (for medical staffs and patients), sensor, and reacting system which receives the information regarding the number of medical staff and the status of the surgery, and controls the air volume of the HEPA air ventilation system accordingly. A pilot program was carried out in a unit of operation rooms of a medical center with 1,500 beds located in central Taiwan from Jan to Aug 2010. The results found the air ventilation system was able to function much more efficiently with less energy consumed. Furthermore, the indoor air quality could still keep qualified and hospital-acquired infection or other occupational diseases could be prevented.

  12. Evaluation of radiation dose during sent-graft treatment using a hybrid operating room system

    International Nuclear Information System (INIS)

    Haga, Yoshihiro; Kaga, Yuji; Chida, Koichi

    2015-01-01

    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. (author)

  13. 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.

  14. 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. Copyright © 2014 King Saud Bin Abdulaziz University for Health Sciences. Published by Elsevier Ltd. All rights reserved.

  15. Role of communication systems in coordinating supervising anesthesiologists' activities outside of operating rooms.

    Science.gov (United States)

    Smallman, Bettina; Dexter, Franklin; Masursky, Danielle; Li, Fenghua; Gorji, Reza; George, Dave; Epstein, Richard H

    2013-04-01

    Theoretically, communication systems have the potential to increase the productivity of anesthesiologists supervising anesthesia providers. We evaluated the maximal potential of communication systems to increase the productivity of anesthesia care by enhancing anesthesiologists' coordination of care (activities) among operating rooms (ORs). At hospital A, data for 13,368 pages were obtained from files recorded in the internal alphanumeric text paging system. Pages from the postanesthesia care unit were processed through a numeric paging system and thus not included. At hospital B, in a different US state, 3 of the authors categorized each of 898 calls received using the internal wireless audio system (Vocera(®)). Lower and upper 95% confidence limits for percentages are the values reported. At least 45% of pages originated from outside the ORs (e.g., 20% from holding area) at hospital A and at least 56% of calls (e.g., 30% administrative) at hospital B. In contrast, requests from ORs for urgent presence of the anesthesiologist were at most 0.2% of pages at hospital A and 1.8% of calls at hospital B. Approximately half of messages to supervising anesthesiologists are for activity originating outside the ORs being supervised. To use communication tools to increase anesthesia productivity on the day of surgery, their use should include a focus on care coordination outside ORs (e.g., holding area) and among ORs (e.g., at the control desk).

  16. Perceptions of communication in the operating room: a pilot survey study.

    Science.gov (United States)

    Wyche, Melville Q; Lemay, Allyson C; Tiemann, Dawn D; Billeaud, Craig B; Ma, John G; Elhassan, Amir O; Fox, Mary E; Diaz, James H; Bell, Laura J; Beutler, Sascha S; Urman, Richard D; Kaye, Alan David

    2015-01-01

    An operating room (OR) environment is challenging and complicated. At any given time, several vital tasks are being performed by skilled individuals, including physicians, nurses, and ancillary staff. There is a potential for multifactorial mistakes; many arise because of communication issues. To evaluate the current state of perceptions of interdisciplinary communication in an OR setting, a survey was developed and administered to four academic residency training departments of anesthesiology in a single U.S. state. The results of this survey show that perceived poor communication within the OR leads to a lack of emphasis on a multidisciplinary approach to patient care in the OR. Survey data can be used internally to identify shortcomings in communication at a facility, to stress the importance of communication, and to serve as a powerful education tool to potentially improve patient care. Through this type of survey, which emphasizes communication in the OR, stakeholders can work more effectively to improve patient care and decrease adverse outcomes in the hospital environment.

  17. The efficiency of a dedicated staff on operating room turnover time in hand surgery.

    Science.gov (United States)

    Avery, Daniel M; Matullo, Kristofer S

    2014-01-01

    To evaluate the effect of orthopedic and nonorthopedic operating room (OR) staff on the efficiency of turnover time in a hand surgery practice. A total of 621 sequential hand surgery cases were retrospectively reviewed. Turnover times for sequential cases were calculated and analyzed with regard to the characteristics of the OR staff being primarily orthopedic or nonorthopedic. A total of 227 turnover times were analyzed. The average turnover time with all nonorthopedic staff was 31 minutes, for having only an orthopedic surgical technician was 32 minutes, for having only an orthopedic circulator was 25 minutes, and for having both an orthopedic surgical technician and a circulator was 20 minutes. Statistical significance was seen when comparing only an orthopedic surgical technician versus both an orthopedic circulator and a surgical technician and when comparing both nonorthopedic staff versus both an orthopedic circulator and a surgical technician. OR efficiency is being increasingly evaluated for its effect on hospital revenue and OR staff costs. Reducing turnover time is one aspect of a multifaceted solution in increasing efficiency. Our study showed that, for hand surgery, orthopedic-specific staff can reduce turnover time. Economic/Decision Analysis III. Copyright © 2014 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

  18. Facile fabrication of CNT-based chemical sensor operating at room temperature

    Science.gov (United States)

    Sheng, Jiadong; Zeng, Xian; Zhu, Qi; Yang, Zhaohui; Zhang, Xiaohua

    2017-12-01

    This paper describes a simple, low cost and effective route to fabricate CNT-based chemical sensors, which operate at room temperature. Firstly, the incorporation of silk fibroin in vertically aligned CNT arrays (CNTA) obtained through a thermal chemical vapor deposition (CVD) method makes the direct removal of CNT arrays from substrates without any rigorous acid or sonication treatment feasible. Through a simple one-step in situ polymerization of anilines, the functionalization of CNT arrays with polyaniline (PANI) significantly improves the sensing performance of CNT-based chemical sensors in detecting ammonia (NH3) and hydrogen chloride (HCl) vapors. Chemically modified CNT arrays also show responses to organic vapors like menthol, ethyl acetate and acetone. Although the detection limits of chemically modified CNT-based chemical sensors are of the same orders of magnitudes reported in previous studies, these CNT-based chemical sensors show advantages of simplicity, low cost and energy efficiency in preparation and fabrication of devices. Additionally, a linear relationship between the relative sensitivity and concentration of analyte makes precise estimations on the concentrations of trace chemical vapors possible.

  19. Assessment of operating room airflow using air particle counts and direct observation of door openings.

    Science.gov (United States)

    Teter, Jonathan; Guajardo, Isabella; Al-Rammah, Tamrah; Rosson, Gedge; Perl, Trish M; Manahan, Michele

    2017-05-01

    The role of the operating room (OR) environment has been thought to contribute to surgical site infection rates. The quality of OR air, disruption of airflow, and other factors may increase contamination risks. We measured air particulate counts (APCs) to determine if they increased in relation to traffic, door opening, and other common activities. During 1 week, we recorded APCs in 5-minute intervals and movement of health care workers. Trained observers recorded information about traffic, door openings, job title of the opener, and the reason for opening. At least 1 OR door was open during 47% of all readings. There were 13.4 door openings per hour during cases. Door opening rates ranged from 0.19-0.28 per minute. During this time, a total of 660 air measurements were obtained. The mean APCs were 9,238 particles (95% confidence interval [CI], 5,494- 12,982) at baseline and 14,292 particles (95% CI, 12,382-16,201) during surgery. Overall APCs increased 13% when either door was opened (P opening. We observed numerous instances of verbal communication and equipment movement. Improving efficiency of communication and equipment can aid in reduction of traffic. Further study is needed to examine links between microbiologic sampling, outcome data, and particulate matter to enable study of risk factors and effects of personnel movement. Copyright © 2017 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

  20. Prominent attractive qualities of nurses' work in operating room departments: A questionnaire study.

    Science.gov (United States)

    Björn, Catrine; Josephson, Malin; Wadensten, Barbro; Rissén, Dag

    2015-01-01

    The shortage of nurses in operating room departments (ORs) in Sweden and other countries can lead to reduced capacity and quality in healthcare, as well as more intense work for those on the job. Little is known about what nurses in ORs perceive as crucial for their workplace to be attractive. To capture attractive qualities of nurses' work in Swedish ORs and take a first step in the process of adapting the Attractive Work Questionnaire for use in a health care context. The Attractive Work Questionnaire was completed by 147 (67% ) nurses in four Swedish ORs. Principal Component Analyses (PCA) were performed to determine the underlying structure of the data. Factors contributing to job attractiveness identified in the area "work conditions" were: relations, leadership, equipment, salary, organisation, physical work environment, location, and working hours; in the area "work content": mental work, autonomy and work rate; and in the area "job satisfaction": status and acknowledgement. The PCA showed consistency with the original Attractive Work Questionnaire, Cronbach's alpha varied between 0.57-0.90. Prominent attractive qualities for nurses' work in Swedish ORs were possible to identify through the Attractive Work Questionnaire and the results suggest that the questionnaire can be useful in a health care context.

  1. 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.

  2. Development of an integrated decision support system to aid cognitive activities of operators

    International Nuclear Information System (INIS)

    Lee, Seung Jun; Seong, Poong Hyun

    2007-01-01

    As digital and computer technologies have grown, Human-Machine Interfaces (HMIs) have evolved. In safety-critical systems, especially in Nuclear Power Plants (NPPs), HMIs are important for reducing operational costs, the number of necessary operators, and the probability of accident occurrence. Efforts have been made to improve Main Control Room (MCR) interface design and to develop automated or decision support systems to ensure convenient operation and maintenance. In this paper, an integrated decision support system to aid operator cognitive processes is proposed for advanced MCRs of future NPPs. This work suggests the design concept of a decision support system which accounts for an operator's cognitive processes. The proposed system supports not only a particular task, but also the entire operation process based on a human cognitive process model. In this paper, the operator's operation processes are analyzed according to a human cognitive process model and appropriate support systems that support each cognitive process activity are suggested

  3. 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.

  4. Assessment of New Components to be integrated in the LHC Room Temperature Vacuum System

    CERN Document Server

    Bregliozzi, G; Chiggiato, P

    2014-01-01

    Integration of new equipment in the long straight sections (LSS) of the LHC must be compatible with the TiZrV non-evaporable getter thin film that coats most of the 6-km-long room-temperature beam pipes. This paper focus on two innovative accelerator devices to be installed in the LSS during the long shutdown 1 (LS1): the beam gas vertex (BGV) and a beam bending experiment using a crystal collimator (LUA9). The BGV necessitates a dedicated pressure bump, generated by local gas injection, in order to create the required rate of inelastic beam-gas interactions. The LAU9 experiments aims at improving beam cleaning efficiency with the use of a crystal collimator. New materials like fibre optics, piezoelectric components, and glues are proposed in the original design of the two devices. The integration feasibility of these set-ups in the LSS is presented. In particular outgassing tests of special components, X-rays photoelectron spectroscopy analysis of NEG coating behaviour in presence of glues during bake-out, a...

  5. 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

  6. Evaluation of exposure limits to toxic gases for nuclear reactor control room operators

    International Nuclear Information System (INIS)

    Mahlum, D.D.; Sasser, L.B.

    1991-07-01

    We have evaluated ammonia, chlorine, Halon (actually a generic name for several halogenated hydro-carbons), and sulfur dioxide for their possible effects during an acute two-minute exposure in order to derive recommendations for maximum exposure levels. To perform this evaluation, we conducted a search to find the most pertinent literature regarding toxicity in humans and in experimental animals. Much of the literature is at least a decade old, not an unexpected finding since acute exposures are less often performed now than they were a few years ago. In most cases, the studies did not specifically examine the effects of two-minute exposures; thus, extrapolations had to be made from studies of longer-exposure periods. Whenever possible, we gave the greatest weight to human data, with experimental animal data serving to strengthen the conclusion arrived at from consideration of the human data. Although certain individuals show hypersensitivity to materials like sulfur dioxide, we have not attempted to factor this information into the recommendations. After our evaluation of the data in the literature, we held a small workshop. Major participants in this workshop were three consultants, all of whom were Diplomates of the American Board of Toxicology, and staff from the Nuclear Regulatory Commission. Our preliminary recommendations for two-minute exposure limits and the rationale for them were discussed and consensus reached on final recommendations. These recommendations are: (1) ammonia-300 to 400-ppm; (2) chlorine-30 ppm; (3) Halon 1301-5%; Halon 1211-2%; and (4) sulfur dioxide-100 ppm. Control room operators should be able to tolerate two-minute exposures to these levels, don fresh-air masks, and continue to operate the reactor if the toxic material is eliminated, or safely shut down the reactor if the toxic gas remains. 96 refs., 9 tabs

  7. Hybrid operating room concept for combined diagnostics, intervention and surgery in acute type A dissection.

    Science.gov (United States)

    Tsagakis, Konstantinos; Konorza, Thomas; Dohle, Daniel Sebastian; Kottenberg, Eva; Buck, Thomas; Thielmann, Matthias; Erbel, Raimund; Jakob, Heinz

    2013-02-01

    In acute type A dissection (AAAD), it is commonly decided to carry out immediate surgical repair without invasive diagnostics. The hybrid operating room (Hybrid OR) concept encompasses simultaneous haemodynamic control, non-invasive and invasive diagnostics and immediate surgical and/or interventional treatment. Results over a seven-year period are presented here. From March 2004 to March 2011, 1883 cardiological and surgical patients were treated in a Hybrid OR. Of these, 124 patients (age 60 ± 13, 64% male) diagnosed with AAAD were operated upon. External computed tomography (CT) was available for 87% (108/124) of cases and angiography in 15% (19/124). Preoperative transoesophageal echocardiography (TEE) was done in all patients and angiography in 57% (71/124). Surgery was performed without angiography in 27% (34/124), of which 14% (17/124) was due to shock. Postoperative control angiography followed in 18% (22/124) due to suspected ongoing malperfusion. Preoperative angiography was performed in 71 patients, and no angiography related complications were observed during the procedure. A total of 32% (23/71) of these underwent coronary artery bypass graft (CABG)--for newly-diagnosed coronary artery disease in 21% of cases and for coronary malperfusion in 11%. Visceral/peripheral malperfusion syndromes, necessitating primary endovascular intervention, were detected in 23% (16/71). Ascending aorta replacement was performed in 100% (124/124) of patients, arch replacement in 88% (109/124) and descending aorta repair in 35% (44/124). Five postoperative endovascular interventions became necessary due to persistent malperfusion. In-hospital mortality was 13% (12/90) in patients who had undergone preoperative invasive diagnostics and 24% (8/34) in patients who had not. The Hybrid OR concept enables the exact diagnosis of coronary status and downstream malperfusion sites and influences the design of surgical and/or endovascular treatment, without time delay and at

  8. Using three-dimension virtual reality main control room for integrated system validation and human reliability analysis

    International Nuclear Information System (INIS)

    Yang Chihwei; Cheng Tsungchieh

    2011-01-01

    This study proposes the performance assessment in three-dimension virtual reality (3D-VR) main control room (MCR). The assessment is conducted for integrated system validation (ISV) purposes, and also for human reliability analyses (HRA). This paper describes the latest developments in 3D-VR applications, designated for the familiarization with MCR, specially taking into account the ISV and HRA. The experiences in 3D-VR application, the benefits and advantages of use of VR in training and maintenances of MCR operators in the target NPP are equally presented in this paper. Results gathered from the performance measurement lead to hazard mitigation and reduces the risk of human error in the operation and maintenance of nuclear equipments. The latest developments in simulation techniques, including 3D presentation enhances the above mentioned benefits, brings the MCR simulators closer to reality. In the near future, this type of 3D solutions should be applied more and more often in the design of MCR simulators. The presented 3D-VR are related to the MCR in NPPs, but the concept of composition and navigation through the system's elements can be easily applied for the purpose of any type of technical equipment and shall contribute in a similar manner to hazard prevention. (author)

  9. Numbers of simultaneous turnovers calculated from anesthesia or operating room information management system data.

    Science.gov (United States)

    Dexter, Franklin; Marcon, Eric; Aker, John; Epstein, Richard H

    2009-09-01

    More personnel are needed to turn over operating rooms (ORs) promptly when there are more simultaneous turnovers. Anesthesia and/or OR information management system data can be analyzed statistically to quantify simultaneous turnovers to evaluate whether to add an additional turnover team. Data collected for each case at a six OR facility were room, date of surgery, time of patient entry into the OR, and time of patient exit from the OR. The number of simultaneous turnovers was calculated for each 1 min of 122 4-wk periods. Our end point was the reduction in the daily minutes of simultaneous turnovers exceeding the number of teams caused by the addition of a team. Increasing from two turnover teams to three teams reduced the mean daily minutes of simultaneous turnovers exceeding the numbers of teams by 19 min. The ratio of 19 min to 8 h valued the time of extra personnel as 4.0% of the time of OR staff, surgeons, and anesthesia providers. Validity was suggested by other methods of analyses also suggesting staffing for three simultaneous turnovers. Discrete-event simulation showed that the reduction in daily minutes of turnover times from the addition of a team would likely match or exceed the reduction in the daily minutes of simultaneous turnovers exceeding the numbers of teams. Confidence intervals for daily minutes of turnover times achieved by increasing from two to three teams were calculated using successive 4-wk periods. The distribution was sufficiently close to normal that accurate confidence intervals could be calculated using Student's t distribution (Lilliefors' test P = 0.58). Analysis generally should use 13 4-wk periods as increasing the number of periods from 6 to 13 significantly reduced the coefficient of variation of the averages but not increasing the number of periods from 6 to 9 or from 9 to 13. The number of simultaneous turnovers can be calculated for each 1 min over 1 yr. The reduction in the daily minutes of simultaneous turnovers

  10. Operating Room Environment Control. Part A: a Valve Cannister System for Anesthetic Gas Adsorption. Part B: a State-of-the-art Survey of Laminar Flow Operating Rooms. Part C: Three Laminar Flow Experiments

    Science.gov (United States)

    Meyer, J. S.; Kosovich, J.

    1973-01-01

    An anesthetic gas flow pop-off valve canister is described that is airtight and permits the patient to breath freely. Once its release mechanism is activated, the exhaust gases are collected at a hose adapter and passed through activated coal for adsorption. A survey of laminar air flow clean rooms is presented and the installation of laminar cross flow air systems in operating rooms is recommended. Laminar flow ventilation experiments determine drying period evaporation rates for chicken intestines, sponges, and sections of pig stomach.

  11. Operation room tool handling and miscommunication scenarios: an object-process methodology conceptual model.

    Science.gov (United States)

    Wachs, Juan P; Frenkel, Boaz; Dori, Dov

    2014-11-01

    Errors in the delivery of medical care are the principal cause of inpatient mortality and morbidity, accounting for around 98,000 deaths in the United States of America (USA) annually. Ineffective team communication, especially in the operation room (OR), is a major root of these errors. This miscommunication can be reduced by analyzing and constructing a conceptual model of communication and miscommunication in the OR. We introduce the principles underlying Object-Process Methodology (OPM)-based modeling of the intricate interactions between the surgeon and the surgical technician while handling surgical instruments in the OR. This model is a software- and hardware-independent description of the agents engaged in communication events, their physical activities, and their interactions. The model enables assessing whether the task-related objectives of the surgical procedure were achieved and completed successfully and what errors can occur during the communication. The facts used to construct the model were gathered from observations of various types of operations miscommunications in the operating room and its outcomes. The model takes advantage of the compact ontology of OPM, which is comprised of stateful objects - things that exist physically or informatically, and processes - things that transform objects by creating them, consuming them or changing their state. The modeled communication modalities are verbal and non-verbal, and errors are modeled as processes that deviate from the "sunny day" scenario. Using OPM refinement mechanism of in-zooming, key processes are drilled into and elaborated, along with the objects that are required as agents or instruments, or objects that these processes transform. The model was developed through an iterative process of observation, modeling, group discussions, and simplification. The model faithfully represents the processes related to tool handling that take place in an OR during an operation. The specification is at

  12. Safety in the operating room during orthopedic trauma surgery-incidence of adverse events related to technical equipment and logistics

    NARCIS (Netherlands)

    van Delft, E. A. K.; Schepers, T.; Bonjer, H. J.; Kerkhoffs, G. M. M. J.; Goslings, J. C.; Schep, N. W. L.

    2017-01-01

    Safety in the operating room is widely debated. Adverse events during surgery are potentially dangerous for the patient and staff. The incidence of adverse events during orthopedic trauma surgery is unknown. Therefore, we performed a study to quantify the incidence of these adverse events. Primary

  13. 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

  14. The thermal comfort, the indoor environment control, and the energy consumption in three types of operating rooms

    NARCIS (Netherlands)

    Melhado, M.D.A.; Beyer, P.O.; Hensen, J.L.M.; Siqueira, L.F.G.

    2005-01-01

    This research investigated the influence of three layouts of operating rooms on the indoor environment control, on thermal comfort and on energy consumption. It was used the EnergyPlus software. The parameters of the environment were described in accordance with standards. The three layouts had

  15. Development of an On-Line Surgeon-Specific Operating Room Time Prediction System (Experience with the Michigan Surgical Monitors)

    OpenAIRE

    Brown, Allan C.D.; Schmidt, Nancy M.

    1984-01-01

    The development of a micro-computer application for the on-line prediction of surgeon-specific operating room time using an IBM - PCXT is described. The reasons leading to the project, together with an assessment of the Condor 20 relational database management system as the basis for the application are discussed.

  16. Work Environment in the Operating Room during Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy : Factors Influencing Choice of Protective Equipment

    OpenAIRE

    Näslund Andréasson, Sara

    2011-01-01

    Peritoneal carcinomatosis (PC) is a common metastatic manifestation of both gastrointestinal and gynecological malignancies. Curative modes of treatment are cytoreductive surgery (CRS) combined with intraoperative hyperthermic intraperitoneal chemotherapy (HIPEC). Surgeons and operating room (OR) staff attending these procedures are exposed to chemotherapy and electrocautery smoke. Heated chemotherapy (HIPEC) may vaporize and become inhaled by those administering it and, moreover, large quant...

  17. Risk factors and musculoskeletal complaints in non-specialized nurses, IC nurses, operation room nurses, and X-ray technologists

    NARCIS (Netherlands)

    Bos, Ellen; Krol, Boudien; van der Star, Lex; Groothoff, Johan

    Objectives: To gain more insight into the prevalence rates of musculoskeletal complaints of neck-shoulder and low back and to determine the relation between physical and psychosocial work-related risk factors and the complaints mentioned in non-specialized nurses, operation room nurses, Intensive

  18. IMPROVING CONTROL ROOM DESIGN AND OPERATIONS BASED ON HUMAN FACTORS ANALYSES OR HOW MUCH HUMAN FACTORS UPGRADE IS ENOUGH ?

    Energy Technology Data Exchange (ETDEWEB)

    HIGGINS,J.C.; OHARA,J.M.; ALMEIDA,P.

    2002-09-19

    THE JOSE CABRERA NUCLEAR POWER PLANT IS A ONE LOOP WESTINGHOUSE PRESSURIZED WATER REACTOR. IN THE CONTROL ROOM, THE DISPLAYS AND CONTROLS USED BY OPERATORS FOR THE EMERGENCY OPERATING PROCEDURES ARE DISTRIBUTED ON FRONT AND BACK PANELS. THIS CONFIGURATION CONTRIBUTED TO RISK IN THE PROBABILISTIC SAFETY ASSESSMENT WHERE IMPORTANT OPERATOR ACTIONS ARE REQUIRED. THIS STUDY WAS UNDERTAKEN TO EVALUATE THE IMPACT OF THE DESIGN ON CREW PERFORMANCE AND PLANT SAFETY AND TO DEVELOP DESIGN IMPROVEMENTS.FIVE POTENTIAL EFFECTS WERE IDENTIFIED. THEN NUREG-0711 [1], PROGRAMMATIC, HUMAN FACTORS, ANALYSES WERE CONDUCTED TO SYSTEMATICALLY EVALUATE THE CR-LA YOUT TO DETERMINE IF THERE WAS EVIDENCE OF THE POTENTIAL EFFECTS. THESE ANALYSES INCLUDED OPERATING EXPERIENCE REVIEW, PSA REVIEW, TASK ANALYSES, AND WALKTHROUGH SIMULATIONS. BASED ON THE RESULTS OF THESE ANALYSES, A VARIETY OF CONTROL ROOM MODIFICATIONS WERE IDENTIFIED. FROM THE ALTERNATIVES, A SELECTION WAS MADE THAT PROVIDED A REASONABLEBALANCE BE TWEEN PERFORMANCE, RISK AND ECONOMICS, AND MODIFICATIONS WERE MADE TO THE PLANT.

  19. Strategies of modeling the cognitive tasks of human operators for accident scenarios in nuclear power plant control rooms

    International Nuclear Information System (INIS)

    Cheon, Se Woo; Sur, Sang Moon; Lee, Yong Hee; Lee, Jeong Wun

    1993-01-01

    This paper presents the development strategies of cognitive task network modeling for accident scenarios in nuclear power plant control rooms. Task network modeling is used to provide useful predictions of operator's performance times and error rates, based upon plant procedures and/or control room changes. Two accident scenarios, small-break loss of coolant accident (LOCA) and steam generator tube rupture (SGTR), are selected for task simulation. To obtain the input data for the model, task elements are extracted by the task analysis of emergency operating procedures. The input data include task performance time, communication ink, panel location, component operating mode, and data for performance shaping factors (PSFs). Operator's verbs are categorized according to the elements of cognitive behavior. The simulation of the task network for the small-break LOCA scenario is presented in this paper. (Author)

  20. Evaluation of Knowledge, Attitude and Practice of Personnel in Operating Room, ERCP, and ESWL Towards Radiation Hazards and Protection

    Directory of Open Access Journals (Sweden)

    Shima Moshfegh

    2017-07-01

    Full Text Available Background Recently, X-rays radiation hazards rise with the exposure of patients and personnel. Exposure of people to radiation in the operating rooms is an important problem to study the safety of personnel and patients. To date, few studies are accomplished to evaluate knowledge, attitude, and practice (KAP among personnel in hospitals. The current study aimed at evaluating KAP level of radiation hazards and protection amongst personnel in the operating room. Methods A questionnaire-based, cross sectional study was conducted in 11 provinces of Iran from 2014 to 2015. Respondents in the current study were 332 personnel of operating room, endoscopic retrograde cholangiopancreatography, and extracorporeal shock-wave lithotripsy. Demographic characteristics, as well as knowledge, attitude, and practice levels of operating room personnel were collected. The selected hospitals were 3 types (educational, non-educational, and private clinics located in 5 different regions of Iran (Tehran, Center, East, North, and West. Data were analyzed using SPSS version 16.0 and statistical analyses were accomplished with the one-way ANOVA. Results The current study results showed no statistically significant difference in the KAP level of operating room personnel towards radiation protection for both genders (P = 0.1, time since graduation (P = 0.4, and work experience (P = 0.1. According to the analyses, the highest level of KAP concerning radiation protection was observed in the personnel of private clinics (mean score = 53.60 and the lowest value was observed in non-educational hospitals (mean score = 45.61. Besides, the KAP level was significantly higher in the Northern region (P < 0.0001 and the lowest was observed in the hospital personnel of the Central region (mean score = 34.27. Conclusions The current study findings showed that the level of KAP regarding radiation protection among operating room personnel was inadequate and it is necessary to pay

  1. Simulation study on the operating characteristics of the heat pipe for combined evaporative cooling of computer room air-conditioning system

    International Nuclear Information System (INIS)

    Han, Zongwei; Zhang, Yanqing; Meng, Xin; Liu, Qiankun; Li, Weiliang; Han, Yu; Zhang, Yanhong

    2016-01-01

    In order to improve the energy efficiency of air conditioning systems in computer rooms, this paper proposed a new concept of integrating evaporative cooling air-conditioning system with heat pipes. Based on a computer room in Shenyang, China, a mathematical model was built to perform transient simulations of the new system. The annual dynamical performance of the new system was then compared with a typical conventional computer room air-conditioning system. The result showed that the new integrated air-conditioning system had better energy efficiency, i.e. 31.31% reduction in energy consumption and 29.49% increase in COP (coefficient of performance), due to the adoption of evaporative condenser and the separate type heat pipe technology. Further study also revealed that the incorporated heat pipes enabled a 36.88% of decrease in the operation duration of the vapor compressor, and a 53.86% of reduction for the activation times of the compressor, which could lead to a longer lifespan of the compressor. The new integrated evaporative cooling air-conditioning system was also tested in different climate regions. It showed that the energy saving of the new system was greatly affected by climate, and it had the best effect in cold and dry regions like Shenyang with up to 31.31% energy saving. In some warm and humid climate regions like Guangzhou, the energy saving could be achieved up to 13.66%. - Highlights: • A novel combined air-conditioning system of computer room is constructed. • The performance of the system and conventional system is simulated and compared. • The applicability of the system in different climate regions is investigated.

  2. Analysis of Communication between Main Control Room Operators in Decision-making Process in Steam Generator Tube Rupture Accident

    International Nuclear Information System (INIS)

    Petkov, M.; Petkov, G.

    2006-01-01

    The paper presents an investigation results for Main Control Room operators' reliability by Performance Evaluation of Teamwork method, based on FSS-1000 training archives in KNPP in case of Steam Generator Tube Rupture accident. The advantages of operators' teamwork are shown: a) group decision-making vs. individual one: b) positive influence of crew initiated communication consisting of orders and reports that are required by instruction. (authors)

  3. Multilevel interfaces for power plant control rooms I: An integrative review

    International Nuclear Information System (INIS)

    Vicente, K.J.

    1992-01-01

    Events that are unfamiliar to operators and that have not been anticipated by designers pose the greatest threat to system safety in nuclear power plants. The abstraction hierarchy has been proposed as a representation framework that can be adopted to design interfaces that support operators in dealing with these unanticipated events. This multilevel representation format represents a plant in terms of both physical and functional constraints. This article reviews, for the first time, the work that has been done in academia, industry, and research laboratories on multilevel interfaces based on the abstraction hierarchy. The review indicates that there are many degrees of freedom in designing an interface based on the abstraction hierarchy but that very little systematic work has been done in evaluating how best to deal with those degrees of freedom. As a result, there is very little defensible guidance to provide designers. As a first step in overcoming this barrier, a companion paper uses the results of the review presented here to develop a preliminary design space for multilevel interfaces based on the abstraction hierarchy. This space serves several worthwhile purposes relevant not only to research but also to design and regulation as well. Consequently this complementary set of papers should be of interest to researchers, designers, and regulators concerned with nuclear power-plant control rooms. 53 refs., 8 figs

  4. Clinical Efficacy of Simulated Vitreoretinal Surgery to Prepare Surgeons for the Upcoming Intervention in the Operating Room.

    Science.gov (United States)

    Deuchler, Svenja; Wagner, Clemens; Singh, Pankaj; Müller, Michael; Al-Dwairi, Rami; Benjilali, Rachid; Schill, Markus; Ackermann, Hanns; Bon, Dimitra; Kohnen, Thomas; Schoene, Benjamin; Koss, Michael; Koch, Frank

    2016-01-01

    To evaluate the efficacy of the virtual reality training simulator Eyesi to prepare surgeons for performing pars plana vitrectomies and its potential to predict the surgeons' performance. In a preparation phase, four participating vitreoretinal surgeons performed repeated simulator training with predefined tasks. If a surgeon was assigned to perform a vitrectomy for the management of complex retinal detachment after a surgical break of at least 60 hours it was randomly decided whether a warmup training on the simulator was required (n = 9) or not (n = 12). Performance at the simulator was measured using the built-in scoring metrics. The surgical performance was determined by two blinded observers who analyzed the video-recorded interventions. One of them repeated the analysis to check for intra-observer consistency. The surgical performance of the interventions with and without simulator training was compared. In addition, for the surgeries with simulator training, the simulator performance was compared to the performance in the operating room. Comparing each surgeon's performance with and without warmup trainingshowed a significant effect of warmup training onto the final outcome in the operating room. For the surgeries that were preceeded by the warmup procedure, the performance at the simulator was compared with the operating room performance. We found that there is a significant relation. The governing factor of low scores in the simulator were iatrogenic retinal holes, bleedings and lens damage. Surgeons who caused minor damage in the simulation also performed well in the operating room. Despite the large variation of conditions, the effect of a warmup training as well as a relation between the performance at the simulator and in the operating room was found with statistical significance. Simulator training is able to serve as a warmup to increase the average performance.

  5. Clinical Efficacy of Simulated Vitreoretinal Surgery to Prepare Surgeons for the Upcoming Intervention in the Operating Room.

    Directory of Open Access Journals (Sweden)

    Svenja Deuchler

    Full Text Available To evaluate the efficacy of the virtual reality training simulator Eyesi to prepare surgeons for performing pars plana vitrectomies and its potential to predict the surgeons' performance.In a preparation phase, four participating vitreoretinal surgeons performed repeated simulator training with predefined tasks. If a surgeon was assigned to perform a vitrectomy for the management of complex retinal detachment after a surgical break of at least 60 hours it was randomly decided whether a warmup training on the simulator was required (n = 9 or not (n = 12. Performance at the simulator was measured using the built-in scoring metrics. The surgical performance was determined by two blinded observers who analyzed the video-recorded interventions. One of them repeated the analysis to check for intra-observer consistency. The surgical performance of the interventions with and without simulator training was compared. In addition, for the surgeries with simulator training, the simulator performance was compared to the performance in the operating room.Comparing each surgeon's performance with and without warmup trainingshowed a significant effect of warmup training onto the final outcome in the operating room. For the surgeries that were preceeded by the warmup procedure, the performance at the simulator was compared with the operating room performance. We found that there is a significant relation. The governing factor of low scores in the simulator were iatrogenic retinal holes, bleedings and lens damage. Surgeons who caused minor damage in the simulation also performed well in the operating room.Despite the large variation of conditions, the effect of a warmup training as well as a relation between the performance at the simulator and in the operating room was found with statistical significance. Simulator training is able to serve as a warmup to increase the average performance.

  6. Scheduling elective surgeries: the tradeoff among bed capacity, waiting patients and operating room utilization using goal programming.

    Science.gov (United States)

    Li, Xiangyong; Rafaliya, N; Baki, M Fazle; Chaouch, Ben A

    2017-03-01

    Scheduling of surgeries in the operating rooms under limited competing resources such as surgical and nursing staff, anesthesiologist, medical equipment, and recovery beds in surgical wards is a complicated process. A well-designed schedule should be concerned with the welfare of the entire system by allocating the available resources in an efficient and effective manner. In this paper, we develop an integer linear programming model in a manner useful for multiple goals for optimally scheduling elective surgeries based on the availability of surgeons and operating rooms over a time horizon. In particular, the model is concerned with the minimization of the following important goals: (1) the anticipated number of patients waiting for service; (2) the underutilization of operating room time; (3) the maximum expected number of patients in the recovery unit; and (4) the expected range (the difference between maximum and minimum expected number) of patients in the recovery unit. We develop two goal programming (GP) models: lexicographic GP model and weighted GP model. The lexicographic GP model schedules operating rooms when various preemptive priority levels are given to these four goals. A numerical study is conducted to illustrate the optimal master-surgery schedule obtained from the models. The numerical results demonstrate that when the available number of surgeons and operating rooms is known without error over the planning horizon, the proposed models can produce good schedules and priority levels and preference weights of four goals affect the resulting schedules. The results quantify the tradeoffs that must take place as the preemptive-weights of the four goals are changed.

  7. 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.

  8. Weather information integration in transportation management center (TMC) operations.

    Science.gov (United States)

    2011-01-02

    This report presents the results of the third phase of an on-going FHWA study on weather integration in Transportation Management Center (TMC) operations. The report briefly describes the earlier phases of the integration study, summarizes the findin...

  9. Operating Reserves and Wind Power Integration: An International Comparison; Preprint

    Energy Technology Data Exchange (ETDEWEB)

    Milligan, M.; Donohoo, P.; Lew, D.; Ela, E.; Kirby, B.; Holttinen, H.; Lannoye, E.; Flynn, D.; O' Malley, M.; Miller, N.; Eriksen, P. B.; Gottig, A.; Rawn, B.; Gibescu, M.; Lazaro, E. G.; Robitaille, A.; Kamwa, I.

    2010-10-01

    This paper provides a high-level international comparison of methods and key results from both operating practice and integration analysis, based on an informal International Energy Agency Task 25: Large-scale Wind Integration.

  10. Oswer integrated health and safety standard operating practices. Directive

    International Nuclear Information System (INIS)

    1993-02-01

    The directive implements the OSWER (Office of Solid Waste and Emergency Response) Integrated Health and Safety Standards Operating Practices in conjunction with the OSHA (Occupational Safety and Health Act) Worker Protection Standards, replacing the OSWER Integrated Health and Safety Policy

  11. Concept of operations : Dallas Integrated Corridor Management (ICM) demonstration project.

    Science.gov (United States)

    2010-06-01

    This concept of operations (Con Ops) for the US-75 Integrated Corridor Management (ICM) Program has been developed as part of the US : Department of Transportation Integrated Corridor Management Initiative, which is an innovative research initiative ...

  12. Gestures for Picture Archiving and Communication Systems (PACS) operation in the operating room: Is there any standard?

    Science.gov (United States)

    Madapana, Naveen; Gonzalez, Glebys; Rodgers, Richard; Zhang, Lingsong; Wachs, Juan P

    2018-01-01

    Gestural interfaces allow accessing and manipulating Electronic Medical Records (EMR) in hospitals while keeping a complete sterile environment. Particularly, in the Operating Room (OR), these interfaces enable surgeons to browse Picture Archiving and Communication System (PACS) without the need of delegating functions to the surgical staff. Existing gesture based medical interfaces rely on a suboptimal and an arbitrary small set of gestures that are mapped to a few commands available in PACS software. The objective of this work is to discuss a method to determine the most suitable set of gestures based on surgeon's acceptability. To achieve this goal, the paper introduces two key innovations: (a) a novel methodology to incorporate gestures' semantic properties into the agreement analysis, and (b) a new agreement metric to determine the most suitable gesture set for a PACS. Three neurosurgical diagnostic tasks were conducted by nine neurosurgeons. The set of commands and gesture lexicons were determined using a Wizard of Oz paradigm. The gestures were decomposed into a set of 55 semantic properties based on the motion trajectory, orientation and pose of the surgeons' hands and their ground truth values were manually annotated. Finally, a new agreement metric was developed, using the known Jaccard similarity to measure consensus between users over a gesture set. A set of 34 PACS commands were found to be a sufficient number of actions for PACS manipulation. In addition, it was found that there is a level of agreement of 0.29 among the surgeons over the gestures found. Two statistical tests including paired t-test and Mann Whitney Wilcoxon test were conducted between the proposed metric and the traditional agreement metric. It was found that the agreement values computed using the former metric are significantly higher (p operation is higher than the previously reported metric (0.29 vs 0.13). This observation is based on the fact that the agreement focuses on main

  13. Space station operations task force. Panel 4 report: Management integration

    Science.gov (United States)

    1987-01-01

    The Management Integration Panel of the Space Station Operations Task Force was chartered to provide a structure and ground rules for integrating the efforts of the other three panels and to address a number of cross cutting issues that affect all areas of space station operations. Issues addressed include operations concept implementation, alternatives development and integration process, strategic policy issues and options, and program management emphasis areas.

  14. An integrated operation mode for green logistics of enterprises

    Institute of Scientific and Technical Information of China (English)

    Yu Chengxue; Wu Chunyou; Fan Yu

    2006-01-01

    The integrated operation mode of green logistics is a new enterprise's logistics operation and management mode concerning environment issues based on the traditional integrated mode. Through comparative study on the integrated operation mode of logistics based on self-operation, the operation mode of an integrated logistics of enterprises based on TPL, the green-supply chain management, and the operation mode of eco-industrial park (EIP), a relatively complete objective system structure is put forward for the integrated operation mode of green logistics of enterprises. Furthermore, the correspondent practical mode is also set up to help enterprises, especially for the manufacturing companies, not only improve the environment effectively, but support the technological framework for the enterprise's economic performance and social benefits in order to realize economic, social and environmental benefits are concerned.

  15. Research on Integration of NPP Operational Safety Management Performance Systems

    International Nuclear Information System (INIS)

    Chi, Miao; Shi, Liping

    2014-01-01

    The operational safety management of Nuclear Power Plants demands systematic planning and integrated control. NPPs are following the well-developed safety indicator systems proposed by IAEA Operational Safety Performance Indicator Programme, NRC Reactor Oversight Process or the other institutions. Integration of the systems is proposed to benefiting from the advantages of both systems and avoiding improper application into the real world. The authors analyzed the possibility and necessity for system integration, and propose an indicator system integrating method

  16. Training experience to improve and reinforce associated aspects to the control room operators' behaviour in the simulator setting

    International Nuclear Information System (INIS)

    Santiago Lucas Soriano, A.

    2002-01-01

    The experience, explained below, is based on the latest works carried out in TECNATOM, to improve the behaviour of the control room personnel, by an effective involvement of the operators in their own improvement, in which they create their own expectations and the instructors are only guides and advisors in a working place very close to the reality, that is, the simulator. The experience mainly deals with aspects such as: Teamwork, effective communications, use of procedures, self-checking, decision making, diagnose, motivation and other aspects that are present in the control room. (author)

  17. Lean principles optimize on-time vascular surgery operating room starts and decrease resident work hours.

    Science.gov (United States)

    Warner, Courtney J; Walsh, Daniel B; Horvath, Alexander J; Walsh, Teri R; Herrick, Daniel P; Prentiss, Steven J; Powell, Richard J

    2013-11-01

    Lean process improvement techniques are used in industry to improve efficiency and quality while controlling costs. These techniques are less commonly applied in health care. This study assessed the effectiveness of Lean principles on first case on-time operating room starts and quantified effects on resident work hours. Standard process improvement techniques (DMAIC methodology: define, measure, analyze, improve, control) were used to identify causes of delayed vascular surgery first case starts. Value stream maps and process flow diagrams were created. Process data were analyzed with Pareto and control charts. High-yield changes were identified and simulated in computer and live settings prior to implementation. The primary outcome measure was the proportion of on-time first case starts; secondary outcomes included hospital costs, resident rounding time, and work hours. Data were compared with existing benchmarks. Prior to implementation, 39% of first cases started on time. Process mapping identified late resident arrival in preoperative holding as a cause of delayed first case starts. Resident rounding process inefficiencies were identified and changed through the use of checklists, standardization, and elimination of nonvalue-added activity. Following implementation of process improvements, first case on-time starts improved to 71% at 6 weeks (P = .002). Improvement was sustained with an 86% on-time rate at 1 year (P < .001). Resident rounding time was reduced by 33% (from 70 to 47 minutes). At 9 weeks following implementation, these changes generated an opportunity cost potential of $12,582. Use of Lean principles allowed rapid identification and implementation of perioperative process changes that improved efficiency and resulted in significant cost savings. This improvement was sustained at 1 year. Downstream effects included improved resident efficiency with decreased work hours. Copyright © 2013 Society for Vascular Surgery. Published by Mosby, Inc. All

  18. In-office drainage of sinus Mucoceles: An alternative to operating-room drainage.

    Science.gov (United States)

    Barrow, Emily M; DelGaudio, John M

    2015-05-01

    Endoscopic drainage has become the standard of care for the treatment of mucoceles. In many patients this can be performed in the office. This study reviews our experience with in-office endoscopic mucocele drainage. Retrospective chart review. A retrospective review of one surgeon's experience with in-office endoscopic drainage of sinus mucoceles between 2006 and 2014 was performed. Charts were reviewed for patient demographics, previous surgery, mucocele location, bone erosion, and outcomes. Thirty-two patients underwent 36 in-office drainage procedures. All procedures were performed under topical/local anesthesia. The mean age was 55 years (range, 17-92 years). The mean follow-up time was 444 days. Fifty-five percent had previous sinus surgery. The primary sinus involved was the frontal (12), anterior (11), posterior ethmoid (six), maxillary (four), and sphenoid (two). Bone erosion was noted to be present on computed tomography in 18 mucoceles (51%) (16 orbital, seven skull-base). All mucoceles were successfully accessed in the office with the exception of one, which was aborted due to neo-osteogenesis. Five patients (14% of mucoceles) required additional surgery, two for mucocele recurrence and three for septated mucoceles not completely drained in the office. No treatment complications occurred. All but one patient preferred in-office to operating-room drainage. In-office drainage of sinus mucoceles is well tolerated by patients, with high success and low complication rates, even in large mucoceles with bone erosion. The presence of septations and neo-osteogenesis reduce the likelihood of complete drainage and are relative contraindications. Orbital and skull base erosion are not contraindications. 4. © 2014 The American Laryngological, Rhinological and Otological Society, Inc.

  19. Teaching operating room conflict management to surgeons: clarifying the optimal approach.

    Science.gov (United States)

    Rogers, David; Lingard, Lorelei; Boehler, Margaret L; Espin, Sherry; Klingensmith, Mary; Mellinger, John D; Schindler, Nancy

    2011-09-01

    Conflict management has been identified as an essential competence for surgeons as they work in operating room (OR) teams; however, the optimal approach is unclear. Social science research offers two alternatives, the first of which recommends that task-related conflict be managed using problem-solving techniques while avoiding relationship conflict. The other approach advocates for the active management of relationship conflict as it almost always accompanies task-related conflict. Clarity about the optimal management strategy can be gained through a better understanding of conflict transformation, or the inter-relationship between conflict types, in this specific setting. The purpose of this study was to evaluate conflict transformation in OR teams in order to clarify the approach most appropriate for an educational conflict management programme for surgeons. A constructivist grounded theory approach was adopted to explore the phenomenon of OR team conflict. Narratives were collected from focus groups of OR nurses and surgeons at five participating centres. A subset of these narratives involved transformation between and within conflict types. This dataset was analysed. The results confirm that misattribution and the use of harsh language cause conflict transformation in OR teams just as they do in stable work teams. Negative emotionality was found to make a substantial contribution to responses to and consequences of conflict, notably in the swiftness with which individuals terminated their working relationships. These findings contribute to a theory of conflict transformation in the OR team. There are a number of behaviours that activate conflict transformation in the OR team and a conflict management education programme should include a description of and alternatives to these behaviours. The types of conflict are tightly interwoven in this setting and thus the most appropriate management strategy is one that assumes that both types of conflict will exist and

  20. [Business organization theory: its potential use in the organization of the operating room].

    Science.gov (United States)

    Bartz, H-J

    2005-07-01

    The paradigm of patient care in the German health system is changing. The introduction of German Diagnosis Related Groups (G-DRGs), a diagnosis-related coding system, has made process-oriented thinking increasingly important. The treatment process is viewed and managed as a whole from the admission to the discharge of the patient. The interfaces of departments and sectors are diminished. A main objective of these measures is to render patient care more cost efficient. Within the hospital, the operating room (OR) is the most expensive factor accounting for 25 - 50 % of the costs of a surgical patient and is also a bottleneck in the surgical patient care. Therefore, controlling of the perioperative treatment process is getting more and more important. Here, the business organisation theory can be a very useful tool. Especially the concepts of process organisation and process management can be applied to hospitals. Process-oriented thinking uncovers and solves typical organisational problems. Competences, responsibilities and tasks are reorganised by process orientation and the enterprise is gradually transformed to a process-oriented system. Process management includes objective-oriented controlling of the value chain of an enterprise with regard to quality, time, costs and customer satisfaction. The quality of the process is continuously improved using process-management techniques. The main advantage of process management is consistent customer orientation. Customer orientation means to be aware of the customer's needs at any time during the daily routine. The performance is therefore always directed towards current market requirements. This paper presents the basics of business organisation theory and to point out its potential use in the organisation of the OR.

  1. 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 < 0.05 for communication to 0.17, p < 0.01 for surgeon buy-in). All measures of teamwork and surgeon buy-in related positively to completing more conversation prompts; none related significantly to procedural checks (estimates from 0.10, p < 0.01 for communication to 0.27, p < 0.001 for surgeon buy-in). Patient age was significantly associated with completing the checklist and prompts (p < 0.05); only case duration was positively associated with performing more checks (p < 0.10). Surgeon buy-in and surgical 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

  2. Operating Room-to-ICU Patient Handovers: A Multidisciplinary Human-Centered Design Approach.

    Science.gov (United States)

    Segall, Noa; Bonifacio, Alberto S; Barbeito, Atilio; Schroeder, Rebecca A; Perfect, Sharon R; Wright, Melanie C; Emery, James D; Atkins, B Zane; Taekman, Jeffrey M; Mark, Jonathan B

    2016-09-01

    Patient handovers (handoffs) following surgery have often been characterized by poor teamwork, unclear procedures, unstructured processes, and distractions. A study was conducted to apply a human-centered approach to the redesign of operating room (OR)-to-ICU patient handovers in a broad surgical ICU (SICU) population. This approach entailed (1) the study of existing practices, (2) the redesign of the handover on the basis of the input of hand over participants and evidence in the medical literature, and (3) the study of the effects of this change on processes and communication. The Durham [North Carolina] Veterans Affairs Medical Center SICU is an 11-bed mixed surgical specialty unit. To understand the existing process for receiving postoperative patients in the SICU, ethnographic methods-a series of observations, surveys, interviews, and focus groups-were used. The handover process was redesigned to better address providers' work flow, information needs, and expectations, as well as concerns identified in the literature. Technical and communication flaws were uncovered, and the handover was redesigned to address them. For the 49 preintervention and 49 postintervention handovers, the information transfer score and number of interruptions were not significantly different. However, staff workload and team behaviors scores improved significantly, while the hand over duration was not prolonged by the new process. Handover participants were also significantly more satisfied with the new handover method. An HCD approach led to improvements in the patient handover process from the OR to the ICU in a mixed adult surgical population. Although the specific handover process would unlikely be optimal in another clinical setting if replicated exactly, the HCD foundation behind the redesign process is widely applicable.

  3. Minimally Invasive Catheter Procedures to Assist Complicated Pacemaker Lead Extraction and Implantation in the Operating Room

    International Nuclear Information System (INIS)

    Kröpil, Patric; Lanzman, Rotem S.; Miese, Falk R.; Blondin, Dirk; Winter, Joachim; Scherer, Axel; Fürst, Günter

    2011-01-01

    We report on percutaneous catheter procedures in the operating room (OR) to assist complicated manual extraction or insertion of pacemaker (PM) and implantable cardioverter defibrillator leads. We retrospectively reviewed complicated PM revisions and implantations performed between 2004 and 2009 that required percutaneous catheter procedures performed in the OR. The type of interventional procedure, catheter and retrieval system used, venous access, success rates, and procedural complications were analyzed. In 41 (12 female and 29 male [mean age 62 ± 17 years]) of 3021 (1.4%) patients, standard manual retrieval of old leads or insertion of new leads was not achievable and thus required percutaneous catheter intervention for retrieval of misplaced leads and/or recanalisation of occluded central veins. Thirteen of 18 (72.2%) catheter-guided retrieval procedures for misplaced (right atrium [RA] or ventricle [RV; n = 3], superior vena cava [n = 2], brachiocephalic vein [n = 5], and subclavian vein [n = 3]) lead fragments in 16 patients were successful. Percutaneous catheter retrieval failed in five patients because there were extremely fixed or adhered lead fragments. Percutaneous transluminal angiography (PTA) of central veins for occlusion or high-grade stenosis was performed in 25 patients. In 22 of 25 patients (88%), recanalization of central veins was successful, thus enabling subsequent lead replacement. Major periprocedural complications were not observed. In the case of complicated manual PM lead implantation or revision, percutaneous catheter-guided extraction of misplaced lead fragments or recanalisation of central veins can be performed safely in the OR, thus enabling subsequent implantation or revision of PM systems in the majority of patients.

  4. Reducing Operating Room Costs Through Real-Time Cost Information Feedback: A Pilot Study.

    Science.gov (United States)

    Tabib, Christian H; Bahler, Clinton D; Hardacker, Thomas J; Ball, Kevin M; Sundaram, Chandru P

    2015-08-01

    To create a protocol for providing real-time operating room (OR) cost feedback to surgeons. We hypothesize that this protocol will reduce costs in a responsible way without sacrificing quality of care. All OR costs were obtained and recorded for robot-assisted partial nephrectomy and laparoscopic donor nephrectomy. Before the beginning of this project, costs pertaining to the 20 most recent cases were analyzed. Items were identified from previous cases as modifiable for replacement or omission. Timely feedback of total OR costs and cost of each item used was provided to the surgeon after each case, and costs were analyzed. A cost analysis of the robot-assisted partial nephrectomy before the washout period indicates expenditures of $5243.04 per case. Ten recommended modifiable items were found to have an average per case cost of $1229.33 representing 23.4% of the total cost. A postwashout period cost analysis found the total OR cost decreased by $899.67 (17.2%) because of changes directly related to the modifiable items. Therefore, 73.2% of the possible identified savings was realized. The same stepwise approach was applied to laparoscopic donor nephrectomies. The average total cost per case before the washout period was $3530.05 with $457.54 attributed to modifiable items. After the washout period, modifiable items costs were reduced by $289.73 (8.0%). No complications occurred in the donor nephrectomy cases while one postoperative complication occurred in the partial nephrectomy group. Providing surgeons with feedback related to OR costs may lead to a change in surgeon behavior and decreased overall costs. Further studies are needed to show equivalence in patient outcomes.

  5. 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...

  6. Special Operations can make a difference in integrated conflict prevention

    DEFF Research Database (Denmark)

    Jensen, Lars H. Ehrensvärd

    The fifth brief in the series about special operations highlights the possible strategic role of special operations in connection with Denmark's revitalized vision of integration of the state's instruments to create security through preventive stabilization efforts. The brief offers suggestion...

  7. The influence of Triga 2000 reactor operation on the surface contamination at reactor room using smear test method

    International Nuclear Information System (INIS)

    Bintu Khoiriyyah; Budi Purnama; Tri Cahyo Laksono

    2016-01-01

    The monitoring of surface contamination should be conducted to determine the safety of work areas. Surface contamination at the TRIGA 2000 reactor room which is on PSTNT-BATAN Bandung remain to be implemented although reactor not operating. In this research monitoring of surface contamination when TRIGA 2000 in operation of the first time after several years not operating aims to determine the influence on the results of monitoring. The monitoring of surface contamination has been done using smear test method at some predetermined in TRIGA 2000 reactor room. The highest surface contamination activities is obtained 0.32 Bq/cm 2 and there are some points that are not detected. Based on keputusan kepala BAPETEN No.1/Ka BAPETEN/ V/99 the work showed that the TRIGA 2000 reactor in the category of low area contamination, that is <3.7 Bq/cm 2 to gross beta. (author)

  8. Integrated Ground Operations Demonstration Units Testing Plans and Status

    Science.gov (United States)

    Johnson, Robert G.; Notardonato, William U.; Currin, Kelly M.; Orozco-Smith, Evelyn M.

    2012-01-01

    Cryogenic propellant loading operations with their associated flight and ground systems are some of the most complex, critical activities in launch operations. Consequently, these systems and operations account for a sizeable portion of the life cycle costs of any launch program. NASA operations for handling cryogens in ground support equipment have not changed substantially in 50 years, despite advances in cryogenics, system health management and command and control technologies. This project was developed to mature, integrate and demonstrate advancement in the current state of the art in these areas using two distinct integrated ground operations demonstration units (GODU): GODU Integrated Refrigeration and Storage (IRAS) and GODU Autonomous Control

  9. Recovery Room

    African Journals Online (AJOL)

    defined postoperative unit or on the hospital ward. Patients were frequently transferred from the operating room directly to the ward where they were placed close to the nursing station. In 1947 the. Anesthesia Study Commission of the Philadelphia.

  10. Research on transfer rule of the monitoring of operator in digital main control room of nuclear power plant

    International Nuclear Information System (INIS)

    Zhang Li; Li Linfeng; Li Pengcheng; Lu Changshen; Huang Weigang; Dai Zhonghua; Huang Yuanzheng; Chen Qingqing

    2013-01-01

    In the digital main control room of nuclear power plants, monitoring the operating status of the system of reactor is not only one of the most important tasks of the operators, but also the basis and premise of controlling the system of reactor running correctly. After analyzing, inducing, summarizing the data obtained, we found the operators' monitor behavior could be classified as procedure transfer, abnormal transfer, and exchange transfer. The times of exchange transfer is 29% of the total transfer times, abnormal transfer is 14%, regulation transfer is 36%, and others are 21%. (authors)

  11. Issues of integrating high-tech concepts into nuclear power plant operation

    International Nuclear Information System (INIS)

    Kisner, R.A.; Carter, R.J.; Lindsay, R.W.

    1990-01-01

    The stockpile of new ideas continues to grow for monitoring nuclear power plant parameters, characteristics, and vital signs and for controlling systems, subsystems, and components. This wide selection of monitoring and control software increases the difficulty of designing an integrated control room. As plant control room operators increase their reliance on computerized systems, including real-time plant data and data base systems, the integration of monitoring, diagnostics, and control software into uniform and seamless environment becomes imperative. A systematic approach to evaluating the usefulness of such high-tech control concepts is needed. This paper concentrates on methods to evaluate control concepts by assessing factors that determine a system's potential effectiveness within the context of the overall environment, including both human and machine components. Although not an in-depth study, this paper serves to outline several measures of utility. 21 refs., 3 figs., 2 tabs

  12. Manifolds with integrable affine shape operator

    Directory of Open Access Journals (Sweden)

    Daniel A. Joaquín

    2005-05-01

    Full Text Available This work establishes the conditions for the existence of vector fields with the property that theirs covariant derivative, with respect to the affine normal connection, be the affine shape operatorS in hypersurfaces. Some results are obtained from this property and, in particular, for some kind of affine decomposable hypersurfaces we explicitely get the actual vector fields.

  13. Integrals of operator-valued functions

    Directory of Open Access Journals (Sweden)

    Raimond A. Struble

    1988-01-01

    Full Text Available Mikusinski-type expansions of operator-valued functions are discussed in some detail. As a natural part of the development, a “kernel” concept for operators is proposed and an elaborate system of convolution quotients in one and two variables is obtained.

  14. Simulation and experimental studies of operators' decision styles and crew composition while using an ecological and traditional user interface for the control room of a nuclear power plant

    International Nuclear Information System (INIS)

    Meshkati, N.; Buller, B.J.; Azadeh, M.A.

    1995-01-01

    The goal of this research is threefold: (1) use of the Skill-, Rule-, and Knowledge-based levels of cognitive control -- the SRK framework -- to develop an integrated information processing conceptual framework (for integration of workstation, job, and team design); (2) to evaluate the user interface component of this framework -- the Ecological display; and (3) to analyze the effect of operators' individual information processing behavior and decision styles on handling plant disturbances plus their performance on, and preference for, Traditional and Ecological user interfaces. A series of studies were conducted. In Part I, a computer simulation model and a mathematical model were developed. In Part II, an experiment was designed and conducted at the EBR-II plant of the Argonne National Laboratory-West in Idaho Falls, Idaho. It is concluded that: the integrated SRK-based information processing model for control room operations is superior to the conventional rule-based model; operators' individual decision styles and the combination of their styles play a significant role in effective handling of nuclear power plant disturbances; use of the Ecological interface results in significantly more accurate event diagnosis and recall of various plant parameters, faster response to plant transients, and higher ratings of subject preference; and operators' decision styles affect on both their performance and preference for the Ecological interface

  15. Simulation and experimental studies of operators` decision styles and crew composition while using an ecological and traditional user interface for the control room of a nuclear power plant

    Energy Technology Data Exchange (ETDEWEB)

    Meshkati, N.; Buller, B.J.; Azadeh, M.A. [Univ. of Southern California, Los Angeles, CA (United States)

    1995-04-01

    The goal of this research is threefold: (1) use of the Skill-, Rule-, and Knowledge-based levels of cognitive control -- the SRK framework -- to develop an integrated information processing conceptual framework (for integration of workstation, job, and team design); (2) to evaluate the user interface component of this framework -- the Ecological display; and (3) to analyze the effect of operators` individual information processing behavior and decision styles on handling plant disturbances plus their performance on, and preference for, Traditional and Ecological user interfaces. A series of studies were conducted. In Part I, a computer simulation model and a mathematical model were developed. In Part II, an experiment was designed and conducted at the EBR-II plant of the Argonne National Laboratory-West in Idaho Falls, Idaho. It is concluded that: the integrated SRK-based information processing model for control room operations is superior to the conventional rule-based model; operators` individual decision styles and the combination of their styles play a significant role in effective handling of nuclear power plant disturbances; use of the Ecological interface results in significantly more accurate event diagnosis and recall of various plant parameters, faster response to plant transients, and higher ratings of subject preference; and operators` decision styles affect on both their performance and preference for the Ecological interface.

  16. Integration of error tolerance into the design of control rooms of nuclear power plants

    International Nuclear Information System (INIS)

    Sepanloo, Kamran

    1998-08-01

    Many complex technological systems' failures have been attributed to human errors. Today, based on extensive research on the role of human element in technological systems it is known that human error can not totally be eliminated in modern, flexible, or changing work environments by conventional style design strategies(e.g. defence in depth), or better instructions nor should they be. Instead, the operators' ability to explore degrees of freedom should be supported and means for recovering from the effects of errors should be included. This calls for innovative error tolerant design of technological systems. Integration of error tolerant concept into the design, construction, startup, and operation of nuclear power plants provides an effective means of reducing human error occurrence during all stages of life of it and therefore leads to considerable enhancement of plant's safety

  17. Reliability analysis of operator's monitoring behavior in digital main control room of nuclear power plants and its application

    International Nuclear Information System (INIS)

    Zhang Li; Hu Hong; Li Pengcheng; Jiang Jianjun; Yi Cannan; Chen Qingqing

    2015-01-01

    In order to build a quantitative model to analyze operators' monitoring behavior reliability of digital main control room of nuclear power plants, based on the analysis of the design characteristics of digital main control room of a nuclear power plant and operator's monitoring behavior, and combining with operators' monitoring behavior process, monitoring behavior reliability was divided into three parts including information transfer reliability among screens, inside-screen information sampling reliability and information detection reliability. Quantitative calculation model of information transfer reliability among screens was established based on Senders's monitoring theory; the inside screen information sampling reliability model was established based on the allocation theory of attention resources; and considering the performance shaping factor causality, a fuzzy Bayesian method was presented to quantify information detection reliability and an example of application was given. The results show that the established model of monitoring behavior reliability gives an objective description for monitoring process, which can quantify the monitoring reliability and overcome the shortcomings of traditional methods. Therefore, it provides theoretical support for operator's monitoring behavior reliability analysis in digital main control room of nuclear power plants and improves the precision of human reliability analysis. (authors)

  18. Experimental Research in Operation Management in Engine Room by using Language Sentiment/Opinion Analysis

    Directory of Open Access Journals (Sweden)

    Dimitris Papachristos

    2014-12-01

    Full Text Available The paper argues for the necessity of a combination MMR methods (questionnaire, interview and sentiment/opinion techniques to personal satisfaction analysis at the maritime and training education and proposes a generic, but practical research approach for this purpose. The proposed approach concerns the personal satisfaction evaluation of Engine Room simulator systems and combines the speech recording (sentiment/opinion analysis for measuring emotional user responses with usability testing (SUS tool. The experimental procedure presented here is a primary effort to research the emotion analysis (satisfaction of the users-students in Engine Room Simulators. Finally, the ultimate goal of this research is to find and test the critical factors that influence the educational practice and user’s satisfaction of Engine Room Simulator Systems and the ability to conduct full-time system control by the marine crew.

  19. 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

  20. 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

  1. Do safety checklists improve teamwork and communication in the operating room? A systematic review.

    Science.gov (United States)

    Russ, Stephanie; Rout, Shantanu; Sevdalis, Nick; Moorthy, Krishna; Darzi, Ara; Vincent, Charles

    2013-12-01

    The aim of this systematic review was to assess the impact of surgical safety checklists on the quality of teamwork and communication in the operating room (OR). Safety checklists have been shown to impact positively on patient morbidity and mortality following surgery, but it is unclear whether this clinical improvement is related to an improvement in OR teamwork and communication. A systematic search strategy of MEDLINE, EMBASE, PsycINFO, Google Scholar, and the Cochrane Database for Systematic Reviews was undertaken to obtain relevant articles. After de-duplication and the addition of limits, 315 articles were screened for inclusion by 2 researchers and all articles meeting a set of prespecified inclusion criteria were retained. Information regarding the type of checklist, study design, assessment tools used, outcomes, and study limitations was extracted. Twenty articles formed the basis of this systematic review. All articles described an empirical study relating to a case-specific safety checklist for surgery as the primary intervention, with some measure of change/improvement in teamwork and/or communication relating to its use. The methods for assessing teamwork and communication varied greatly, including surveys, observations, interviews, and 360° assessments. The evidence suggests that safety checklists improve the perceived quality of OR teamwork and communication and reduce observable errors relating to poor team skills. This is likely to function through establishing an open platform for communication at the start of a procedure: encouraging the sharing of critical case-related information, promoting team coordination and decision making, flagging knowledge gaps, and enhancing team cohesion. However, the evidence would also suggest that when used suboptimally or when individuals have not bought in to the process, checklists may conversely have a negative impact on the function of the team. Safety checklists are beneficial for OR teamwork and

  2. Glass operational file. Operational models and integration calculations

    International Nuclear Information System (INIS)

    Ribet, I.

    2004-01-01

    This document presents the operational choices of dominating phenomena, hypotheses, equations and numerical data of the parameters used in the two operational models elaborated for the calculation of the glass source terms with respect to the waste packages considered: existing packages (R7T7, AVM and CEA glasses) and future ones (UOX2, UOX3, UMo, others). The overall operational choices are justified and demonstrated and a critical analysis of the approach is systematically proposed. The use of the operational model (OPM) V 0 → V r , realistic, conservative and robust, is recommended for glasses with a high thermal and radioactive load, which represent the main part of the vitrified wastes. The OPM V 0 S, much more overestimating but faster to parameterize, can be used for the long-term behaviour forecasting of glasses with low thermal and radioactive load, considering today's lack of knowledge for the parameterization of a V 0 → V r type OPM. Efficiency estimations have been made for R7T7 glasses (OPM V 0 → V r ) and AVM glasses (OPM V 0 S), which correspond to more than 99.9% of the vitrified waste packages activity. The very contrasted results obtained, illustrate the importance of the choice of operational models: in conditions representative of a geologic disposal, the estimation of R7T7-type package lifetime exceeds several hundred thousands years. Even if the estimated lifetime of AVM packages is much shorter (because of the overestimating character of the OPM V 0 S), the release potential radiotoxicity is of the same order as the one of R7T7 packages. (J.S.)

  3. Analysis of Optimal Operation of an Energy Integrated Distillation Plant

    DEFF Research Database (Denmark)

    Li, Hong Wen; Hansen, C.A.; Gani, Rafiqul

    2003-01-01

    The efficiency of manufacturing systems can be significantly increased through diligent application of control based on mathematical models thereby enabling more tight integration of decision making with systems operation. In the present paper analysis of optimal operation of an energy integrated...

  4. Some classes of analytic functions involving Noor integral operator

    Science.gov (United States)

    Patel, J.; Cho, N. E.

    2005-12-01

    The object of the present paper is to investigate some inclusion properties of certain subclasses of analytic functions defined by using the Noor integral operator. The integral preserving properties in connection with the operator are also considered. Relevant connections of the results presented here with those obtained in earlier works are pointed out.

  5. Fractional quantum integral operator with general kernels and applications

    Science.gov (United States)

    Babakhani, Azizollah; Neamaty, Abdolali; Yadollahzadeh, Milad; Agahi, Hamzeh

    In this paper, we first introduce the concept of fractional quantum integral with general kernels, which generalizes several types of fractional integrals known from the literature. Then we give more general versions of some integral inequalities for this operator, thus generalizing some previous results obtained by many researchers.2,8,25,29,30,36

  6. Eigenvalue estimates of positive integral operators with analytic ...

    Indian Academy of Sciences (India)

    Eigenvalue estimates of positive integral operators. 337 will be used to denote, respectively, the complex line integral of f along γ and the integral of f with respect to arc-length measure. In the first case we assume γ has an orientation. The notation Lp(γ ) will denote the Lp space of normalized arc length measure on γ with.

  7. Continuous-Wave Operation of GaN Based Multi-Quantum-Well Laser Diode at Room Temperature

    International Nuclear Information System (INIS)

    Li-Qun, Zhang; Shu-Ming, Zhang; Hui, Yang; Lian, Ji; Jian-Jun, Zhu; Zong-Shun, Liu; De-Gang, Zhao; De-Sheng, Jiang; Li-Hong, Duan; Hai, Wang; Yong-Sheng, Shi; Su-Ying, Liu; Jun-Wu, Liang; Qing, Cao; Liang-Hui, Chen

    2008-01-01

    Room-temperature operation of cw GaN based multi-quantum-well laser diodes (LDs) is demonstrated. The LD structure is grown on a sapphire (0001) substrate by metalorganic chemical vapour deposition. A 2.5μm × 800μm ridge waveguide structure is fabricated. The electrical and optical characteristics of the laser diode under direct current injection at room temperature are investigated. The threshold current and voltage of the LD under cw operation are 110 mA and 10.5 V, respectively. Thermal induced series resistance decrease and emission wavelength red-shift are observed as the injection current is increased. The full width at half maximum for the parallel and perpendicular far field pattern (FFP) are 12° and 32°, respectively

  8. Projection operator and propagator for an arbitrary integral spin

    CERN Document Server

    Huang Shi Zhong; Wu Ning; Zheng Zhi Peng

    2002-01-01

    Based on the solution of the Bargmann-Wigner equation for an arbitrary integral spin, a direct derivation of the projection operator and propagator for an arbitrary integral spin is presented. The explicit form for the spin projection operators constructed by Behrends and Fronsdal is confirmed. The commutation rules and a general expression for the Feynman propagator for a free particle of arbitrary integral spin are deduced

  9. [Effect of dexmedetomidine on emergence agitation after general anesthesia in children undergoing odontotherapy in day-surgery operating room].

    Science.gov (United States)

    Lin, Luo; Yueming, Zhang; Meisheng, Li; Jiexue, Wang; Yang, Ji

    2017-12-01

    To study the effectiveness of dexmedetomidine used for general anesthesia maintenance in children undergoing odontotherapy in day-surgery operating room in reducing the incidence of emergence agitation (EA). Eighty children undergoing odontotherapy and under general anesthesia in day-surgery operating room were randomized into two groups, group A (n=40) and group B (n=40). Each patient in group A was administered with a bolus dose of dexmedetomidine (1.0 μg·kg⁻¹, saline diluted to 10 mL) pump-infused after intubation and a maintenance dose of 0.1-0.4 mL·(kg·h)⁻¹ followed-up until 45 min before the end of operation. Each patient in group B was administered with a bolus dose of normal saline 10 mL pump-infused after intubation and maintenance dose of 0.1-0.4 mL·(kg·h)⁻¹ followed-up until 45 min before the end of operation. Gender, age, weight, physical status according to the American Society of Anesthesiologists, perioperative heart rate (HR), mean arterial pressure (MAP), pulse oxygen saturation (SpO₂), sufentanil dosage, duration of surgery, time of extubation, time of regaining consciousness, and time to reach modified Aldrete's score≥12 were recorded. Behavior in postanesthesia care unit was rated on the four-point agitation scale. Compared with group B, decreases were observed in HR and MAP at the beginning of operation, in 10 and 30 min, 1 and 2 h after the beginning of operation, and after extubation of group A (Pgeneral anesthesia maintenance in children undergoing odontotherapy in day-surgery operating room, dexmedetomidine results in low incidence of EA during recovery and more stable vital signs.

  10. Room-temperature operation of a 2.25 μm electrically pumped laser fabricated on a silicon substrate

    International Nuclear Information System (INIS)

    Rodriguez, J. B.; Cerutti, L.; Grech, P.; Tournie, E.

    2009-01-01

    We report on a GaSb-based type-I laser structure grown by molecular beam epitaxy on a (001) silicon substrate. A thin AlSb nucleation layer followed by a 1 μm thick GaSb buffer layer was used to accommodate the very large lattice mismatch existing with the silicon substrate. Processed devices with mesa geometry exhibited laser operation in pulsed mode with a duty cycle up to 10% at room temperature

  11. Full scope simulator of a nuclear power plant control room using 3D stereo virtual reality techniques for operators training

    International Nuclear Information System (INIS)

    Aghina, Mauricio A.C.; Mol, Antonio Carlos A.; Almeida, Adino Americo A.; Pereira, Claudio M.N.A.; Varela, Thiago F.B.

    2007-01-01

    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)

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

    OpenAIRE

    H Nabavizade; R Amin

    2007-01-01

    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 descr...

  13. Lessons from Evidence-Based Operating Room Management in Balancing the Needs for Efficient, Effective and Ethical Healthcare

    OpenAIRE

    Rosen, A.C.; Dexter, F.

    2009-01-01

    Foglia et al. (in press) describe tension in two veteran's hospitals among managers, clinicians, and patients over allocating appropriate resources to support care and inefficiencies in care delivery. Ultimately ethical healthcare in a system which is committed to caring for an entire population of patients must use its limited resources effectively while not compromising patient safety. This discussion gives examples from operating room management in which systematic analyses of existing dat...

  14. 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

  15. 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.

  16. 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.

  17. Applying cost accounting to operating room staffing in otolaryngology: time-driven activity-based costing and outpatient adenotonsillectomy.

    Science.gov (United States)

    Balakrishnan, Karthik; Goico, Brian; Arjmand, Ellis M

    2015-04-01

    (1) To describe the application of a detailed cost-accounting method (time-driven activity-cased costing) to operating room personnel costs, avoiding the proxy use of hospital and provider charges. (2) To model potential cost efficiencies using different staffing models with the case study of outpatient adenotonsillectomy. Prospective cost analysis case study. Tertiary pediatric hospital. All otolaryngology providers and otolaryngology operating room staff at our institution. Time-driven activity-based costing demonstrated precise per-case and per-minute calculation of personnel costs. We identified several areas of unused personnel capacity in a basic staffing model. Per-case personnel costs decreased by 23.2% by allowing a surgeon to run 2 operating rooms, despite doubling all other staff. Further cost reductions up to a total of 26.4% were predicted with additional staffing rearrangements. Time-driven activity-based costing allows detailed understanding of not only personnel costs but also how personnel time is used. This in turn allows testing of alternative staffing models to decrease unused personnel capacity and increase efficiency. © American Academy of Otolaryngology—Head and Neck Surgery Foundation 2015.

  18. 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.

  19. Adoption of an integrated radiology reading room within a urologic oncology clinic: initial experience in facilitating clinician consultations.

    Science.gov (United States)

    Rosenkrantz, Andrew B; Lepor, Herbert; Taneja, Samir S; Recht, Michael P

    2014-05-01

    The authors describe their initial experience in implementing an integrated radiology reading room within a urologic oncology clinic, including the frequency and nature of clinician consultations and the perceived impact on patient management by clinicians. A radiology reading room was established within an office-based urologic oncology clinic in proximity to the surgeon's work area. A radiologist was present in this reading room for a 3-hour shift each day. The frequency and nature of consultations during these shifts were recorded. Also, the clinic's staff completed a survey assessing perceptions of the impact of the integrated reading room on patient management. One hundred two consultations occurred during 57 included dates (average, 1.8 consultations per shift): 52% for review of external cases brought in by patients on discs, 43% for review of internal cases, and 5% for direct review by the radiologist of imaging with patients. The maximum number of consultations during a single shift was 8. All of the clinic's urologists indicated that >90% of consultations benefited patient care. The clinicians indicated tendencies to view consultations as affecting management in the majority of cases, to be more likely to seek consultation for outside imaging when the radiologist was on site, and to be less likely to repeat outside imaging when the radiologist was on site. The integrated reading room within the clinic has potential to improve the quality of care, for instance by facilitating increased review of outside imaging studies and thereby potentially reducing duplicate ordering and by enabling occasional direct image review with patients by radiologists. Copyright © 2014 American College of Radiology. Published by Elsevier Inc. All rights reserved.

  20. Integrated operation of hydro thermal system

    International Nuclear Information System (INIS)

    Nanthakumar, J.

    1994-01-01

    Long-term power system expansion planning studies are carried out to meet the electricity requirement in the future. Prior to the expansion planning studies, it is essential to know the energy potential of the existing generating system, especially the hydro power plants. Detailed hydro thermal stimulation studies of the integrated system is therefore carried out to determine the best way to maximise the hydro energy of the existing and committed plants. The results of the integrated system simulated model are stored in numerous files and are available for retrieval. Most important output used for expansion analysis is the energy production of each hydro plant. The annual hydro energy potential of the total hydro system of Sri Lanka for the hydrological year from 1949 to 1988 is given. Hydro condition data with different probability levels are also indicated

  1. Integrated Air Surveillance Concept of Operations

    Science.gov (United States)

    2011-11-01

    Intelligence (SIGINT) Human Intelligence (HUMINT) Measurement and Signature Intelligence (MASINT) Open Source Intelligence ( OSINT ) In...Office of Management and Budget OpsCon: Operational Concept OSINT : Open Source Intelligence OSTP: Office of Science & Technology Policy Pt–to-Pt...data, all- source intelligence , law enforcement information and relevant open - source data from public and private sectors,

  2. 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.

  3. Description of the tasks of control room operators in German nuclear power plants and support possibilities by advanced computer systems

    International Nuclear Information System (INIS)

    Buettner, W.E.

    1984-01-01

    In course of the development of nuclear power plants the instrumentation and control systems and the information in the control room have been increasing substantially. With this background it is described which operator tasks might be supported by advanced computer aid systems with main emphasis to safety related information and diagnose facilities. Nevertheless, some of this systems under development may be helpful for normal operation modes too. As far as possible recommendations for the realization and test of such systems are made. (orig.) [de

  4. 4.5 μm wavelength vertical external cavity surface emitting laser operating above room temperature

    Science.gov (United States)

    Rahim, M.; Khiar, A.; Felder, F.; Fill, M.; Zogg, H.

    2009-05-01

    A midinfrared vertical external cavity surface emitting laser with 4.5 μm emission wavelength and operating above room temperature has been realized. The active part consists of a single 850 nm thick epitaxial PbSe gain layer. It is followed by a 2 1/2 pair Pb1-yEuyTe/BaF2 Bragg mirror. No microstructural processing is needed. Excitation is done optically with a 1.5 μm wavelength laser. The device operates up to 45 °C with 100 ns pulses and delivers 6 mW output power at 27 °C heat-sink temperature.

  5. Team interaction skills evaluation criteria for nuclear power plant control room operators

    International Nuclear Information System (INIS)

    Montgomery, J.; Gaddy, C.; Toquam, J.

    1991-01-01

    This paper reports on previous research which has shown the value of good team interaction skills to group performance, yet little progress has been made in measuring such skills. Dimensions of team interaction skills developed in an earlier study were extensively revised and cast into a Behaviorally anchored Rating scales (BARS) and a Behavioral Frequency scale format. Rating data were collected using training instructors at a nuclear plant, who rated videotape scenarios of control room performance and later rated control room crews during requalification training. High levels of interrater agreement on both rating scales was, although the hypothesized factor structure did not emerge. Analysis of ratings of the videotapes using Cronbach's components of accuracy indicted that BARS ratings generally exhibited less error than did the Behavioral Frequency ratings. This paper discusses results in terms of both field and research implications

  6. A Study of the Operating Room Scheduling System at Tripler Army Medical Center, Hawaii

    Science.gov (United States)

    1981-08-01

    PROCESSING CLASS V SYSTEM .... .......... . A BIBLIOGRAPHY ....... ........... . . . .. . ii ’I. INTRODUCTIO9 Development of the Problem Convinced that...of the most difficult administrativo tasks that a modern hospital must face, and proposed using a combination of a master posting sheet and a...deal with scheduling problems.9 This particular process also incorporates the two-room system doscribed earlier, and the author admits that this

  7. Systems Integration Operations/Logistics Model (SOLMOD)

    International Nuclear Information System (INIS)

    Vogel, L.W.; Joy, D.S.

    1990-01-01

    SOLMOD is a discrete event simulation model written in FORTRAN 77 and operates in a VAX or PC environment. The model emulates the movement and interaction of equipment and radioactive waste as it is processed through the FWMS. SOLMOD can be used to measure the impacts of different operating schedules and rules, system configurations, reliability, availability, maintainability (RAM) considerations, and equipment and other resource availabilities on the performance of processes comprising the FWMS and how these factors combine to determine overall system performance. Model outputs are a series of measurements of the amount and characteristics of waste at selected points in the FWMS and the utilization of resources needed to transport and process the waste. The model results may be reported on a yearly, monthly, weekly, or daily basis to facilitate analysis. 3 refs., 3 figs., 2 tabs

  8. Joint Urban Operations Joint Integrating Concept

    Science.gov (United States)

    2007-07-23

    concept could lead to a systems-engineering approach to urban operations based on the misconception that urban ecologies can be treated as if they...profits at the cost of irreparable societal and ecological destruction. The firms conduct a series of focus groups to determine what countermessages...Group, moving directly behind Task Force 1, quickly assemble “pop-up” prefabricated encampments to create temporary refugee camps off the main axis of

  9. Problems with Interagency Integration in Contemporary Operations

    Science.gov (United States)

    2014-12-04

    also conducted other tasks that included providing security for NGO food distribution and creating a prioritized list of requirements. The Joint...operation moved into February. In several instances, United States military airdropped food and other resources into urban areas that 46 Guha-Sapir...Up to thirty percent of crops rotted in farmer’s fields due to insufficient road networks. They also identified electricity as critical. Over

  10. Re-integrating Influence and Cyber Operations

    Science.gov (United States)

    2011-06-01

    30 3.6 Social Engineering ......................................................................................................... 33 3.7 The “ Sexy ...need to show results. 3.7 The “ Sexy Part” of IO In early 2001, the 92 nd Information Warfare Aggressor Squadron in San Antonio was struggling with...commander, “Network Operations is the Sexy Part of IO”. This commander was correct in a way, but for reasons unknown at the time. The Air Force has

  11. Integration of a browser based operator manual in the system environment of a process computer system; Integration eines browserbasierten Betriebshandbuchs in die Systemumgebung einer Prozessrechneranlage

    Energy Technology Data Exchange (ETDEWEB)

    Weber, Andreas [Westinghouse Electric Germany GmbH (Germany); Erfle, Robert [DOSCO GmbH, Heidelberg (Germany); Feinkohl, Dirk [E.ON Kernkraft GmbH (Germany). Kernkraftwerk Unterweser

    2012-11-01

    The integration of a browser based operator manual in the system environment of a process computer system is an optimization of the operating procedure in the control room and a safety enhancement due to faster and error-free access to the manual contents. Several requirements by the authorities have to be fulfilled: the operating manual has to be available as hard copy, the format has to be true to original, protection against manipulation has to be provided, the manual content of the browser-based version and the hard copy have to identical, and the display presentation has to be consistent with ergonomic principals. The integration of the on-line manual in the surveillance process computer system provides the operator with the relevant comments to the surveillance signal. The described integration of the on-line manual is an optimization of the operator's everyday job with respect to ergonomics and safety (human performance).

  12. INTEGRATED OPERATIONAL DOSIMETRY SYSTEM AT CERN.

    Science.gov (United States)

    Dumont, Gérald; Pedrosa, Fernando Baltasar Dos Santos; Carbonez, Pierre; Forkel-Wirth, Doris; Ninin, Pierre; Fuentes, Eloy Reguero; Roesler, Stefan; Vollaire, Joachim

    2017-04-01

    CERN, the European Organization for Nuclear Research, upgraded its operational dosimetry system in March 2013 to be prepared for the first Long Shutdown of CERN's facilities. The new system allows the immediate and automatic checking and recording of the dosimetry data before and after interventions in radiation areas. To facilitate the analysis of the data in context of CERN's approach to As Low As Reasonably Achievable (ALARA), this new system is interfaced to the Intervention Management Planning and Coordination Tool (IMPACT). IMPACT is a web-based application widely used in all CERN's accelerators and their associated technical infrastructures for the planning, the coordination and the approval of interventions (work permit principle). The coupling of the operational dosimetry database with the IMPACT repository allows a direct and almost immediate comparison of the actual dose with the estimations, in addition to enabling the configuration of alarm levels in the dosemeter in function of the intervention to be performed. © The Author 2016. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  13. An operator expansion technique for path integral analysis

    International Nuclear Information System (INIS)

    Tsvetkov, I.V.

    1995-01-01

    A new method of path integral analysis in the framework of a power series technique is presented. The method is based on the operator expansion of an exponential. A regular procedure to calculate the correction terms is found. (orig.)

  14. Prototype development and demonstration for integrated dynamic transit operations.

    Science.gov (United States)

    2016-01-01

    This document serves as the Final Report specific to the Integrated Dynamic Transit Operations (IDTO) Prototype Development and Deployment Project, hereafter referred to as IDTO Prototype Deployment or IDTO PD project. This project was performed unde...

  15. A Generalized Analytic Operator-Valued Function Space Integral and a Related Integral Equation

    International Nuclear Information System (INIS)

    Chang, K.S.; Kim, B.S.; Park, C.H.; Ryu, K.S.

    2003-01-01

    We introduce a generalized Wiener measure associated with a Gaussian Markov process and define a generalized analytic operator-valued function space integral as a bounded linear operator from L p into L p-ci r cumflexprime (1< p ≤ 2) by the analytic continuation of the generalized Wiener integral. We prove the existence of the integral for certain functionals which involve some Borel measures. Also we show that the generalized analytic operator-valued function space integral satisfies an integral equation related to the generalized Schroedinger equation. The resulting theorems extend the theory of operator-valued function space integrals substantially and previous theorems about these integrals are generalized by our results

  16. Certain Inequalities Involving the Fractional q-Integral Operators

    Directory of Open Access Journals (Sweden)

    Dumitru Baleanu

    2014-01-01

    Full Text Available We establish some inequalities involving Saigo fractional q-integral operator in the theory of quantum calculus by using the two parameters of deformation, q1 and q2, whose special cases are shown to yield corresponding inequalities associated with Riemann-Liouville and Kober fractional q-integral operators, respectively. Furthermore, we also consider their relevance with other related known results.

  17. Guidelines for control room design reviews

    International Nuclear Information System (INIS)

    1981-09-01

    whether the control room provides the system status information, control capabilities, feedback, and analytic aids necessary for control room operators to accomplish their functions effectively. To identify characteristics of the existing control room instrumentation, controls, other equipment, and physical arrangements that may detract from operator performance. o analyze and evaluate the problems that could arise from discrepancies of the above kinds, and to analyze means of correcting those discrepancies which could lead to substantial problems. To define and put into effect a plan of action that applies human factors principles to improve control room design and enhance operator effectiveness. Particular emphasis should be placed on improvements affecting control room design and operator performance under abnormal or emergency conditions. To integrate the control room design review with other areas of human factors inquiry identified in the NRC Task Action Plan

  18. Elements of an advanced integrated operator control station

    International Nuclear Information System (INIS)

    Clarke, M.M.; Kreifeldt, J.G.

    1984-01-01

    One of the critical determinants of performance for any remotely operated maintenance system is the compatibility achieved between elements of the man/machine interface (e.g., master manipulator controller, controls, displays) and the human operator. In the remote control engineering task of the Consolidated Fuel Reprocessing Program, considerable attention has been devoted to optimizing the man/machine interface of the operator control station. This system must be considered an integral element of the overall maintenance work system which includes transporters, manipulators, remote viewing