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

PubMed

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.

Lean management in academic surgery.

PubMed

Collar, Ryan M; Shuman, Andrew G; Feiner, Sandra; McGonegal, Amy K; Heidel, Natalie; Duck, Mary; McLean, Scott A; Billi, John E; Healy, David W; Bradford, Carol R

2012-06-01

Lean is a management system designed to enhance productivity by eliminating waste. Surgical practice offers many opportunities for improving efficiency. Our objective was to determine whether systematic implementation of lean thinking in an academic otolaryngology operating room improves efficiency and profitability and preserves team morale and educational opportunities. In an 18-month prospective quasi-experimental study, a multidisciplinary task force systematically implemented lean thinking within an otolaryngology operating room of an academic health system. Operating room turnover time and turnaround time were measured during a baseline period; an observer-effect period in which workers were made aware that their efficiency was being measured but before implementing lean changes; and an intervention period after redesign principles had been used. The impact on teamwork, morale, and surgical resident education were measured during the baseline and intervention periods through validated surveys. A profit model was applied to estimate the financial implications of the study. There was no difference between the baseline and observer-effect periods of the study for turnover time (p = 0.98) or turnaround time (p = 0.20). During the intervention period, the mean turnover time and turnaround time were significantly shorter than during the baseline period (29 vs 38 minutes; p < 0.001 and 69 vs 89 minutes; p < 0.001, respectively). The composite morale score suggested improved morale after implementation (p = 0.011). Educational metrics were unchanged before and after implementation. The annual opportunity revenue for the involved operating room is $330,000; when extrapolated throughout the operating rooms, lean thinking could create 6,500 hours of capacity annually. Application of lean management techniques to a single operating room and surgical service improved operating room efficiency and morale, sustained resident education, and can provide considerable financial gains when scaled to an entire academic surgical suite. Copyright © 2012. Published by Elsevier Inc.

Crew Field Notes: A New Tool for Planetary Surface Exploration

NASA Technical Reports Server (NTRS)

Horz, Friedrich; Evans, Cynthia; Eppler, Dean; Gernhardt, Michael; Bluethmann, William; Graf, Jodi; Bleisath, Scott

2011-01-01

The Desert Research and Technology Studies (DRATS) field tests of 2010 focused on the simultaneous operation of two rovers, a historical first. The complexity and data volume of two rovers operating simultaneously presented significant operational challenges for the on-site Mission Control Center, including the real time science support function. The latter was split into two "tactical" back rooms, one for each rover, that supported the real time traverse activities; in addition, a "strategic" science team convened overnight to synthesize the day's findings, and to conduct the strategic forward planning of the next day or days as detailed in [1, 2]. Current DRATS simulations and operations differ dramatically from those of Apollo, including the most evolved Apollo 15-17 missions, due to the advent of digital technologies. Modern digital still and video cameras, combined with the capability for real time transmission of large volumes of data, including multiple video streams, offer the prospect for the ground based science support room(s) in Mission Control to witness all crew activities in unprecedented detail and in real time. It was not uncommon during DRATS 2010 that each tactical science back room simultaneously received some 4-6 video streams from cameras mounted on the rover or the crews' backpacks. Some of the rover cameras are controllable PZT (pan, zoom, tilt) devices that can be operated by the crews (during extensive drives) or remotely by the back room (during EVAs). Typically, a dedicated "expert" and professional geologist in the tactical back room(s) controls, monitors and analyses a single video stream and provides the findings to the team, commonly supported by screen-saved images. It seems obvious, that the real time comprehension and synthesis of the verbal descriptions, extensive imagery, and other information (e.g. navigation data; time lines etc) flowing into the science support room(s) constitute a fundamental challenge to future mission operations: how can one analyze, comprehend and synthesize -in real time- the enormous data volume coming to the ground? Real time understanding of all data is needed for constructive interaction with the surface crews, and it becomes critical for the strategic forward planning process.

Fire safety in the operating room.

PubMed

Rinder, Christine Stowe

2008-12-01

Elimination of flammable anesthetic gases has had little effect on operating-room fires except to change their etiology. Electrocautery and lasers, in an oxygen-enriched environment, can ignite even the most fire-resistant materials, including the patient, and the fire triad possibilities in the operating room are nearly limitless. This review will: identify operating room contents capable of acting as ignition/oxidizer/fuel sources, highlight operating room items that are uniquely potent fire triad contributors, and operating room identify settings where fire risk is enhanced by proximity of triad components in time or space. Anesthesiologists are cognizant of the risk of airway surgery fires due to laser ignition of the endotracheal tube and/or its contents. Recently, however, head/neck surgery under monitored anesthesia care has emerged as a high-risk setting for operating room fires; burn injuries represent 20% of monitored anesthesia care-related malpractice claims, 95% of which involved head/neck surgery. Operating room fires are infrequent but catastrophic. Operating room fire prevention depends on: (a)understanding how fire triad elements interact to create a fire, (b) recognizing how standard operating-room equipment, materials, and supplemental oxygen can become one of those elements, and (c) vigilance for circumstances that bring fire triad elements into close proximity.

Status quo and current trends of operating room management in Germany.

PubMed

Baumgart, André; Schüpfer, Guido; Welker, Andreas; Bender, Hans-Joachim; Schleppers, Alexander

2010-04-01

Ongoing healthcare reforms in Germany have required strenuous efforts to adapt hospital and operating room organizations to the needs of patients, new technological developments, and social and economic demands. This review addresses the major developments in German operating room management research and current practice. The introduction of the diagnosis-related group system in 2003 has changed the incentive structure of German hospitals to redesign their operating room units. The role of operating room managers has been gradually changing in hospitals in response to the change in the reimbursement system. Operating room managers are today specifically qualified and increasingly externally hired staff. They are more and more empowered with authority to plan and control operating rooms as profit centers. For measuring performance, common perioperative performance indicators are still scarcely implemented in German hospitals. In 2008, a concerted time glossary was established to enable consistent monitoring of operating room performance with generally accepted process indicators. These key performance indicators are a consistent way to make a procedure or case - and also the effectiveness of the operating room management - more transparent. In the presence of increasing financial pressure, a hospital's executives need to empower an independent operating room management function to achieve the hospital's economic goals. Operating room managers need to adopt evidence-based methods also from other scientific fields, for example management science and information technology, to further sustain operating room performance.

Time-motion analysis of clinical nursing documentation during implementation of an electronic operating room management system for ophthalmic surgery.

PubMed

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.

Time-Motion Analysis of Clinical Nursing Documentation During Implementation of an Electronic Operating Room Management System for Ophthalmic Surgery

PubMed Central

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. PMID:24551402

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

PubMed

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.

[Implementation of modern operating room management -- experiences made at an university hospital].

PubMed

Hensel, M; Wauer, H; Bloch, A; Volk, T; Kox, W J; Spies, C

2005-07-01

Caused by structural changes in health care the general need for cost control is evident for all hospitals. As operating room is one of the most cost-intensive sectors in a hospital, optimisation of workflow processes in this area is of particular interest for health care providers. While modern operating room management is established in several clinics yet, others are less prepared for economic challenges. Therefore, the operating room statute of the Charité university hospital useful for other hospitals to develop an own concept is presented. In addition, experiences made with implementation of new management structures are described and results obtained over the last 5 years are reported. Whereas the total number of operation procedures increased by 15 %, the operating room utilization increased more markedly in terms of time and cases. Summarizing the results, central operating room management has been proved to be an effective tool to increase the efficiency of workflow processes in the operating room.

Allocation of surgical procedures to operating rooms.

PubMed

Ozkarahan, I

1995-08-01

Reduction of health care costs is of paramount importance in our time. This paper is a part of the research which proposes an expert hospital decision support system for resource scheduling. The proposed system combines mathematical programming, knowledge base, and database technologies, and what is more, its friendly interface is suitable for any novice user. Operating rooms in hospitals represent big investments and must be utilized efficiently. In this paper, first a mathematical model similar to job shop scheduling models is developed. The model loads surgical cases to operating rooms by maximizing room utilization and minimizing overtime in a multiple operating room setting. Then a prototype expert system which replaces the expertise of the operations research analyst for the model, drives the modelbase, database, and manages the user dialog is developed. Finally, an overview of the sequencing procedures for operations within an operating room is also presented.

Foucault could have been an operating room nurse.

PubMed

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.

Applying cost accounting to operating room staffing in otolaryngology: time-driven activity-based costing and outpatient adenotonsillectomy.

PubMed

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.

Operating room fires in periocular surgery.

PubMed

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.

Psychomotor performance measured in a virtual environment correlates with technical skills in the operating room.

PubMed

Kundhal, Pavi S; Grantcharov, Teodor P

2009-03-01

This study was conducted to validate the role of virtual reality computer simulation as an objective method for assessing laparoscopic technical skills. The authors aimed to investigate whether performance in the operating room, assessed using a modified Objective Structured Assessment of Technical Skill (OSATS), correlated with the performance parameters registered by a virtual reality laparoscopic trainer (LapSim). The study enrolled 10 surgical residents (3 females) with a median of 5.5 years (range, 2-6 years) since graduation who had similar limited experience in laparoscopic surgery (median, 5; range, 1-16 laparoscopic cholecystectomies). All the participants performed three repetitions of seven basic skills tasks on the LapSim laparoscopic trainer and one laparoscopic cholecystectomy in the operating room. The operating room procedure was video recorded and blindly assessed by two independent observers using a modified OSATS rating scale. Assessment in the operating room was based on three parameters: time used, error score, and economy of motion score. During the tasks on the LapSim, time, error (tissue damage and millimeters of tissue damage [tasks 2-6], error score [incomplete target areas, badly placed clips, and dropped clips [task 7]), and economy of movement parameters (path length and angular path) were registered. The correlation between time, economy, and error parameters during the simulated tasks and the operating room procedure was statistically assessed using Spearman's test. Significant correlations were demonstrated between the time used to complete the operating room procedure and time used for task 7 (r (s) = 0.74; p = 0.015). The error score demonstrated during the laparoscopic cholecystectomy correlated well with the tissue damage in three of the seven tasks (p < 0.05), the millimeters of tissue damage during two of the tasks, and the error score in task 7 (r (s) = 0.67; p = 0.034). Furthermore, statistically significant correlations were observed between the economy of motion score from the operative procedure and LapSim's economy parameters (path length and angular path in six of the tasks) (p < 0.05). The current study demonstrated significant correlations between operative performance in the operating room (assessed using a well-validated rating scale) and psychomotor performance in virtual environment assessed by a computer simulator. This provides strong evidence for the validity of the simulator system as an objective tool for assessing laparoscopic skills. Virtual reality simulation can be used in practice to assess technical skills relevant for minimally invasive surgery.

Future of operating rooms.

PubMed

Reijnen, Michel M P J; Zeebregts, Clark J; Meijerink, Wilhelmus J H J

2005-01-01

Operating-room design has not changed significantly since the modern era of surgery began. Minimal invasive, endoscopic, procedures, and evolution of technology will affect operating-room design in the near future. Poor ergonomics has always been one of the major drawbacks of endoscopic surgery. Use of retractable arms and monitors will improve ergonomics of the operating team. Developments in telecommunication will allow surgeons to communicate with colleagues and experts during the procedure in virtually any location around the world, which increases teaching possibilities and procedural safety. Introduction and further development of intraoperative imaging, including real-time, three-dimensional (3-D) reconstructions of patient, and computer-aided surgery offer surgeons the opportunity to train the planned surgical procedure. Moreover, they will improve control and supervision of the procedure in learning situations. The last decade's robotics have made their introduction into the operating rooms. They improve control over the operating-room environment and will facilitate the performance of more complex procedures. However, high costs and lack of force feedback remain its major drawbacks. Improvements of robotic techniques and its implementation into the operating rooms will further guide their design into highly specialized operating units.

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

PubMed

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.

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

PubMed

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.

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

PubMed

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 procedure duration. Copyright © 2016 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

Single-use instruments, cutting blocks, and trials increase efficiency in the operating room during total knee arthroplasty: a prospective comparison of navigated and non-navigated cases.

PubMed

Mont, Michael A; McElroy, Mark J; Johnson, Aaron J; Pivec, Robert

2013-08-01

The purpose of this prospective controlled trial was to determine if efficiency increases could be achieved in non-navigated and navigated total knee arthroplasties by replacing traditional saws, cutting blocks, and trials with specialized saws and single-use cutting blocks and trials. Various timing metrics during total knee arthroplasty, including operating room preparation times and specific intra-operative times, were measured in 400 procedures performed by eight different surgeons at 6 institutions. Efficiency increases were the result of statistically significant reductions in combined instrument setup and cleanup times as well as in adjusted surgical episode times in navigated total knee arthroplasties. Single-use instruments show promising benefits, but adequate patient follow-up is needed to confirm safety and efficacy before they can be widely adopted. Nevertheless, the authors believe that the use of single-use instruments, cutting guides, and trial implants for total knee arthroplasty will play an increasing role in improving operating room efficiency. Copyright © 2013 Elsevier Inc. All rights reserved.

9 CFR 354.241 - Cleaning of rooms and compartments.

Code of Federal Regulations, 2012 CFR

2012-01-01

... skinning room shall be kept clean and free from offensive odors at all times. (g) The walls, floors, and all equipment and utensils used in the killing and skinning room shall be thoroughly washed and cleaned after each day's operation. (h) The floor in the killing and skinning rooms shall be cleaned...

9 CFR 354.241 - Cleaning of rooms and compartments.

Code of Federal Regulations, 2011 CFR

2011-01-01

... skinning room shall be kept clean and free from offensive odors at all times. (g) The walls, floors, and all equipment and utensils used in the killing and skinning room shall be thoroughly washed and cleaned after each day's operation. (h) The floor in the killing and skinning rooms shall be cleaned...

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

PubMed

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.

Simulating environmental and psychological acoustic factors of the operating room.

PubMed

Bennett, Christopher L; Dudaryk, Roman; Ayers, Andrew L; McNeer, Richard R

2015-12-01

In this study, an operating room simulation environment was adapted to include quadraphonic speakers, which were used to recreate a composed clinical soundscape. To assess validity of the composed soundscape, several acoustic parameters of this simulated environment were acquired in the presence of alarms only, background noise only, or both. These parameters were also measured for comparison from size-matched operating rooms at Jackson Memorial Hospital. The parameters examined included sound level, reverberation time, and predictive metrics of speech intelligibility in quiet and noise. It was found that the sound levels and acoustic parameters were comparable between the simulated environment and the actual operating rooms. The impact of the background noise on the perception of medical alarms was then examined, and was found to have little impact on the audibility of the alarms. This study is a first in kind report of a comparison between the environmental and psychological acoustical parameters of a hospital simulation environment and actual operating rooms.

Room-temperature operation of a Co:MgF2 laser

NASA Technical Reports Server (NTRS)

Welford, D.; Moulton, P. F.

1988-01-01

A normal-mode, pulsed Co:MgF2 laser has been operated at room temperature for the first time. Continuous tuning from 1750 to 2500 nm with pulse energies up to 70 mJ and 46-percent slope efficiency was obtained with a 1338-nm Nd:YAG pump laser.

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

PubMed

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.

Successful strategies for improving operating room efficiency at academic institutions.

PubMed

Overdyk, F J; Harvey, S C; Fishman, R L; Shippey, F

1998-04-01

In this prospective study, we evaluated the etiology of operating room (OR) delays in an academic institution, examined the impact of multidisciplinary strategies to improve OR efficiency, and established OR timing benchmarks for use in future OR efficiency studies. OR times and delay etiologies were collected for 94 cases during the initial phase of the study. Timing data and delay etiologies were analyzed, and 2 wk of multidisciplinary OR efficiency awareness education was conducted for the nursing, surgical, and anesthesia staff. After the education period, timing data were collected from 1787 cases, and monthly reports listing individual case delays and timing data were sent to the Chiefs of Service. For the first case of the day, patient in room, anesthesia ready, surgical preparation start, and procedure start time were significantly earlier (P < 0.01) in the posteducation period compared with the preeducation period, and the procedure start time for the first case of the day occurred, on average, 22 min earlier than all other procedures. For all cases combined, turnover time decreased, on average, by 16 min. Unavailability of surgeons, anesthesiologists, and residents decreased significantly (P < 0.05) as causes of OR delays. Anesthesia induction times were consistently longer for the vascular and cardiothoracic services, whereas surgical preparation time was increased for the neurosurgical and orthopedic services (P < 0.05). Identification of the etiology of OR inefficiency, combined with multidisciplinary awareness training and personal accountability, can improve OR efficiency. The time savings realized are probably most cost-effective when combined with more flexible OR staffing and improved OR scheduling. We achieved significant improvements in operating room efficiency by analyzing operating room data on causes of delays, devising strategies for minimizing the most common delays, and subsequently measuring delay data. Personal accountability, streamlining of procedures, interdisciplinary team work, and accurate data collection were all important contributors to improved efficiency.

Situation-Dependent Medical Device Risk Estimation: Design and Evaluation of an Equipment Management Center For Vendor-Independent Integrated Operating Rooms.

PubMed

Maktabi, Marianne; Neumuth, Thomas

2017-12-22

The complexity of surgical interventions and the number of technologies involved are constantly rising. Hospital staff has to learn how to handle new medical devices efficiently. However, if medical device-related incidents occur, the patient treatment is delayed. Patient safety could therefore be supported by an optimized assistance system that helps improve the management of technical equipment by nonmedical hospital staff. We developed a system for the optimal monitoring of networked medical device activity and maintenance requirements, which works in conjunction with a vendor-independent integrated operating room and an accurate surgical intervention Time And Resource Management System. An integrated situation-dependent risk assessment system gives the medical engineers optimal awareness of the medical devices in the operating room. A qualitative and quantitative survey among ten medical engineers from three different hospitals was performed to evaluate the approach. A series of 25 questions was used to evaluate various aspects of our system as well as the system currently used. Moreover, the respondents were asked to perform five tasks related to system supervision and incident handling. Our system received a very positive feedback. The evaluation studies showed that the integration of information, the structured presentation of information, and the assistance modules provide valuable support to medical engineers. An automated operating room monitoring system with an integrated risk assessment and Time And Resource Management System module is a new way to assist the staff being outside of a vendor-independent integrated operating room, who are nevertheless involved in processes in the operating room.

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

PubMed

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.

Evaluation of optimum room entry times for radiation therapists after high energy whole pelvic photon treatments.

PubMed

Ho, Lavine; White, Peter; Chan, Edward; Chan, Kim; Ng, Janet; Tam, Timothy

2012-01-01

Linear accelerators operating at or above 10 MV produce neutrons by photonuclear reactions and induce activation in machine components, which are a source of potential exposure for radiation therapists. This study estimated gamma dose contributions to radiation therapists during high energy, whole pelvic, photon beam treatments and determined the optimum room entry times, in terms of safety of radiation therapists. Two types of technique (anterior-posterior opposing and 3-field technique) were studied. An Elekta Precise treatment system, operating up to 18 MV, was investigated. Measurements with an area monitoring device (a Mini 900R radiation monitor) were performed, to calculate gamma dose rates around the radiotherapy facility. Measurements inside the treatment room were performed when the linear accelerator was in use. The doses received by radiation therapists were estimated, and optimum room entry times were determined. The highest gamma dose rates were approximately 7 μSv/h inside the treatment room, while the doses in the control room were close to background (~0 μSv/h) for all techniques. The highest personal dose received by radiation therapists was estimated at 5 mSv/yr. To optimize protection, radiation therapists should wait for up to11 min after beam-off prior to room entry. The potential risks to radiation therapists with standard safety procedures were well below internationally recommended values, but risks could be further decreased by delaying room entry times. Dependent on the technique used, optimum entry times ranged between 7 to 11 min. A balance between moderate treatment times versus reduction in measured equivalent doses should be considered.

Closing emergency operating rooms improves efficiency.

PubMed

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

2007-12-01

Long waiting times for emergency operations increase a patient's risk of postoperative complications and morbidity. Reserving Operating Room (OR) capacity is a common technique to maximize the responsiveness of an OR in case of arrival of an emergency patient. This study determines the best way to reserve OR time for emergency surgery. In this study two approaches of reserving capacity were compared: (1) concentrating all reserved OR capacity in dedicated emergency ORs, and (2) evenly reserving capacity in all elective ORs. By using a discrete event simulation model the real situation was modelled. Main outcome measures were: (1) waiting time, (2) staff overtime, and (3) OR utilisation were evaluated for the two approaches. Results indicated that the policy of reserving capacity for emergency surgery in all elective ORs led to an improvement in waiting times for emergency surgery from 74 (+/-4.4) minutes to 8 (+/-0.5) min. Working in overtime was reduced by 20%, and overall OR utilisation can increase by around 3%. Emergency patients are operated upon more efficiently on elective Operating Rooms instead of a dedicated Emergency OR. The results of this study led to closing of the Emergency OR in the Erasmus MC (Rotterdam, The Netherlands).

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

PubMed

Costa, Altair da Silva

2017-01-01

To evaluate the indicators duration of anesthesia, operative time and time patients stay in the operating rooms of different surgical specialties at a public university hospital. It was done by a descriptive cross-sectional study based on the operating room database. The following stages were measured: duration of anesthesia, procedure time and patient length of stay in the room of the various specialties. We included surgeries carried out in sequence in the same room, between 7:00 a.m. and 5 p.m., either elective or emergency. We calculated the 80th percentile of the stages, where 80% of procedures were below this value. The study measured 8,337 operations of 12 surgical specialties performed within one year. The overall mean duration of anesthesia of all specialties was 178.12±110.46 minutes, and the 80th percentile was 252 minutes. The mean operative time was 130.45±97.23 minutes, and the 80th percentile was 195 minutes. The mean total time of the patient in the operating room was 197.30±113.71 minutes, and the 80th percentile was 285 minutes. Thus, the variation of the overall mean compared to the 80th percentile was 41% for anesthesia, 49% for surgeries and 44% for operating room time. In average, anesthesia took up 88% of the operating room period, and surgery, 61%. This study identified patterns in the duration of surgery stages. The mean values of the specialties can assist with operating room planning and reduce delays. Avaliar os indicadores de tempo da anestesia, da operação e da permanência do paciente em sala de diversas especialidades do centro cirúrgico de um hospital universitário. Foi realizado em estudo descritivo transversal a partir da base de dados do centro cirúrgico e mensuradas as seguintes etapas: duração de anestesia, tempo do procedimento e tempo de permanência do paciente em sala das diversas especialidades. Foram incluídas as operações realizadas em sequência na mesma sala, das 7h às 17h, eletivas ou de urgências. Realizamos o calculo do percentil 80 da duração das etapas, onde 80% dos procedimentos ficaram abaixo deste valor obtido. O estudo incluiu 8.337 operações realizadas no período de 1 ano de 12 especialidades cirúrgicas. A média geral da duração da anestesia de todas as especialidades foi de 178,12±110,46 minutos, e o percentil 80 foi de 252 minutos. A média do tempo operatório foi 130,45±97,23 minutos, e o percentil 80 foi de 195 minutos. A média do tempo total do paciente em sala operatória foi de 197,30±113,71 minutos, e o percentil 80 foi de 285 minutos. A variação da média geral em relação ao percentil 80 foi de 41% na anestesia, 49% nas operações e 44% no tempo de sala. Na média geral, a anestesia ocupou 88% do tempo de sala e a operação, 61%. Este estudo identificou padrões nas durações das etapas das operações. A informação das médias históricas das especialidades pode auxiliar no planejamento do centro cirúrgico e diminuir os atrasos.

AuPd/polyaniline as the anode in an ethylene glycol microfluidic fuel cell operated at room temperature.

PubMed

Arjona, N; Palacios, A; Moreno-Zuria, A; Guerra-Balcázar, M; Ledesma-García, J; Arriaga, L G

2014-08-04

AuPd/polyaniline was used for the first time, for ethylene glycol (EG) electrooxidation in a novel microfluidic fuel cell (MFC) operated at room temperature. The device exhibits high electrocatalytic performance and stability for the conversion of cheap and fully available EG as fuel.

Hand-assisted laparoscopic versus robot-assisted laparoscopic partial nephrectomy: comparison of short-term outcomes and cost.

PubMed

Elsamra, Sammy E; Leone, Andrew R; Lasser, Michael S; Thavaseelan, Simone; Golijanin, Dragan; Haleblian, George E; Pareek, Gyan

2013-02-01

Robot-assisted laparoscopic partial nephrectomy (RALPN) and laparoscopic partial nephrectomy (LPN) have become standard for the surgical management of small renal masses (SRMs). However, no studies have evaluated the short-term outcomes or cost of RALPN as compared with hand-assisted laparoscopic partial nephrectomy (HALPN) in a standardized fashion. A retrospective review of all patients who underwent HALPN or RALPN from 2006 to 2010 were assessed for patient age, body mass index (BMI), American Society of Anesthesiologists (ASA) score, radiographic tumor size, nephrometry (radius, endo/exophytic, nearness to collecting system, anterior/posterior, lines of polarity [RENAL]) scores, operative and room times, hospital length of stay (LOS), estimated blood loss (EBL), requirement of hilar vessel clamping, warm ischemia time (WIT), pre- and postprocedural creatinine and hemoglobin levels, and complications. Total costs of the procedures were estimated based on operating room component (operative staff time, anesthesia, and supply) and hospital stay cost (room and board, pharmacy). A robotic premium cost, estimated based on the yearly overall cost of the da Vinci S surgical system divided by the annual number of cases, was included in the RALPN cost. Cost figures were obtained from hospital administration and applied to the mean HALPN and RALPN patient. Forty-seven patients underwent HALPN since 2006 and 21 patients underwent RALPN since 2008. ASA, BMI, EBL, tumor size, nephrometry score, positive margin rate, change in creatinine, change in hemoglobin, morphine equivalents used, and complication rate were all similar in both groups (p>0.05). Room time and operative time were significantly shorter for the HALPN cohort (p=0.001) whereas LOS was significantly shorter in the RALPN cohort (p=0.019). Despite the shorter LOS, RALPN was associated with a $1165 increased cost, mainly due to increased operating room time and premium cost of the robot. While early in our experience, RALPN offered no significant advantage in short-term outcomes over HALPN and was associated with an increased cost of over $1150.

9 CFR 590.522 - Breaking room operations.

Code of Federal Regulations, 2013 CFR

2013-01-01

... room personnel shall wash their hands thoroughly with odorless soap and water each time they enter the... wholesomeness by smelling the shell or the egg meat and by visual examination at the time of breaking. All egg... of shell particles and other foreign material shall be cleaned and sanitized each time it is...

9 CFR 590.522 - Breaking room operations.

Code of Federal Regulations, 2012 CFR

2012-01-01

... room personnel shall wash their hands thoroughly with odorless soap and water each time they enter the... wholesomeness by smelling the shell or the egg meat and by visual examination at the time of breaking. All egg... of shell particles and other foreign material shall be cleaned and sanitized each time it is...

9 CFR 590.522 - Breaking room operations.

Code of Federal Regulations, 2014 CFR

2014-01-01

... room personnel shall wash their hands thoroughly with odorless soap and water each time they enter the... wholesomeness by smelling the shell or the egg meat and by visual examination at the time of breaking. All egg... of shell particles and other foreign material shall be cleaned and sanitized each time it is...

Operating room-to-incision interval and neonatal outcome in emergency caesarean section: a retrospective 5-year cohort study.

PubMed

Palmer, E; Ciechanowicz, S; Reeve, A; Harris, S; Wong, D J N; Sultan, P

2018-07-01

We conducted a 5-year retrospective cohort study on women undergoing caesarean section to investigate factors influencing the operating room-to-incision interval. Time-to-event analysis was performed for category-1 caesarean section using a Cox proportional hazards regression model. Covariates included: anaesthetic technique; body mass index; age; parity; time of delivery; and gestational age. Binary logistic regression was performed for 5-min Apgar score ≥ 7. There were 677 women who underwent category-1 caesarean section and who met the entry criteria. Unadjusted median (IQR [range]) operating room-to-incision intervals were: epidural top-up 11 (7-17 [0-87]) min; general anaesthesia 6 (4-11 [0-69]) min; spinal 13 (10-20 [0-83]) min; and combined spinal-epidural 24 (13-35 [0-75]) min. Cox regression showed general anaesthesia to be the most rapid method with a hazard ratio (95%CI) of 1.97 (1.60-2.44; p < 0.0001), followed by epidural top-up (reference group), spinal anaesthesia 0.79 (0.65-0.96; p = 0.02) and combined spinal-epidural 0.48 (0.35-0.67; p < 0.0001). Underweight and overweight body mass indexes were associated with longer operating room-to-incision intervals. General anaesthesia was associated with fewer 5-min Apgar scores ≥ 7 with an odds ratio (95%CI) of 0.28 (0.11-0.68; p < 0.01). There was no difference in neonatal outcomes between the first and fifth quintiles for operating room-to-incision intervals. General anaesthesia is associated with the most rapid operating room-to-incision interval for category-1 caesarean section, but is also associated with worse short term neonatal outcomes. Longer operating room-to-incision intervals were not associated with worse neonatal outcomes. © 2018 The Association of Anaesthetists of Great Britain and Ireland.

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

PubMed

Miller, Anya J; Gardner, Glendon M

2017-01-01

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

Statistical analysis of environmental monitoring data: does a worst case time for monitoring clean rooms exist?

PubMed

Cundell, A M; Bean, R; Massimore, L; Maier, C

1998-01-01

To determine the relationship between the sampling time of the environmental monitoring, i.e., viable counts, in aseptic filling areas and the microbial count and frequency of alerts for air, surface and personnel microbial monitoring, statistical analyses were conducted on 1) the frequency of alerts versus the time of day for routine environmental sampling conducted in calendar year 1994, and 2) environmental monitoring data collected at 30-minute intervals during routine aseptic filling operations over two separate days in four different clean rooms with multiple shifts and equipment set-ups at a parenteral manufacturing facility. Statistical analyses showed, except for one floor location that had significantly higher number of counts but no alert or action level samplings in the first two hours of operation, there was no relationship between the number of counts and the time of sampling. Further studies over a 30-day period at the floor location showed no relationship between time of sampling and microbial counts. The conclusion reached in the study was that there is no worst case time for environmental monitoring at that facility and that sampling any time during the aseptic filling operation will give a satisfactory measure of the microbial cleanliness in the clean room during the set-up and aseptic filling operation.

Exposure of hospital operating room personnel to potentially harmful environmental agents

DOE Office of Scientific and Technical Information (OSTI.GOV)

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

1992-03-01

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, typemore » 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.« less

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

PubMed

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.

A simulator-based nuclear reactor emergency response training exercise.

PubMed

Waller, Edward; Bereznai, George; Shaw, John; Chaput, Joseph; Lafortune, Jean-Francois

Training offsite emergency response personnel basic awareness of onsite control room operations during nuclear power plant emergency conditions was the primary objective of a week-long workshop conducted on a CANDU® virtual nuclear reactor simulator available at the University of Ontario Institute of Technology, Oshawa, Canada. The workshop was designed to examine both normal and abnormal reactor operating conditions, and to observe the conditions in the control room that may have impact on the subsequent offsite emergency response. The workshop was attended by participants from a number of countries encompassing diverse job functions related to nuclear emergency response. Objectives of the workshop were to provide opportunities for participants to act in the roles of control room personnel under different reactor operating scenarios, providing a unique experience for participants to interact with the simulator in real-time, and providing increased awareness of control room operations during accident conditions. The ability to "pause" the simulator during exercises allowed the instructors to evaluate and critique the performance of participants, and to provide context with respect to potential offsite emergency actions. Feedback from the participants highlighted (i) advantages of observing and participating "hands-on" with operational exercises, (ii) their general unfamiliarity with control room operational procedures and arrangements prior to the workshop, (iii) awareness of the vast quantity of detailed control room procedures for both normal and transient conditions, and (iv) appreciation of the increased workload for the operators in the control room during a transient from normal operations. Based upon participant feedback, it was determined that the objectives of the training had been met, and that future workshops should be conducted.

[Computerized monitoring system in the operating center with UNIX and X-window].

PubMed

Tanaka, Y; Hashimoto, S; Chihara, E; Kinoshita, T; Hirose, M; Nakagawa, M; Murakami, T

1992-01-01

We previously reported the fully automated data logging system in the operating center. Presently, we revised the system using a highly integrated operating system, UNIX instead of OS/9. With this multi-task and multi-window (X-window) system, we could monitor all 12 rooms in the operating center at a time. The system in the operating center consists of 2 computers, SONY NEWS1450 (UNIX workstation) and Sord M223 (CP/M, data logger). On the bitmapped display of the workstation, using X-window, the data of all the operating rooms can be visualized. Furthermore, 2 other minicomputers (Fujitsu A50 in the conference room, and A60 in the ICU) and a workstation (Sun3-80 in the ICU) were connected with ethernet. With the remote login function (NFS), we could easily obtain the data during the operation from outside the operating center. This system works automatically and needs no routine maintenance.

Quantitative Investigation of Room-Temperature Breakdown Effects in Pixelated TlBr Detectors

NASA Astrophysics Data System (ADS)

Koehler, Will; He, Zhong; Thrall, Crystal; O'Neal, Sean; Kim, Hadong; Cirignano, Leonard; Shah, Kanai

2014-10-01

Due to favorable material properties such as high atomic number (Tl: 81, Br: 35), high density ( 7.56 g/cm3), and a wide band gap (2.68 eV), thallium-bromide (TlBr) is currently under investigation for use as an alternative room-temperature semiconductor gamma-ray spectrometer. TlBr detectors can achieve less than 1% FWHM energy resolution at 662 keV, but these results are limited to stable operation at - 20°C. After days to months of room-temperature operation, ionic conduction causes these devices to fail. This work correlates the varying leakage current with alpha-particle and gamma-ray spectroscopic performances at various operating temperatures. Depth-dependent photopeak centroids exhibit time-dependent transient behavior, which indicates trapping sites form near the anode surface during room-temperature operation. After refabrication, similar performance and functionality of failed detectors returned.

Implications of Perioperative Team Setups for Operating Room Management Decisions.

PubMed

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.

Operating room discharge after deep neuromuscular block reversed with sugammadex compared with shallow block reversed with neostigmine: a randomized controlled trial.

PubMed

Putz, Laurie; Dransart, Christophe; Jamart, Jacques; Marotta, Maria-Laura; Delnooz, Geraldine; Dubois, Philippe E

2016-12-01

To determine if reversing a deep or moderate block with sugammadex, compared with a shallow block reversed with neostigmine, reduces the time to operating room discharge after surgery and the time spent in the postanesthesia care unit. A randomized controlled trial. Monocentric study performed from February 2011 until May 2012. One hundred consenting women with American Society of Anesthesiologists grade I or II were randomized into 2 groups. Laparoscopic hysterectomy was performed under desflurane general anesthesia. For the neostigmine (N) group, 0.45 mg · kg -1 rocuronium was followed by spontaneous recovery. A 5-mg rescue bolus was administered only if surgical evaluation was unacceptable. At the end of surgery, 50 μg · kg -1 neostigmine with glycopyrrolate was administered. For the sugammadex (S) group, a higher intubating rocuronium dose (0.6 mg · kg -1 ) was followed by 5-mg boluses each time the train-of-four count exceeded 2. Sugammadex (2-4 mg · kg -1 ) was administered to reverse the block. All patients were extubated after obtaining a train-of-four ratio of 0.9. The duration between the end of surgery and operating room discharge and the time spent in the postanesthesia care unit. The time till operating room discharge was shorter and more predictable in group S (9.15±4.28 minutes vs 13.87±11.43 minutes in group N; P=.005). The maximal duration in group S was 22 minutes, compared with 72 minutes in group N. The time spent in the postanesthesia care unit was not significantly different (group S: 47.75±31.77 minutes and group N: 53.43±40.57 minutes; P=.543). Maintaining a deep neuromuscular block during laparoscopic hysterectomy reversed at the end of the procedure with sugammadex enabled a faster and more predictable time till operating room discharge than did the classical combination of a shallower block reversed with neostigmine. Copyright © 2016 Elsevier Inc. All rights reserved.

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

PubMed

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.

Telementoring: use of augmented reality in orthopaedic education: AAOS exhibit selection.

PubMed

Ponce, Brent A; Jennings, Jonathan K; Clay, Terry B; May, Mathew B; Huisingh, Carrie; Sheppard, Evan D

2014-05-21

Virtual interactive presence (VIP) is a new technology that allows an individual to deliver real-time virtual assistance to another geographically remote individual via a standard Internet connection. The objectives of this pilot study were to evaluate the efficiency and performance of a VIP system implemented in an operating room setting, determine the potential utility of the system for guidance of surgical procedures, and assess the safety of the system. Following institutional review board approval, fifteen patients underwent arthroscopic shoulder procedures. Two VIP stations were used, one in the operating room and the other in an adjoining dictation room. The attending surgeon proctored operating resident surgeons from the dictation room until his physical presence was required in the operating room. Following each procedure, the attending surgeon, resident surgeons, and three surgical staff members completed a Likert-scale questionnaire regarding the educational utility, efficiency of use, and safety of the system. The operative time was also compared with historical data. Both attending and resident surgeons assigned a favorable rating to the utility of the VIP to highlight anatomy and provide feedback to the resident (p > 0.05 for the difference). Both groups agreed that the system was easy to use and that safety was not compromised (p > 0.05). The majority of resident and attending surgeon responses indicated no perceptible lag between motions (95% and 100%, respectively; p > 0.99) and no interference of the VIP system with the surgical procedure (85% and 100%, respectively; p = 0.24). The mean operative times with and without VIP use did not differ significantly for rotator cuff repair (p = 0.90) or for treatment of instability (p = 0.57). This pilot study revealed that the VIP technology was efficient, safe, and effective as a teaching tool. The attending and resident surgeons agreed that training was enhanced, and this occurred without increasing operative times. Furthermore, the attending surgeon believed that this technology improved teaching effectiveness. These results are promising, and further objective quantification is warranted.

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

PubMed

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.

Patient doses and occupational exposure in a hybrid operating room.

PubMed

Andrés, C; Pérez-García, H; Agulla, M; Torres, R; Miguel, D; Del Castillo, A; Flota, C M; Alonso, D; de Frutos, J; Vaquero, C

2017-05-01

This study aimed to characterize the radiation exposure to patients and workers in a new vascular hybrid operating room during X-ray-guided procedures. During one year, data from 260 interventions performed in a hybrid operating room equipped with a Siemens Artis Zeego angiography system were monitored. The patient doses were analysed using the following parameters: radiation time, kerma-area product, patient entrance reference point dose and peak skin dose. Staff radiation exposure and ambient dose equivalent were also measured using direct reading dosimeters and thermoluminescent dosimeters. The radiation time, kerma-area product, patient entrance reference point dose and peak skin dose were, on average, 19:15min, 67Gy·cm 2 , 0.41Gy and 0.23Gy, respectively. Although the contribution of the acquisition mode was smaller than 5% in terms of the radiation time, this mode accounted for more than 60% of the effective dose per patient. All of the worker dose measurements remained below the limits established by law. The working conditions in the hybrid operating room HOR are safe in terms of patient and staff radiation protection. Nevertheless, doses are highly dependent on the workload; thus, further research is necessary to evaluate any possible radiological deviation of the daily working conditions in the HOR. Copyright © 2017 Associazione Italiana di Fisica Medica. Published by Elsevier Ltd. All rights reserved.

Ultrasensitive Room-Temperature Operable Gas Sensors Using p-Type Na:ZnO Nanoflowers for Diabetes Detection.

PubMed

Jaisutti, Rawat; Lee, Minkyung; Kim, Jaeyoung; Choi, Seungbeom; Ha, Tae-Jun; Kim, Jaekyun; Kim, Hyoungsub; Park, Sung Kyu; Kim, Yong-Hoon

2017-03-15

Ultrasensitive room-temperature operable gas sensors utilizing the photocatalytic activity of Na-doped p-type ZnO (Na:ZnO) nanoflowers (NFs) are demonstrated as a promising candidate for diabetes detection. The flowerlike Na:ZnO nanoparticles possessing ultrathin hierarchical nanosheets were synthesized by a facile solution route at a low processing temperature of 40 °C. It was found that the Na element acting as a p-type dopant was successfully incorporated in the ZnO lattice. On the basis of the synthesized p-type Na:ZnO NFs, room-temperature operable chemiresistive-type gas sensors were realized, activated by ultraviolet (UV) illumination. The Na:ZnO NF gas sensors exhibited high gas response (S of 3.35) and fast response time (∼18 s) and recovery time (∼63 s) to acetone gas (100 ppm, UV intensity of 5 mW cm -2 ), and furthermore, subppm level (0.2 ppm) detection was achieved at room temperature, which enables the diagnosis of various diseases including diabetes from exhaled breath.

The operating room charge nurse: coordinator and communicator.

PubMed Central

Moss, J.; Xiao, Y.; Zubaidah, S.

2001-01-01

To achieve the potential inherent in the use of computer applications in distributed environments, we need to understand the information needs of users. The purpose of this descriptive study was to document the communication of an operating room charge nurse to inform the design of technological communication applications for operating room coordination. A data collection tool was developed to record: 1) the purpose of the communication, 2) mode of communication, 3) the target individual, and 4) the length of time taken for each occurrence. The chosen data collection categories provided a functional structure for data collection and analysis involving communication. Study findings are discussed within the context of application design. PMID:11825234

Fire Safety for the Oral and Maxillofacial Surgeon and Surgical Staff.

PubMed

Di Pasquale, LisaMarie; Ferneini, Elie M

2017-05-01

Fire in the operating room is a life-threatening emergency that demands quick, efficient intervention. Because the circumstances surrounding fires are generally well-understood, virtually every operating room fire is preventable. Before every operating room case, thorough preprocedure "time outs" should address each team members' awareness of specific fire risks and agreement regarding fire concerns and emergency actions. Fire prevention centers on 3 constituent parts of the fire triad necessary for fire formation. Regular fire drills should guide policies and procedures to prevent surgical fires. Delivering optimal patient care in emergent situations requires surgical team training, practicing emergency roles, and specific actions. Copyright © 2016 Elsevier Inc. All rights reserved.

Learning curve evaluation using cumulative summation analysis-a clinical example of pediatric robot-assisted laparoscopic pyeloplasty.

PubMed

Cundy, Thomas P; Gattas, Nicholas E; White, Alan D; Najmaldin, Azad S

2015-08-01

The cumulative summation (CUSUM) method for learning curve analysis remains under-utilized in the surgical literature in general, and is described in only a small number of publications within the field of pediatric surgery. This study introduces the CUSUM analysis technique and applies it to evaluate the learning curve for pediatric robot-assisted laparoscopic pyeloplasty (RP). Clinical data were prospectively recorded for consecutive pediatric RP cases performed by a single-surgeon. CUSUM charts and tests were generated for set-up time, docking time, console time, operating time, total operating room time, and postoperative complications. Conversions and avoidable operating room delay were separately evaluated with respect to case experience. Comparisons between case experience and time-based outcomes were assessed using the Student's t-test and ANOVA for bi-phasic and multi-phasic learning curves respectively. Comparison between case experience and complication frequency was assessed using the Kruskal-Wallis test. A total of 90 RP cases were evaluated. The learning curve transitioned beyond the learning phase at cases 10, 15, 42, 57, and 58 for set-up time, docking time, console time, operating time, and total operating room time respectively. All comparisons of mean operating times between the learning phase and subsequent phases were statistically significant (P=<0.001-0.01). No significant difference was observed between case experience and frequency of post-operative complications (P=0.125), although the CUSUM chart demonstrated a directional change in slope for the last 12 cases in which there were high proportions of re-do cases and patients <6 months of age. The CUSUM method has a valuable role for learning curve evaluation and outcome quality monitoring. In applying this statistical technique to the largest reported single surgeon series of pediatric RP, we demonstrate numerous distinctly shaped learning curves and well-defined learning phase transition points. Copyright © 2015 Elsevier Inc. All rights reserved.

Evaluation of exposures of hospital employees to anesthetic gases

DOE Office of Scientific and Technical Information (OSTI.GOV)

Lambeth, J.D.

1988-01-01

Hospital employees who work in hospital operating and recovery rooms are often exposed to a number of anesthetic gases. There is evidence to support the belief that such exposures have led to higher rates of miscarriages and spontaneous abortions of pregnancies among women directly exposed to these gases than among women not exposed. Most of the studies assessing exposure levels were conducted prior to the widespread use of scavenging systems. Air sampling was conducted in hospital operatories and recovery rooms of three large hospitals to assess the current exposure levels in these areas and determine the effectiveness of these systemsmore » in reducing exposures to fluoride-containing anesthetic gases. It was determined that recovery-room personnel are exposed to levels of anesthesia gases that often approach and exceed the recommended Threshold Limit Value-Time Weighted Average (TLV-TWA) of 2.0 ppm. Recovery-room personnel do not have the protection from exposure provided by scavenging systems in operating rooms. Operating-room personnel were exposed to anesthesia gas levels above the TLV-TWA only when patients were masked, or connected and disconnected from the scavenging systems. Recovery-room personnel also need to be protected from exposure to anesthesia gases by a scavenging system.« less

Improving Operating Room Efficiency: First Case On-Time Start Project.

PubMed

Phieffer, Laura; Hefner, Jennifer L; Rahmanian, Armin; Swartz, Jason; Ellison, Christopher E; Harter, Ronald; Lumbley, Joshua; Moffatt-Bruce, Susan D

Operating rooms (ORs) are costly to run, and multiple factors influence efficiency. The first case on-time start (FCOS) of an OR is viewed as a harbinger of efficiency for the daily schedule. Across 26 ORs of a large, academic medical center, only 49% of cases started on time in October 2011. The Perioperative Services Department engaged an interdisciplinary Operating Room Committee to apply Six Sigma tools to this problem. The steps of this project included (1) problem mapping, (2) process improvements to preoperative readiness, (3) informatics support improvements, and (4) continuous measurement and feedback. By June 2013, there was a peak of 92% first case on-time starts across service lines, decreasing to 78% through 2014, still significantly above the preintervention level of 49% (p = .000). Delay minutes also significantly decreased through the study period (p = .000). Across 2013, the most common delay owners were the patient, the surgeon, the facility, and the anesthesia department. Continuous and sustained improvement of first case on-time starts is attributed to tracking the FCOS metric, establishing embedded process improvement resources and creating transparency of data. This article highlights success factors and barriers to program success and sustainability.

Phasor Simulator for Operator Training Project

DOE Office of Scientific and Technical Information (OSTI.GOV)

Dyer, Jim

2016-09-14

Synchrophasor systems are being deployed in power systems throughout the North American Power Grid and there are plans to integrate this technology and its associated tools into Independent System Operator (ISO)/utility control room operations. A pre-requisite to using synchrophasor technologies in control rooms is for operators to obtain training and understand how to use this technology in real-time situations. The Phasor Simulator for Operator Training (PSOT) project objective was to develop, deploy and demonstrate a pre-commercial training simulator for operators on the use of this technology and to promote acceptance of the technology in utility and ISO/Regional Transmission Owner (RTO)more » control centers.« less

[Present status of critical hemorrhage and its management in the operating room].

PubMed

Irita, Kazuo

2014-12-01

Hemorrhage is a major cause of cardiac arrest in the operating room. Many human factors, including surgical procedures, transfusion practices, blood supply, and anesthetic management, are involved in the process that leads to hemorrhage developing into a critical situation. It is desirable for hospital transfusion committees to prepare hospital-based regulations on 'actions to be taken to manage critical hemorrhage', and practice the implementation of these regulations with simulated drills. If intraoperative hemorrhage may become critical, a state of emergency should immediately be declared to the operating room staff, the blood transfusion service staff, and blood bank staff in order to organize a systematic approach to the ongoing problem and keep all responsible staff working outside the operating room informed of events developing in the room. To rapidly deal with critical hemorrhage, not only cooperation between anesthesiologists and surgeons but also linkage of operating rooms with blood transfusion services and a blood bank are important. When time is short, cross-matching tests are omitted, and ABO-identical red blood cells are used. When supplies of ABO-identical red blood cells are not available, ABO-compatible, non-identical red blood cells are used. Because a systematic, not individual, approach is required to prevent and manage critical hemorrhage, whether or not a hospital can establish a procedure to deal with it depends on the overall capability of critical and crisis management of the hospital. (Review).

[Effect of dexmedetomidine on emergence agitation after general anesthesia in children undergoing odontotherapy in day-surgery operating room].

PubMed

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 (P<0.05). Sufentanil dosage and incidence of EA during recovery of group A were also lower than those of group B (P<0.05). Time to regain consciousness and time to reach modified Aldrete's score≥12 of group A were longer than those of group B (P<0.05). No statistical difference was observed between other indexes of the two groups. As an anesthetic used for general 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.

Acute surgical treatment of perforated peptic ulcer in the elderly patients.

PubMed

Su, Yen-Hao; Yeh, Chi-Chuan; Lee, Chih-Yuan; Lin, Mong-Wei; Kuan, Chen-Hsiang; Lai, I-Rue; Chen, Chiung-Nien; Lin, Hong-Mau; Lee, Po-Huang; Lin, Ming-Tsan

2010-01-01

Emergency abdominal surgery is associated with high morbidity and mortality rates, especially in the elderly patients, but prompt diagnoses and treatment should not be delayed. We conducted a retrospective review (1) to identify risk factors for morbidity and mortality among elderly patients admitted for emergent surgery of perforated peptic ulcers; and (2) to determine whether there were any differences between those who are 70-79 years old and those 80 years old and older. 94 patients who were older than 70 years old and underwent emergency surgery for perforated peptic ulcer between 2000 and 2004 in our institution were reviewed retrospectively. The following variables were followed: age, sex, comorbidity, previous medications, time from onset of symptoms/signs to surgery, time from arrival in emergent room to surgery, perioperative risks, operative findings, type of operation, morbidity, mortality and length of hospital stay. The age, morbidity, mortality and the length of intensive care unit stay were increased in Group 2 (>80 yrs) than Group 1 (70 to 79 yrs), but they did not achieve significant differences statistically. Time from symptoms/signs to emergency room over 24 hours, American Society of Anesthesiologist grade over IV and limited procedure showed significant contributions to postoperative morbidity on univariate analysis. Comorbidity, time from emergency room to operation room over 12 hours, American Society of Anesthesiologists grade over IV, peri-operative blood transfusion, postoperative morbidity and duration of ICU stays over 5 days were significant factors contributed to mortality on univariate analysis. Further analysis showed comorbidity, peri-operative blood transfusion, and postoperative morbidity were independent and predictive factors of mortality on multivariate model. Although perforated peptic ulcer in the elderly patients is associated with high morbidity and mortality, we should not delay the surgical intervention for patients with advanced age. Timely diagnosis and early surgical management of perforated peptic ulcers was imperative for elderly patients. The abdominal computer tomography was recommended in elderly patients for who had vague and atypical clinical symptoms/signs of perforated peptic ulcer. In addition, more attention should be paid to patients with preoperative comorbidities, peri-operative blood transfusion and post-operative morbidity for which were associated with high post-operative mortality.

High efficiency endocrine operation protocol: From design to implementation.

PubMed

Mascarella, Marco A; Lahrichi, Nadia; Cloutier, Fabienne; Kleiman, Simcha; Payne, Richard J; Rosenberg, Lawrence

2016-10-01

We developed a high efficiency endocrine operative protocol based on a mathematical programming approach, process reengineering, and value-stream mapping to increase the number of operations completed per day without increasing operating room time at a tertiary-care, academic center. Using this protocol, a case-control study of 72 patients undergoing endocrine operation during high efficiency days were age, sex, and procedure-matched to 72 patients undergoing operation during standard days. The demographic profile, operative times, and perioperative complications were noted. The average number of cases per 8-hour workday in the high efficiency and standard operating rooms were 7 and 5, respectively. Mean procedure times in both groups were similar. The turnaround time (mean ± standard deviation) in the high efficiency group was 8.5 (±2.7) minutes as compared with 15.4 (±4.9) minutes in the standard group (P < .001). Transient postoperative hypocalcemia was 6.9% (5/72) and 8.3% (6/72) for the high efficiency and standard groups, respectively (P = .99). In this study, patients undergoing high efficiency endocrine operation had similar procedure times and perioperative complications compared with the standard group. The proposed high efficiency protocol seems to better utilize operative time and decrease the backlog of patients waiting for endocrine operation in a country with a universal national health care program. Copyright © 2016 Elsevier Inc. All rights reserved.

Principles of a clean operating room environment.

PubMed

Howard, James L; Hanssen, Arlen D

2007-10-01

Optimizing the operating room environment is necessary to minimize the prevalence of arthroplasty infection. Reduction of bacterial contamination in the operating room should be a primary focus of all members of the operating room team. However, in recent years, there has been a decline in the emphasis of the basic principles of antisepsis in many operating rooms. The purpose of this review is to highlight important considerations for optimizing the operating room environment. These principles should be actively promoted by orthopedic surgeons in their operating rooms as part of a comprehensive approach to minimizing arthroplasty infection.

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

PubMed

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.

Effects of sugammadex on incidence of postoperative residual neuromuscular blockade: a randomized, controlled study.

PubMed

Brueckmann, B; Sasaki, N; Grobara, P; Li, M K; Woo, T; de Bie, J; Maktabi, M; Lee, J; Kwo, J; Pino, R; Sabouri, A S; McGovern, F; Staehr-Rye, A K; Eikermann, M

2015-11-01

This study aimed to investigate whether reversal of rocuronium-induced neuromuscular blockade with sugammadex reduced the incidence of residual blockade and facilitated operating room discharge readiness. Adult patients undergoing abdominal surgery received rocuronium, followed by randomized allocation to sugammadex (2 or 4 mg kg(-1)) or usual care (neostigmine/glycopyrrolate, dosing per usual care practice) for reversal of neuromuscular blockade. Timing of reversal agent administration was based on the providers' clinical judgement. Primary endpoint was the presence of residual neuromuscular blockade at PACU admission, defined as a train-of-four (TOF) ratio <0.9, using TOF-Watch® SX. Key secondary endpoint was time between reversal agent administration and operating room discharge-readiness; analysed with analysis of covariance. Of 154 patients randomized, 150 had a TOF value measured at PACU entry. Zero out of 74 sugammadex patients and 33 out of 76 (43.4%) usual care patients had TOF-Watch SX-assessed residual neuromuscular blockade at PACU admission (odds ratio 0.0, 95% CI [0-0.06], P<0.0001). Of these 33 usual care patients, 2 also had clinical evidence of partial paralysis. Time between reversal agent administration and operating room discharge-readiness was shorter for sugammadex vs usual care (14.7 vs. 18.6 min respectively; P=0.02). After abdominal surgery, sugammadex reversal eliminated residual neuromuscular blockade in the PACU, and shortened the time from start of study medication administration to the time the patient was ready for discharge from the operating room. Clinicaltrials.gov:NCT01479764. © The Author 2015. Published by Oxford University Press on behalf of the British Journal of Anaesthesia. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

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

PubMed

Epstein, R H; Dexter, F

2000-08-01

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

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

PubMed

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 < 0.001). Because they met one of the exclusion criteria, 61 patients (17%) were not extubated in the operating room. Eight patients (2.7%) required re-intubation after early extubation in the operating room, and longer operation time was significantly associated with re-intubation (P < 0.001).Extubation in the operating room after congenital 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.

Concentrations of methoxyflurane and nitrous oxide in veterinary operating rooms

DOE Office of Scientific and Technical Information (OSTI.GOV)

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

1982-02-01

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

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

PubMed

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.

Time to first take-back operation predicts successful primary fascial closure in patients undergoing damage control laparotomy.

PubMed

Pommerening, Matthew J; DuBose, Joseph J; Zielinski, Martin D; Phelan, Herb A; Scalea, Thomas M; Inaba, Kenji; Velmahos, George C; Whelan, James F; Wade, Charles E; Holcomb, John B; Cotton, Bryan A

2014-08-01

Failure to achieve primary fascial closure (PFC) after damage control laparotomy is costly and carries great morbidity. We hypothesized that time from the initial laparotomy to the first take-back operation would be predictive of successful PFC. Trauma patients managed with open abdominal techniques after damage control laparotomy were prospectively followed at 14 Level 1 trauma centers during a 2-year period. Time to the first take-back was evaluated as a predictor of PFC using hierarchical multivariate logistic regression analysis. A total of 499 patients underwent damage control laparotomy and were included in this analysis. PFC was achieved in 327 (65.5%) patients. Median time to the first take-back operation was 36 hours (interquartile range 24-48). After we adjusted for patient demographics, resuscitation volumes, and operative characteristics, increasing time to the first take-back was associated with a decreased likelihood of PFC. Specifically, each hour delay in return to the operating room (24 hours after initial laparotomy) was associated with a 1.1% decrease in the odds of PFC (odds ratio 0.989; 95% confidence interval 0.978-0.999; P = .045). In addition, there was a trend towards increased intra-abdominal complications in patients returning after 48 hours (odds ratio 1.80; 95% confidence interval 1.00-3.25; P = .05). Data from this prospective, multicenter study demonstrate that delays in returning to the operating room after damage control laparotomy are associated with reductions in PFC. These findings suggest that emphasis should be placed on returning to the operating room within 24 hours after the initial laparotomy if possible (and no later than 48 hours). Copyright © 2014 Mosby, Inc. All rights reserved.

Comparison of submuscular and open plating of pediatric femur fractures: a retrospective review.

PubMed

Abbott, Matthew D; Loder, Randall T; Anglen, Jeffrey O

2013-01-01

Plate osteosynthesis is an accepted method of treatment of pediatric femur fractures. Historically, open plating has been used. Submuscular bridge plating has gained recent popularity due to the theoretical advantages of decreased operative time, decreased blood loss, and decreased risk for infection. The purpose of this study was to compare submuscular bridge plating to open plating of pediatric femur fractures. We retrospectively reviewed 79 patients (80 treated femur fractures) between 1999 and 2011 that underwent either open plating (58 femur fractures) or submuscular bridge plating (22 femur fractures). The outcome measures evaluated were operative time, estimated blood loss, malunion, leg length discrepancy, time to union, infection, unplanned return to the operating room, and length of hospital stay after surgery. Among our outcome measures, there was no difference between the 2 groups in terms of operative time, leg length discrepancy, time to union, infection, or length of hospital stay after surgery. There was greater estimated blood loss in the open plating group (P≤0.0001) and greater rotational asymmetry in the submuscular bridge plating group (P=0.005). There was a trend of increased unplanned return to the operating room in the open plating group (5/58 vs. 0/22) although not statistically significant (P=0.32). Submuscular bridge plating and open plating seem to be equally viable options for the management of pediatric diaphyseal femur fractures. In this study, open plating had an increase in estimated blood loss and a trend of more unplanned returns to the operating room, whereas submuscular bridge plating had an increase in asymptomatic rotational asymmetry. Further larger, prospective, randomized studies are necessary to further evaluate these operative techniques. Therapeutic Level III.

Concept and design engineering: endourology operating room.

PubMed

Sabnis, Ravindra; Ganesamoni, Raguram; Mishra, Shashikant; Sinha, Lokesh; Desai, Mahesh R

2013-03-01

A dedicated operating room with fluoroscopic imaging capability and adequate data connectivity is important to the success of any endourology program. Proper understanding of the recent developments in technology in relation to operating room is necessary before planning an endourology operating room. An endourology operating room is a fluorocompatible operating room with enough space to accommodate equipment like multiple flat monitors to display video, C-arm with its monitor, ultrasonography machine, laser machine, intracorporeal lithotripsy unit, irrigation pumps and two large trolleys with instruments. This operating room is integrated with devices to continuously record and archive data from endovision and surface cameras, ultrasound and fluoroscopy. Moreover, advances made in data relay systems have created seamless two-way communication between the operating room and electronic medical records, radiological picture archiving and communication system, classroom, auditorium and literally anywhere in the world. A dedicated endourology operating room is required for any hospital, which has a significant amount of endourology procedures. A custom-made integrated endourology operating room will facilitate endourology procedures, smoothen the workflow in operating room and improve patient outcomes. Meticulous planning and involving experts in the field are critical for the success of the project.

Time-of-flight-assisted Kinect camera-based people detection for intuitive human robot cooperation in the surgical operating room.

PubMed

Beyl, Tim; Nicolai, Philip; Comparetti, Mirko D; Raczkowsky, Jörg; De Momi, Elena; Wörn, Heinz

2016-07-01

Scene supervision is a major tool to make medical robots safer and more intuitive. The paper shows an approach to efficiently use 3D cameras within the surgical operating room to enable for safe human robot interaction and action perception. Additionally the presented approach aims to make 3D camera-based scene supervision more reliable and accurate. A camera system composed of multiple Kinect and time-of-flight cameras has been designed, implemented and calibrated. Calibration and object detection as well as people tracking methods have been designed and evaluated. The camera system shows a good registration accuracy of 0.05 m. The tracking of humans is reliable and accurate and has been evaluated in an experimental setup using operating clothing. The robot detection shows an error of around 0.04 m. The robustness and accuracy of the approach allow for an integration into modern operating room. The data output can be used directly for situation and workflow detection as well as collision avoidance.

Imaging System for Vaginal Surgery.

PubMed

Taylor, G Bernard; Myers, Erinn M

2015-12-01

The vaginal surgeon is challenged with performing complex procedures within a surgical field of limited light and exposure. The video telescopic operating microscope is an illumination and imaging system that provides visualization during open surgical procedures with a limited field of view. The imaging system is positioned within the surgical field and then secured to the operating room table with a maneuverable holding arm. A high-definition camera and Xenon light source allow transmission of the magnified image to a high-definition monitor in the operating room. The monitor screen is positioned above the patient for the surgeon and assistants to view real time throughout the operation. The video telescopic operating microscope system was used to provide surgical illumination and magnification during total vaginal hysterectomy and salpingectomy, midurethral sling, and release of vaginal scar procedures. All procedures were completed without complications. The video telescopic operating microscope provided illumination of the vaginal operative field and display of the magnified image onto high-definition monitors in the operating room for the surgeon and staff to simultaneously view the procedures. The video telescopic operating microscope provides high-definition display, magnification, and illumination during vaginal surgery.

Improving operating room safety

PubMed Central

2009-01-01

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. PMID:19930577

[Economic impact of strategies using ephedrine prefilled syringes].

PubMed

Crégut-Corbaton, J; Malbranche, C; Guignard, M-H; Fagnoni, P

2013-11-01

Ephedrine is an emergency drug available in ampules and syringes need to be prepared in advance according to one of two strategies in our establishment: strategy 1 (S1: 1 ampule per patient) and strategy 2 (S2: 1 ampule per operating room). There are also prefilled syringes. Because of their high cost and conflicting results in the literature, we assessed the economic interest of using prefilled syringes compared with strategies S1 and S2. This was a prospective observational study. The consumption of ephedrine was recorded over two periods of 14 days: P1 with syringes prepared in advance according to S1 or S2 and P2 with the on-demand use of prefilled syringes. The cost of a syringe of ephedrine prepared in advance (nurse time preparation included) was evaluated at €1.65 vs. €3.57 for a prefilled syringe. In operating rooms using S1, the use of prefilled syringes reduced overall the cost per patient about €1.22 and global annual costs by 72% (€2830), while the decrease was about €0.32 for the cost per patient and about 47% (€2760) for global annual costs for operating rooms using S2. The interest of our study is that we investigated different supply strategies for ephedrine within a large number of operating rooms. In our establishment, it was decided to use prefilled syringes in operating rooms that used S1. As well as the economic interest, prefilled syringes contributed to improved safety and saved nursing time. Copyright © 2013 Société française d’anesthésie et de réanimation (Sfar). Published by Elsevier SAS. All rights reserved.

Specialized operating room for cesarean section in the perinatal care unit: a review of the opening process and operating room management.

PubMed

Kasagi, Yoshihiro; Okutani, Ryu; Oda, Yutaka

2015-02-01

We have opened an operating room in the perinatal care unit (PNCU), separate from our existing central operating rooms, to be used exclusively for cesarean sections. The purpose is to meet the increasing need for both emergency cesarean sections and non-obstetric surgeries. It is equipped with the same surgical instruments, anesthesia machine, monitoring system, rapid infusion system and airway devices as the central operating rooms. An anesthesiologist and a nurse from the central operating rooms trained the nurses working in the new operating room, and discussed solutions to numerous problems that arose before and after its opening. Currently most of the elective and emergency cesarean sections carried out during the daytime on weekdays are performed in the PNCU operating room. A total of 328 and 347 cesarean sections were performed in our hospital during 2011 and 2012, respectively, of which 192 (55.5 %) and 254 (73.2 %) were performed in the PNCU operating room. The mean occupancy rate of the central operating rooms also increased from 81 % in 2011 to 90 % in 2012. The PNCU operating room was built with the support of motivated personnel and multidisciplinary teamwork, and has been found to be beneficial for both surgeons and anesthesiologists, while it also contributes to hospital revenue.

Locker-Room Talk.

ERIC Educational Resources Information Center

Lowe, Jason; Noyes, Brad

1999-01-01

Explains how proper athletic facility locker-room design can save time and money. Design factors that address who will be using the facility are discussed as are user requirements, such as preparation areas, total storage area per user, grooming area, and security areas. Final comments address maintenance and operations issues. (GR)

[Rocuronium or vecuronium for intubation for short operations in the preschool age? Effects on time in the operating room and postoperative phase].

PubMed

Pestel, G; Uhlig, T; Unrein, H; Rothhammer, A

2001-01-01

This prospective randomized study compares the effects of rocuronium (R) and vecuronium (V) on the early postoperative period in infants. Forty-eight infants between the ages of three and six, scheduled for elective ENT procedures, were studied after prior approval of local ethics committee and informed parental consent. All children were premedicated with chlorprotixene and belladonna. Anaesthesia was induced with 5 mg/kg thiopentone and 1 vol.-% halothane. Subsequently, 0.4 mg/kg rocuronium or 0.075 mg/kg vecuronium were administered, respectively. Anaesthesia and post-operative care were conducted by independent anaesthetists, who were unaware of the drug used and of the relaxometric data obtained. All children were monitored in the recovery room by pulse oximetry until they reached a Steward Score of 6. Demographic data did not differ between the groups. No differences were recorded between the non-depolarizing relaxants regarding intubation time (R: 24.1 +/- 4.2 min, V: 25.8 +/- 6.8 min) and the time interval from end extubation to leaving the operating theatre (R: 2.3 +/- 0.8 min, V: 2.6 +/- 1.2 min), respectively. Similarly, no differences in SaO2 were noted during the recovery period in the recovery room. Significant differences between the non-depolarizing relaxants were found in the TOF-ratios at extubation (R: 0.73 +/- 0.31 min, V: 0.48 +/- 0.34 min) and arrival in the recovery room (R: 0.88 +/- 0.21 min, V: 0.69 +/- 0.26 min). 0.4 mg/kg Rocuronium and 0.075 mg/kg vecuronium can be used for intubation during short operations on pre-school children. Rocuronium may be the better alternative, due to its faster neuromuscular recovery properties.

The Spin Move: A Reliable and Cost-Effective Gowning Technique for the 21st Century.

PubMed

Ochiai, Derek H; Adib, Farshad

2015-04-01

Operating room efficiency (ORE) and utilization are considered one of the most crucial components of quality improvement in every hospital. We introduced a new gowning technique that could optimize ORE. The Spin Move quickly and efficiently wraps a surgical gown around the surgeon's body. This saves the operative time expended through the traditional gowning techniques. In the Spin Move, while the surgeon is approaching the scrub nurse, he or she uses the left heel as the fulcrum. The torque, which is generated by twisting the right leg around the left leg, helps the surgeon to close the gown as quickly and safely as possible. From 2003 to 2012, the Spin Move was performed in 1,725 consecutive procedures with no complication. The estimated average time was 5.3 and 7.8 seconds for the Spin Move and traditional gowning, respectively. The estimated time saving for the senior author during this period was 71.875 minutes. Approximately 20,000 orthopaedic surgeons practice in the United States. If this technique had been used, 23,958 hours could have been saved. The money saving could have been $14,374,800.00 (23,958 hours × $600/operating room hour) during the past 10 years. The Spin Move is easy to perform and reproducible. It saves operating room time and increases ORE.

The Spin Move: A Reliable and Cost-Effective Gowning Technique for the 21st Century

PubMed Central

Ochiai, Derek H.; Adib, Farshad

2015-01-01

Operating room efficiency (ORE) and utilization are considered one of the most crucial components of quality improvement in every hospital. We introduced a new gowning technique that could optimize ORE. The Spin Move quickly and efficiently wraps a surgical gown around the surgeon's body. This saves the operative time expended through the traditional gowning techniques. In the Spin Move, while the surgeon is approaching the scrub nurse, he or she uses the left heel as the fulcrum. The torque, which is generated by twisting the right leg around the left leg, helps the surgeon to close the gown as quickly and safely as possible. From 2003 to 2012, the Spin Move was performed in 1,725 consecutive procedures with no complication. The estimated average time was 5.3 and 7.8 seconds for the Spin Move and traditional gowning, respectively. The estimated time saving for the senior author during this period was 71.875 minutes. Approximately 20,000 orthopaedic surgeons practice in the United States. If this technique had been used, 23,958 hours could have been saved. The money saving could have been $14,374,800.00 (23,958 hours × $600/operating room hour) during the past 10 years. The Spin Move is easy to perform and reproducible. It saves operating room time and increases ORE. PMID:26052490

Integrating robotic partial nephrectomy to an existing robotic surgery program.

PubMed

Yuh, Bertram; Muldrew, Shantel; Menchaca, Anita; Yip, Wesley; Lau, Clayton; Wilson, Timothy; Josephson, David

2012-04-01

As more centers develop robotic proficiency, progressing to a successful robot-assisted partial nephrectomy (RAPN) program depends on a number of factors. We describe our technique, results, and analysis of program setup for RAPN. Between 2005 and 2011, 92 RAPNs were performed following maturation of a robotic prostatectomy program. Operating rooms and supply rooms were outfitted for efficient robotic throughput. Tilepro and intraoperative ultrasound were used for all cases. Training and experiential learning for surgeons, anesthesia and nursing staff was a high priority. An onsite robotic technician helped troubleshoot, prepare the room and staff prior to starting surgery, and provide assistance with different robotic models. Average operative time decreased over time from 235 min to 199 min (p = .03). Warm ischemia time decreased from 26 minutes to 23 minutes (p = .02) despite an increased complexity of tumors and operations on multiple tumors. Median estimated blood loss was 150 mL. Average length of hospital stay was 3 days (range 1-9). Average size of lesions was 2.7 cm (range 0.7-8.6). Final pathology demonstrated 71 (77%) malignant lesions and 21 (23%) benign lesions. The addition of a robot-assisted partial nephrectomy program to an institutional robotic program can be coordinated with several key steps. Outcomes from an operational, oncologic, and renal functional standpoint are acceptable. Despite increased complexity of tumors and treatment of multiple lesions, operative and warm ischemia times showed a decrease over time. An organizational model that involves the surgeons, anesthesia, nursing staff, and possibly a robotic technical specialist helps to overcome the learning curve.

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

PubMed

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 < .001) and total intraoperative direct cost savings ($254.16 per case). A single-use 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.

Use of computer-assisted drug therapy outside the operating room.

PubMed

Singh, Preet Mohinder; Borle, Anuradha; Goudra, Basavana G

2016-08-01

The number of procedures performed in the out-of-operating room setting under sedation has increased many fold in recent years. Sedation techniques aim to achieve rapid patient turnover through the use of short-acting drugs with minimal residual side-effects (mainly propofol and opioids). Even for common procedures, the practice of sedation delivery varies widely among providers. Computer-based sedation models have the potential to assist sedation providers and offer a more consistent and safer sedation experience for patients. Target-controlled infusions using propofol and other short-acting opioids for sedation have shown promising results in terms of increasing patient safety and allowing for more rapid wake-up times. Target-controlled infusion systems with real-time patient monitoring can titrate drug doses automatically to maintain optimal depth of sedation. The best recent example of this is the propofol-based Sedasys sedation system. Sedasys redefined individualized sedation by the addition of an automated clinical parameter that monitors depth of sedation. However, because of poor adoption and cost issues, it has been recently withdrawn by the manufacturer. Present automated drug delivery systems can assist in the provision of sedation for out-of-operating room procedures but cannot substitute for anesthesia providers. Use of the available technology has the potential to improve patient outcomes, decrease provider workload, and have a long-term economic impact on anesthesia care delivery outside of the operating room.

Mortality in patients with end-stage renal disease and the risk of returning to the operating room after common General Surgery procedures.

PubMed

Brakoniecki, Katrina; Tam, Sophia; Chung, Paul; Smith, Michael; Alfonso, Antonio; Sugiyama, Gainosuke

2017-02-01

The prevalence of end-stage renal disease (ESRD) has increased, and there is limited data on the risks faced by this patient population undergoing surgery. Using American College of Surgeons National Surgical Quality Improvement Program, we identified common surgical procedures undergone by patients with ESRD. These patients were compared with a matched-control group. A subanalysis was performed to determine the risk factors for returning to the operating room in patients with ESRD. Of the 195,585 patients identified, 1,163 had ESRD. ESRD was associated with increased mortality (odds ratio [OR] 9.05, confidence interval [CI] 4.09 to 20.00) and rates of return to the operating room (OR 2.97, CI 1.99 to 4.46). Returning to the OR was associated with increased operation times (98.9 vs 130.2 minutes, P < .05), mortality (OR 4.35, CI 2.11 to 8.99), and morbidity (OR 7.6, CI 4.68 to 12.41). Patients with ESRD face greater risks when entering the operating room, and further study is needed to elucidate preventable risk factors. Copyright © 2016 Elsevier Inc. All rights reserved.

Designing an Alternate Mission Operations Control Room

NASA Technical Reports Server (NTRS)

Montgomery, Patty; Reeves, A. Scott

2014-01-01

The Huntsville Operations Support Center (HOSC) is a multi-project facility that is responsible for 24x7 real-time International Space Station (ISS) payload operations management, integration, and control and has the capability to support small satellite projects and will provide real-time support for SLS launches. The HOSC is a service-oriented/ highly available operations center for ISS payloads-directly supporting science teams across the world responsible for the payloads. The HOSC is required to endure an annual 2-day power outage event for facility preventive maintenance and safety inspection of the core electro-mechanical systems. While complete system shut-downs are against the grain of a highly available sub-system, the entire facility must be powered down for a weekend for environmental and safety purposes. The consequence of this ground system outage is far reaching: any science performed on ISS during this outage weekend is lost. Engineering efforts were focused to maximize the ISS investment by engineering a suitable solution capable of continuing HOSC services while supporting safety requirements. The HOSC Power Outage Contingency (HPOC) System is a physically diversified compliment of systems capable of providing identified real-time services for the duration of a planned power outage condition from an alternate control room. HPOC was designed to maintain ISS payload operations for approximately three continuous days during planned HOSC power outages and support a local Payload Operations Team, International Partners, as well as remote users from the alternate control room located in another building.

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

PubMed

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.

Use of Lean methodology to improve operating room efficiency in hospitals across the Kingdom of Saudi Arabia.

PubMed

Hassanain, Mazen; Zamakhshary, Mohammed; Farhat, Ghada; Al-Badr, Ahmed

2017-04-01

The objective of this study was to assess whether an intervention on process efficiency using the Lean methodology leads to improved utilization of the operating room (OR), as measured by key performance metrics of OR efficiency. A quasi-experimental design was used to test the impact of the intervention by comparing pre-intervention and post-intervention data on five key performance indicators. The ORs of 12 hospitals were selected across regions of the Kingdom of Saudi Arabia (KSA). The participants were patients treated at these hospitals during the study period. The intervention comprised the following: (i) creation of visual dashboards that enable starting the first case on time; (ii) use of computerized surgical list management; (iii) optimization of time allocation; (iv) development of an operating model with policies and procedures for the pre-anesthesia clinic; and (iv) creation of a governance structure with policies and procedures for day surgeries. The following were the main outcome measures: on-time start for the first case, room turnover times, percent of overrun cases, average weekly procedure volume and OR utilization. The hospital exhibited statistically significant improvements in the following performance metrics: on-time start for the first case, room turnover times and percent of overrun cases. A statistically significant difference in OR utilization or average weekly procedure volumes was not detected. The implementation of a Lean-based intervention targeting process efficiency applied in ORs across various KSA hospitals resulted in encouraging results on some metrics at some sites, suggesting that the approach has the potential to produce significant benefit in the future. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.

The Association Between Operating Room Personnel and Turnover With Surgical Site Infection in More Than 12 000 Neurosurgical Cases.

PubMed

Wathen, Connor; Kshettry, Varun R; Krishnaney, Ajit; Gordon, Steven M; Fraser, Thomas; Benzel, Edward C; Modic, Michael T; Butler, Sam; Machado, Andre G

2016-12-01

Surgical site infection (SSI) contributes significantly to postoperative morbidity and mortality and greatly increases the cost of care. To identify the impact of workflow and personnel-related risk factors contributing to the incidence of SSIs in a large sample of neurological surgeries. Data were obtained using an enterprisewide electronic health record system, operating room, and anesthesia records for neurological procedures conducted between January 1, 2009, and November 30, 2012. SSI data were obtained from prospective surveillance by infection preventionists using Centers for Disease Control and Prevention definitions. A multivariate model was constructed and refined using backward elimination logistic regression methods. The analysis included 12 528 procedures. Most cases were elective (94.5%), and the average procedure length was 4.8 hours. The average number of people present in the operating room at any time during the procedure was 10.0. The overall infection rate was 2.3%. Patient body mass index (odds ratio, 1.03; 95% confidence interval [CI], 1.01-1.04) and sex (odds ratio, 1.36; 95% CI, 1.07-1.72) as well as procedure length (odds ratio, 1.19 per additional hour; 95% CI, 1.15-1.23) and nursing staff turnovers (odds ratio, 1.095 per additional turnover; 95% CI, 1.02-1.21) were significantly correlated with the risk of SSI. This study found that patient body mass index and male sex were associated with an increased risk of SSI. Operating room personnel turnover, a modifiable, work flow-related factor, was an independent variable positively correlated with SSI. This study suggests that efforts to reduce operating room turnover may be effective in preventing SSI. OR, operating roomSSI, surgical site infection.

Predictors of operating room extubation in adult cardiac surgery.

PubMed

Subramaniam, Kathirvel; DeAndrade, Diana S; Mandell, Daniel R; Althouse, Andrew D; Manmohan, Rajan; Esper, Stephen A; Varga, Jeffrey M; Badhwar, Vinay

2017-11-01

The primary objective of the study was to identify perioperative factors associated with successful immediate extubation in the operating room after adult cardiac surgery. The secondary objective was to derive a simplified predictive scoring system to guide clinicians in operating room extubation. All 1518 patients in this retrospective cohort study underwent standardized fast-track cardiac anesthetic protocol during adult cardiac surgery. Perioperative variables between patients who had successful extubation in the operating room versus in the intensive care unit were retrospectively analyzed using both univariate and multivariable logistic regression analyses. A predictive score of successful operating room extubation was constructed from the multivariable results of 800 patients (derivation set), and the scoring system was further tested using a validation set of 398 patients. Younger age, lower body mass index, higher preoperative serum albumin, absence of chronic lung disease and diabetes, less-invasive surgical approach, isolated coronary bypass surgery, elective surgery, and lower doses of intraoperative intravenous fentanyl were independently associated with higher probability of operating room extubation. The extubation prediction score created in a derivation set of patients performed well in the validation set. Patient scores less than 0 had a minimal probability of successful operating room extubation. Operating room extubation was highly predicted with scores of 5 or greater. Perioperative factors that are independently associated with successful operating room extubation after adult cardiac operations were identified, and an operating room extubation prediction scoring system was validated. This scoring system may be used to guide safe operating room extubation after cardiac operations. Copyright © 2017 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

A National Coordinating Center for Prehospital Trauma Research Funding Transfusion Using Stored Fresh Whole Blood

DTIC Science & Technology

2016-09-01

bank data base 28-30 5% Analyze blood bank data base 28-33 0% Other Major Tasks: Identification of communities in the UCLA catchment area 1-3 N/A...coagulopathy in real-time is underway. The Blood Bank is working to identify a pool of whole blood donors and incorporating the new product (FWB) in...Blood Bank , emergency Room, Trauma, Operating Room, Intensive Care Unit, etc) to coordinate and streamline standard operating procedures for the

Reliability of constricted double-heterojunction AlGaAs diode lasers

NASA Technical Reports Server (NTRS)

Botez, D.; Connolly, J. C.; Ettenberg, M.; Gilbert, D. B.; Hughes, J. J.

1983-01-01

Constricted double-heterojunction diode lasers have been life tested at 70 C heatsink temperature and 3-4 mW/facet in CW operation. A median life of 7800 h is obtained at 70 C, which extrapolates to 400,000 h median life at room temperature. The extrapolated mean time to failure at room temperature is in excess of 1,000,000 h. Single-longitudinal-mode CW operation is maintained after 10,000 h of accelerated aging at 70 C.

Operating Room of the Future: Advanced Technologies in Safe and Efficient Operating Rooms

DTIC Science & Technology

2010-10-01

research, and treatment purposes. A laser optical mouse and a graphics tablet were used by radiologists to segment 12 simulated reference lesions per...radiologists seg- mented a total of 132 simulated lesions. Overall error in contour segmentation was less with the graphics tablet than with the mouse...PG0.0001). Error in area of segmentation was not significantly different between the tablet and the mouse (P=0.62). Time for segmen- tation was less with

Surgery scheduling optimization considering real life constraints and comprehensive operation cost of operating room.

PubMed

Xiang, Wei; Li, Chong

2015-01-01

Operating Room (OR) is the core sector in hospital expenditure, the operation management of which involves a complete three-stage surgery flow, multiple resources, prioritization of the various surgeries, and several real-life OR constraints. As such reasonable surgery scheduling is crucial to OR management. To optimize OR management and reduce operation cost, a short-term surgery scheduling problem is proposed and defined based on the survey of the OR operation in a typical hospital in China. The comprehensive operation cost is clearly defined considering both under-utilization and overutilization. A nested Ant Colony Optimization (nested-ACO) incorporated with several real-life OR constraints is proposed to solve such a combinatorial optimization problem. The 10-day manual surgery schedules from a hospital in China are compared with the optimized schedules solved by the nested-ACO. Comparison results show the advantage using the nested-ACO in several measurements: OR-related time, nurse-related time, variation in resources' working time, and the end time. The nested-ACO considering real-life operation constraints such as the difference between first and following case, surgeries priority, and fixed nurses in pre/post-operative stage is proposed to solve the surgery scheduling optimization problem. The results clearly show the benefit of using the nested-ACO in enhancing the OR management efficiency and minimizing the comprehensive overall operation cost.

Sampling for Patient Exit Interviews: Assessment of Methods Using Mathematical Derivation and Computer Simulations.

PubMed

Geldsetzer, Pascal; Fink, Günther; Vaikath, Maria; Bärnighausen, Till

2018-02-01

(1) To evaluate the operational efficiency of various sampling methods for patient exit interviews; (2) to discuss under what circumstances each method yields an unbiased sample; and (3) to propose a new, operationally efficient, and unbiased sampling method. Literature review, mathematical derivation, and Monte Carlo simulations. Our simulations show that in patient exit interviews it is most operationally efficient if the interviewer, after completing an interview, selects the next patient exiting the clinical consultation. We demonstrate mathematically that this method yields a biased sample: patients who spend a longer time with the clinician are overrepresented. This bias can be removed by selecting the next patient who enters, rather than exits, the consultation room. We show that this sampling method is operationally more efficient than alternative methods (systematic and simple random sampling) in most primary health care settings. Under the assumption that the order in which patients enter the consultation room is unrelated to the length of time spent with the clinician and the interviewer, selecting the next patient entering the consultation room tends to be the operationally most efficient unbiased sampling method for patient exit interviews. © 2016 The Authors. Health Services Research published by Wiley Periodicals, Inc. on behalf of Health Research and Educational Trust.

Preoperative care management of patients with hip fractures during the wait time between emergency department discharge and operating room admission for surgical repair.

PubMed

Lucki, Michelle M; Napier, Deborah E; Wagner, Cynthia

2012-01-01

Recognizing a patient's needs during the emergency department to operating room interval is crucial to identify areas for improvement. A review of the literature provided no pertinent research regarding this phase of the preoperative experience. This descriptive study examined the preoperative care management of patients with hip fractures during the wait time between emergency department discharge and operating room admission. Data were collected through a systematic retrospective chart review. Demographic variables included gender, age, and comorbidities. Preoperative patient variables included type of analgesia, level of pain, antiembolism interventions, fluid intake, sensory perception/cognition, mobility, and nutritional intake. Subjects were patients cared for at 3 sites in a large multihospital system. A total of 137 charts were reviewed. Although findings were not statistically significant, opportunities to improve care were identified. More attention is needed to evaluate patients effectively for pain, particularly where there are cognitive deficits. Designing and implementing a program for increased bed mobility and protocols that closely monitor and manage fluid intake may offset postoperative complications.

Catheter radiofrequency ablation for arrhythmias under the guidance of the Carto 3 three-dimensional mapping system in an operating room without digital subtraction angiography.

PubMed

Huang, Xingfu; Chen, Yanjia; Huang, Zheng; He, Liwei; Liu, Shenrong; Deng, Xiaojiang; Wang, Yongsheng; Li, Rucheng; Xu, Dingli; Peng, Jian

2018-06-01

Several studies have reported the efficacy of a zero-fluoroscopy approach for catheter radiofrequency ablation of arrhythmias in a digital subtraction angiography (DSA) room. However, no reports are available on the ablation of arrhythmias in the absence of DSA in the operating room. To investigate the efficacy and safety of catheter radiofrequency ablation for arrhythmias under the guidance of a Carto 3 three-dimensional (3D) mapping system in an operating room without DSA. Patients were enrolled according to the type of arrhythmia. The Carto 3 mapping system was used to reconstruct heart models and guide the electrophysiologic examination, mapping, and ablation. The total procedure, reconstruction, electrophysiologic examination, and mapping times were recorded. Furthermore, immediate success rates and complications were also recorded. A total of 20 patients were enrolled, including 12 males. The average age was 51.3 ± 17.2 (19-76) years. Nine cases of atrioventricular nodal re-entrant tachycardia, 7 cases of frequent ventricular premature contractions, 3 cases of Wolff-Parkinson-White syndrome, and 1 case of typical atrial flutter were included. All arrhythmias were successfully ablated. The procedure time was 127.0 ± 21.0 (99-177) minutes, the reconstruction time was 6.5 ± 2.9 (3-14) minutes, the electrophysiologic study time was 10.4 ± 3.4 (6-20) minutes, and the mapping time was 11.7 ± 8.3 (3-36) minutes. No complications occurred. Radiofrequency ablation of arrhythmias without DSA is effective and feasible under the guidance of the Carto 3 mapping system. However, the electrophysiology physician must have sufficient experience, and related emergency measures must be present to ensure safety.

[Operation room management in quality control certification of a mainstream hospital].

PubMed

Leidinger, W; Meierhofer, J N; Schüpfer, G

2006-11-01

We report the results of our study concerning the organisation of operating room (OR) capacity planned 1 year in advance. The use of OR is controlled using 2 global controlling numbers: a) the actual time difference between the expected optimal and previously calculated OR running time and b) the punctuality of starting the first operation in each OR. The focal point of the presented OR management concept is a consensus-oriented decision-making and steering process led by a coordinator who achieves a high degree of acceptance by means of comprehensive transparency. Based on the accepted running time, the optimal productivity of OR's (OP_A(%) can be calculated. In this way an increase of the overall capacity (actual running time) of ORs was from 40% to over 55% was achieved. Nevertheless, enthusiasm and teamwork from all persons involved in the system are vital for success as well as a completely independent operating theatre manager. Using this concept over 90% of the requirements for the new certification catalogue for hospitals in Germany was achieved.

Poster - 26: Electronic Waiting Room Management for a busy Cancer Centre

DOE Office of Scientific and Technical Information (OSTI.GOV)

Kildea, John; Hijal, Tarek

We describe an electronic waiting room management system that we have developed and deployed in our cancer centre. Our system connects with our electronic medical records systems, gathers data for a machine learning algorithm to predict future patient waiting times, and is integrated with a mobile phone app. The system has been in operation for over nine months and has led to reduced lines, calmer waiting rooms and overwhelming patient and staff satisfaction.

[Risk management in the operating room in cardiovascular and thoracic surgery; from the nursing point of view].

PubMed

Nakano, Yaemi

2008-08-01

The primary risk management, on the side of a nurse, in the operating room includes prevention of misidentificatin of both the patient and the site of operation. Leaving of a foreign body in the patient, falling of the patient from the operating table, incidence of deep venous thrombosis and mismatch of blood transfusion should also be prevented with utmost care. The long operating time in cardiovascular surgery and the lateral position of the patient on the operating table in chest or esophageal surgery require additional risk management. Risks of pressure sore as well as nervous injury can be prevented by fixing the patient securely with soft pads to maintain comfortable posture. Above all, careful watching of the patient's condition is most important.

"Knife to skin" time is a poor marker of operating room utilization and efficiency in cardiac surgery.

PubMed

Luthra, Suvitesh; Ramady, Omar; Monge, Mary; Fitzsimons, Michael G; Kaleta, Terry R; Sundt, Thoralf M

2015-06-01

Markers of operation room (OR) efficiency in cardiac surgery are focused on "knife to skin" and "start time tardiness." These do not evaluate the middle and later parts of the cardiac surgical pathway. The purpose of this analysis was to evaluate knife to skin time as an efficiency marker in cardiac surgery. We looked at knife to skin time, procedure time, and transfer times in the cardiac operational pathway for their correlation with predefined indices of operational efficiency (Index of Operation Efficiency - InOE, Surgical Index of Operational Efficiency - sInOE). A regression analysis was performed to test the goodness of fit of the regression curves estimated for InOE relative to the times on the operational pathway. The mean knife to skin time was 90.6 ± 13 minutes (23% of total OR time). The mean procedure time was 282 ± 123 minutes (71% of total OR time). Utilization efficiencies were highest for aortic valve replacement and coronary artery bypass grafting and least for complex aortic procedures. There were no significant procedure-specific or team-specific differences for standard procedures. Procedure times correlated the strongest with InOE (r = -0.98, p < 0.01). Compared to procedure times, knife to skin is not as strong an indicator of efficiency. A statistically significant linear dependence on InOE was observed with "procedure times" only. Procedure times are a better marker of OR efficiency than knife to skin in cardiac cases. Strategies to increase OR utilization and efficiency should address procedure times in addition to knife to skin times. © 2015 Wiley Periodicals, Inc.

Optimization and planning of operating theatre activities: an original definition of pathways and process modeling.

PubMed

Barbagallo, Simone; Corradi, Luca; de Ville de Goyet, Jean; Iannucci, Marina; Porro, Ivan; Rosso, Nicola; Tanfani, Elena; Testi, Angela

2015-05-17

The Operating Room (OR) is a key resource of all major hospitals, but it also accounts for up 40% of resource costs. Improving cost effectiveness, while maintaining a quality of care, is a universal objective. These goals imply an optimization of planning and a scheduling of the activities involved. This is highly challenging due to the inherent variable and unpredictable nature of surgery. A Business Process Modeling Notation (BPMN 2.0) was used for the representation of the "OR Process" (being defined as the sequence of all of the elementary steps between "patient ready for surgery" to "patient operated upon") as a general pathway ("path"). The path was then both further standardized as much as possible and, at the same time, keeping all of the key-elements that would allow one to address or define the other steps of planning, and the inherent and wide variability in terms of patient specificity. The path was used to schedule OR activity, room-by-room, and day-by-day, feeding the process from a "waiting list database" and using a mathematical optimization model with the objective of ending up in an optimized planning. The OR process was defined with special attention paid to flows, timing and resource involvement. Standardization involved a dynamics operation and defined an expected operating time for each operation. The optimization model has been implemented and tested on real clinical data. The comparison of the results reported with the real data, shows that by using the optimization model, allows for the scheduling of about 30% more patients than in actual practice, as well as to better exploit the OR efficiency, increasing the average operating room utilization rate up to 20%. The optimization of OR activity planning is essential in order to manage the hospital's waiting list. Optimal planning is facilitated by defining the operation as a standard pathway where all variables are taken into account. By allowing a precise scheduling, it feeds the process of planning and, further up-stream, the management of a waiting list in an interactive and bi-directional dynamic process.

Can efficient supply management in the operating room save millions?

PubMed

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.

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

PubMed

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.

Esophageal button battery ingestions: decreasing time to operative intervention by level I trauma activation.

PubMed

Russell, Robert T; Griffin, Russell L; Weinstein, Elizabeth; Billmire, Deborah F

2014-09-01

The incidence of button battery ingestions is increasing and injury due to esophageal impaction begins within minutes of exposure. We changed our management algorithm for suspected button battery ingestions with intent to reduce time to evaluation and operative removal. A retrospective study was performed to identify and evaluate time to treatment and outcome for all esophageal button battery ingestions presenting to a major children's hospital emergency room from February 1, 2010 through February 1, 2012. During the first year, standard emergency room triage (ST) was used. During the second year, the triage protocol was changed and Trauma I triage (TT) was used. 24 children had suspected button battery ingestions with 11 having esophageal impaction. One esophageal impaction was due to 2 stacked coins. Time from arrival in emergency room to battery removal was 183minutes in ST group (n=4) and 33minutes in TT group (n=7) (p=0.04). One patient in ST developed a tracheoesophageal fistula. There were no complications in the TT group. The use of Trauma 1 activations for suspected button battery ingestions has led to more expedient evaluation and shortened time to removal of impacted esophageal batteries. Copyright © 2014 Elsevier Inc. All rights reserved.

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

PubMed

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

2014-01-01

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

Making meaning from sensory cues: a qualitative investigation of postgraduate learning in the operating room.

PubMed

Cope, Alexandra C; Mavroveli, Stella; Bezemer, Jeff; Hanna, George B; Kneebone, Roger

2015-08-01

The authors aimed to map and explicate what surgeons perceive they learn in the operating room. The researchers used a grounded theory method in which data were iteratively collected through semistructured one-to-one interviews in 2010 and 2011 at four participating hospital sites. A four-person data analysis team from differing academic backgrounds qualitatively analyzed the content of the transcripts employing an immersion/crystallization approach. Participants were 22 UK surgeons, some of whom were in training at the time of the study and some of whom were attending surgeons. Major themes of learning in the operating room were perceived to be factual knowledge, motor skills, sensory semiosis, adaptive strategies, team working and management, and attitudes and behaviors. The analysis team classified 277 data points (short paragraphs or groups of sentences conveying meaning) under these major themes and subthemes. A key component of learning in the operating room that emerged from these data was sensory semiosis, defined as learning to make sense of visual and haptic cues. Although the authors found that learning in the operating room occurred across a wide range of domains, sensory semiosis was found to be an important theme that has not previously been fully acknowledged or discussed in the surgical literature. The discussion draws on the wider literature from the social sciences and cognitive psychology literature to examine how professionals learn to make meaning from "signs" making parallels with other medical specialties.

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

PubMed

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

2017-04-01

Sufficient quantities of quality air and controlled, unidirectional flow are important elements in providing a safe building environment for operating rooms. To make dynamic assessments of an operating room environment, a validated method of testing the multiple factors influencing the air quality in health care settings needed to be constructed. These include the following: temperature, humidity, particle load, number of microbial contaminants, pressurization, air velocity, and air distribution. The team developed the name environmental quality indicators (EQIs) to describe the overall air quality based on the actual measurements of these properties taken during the mock surgical procedures. These indicators were measured at 3 different hospitals during mock surgical procedures to simulate actual operating room conditions. EQIs included microbial assessments at the operating table and the back instrument table and real-time analysis of particle counts at 9 different defined locations in the operating suites. Air velocities were measured at the face of the supply diffusers, at the sterile field, at the back table, and at a return grille. The testing protocol provided consistent and comparable measurements of air quality indicators between institutions. At 20 air changes per hour (ACH), and an average temperature of 66.3°F, the median of the microbial contaminants for the 3 operating room sites ranged from 3-22 colony forming units (CFU)/m 3 at the sterile field and 5-27 CFU/m 3 at the back table. At 20 ACH, the median levels of the 0.5-µm particles at the 3 sites were 85,079, 85,325, and 912,232 in particles per cubic meter, with a predictable increase in particle load in the non-high-efficiency particulate air-filtered operating room site. Using a comparison with cleanroom standards, the microbial and particle counts in all 3 operating rooms were equivalent to International Organization for Standardization classifications 7 and 8 during the mock surgical procedures. The EQI protocol was measurable and repeatable and therefore can be safely used to evaluate air quality within the health care environment to provide guidance for operational practices and regulatory requirements. Copyright © 2017 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

The RoboConsultant: telementoring and remote presence in the operating room during minimally invasive urologic surgeries using a novel mobile robotic interface.

PubMed

Agarwal, Rahul; Levinson, Adam W; Allaf, Mohamad; Makarov, Danil; Nason, Alex; Su, Li-Ming

2007-11-01

Remote presence is the ability of an individual to project himself from one location to another to see, hear, roam, talk, and interact just as if that individual were actually there. The objective of this study was to evaluate the efficacy and functionality of a novel mobile robotic telementoring system controlled by a portable laptop control station linked via broadband Internet connection. RoboConsultant (RemotePresence-7; InTouch Health, Sunnyvale, CA) was employed for the purpose of intraoperative telementoring and consultation during five laparoscopic and endoscopic urologic procedures. Robot functionality including navigation, zoom capability, examination of external and internal endoscopic camera views, and telestration were evaluated. The robot was controlled by a senior surgeon from various locations ranging from an adjacent operating room to an affiliated hospital 5 miles away. The RoboConsultant performed without connection failure or interruption in each case, allowing the consulting surgeon to immerse himself and navigate within the operating room environment and provide effective communication, mentoring, telestration, and consultation. RoboConsultant provided clear, real-time, and effective telementoring and telestration and allowed the operator to experience remote presence in the operating room environment as a surgical consultant. The portable laptop control station and wireless connectivity allowed the consultant to be mobile and interact with the operating room team from virtually any location. In the future, the remote presence provided by the RoboConsultant may provide useful and effective intraoperative consultation by expert surgeons located in remote sites.

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

PubMed

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.

Physics and function of operating room suction.

PubMed

Meagher, A P; Hugh, T B; Li, B; Montano, S R

1991-09-01

A study was done to evaluate the performance of suction apparatus in the operating room. The investigation was prompted by perceived poor suction performance in a suite of new operating rooms built in accordance with Standards Australia (SA) specifications. SA performance tests were conducted on each of four suction outlets in nine operating rooms. All 36 outlets complied with SA standards for flow-rate (minimum 40 L/min) and occluded negative pressure (ONP; minimum -60 kPa). However, 24 collection units failed to comply with standards (ONP) of -40 kPa achieved in less than 4 s when a 4 L disposable suction apparatus was connected (mean time to ONP: 6.1 s, 95% confidence interval: 4.9, 7.3). When smaller capacity suction jars were substituted, more units met SA standards. The standards therefore need revision to include specification of the capacity of the collecting apparatus. Other factors that were found to degrade suction performance significantly were air leakage and defective shut-off valves. The physical principles involved in operating room suction are described. Surgeons and anaesthetists should understand these principles, and it is recommended that a simple pre-operative check of the suction apparatus should be carried out, as follows: (1) Turn the wall control knob fully on, and disconnect the suction apparatus. The gauge should register zero. (2) Connect the suction jars. If the indicated gauge pressure is in excess of -15 kPa, investigate the equipment for excessive resistance, particularly in the shut-off valve, which should be replaced with a new unit if necessary.(ABSTRACT TRUNCATED AT 250 WORDS)

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

PubMed

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

2003-10-01

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

DOE Office of Scientific and Technical Information (OSTI.GOV)

Ryan, E. Ronan, E-mail: ronan@ronanryan.com; Thornton, Raymond; Sofocleous, Constantinos T.

PurposeTo quantify radiation exposure to the primary operator and staff during PET/CT-guided interventional procedures.MethodsIn this prospective study, 12 patients underwent PET/CT-guided interventions over a 6 month period. Radiation exposure was measured for the primary operator, the radiology technologist, and the nurse anesthetist by means of optically stimulated luminescence dosimeters. Radiation exposure was correlated with the procedure time and the use of in-room image guidance (CT fluoroscopy or ultrasound).ResultsThe median effective dose was 0.02 (range 0-0.13) mSv for the primary operator, 0.01 (range 0-0.05) mSv for the nurse anesthetist, and 0.02 (range 0-0.05) mSv for the radiology technologist. The median extremitymore » dose equivalent for the operator was 0.05 (range 0-0.62) mSv. Radiation exposure correlated with procedure duration and with the use of in-room image guidance. The median operator effective dose for the procedure was 0.015 mSv when conventional biopsy mode CT was used, compared to 0.06 mSv for in-room image guidance, although this did not achieve statistical significance as a result of the small sample size (p = 0.06).ConclusionThe operator dose from PET/CT-guided procedures is not significantly different than typical doses from fluoroscopically guided procedures. The major determinant of radiation exposure to the operator from PET/CT-guided interventional procedures is time spent in close proximity to the patient.« less

Application of robotics in general surgery: initial experience.

PubMed

Nguyen, Ninh T; Hinojosa, Marcelo W; Finley, David; Stevens, Melinda; Paya, Mahbod

2004-10-01

Robotic surgery was recently approved for clinical use in general abdominal surgery. The aim of this study was to review our experience with the da Vinci surgical system during laparoscopic general surgical procedures. Eighteen patients underwent robotically assisted laparoscopic abdominal surgery between June 2002 and March 2003. Main outcome measures were operative time, room setup time, robotic arm-positioning and surgical time, blood loss, conversion to laparoscopy, length of stay, and morbidity. The types of robotically assisted laparoscopic procedures were excision of gastric leiomyoma (n = 1), Heller myotomy (n = 1), cholecystectomy (n = 2), gastric banding (n = 2), Nissen fundoplication (n = 4), and gastric bypass (n = 8). The mean room setup time was 63 +/- 14 minutes, and the mean robotic arm-positioning time was 16 +/- 7 minutes. Conversion to laparoscopy occurred in two (11%) of 18 cases because of equipment difficulty (n = 1) and technical difficulty (n = 1). Estimated blood loss was 91 +/- 71 mL. The mean operative time was 156 +/- 42 minutes, and the robotic operative time was 27% of the total operative time. The mean length of hospital stay was 2.2 +/- 1.5 days. There was one postoperative wound infection and one anastomotic stricture. Robotically assisted laparoscopic abdominal surgery is feasible and safe; however, the theoretical advantages of the da Vinci surgical system were not clinically apparent.

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

PubMed

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.

Improving operative flow during pediatric airway evaluation: a quality-improvement initiative.

PubMed

Prager, Jeremy D; Ruiz, Amanda G; Mooney, Kristin; Gao, Dexiang; Szolnoki, Judit; Shah, Rahul K

2015-03-01

Microlaryngoscopy and bronchoscopy procedures (MLBs) are short-duration, high-acuity procedures that carry risk. Poor case flow and communication exacerbate such potential risk. Efficient operative flow is critical for patient safety and resource expenditure. To identify areas for improvement and evaluate the effectiveness of a multidisciplinary quality-improvement (QI) initiative. A QI project using the "Plan-Do-Study-Act" (PDSA) cycle was implemented to assess MLBs performed on pediatric patients in a tertiary academic children's hospital. Forty MLBs were audited using a QI evaluation tool containing 144 fields. Each MLB was evaluated for flow, communication, and timing. Opportunities for improvement were identified. Subsequently, QI interventions were implemented in an iterative cycle, and 66 MLBs were audited after the intervention. Specific QI interventions addressed issues of personnel frequently exiting the operating room (OR) and poor preoperative preparation, identified during QI audit as areas for improvement. Interventions included (1) conducting "huddles" between surgeon and OR staff to discuss needed equipment; (2) implementing improvements to surgeon case ordering and preference cards review; (3) posting an OR door sign to limit traffic during airway procedures; and (4) discouraging personnel breaks during airway procedures. Operating room exiting behavior of OR personnel, preoperative preparation, and case timing were assessed and compared before and after the QI intervention. Personnel exiting the OR during the MLB was identified as a preintervention issue, with the surgical technologist, circulator, or surgeon exiting the room in 55% of cases (n = 22). The surgical technologist and circulator left the room to retrieve equipment in 40% of cases (n = 16), which indicated the need for increased preoperative preparation to improve case timing and operative flow. The QI interventions implemented to address these concerns included education regarding break timing, improvements in communication, and improvements in ordering and preparation of equipment. After the QI intervention, the surgical technologist exiting rate decreased from 20% (n = 8) to 8% (n = 5), and the circulator exiting rate decreased from 38% (n = 15) to 27% (n = 17). In addition, the rate of surgeon exiting decreased significantly (from 25% [n = 10 of 40] to 9% [n = 6 of 66]) (P = .03). The surgical technologist and circulating nurse remaining in the room were significantly associated with decreased operating time (1.84-minute decrease for surgical technologist [P = .04] and 1.95-minute decrease for circulating nurse [P = .001]). Gains were made in personnel exiting behavior and case timing after implementation of the QI interventions, potentially leading to decreased risk. This process is easily reproduced and is widely accepted by stakeholders.

Effects of operational decisions on the diffusion of epidemic disease: A system dynamics modeling of the MERS-CoV outbreak in South Korea.

PubMed

Shin, Nina; Kwag, Taewoo; Park, Sangwook; Kim, Yon Hui

2017-05-21

We evaluated the nosocomial outbreak of Middle East Respiratory Syndrome (MERS) Coronavirus (CoV) in the Republic of Korea, 2015, from a healthcare operations management perspective. Establishment of healthcare policy in South Korea provides patients' freedom to select and visit multiple hospitals. Current policy enforces hospitals preference for multi-patient rooms to single-patient rooms, to lower financial burden. Existing healthcare systems tragically contributed to 186 MERS outbreak cases, starting from single "index patient" into three generations of secondary infections. By developing a macro-level health system dynamics model, we provide empirical knowledge to examining the case from both operational and financial perspectives. In our simulation, under base infectivity scenario, high emergency room occupancy circumstance contributed to an estimated average of 101 (917%) more infected patients, compared to when in low occupancy circumstance. Economic patient room design showed an estimated 702% increase in the number of infected patients, despite the overall 98% savings in total expected costs compared to optimal room design. This study provides first time, system dynamics model, performance measurements from an operational perspective. Importantly, the intent of this study was to provide evidence to motivate public, private, and government healthcare administrators' recognition of current shortcomings, to optimize performance as a whole system, rather than mere individual aspects. Copyright © 2017 Elsevier Ltd. All rights reserved.

The role of 'no-touch' automated room disinfection systems in infection prevention and control.

PubMed

Otter, J A; Yezli, S; Perl, T M; Barbut, F; French, G L

2013-01-01

Surface contamination in hospitals is involved in the transmission of pathogens in a proportion of healthcare-associated infections. Admission to a room previously occupied by a patient colonized or infected with certain nosocomial pathogens increases the risk of acquisition by subsequent occupants; thus, there is a need to improve terminal disinfection of these patient rooms. Conventional disinfection methods may be limited by reliance on the operator to ensure appropriate selection, formulation, distribution and contact time of the agent. These problems can be reduced by the use of 'no-touch' automated room disinfection (NTD) systems. To summarize published data related to NTD systems. Pubmed searches for relevant articles. A number of NTD systems have emerged, which remove or reduce reliance on the operator to ensure distribution, contact time and process repeatability, and aim to improve the level of disinfection and thus mitigate the increased risk from the prior room occupant. Available NTD systems include hydrogen peroxide (H(2)O(2)) vapour systems, aerosolized hydrogen peroxide (aHP) and ultraviolet radiation. These systems have important differences in their active agent, delivery mechanism, efficacy, process time and ease of use. Typically, there is a trade-off between time and effectiveness among NTD systems. The choice of NTD system should be influenced by the intended application, the evidence base for effectiveness, practicalities of implementation and cost constraints. NTD systems are gaining acceptance as a useful tool for infection prevention and control. Copyright © 2012 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.

Orientation based on nursing diagnoses. Old concepts in today's practice.

PubMed

Anderson, L K; Vincent, N

1991-10-01

Although many operating room orientation programs contain content necessary to meet accrediting guidelines, very few tie the nursing process to the content. Our orientation is structured within a nursing framework (ie, Dr Gordon's "Eleven Functional Health Patterns") and emphasizes nursing diagnoses, theory, and clinical competencies. Although the new orientation program has been in effect for only two years, we feel the following list reflects the positive outcomes so far: decreased staff turnover (ie, one nurse out of 26 full-time equivalents in 18 months), increased success in recruiting nurses into the operating room (ie, multiple applicants as positions open), new nurses demonstrate comfort with basic perioperative nursing practice with-in six months, and nurses who did not complete new orientation program are requesting all or portions of the content. By using this plan, essential aspects of perioperative practice are consistent with hospital-wide nursing practice, practice standards for the operating room, and accrediting standards.

The operating room of the future: observations and commentary.

PubMed

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.

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

PubMed

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 revenues or were slightly reduced. This improvement in process quality and cumulative incision-suture times as well as the increase in revenues, reflect the positive impact of an efficiency-oriented central OR management. The OR management releases due to measures of process optimization the necessary personnel and time resources and therefore achieves the basic prerequisites for increased revenues of surgical disciplines. The method presented can be used by other hospitals as a guideline to analyze performance development.

Effect of provider volume on resource utilization for surgical procedures of the knee.

PubMed

Jain, Nitin; Pietrobon, Ricardo; Guller, Ulrich; Shankar, Anoop; Ahluwalia, Ajit S; Higgins, Laurence D

2005-05-01

Operating-room time and patient disposition on discharge are important determinants of healthcare resource utilization and cost. We examined the relation between these determinants and hospital/surgeon volume for anterior cruciate ligament (ACL) reconstruction and meniscectomy procedures. Patients undergoing ACL reconstruction (18,390 cases) and meniscectomy (123,012 cases) were extracted from the State Ambulatory Surgery Databases for the years 1997-2000. Surgeon and hospital volume were divided into low-, intermediate-, and high-volume categories. Multivariate logistic regression models were used to estimate the adjusted association between surgeon and hospital volume and patient discharge status and operating-room time. Patients undergoing ACL reconstruction or meniscectomy performed by low-volume surgeons were significantly more likely to be non-routinely discharged as compared to high-volume surgeons (adjusted odds ratio 3.5, 95% confidence interval 1.7-7.2 for ACL reconstruction; adjusted odds ratio 2.0, 95% confidence interval 1.6-2.3 for meniscectomy). The mean operating-room time for performing ACL reconstruction or meniscectomy was significantly higher in low- and intermediate-volume surgeons and hospitals as compared to high-volume surgeons and hospitals (p < or = 0.001). High-volume providers utilize healthcare resources more efficiently. Our findings may help surgeons and hospitals in optimizing resource utilization and cost for routinely-performed ambulatory surgery procedures.

[Improving operating room efficiency: an observational and multidimensional approach in the San Camillo-Forlanini Hospital, Rome].

PubMed

Mitello, Lucia; D'Alba, Fabrizio; Milito, Francesca; Monaco, Cinzia; Orazi, Daniela; Battilana, Daniela; Marucci, Anna Rita; Longo, Angelo; Latina, Roberto

2017-01-01

The management of operating rooms (ORs) is a complex process which requires an effective organizational scheme. In order to amore convinient allocation of resources a rigorous monitoring plan is needed to ensure operating rooms performances. All the necessary actions should be taken to improve the quality of the planning and scheduling procedure. Between April-December, 2016 an organizational analysis has been carried out on the performances of the A.O. S. Camillo-Forlanini Hospital Operating Block applying the "process management" approach to the ORs efficiency. The project involved two different surgical areas of the same operating block the multi-specialist and elective surgery and cardio-vascular surgery . The analyses of the processes was made through the product, patient and safety approach and from different points of view: the "asis", process and stakeholder perspectives. Descriptive statistics was used to process raw data and Student's t-distribution was used to assess the difference between the two means (significant p value ˂0,05). The Coefficient of Variation (CV) was used to describe the variabilityamong data. The asis approach allowed us to describe the ORs inbound activities. For both operating block the most demanding weekly commitments in terms of time turned out to be the inventory management procedures of controlling and stocking medicines, general medical supplies and instruments (130[DS=±14] for BOE and 30[DS=±18] for CCH. The average time spent on preparing the operating room, separately calculated starting from the first surgical case, was of 27 minutes (SD=± 17) while for the following surgical procedures preparation time decreased to 15 minutes (SD= ± 10), which highlighted a meaningful difference of 12 minutes. A great variability was registered in CCH due to the unpredictability of these operations (CV 82%). The stakeholders' perspective revealed a reasonable level of satisfaction among nurses and surgeons (2.9 vs 2.3, respectively) and in anesthesiologist (2.8-BOE vs 2.4 CCH).Being brought to the surgical suite from an "external Unit" seems to have negatively influenced the patient's perception: preparation time turned out to be significantly lower for CCH patients rather than BOE ones (p˂0,001).The results of the safety procedure approach highlighted a moderate criticality in terms of cleaning up time and delay in the starting time of the first surgical case. More effort should be made to avoid any slowdown during the whole process. It is advisable to implement a lean system that may improve efficiency and quality of the service to reduce wastes and unproductive times. This would inevitably generate a more positive outcomes.

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

PubMed

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.

The use of distributed displays of operating room video when real-time occupancy status was available.

PubMed

Xiao, Yan; Dexter, Franklin; Hu, Peter; Dutton, Richard P

2008-02-01

On the day of surgery, real-time information of both room occupancy and activities within the operating room (OR) is needed for management of staff, equipment, and unexpected events. A status display system showed color OR video with controllable image quality and showed times that patients entered and exited each OR (obtained automatically). The system was installed and its use was studied in a 6-OR trauma suite and at four locations in a 19-OR tertiary suite. Trauma staff were surveyed for their perceptions of the system. Evidence of staff acceptance of distributed OR video included its operational use for >3 yr in the two suites, with no administrative complaints. Individuals of all job categories used the video. Anesthesiologists were the most frequent users for more than half of the days (95% confidence interval [CI] >50%) in the tertiary ORs. The OR charge nurses accessed the video mostly early in the day when the OR occupancy was high. In comparison (P < 0.001), anesthesiologists accessed it mostly at the end of the workday when occupancy was declining and few cases were starting. Of all 30-min periods during which the video was accessed in the trauma suite, many accesses (95% CI >42%) occurred in periods with no cases starting or ending (i.e., the video was used during the middle of cases). The three stated reasons for using video that had median surveyed responses of "very useful" were "to see if cases are finished," "to see if a room is ready," and "to see when cases are about to finish." Our nurses and physicians both accepted and used distributed OR video as it provided useful information, regardless of whether real-time display of milestones was available (e.g., through anesthesia information system data).

Development of an image operation system with a motion sensor in dental radiology.

PubMed

Sato, Mitsuru; Ogura, Toshihiro; Yasumoto, Yoshiaki; Kadowaki, Yuta; Hayashi, Norio; Doi, Kunio

2015-07-01

During examinations and/or treatment, a dentist in the examination room needs to view images with a proper display system. However, they cannot operate the image display system by hands, because dentists always wear gloves to be kept their hands away from unsanitized materials. Therefore, we developed a new image operating system that uses a motion sensor. We used the Leap motion sensor technique to read the hand movements of a dentist. We programmed the system using C++ to enable various movements of the display system, i.e., click, double click, drag, and drop. Thus, dentists with their gloves on in the examination room can control dental and panoramic images on the image display system intuitively and quickly with movement of their hands only. We investigated the time required with the conventional method using a mouse and with the new method using the finger operation. The average operation time with the finger method was significantly shorter than that with the mouse method. This motion sensor method, with appropriate training for finger movements, can provide a better operating performance than the conventional mouse method.

Operating experience review of an INL gas monitoring system

DOE Office of Scientific and Technical Information (OSTI.GOV)

Cadwallader, Lee C.; DeWall, K. G.; Herring, J. S.

2015-03-12

This article describes the operations of several types of gas monitors in use at the Idaho National Laboratory (INL) High Temperature Electrolysis Experiment (HTE) laboratory. The gases monitored in the lab room are hydrogen, carbon monoxide, carbon dioxide, and oxygen. The operating time, calibration, and both actual and unwanted alarms are described. The calibration session time durations are described. In addition, some simple calculations are given to estimate the reliability of these monitors and the results are compared to operating experiences of other types of monitors.

Evaluating the effect of distractions in the operating room on clinical decision-making and patient safety.

PubMed

Murji, Ally; Luketic, Lea; Sobel, Mara L; Kulasegaram, Kulamakan Mahan; Leyland, Nicholas; Posner, Glenn

2016-10-01

Answering telephone calls and pagers is common distraction in the operating room. We sought to evaluate the impact of distractions on patient care by (1) assessing the accuracy and safety of responses to clinical questions posed to a surgeon while operating and (2) determining whether pager distractions affect simulation-based surgical performance. We conducted a randomized crossover study of obstetrics and gynecology residents. After studying a patient sign-out list, subjects performed a virtual salpingectomy. They were randomized to a distraction phase followed by quiet phase or vice versa. In the distraction phase, a pager beeped and subjects were asked questions based on the sign-out list. Accuracy of responses and the number of unsafe responses were recorded. In the quiet phase, trainees performed the task uninterrupted. Measures of surgical performance were successful task completion, time to task completion and operative blood loss. The mean score for correct responses to clinical questions during the distracted phase was 80 % (SD ±14 %). Nineteen residents (63 %) made at least 1 unsafe clinical decision while operating on the simulator (range 0-3). Subjects were more likely to successfully complete the surgical task in the allotted time under the quiet compared to distraction condition (OR 11.3, p = 0.03). There was no difference between the conditions in paired analysis for mean time (seconds) to task completion [426 (SD 133) vs. 440 (SD 186), p = 0.61] and mean operative blood loss (mL) [73.14 (SD 106) vs. 112.70 (SD 358), p = 0.47]. Distractions in the operating room may have a profound impact on patient safety on the wards. While multitasking in a simulated setting, the majority of residents made at least one unsafe clinical decision. Pager distractions also hindered surgical residents' ability to complete a simulated laparoscopic task in the allotted time without affecting other variables of surgical performance.

A Psychomotor Skills Course for Orthopaedic Residents

ERIC Educational Resources Information Center

Lippert, Frederick G.; And Others

1975-01-01

The course described and evaluated here was developed at the University of Washington School of Medicine to teach 20 orthopaedic residents operative techniques, instrument usage, and safety precautions outside of the operating room without hazard to the patient or regard to time constraints. (JT)

Construction of a high-tech operating room for image-guided surgery using VR.

PubMed

Suzuki, Naoki; Hattori, Asaki; Suzuki, Shigeyuki; Otake, Yoshito; Hayashibe, Mitsuhiro; Kobayashi, Susumu; Nezu, Takehiko; Sakai, Haruo; Umezawa, Yuji

2005-01-01

This project aimed to construct an operating room to implement high dimensional (3D, 4D) medical imaging and medical virtual reality techniques that would enable clinical tests for new surgical procedures. We designed and constructed such an operating room at Dai-san Hospital, the Jikei Univ. School of Medicine, Tokyo, Japan. The room was equipped with various facilities for image-guided, robot and tele- surgery. In this report, we describe an outline of our "high-tech operating room" and future plans.

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

PubMed

Feng, Jingyi; Chen, Hua; Liu, Jiquan

2011-10-01

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

Effectiveness of in-room air filtration and dilution ventilation for tuberculosis infection control.

PubMed

Miller-Leiden, S; Lobascio, C; Nazaroff, W W; Macher, J M

1996-09-01

Tuberculosis (TB) is a public health problem that may pose substantial risks to health care workers and others. TB infection occurs by inhalation of airborne bacteria emitted by persons with active disease. We experimentally evaluated the effectiveness of in-room air filtration systems, specifically portable air filters (PAFs) and ceiling-mounted air filters (CMAFs), in conjunction with dilution ventilation, for controlling TB exposure in high-risk settings. For each experiment, a test aerosol was continuously generated and released into a full-sized room. With the in-room air filter and room ventilation system operating, time-averaged airborne particle concentrations were measured at several points. The effectiveness of in-room air filtration plus ventilation was determined by comparing particle concentrations with and without device operation. The four PAFs and three CMAFs we evaluated reduced room-average particle concentrations, typically by 30% to 90%, relative to a baseline scenario with two air-changes per hour of ventilation (outside air) only. Increasing the rate of air flow recirculating through the filter and/or air flow from the ventilation did not always increase effectiveness. Concentrations were generally higher near the emission source than elsewhere in the room. Both the air flow configuration of the filter and its placement within the room were important, influencing room air flow patterns and the spatial distribution of concentrations. Air filters containing efficient, but non-high efficiency particulate air (HEPA) filter media were as effective as air filters containing HEPA filter media.

Effectiveness of In-Room Air Filtration and Dilution Ventilation for Tuberculosis Infection Control.

PubMed

Miller-Leiden, S; Lohascio, C; Nazaroff, W W; Macher, J M

1996-09-01

Tuberculosis (TB) is a public health problem that may pose substantial risks to health care workers and others. TB infection occurs by inhalation of airborne bacteria emitted by persons with active disease. We experimentally evaluated the effectiveness of in-room air filtration systems, specifically portable air filters (PAFs) and ceiling-mounted air filters (CMAFs), in conjunction with dilution ventilation, for controlling TB exposure in high-risk settings. For each experiment, a test aerosol was continuously generated and released into a full-sized room. With the in-room air filter and room ventilation system operating, time-averaged airborne particle concentrations were measured at several points. The effectiveness of in-room air filtration plus ventilation was determined by comparing particle concentrations with and without device operation. The four PAFs and three CMAFs we evaluated reduced room-average particle concentrations, typically by 30% to 90%, relative to a baseline scenario with two air-changes per hour of ventilation (outside air) only. Increasing the rate of air flow recirculating through the filter and/or air flow from the ventilation did not always increase effectiveness. Concentrations were generally higher near the emission source than elsewhere in the room. Both the air flow configuration of the filter and its placement within the room were important, influencing room air flow patterns and the spatial distribution of concentrations. Air filters containing efficient, but non-high efficiency particulate air (HEPA) filter media were as effective as air filters containing HEPA filter media.

Hybrid procedure for orbital venous malformation in the endovascular operation room.

PubMed

Cheng, A C O; Li, E Y M; Chan, T C Y; Wong, A C W; Chan, P C M; Poon, W W L; Fung, D H S; Yuen, H K L

2015-08-01

To describe a hybrid procedure for orbital venous malformation in the endovascular operating room (EVOR). Five consecutive patients with venous malformation in the periocular and orbital region were included. All patients received a one-stage direct puncture venogram, image-guided glue injection, and surgical resection in the EVOR equipped with a biplane digital subtraction angiography system (BDSAS). The mean age at the time of operation was 37.4 years (range, 22-69 years). The mean operative time was 193 min (range, 138-324 min). No intraoperative complications were noted. The mean follow-up duration was 18.8 months (range, 10-24 months). Three patients had complete removal of the vascular lesions. At the latest follow-up, no recurrence of symptoms related to the lesions was noted. All patients had an uneventful recovery and satisfactory outcome. The hybrid procedure of orbital venous malformation in the EVOR is a novel application in ophthalmology. It is a safe and well-controlled procedure with real-time high-quality BDSAS surveillance to facilitate surgical resection. Its success requires collaboration between the interventional radiologist, the surgeon, and the ophthalmologist.

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

PubMed

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.

Anesthesia preparation time is not affected by the experience level of the resident involved during his/her first month of adult cardiac surgery.

PubMed

Broussard, David M; Couch, Michael C

2011-10-01

This study was designed to answer the question of whether the experience level of the resident on his/her first month of adult cardiothoracic anesthesiology has an impact on operating room efficiency in a large academic medical center. Traditionally, the resident's 1st month of cardiac anesthesia had been reserved for the clinical anesthesia (CA)-2 year of training. This study analyzed the impact on operating room efficiency of moving the 1st month of cardiac anesthesia into the CA-1 year. The authors hypothesized that there would be no difference in anesthesia preparation times (defined as the interval between "in-room" and "anesthesia-ready" times) between CA-1 and CA-2 residents on their 1st month of cardiac anesthesia. This study was retrospective and used an electronic anesthesia information management system database. This study was conducted on care provided at a single 450-bed academic medical center. This study included 12 residents in their 1st month of cardiac anesthesia. The anesthesia preparation time (defined as the interval between "in-room" and "anesthesia-ready" times) was measured for cases involving residents on their first month of cardiac anesthesia. Anesthesia preparation times for 6 CA-1 resident months and 6 CA-2 resident months (100 adult cardiac procedures in total) were analyzed (49 for the CA-1 residents and 51 for the CA-2s). There were no differences in preparation time between CA-1 and CA-2 residents as a group (p = 0.8169). The CA-1 residents had an unadjusted mean (±standard error) of 51.1 ± 3.18 minutes, whereas the CA-2 residents' unadjusted mean was 50.2 ± 2.41 minutes. Adjusting for case mix (valves v coronary artery bypass graft surgery), the CA-1 mean was 49.1 ± 5.22 minutes, whereas the CA-2 mean was 49.1 ± 4.54 minutes. These findings suggest that operating room efficiency as measured by the anesthesia preparation time may not be affected by the level of the resident on his/her 1st month of adult cardiac anesthesia. Copyright © 2011 Elsevier Inc. All rights reserved.

9 CFR 590.508 - Candling and transfer-room operations.

Code of Federal Regulations, 2011 CFR

2011-01-01

..., Processing, and Facility Requirements § 590.508 Candling and transfer-room operations. (a) Candling and transfer rooms and equipment shall be kept clean, free from cobwebs, dust, objectionable odors, and excess... 9 Animals and Animal Products 2 2011-01-01 2011-01-01 false Candling and transfer-room operations...

9 CFR 590.508 - Candling and transfer-room operations.

Code of Federal Regulations, 2013 CFR

2013-01-01

..., Processing, and Facility Requirements § 590.508 Candling and transfer-room operations. (a) Candling and transfer rooms and equipment shall be kept clean, free from cobwebs, dust, objectionable odors, and excess... 9 Animals and Animal Products 2 2013-01-01 2013-01-01 false Candling and transfer-room operations...

9 CFR 590.508 - Candling and transfer-room operations.

Code of Federal Regulations, 2010 CFR

2010-01-01

..., Processing, and Facility Requirements § 590.508 Candling and transfer-room operations. (a) Candling and transfer rooms and equipment shall be kept clean, free from cobwebs, dust, objectionable odors, and excess... 9 Animals and Animal Products 2 2010-01-01 2010-01-01 false Candling and transfer-room operations...

9 CFR 590.508 - Candling and transfer-room operations.

Code of Federal Regulations, 2014 CFR

2014-01-01

..., Processing, and Facility Requirements § 590.508 Candling and transfer-room operations. (a) Candling and transfer rooms and equipment shall be kept clean, free from cobwebs, dust, objectionable odors, and excess... 9 Animals and Animal Products 2 2014-01-01 2014-01-01 false Candling and transfer-room operations...

9 CFR 590.508 - Candling and transfer-room operations.

Code of Federal Regulations, 2012 CFR

2012-01-01

..., Processing, and Facility Requirements § 590.508 Candling and transfer-room operations. (a) Candling and transfer rooms and equipment shall be kept clean, free from cobwebs, dust, objectionable odors, and excess... 9 Animals and Animal Products 2 2012-01-01 2012-01-01 false Candling and transfer-room operations...

Dental occlusion ties: A rapid, safe, and non‐invasive maxillo‐mandibular fixation technology

PubMed Central

2017-01-01

Objectives For decades, Erich arch bars have been a standard in establishing maxillo‐mandibular fixation (MMF). While reliable, the approach risks sharps injury, consumes operating room time, and inflicts gingival trauma. Newer technologies including screw‐based techniques and “hybrid” techniques have improved MMF by reducing sharps injuries and operating room time, but risk injury to tooth roots, nerves, and gingiva. This study aims to establish the application, strengths, and limitations of dental occlusion ties as a novel alternative in maxillo‐mandibular fixation. Study Design Prospective, non‐blinded, human feasibility clinical trial. Materials and Methods An iterative prototyping process was used to invent dental occlusion ties (brand name: Minne Ties). Development included 3D printing, cadaver prototype testing, human apical embrasure measurement, and ultimately non‐significant risk human clinical trial testing. In the IRB‐approved feasibility clinical trial, the devices were applied to mandible and maxilla fracture candidates with fractures amenable to intra‐operative MMF with open reduction with internal fixation. The ties were removed prior to extubation. Pre‐teens, comminuted fracture patients, and patients requiring post‐operative MMF were excluded. Results Manufactured, sterile prototypes secured MMF successfully in management of unilateral and bilateral mandible and maxilla fractures. All patients reported correction of pre‐operative malocclusion. Application times were typically 12–15 minutes for a single surgeon to achieve MMF. Patients incurred negligible gingival trauma from the technology as the ties require no tissue penetration for application. Conclusions Dental occlusion ties offer a non‐invasive solution featuring operating room efficiency, minimized sharps risk, and less bony and soft tissue trauma than current commercialized solutions. Level of Evidence Therapeutic, IV PMID:28894837

A financial analysis of operating room charges for robot-assisted gynaecologic surgery: Efficiency strategies in the operating room for reducing the costs

PubMed Central

Zeybek, Burak; Öge, Tufan; Kılıç, Cemil Hakan; Borahay, Mostafa A.; Kılıç, Gökhan Sami

2014-01-01

Objective To analyse the steps taking place in the operating room (OR) before the console time starts in robot-assisted gynaecologic surgery and to identify potential ways to decrease non-operative time in the OR. Material and Methods Thirteen consecutive robotic cases for benign gynaecologic disease at the Department of Obstetrics and Gynecology at University of Texas Medical Branch (UTMB) were retrospectively reviewed. The collected data included the specific terms ‘Anaesthesia Done’ (step 1), ‘Drape Done’ (step 2), and ‘Trocar In’ (step 3), all of which refer to the time before the actual surgery began and OR charges were evaluated as level 3, 4, and 5 for open abdominal/vaginal hysterectomy, laparoscopic hysterectomy, and robot-assisted hysterectomy, respectively. Results The cost of the OR for 0–30 minutes and each additional 30 minutes were $3,693 and $1,488, $4,961 and $2,426, $5,513 and $2,756 in level 3, 4, and 5 surgeries, respectively. The median time for step 1 was 12.1 min (5.25–23.3), for step 2 was 19 (4.59–44) min, and for step 3 was 25.3 (16.45–45) min. The total median time until the actual operation began was 54.58 min (40–100). The total cost was $6948.7 when the charge was calculated according to level 4 and $7771.1 when the charge was calculated according to level 5. Conclusion Robot-assisted surgery is already ‘cost-expensive’ in the preparation stage of a surgical procedure during anaesthesia induction and draping of the patient because of charging levels. Every effort should be made to shorten the time and reduce the number of instruments used without compromising care. (J Turk Ger Gynecol Assoc 2014; 15: 25–9) PMID:24790513

Process simulation during the design process makes the difference: process simulations applied to a traditional design.

PubMed

Traversari, Roberto; Goedhart, Rien; Schraagen, Jan Maarten

2013-01-01

The objective is evaluation of a traditionally designed operating room using simulation of various surgical workflows. A literature search showed that there is no evidence for an optimal operating room layout regarding the position and size of an ultraclean ventilation (UCV) canopy with a separate preparation room for laying out instruments and in which patients are induced in the operating room itself. Neither was literature found reporting on process simulation being used for this application. Many technical guidelines and designs have mainly evolved over time, and there is no evidence on whether the proposed measures are also effective for the optimization of the layout for workflows. The study was conducted by applying observational techniques to simulated typical surgical procedures. Process simulations which included complete surgical teams and equipment required for the intervention were carried out for four typical interventions. Four observers used a form to record conflicts with the clean area boundaries and the height of the supply bridge. Preferences for particular layouts were discussed with the surgical team after each simulated procedure. We established that a clean area measuring 3 × 3 m and a supply bridge height of 2.05 m was satisfactory for most situations, provided a movable operation table is used. The only cases in which conflicts with the supply bridge were observed were during the use of a surgical robot (Da Vinci) and a surgical microscope. During multiple trauma interventions, bottlenecks regarding the dimensions of the clean area will probably arise. The process simulation of four typical interventions has led to significantly different operating room layouts than were arrived at through the traditional design process. Evidence-based design, human factors, work environment, operating room, traditional design, process simulation, surgical workflowsPreferred Citation: Traversari, R., Goedhart, R., & Schraagen, J. M. (2013). Process simulation during the design process makes the difference: Process simulations applied to a traditional design. Health Environments Research & Design Journal 6(2), pp 58-76.

Improving operating room schedules.

PubMed

Li, Fei; Gupta, Diwakar; Potthoff, Sandra

2016-09-01

Operating rooms (ORs) in US hospitals are costly to staff, generate about 70 % of a hospital's revenues, and operate at a staffed-capacity utilization of 60-70 %. Many hospitals allocate blocks of OR time to individual or groups of surgeons as guaranteed allocation, who book surgeries one at a time in their blocks. The booking procedure frequently results in unused time between surgeries. Realizing that this presents an opportunity to improve OR utilization, hospitals manually reschedule surgery start times one or two days before each day of surgical operations. The purpose of rescheduling is to decrease OR staffing costs, which are determined by the number of concurrently staffed ORs. We formulate the rescheduling problem as a variant of the bin-packing problem with interrelated items, which are the surgeries performed by the same surgeon. We develop a lower bound (LB) construction algorithm and prove that the LB is at least (2/3) of the optimal staffing cost. A key feature of our approach is that we allow hospitals to have two shift lengths. Our analytical results form the basis of a branch-and-bound algorithm, which we test on data obtained from three hospitals. Experiments show that rescheduling saves significant staffing costs.

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

PubMed

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.

Operating Room Delays: Meaningful Use in Electronic Health Record.

PubMed

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.

Optimization of fluorescent imaging in the operating room through pulsed acquisition and gating to ambient background cycling

PubMed Central

Sexton, Kristian J.; Zhao, Yan; Davis, Scott C.; Jiang, Shudong; Pogue, Brian W.

2017-01-01

The design of fluorescence imaging instruments for surgical guidance is rapidly evolving, and a key issue is to efficiently capture signals with high ambient room lighting. Here, we introduce a novel time-gated approach to fluorescence imaging synchronizing acquisition to the 120 Hz light of the room, with pulsed LED excitation and gated ICCD detection. It is shown that under bright ambient room light this technique allows for the detection of physiologically relevant nanomolar fluorophore concentrations, and in particular reduces the light fluctuations present from the room lights, making low concentration measurements more reliable. This is particularly relevant for the light bands near 700nm that are more dominated by ambient lights. PMID:28663895

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

PubMed

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.

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

PubMed

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

2016-05-01

Students undertake their clinical placement in various clinical settings for the exposure to and acquisition of skills related to that particular context. The operating room is a context that offers the opportunity to develop critical skills related to the perioperative care of the patient. Despite numerous studies that have been undertaken in this field, few have investigated the operating room as a clinical learning environment in the South African private healthcare context. The aim of this study was to determine nursing students' perceptions of the operating room as a clinical learning environment. An exploratory, interpretive and descriptive design generating qualitative data was utilized. Eight nursing students completed an open-ended questionnaire, and twelve nursing students participated in the focus group discussion. Four themes emerged, namely, 'interpersonal factors', 'educational factors', 'private operating room context', and 'recommendations'. The opinion that the operating room offers an opportunity to gain skills unique to this context was expressed. However, despite the potential learning opportunities, the key findings of this study reveal negative perceptions of nursing students regarding learning experiences in the operating room. Exploration into the preparatory needs of students specific to learning outcomes before operating room placement should be considered. It will also be necessary to improve collaboration between lecturers, mentors and theatre managers. Copyright © 2016 Elsevier Ltd. All rights reserved.

Submilliampere continuous-wave room-temperature lasing operation of a GaAs mushroom structure surface-emitting laser

DOE Office of Scientific and Technical Information (OSTI.GOV)

Yang, Y.J.; Dziura, T.G.; Wang, S.C.

1990-05-07

We report a GaAs mushroom structure surface-emitting laser at 900 nm with submilliampere (0.2--0.5 mA) threshold under room-temperature cw operation for the first time. The very low threshold current was achieved on devices which consisted of a 2--4 {mu}m diameter active region formed by chemical selective etching, and sandwiched between two Al{sub 0.05}Ga{sub 0.95} As/ Al{sub 0.53}Ga{sub 0.47} As distributed Bragg reflectors of very high reflectivity (98--99%) grown by metalorganic chemical vapor deposition.

Submilliampere continuous-wave room-temperature lasing operation of a GaAs mushroom structure surface-emitting laser

NASA Astrophysics Data System (ADS)

Yang, Ying Jay; Dziura, Thaddeus G.; Wang, S. C.; Hsin, Wei; Wang, Shyh

1990-05-01

We report a GaAs mushroom structure surface-emitting laser at 900 nm with submilliampere (0.2-0.5 mA) threshold under room-temperature cw operation for the first time. The very low threshold current was achieved on devices which consisted of a 2-4 μm diameter active region formed by chemical selective etching, and sandwiched between two Al0.05Ga0.95 As/ Al0.53Ga0.47 As distributed Bragg reflectors of very high reflectivity (98-99%) grown by metalorganic chemical vapor deposition.

An update on intraoperative three-dimensional transesophageal echocardiography

PubMed Central

2017-01-01

Transesophageal echocardiography (TEE) was first used routinely in the operating rooms in the 1980s to facilitate surgical decision-making. Since then, TEE has evolved from the standard two-dimensional (2D) exam to include focused real-time three-dimensional (RT-3D) imaging both inside and outside the operating rooms. Improved spatial and temporal resolution due to technological advances has expedited surgical interventions in diseased valves. 3D imaging has also emerged as a crucial adjunct in percutaneous interventions for structural heart disease. With continued advancement in software, RT-3D TEE will continue to impact perioperative decisions. PMID:28540070

Monitoring universal protocol compliance through real-time clandestine observation by medical students results in performance improvement.

PubMed

Logan, Catherine A; Cressey, Brienne D; Wu, Roger Y; Janicki, Adam J; Chen, Cyril X; Bolourchi, Meena L; Hodnett, Jessica L; Stratigis, John D; Mackey, William C; Fairchild, David G

2012-01-01

To measure universal protocol compliance through real-time, clandestine observation by medical students compared with chart audit reviews, and to enable medical students the opportunity to become conscious of the importance of medical errors and safety initiatives. With endorsement from Tufts Medical Center's (TMC's) Chief Medical Officer and Surgeon-in-Chief, 8 medical students performed clandestine observation audits of 98 cases from April to August 2009. A compliance checklist was based on TMC's presurgical checklist. Our initial results led to interventions to improve our universal protocol procedures, including modifications to the operating room white board and presurgical checklist, and specific feedback to surgical departments. One year later, 6 medical students performed observations of 100 cases from June to August 2010. Tufts Medical Center, Boston, Massachusetts, which is an academic medical center and the principal teaching hospital for Tufts University School of Medicine. An operating room coordinator placed the medical students into 1 of our 25 operating rooms with students entering under the premise of observing the anesthesiologist for clinical education. The observations were performed Monday to Friday between 7 am and 4 pm. Although observations were not randomized, no single service or type of surgery was targeted for observation. A broad range of departments was observed. In 8.2% of cases, the surgical site was unmarked. A Time Out occurred in 89.7% of cases. The entire surgical team was attentive during the time out in 82% of cases. The presurgical checklist was incomplete before incision in 13 cases. Images were displayed in 82% of cases. The operating room "white board" was filled out completely in 49% of cases. Team introductions occurred in 13 cases. One year later, compliance increased in all Universal Protocol dimensions. Direct, real-time observation by medical students provides an accurate and granular assessment of compliance with specific components of the universal protocol and engages medical students in the quality improvement process, raises their awareness of the gravity of medical errors, and ensures appreciation of the importance of quality and safety initiatives. Copyright © 2012 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

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

PubMed

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 < 0.0001). The CO2 concentration at the end of the ESU pencil tip was 95%, while the average CO2 concentration 1 to 1.4 cm away from the pencil tip on the bottom plane was 64%. In conclusion, an operating room 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. Future testing should determine optimum CO2 flow rates and ideal nozzle shapes. Use of this device may substantially reduce the risk of patient injury due to operating room fires.

Tactical decision making for selective expansion of operating room resources incorporating financial criteria and uncertainty in subspecialties' future workloads.

PubMed

Dexter, Franklin; Ledolter, Johannes; Wachtel, Ruth E

2005-05-01

We considered the allocation of operating room (OR) time at facilities where the strategic decision had been made to increase the number of ORs. Allocation occurs in two stages: a long-term tactical stage followed by short-term operational stage. Tactical decisions, approximately 1 yr in advance, determine what specialized equipment and expertise will be needed. Tactical decisions are based on estimates of future OR workload for each subspecialty or surgeon. We show that groups of surgeons can be excluded from consideration at this tactical stage (e.g., surgeons who need intensive care beds or those with below average contribution margins per OR hour). Lower and upper limits are estimated for the future demand of OR time by the remaining surgeons. Thus, initial OR allocations can be accomplished with only partial information on future OR workload. Once the new ORs open, operational decision-making based on OR efficiency is used to fill the OR time and adjust staffing. Surgeons who were not allocated additional time at the tactical stage are provided increased OR time through operational adjustments based on their actual workload. In a case study from a tertiary hospital, future demand estimates were needed for only 15% of surgeons, illustrating the practicality of these methods for use in tactical OR allocation decisions.

Planning for patient privacy and hospitability: a must do in oncology care.

PubMed

Easter, James G

2003-01-01

The number one design challenge in the healthcare environment is the patient room. This space is one of the primary functional areas impacting hospital design and, quite often, the place of greatest controversy. This controversy is due to the length of time the patient spends in the room (compared to other areas), the amount of overall space required and the time dedicated to patient room utilization, maintenance, general arrangement and overall efficiency. In addition, there is a growing list of room types to be considered, many are of the ambulatory care, short stay and observation category. Other room types beyond the routine medical/surgical room include Intensive Care, Coronary Care, Surgical Intensive Care, Skilled Nursing, Rehabilitation and Oncology Care as well as more intensive Bone Marrow Transplantation, for example. Major features of the traditional acute care patient room require the space to be flexible, convertible, expandable and, most importantly, hospitable. For many, many years the patient room was considered a shared space with multiple beds and multiple users. The term semi-private has been used to describe the traditional two-bed and, sometimes 4-bed patient room. This article will address the programmatic elements of an inpatient area, the room and its functional components along with some examples for comparative purposes. For the oncology patient, the development of a family-focused, private room is mandatory. The private room is more flexible, less expensive to operate, safer and environmentally more appealing for the patient, family and staff.

Virtual operating room for team training in surgery.

PubMed

Abelson, Jonathan S; Silverman, Elliott; Banfelder, Jason; Naides, Alexandra; Costa, Ricardo; Dakin, Gregory

2015-09-01

We proposed to develop a novel virtual reality (VR) team training system. The objective of this study was to determine the feasibility of creating a VR operating room to simulate a surgical crisis scenario and evaluate the simulator for construct and face validity. We modified ICE STORM (Integrated Clinical Environment; Systems, Training, Operations, Research, Methods), a VR-based system capable of modeling a variety of health care personnel and environments. ICE STORM was used to simulate a standardized surgical crisis scenario, whereby participants needed to correct 4 elements responsible for loss of laparoscopic visualization. The construct and face validity of the environment were measured. Thirty-three participants completed the VR simulation. Attendings completed the simulation in less time than trainees (271 vs 201 seconds, P = .032). Participants felt the training environment was realistic and had a favorable impression of the simulation. All participants felt the workload of the simulation was low. Creation of a VR-based operating room for team training in surgery is feasible and can afford a realistic team training environment. Copyright © 2015 Elsevier Inc. All rights reserved.

Simulated life-threatening emergency during robot-assisted surgery.

PubMed

Huser, Anna-Sophia; Müller, Dirk; Brunkhorst, Violeta; Kannisto, Päivi; Musch, Michael; Kröpfl, Darko; Groeben, Harald

2014-06-01

With the increasing use of robot-assisted techniques for urologic and gynecologic surgery in patients with severe comorbidities, the risk of a critical incidence during surgery increases. Due to limited access to the patient the start of effective measures to treat a life-threatening emergency could be delayed. Therefore, we tested the management of an acute emergency in an operating room setting with a full-size simulator in six complete teams. A full-size simulator (ISTAN, Meti, CA), modified to hold five trocars, was placed in a regular operating room and connected to a robotic system. Six teams (each with three nurses, one anesthesiologist, two urologists or gynecologists) were introduced to the scenario. Subsequently, myocardial fibrillation occurred. Time to first chest compression, removal of the robot, first defibrillation, and stabilization of circulation were obtained. After 7 weeks the simulation was repeated. The time to the start of chest compressions, removal of the robotic system, and first defibrillation were significantly improved at the second simulation. Time for restoration of stable circulation was improved from 417 ± 125 seconds to 224 ± 37 seconds (P=0.0054). Unexpected delays occurred during the first simulation because trocars had been removed from the patient but not from the robot, thus preventing the robot to be moved. Following proper training, resuscitation can be started within seconds. A repetition of the simulation significantly improved time for all steps of resuscitation. An emergency simulation of a multidisciplinary team in a real operating room setting can be strongly recommended.

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

PubMed

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 supportive environment for the patients, the doctors, and the staff.

DETAIL VIEW OF OPERATIONS MANAGEMENT ROOM, FIRING ROOM NO. 3, ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

DETAIL VIEW OF OPERATIONS MANAGEMENT ROOM, FIRING ROOM NO. 3, FACING NORTH - Cape Canaveral Air Force Station, Launch Complex 39, Launch Control Center, LCC Road, East of Kennedy Parkway North, Cape Canaveral, Brevard County, FL

DETAIL VIEW OF OPERATIONS MANAGEMENT ROOM, FIRING ROOM NO. 3, ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

DETAIL VIEW OF OPERATIONS MANAGEMENT ROOM, FIRING ROOM NO. 3, FACING SOUTHEAST - Cape Canaveral Air Force Station, Launch Complex 39, Launch Control Center, LCC Road, East of Kennedy Parkway North, Cape Canaveral, Brevard County, FL

DETAIL VIEW OF OPERATIONS MANAGEMENT ROOM, FIRING ROOM NO. 3, ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

DETAIL VIEW OF OPERATIONS MANAGEMENT ROOM, FIRING ROOM NO. 3, FACING EAST - Cape Canaveral Air Force Station, Launch Complex 39, Launch Control Center, LCC Road, East of Kennedy Parkway North, Cape Canaveral, Brevard County, FL

DETAIL VIEW OF OPERATIONS MANAGEMENT ROOM, FIRING ROOM NO. 4, ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

DETAIL VIEW OF OPERATIONS MANAGEMENT ROOM, FIRING ROOM NO. 4, FACING WEST - Cape Canaveral Air Force Station, Launch Complex 39, Launch Control Center, LCC Road, East of Kennedy Parkway North, Cape Canaveral, Brevard County, FL

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

PubMed Central

Tang, Chin-Sheng; Wan, Gwo-Hwa

2013-01-01

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

Costs of disposable material in the operating room do not show high correlation with surgical time: Implications for hospital payment.

PubMed

Delo, Caroline; Leclercq, Pol; Martins, Dimitri; Pirson, Magali

2015-08-01

The objectives of this study are to analyze the variation of the surgical time and of disposable costs per surgical procedure and to analyze the association between disposable costs and the surgical time. The registration of data was done in an operating room of a 419 bed general hospital, over a period of three months (n = 1556 surgical procedures). Disposable material per procedure used was recorded through a barcode scanning method. The average cost (standard deviation) of disposable material is €183.66 (€183.44). The mean surgical time (standard deviation) is 96 min (63). Results have shown that the homogeneity of operating time and DM costs was quite good per surgical procedure. The correlation between the surgical time and DM costs is not high (r = 0.65). In a context of Diagnosis Related Group (DRG) based hospital payment, it is important that costs information systems are able to precisely calculate costs per case. Our results show that the correlation between surgical time and costs of disposable materials is not good. Therefore, empirical data or itemized lists should be used instead of surgical time as a cost driver for the allocation of costs of disposable materials to patients. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

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

PubMed

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.

Mediated interruptions of anaesthesia providers using predictions of workload from anaesthesia information management system data.

PubMed

Epstein, R H; Dexter, F

2012-09-01

Perioperative interruptions generated electronically from anaesthesia information management systems (AIMS) can provide useful feedback, but may adversely affect task performance if distractions occur at inopportune moments. Ideally such interruptions would occur only at times when their impact would be minimal. In this study of AIMS data, we evaluated the times of comments, drugs, fluids and periodic assessments (e.g. electrocardiogram diagnosis and train-of-four) to develop recommendations for the timing of interruptions during the intraoperative period. The 39,707 cases studied were divided into intervals between: 1) enter operating room; 2) induction; 3) intubation; 4) surgical incision; and 5) end surgery. Five-minute intervals of no documentation were determined for each case. The offsets from the start of each interval when >50% of ongoing cases had completed initial documentation were calculated (MIN50). The primary endpoint for each interval was the percentage of all cases still ongoing at MIN50. Results were that the intervals from entering the operating room to induction and from induction to intubation were unsuitable for interruptions confirming prior observational studies of anaesthesia workload. At least 13 minutes after surgical incision was the most suitable time for interruptions with 92% of cases still ongoing. Timing was minimally affected by the type of anaesthesia, surgical facility, surgical service, prone positioning or scheduled case duration. The implication of our results is that for mediated interruptions, waiting at least 13 minutes after the start of surgery is appropriate. Although we used AIMS data, operating room information system data is also suitable.

78 FR 15655 - Airworthiness Directives; Bombardier, Inc. Airplanes

Federal Register 2010, 2011, 2012, 2013, 2014

2013-03-12

... Transportation, Docket Operations, M-30, West Building Ground Floor, Room W12-140, 1200 New Jersey Avenue SE..., New York Aircraft Certification Office, 1600 Stewart Avenue, Suite 410, Westbury, New York 11590... that the word `new' implies a zero-time unit that is new from the manufacturer, and that operators...

Efficiency of endoscopy units can be improved with use of discrete event simulation modeling.

PubMed

Sauer, Bryan G; Singh, Kanwar P; Wagner, Barry L; Vanden Hoek, Matthew S; Twilley, Katherine; Cohn, Steven M; Shami, Vanessa M; Wang, Andrew Y

2016-11-01

Background and study aims: The projected increased demand for health services obligates healthcare organizations to operate efficiently. Discrete event simulation (DES) is a modeling method that allows for optimization of systems through virtual testing of different configurations before implementation. The objective of this study was to identify strategies to improve the daily efficiencies of an endoscopy center with the use of DES. Methods: We built a DES model of a five procedure room endoscopy unit at a tertiary-care university medical center. After validating the baseline model, we tested alternate configurations to run the endoscopy suite and evaluated outcomes associated with each change. The main outcome measures included adequate number of preparation and recovery rooms, blocked inflow, delay times, blocked outflows, and patient cycle time. Results: Based on a sensitivity analysis, the adequate number of preparation rooms is eight and recovery rooms is nine for a five procedure room unit (total 3.4 preparation and recovery rooms per procedure room). Simple changes to procedure scheduling and patient arrival times led to a modest improvement in efficiency. Increasing the preparation/recovery rooms based on the sensitivity analysis led to significant improvements in efficiency. Conclusions: By applying tools such as DES, we can model changes in an environment with complex interactions and find ways to improve the medical care we provide. DES is applicable to any endoscopy unit and would be particularly valuable to those who are trying to improve on the efficiency of care and patient experience.

Efficiency of endoscopy units can be improved with use of discrete event simulation modeling

PubMed Central

Sauer, Bryan G.; Singh, Kanwar P.; Wagner, Barry L.; Vanden Hoek, Matthew S.; Twilley, Katherine; Cohn, Steven M.; Shami, Vanessa M.; Wang, Andrew Y.

2016-01-01

Background and study aims: The projected increased demand for health services obligates healthcare organizations to operate efficiently. Discrete event simulation (DES) is a modeling method that allows for optimization of systems through virtual testing of different configurations before implementation. The objective of this study was to identify strategies to improve the daily efficiencies of an endoscopy center with the use of DES. Methods: We built a DES model of a five procedure room endoscopy unit at a tertiary-care university medical center. After validating the baseline model, we tested alternate configurations to run the endoscopy suite and evaluated outcomes associated with each change. The main outcome measures included adequate number of preparation and recovery rooms, blocked inflow, delay times, blocked outflows, and patient cycle time. Results: Based on a sensitivity analysis, the adequate number of preparation rooms is eight and recovery rooms is nine for a five procedure room unit (total 3.4 preparation and recovery rooms per procedure room). Simple changes to procedure scheduling and patient arrival times led to a modest improvement in efficiency. Increasing the preparation/recovery rooms based on the sensitivity analysis led to significant improvements in efficiency. Conclusions: By applying tools such as DES, we can model changes in an environment with complex interactions and find ways to improve the medical care we provide. DES is applicable to any endoscopy unit and would be particularly valuable to those who are trying to improve on the efficiency of care and patient experience. PMID:27853739

Impact of computerized information systems on workload in operating room and intensive care unit.

PubMed

Bosman, R J

2009-03-01

The number of operating rooms and intensive care departments equipped with a clinical information system (CIS) is rapidly expanding. Amongst the putative advantages of such an installation, reduction in workload for the clinician is one of the most appealing. The scarce studies looking at workload variations associated with the implementation of a CIS, only focus on direct workload discarding indirect changes in workload. Descriptions of the various methods to quantify workload are provided. The hypothesis that a third generation CIS can reduce documentation time for ICU nurses and increase time they spend on patient care, is supported by recent literature. Though it seems obvious to extrapolate these advantages of a CIS to the anesthesiology department or physicians in the intensive care, studies examining this assumption are scarce.

Use of patient safety culture instruments in operating rooms: A systematic literature review.

PubMed

Zhao, Pujng; Li, Yaqin; Li, Zhi; Jia, Pengli; Zhang, Longhao; Zhang, Mingming

2017-05-01

To identify and qualitatively describe, in a literature review, how the instruments were used to evaluate patient safety culture in the operating rooms of published studies. Systematic searches of the literature were conducted using the major database including MEDLINE, EMbase, The Cochrane Library, and four Chinese databases including Chinese Biomedical Literature Database (CBM), Wanfang Data, Chinese Scientific Journal Database (VIP), and Chinese Journals Full-text Database (CNKI) for studies published up to March 2016. We summarized and analyzed the country scope, the instrument utilized in the study, the year when the instrument was used, and fields of operating rooms. Study populations, study settings, and the time span between baseline and follow-up phase were evaluated according to the study design. We identified 1025 references, of which 99 were obtained for full-text assessment; 47 of these studies were deemed relevant and included in the literature review. Most of the studies were from the USA. The most commonly used patient safety culture instrument was Safety Attitude Questionnaire. All identified instruments were used after 2002 and across many fields. Most included studies on patient safety culture were conducted in teaching hospitals or university hospitals. The study population in the cross-sectional studies was much more than that in the before-after studies. The time span between baseline and follow-up phase of before-after studies were almost over three months. Although patient safety culture is considered important in health care and patient safety, the number of studies in which patient safety culture has been estimated using the instruments in operating rooms, is fairly small. © 2017 Chinese Cochrane Center, West China Hospital of Sichuan University and John Wiley & Sons Australia, Ltd.

Fully Stretchable and Humidity-Resistant Quantum Dot Gas Sensors.

PubMed

Song, Zhilong; Huang, Zhao; Liu, Jingyao; Hu, Zhixiang; Zhang, Jianbing; Zhang, Guangzu; Yi, Fei; Jiang, Shenglin; Lian, Jiabiao; Yan, Jia; Zang, Jianfeng; Liu, Huan

2018-05-25

Stretchable gas sensors that accommodate the shape and motion characteristics of human body are indispensable to a wearable or attachable smart sensing system. However, these gas sensors usually have poor response and recovery kinetics when operated at room temperature, and especially suffer from humidity interference and mechanical robustness issues. Here, we demonstrate the first fully stretchable gas sensors which are operated at room temperature with enhanced stability against humidity. We created a crumpled quantum dot (QD) sensing layer on elastomeric substrate with flexible graphene as electrodes. Through the control over the prestrain of the flexible substrate, we achieved a 5.8 times improvement in NO 2 response at room temperature with desirable stretchability even under 1000 stretch/relax cycles mechanism deformation. The uniformly wavy structural configuration of the crumpled QD gas-sensing layer enabled an improvement in the antihumidity interference. The sensor response shows a minor vibration of 15.9% at room temperature from relative humidity of 0 to 86.7% compared to that of the flat-film sensors with vibration of 84.2%. The successful assembly of QD solids into a crumpled gas-sensing layer enabled a body-attachable, mechanically robust, and humidity-resistant gas sensor, opening up a new pathway to room-temperature operable gas sensors which may be implemented in future smart sensing systems such as stretchable electronic nose and multipurpose electronic skin.

A Coordinated Patient Transport System for ICU Patients Requiring Surgery: Impact on Operating Room Efficiency and ICU Workflow.

PubMed

Brown, Michael J; Kor, Daryl J; Curry, Timothy B; Marmor, Yariv; Rohleder, Thomas R

2015-01-01

Transfer of intensive care unit (ICU) patients to the operating room (OR) is a resource-intensive, time-consuming process that often results in patient throughput inefficiencies, deficiencies in information transfer, and suboptimal nurse to patient ratios. This study evaluates the implementation of a coordinated patient transport system (CPTS) designed to address these issues. Using data from 1,557 patient transfers covering the 2006-2010 period, interrupted time series and before and after designs were used to analyze the effect of implementing a CPTS at Mayo Clinic, Rochester. Using a segmented regression for the interrupted time series, on-time OR start time deviations were found to be significantly lower after the implementation of CPTS (p < .0001). The implementation resulted in a fourfold improvement in on-time OR starts (p < .01) while significantly reducing idle OR time (p < .01). A coordinated patient transfer process for moving patient from ICUs to ORs can significantly improve OR efficiency, reduce nonvalue added time, and ensure quality of care by preserving appropriate care provider to patient ratios.

Nickel release from surgical instruments and operating room equipment.

PubMed

Boyd, Anne H; Hylwa, Sara A

2018-04-15

Background There has been no systematic study assessing nickel release from surgical instruments and equipment used within the operating suite. This equipment represents important potential sources of exposure for nickel-sensitive patients and hospital staff. To investigate nickel release from commonly used surgical instruments and operating room equipment. Using the dimethylglyoxime nickel spot test, a variety of surgical instruments and operating room equipment were tested for nickel release at our institution. Of the 128 surgical instruments tested, only 1 was positive for nickel release. Of the 43 operating room items tested, 19 were positive for nickel release, 7 of which have the potential for direct contact with patients and/or hospital staff. Hospital systems should be aware of surgical instruments and operating room equipment as potential sources of nickel exposure.

Nursing in a technological environment: nursing care in the operating room.

PubMed

Bull, Rosalind; FitzGerald, Mary

2006-02-01

Operating room nurses continue to draw criticism regarding the appropriateness of a nursing presence in the operating room. The technological focus of the theatre and the ways in which nurses in the theatre have shaped and reshaped their practice in response to technological change have caused people within and outside the nursing profession to question whether operating room nursing is a technological rather than nursing undertaking. This paper reports findings from an ethnographic study that was conducted in an Australian operating department. The study examined the contribution of nurses to the work of the operating room through intensive observation and ethnographic interviews. This paper uses selected findings from the study to explore the ways in which nurses in theatre interpret their role in terms of caring in a technological environment.

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

PubMed

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.

Designing an Alternate Mission Operations Control Room

NASA Technical Reports Server (NTRS)

Montgomery, Patty; Reeves, A. Scott

2014-01-01

The Huntsville Operations Support Center (HOSC) is a multi-project facility that is responsible for 24x7 real-time International Space Station (ISS) payload operations management, integration, and control and has the capability to support small satellite projects and will provide real-time support for SLS launches. The HOSC is a serviceoriented/ highly available operations center for ISS payloads-directly supporting science teams across the world responsible for the payloads. The HOSC is required to endure an annual 2-day power outage event for facility preventive maintenance and safety inspection of the core electro-mechanical systems. While complete system shut-downs are against the grain of a highly available sub-system, the entire facility must be powered down for a weekend for environmental and safety purposes. The consequence of this ground system outage is far reaching: any science performed on ISS during this outage weekend is lost. Engineering efforts were focused to maximize the ISS investment by engineering a suitable solution capable of continuing HOSC services while supporting safety requirements. The HOSC Power Outage Contingency (HPOC) System is a physically diversified compliment of systems capable of providing identified real-time services for the duration of a planned power outage condition from an alternate control room. HPOC was designed to maintain ISS payload operations for approximately three continuous days during planned HOSC power outages and support a local Payload Operations Team, International Partners, as well as remote users from the alternate control room located in another building. This paper presents the HPOC architecture and lessons learned during testing and the planned maiden operational commissioning. Additionally, this paper documents the necessity of an HPOC capability given the unplanned HOSC Facility power outage on April 27th, 2011, as a result of the tornado outbreak that damaged the electrical grid to such a degree that significantly inhibited the Tennessee Valley Authority's ability to transmit electricity throughout the North Alabama region.

Complementing Operating Room Teaching With Video-Based Coaching.

PubMed

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 < .001). Surgeons also more frequently validated residents' experiences (8.40 vs 1.81, P < .01), and they tended to ask more questions to promote critical thinking (9.30 vs 3.32, P = .07) and set more learning goals (2.90 vs 0.28, P = .11). More complex topics, including intraoperative decision making (mean, 9.70 vs 2.77 instances per hour, P = .03) and failure to progress (mean, 1.20 vs 0.13 instances per hour, P = .04) were addressed, and they were more thoroughly developed and explored. Excerpts of dialogue are presented to illustrate these findings. Video-based coaching is a novel and feasible modality for supplementing intraoperative learning. Objective evaluation demonstrates that video-based coaching may be particularly useful for teaching higher-level concepts, such as decision making, and for individualizing instruction and feedback to each resident.

The risk for syncope and presyncope during surgery in surgeons and nurses.

PubMed

Rudnicki, Jerzy; Zyśko, Dorota; Gajek, Jacek; Kuliczkowski, Wiktor; Rosińczuk-Tonderys, Joanna; Zielińska, Dominika; Terpiłowski, Łukasz; Agrawal, Anil Kumar

2011-11-01

Surgeons and nurses are exposed to orthostatic stress. To assess the lifetime incidence of syncopal and presyncopal events during surgery in operation room staff and reveal the predicting factors. The study included 317 subjects (161 F, 156 M) aged 43.9 ± 9.6; 216 surgeons and 101 instrumenters. The study included filling of an anonymous questionnaire on the syncope and presyncope history. At least one syncopal event during operation was reported by 4.7% and presyncope by 14.8% of the studied population. All but one subject reported prodromal symptoms before syncope. In the medical history, syncope outside the operating room was reported by 11% of the studied group. Syncope and presyncope during operation was related to syncope in the medical history outside the operation room, respectively: odds ratio (OR) 20.2 95% confidence interval (CI): 2.0-70.5 and OR 10.8; CI: 5.0-23.4 and to presyncope in the medical history, respectively: OR 23.5; CI: 7.4-74.4 OR 8.9; CI: 3.6-11.2 (P < 0.001). (1) Syncope and presyncope may occur during surgery in the staff of the operating room. (2) Syncope in the operating room is usually preceded by prodromal symptoms and has vasovagal origin. (3) Both lower then expected occurrence of syncope in the operating room staff and absence of any difference between genders in this regard indicate preselection in the process of choosing profession and specialization. (4) Syncope and presyncope outside the operating room in medical history increases the risk of syncope and presyncope inside the operation room.

The rationale for combining an online audiovisual curriculum with simulation to better educate general surgery trainees.

PubMed

AlJamal, Yazan N; Ali, Shahzad M; Ruparel, Raaj K; Brahmbhatt, Rushin D; Yadav, Siddhant; Farley, David R

2014-09-01

Surgery interns' training has historically been weighted toward patient care, operative observation, and sleeping when possible. With more protected free time and less clinical time, real educational hours for trainees in 2013 are precious. We created a 20-session (3 hours each) simulation curriculum (with pre- and post-tests) and a 24/7 online audiovisual (AV) curriculum for surgery interns. Friday morning simulation sessions emphasize operative skills and judgment. AV clips (using operating room, whiteboard, and simulation center videos) take learners through 20 different general surgery operations with follow-up quizzes. We report our early experience with this novel setup. Thirty-two surgical interns (2012-2013) attended simulation sessions on 20 separate subjects (hernia, breast, hepatobiliary, endocrine, etc). Post-test scores improved (P < .05) and trainees enjoyed using surgical skills for 3 hours each Friday morning (mean, >4.5; Likert scale, 1-5). The AV curriculum feedback is similar (mean, >4.3) and usage is available 24/7 preparing learners for both operating room and simulation sessions. Most simulation sessions utilize low-fidelity models to keep costs <$50 per session. Scores on our semiannual Surgical Olympics (mean score of 49.6 in July vs 82.9 in January; P < .05) improved significantly, suggesting that interns are improving their surgical skills and knowledge. Residents enjoy and learn from the step-by-step, in-house, AV curriculum and both appreciate and thrive on the 'hands-on' simulation sessions mimicking operations they see in real operating rooms. The cost of these programs is not prohibitive and the programs offer simulated repetitions for duty-hour-regulated trainees. Copyright © 2014 Mosby, Inc. All rights reserved.

Construct and face validity of the American College of Surgeons/Association of Program Directors in Surgery laparoscopic troubleshooting team training exercise.

PubMed

Arain, Nabeel A; Hogg, Deborah C; Gala, Rajiv B; Bhoja, Ravi; Tesfay, Seifu T; Webb, Erin M; Scott, Daniel J

2012-01-01

Our aim was to develop an objective scoring system and evaluate construct and face validity for a laparoscopic troubleshooting team training exercise. Surgery and gynecology novices (n = 14) and experts (n = 10) participated. Assessments included the following: time-out, scenario decision making (SDM) score (based on essential treatments rendered and completion time), operating room communication assessment (investigator developed), line operations safety audits (teamwork), and National Aeronautics and Space Administration-Task Load Index (workload). Significant differences were detected for SDM scores for scenarios 1 (192 vs 278; P = .01) and 3 (129 vs 225; P = .004), operating room communication assessment (67 vs 91; P = .002), and line operations safety audits (58 vs 87; P = .001), but not for time-out (46 vs 51) or scenario 2 SDM score (301 vs 322). Workload was similar for both groups and face validity (8.8 on a 10-point scale) was strongly supported. Objective decision-making scoring for 2 of 3 scenarios and communication and teamwork ratings showed construct validity. Face validity and participant feedback were excellent. Copyright © 2012 Elsevier Inc. All rights reserved.

Advice and Learning in Problem Solving

DTIC Science & Technology

2005-02-01

Person op Harry : Person op Ivy : Person op DarkRoom : Room op LightRoom : Room op RedRoom : Room op OrangeRoom : Room op...Time7) & % FreeRoom(DarkRoom, Time8) axiom RedRoom_Free_Time is FreeRoom( RedRoom , Time1) & FreeRoom( RedRoom , Time2) & FreeRoom... RedRoom , Time3) & FreeRoom( RedRoom , Time4) & % FreeRoom( RedRoom , Time5) & FreeRoom( RedRoom , Time6) & FreeRoom( RedRoom , Time7) & FreeRoom

Improved Operating Room Efficiency via Constraint Management: Experience of a Tertiary-Care Academic Medical Center.

PubMed

Kimbrough, Charles W; McMasters, Kelly M; Canary, Jeff; Jackson, Lisa; Farah, Ian; Boswell, Mark V; Kim, Daniel; Scoggins, Charles R

2015-07-01

Suboptimal operating room (OR) efficiency is a universal complaint among surgeons. Nonetheless, maximizing efficiency is critical to institutional success. Here, we report improvement achieved from low-cost, low-technology measures instituted within a tertiary-care academic medical center/Level I trauma center. Improvements in preadmission testing and OR scheduling, including appointing a senior nurse anesthetist to help direct OR use, were instituted in March 2012. A retrospective review of prospectively maintained OR case data was performed to evaluate time periods before and after program implementation, as well as to assess trends over time. Operating room performance metrics were compared using Mann-Whitney and chi-squared tests. Changes over time were analyzed using linear regression. Data including all surgical cases were available for a 36-month period; 10 months (6,581 cases) before program implementation and 26 months afterward (17,574 cases). Dramatic improvement was seen in first-case on-time starts, which increased from 39.3% to 83.8% (p < 0.0001). Additionally, the percent utilization of available OR time demonstrated a steady increase (p < 0.001). After an initial lag, case volume also improved, evident by an increase observed in the 12-month rolling average of cases per month (p < 0.001). The increase in case volume occurred during peak OR time (7 am to 5 pm), and did not result from adding cases after hours (5 pm to 11 pm). After many years of what seemed an insoluble problem, simple changes fostering collaboration among services, including active management of the OR schedule and transparent data, have resulted in substantial improvement in OR efficiency and case volume. Copyright © 2015 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

[Time based management in health care system: the chosen aspects].

PubMed

Kobza, Joanna; Syrkiewicz-Świtała, Magdalena

2014-01-01

Time-based management (TBM) is the key element of the whole management process. For many years in health care systems of highly developed countries modern and effective methods of time-based management have been implemented in both primary health care and hospitals (emergency departments and operating rooms). Over the past two decades a systematic review of Polish literature (since 1990) and peer reviewed articles published in international journals based on PubMed/Medline (2001-2011) have been carried out. The collected results indicate that the demographic and health changes in the populations are one of the main challenges facing general practitioners in the nearest future. Time-based management needs new and effective tools and skills, i.e., identification of priorities, well designed planning, delegation of the tasks, proper coordination, and creation of primary care teams that include additional members and human resources management. Proper reimbursement of health services, development of IT in health care system, better collection, storage, processing, analysis and exchange of information and research findings will also be needed. The use of innovative technologies, like telemedicine consultations, provides the possibility of reducing waiting time for diagnosis and treatment and in some cases could be applied in terms of secondary care. To improve the efficiency of operating rooms it is necessary to introduce different solutions, such as operating room coordinator involvement, application of automation to guide decision-making or use of robotic tools to assist surgical procedures. Overcrowded emergency departments have a major detrimental effect on the quality of hospital functions, therefore, efforts should be made to reduce them. Time-based management training among physicians and health care management in Poland, as well as the implementation of practice-based solutions still applied in highly developed countries seem to be necessary.

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

PubMed

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.

Increasing operating room efficiency through electronic medical record analysis.

PubMed

Attaallah, A F; Elzamzamy, O M; Phelps, A L; Ranganthan, P; Vallejo, M C

2016-05-01

We used electronic medical record (EMR) analysis to determine errors in operating room (OR) time utilisation. Over a two year period EMR data of 44,503 surgical procedures was analysed for OR duration, on-time, first case, and add-on time performance, within 19 surgical specialties. Maximal OR time utilisation at our institution could have saved over 302,620 min or 5,044 hours of OR efficiency over a two year period. Most specialties (78.95%) had inaccurately scheduled procedure times and therefore used the OR more than their scheduled allotment time. Significant differences occurred between the mean scheduled surgical durations (101.38 ± 87.11 min) and actual durations (108.18 ± 102.27 min; P < 0.001). Significant differences also occurred between the mean scheduled add-on durations (111.4 ± 75.5 min) and the actual add-on scheduled durations (118.6 ± 90.1 minutes; P < 0.001). EMR quality improvement analysis can be used to determine scheduling error and bias, in order to improve efficiency and increase OR time utilisation.

Intraoperative computed tomography guided neuronavigation: concepts, efficiency, and work flow.

PubMed

Matula, C; Rössler, K; Reddy, M; Schindler, E; Koos, W T

1998-01-01

Image-guided surgery is currently considered to be of undisputed value in microsurgical and endoscopical neurosurgery, but one of its major drawbacks is the degradation of accuracy during frameless stereotactic neuronavigation due to brain and/or lesion shift. A computed tomography (CT) scanner system (Philips Tomoscan M) developed for the operating room was connected to a pointer device navigation system for image-guided surgery (Philips EasyGuide system) in order to provide an integrated solution to this problem, and the advantages of this combination were evaluated in 20 cases (15 microsurgical and 5 endoscopic). The integration of the scanner into the operating room setup was successful in all procedures. The patients were positioned on a specially developed scanner table, which permitted movement to a scanning position then back to the operating position at any time during surgery. Contrast-enhanced preoperative CCTs performed following positioning and draping were of high quality in all cases, because a radiolucent head fixation technique was used. The accuracy achieved with this combination was significantly better (1.6:1.22.2). The overall concept is one of working in a closed system where everything is done in the same room, and the efficiency of this is clearly proven in different ways. The most important fact is the time saved in the overall treatment process (about 55 h for one operating room over a 6-month period). The combination of an intraoperative CCT scanner with the pointer device neuronavigation system permits not only the intraoperative control of resection of brain tumors, but also (in about 20% of cases) the identification of otherwise invisible residual tumor tissue by intraoperative update of the neuronavigation data set. Additionally, an image update solves the problem of intraoperative brain and/or tumor shifts during image-guided resection. Having the option of making an intraoperative quality check at any time leads to significantly increased efficiency, improves the operating work flow because of the closed-system concept, and offers an integrated solution for improved patient work flow and clinical outcome.

Control Room at the NACA’s Rocket Engine Test Facility

NASA Image and Video Library

1957-05-21

Test engineers monitor an engine firing from the control room of the Rocket Engine Test Facility at the National Advisory Committee for Aeronautics (NACA) Lewis Flight Propulsion Laboratory. The Rocket Engine Test Facility, built in the early 1950s, had a rocket stand designed to evaluate high-energy propellants and rocket engine designs. The facility was used to study numerous different types of rocket engines including the Pratt and Whitney RL-10 engine for the Centaur rocket and Rocketdyne’s F-1 and J-2 engines for the Saturn rockets. The Rocket Engine Test Facility was built in a ravine at the far end of the laboratory because of its use of the dangerous propellants such as liquid hydrogen and liquid fluorine. The control room was located in a building 1,600 feet north of the test stand to protect the engineers running the tests. The main control and instrument consoles were centrally located in the control room and surrounded by boards controlling and monitoring the major valves, pumps, motors, and actuators. A camera system at the test stand allowed the operators to view the tests, but the researchers were reliant on data recording equipment, sensors, and other devices to provide test data. The facility’s control room was upgraded several times over the years. Programmable logic controllers replaced the electro-mechanical control devices. The new controllers were programed to operate the valves and actuators controlling the fuel, oxidant, and ignition sequence according to a predetermined time schedule.

Laparoscopic Skills Are Improved With LapMentor™ Training

PubMed Central

Andreatta, Pamela B.; Woodrum, Derek T.; Birkmeyer, John D.; Yellamanchilli, Rajani K.; Doherty, Gerard M.; Gauger, Paul G.; Minter, Rebecca M.

2006-01-01

Objective: To determine if prior training on the LapMentor™ laparoscopic simulator leads to improved performance of basic laparoscopic skills in the animate operating room environment. Summary Background Data: Numerous influences have led to the development of computer-aided laparoscopic simulators: a need for greater efficiency in training, the unique and complex nature of laparoscopic surgery, and the increasing demand that surgeons demonstrate competence before proceeding to the operating room. The LapMentor™ simulator is expensive, however, and its use must be validated and justified prior to implementation into surgical training programs. Methods: Nineteen surgical interns were randomized to training on the LapMentor™ laparoscopic simulator (n = 10) or to a control group (no simulator training, n = 9). Subjects randomized to the LapMentor™ trained to expert criterion levels 2 consecutive times on 6 designated basic skills modules. All subjects then completed a series of laparoscopic exercises in a live porcine model, and performance was assessed independently by 2 blinded reviewers. Time, accuracy rates, and global assessments of performance were recorded with an interrater reliability between reviewers of 0.99. Results: LapMentor™ trained interns completed the 30° camera navigation exercise in significantly less time than control interns (166 ± 52 vs. 220 ± 39 seconds, P < 0.05); they also achieved higher accuracy rates in identifying the required objects with the laparoscope (96% ± 8% vs. 82% ± 15%, P < 0.05). Similarly, on the two-handed object transfer exercise, task completion time for LapMentor™ trained versus control interns was 130 ± 23 versus 184 ± 43 seconds (P < 0.01) with an accuracy rate of 98% ± 5% versus 80% ± 13% (P < 0.001). Additionally, LapMentor™ trained interns outperformed control subjects with regard to camera navigation skills, efficiency of motion, optimal instrument handling, perceptual ability, and performance of safe electrocautery. Conclusions: This study demonstrates that prior training on the LapMentor™ laparoscopic simulator leads to improved resident performance of basic skills in the animate operating room environment. This work marks the first prospective, randomized evaluation of the LapMentor™ simulator, and provides evidence that LapMentor™ training may lead to improved operating room performance. PMID:16772789

Perceptions of Recent Graduates of the Adequacy of Anesthesia Training Programs.

ERIC Educational Resources Information Center

Spielman, Fred J.; Bowe, Edwin A.

1983-01-01

A survey examined physician attitudes toward operating room, nonoperating room, and nonpatient care responsibilities in their residencies. Training for operating room responsibilities was deemed adequate by most, and nonoperating room training inadequate. Recommendations include: hospital cooperation, more effective sessions, and supplementary…

The Influence of Modulated Signal Risetime in Flight Electronics Radiated Immunity Testing with a Mode-Stirred Chamber

NASA Technical Reports Server (NTRS)

Ely, Jay J.; Nguyen, Truong X.; Scearce, Stephen A.

2000-01-01

For electromagnetic immunity testing of an electronic system, it is desirable to demonstrate its functional integrity when exposed to the full range and intensity of environmental electromagnetic threats that may be encountered over its operational life. As part of this, it is necessary to show proper system operation when exposed to representative threat signal modulations. Modulated signal transition time is easily overlooked, but can be highly significant to system susceptibility. Radiated electromagnetic field immunity testing is increasingly being performed in Mode Stirred Chambers. Because the peak field vs. time relationship is affected by the operation of a reverberating room, it is important to understand how the room may influence any input signal modulation characteristics. This paper will provide insight into the field intensity vs. time relationship within the test environment of a mode stirred chamber. An understanding of this relationship is important to EMC engineers in determining what input signal modulation characteristics will be transferred to the equipment under test. References will be given for the development of this topic, and experimental data will be presented

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

PubMed

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.

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

DOE Office of Scientific and Technical Information (OSTI.GOV)

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.

Operating Room Technology. Post Secondary Curriculum Guide.

ERIC Educational Resources Information Center

Simpson, Bruce; And Others

This curriculum guide was designed for use in postsecondary operating room technology education programs in Georgia. Its purpose is to provide for development of entry level skills in operating room technology in the areas of knowledge, theoretical structure, tool usage, diagnostic ability, related supportive skills, and occupational survival…

[Fire in the operating room].

PubMed

Koljonen, Virve; Mäkisalo, Heikki

2013-01-01

This article reviews the recent literature on operating room fires. Most of the reported cases have occurred from a spark from an ignition source in an oxygen-enriched atmosphere. Fire requires the presence of three components which all are ample in the operating room: heat, flammable materials or flammable gases.

Operative time and cost of resident surgical experience: effect of instituting an otolaryngology residency program.

PubMed

Pollei, Taylor R; Barrs, David M; Hinni, Michael L; Bansberg, Stephen F; Walter, Logan C

2013-06-01

Describe the procedure length difference between surgeries performed by an attending surgeon alone compared with the resident surgeon supervised by the same attending surgeon. Case series with chart review. Tertiary care center and residency program. Six common otolaryngologic procedures performed between August 1994 and May 2012 were divided into 2 cohorts: attending surgeon alone or resident surgeon. This division coincided with our July 2006 initiation of an otolaryngology-head and neck surgery residency program. Operative duration was compared between cohorts with confounding factors controlled. In addition, the direct result of increased surgical length on operating room cost was calculated and applied to departmental and published resident case log report data. Five of the 6 procedures evaluated showed a statistically significant increase in surgery length with resident involvement. Operative time increased 6.8 minutes for a cricopharyngeal myotomy (P = .0097), 11.3 minutes for a tonsillectomy (P < .0001), 27.4 minutes for a parotidectomy (P = .028), 38.3 minutes for a septoplasty (P < .0001), and 51 minutes for tympanomastoidectomy (P < .0021). Thyroidectomy showed no operative time difference. Cost of increased surgical time was calculated per surgery and ranged from $286 (cricopharyngeal myotomy) to $2142 (mastoidectomy). When applied to reported national case log averages for graduating residents, this resulted in a significant increase of direct training-related costs. Resident participation in the operating room results in increased surgical length and additional system cost. Although residency is a necessary part of surgical training, associated costs need to be acknowledged.

Scheduling for anesthesia at geographic locations remote from the operating room.

PubMed

Dexter, Franklin; Wachtel, Ruth E

2014-08-01

Providing general anesthesia at locations away from the operating room, called remote locations, poses many medical and scheduling challenges. This review discusses how to schedule procedures at remote locations to maximize anesthesia productivity (see Video, Supplemental Digital Content 1). Anesthesia labour productivity can be maximized by assigning one or more 8-h or 10-h periods of allocated time every 2 weeks dedicated specifically to each remote specialty that has enough cases to fill those periods. Remote specialties can then schedule their cases themselves into their own allocated time. Periods of allocated time (called open, unblocked or first come first served time) can be used by remote locations that do not have their own allocated time. Unless cases are scheduled sequentially into allocated time, there will be substantial extra underutilized time (time during which procedures are not being performed and personnel sit idle even though staffing has been planned) and a concomitant reduction in percent productivity. Allocated time should be calculated on the basis of usage. Remote locations with sufficient hours of cases should be allocated time reserved especially for them in which to schedule their cases, with a maximum waiting time of 2 weeks, to achieve an average wait of 1 week.

Feasibility of touch-less control of operating room lights.

PubMed

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.

OK432 versus doxycycline for treatment of macrocystic lymphatic malformations.

PubMed

Motz, Kevin M; Nickley, Katherine B; Bedwell, Joshua R; Yadav, Bhupender; Guzzetta, Philip C; Oh, Albert K; Bauman, Nancy M

2014-02-01

A variety of sclerotherapy agents are used to treat macrocystic lymphatic malformations (LMs). This retrospective study at a single institution was performed to compare the outcomes of pediatric macrocystic LMs of the head and neck that were treated with doxycycline or with OK432. The outcomes measured included early response to therapy, number of treatments required, operating room time, and adverse events. The rates of clinical success for OK432 and doxycycline were similar (83% and 82%, respectively; p > 0.05), although OK432-treated patients required more treatments than did doxycycline-treated patients (1.9 versus 1.0 injections; p = 0.01; 95% confidence interval, 1.57 to 0.27). The average operating room time for a single OK432 injection was significantly shorter than that for doxycycline (53.2 versus 98.1 minutes; p < 0.001); however, when the total number of treatments administered was considered, the overall times in the operating room were similar. Adverse events in the early postoperative period were more common in OK432-treated patients, who experienced marked postoperative swelling compared to doxycycline-treated patients. OK432 and doxycycline are both effective sclerosants for the treatment of predominantly macrocystic LMs. The administration time for OK432 is shorter than that for doxycycline, but OK432 required more treatments overall to achieve clinical success. Early adverse events were more common in OK432-treated patients, but longer follow-up is necessary to determine whether rates of recurrence and adverse events are similar, particularly in light of the risk of tooth discoloration in doxycycline-treated patients.

Improving operating theatre efficiency: an intervention to significantly reduce changeover time.

PubMed

Soliman, Bishoy A B; Stanton, Raymond; Sowter, Steven; Rozen, Warren Matthew; Shahbaz, Shekib

2013-07-01

Operating theatre inefficiency and changeover delays are not only a significant source of wasted resources, but also a familiar source of frustration to patients and health-care providers. This study aimed to prove that the surgical registrar through active involvement in patient changeover can significantly improve operating room efficiency and minimize delays. A two-phase prospective cohort study was undertaken, conducted over the course of 4 weeks at a single institution. The only inclusion criteria comprised patients to undertake endoscopic urological day surgery cases and require general anaesthesia. There were no exclusions. In the first phase (observational, with no intervention), changeover times between cases were documented. The second phase followed a structured intervention, involving the surgical registrar being actively involved in the patient's operative journey. Outcome measures were qualitative measures of operative efficiency. Statistical analysis was undertaken. There were 42 patients included in this study, with 21 patients in each of its arms. A 48% (P-value < 0.01) reduction in overall case changeover times was demonstrated with the utilization of a structured intervention from 27.7 min (95% confidence interval (CI) 22.8-32.7%) to 15.7 min (95% CI 13.2-18.2%). The intervention results were statistically significant (P-value < 0.05) for all markers of efficiency except for the waiting time in the anaesthetic holding bay (P-value 0.13). The surgical registrar can improve operating room efficiency by using a structured intervention, ultimately reducing patient changeover times. © 2012 The Authors. ANZ Journal of Surgery © 2012 Royal Australasian College of Surgeons.

Operating Room Time Savings with the Use of Splint Packs: A Randomized Controlled Trial

PubMed Central

Gonzalez, Tyler A.; Bluman, Eric M.; Palms, David; Smith, Jeremy T.; Chiodo, Christopher P.

2016-01-01

Background: The most expensive variable in the operating room (OR) is time. Lean Process Management is being used in the medical field to improve efficiency in the OR. Streamlining individual processes within the OR is crucial to a comprehensive time saving and cost-cutting health care strategy. At our institution, one hour of OR time costs approximately $500, exclusive of supply and personnel costs. Commercially prepared splint packs (SP) contain all components necessary for plaster-of-Paris short-leg splint application and have the potential to decrease splint application time and overall costs by making it a more lean process. We conducted a randomized controlled trial comparing OR time savings between SP use and bulk supply (BS) splint application. Methods: Fifty consecutive adult operative patients on whom post-operative short-leg splint immobilization was indicated were randomized to either a control group using BS or an experimental group using SP. One orthopaedic surgeon (EMB) prepared and applied all of the splints in a standardized fashion. Retrieval time, preparation time, splint application time, and total splinting time for both groups were measured and statistically analyzed. Results: The retrieval time, preparation time and total splinting time were significantly less (p<0.001) in the SP group compared with the BS group. There was no significant difference in application time between the SP group and BS group. Conclusion: The use of SP made the process of splinting more lean. This has resulted in an average of 2 minutes 52 seconds saved in total splinting time compared to BS, making it an effective cost-cutting and time saving technique. For high volume ORs, use of splint packs may contribute to substantial time and cost savings without impacting patient safety. PMID:26894212

[Simulation-based training and OR apprenticeship for medical students : A prospective, randomized, single-blind study of clinical skills].

PubMed

Ott, T; Schmidtmann, I; Limbach, T; Gottschling, P F; Buggenhagen, H; Kurz, S; Pestel, G

2016-11-01

Simulation-based training (SBT) has developed into an established method of medical training. Studies focusing on the education of medical students have used simulation as an evaluation tool for defined skills. A small number of studies provide evidence that SBT improves medical students' skills in the clinical setting. Moreover, they were strictly limited to a few areas, such as the diagnosis of heart murmurs or the correct application of cricoid pressure. Other studies could not prove adequate transferability from the skills gained in SBT to the patient site. Whether SBT has an effect on medical students' skills in anesthesiology in the clinical setting is controversial. To explore this issue, we designed a prospective, randomized, single-blind trial that was integrated into the undergraduate anesthesiology curriculum of our department during the second year of the clinical phase of medical school. This study intended to explore the effect of SBT on medical students within the mandatory undergraduate anesthesiology curriculum of our department in the operating room with respect to basic skills in anesthesiology. After obtaining ethical approval, the participating students of the third clinical semester were randomized into two groups: the SIM-OR group was trained by a 225 min long SBT in basic skills in anesthesiology before attending the operating room (OR) apprenticeship. The OR-SIM group was trained after the operating room apprenticeship by SBT. During SBT the students were trained in five clinical skills detailed below. Further, two clinical scenarios were simulated using a full-scale simulator. The students had to prepare the patient and perform induction of anesthesia, including bag-mask ventilation after induction in scenario 1 and rapid sequence induction in scenario 2. Using the five-point Likert scale, five defined skills were evaluated at defined time points during the study period. 1) application of the safety checklist, 2) application of basic patient monitoring, 3) establishment of intravenous access, 4) bag-and-mask ventilation, and 5) adjustment of ventilatory parameters after the patients' airways were secured. A cumulative score of 5 points was defined as the best and a cumulative score of 25 as the worst rating for a defined time point. The primary endpoint was the cumulative score after day 1 in the operating room apprenticeship and the difference in cumulative scores from days 1 to 4. Our hypothesis was that the SIM-OR group would achieve a better score after day 1 in the operating room apprenticeship and would gain a larger increase in score from day 1 to day 4 than the OR-SIM group. 73 students were allocated to the OR-SIM group and 70 students to the SIM-OR group. There was no significant difference between the two groups after day 1 of the operating room apprenticeship and no difference in increase of the cumulative score from day 1 to day 4 (median of cumulative score on day 1: 'SIM-OR' 11.2 points vs. 'OR-SIM' 14.6 points; p = 0.067; median of difference from day 1 to day 4: 'SIM-OR' -3.7 vs. 'OR-SIM' -6.4; p = 0.110). With the methods applied, this study could not prove that 225 min of SBT before the operating room apprenticeship increased the medical students' clinical skills as evaluated in the operating room. Secondary endpoints indicate that medical students have better clinical skills at the end of the entire curriculum when they have been trained through SBT before the operating room apprenticeship. However, the authors believe that simulator training has a positive impact on students' acquisition of procedural and patient safety skills, even if the methods applied in this study may not mirror this aspect sufficiently.

A multicenter prospective cohort study on camera navigation training for key user groups in minimally invasive surgery.

PubMed

Graafland, Maurits; Bok, Kiki; Schreuder, Henk W R; Schijven, Marlies P

2014-06-01

Untrained laparoscopic camera assistants in minimally invasive surgery (MIS) may cause suboptimal view of the operating field, thereby increasing risk for errors. Camera navigation is often performed by the least experienced member of the operating team, such as inexperienced surgical residents, operating room nurses, and medical students. The operating room nurses and medical students are currently not included as key user groups in structured laparoscopic training programs. A new virtual reality laparoscopic camera navigation (LCN) module was specifically developed for these key user groups. This multicenter prospective cohort study assesses face validity and construct validity of the LCN module on the Simendo virtual reality simulator. Face validity was assessed through a questionnaire on resemblance to reality and perceived usability of the instrument among experts and trainees. Construct validity was assessed by comparing scores of groups with different levels of experience on outcome parameters of speed and movement proficiency. The results obtained show uniform and positive evaluation of the LCN module among expert users and trainees, signifying face validity. Experts and intermediate experience groups performed significantly better in task time and camera stability during three repetitions, compared to the less experienced user groups (P < .007). Comparison of learning curves showed significant improvement of proficiency in time and camera stability for all groups during three repetitions (P < .007). The results of this study show face validity and construct validity of the LCN module. The module is suitable for use in training curricula for operating room nurses and novice surgical trainees, aimed at improving team performance in minimally invasive surgery. © The Author(s) 2013.

29 CFR 793.7 - “Announcer.”

Code of Federal Regulations, 2014 CFR

2014-07-01

... time signals, and present other similar routine on-the-air material. In small stations, an announcer may, in addition to these duties, operate the studio control board, give cues to the control room for...

29 CFR 793.7 - “Announcer.”

Code of Federal Regulations, 2012 CFR

2012-07-01

... time signals, and present other similar routine on-the-air material. In small stations, an announcer may, in addition to these duties, operate the studio control board, give cues to the control room for...

29 CFR 793.7 - “Announcer.”

Code of Federal Regulations, 2013 CFR

2013-07-01

... time signals, and present other similar routine on-the-air material. In small stations, an announcer may, in addition to these duties, operate the studio control board, give cues to the control room for...

Have Recent Modifications of Operating Room Attire Policies Decreased Surgical Site Infections? An American College of Surgeons NSQIP Review of 6,517 Patients.

PubMed

Farach, Sandra M; Kelly, Kristin N; Farkas, Rachel L; Ruan, Daniel T; Matroniano, Amy; Linehan, David C; Moalem, Jacob

2018-05-01

After a Department of Health site visit, 2 teaching hospitals imposed strict regulations on operating room attire, including full coverage of ears and facial hair. We hypothesized that this intervention would reduce superficial surgical site infections (SSIs). We compared NSQIP data from all patients undergoing operations in the 9 months before implementation (n = 3,077) to time-matched data 9 months post-implementation (n = 3,440). Univariate and multivariable analyses were used to examine patient, clinical, and operative factors associated with SSIs. Power analysis was performed using pre-intervention SSI rates. Despite a shift toward more clean cases, there were more SSIs post-implementation (33 vs 30 [1%]; p = 0.95). There were no differences in length of stay, complications, or mortality between the 2 time periods. Overall, SSI increased with wound class: 0.6%, 0.9%, 2.3%, and 3.8% in clean, clean-contaminated, contaminated, and infected cases, respectively. Limiting the review to clean or clean-contaminated cases, incisional SSIs increased from 0.7% (20 of 2,754) to 0.8% (24 of 3,115) (p = 0.85). A multivariable analysis showed that implementation of these policies was not associated with decreased SSIs (odds ratio 1.2; 95% CI 0.70 to 1.96; p = 0.56). The largest predictors of SSIs were preoperative infection, operative time >75th percentile, open wounds, and dirty/contaminated wounds. A hypothetical analysis revealed that a sample size of 485,154 patients would be required to demonstrate a 10% SSI reduction among patients with clean or clean-contaminated wounds. Implementation of stringent operating room attire policies do not reduce SSI rates. A study to prove this principle further would be impractical to conduct. Copyright © 2018 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

What Happens in the Operating Room? (For Kids)

MedlinePlus

... to stay a while after your surgery. Other times, a kid can have minor surgery and go home the ... be able to stay with you until it's time for surgery. Sometimes, parents can even be there while their kid gets the anesthesia. But parents can't stay ...

Synthesis of AuPd alloyed nanoparticles via room-temperature electron reduction with argon glow discharge as electron source.

PubMed

Yang, Manman; Wang, Zongyuan; Wang, Wei; Liu, Chang-Jun

2014-01-01

Argon glow discharge has been employed as a cheap, environmentally friendly, and convenient electron source for simultaneous reduction of HAuCl4 and PdCl2 on the anodic aluminum oxide (AAO) substrate. The thermal imaging confirms that the synthesis is operated at room temperature. The reduction is conducted with a short time (30 min) under the pressure of approximately 100 Pa. This room-temperature electron reduction operates in a dry way and requires neither hydrogen nor extra heating nor chemical reducing agent. The analyses using X-ray photoelectron spectroscopy (XPS) confirm all the metallic ions have been reduced. The characterization with X-ray diffraction (XRD) and high-resolution transmission electron microscopy (HRTEM) shows that AuPd alloyed nanoparticles are formed. There also exist some highly dispersed Au and Pd monometallic particles that cannot be detected by XRD and transmission electron microscopy (TEM) because of their small particle sizes. The observed AuPd alloyed nanoparticles are spherical with an average size of 14 nm. No core-shell structure can be observed. The room-temperature electron reduction can be operated in a larger scale. It is an easy way for the synthesis of AuPd alloyed nanoparticles.

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

PubMed Central

Batra, Sumit; Gupta, Rajiv

2008-01-01

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. PMID:18439304

Operating room efficiency: benefits of an orthopaedic traumatologist at a level II trauma center.

PubMed

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

2014-05-01

Fellowship-trained orthopaedic traumatologists are presumably taught skill sets leading to "best practice" outcomes and more efficient use of hospital resources. This should result in more favorable economic opportunities when compared with general orthopaedic surgeons (GOSs) providing similar clinical services. The purpose of our study was to compare the operating room utilization and financial data of traumatologists versus GOSs at a level II trauma center. Retrospective review. Level II community-based trauma hospital. Patients who presented to the emergency room at our institution with fractures and orthopaedic conditions requiring surgical intervention from January 1, 2010, to December 31, 2011. Operative fracture fixation by members of our orthopaedic trauma panel, including fellowship and nontrauma fellowship-trained orthopaedic surgeons. Our institutional database was queried to determine operative times, surgical supply and implant costs, and surgery labor expenses. Patients were stratified according to those treated by our trauma panel's 3 traumatologists and those treated by the 15 GOSs on our trauma panel. These 2 groups were then compared using standard statistical methods. A total of 6449 orthopedic cases were identified and 2076 of these involved fracture care. One thousand one hundred ninety-nine patients were treated by traumatologists and 877 by GOSs. There was no statistical difference detected in American Society of Anesthesiologists score between trauma and nontrauma groups. Overall, the traumatologist group demonstrated significantly decreased procedure times when compared with the GOS group (55.6 vs. 75.8 minutes, P < 0.0001). In 16 of 18 most common procedure types, traumatologists were more efficient. This led to significantly decreased surgical labor costs ($381.4 vs. $484.8; P < 0.0001) and surgical supply and implant costs ($2567 vs. $3003; P < 0.0001). This study demonstrates that in our community-based trauma system, fracture care provided by traumatologists results in improved utilization of hospital-based resources when compared with equivalent services provided by GOSs. Significantly decreased operative times, surgical labor expenses, and supply and implant costs by the fellowship-trained group represent enhanced control of the design, plan, execution, and monitoring of orthopaedic trauma care. Traumatologists can provide leadership recommendations for operating room efficiency in community-based orthopaedic trauma care models. Economic Level IV. See Instructions for Authors for a complete description of levels of evidence.

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

PubMed

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

2016-12-01

Fellowship-trained orthopaedic traumatologists are presumably taught skill sets leading to "best practice" outcomes and more efficient use of hospital resources. This should result in more favorable economic opportunities when compared with general orthopaedic surgeons (GOSs) providing similar clinical services. The purpose of our study was to compare the operating room utilization and financial data of traumatologists versus GOSs at a level II trauma center. Retrospective review. Level II community-based trauma hospital. Patients who presented to the emergency room at our institution with fractures and orthopaedic conditions requiring surgical intervention from January 1, 2010, to December 31, 2011. Operative fracture fixation by members of our orthopaedic trauma panel, including fellowship and nontrauma fellowship-trained orthopaedic surgeons. Our institutional database was queried to determine operative times, surgical supply and implant costs, and surgery labor expenses. Patients were stratified according to those treated by our trauma panel's 3 traumatologists and those treated by the 15 GOSs on our trauma panel. These 2 groups were then compared using standard statistical methods. A total of 6449 orthopedic cases were identified and 2076 of these involved fracture care. One thousand one hundred ninety-nine patients were treated by traumatologists and 877 by GOSs. There was no statistical difference detected in American Society of Anesthesiologists score between trauma and nontrauma groups. Overall, the traumatologist group demonstrated significantly decreased procedure times when compared with the GOS group (55.6 vs. 75.8 minutes, P , 0.0001). In 16 of 18 most common procedure types, traumatologists were more efficient. This led to significantly decreased surgical labor costs ($381.4 vs. $484.8; P < 0.0001) and surgical supply and implant costs ($2567 vs. $3003; P < 0.0001). This study demonstrates that in our communitybased trauma system, fracture care provided by traumatologists results in improved utilization of hospital-based resources when compared with equivalent services provided by GOSs. Significantly decreased operative times, surgical labor expenses, and supply and implant costs by the fellowship-trained group represent enhanced control of the design, plan, execution, and monitoring of orthopaedic trauma care. Traumatologists can provide leadership recommendations for operating room efficiency in community-based orthopaedic trauma care models. Economic Level IV. See Instructions for Authors for a complete description of levels of evidence.

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

PubMed

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 < .05 was considered to be significant. Operating room B demonstrated decreased 5.0- µm particle sizes with the use of sleeves, while operating rooms A and C showed decreased total microbes only with the use of sleeves. Despite there being no difference in the average number of total microbes for all operating rooms assessed, the use of sleeves specifically appeared to decrease the shed of Micrococcus. The use of long sleeves and gloves while applying the skin preparation solution decreased particulate and microbial shedding in several of the operating rooms tested. Although long sleeves may not be necessary for all operating room personnel, they may decrease 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.

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

ERIC Educational Resources Information Center

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…

The effect of ultraviolet irradiation on the ultra-thin HfO{sub 2} based CO gas sensor

DOE Office of Scientific and Technical Information (OSTI.GOV)

Karaduman, Irmak; Barin, Özlem; Acar, Selim

2015-11-07

In this work, an effort has been made to fabricate ultrathin HfO{sub 2}/Al{sub 2}O{sub 3} sample by atomic layer deposition method for the fast detection of CO gas at room temperature. The effect of the operating temperature and the UV light on the gas sensing characteristics has been studied. We investigated the optimum operating temperature for the sample by sensing 25 ppm CO and CO{sub 2} gases from room temperature to 150 °C for 10 °C steps. The maximum response was obtained at 150 °C for both gases in the measurement temperature range. Also, the photoresponse measurements clearly show the effect of UV lightmore » on the sample. At room temperature, sensor showed superior response (14%) for 5 ppm CO gas. The response time of sensor is 6 s to 5 ppm CO gas concentration. The ultrathin HfO{sub 2} based sample shows acceptable gas sensitivity for 5 ppm CO gas at room temperature under UV light irradiation.« less

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

ERIC Educational Resources Information Center

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…

21 CFR 878.5070 - Air-handling apparatus for a surgical operating room.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Air-handling apparatus for a surgical operating room. 878.5070 Section 878.5070 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND....5070 Air-handling apparatus for a surgical operating room. (a) Identification. Air-handling apparatus...

21 CFR 878.5070 - Air-handling apparatus for a surgical operating room.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Air-handling apparatus for a surgical operating room. 878.5070 Section 878.5070 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND....5070 Air-handling apparatus for a surgical operating room. (a) Identification. Air-handling apparatus...

Launch vehicle operations cost reduction through artificial intelligence techniques

NASA Technical Reports Server (NTRS)

Davis, Tom C., Jr.

1988-01-01

NASA's Kennedy Space Center has attempted to develop AI methods in order to reduce the cost of launch vehicle ground operations as well as to improve the reliability and safety of such operations. Attention is presently given to cost savings estimates for systems involving launch vehicle firing-room software and hardware real-time diagnostics, as well as the nature of configuration control and the real-time autonomous diagnostics of launch-processing systems by these means. Intelligent launch decisions and intelligent weather forecasting are additional applications of AI being considered.

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

PubMed

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.

Room temperature single-photon detectors for high bit rate quantum key distribution

DOE Office of Scientific and Technical Information (OSTI.GOV)

Comandar, L. C.; Patel, K. A.; Engineering Department, Cambridge University, 9 J J Thomson Ave., Cambridge CB3 0FA

We report room temperature operation of telecom wavelength single-photon detectors for high bit rate quantum key distribution (QKD). Room temperature operation is achieved using InGaAs avalanche photodiodes integrated with electronics based on the self-differencing technique that increases avalanche discrimination sensitivity. Despite using room temperature detectors, we demonstrate QKD with record secure bit rates over a range of fiber lengths (e.g., 1.26 Mbit/s over 50 km). Furthermore, our results indicate that operating the detectors at room temperature increases the secure bit rate for short distances.

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

PubMed

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 < 0.001) in each operation. Other procedural problems and errors were related to the intraoperative LM 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.

Noise in the operating rooms of Greek hospitals.

PubMed

Tsiou, Chrisoula; Efthymiatos, Gerasimos; Katostaras, Theophanis

2008-02-01

This study is an evaluation of the problem of noise pollution in operating rooms. The high sound pressure level of noise in the operating theatre has a negative impact on communication between operating room personnel. The research took place at nine Greek public hospitals with more than 400 beds. The objective evaluation consisted of sound pressure level measurements in terms of L(eq), as well as peak sound pressure levels in recordings during 43 surgeries in order to identify sources of noise. The subjective evaluation consisted of a questionnaire answered by 684 operating room personnel. The views of operating room personnel were studied using Pearson's X(2) Test and Fisher's Exact Test (SPSS Version 10.00), a t-test comparison was made of mean sound pressure levels, and the relationship of measurement duration and sound pressure level was examined using linear regression analysis (SPSS Version 13.00). The sound pressure levels of noise per operation and the sources of noise varied. The maximum measured level of noise during the main procedure of an operation was measured at L(eq)=71.9 dB(A), L(1)=84.7 dB(A), L(10)=76.2 dB(A), and L(99)=56.7 dB(A). The hospital building, machinery, tools, and people in the operating room were the main noise factors. In order to eliminate excess noise in the operating room it may be necessary to adopt a multidisciplinary approach. An improvement in environment (background noise levels), the implementation of effective standards, and the focusing of the surgical team on noise matters are considered necessary changes.

Transtracheal single-point stent fixation in posttracheotomy tracheomalacia under cone-beam computer tomography guidance by transmural suturing with the Berci needle - a perspective on a new tool to avoid stent migration of Dumon stents.

PubMed

Hohenforst-Schmidt, Wolfgang; Linsmeier, Bernd; Zarogoulidis, Paul; Freitag, Lutz; Darwiche, Kaid; Browning, Robert; Turner, J Francis; Huang, Haidong; Li, Qiang; Vogl, Thomas; Zarogoulidis, Konstantinos; Brachmann, Johannes; Rittger, Harald

2015-01-01

Tracheomalacia or tracheobronchomalacia (TM or TBM) is a common problem especially for elderly patients often unfit for surgical techniques. Several surgical or minimally invasive techniques have already been described. Stenting is one option but in general long-time stenting is accompanied by a high complication rate. Stent removal is more difficult in case of self-expandable nitinol stents or metallic stents in general in comparison to silicone stents. The main disadvantage of silicone stents in comparison to uncovered metallic stents is migration and plugging. We compared the operation time and in particular the duration of a sufficient Dumon stent fixation with different techniques in a patient with severe posttracheotomy TM and strongly reduced mobility of the vocal cords due to Parkinson's disease. The combined approach with simultaneous Dumon stenting and endoluminal transtracheal externalized suture under cone-beam computer tomography guidance with the Berci needle was by far the fastest approach compared to a (not performed) surgical intervention, or even purely endoluminal suturing through the rigid bronchoscope. The duration of the endoluminal transtracheal externalized suture was between 5 minutes and 9 minutes with the Berci needle; the pure endoluminal approach needed 51 minutes. The alternative of tracheobronchoplasty was refused by the patient. In general, 180 minutes for this surgical approach is calculated. The costs of the different approaches are supposed to vary widely due to the fact that in Germany 1 minute in an operation room costs on average approximately 50-60€ inclusive of taxes. In our own hospital (tertiary level), it is nearly 30€ per minute in an operation room for a surgical approach. Calculating an additional 15 minutes for patient preparation and transfer to wake-up room, therefore a total duration inside the investigation room of 30 minutes, the cost per flexible bronchoscopy is per minute on average less than 6€. Although the Dumon stenting requires a set-up with more expensive anesthesiology accompaniment, which takes longer than a flexible investigation estimated at 1 hour in an operation room, still without calculation of the costs of the materials and specialized staff that the surgical approach would consume at least 3,000€ more than a minimally invasive approach performed with the Berci needle. This difference is due to the longer time of the surgical intervention which is calculated at approximately 180 minutes in comparison to the achieved non-surgical approach of 60 minutes in the operation suite.

10 CFR 36.67 - Entering and leaving the radiation room.

Code of Federal Regulations, 2011 CFR

2011-01-01

... radiation room of a panoramic irradiator after an irradiation, the irradiator operator shall use a survey... irradiation, the irradiator operator shall: (1) Visually inspect the entire radiation room to verify that no...

10 CFR 36.67 - Entering and leaving the radiation room.

Code of Federal Regulations, 2010 CFR

2010-01-01

... radiation room of a panoramic irradiator after an irradiation, the irradiator operator shall use a survey... irradiation, the irradiator operator shall: (1) Visually inspect the entire radiation room to verify that no...

10 CFR 36.67 - Entering and leaving the radiation room.

Code of Federal Regulations, 2014 CFR

2014-01-01

... radiation room of a panoramic irradiator after an irradiation, the irradiator operator shall use a survey... irradiation, the irradiator operator shall: (1) Visually inspect the entire radiation room to verify that no...

10 CFR 36.67 - Entering and leaving the radiation room.

Code of Federal Regulations, 2012 CFR

2012-01-01

... radiation room of a panoramic irradiator after an irradiation, the irradiator operator shall use a survey... irradiation, the irradiator operator shall: (1) Visually inspect the entire radiation room to verify that no...

10 CFR 36.67 - Entering and leaving the radiation room.

Code of Federal Regulations, 2013 CFR

2013-01-01

... radiation room of a panoramic irradiator after an irradiation, the irradiator operator shall use a survey... irradiation, the irradiator operator shall: (1) Visually inspect the entire radiation room to verify that no...

[OR management - Checklists for OR-design for OR-managers - results of a workshop].

PubMed

Bock, Matthias; Steinmeyer-Bauer, Klaus; Schüpfer, Guido

2014-10-01

The construction of an operating room (OR) suite represents an important intermediate- and long term investment. The planning process starts with the quantitative estimation of the procedures to be carried out which defines the operative capacity for the life time of the facility. This permits the calculation of the number of ORs and the definition of the resources for the recovery room, the intermediate care and intensive care unit.The projectors should integrate the new facility into workflow, workload and logistics of the entire hospital. The simulation flow of patients and accompanying persons and of the routes of the personnel is helpful for this purpose. Separating structures for outpatients from those for inpatients and avoiding de-centralized rooms helps designing an efficient and safe OR suite.The design of the single ORs should be flexible to permit changes or technical innovations during their use period. Mobile equipment is preferable to permanently installed devices. We consider an expanse of at least 45 m(2) for any location adequate for general ORs. The space requirements are elevated for hybrid ORs and rooms dedicated for robotic surgery.The design of the suite should separate the flow of personnel, patients and logistics. Surgical instruments and their logistics should be standardized. Dedicated locations for a simultaneous preparation of the instrumentation tables permit parallel processing. Thus an adequate capacity of preparation rooms and storage rooms is necessary. Dressing rooms, rest rooms, showers and lounges are important for the working conditions and should be planned in an adequate size and number. © Georg Thieme Verlag Stuttgart · New York.

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

PubMed

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

2007-06-01

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

Estimating Surgical Procedure Times Using Anesthesia Billing Data and Operating Room Records.

PubMed

Burgette, Lane F; Mulcahy, Andrew W; Mehrotra, Ateev; Ruder, Teague; Wynn, Barbara O

2017-02-01

The median time required to perform a surgical procedure is important in determining payment under Medicare's physician fee schedule. Prior studies have demonstrated that the current methodology of using physician surveys to determine surgical times results in overstated times. To measure surgical times more accurately, we developed and validated a methodology using available data from anesthesia billing data and operating room (OR) records. We estimated surgical times using Medicare 2011 anesthesia claims and New York Statewide Planning and Research Cooperative System 2011 OR times. Estimated times were validated using data from the National Surgical Quality Improvement Program. We compared our time estimates to those used by Medicare in the fee schedule. We estimate surgical times via piecewise linear median regression models. Using 3.0 million observations of anesthesia and OR times, we estimated surgical time for 921 procedures. Correlation between these time estimates and directly measured surgical time from the validation database was 0.98. Our estimates of surgical time were shorter than the Medicare fee schedule estimates for 78 percent of procedures. Anesthesia and OR times can be used to measure surgical time and thereby improve the payment for surgical procedures in the Medicare fee schedule. © Health Research and Educational Trust.

Improved alignment and operating room efficiency with patient-specific instrumentation for TKA.

PubMed

Renson, Luc; Poilvache, Pascal; Van den Wyngaert, Hans

2014-12-01

Achieving accurate alignment in total knee arthroplasty (TKA) remains a concern. Patient-specific instrumentation (PSI) produced using preoperative 3D models was developed to offer surgeons a simplified, reliable, efficient and customised TKA procedure. In this prospective study, 60 patients underwent TKA with conventional instrumentation and 71 patients were operated on using PSI. The primary endpoint was surgical time. Secondary endpoints included operating room (OR) time, the number of instrument trays used and postoperative radiographic limb alignment. Compared to conventional instrumentation, PSI significantly reduced total surgical time by 8.9 ± 3.3 min (p=0.038), OR time by 8.6 ± 4.2 min (p=0.043), and the number of instrument trays by six trays (p<0.001). Mechanical axis malalignment of the lower limb of >3° was observed in 13% of PSI patients versus 29% with conventional instrumentation (p=0.043). PSI predicted the size of the femoral and tibial components actually used in 85.9% and 78.9% of cases, respectively. PSI improves alignment, surgical and OR time, reduces the number of instruments trays used compared to conventional instrumentation in patients undergoing TKA and results in fewer outliers in overall mechanical alignment in the coronal plane. Prospective comparative therapeutic study. Copyright © 2014 Elsevier B.V. All rights reserved.

A robust and non-obtrusive automatic event tracking system for operating room management to improve patient care.

PubMed

Huang, Albert Y; Joerger, Guillaume; Salmon, Remi; Dunkin, Brian; Sherman, Vadim; Bass, Barbara L; Garbey, Marc

2016-08-01

Optimization of OR management is a complex problem as each OR has different procedures throughout the day inevitably resulting in scheduling delays, variations in time durations and overall suboptimal performance. There exists a need for a system that automatically tracks procedural progress in real time in the OR. This would allow for efficient monitoring of operating room states and target sources of inefficiency and points of improvement. We placed three wireless sensors (floor-mounted pressure sensor, ventilator-mounted bellows motion sensor and ambient light detector, and a general room motion detector) in two ORs at our institution and tracked cases 24 h a day for over 4 months. We collected data on 238 total cases (107 laparoscopic cases). A total of 176 turnover times were also captured, and we found that the average turnover time between cases was 35 min while the institutional goal was 30 min. Deeper examination showed that 38 % of laparoscopic cases had some aspect of suboptimal activity with the time between extubation and patient exiting the OR being the biggest contributor (16 %). Our automated system allows for robust, wireless real-time OR monitoring as well as data collection and retrospective data analyses. We plan to continue expanding our system and to project the data in real time for all OR personnel to see. At the same time, we plan on adding key pieces of technology such as RFID and other radio-frequency systems to track patients and physicians to further increase efficiency and patient safety.

Outcomes After Cardiac Arrest in an Adult Burn Center

DTIC Science & Technology

2013-12-07

defibrillation at our institution, either in the burn operating room (BOR) or burn intensive care unit (BICU). We included patients who experi- enced CA in...of this study design. In other studies, the time between CA and defibrillation and, in children, the time between burn and fluid resuscitation have

PubMed Central

SARTINI, M.; PANATTO, D.; PERDELLI, F.; CRISTINA, M.L.

2013-01-01

Summary An experimental study was conducted in a hospital in Liguria (northern Italy) on two groups of patients with the same disease severity who were undergoing the same type of surgery (primary hemiarthroplasty). Our aim was to assessing the results of a quality- improvement scheme implemented in the operating room. The quality-improvement protocol involved analyzing a set of parameters concerning the operating team's behavior and environmental conditions that could be attributed to the operating team itself. A program of training and sanitary education was carried to rectify any improper behavior of the operating staff. Two hundred and six hip-joint replacement operations (primary hip hemiarthroplasty - ICD9-CM 81.51) all conducted in the same operating room were studied: 103 patients, i.e. operations performed before the quality-improvement scheme and 103 patients, i.e. operations performed after the quality improvement scheme; all were comparable in terms of type of surgery and severity. The scheme resulted in an improvement in both behavioral and environmental parameters and an 80% reduction in the level of microbial air contamination (p < 0.001). Patient outcomes improved in terms of average postoperative hospitalization time, the occurrence and duration of fever (>37.5°C) and microbiological contamination of surgical wounds. From an economic point of view, facility efficiency increased by 28.57%, average hospitalization time decreased (p<0.001) and a theoretical increase of € 1,441,373.58 a year in revenues was achieved. PMID:24396985

Radiation protection measures: Implications on the design of neurosurgery operating rooms.

PubMed

Delgado-López, Pedro David; Sánchez-Jiménez, Javier; Herrero-Gutiérrez, Ana Isabel; Inclán-Cuesta, María Teresa; Corrales-García, Eva María; Martín-Alonso, Javier; Galacho-Harriero, Ana María; Rodríguez-Salazar, Antonio

To describe pros and cons of some radiation protection measures and the implications on the design of a neurosurgery operating room. Concurring with the acquisition and use of an O-arm device, a structural remodeling of our neurosurgery operating room was carried out. The theater was enlarged, the shielding was reinforced and a foldable leaded screen was installed inside the operating room. Radiation doses were measured in front of and behind the screen. The screen provides whole-body radiation protection for all the personnel inside the theater (effective dose <5μSv at 2,5 m from the gantry per O-arm exploration; 0,0μSv received behind the screen per O-arm exploration; and undetectable cumulative annual radiation dose behind the screen), obviates the need for leaded aprons and personal dosimeters, and minimizes the circulation of personnel. Enlarging the size of the operating room allows storing the equipment inside and minimizes the risk of collision and contamination. Rectangular rooms provide greater distance from the source of radiation. Floor, ceiling and walls shielding, a rectangular-shaped and large enough theater, the presence of a foldable leaded screen, and the security systems precluding an unexpected irruption into the operating room during irradiation are relevant issues to consider when designing a neurosurgery operating theater. Copyright © 2018 Sociedad Española de Neurocirugía. Publicado por Elsevier España, S.L.U. All rights reserved.

Introduction of an operating room information management system improved overall operating room efficiency.

PubMed

De Deyne, Cathy; Heylen, René

2004-01-01

Operating Room (OR) information systems should manage the OR time, assigned to every surgeon, thereby minimizing the sum of costs of unused OR time and minimizing the costs of elective cases performed outside normal allocated OR time (excess OR-time). The aim of this paper is to illustrate how the introduction of an OR information system influenced daily OR activity performance. Since January 2001, we introduced an OR information system with a visual, airport-like, screen as central part, displaying all scheduled OR activity linked in real-time activity with all OR theatres. For the aim of this paper, we compared all data of OR activity for elective abdominal surgery (EAS) for the first half of 2000 compared to the first half of 2001, after the introduction of our information system. In 2000, 764 elective cases were performed, compared to 815 cases in 2001. For both periods, the total OR time allocated to EAS for this 6 months period was 805 h. For 2000, the total duration of OR activity for EAS was 1044 h 50 min (implicating 239 h 50 min over-time), compared to 1127 h 35 min (implicating 322 h 35 min overtime) for 2001. For 2000, we recorded 147 h 20 min excess time (=exceeding the time limits of OR activity and inducing extra costs) and 46h45min unused OR time. For 2001, we recorded 123 h 04 min excess time and 35 h 21 min unused time. In conclusion, in 2001 we recorded an increase in total OR activity for elective abdominal surgery by 7% in number of procedures and by 8% in total duration. However, in 2001 we recorded a decrease in excess time by 16% (123 h 04 min vs 147 h 20 min), which was for a large part due to a 23% decrease in unused OR time in 2001 compared to 2000 (35 h 21min vs 46 h 45 min). Therefore, the introduction of an OR information system, with a real-time visual display of ongoing OR activity, resulted in a increased performance of OR activity, with more OR procedures performed despite less excess time and less extra costs.

Safety culture in the gynecology robotics operating room.

PubMed

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.

Anaesthesiologists' views on the need for point-of-care information system in the operating room: a survey of the European Society of Anaesthesiologists.

PubMed

Perel, A; Berkenstadt, H; Ziv, A; Katzenelson, R; Aitkenhead, A

2004-11-01

In this preliminary study we wanted to explore the attitudes of anaesthesiologists to a point-of-care information system in the operating room. The study was conducted as a preliminary step in the process of developing such a system by the European Society of Anaesthesiologists (ESA). A questionnaire was distributed to all 2240 attendees of the ESA's annual meeting in Gothenburg, Sweden, which took place in April 2001. Of the 329 responders (response rate of 14.6%), 79% were qualified specialists with more than 10 yr of experience (68%), mostly from Western Europe. Most responders admitted to regularly experiencing lack of medical knowledge relating to real-time patient care at least once a month (74%) or at least once a week (46%), and 39% admitted to having made errors during anaesthesia due to lack of medical information that can be otherwise found in a handbook. The choice ofa less optimal but more familiar approach to patient management due to lack of knowledge was reported by 37%. Eighty-eight percent of responders believe that having a point-of-care information system for the anaesthesiologists in the operating room is either important or very important. This preliminary survey demonstrates that lack of knowledge of anaesthesiologists may be a significant source of medical errors in the operating room, and suggests that a point-of-care information system for the anaesthesiologist may be of value.

Decreasing airborne contamination levels in high-risk hospital areas using a novel mobile air-treatment unit.

PubMed

Bergeron, V; Reboux, G; Poirot, J L; Laudinet, N

2007-10-01

To evaluate the performance of a new mobile air-treatment unit that uses nonthermal-plasma reactors for lowering the airborne bioburden in critical hospital environments and reducing the risk of nosocomial infection due to opportunistic airborne pathogens, such as Aspergillus fumigatus. Tests were conducted in 2 different high-risk hospital areas: an operating room under simulated conditions and rooms hosting patients in a pediatric hematology ward. Operating room testing provided performance evaluations of removal rates for airborne contamination (ie, particles larger than 0.5 microm) and overall lowering of the airborne bioburden (ie, colony-forming units of total mesophilic flora and fungal flora per cubic meter of air). In the hematology service, opportunistic and nonpathogenic airborne fungal levels in a patient's room equipped with an air-treatment unit were compared to those in a control room. In an operating room with a volume of 118 m(3), the time required to lower the concentration of airborne particles larger than 0.5 microm by 90% was decreased from 12 minutes with the existing high-efficiency particulate air filtration system to less than 2 minutes with the units tested, with a 2-log decrease in the steady-state levels of such particles (P<.01). Concurrently, total airborne mesophilic flora concentrations dropped by a factor of 2, and the concentrations of fungal species were reduced to undetectable levels (P<.01). The 12-day test period in the hematology ward revealed a significant reduction in airborne fungus levels (P<.01), with average reductions of 75% for opportunistic species and 82% for nonpathogenic species. Our data indicate that the mobile, nonthermal-plasma air treatment unit tested in this study can rapidly reduce the levels of airborne particles and significantly lower the airborne bioburden in high-risk hospital environments.

Longer Operative Time During Benign Laparoscopic and Robotic Hysterectomy Is Associated With Increased 30-Day Perioperative Complications.

PubMed

Catanzarite, Tatiana; Saha, Sujata; Pilecki, Matthew A; Kim, John Y S; Milad, Magdy P

2015-01-01

The relationship between operative time and perioperative morbidity has not been fully characterized in gynecology. We aimed to determine the impact of operative time on 30-day perioperative complications after laparoscopic and robotic hysterectomy. Patients undergoing laparoscopic and robotic hysterectomy for benign disease from 2006 to 2011 within the National Surgical Quality Improvement Program (NSQIP) database were identified by Current Procedural Terminology code. Operative times were stratified into 60-minute intervals and complication rates analyzed. Primary outcomes included 30-day overall, medical, and surgical complications. Bivariate analyses using χ(2), Fisher's exact, and one-way analysis of variance tests were performed to compare clinical and procedural characteristics associated with longer operative time and complications. Multivariable logistic regression analyses were then performed to determine the independent association between operative time and perioperative complications. Canadian Task Force classification II-2 (Evidence obtained from well-designed cohort or case-control studies preferably from more than 1 center or research group). American College of Surgeons NSQIP. Patients who underwent laparoscopic or robotic hysterectomy for benign disease from 2006 to 2011 at any institution participating in NSQIP. None, retrospective database study. Of the 7630 laparoscopic and robotic hysterectomies identified, 399 patients (5.2%) experienced complications, most commonly urinary tract infection (UTI; 2.1%), superficial surgical site infection (1.0%), and blood transfusion (1.0%). Return to the operating room was required in 97 patients (1.3%), and there were 4 deaths, for a mortality rate of .05%. Complications increased steadily with longer operative time. Operative time ≥ 240 minutes was associated with increased overall complications (13.8% vs 4.6%, p < .001), surgical complications (5.4% vs 1.5%, p < .001), medical complications (10.4% vs 3.2%, p < .001), return to the operating room (2.7% vs 1.2%, p = .002), deep venous thrombosis (.5% vs .06%, p = .011), pulmonary embolism (.7% vs .1%, p = .012), and blood transfusion (3.4% vs .8%, p < .001). These associations remained statistically significant after multivariable regression analysis. Based on continuous regression modeling, each additional hour of operative time would be expected to increase odds of overall complications (odds ratio [OR], 1.4; 95% confidence interval [CI], 1.28-1.54; p < .001), medical complications (OR, 1.42; 95% CI, 1.28-1.57; p < .001), surgical complications (OR, 1.32; 95% CI, 1.17-1.49; p < .001), venous thromboembolism (OR, 1.47; 95% CI, 1.12-1.92; p = .005), UTI (OR, 1.20; 95% CI, 1.05-1.36; p = .006), blood transfusion (OR, 1.42; 95% CI, 1.18-1.71; p < .001), and return to the operating room (OR, 1.25; 95% CI, 1.08-1.45; p = .003). We demonstrated a direct, independent association between operative time and 30-day complications after laparoscopic and robotic hysterectomy. Future research should aim to further delineate risk factors for prolonged operative time and morbidity in laparoscopic hysterectomy to allow surgeons to maximize preoperative planning and optimize patient selection for minimally invasive hysterectomy. Copyright © 2015 AAGL. Published by Elsevier Inc. All rights reserved.

KSC-2009-5248

NASA Image and Video Library

2009-09-25

CAPE CANAVERAL, Fla. – This ribbon cutting officially turns over NASA Kennedy Space Center's Launch Control Center Firing Room 1 from the Space Shuttle Program to the Constellation Program. Participating are (from left) Pepper Phillips, director of the Constellation Project Office at Kennedy; Bob Cabana, Kennedy's director; Robert Crippen, former astronaut; Jeff Hanley, manager of the Constellation Program at NASA's Johnson Space Center; and Nancy Bray, deputy director of Center Operations at Kennedy. The room has undergone demolition and construction and been outfitted with consoles for the upcoming Ares I-X rocket flight test targeted for launch on Oct. 27. As the center of launch operations at Kennedy since the Apollo Program, the Launch Control Center, or LCC, has played a central role in NASA's human spaceflight programs. Firing Room 1 was the first operational firing room constructed. From this room, controllers launched the first Saturn V, the first crewed flight of Saturn V, the first crewed mission to the moon and the first space shuttle. Firing Room 1 will continue this tradition of firsts when controllers launch the Constellation Program's first flight test. Also, this firing room will be the center of operations for the upcoming Ares I and Orion operations. Photo credit: NASA/Kim Shiflett

Auto identification technology and its impact on patient safety in the Operating Room of the Future.

PubMed

Egan, Marie T; Sandberg, Warren S

2007-03-01

Automatic identification technologies, such as bar coding and radio frequency identification, are ubiquitous in everyday life but virtually nonexistent in the operating room. User expectations, based on everyday experience with automatic identification technologies, have generated much anticipation that these systems will improve readiness, workflow, and safety in the operating room, with minimal training requirements. We report, in narrative form, a multi-year experience with various automatic identification technologies in the Operating Room of the Future Project at Massachusetts General Hospital. In each case, the additional human labor required to make these ;labor-saving' technologies function in the medical environment has proved to be their undoing. We conclude that while automatic identification technologies show promise, significant barriers to realizing their potential still exist. Nevertheless, overcoming these obstacles is necessary if the vision of an operating room of the future in which all processes are monitored, controlled, and optimized is to be achieved.

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

PubMed

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.

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

PubMed

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.

Resident Autonomy in the Operating Room: Expectations Versus Reality.

PubMed

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.

[Comprehensive system integration and networking in operating rooms].

PubMed

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.

Demonstration of a Dual-Band Mid-Wavelength HgCdTe Detector Operating at Room Temperature

NASA Astrophysics Data System (ADS)

Martyniuk, P.; Madejczyk, P.; Gawron, W.; Rutkowski, J.

2018-03-01

In this paper, the performance of sequential dual-band mid-wavelength N+-n-p-p-P+-p-p-n-n+ back-to-back HgCdTe photodiode grown by metal-organic chemical vapor deposition (MOCVD) operating at room temperature is presented. The details of the MOCVD growth procedure are given. The influence of p-type separating-barrier layer on dark current, photocurrent and response time was analyzed. Detectivity without immersion D * higher than 1 × 108 cmHz1/2/W was estimated for λ Peak = 3.2 μm and 4.2 μm, respectively. A response time of τ s ˜ 1 ns could be reached in both MW1 and MW2 ranges for the optimal P+ barrier Cd composition at the range 0.38-0.42, and extra series resistance related to the processing R Series equal to 500 Ω.

Gigabit free-space multi-level signal transmission with a mid-infrared quantum cascade laser operating at room temperature.

PubMed

Pang, Xiaodan; Ozolins, Oskars; Schatz, Richard; Storck, Joakim; Udalcovs, Aleksejs; Navarro, Jaime Rodrigo; Kakkar, Aditya; Maisons, Gregory; Carras, Mathieu; Jacobsen, Gunnar; Popov, Sergei; Lourdudoss, Sebastian

2017-09-15

Gigabit free-space transmissions are experimentally demonstrated with a quantum cascaded laser (QCL) emitting at mid-wavelength infrared of 4.65 μm, and a commercial infrared photovoltaic detector. The QCL operating at room temperature is directly modulated using on-off keying and, for the first time, to the best of our knowledge, four- and eight-level pulse amplitude modulations (PAM-4, PAM-8). By applying pre- and post-digital equalizations, we achieve up to 3  Gbit/s line data rate in all three modulation configurations with a bit error rate performance of below the 7% overhead hard decision forward error correction limit of 3.8×10 -3 . The proposed transmission link also shows a stable operational performance in the lab environment.

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

PubMed

Du, Hui; He, Anjie; Zeng, Leilei

2010-09-01

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

Improving operating room efficiency via an interprofessional approach.

PubMed

Bender, Jeffrey S; Nicolescu, Teodora O; Hollingsworth, Susan B; Murer, Krystal; Wallace, Kristina R; Ertl, William J

2015-03-01

Third-party payer reimbursements will likely continue to decrease. Therefore, it is imperative for operating rooms (ORs), often a hospital's largest revenue source, to improve efficiency. We report the outcome after 3 years of a lean, Six Sigma program to improve OR utilization. In January 2011, our hospital system instituted a facility-wide approach to address the problem of OR efficiency. Interprofessional teams were formed to examine all aspects of OR use. An OR Governance Committee consisting of Department Chairs, nursing and senior administration oversaw the project. Outpatients' readiness on time for surgery increased from 59% to 95%, while first case on-time starts improved from 32% to 73%. Block utilization went from 68% to 74% and actual room utilization improved from 56% to 68%. The number of cases increased by 9%. Overtime went from 7% of total to 4%, so personnel costs decreased 14% despite 26% more employees. There was a reduction in annual voluntary OR staff turnover from 28% to 11%. Revenues increased more than 10% annually. A concerted effort to optimize OR performance resulted in marked improvements in access, overall case efficiency, staff satisfaction, and financial performance. Copyright © 2015 Elsevier Inc. All rights reserved.

[Working conditions in the operating room: surgeons surveyed during the annual meeting of the German society of surgery 2004].

PubMed

Matern, U; Koneczny, S

2006-10-01

For the evaluation of working place conditions in the operating room a survey was conducted among the surgeons working in German hospitals. Questions regarded the personal profile, the architectural situation, the devices and instruments as well as the working posture. The answers to the 60 questions display a high potential for improvement within all fields. Every single group working in the operating room, as well as their professional organizations are asked to work on the optimization of the working place conditions in the operating room in terms of improvement of quality and efficiency.

The keys to CERN conference rooms - Managing local collaboration facilities in large organisations

NASA Astrophysics Data System (ADS)

Baron, T.; Domaracky, M.; Duran, G.; Fernandes, J.; Ferreira, P.; Gonzalez Lopez, J. B.; Jouberjean, F.; Lavrut, L.; Tarocco, N.

2014-06-01

For a long time HEP has been ahead of the curve in its usage of remote collaboration tools, like videoconference and webcast, while the local CERN collaboration facilities were somewhat behind the expected quality standards for various reasons. This time is now over with the creation by the CERN IT department in 2012 of an integrated conference room service which provides guidance and installation services for new rooms (either equipped for videoconference or not), as well as maintenance and local support. Managing now nearly half of the 246 meeting rooms available on the CERN sites, this service has been built to cope with the management of all CERN rooms with limited human resources. This has been made possible by the intensive use of professional software to manage and monitor all the room equipment, maintenance and activity. This paper focuses on presenting these packages, either off-the-shelf commercial products (asset and maintenance management tool, remote audio-visual equipment monitoring systems, local automation devices, new generation touch screen interfaces for interacting with the room) when available or locally developed integration and operational layers (generic audio-visual control and monitoring framework) and how they help overcoming the challenges presented by such a service. The aim is to minimise local human interventions while preserving the highest service quality and placing the end user back in the centre of this collaboration platform.

Information Foraging in Nuclear Power Plant Control Rooms

DOE Office of Scientific and Technical Information (OSTI.GOV)

R.L. Boring

2011-09-01

nformation foraging theory articulates the role of the human as an 'informavore' that seeks information and follows optimal foraging strategies (i.e., the 'information scent') to find meaningful information. This paper briefly reviews the findings from information foraging theory outside the nuclear domain and then discusses the types of information foraging strategies operators employ for normal and off-normal operations in the control room. For example, operators may employ a predatory 'wolf' strategy of hunting for information in the face of a plant upset. However, during routine operations, the operators may employ a trapping 'spider' strategy of waiting for relevant indicators tomore » appear. This delineation corresponds to information pull and push strategies, respectively. No studies have been conducted to determine explicitly the characteristics of a control room interface that is optimized for both push and pull information foraging strategies, nor has there been empirical work to validate operator performance when transitioning between push and pull strategies. This paper explores examples of control room operators as wolves vs. spiders and con- cludes by proposing a set of research questions to investigate information foraging in control room settings.« less

Flow analysis of airborne particles in a hospital operating room

NASA Astrophysics Data System (ADS)

Faeghi, Shiva; Lennerts, Kunibert

2016-06-01

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

A Portable Shoulder-Mounted Camera System for Surgical Education in Spine Surgery.

PubMed

Pham, Martin H; Ohiorhenuan, Ifije E; Patel, Neil N; Jakoi, Andre M; Hsieh, Patrick C; Acosta, Frank L; Wang, Jeffrey C; Liu, John C

2017-02-07

The past several years have demonstrated an increased recognition of operative videos as an important adjunct for resident education. Currently lacking, however, are effective methods to record video for the purposes of illustrating the techniques of minimally invasive (MIS) and complex spine surgery. We describe here our experiences developing and using a shoulder-mounted camera system for recording surgical video. Our requirements for an effective camera system included wireless portability to allow for movement around the operating room, camera mount location for comfort and loupes/headlight usage, battery life for long operative days, and sterile control of on/off recording. With this in mind, we created a shoulder-mounted camera system utilizing a GoPro™ HERO3+, its Smart Remote (GoPro, Inc., San Mateo, California), a high-capacity external battery pack, and a commercially available shoulder-mount harness. This shoulder-mounted system was more comfortable to wear for long periods of time in comparison to existing head-mounted and loupe-mounted systems. Without requiring any wired connections, the surgeon was free to move around the room as needed. Over the past several years, we have recorded numerous MIS and complex spine surgeries for the purposes of surgical video creation for resident education. Surgical videos serve as a platform to distribute important operative nuances in rich multimedia. Effective and practical camera system setups are needed to encourage the continued creation of videos to illustrate the surgical maneuvers in minimally invasive and complex spinal surgery. We describe here a novel portable shoulder-mounted camera system setup specifically designed to be worn and used for long periods of time in the operating room.

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

PubMed

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 < .0001). For Dmax (maximum distance where there is <15% loss of consonant articulation), both VR and VC β coefficients were significant. For RT60 and Dmax, after controlling for VC, partial correlations were 0.825 (P < .0001) and 0.718 (P < .0001), respectively, while after controlling for VR, partial correlations were -0.322 (P = .169) and 0.381 (P < .05), respectively. Our results suggest that 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 correlated with improved speech intelligibility. This study provides valuable descriptive data and a predictive method for identifying existing ORs that may benefit from acoustic modifiers (eg, sound absorption panels). Additionally, it suggests that room dimensions and projected clinical use should be considered during the design phase of OR suites to optimize acoustic performance.

The Design of a Real Time Operating System for a Fault Tolerant Microcomputer

DTIC Science & Technology

1986-12-01

Scheduler then enqueues all the new jobs for the new frame. Upon completion of the Purge and Task Scheduler routines the Cycle Interrupt Handler returns...the scheduling of new tasks in a new minor cycle to make room for the new jobs . The purge operation will usually not remove the same number of jobs each

Human Factors Principles in Information Dashboard Design

DOE Office of Scientific and Technical Information (OSTI.GOV)

Hugo, Jacques V.; St. Germain, Shawn

When planning for control room upgrades, nuclear power plants have to deal with a multitude of engineering and operational impacts. This will inevitably include several human factors considerations, including physical ergonomics of workstations, viewing angles, lighting, seating, new communication requirements, and new concepts of operation. In helping nuclear power utilities to deal with these challenges, the Idaho National Laboratory (INL) has developed effective methods to manage the various phases of the upgrade life cycle. These methods focus on integrating human factors engineering processes with the plant’s systems engineering process, a large part of which is the development of end-state conceptsmore » for control room modernization. Such an end-state concept is a description of a set of required conditions that define the achievement of the plant’s objectives for the upgrade. Typically, the end-state concept describes the transition of a conventional control room, over time, to a facility that employs advanced digital automation technologies in a way that significantly improves system reliability, reduces human and control room-related hazards, reduces system and component obsolescence, and significantly improves operator performance. To make the various upgrade phases as concrete and as visible as possible, an end-state concept would include a set of visual representations of the control room before and after various upgrade phases to provide the context and a framework within which to consider the various options in the upgrade. This includes the various control systems, human-system interfaces to be replaced, and possible changes to operator workstations. This paper describes how this framework helps to ensure an integrated and cohesive outcome that is consistent with human factors engineering principles and also provide substantial improvement in operator performance. The paper further describes the application of this integrated approach in the strategic modernization program at a nuclear power plant where legacy systems are upgraded to advanced digital technologies through a systematic process that links human factors principles to the systems engineering process. This approach will help to create an integrated control room architecture beyond what is possible for individual subsystem upgrades alone. In addition, several human factors design and evaluation methods were used to develop the end-state concept, including interactive sessions with operators in INL’s Human System Simulation Laboratory, three-dimensional modeling to visualize control board changes.« less

Operating room myths: what is the evidence for common practices.

PubMed

Pada, Surinder; Perl, Trish M

2015-08-01

In order to ensure patient safety and prevent surgical site infections (SSIs), operating theaters/rooms have evolved into complex, highly technical environments. Prevention of healthcare-associated infections, and strategies to limit patient harm, have gained momentum over the last decade. This article aims to examine and dispute some commonly held beliefs with specific reference to: laminar airflow, noise and operating theater door openings and how these impact SSI. Laminar airflow may not be necessary for prosthetic implant surgery. Some recent data suggest that there may be patient harm. With the development of better surgical techniques and perioperative care, such costly systems may not be needed. Operating rooms with a high number of door openings have also been shown to experience higher SSI rates, as have operating rooms with high noise levels. These may serve as surrogate markers for operating room discipline. Initiatives which target these areas may be worth considering when devising strategies to reduce SSIs. Improved surveillance systems for SSIs are needed and should include operating theater airflow type. This will allow further analysis of the effect of laminar air flow on SSIs and provide evidence for a decisive recommendation. Cultivating a culture of good operating theater discipline may also reduce SSIs.

Cognitive consequences of clumsy automation on high workload, high consequence human performance

NASA Technical Reports Server (NTRS)

Cook, Richard I.; Woods, David D.; Mccolligan, Elizabeth; Howie, Michael B.

1991-01-01

The growth of computational power has fueled attempts to automate more of the human role in complex problem solving domains, especially those where system faults have high consequences and where periods of high workload may saturate the performance capacity of human operators. Examples of these domains include flightdecks, space stations, air traffic control, nuclear power operation, ground satellite control rooms, and surgical operating rooms. Automation efforts may have unanticipated effects on human performance, particularly if they increase the workload at peak workload times or change the practitioners' strategies for coping with workload. Smooth and effective changes in automation requires detailed understanding of the congnitive tasks confronting the user: it has been called user centered automation. The introduction of a new computerized technology in a group of hospital operating rooms used for heart surgery was observed. The study revealed how automation, especially 'clumsy automation', effects practitioner work patterns and suggest that clumsy automation constrains users in specific and significant ways. Users tailor both the new system and their tasks in order to accommodate the needs of process and production. The study of this tailoring may prove a powerful tool for exposing previously hidden patterns of user data processing, integration, and decision making which may, in turn, be useful in the design of more effective human-machine systems.

Quality assurance for patients with head injuries admitted to a regional trauma unit.

PubMed

Schwartz, M L; Sharkey, P W; Andersen, J A

1991-07-01

The efficacy of trauma systems in reducing preventable deaths has been established but the methods of auditing care are still evolving. Various "audit filters" to identify which patients' charts should be reviewed have been proposed. An analysis of all patients admitted to the Regional Trauma Unit (RTU) over a 19-month period was conducted. Of 729 patients, 135 were identified as having suffered a traumatic intracranial hemorrhage (TICH). On review, neither delay in transfer from the emergency room to the operating room nor increasing time from the incident to the operating room correlated with increasing mortality. In contrast to delay, the Glasgow Coma Scale (GCS) score on admission correlated well with outcome. The charts of patients with anomalous outcomes based on admission GCS score were reviewed, and two possibly preventable deaths were identified. There were 48 patients with TICH who had no operations but there were no deaths attributable to a missed operation. There were 76 patients for whom the GCS score at the referring hospital and the GCS score on admission to the RTU were available. Seven of 19 patients who worsened on transfer declined because of significant pulmonary injuries. Anomalous outcomes based on admission GCS score and declining GCS scores are recommended as quality assurance filters.

Understanding Cognitive and Collaborative Work: Observations in an Electric Transmission Operations Control Center

DOE Office of Scientific and Technical Information (OSTI.GOV)

Obradovich, Jodi H.

2011-09-30

This paper describes research that is part of an ongoing project to design tools to assist in the integration of renewable energy into the electric grid. These tools will support control room dispatchers in real-time system operations of the electric power transmission system which serves much of the Western United States. Field observations comprise the first phase of this research in which 15 operators have been observed over various shifts and times of day for approximately 90 hours. Findings describing some of the cognitive and environmental challenges of managing the dynamically changing electric grid are presented.

Cognitive Task Analysis of the HALIFAX-Class Operations Room Officer

DTIC Science & Technology

1999-03-10

Image Cover Sheet CLASSIFICATION SYSTEM NUMBER 510918 UNCLASSIFIED llllllllllllllllllllllllllllllllllllllll TITLE COGNITIVE TASK ANALYSIS OF THE...DATES COVERED 00-00-1999 to 00-00-1999 4. TITLE AND SUBTITLE Cognitive Task Analysis of the HALIFAX-Class Operations Room Officer 5a. CONTRACT...Ontario . ~ -- . ’ c ... - Incorporated Cognitive Task Analysis of the HALIFAX-Class Operations Room Officer: PWGSC Contract No. W7711-7-7404/001/SV

[Cleanliness in the operating room].

PubMed

Suzuki, Toshiyasu

2010-05-01

With regard to recent findings in the cleanliness of the operating room, concerning handwashing and performing operations, the traditional method of excessive scrubbing using a brush is not effective, and handwashing using only an alcohol-containing antiseptic hand rub (rubbing method) has become common practice. Use of a brush has already been abolished in some medical institutions. In addition, sterilized water used for handwashing when performing operations has no scientific basis and use of tap water is considered sufficient. Furthermore, the concept of operating room zoning has also undergone a dramatic change. It was discovered that a layout focusing on work efficiency is more desirable than the one that follows an excessively rigid zoning pattern. One-footwear System not requiring change of shoes also has various advantages in improving the efficiency of the operation room, and this is thought to become commonplace in the future.

Operator Support System Design forthe Operation of RSG-GAS Research Reactor

NASA Astrophysics Data System (ADS)

Santoso, S.; Situmorang, J.; Bakhri, S.; Subekti, M.; Sunaryo, G. R.

2018-02-01

The components of RSG-GAS main control room are facing the problem of material ageing and technology obsolescence as well, and therefore the need for modernization and refurbishment are essential. The modernization in control room can be applied on the operator support system which bears the function in providing information for assisting the operator in conducting diagnosis and actions. The research purpose is to design an operator support system for RSG-GAS control room. The design was developed based on the operator requirement in conducting task operation scenarios and the reactor operation characteristics. These scenarios include power operation, low power operation and shutdown/scram reactor. The operator support system design is presented in a single computer display which contains structure and support system elements e.g. operation procedure, status of safety related components and operational requirements, operation limit condition of parameters, alarm information, and prognosis function. The prototype was developed using LabView software and consisted of components structure and features of the operator support system. Information of each component in the operator support system need to be completed before it can be applied and integrated in the RSG-GAS main control room.

Study of a dry room in a battery manufacturing plant using a process model

NASA Astrophysics Data System (ADS)

Ahmed, Shabbir; Nelson, Paul A.; Dees, Dennis W.

2016-09-01

The manufacture of lithium ion batteries requires some processing steps to be carried out in a dry room, where the moisture content should remain below 100 parts per million. The design and operation of such a dry room adds to the cost of the battery. This paper studied the humidity management of the air to and from the dry room to understand the impact of design and operating parameters on the energy demand and the cost contribution towards the battery manufacturing cost. The study was conducted with the help of a process model for a dry room with a volume of 16,000 cubic meters. For a defined base case scenario it was found that the dry room operation has an energy demand of approximately 400 kW. The paper explores some tradeoffs in design and operating parameters by looking at the humidity reduction by quenching the make-up air vs. at the desiccant wheel, and the impact of the heat recovery from the desiccant regeneration cycle.

Effect of time to operation on mortality for hypotensive patients with gunshot wounds to the torso: The golden 10 minutes.

PubMed

Meizoso, Jonathan P; Ray, Juliet J; Karcutskie, Charles A; Allen, Casey J; Zakrison, Tanya L; Pust, Gerd D; Koru-Sengul, Tulay; Ginzburg, Enrique; Pizano, Louis R; Schulman, Carl I; Livingstone, Alan S; Proctor, Kenneth G; Namias, Nicholas

2016-10-01

Timely hemorrhage control is paramount in trauma; however, a critical time interval from emergency department arrival to operation for hypotensive gunshot wound (GSW) victims is not established. We hypothesize that delaying surgery for more than 10 minutes from arrival increases all-cause mortality in hypotensive patients with GSW. Data of adults (n = 309) with hypotension and GSW to the torso requiring immediate operation from January 2004 to September 2013 were retrospectively reviewed. Patients with resuscitative thoracotomies, traumatic brain injury, transfer from outside institutions, and operations occurring more than 1 hour after arrival were excluded. Survival analysis using multivariate Cox regression models was used for comparison. Hazard ratios (HRs) and 95% confidence intervals (CIs) are reported. Statistical significance was considered at p ≤ 0.05. The study population was aged 32 ± 12 years, 92% were male, Injury Severity Score was 24 ± 15, systolic blood pressure was 81 ± 29 mm Hg, Glasgow Coma Scale score was 13 ± 4. Overall mortality was 27%. Mean time to operation was 19 ± 13 minutes. After controlling for organ injury, patients who arrived to the operating room after 10 minutes had a higher likelihood of mortality compared with those who arrived in 10 minutes or less (HR, 1.89; 95% CI, 1.10-3.26; p = 0.02); this was also true in the severely hypotensive patients with systolic blood pressure of 70 mm Hg or less (HR, 2.67; 95% CI, 0.97-7.34; p = 0.05). The time associated with a 50% cumulative mortality was 16 minutes. Delay to the operating room of more than 10 minutes increases the risk of mortality by almost threefold in hypotensive patients with GSW. Protocols should be designed to shorten time in the emergency department. Further prospective observational studies are required to validate these findings. Therapeutic study, level IV.

Endometrial cancer surgery costs: robot vs laparoscopy.

PubMed

Holtz, David O; Miroshnichenko, Gennady; Finnegan, Mark O; Chernick, Michael; Dunton, Charles J

2010-01-01

To compare surgical costs for endometrial cancer staging between robotic-assisted and traditional laparoscopic methods. Retrospective chart review from November 2005 to July 2006 (Canadian Task Force classification II-3). Non-university-affiliated teaching hospital. Thirty-three women with diagnosed endometrial cancer undergoing hysterectomy, bilateral salpingo-oophorectomy, and pelvic and paraaortic lymph node resection. Patients underwent either robotic or traditional laparoscopic surgery without randomization. Hospital cost data were obtained for operating room time, instrument use, and disposable items from hospital billing records and provided by the finance department. Separate overall hospital stay costs were also obtained. Mean operative costs were higher for robotic procedures ($3323 vs $2029; p<.001), due in part to longer operating room time ($1549 vs $1335; p=.03). The more significant cost difference was due to disposable instrumentation ($1755 vs $672; p<.001). Total hospital costs were also higher for robotic-assisted procedures ($5084 vs $ 3615; p=.002). Robotic surgery costs were significantly higher than traditional laparoscopy costs for staging of endometrial cancer in this small cohort of patients. Copyright (c) 2010 AAGL. Published by Elsevier Inc. All rights reserved.

Accident diagnosis system based on real-time decision tree expert system

NASA Astrophysics Data System (ADS)

Nicolau, Andressa dos S.; Augusto, João P. da S. C.; Schirru, Roberto

2017-06-01

Safety is one of the most studied topics when referring to power stations. For that reason, sensors and alarms develop an important role in environmental and human protection. When abnormal event happens, it triggers a chain of alarms that must be, somehow, checked by the control room operators. In this case, diagnosis support system can help operators to accurately identify the possible root-cause of the problem in short time. In this article, we present a computational model of a generic diagnose support system based on artificial intelligence, that was applied on the dataset of two real power stations: Angra1 Nuclear Power Plant and Santo Antônio Hydroelectric Plant. The proposed system processes all the information logged in the sequence of events before a shutdown signal using the expert's knowledge inputted into an expert system indicating the chain of events, from the shutdown signal to its root-cause. The results of both applications showed that the support system is a potential tool to help the control room operators identify abnormal events, as accidents and consequently increase the safety.

Surgical simulation in orthopaedic skills training.

PubMed

Atesok, Kivanc; Mabrey, Jay D; Jazrawi, Laith M; Egol, Kenneth A

2012-07-01

Mastering rapidly evolving orthopaedic surgical techniques requires a lengthy period of training. Current work-hour restrictions and cost pressures force trainees to face the challenge of acquiring more complex surgical skills in a shorter amount of time. As a result, alternative methods to improve the surgical skills of orthopaedic trainees outside the operating room have been developed. These methods include hands-on training in a laboratory setting using synthetic bones or cadaver models as well as software tools and computerized simulators that enable trainees to plan and simulate orthopaedic operations in a three-dimensional virtual environment. Laboratory-based training offers potential benefits in the development of basic surgical skills, such as using surgical tools and implants appropriately, achieving competency in procedures that have a steep learning curve, and assessing already acquired skills while minimizing concerns for patient safety, operating room time, and financial constraints. Current evidence supporting the educational advantages of surgical simulation in orthopaedic skills training is limited. Despite this, positive effects on the overall education of orthopaedic residents, and on maintaining the proficiency of practicing orthopaedic surgeons, are anticipated.

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

PubMed

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 < 0.0001). Role definition, task allocation and sequencing, combined with a visual cue for ease-of-use, create efficient, and sustainable approaches to decreasing robotic OR turnover times. Broader 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.

Plum Brook Reactor Facility Control Room during Facility Startup

NASA Image and Video Library

1961-02-21

Operators test the National Aeronautics and Space Administration’s (NASA) Plum Brook Reactor Facility systems in the months leading up to its actual operation. The “Reactor On” signs are illuminated but the reactor core was not yet ready for chain reactions. Just a couple weeks after this photograph, Plum Brook Station held a media open house to unveil the 60-megawatt test reactor near Sandusky, Ohio. More than 60 members of the print media and radio and television news services met at the site to talk with community leaders and representatives from NASA and Atomic Energy Commission. The Plum Brook reactor went critical for the first time on the evening of June 14, 1961. It was not until April 1963 that the reactor reached its full potential of 60 megawatts. The reactor control room, located on the second floor of the facility, was run by licensed operators. The operators manually operated the shim rods which adjusted the chain reaction in the reactor core. The regulating rods could partially or completely shut down the reactor. The control room also housed remote area monitoring panels and other monitoring equipment that allowed operators to monitor radiation sensors located throughout the facility and to scram the reactor instantly if necessary. The color of the indicator lights corresponded with the elevation of the detectors in the various buildings. The reactor could also shut itself down automatically if the monitors detected any sudden irregularities.

40 CFR 62.15105 - Who must complete the operator training course? By when?

Code of Federal Regulations, 2011 CFR

2011-07-01

... supervisors, and control room operators who have obtained full certification from the American Society of... supervisors, and control room operators who have obtained provisional certification from the American Society...

40 CFR 62.15105 - Who must complete the operator training course? By when?

Code of Federal Regulations, 2010 CFR

2010-07-01

... supervisors, and control room operators who have obtained full certification from the American Society of... supervisors, and control room operators who have obtained provisional certification from the American Society...

Evaluation of operating room suite efficiency in the Veterans Health Administration system by using data-envelopment analysis.

PubMed

Basson, Marc D; Butler, Timothy

2006-11-01

Operating room (OR) activity transcends single ratios such as cases/room, but weighting multiple inputs and outputs may be arbitrary. Data-envelopment analysis (DEA) is a novel technique by which each facility is analyzed by the weightings that optimize its score. We performed DEA analysis of 23 Veterans Health Administration annual OR activity; 87,180 cases were performed, 24 publications generated, and 560 trainee-years of education delivered, in 168 ORs over 166,377 hours by 1,384 full-time equivalents of surgical and anesthesia providers and 523 nonproviders. Varying analyzed parameters produced similar efficiency rankings, with individual differences suggesting possible inefficiencies. We characterized returns to scale for efficient sites, suggesting whether patient flow might be efficiently further increased through these sites. We matched inefficient sites to similar efficient sites for comparison and suggested resource alterations to increase efficiency. Broader DEA application might characterize OR efficiency more informatively than conventional single-ratio rank ordering.

Indoor air bacterial load and antibiotic susceptibility pattern of isolates in operating rooms and surgical wards at jimma university specialized hospital, southwest ethiopia.

PubMed

Genet, Chalachew; Kibru, Gebre; Tsegaye, Wondewosen

2011-03-01

Surgical site infection is the second most common health care associated infection. One of the risk factors for such infection is bacterial contamination of operating rooms' and surgical wards' indoor air. In view of that, the microbiological quality of air can be considered as a mirror of the hygienic condition of these rooms. Thus, the objective of this study was to determine the bacterial load and antibiotic susceptibility pattern of isolates in operating rooms' and surgical wards' indoor air of Jimma University Specialized Hospital. A cross sectional study was conducted to measure indoor air microbial quality of operating rooms and surgical wards from October to January 2009/2010 on 108 indoor air samples collected in twelve rounds using purposive sampling technique by Settle Plate Method (Passive Air Sampling following 1/1/1 Schedule). Sample processing and antimicrobial susceptibility testing were done following standard bacteriological techniques. The data was analyzed using SPSS version 16 and interpreted according to scientifically determined baseline values initially suggested by Fisher. The mean aerobic colony counts obtained in OR-1(46cfu/hr) and OR-2(28cfu/hr) was far beyond the set 5-8cfu/hr acceptable standards for passive room. Similarly the highest mean aerobic colony counts of 465cfu/hr and 461cfu/hr were observed in Female room-1 and room-2 respectively when compared to the acceptable range of 250-450cfu/hr. In this study only 3 isolates of S. pyogenes and 48 isolates of S. aureus were identified. Over 66% of S. aureus was identified in Critical Zone of Operating rooms. All isolates of S. aureus showed 100% and 82.8% resistance to methicillin and ampicillin respectively. Higher degree of aerobic bacterial load was measured from operating rooms' and surgical wards' indoor air. Reducing foot trafficking, improving the ventilation system and routine cleaning has to be made to maintain the aerobic bacteria load with in optimal level.

Prevention of 3 "never events" in the operating room: fires, gossypiboma, and wrong-site surgery.

PubMed

Zahiri, Hamid R; Stromberg, Jeffrey; Skupsky, Hadas; Knepp, Erin K; Folstein, Matthew; Silverman, Ronald; Singh, Devinder

2011-03-01

This study sought to identify and provide preventative recommendations for potentially devastating safety violations in the operating room. A Medline database search from 1950 to current using the terms patient safety and operating room was conducted. All topics identified were reviewed. Three patient safety violations with potential for immediate and devastating outcomes were selected for discussion using evidence-based literature. The search identified 2851 articles, 807 of which were directly related to patient safety in the operating room. Topics addressed by these 807 included infectious complications (26%), fires (11%), communication/teamwork (6%), retained foreign objects (3%), safety checklists (1%), and wrong-site surgery (1%). Fires, gossypiboma, and wrong-site surgery were selected for discussion. Although fire, gossypiboma, and wrong-site surgery should be "never events" in the operating room, they continue to persist as 3 common patient safety violations. This study provides the epidemiology, common etiologies, and evidence-based preventative recommendations for each.

Retrospective Chart Review of Skin-to-Skin Contact in the Operating Room and Administration of Analgesic and Anxiolytic Medication to Women After Cesarean Birth.

PubMed

Wagner, Debra L; Lawrence, Stephen; Xu, Jing; Melsom, Janice

2018-04-01

Transporting a newborn out of the operating room after cesarean birth can contribute to maternal awareness of discomfort, anxiety, and the need for administration of analgesics and anxiolytics for relief. This retrospective study analyzed the association between skin-to-skin contact in the operating room and administration of analgesics and anxiolytics to women in the operating and recovery rooms after cesarean birth. Our results indicated a trend toward decreased medication administration for women who experienced skin-to-skin contact and add to evidence supporting the incorporation of skin-to-skin contact in the operating room as the standard of care for cesarean birth. This practice has the potential to enhance the birth experience, promote breastfeeding, and provide greater safety with less exposure to opioids and benzodiazepines for women and their newborns. © 2018 AWHONN, the Association of Women’s Health, Obstetric and Neonatal Nurses.

How to implement information technology in the operating room and the intensive care unit.

PubMed

Meyfroidt, Geert

2009-03-01

The number of operating rooms and intensive care units looking for a data management system to perform their increasingly complex tasks is rising. Although at this time only a minority is computerized, within the next few years many centres will start implementing information technology. The transition towards a computerized system is a major venture, which will have a major impact on workflow. This chapter reviews the present literature. Published papers on this subject are predominantly single- or multi-centre implementation reports. The general principles that should guide such a process are described. For healthcare institutions or individual practitioners that plan to undertake this venture, the implementation process is described in a practical, nine-step overview.

Consultation sequencing of a hospital with multiple service points using genetic programming

NASA Astrophysics Data System (ADS)

Morikawa, Katsumi; Takahashi, Katsuhiko; Nagasawa, Keisuke

2018-07-01

A hospital with one consultation room operated by a physician and several examination rooms is investigated. Scheduled patients and walk-ins arrive at the hospital, each patient goes to the consultation room first, and some of them visit other service points before consulting the physician again. The objective function consists of the sum of three weighted average waiting times. The problem of sequencing patients for consultation is focused. To alleviate the stress of waiting, the consultation sequence is displayed. A dispatching rule is used to decide the sequence, and best rules are explored by genetic programming (GP). The simulation experiments indicate that the rules produced by GP can be reduced to simple permutations of queues, and the best permutation depends on the weight used in the objective function. This implies that a balanced allocation of waiting times can be achieved by ordering the priority among three queues.

The impact on revenue of increasing patient volume at surgical suites with relatively high operating room utilization.

PubMed

Dexter, F; Macario, A; Lubarsky, D A

2001-05-01

We previously studied hospitals in the United States of America that are losing money despite limiting the hours that operating room (OR) staff are available to care for patients undergoing elective surgery. These hospitals routinely keep utilization relatively high to maximize revenue. We tested, using discrete-event computer simulation, whether increasing patient volume while being reimbursed less for each additional patient can reliably achieve an increase in revenue when initial adjusted OR utilization is 90%. We found that increasing the volume of referred patients by the amount expected to fill the surgical suite (100%/90%) would increase utilization by <1% for a hospital surgical suite (with longer duration cases) and 4% for an ambulatory surgery suite (with short cases). The increase in patient volume would result in longer patient waiting times for surgery and more patients leaving the surgical queue. With a 15% reduction in payment for the new patients, the increase in volume may not increase revenue and can even decrease the contribution margin for the hospital surgical suite. The implication is that for hospitals with a relatively high OR utilization, signing discounted contracts to increase patient volume by the amount expected to "fill" the OR can have the net effect of decreasing the contribution margin (i.e., profitability). Hospitals may try to attract new surgical volume by offering discounted rates. For hospitals with a relatively high operating room utilization (e.g., 90%), computer simulations predict that increasing patient volume by the amount expected to "fill" the operating room can have the net effect of decreasing contribution margin (i.e., profitability).

Software Support during a Control Room Upgrade

DOE Office of Scientific and Technical Information (OSTI.GOV)

Michele Joyce; Michael Spata; Thomas Oren

2005-09-21

In 2004, after 14 years of accelerator operations and commissioning, Jefferson Lab renovated its main control room. Changes in technology and lessons learned during those 14 years drove the control room redesign in a new direction, one that optimizes workflow and makes critical information and controls available to everyone in the control room. Fundamental changes in a variety of software applications were required to facilitate the new operating paradigm. A critical component of the new control room design is a large-format video wall that is used to make a variety of operating information available to everyone in the room. Analogmore » devices such as oscilloscopes and function generators are now displayed on the video wall through two crosspoint switchers: one for analog signals and another for video signals. A new software GUI replaces manual configuration of the oscilloscopes and function generators and helps automate setup. Monitoring screens, customized for the video wall, now make important operating information visible to everyone, not just a single operator. New alarm handler software gives any operator, on any workstation, access to all alarm handler functionality, and multiple users can now contribute to a single electronic logbook entry. To further support the shift to distributed access and control, many applications have been redesigned to run on servers instead of on individual workstations.« less

Performance analysis of air conditioning system and airflow simulation in an operating theater

NASA Astrophysics Data System (ADS)

Alhamid, Muhammad Idrus; Budihardjo, Rahmat

2018-02-01

The importance of maintaining performance of a hospital operating theater is to establish an adequate circulation of clean air within the room. The parameter of air distribution in a space should be based on Air Changes per Hour (ACH) to maintain a positive room pressure. The dispersion of airborne particles in the operating theater was governed by regulating the air distribution so that the operating theater meets clean room standards ie ISO 14664 and ASHRAE 170. Here, we introduced several input parameters in a simulation environment to observe the pressure distribution in the room. Input parameters were air temperature, air velocity and volumetric flow rate entering and leaving room for existing and designed condition. In the existing operating theatre, several observations were found. It was found that the outlet air velocity at the HEPA filter above the operating table was too high thus causing a turbulent airflow pattern. Moreover, the setting temperature at 19°C was found to be too low. The supply of air into the room was observed at lower than 20 ACH which is under the standard requirement. Our simulation using FloVent 8.2™ program showed that not only airflow turbulence could be reduced but also the amount of particle contamination could also be minimized.

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

PubMed

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.

Buoyancy driven acceleration in a hospital operating room indoor environment

NASA Astrophysics Data System (ADS)

McNeill, James; Hertzberg, Jean; Zhai, John

2011-11-01

In hospital operating rooms, centrally located non-isothermal ceiling jets provide sterile air for protecting the surgical site from infectious particles in the room air as well as room cooling. Modern operating rooms are requiring larger temperature differences to accommodate increasing cooling loads for heat gains from medical equipment. This trend may lead to significant changes in the room air distribution patterns that may sacrifice the sterile air field across the surgical table. Quantitative flow visualization experiments using laser sheet illumination and RANS modeling of the indoor environment were conducted to demonstrate the impact of the indoor environment thermal conditions on the room air distribution. The angle of the jet shear layer was studied as function of the area of the vena contracta of the jet, which is in turn dependent upon the Archimedes number of the jet. Increases in the buoyancy forces cause greater air velocities in the vicinity of the surgical site increasing the likelihood of deposition of contaminants in the flow field. The outcome of this study shows the Archimedes number should be used as the design parameter for hospital operating room air distribution in order to maintain a proper supply air jet for covering the sterile region. This work is supported by ASHRAE.

The Attitudes and Behaviors of Anaesthesiology and Reanimation Specialists in Anaesthesia Care Applications Outside the Operating Room in Turkey: A Survey Study

PubMed Central

Yıldız, Mehmet; İyilikçi, Leyla; Duru, Seden; Hancı, Volkan

2014-01-01

Objective We aimed to investigate the attitudes and behaviors of anaesthesiologists in “non-operating room anaesthesia” applications, which can be described as anaesthesia applications performed outside the operating room, and their reflection on practice all over Turkey. Methods Our study was conducted between November 5, 2012 and January 7, 2013 with the approval of the Research Ethics Board. Survey data were obtained through distributing printed questionnaires to be completed either by hand or via the web. The questionnaire consisted of 38 questions. The data obtained were analyzed with the Statistical Package for Social Sciences (SPSS) program. Results A total of 500 anaesthesiologists replied to our survey; 93% of anaesthesia specialists reported that there was a request that the anaesthesia and anaesthesia outside the operating room was given in their institution. Among anaesthesiologists, 56% reported that there were other sections that can provide sedation other than the anaesthesiology department in their institutions. Anaesthesia care team members; equipment; anaesthetic techniques; monitoring methods; and hypnotic, analgesic, and antagonist agents had statistically significant differences according to the participants’ institutions. Equipment used in the anaesthesia practice outside the operating room, anaesthesia, and monitoring methods had statistically significant differences according to geographical distribution (p<0.05). Conclusion Outside the operating room, anaesthesia practices and security measures are compliant with the standards set by the guidelines, the key to the prevention of complications. In our study, the current status of anaesthetic procedures outside the operating room in our country have been analyzed. PMID:27366420

Real-time measurements of airborne biologic particles using fluorescent particle counter to evaluate microbial contamination: results of a comparative study in an operating theater.

PubMed

Dai, Chunyang; Zhang, Yan; Ma, Xiaoling; Yin, Meiling; Zheng, Haiyang; Gu, Xuejun; Xie, Shaoqing; Jia, Hengmin; Zhang, Liang; Zhang, Weijun

2015-01-01

Airborne bacterial contamination poses a risk for surgical site infection, and routine surveillance of airborne bacteria is important. Traditional methods for detecting airborne bacteria are time consuming and strenuous. Measurement of biologic particle concentrations using a fluorescent particle counter is a novel method for evaluating air quality. The current study was to determine whether the number of biologic particles detected by the fluorescent particle counter can be used to indicate airborne bacterial counts in operating rooms. The study was performed in an operating theater at a university hospital in Hefei, China. The number of airborne biologic particles every minute was quantified using a fluorescent particle counter. Microbiologic air sampling was performed every 30 minutes using an Andersen air sampler (Pusong Electronic Instruments, Changzhou, China). Correlations between the 2 different methods were analyzed by Pearson correlation coefficients. A significant correlation was observed between biologic particle and bacterial counts (Pearson correlation coefficient = 0.76), and the counting results from 2 methods both increased substantially between operations, corresponding with human movements in the operating room. Fluorescent particle counters show potential as important tools for monitoring bacterial contamination in operating theatres. Copyright © 2015 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

9 CFR 355.15 - Inedible material operating and storage rooms; outer premises, docks, driveways, etc.; fly...

Code of Federal Regulations, 2012 CFR

2012-01-01

... storage rooms; outer premises, docks, driveways, etc.; fly-breeding material; nuisances. 355.15 Section....15 Inedible material operating and storage rooms; outer premises, docks, driveways, etc.; fly... departments where certified products are prepared, handled, or stored. Docks and areas where cars and vehicles...

9 CFR 355.15 - Inedible material operating and storage rooms; outer premises, docks, driveways, etc.; fly...

Code of Federal Regulations, 2014 CFR

2014-01-01

... storage rooms; outer premises, docks, driveways, etc.; fly-breeding material; nuisances. 355.15 Section....15 Inedible material operating and storage rooms; outer premises, docks, driveways, etc.; fly... departments where certified products are prepared, handled, or stored. Docks and areas where cars and vehicles...

9 CFR 355.15 - Inedible material operating and storage rooms; outer premises, docks, driveways, etc.; fly...

Code of Federal Regulations, 2013 CFR

2013-01-01

... storage rooms; outer premises, docks, driveways, etc.; fly-breeding material; nuisances. 355.15 Section....15 Inedible material operating and storage rooms; outer premises, docks, driveways, etc.; fly... departments where certified products are prepared, handled, or stored. Docks and areas where cars and vehicles...

Magnetocardiography measurements with 4He vector optically pumped magnetometers at room temperature

NASA Astrophysics Data System (ADS)

Morales, S.; Corsi, M. C.; Fourcault, W.; Bertrand, F.; Cauffet, G.; Gobbo, C.; Alcouffe, F.; Lenouvel, F.; Le Prado, M.; Berger, F.; Vanzetto, G.; Labyt, E.

2017-09-01

In this paper, we present a proof of concept study which demonstrates for the first time the possibility of recording magnetocardiography (MCG) signals with 4He vector optically pumped magnetometers (OPM) operated in a gradiometer mode. Resulting from a compromise between sensitivity, size and operability in a clinical environment, the developed magnetometers are based on the parametric resonance of helium in a zero magnetic field. Sensors are operated at room temperature and provide a tri-axis vector measurement of the magnetic field. Measured sensitivity is around 210 f T (√Hz)-1 in the bandwidth (2 Hz; 300 Hz). MCG signals from a phantom and two healthy subjects are successfully recorded. Human MCG data obtained with the OPMs are compared to reference electrocardiogram recordings: similar heart rates, shapes of the main patterns of the cardiac cycle (P/T waves, QRS complex) and QRS widths are obtained with both techniques.

Transtracheal single-point stent fixation in posttracheotomy tracheomalacia under cone-beam computer tomography guidance by transmural suturing with the Berci needle – a perspective on a new tool to avoid stent migration of Dumon stents

PubMed Central

Hohenforst-Schmidt, Wolfgang; Linsmeier, Bernd; Zarogoulidis, Paul; Freitag, Lutz; Darwiche, Kaid; Browning, Robert; Turner, J Francis; Huang, Haidong; Li, Qiang; Vogl, Thomas; Zarogoulidis, Konstantinos; Brachmann, Johannes; Rittger, Harald

2015-01-01

Tracheomalacia or tracheobronchomalacia (TM or TBM) is a common problem especially for elderly patients often unfit for surgical techniques. Several surgical or minimally invasive techniques have already been described. Stenting is one option but in general long-time stenting is accompanied by a high complication rate. Stent removal is more difficult in case of self-expandable nitinol stents or metallic stents in general in comparison to silicone stents. The main disadvantage of silicone stents in comparison to uncovered metallic stents is migration and plugging. We compared the operation time and in particular the duration of a sufficient Dumon stent fixation with different techniques in a patient with severe posttracheotomy TM and strongly reduced mobility of the vocal cords due to Parkinson’s disease. The combined approach with simultaneous Dumon stenting and endoluminal transtracheal externalized suture under cone-beam computer tomography guidance with the Berci needle was by far the fastest approach compared to a (not performed) surgical intervention, or even purely endoluminal suturing through the rigid bronchoscope. The duration of the endoluminal transtracheal externalized suture was between 5 minutes and 9 minutes with the Berci needle; the pure endoluminal approach needed 51 minutes. The alternative of tracheobronchoplasty was refused by the patient. In general, 180 minutes for this surgical approach is calculated. The costs of the different approaches are supposed to vary widely due to the fact that in Germany 1 minute in an operation room costs on average approximately 50–60€ inclusive of taxes. In our own hospital (tertiary level), it is nearly 30€ per minute in an operation room for a surgical approach. Calculating an additional 15 minutes for patient preparation and transfer to wake-up room, therefore a total duration inside the investigation room of 30 minutes, the cost per flexible bronchoscopy is per minute on average less than 6€. Although the Dumon stenting requires a set-up with more expensive anesthesiology accompaniment, which takes longer than a flexible investigation estimated at 1 hour in an operation room, still without calculation of the costs of the materials and specialized staff that the surgical approach would consume at least 3,000€ more than a minimally invasive approach performed with the Berci needle. This difference is due to the longer time of the surgical intervention which is calculated at approximately 180 minutes in comparison to the achieved non-surgical approach of 60 minutes in the operation suite. PMID:26045666

[Evaluation of Radiation Dose during Stent-graft Treatment Using a Hybrid Operating Room System].

PubMed

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.

The Doctrinal Basis for Medical Stability Operations

DTIC Science & Technology

2010-01-01

lead actor, preferably a HN agency, but sometimes the military must take the lead in medical stability operations when overwhelming violence prevents...34 Assessment Tasks Administration of hospital Communications Obstetrics , Pediatrics, Emergency room. Operating room Nursing procedures Medical supply

Estimation of Blood Loss: Comparing the Accuracy of Operating Room Personnel

DTIC Science & Technology

1991-02-01

Operating Room Services to reserve an unutilized room for the day of the experiment . The experimental period was on June 14, 1990, from 8:30 AM to 12:00...moderate loss he may experience a decrease in pulse pressure, tachycardia, tachypnea, and postural hypotension. A major blood loss may constitute...during the procedure. In discussing his experience with 3,000 transfusions, Blain (1929) emphasized that the amount of blood lost during operations

Wide bandgap BaSnO3 films with room temperature conductivity exceeding 104 S cm−1

PubMed Central

Prakash, Abhinav; Xu, Peng; Faghaninia, Alireza; Shukla, Sudhanshu; Ager, Joel W.; Lo, Cynthia S.; Jalan, Bharat

2017-01-01

Wide bandgap perovskite oxides with high room temperature conductivities and structural compatibility with a diverse family of organic/inorganic perovskite materials are of significant interest as transparent conductors and as active components in power electronics. Such materials must also possess high room temperature mobility to minimize power consumption and to enable high-frequency applications. Here, we report n-type BaSnO3 films grown using hybrid molecular beam epitaxy with room temperature conductivity exceeding 104 S cm−1. Significantly, these films show room temperature mobilities up to 120 cm2 V−1 s−1 even at carrier concentrations above 3 × 1020 cm−3 together with a wide bandgap (3 eV). We examine the mobility-limiting scattering mechanisms by calculating temperature-dependent mobility, and Seebeck coefficient using the Boltzmann transport framework and ab-initio calculations. These results place perovskite oxide semiconductors for the first time on par with the highly successful III–N system, thereby bringing all-transparent, high-power oxide electronics operating at room temperature a step closer to reality. PMID:28474675

Proposal for a room-temperature diamond maser

PubMed Central

Jin, Liang; Pfender, Matthias; Aslam, Nabeel; Neumann, Philipp; Yang, Sen; Wrachtrup, Jörg; Liu, Ren-Bao

2015-01-01

The application of masers is limited by its demanding working conditions (high vacuum or low temperature). A room-temperature solid-state maser is highly desirable, but the lifetimes of emitters (electron spins) in solids at room temperature are usually too short (∼ns) for population inversion. Masing from pentacene spins in p-terphenyl crystals, which have a long spin lifetime (∼0.1 ms), has been demonstrated. This maser, however, operates only in the pulsed mode. Here we propose a room-temperature maser based on nitrogen-vacancy centres in diamond, which features the longest known solid-state spin lifetime (∼5 ms) at room temperature, high optical pumping efficiency (∼106 s−1) and material stability. Our numerical simulation demonstrates that a maser with a coherence time of approximately minutes is feasible under readily accessible conditions (cavity Q-factor ∼5 × 104, diamond size ∼3 × 3 × 0.5 mm3 and pump power <10 W). A room-temperature diamond maser may facilitate a broad range of microwave technologies. PMID:26394758

Wide bandgap BaSnO 3 films with room temperature conductivity exceeding 10 4 S cm -1

DOE PAGES

Prakash, Abhinav; Xu, Peng; Faghaninia, Alireza; ...

2017-05-05

Wide bandgap perovskite oxides with high room temperature conductivities and structural compatibility with a diverse family of organic/inorganic perovskite materials are of sign ificant interest as transparent conductors and as active components in power electronics. Such materials must also possess high room temperature mobility to minimize power consumption and to enable high-frequency applications. Here, we report n-type BaSnO 3 films grown using hybrid molecular beam epitaxy with room temperature conductivity exceeding 10 4 S cm -1 . Significantly, these films show room temperature mobilities up to 120 cm 2 V -1 s -1 even at carrier concentrations abovemore » 3 × 10 20 cm -3 together with a wide bandgap (3 eV). We examine the mobility-limiting scattering mechanisms by calculating temperature-dependent mobility, and Seebeck coefficient using the Boltzmann transport framework and ab-initio calculations. These results place perovskite oxide semiconductors for the first time on par with the highly successful III-N system, thereby bringing all-transparent, high-power oxide electronics operating at room temperature a step closer to reality.« less

Open for business: private networks create a marketplace for health information exchange.

PubMed

Dimick, Chris

2012-05-01

Large health systems and their IT vendors are creating private information exchange networks at a time when federally funded state operations are gearing up for launch, Is there room for private and public offerings in the new HIE marketplace?

Anesthesiology Teaching of Medical Students: A Changing Curriculum for Changing Times

ERIC Educational Resources Information Center

Ravin, Mark B.; Modell, Jerome H.

1975-01-01

A course in Life Support Systems that has been adapted to increased class size is described. The curriculum includes lectures, seminars, laboratory demonstrations and operating room and intensive care rounds to introduce the student to life support concepts. (Author/PG)

C-arm positioning using virtual fluoroscopy for image-guided surgery

NASA Astrophysics Data System (ADS)

de Silva, T.; Punnoose, J.; Uneri, A.; Goerres, J.; Jacobson, M.; Ketcha, M. D.; Manbachi, A.; Vogt, S.; Kleinszig, G.; Khanna, A. J.; Wolinsky, J.-P.; Osgood, G.; Siewerdsen, J. H.

2017-03-01

Introduction: Fluoroscopically guided procedures often involve repeated acquisitions for C-arm positioning at the cost of radiation exposure and time in the operating room. A virtual fluoroscopy system is reported with the potential of reducing dose and time spent in C-arm positioning, utilizing three key advances: robust 3D-2D registration to a preoperative CT; real-time forward projection on GPU; and a motorized mobile C-arm with encoder feedback on C-arm orientation. Method: Geometric calibration of the C-arm was performed offline in two rotational directions (orbit α, orbit β). Patient registration was performed using image-based 3D-2D registration with an initially acquired radiograph of the patient. This approach for patient registration eliminated the requirement for external tracking devices inside the operating room, allowing virtual fluoroscopy using commonly available systems in fluoroscopically guided procedures within standard surgical workflow. Geometric accuracy was evaluated in terms of projection distance error (PDE) in anatomical fiducials. A pilot study was conducted to evaluate the utility of virtual fluoroscopy to aid C-arm positioning in image guided surgery, assessing potential improvements in time, dose, and agreement between the virtual and desired view. Results: The overall geometric accuracy of DRRs in comparison to the actual radiographs at various C-arm positions was PDE (mean ± std) = 1.6 ± 1.1 mm. The conventional approach required on average 8.0 ± 4.5 radiographs spent "fluoro hunting" to obtain the desired view. Positioning accuracy improved from 2.6o ± 2.3o (in α) and 4.1o ± 5.1o (in β) in the conventional approach to 1.5o ± 1.3o and 1.8o ± 1.7o, respectively, with the virtual fluoroscopy approach. Conclusion: Virtual fluoroscopy could improve accuracy of C-arm positioning and save time and radiation dose in the operating room. Such a system could be valuable to training of fluoroscopy technicians as well as intraoperative use in fluoroscopically guided procedures.

9 CFR 355.15 - Inedible material operating and storage rooms; outer premises, docks, driveways, etc.; fly...

Code of Federal Regulations, 2010 CFR

2010-01-01

...-breeding material; nuisances. All operating and storage rooms and departments of inspected plants used for... storage rooms; outer premises, docks, driveways, etc.; fly-breeding material; nuisances. 355.15 Section... premises of every inspected plant shall be kept in clean and orderly condition. All catchbasins on the...

9 CFR 355.15 - Inedible material operating and storage rooms; outer premises, docks, driveways, etc.; fly...

Code of Federal Regulations, 2011 CFR

2011-01-01

...-breeding material; nuisances. All operating and storage rooms and departments of inspected plants used for... storage rooms; outer premises, docks, driveways, etc.; fly-breeding material; nuisances. 355.15 Section... premises of every inspected plant shall be kept in clean and orderly condition. All catchbasins on the...

Study of a dry room in a battery manufacturing plant using a process model

DOE Office of Scientific and Technical Information (OSTI.GOV)

Ahmed, Shabbir; Nelson, Paul A.; Dees, Dennis W.

The manufacture of lithium ion batteries requires some processing steps to be carried out in a dry room, where the moisture content should remain below 100 parts per million. The design and operation of such a dry room adds to the cost of the battery. This paper studies the humidity management of the air to and from the dry room to understand the impact of design and operating parameters on the energy demand and the cost contribution towards the battery manufacturing cost. The study is conducted with the help of a process model for a dry room with a volumemore » of 16000 cubic meters. For a defined base case scenario it is found that the dry room operation has an energy demand of approximately 400 kW. The paper explores some tradeoffs in design and operating parameters by looking at the humidity reduction by quenching the make-up air vs. at the desiccant wheel, and the impact of the heat recovery from the desiccant regeneration cycle.« less

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

PubMed

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.

Use of Recirculating Ventilation with Dust Filtration to Improve Wintertime Air Quality in a Swine Farrowing Room

PubMed Central

Anthony, T. Renée; Altmaier, Ralph; Jones, Samuel; Gassman, Rich; Park, Jae Hong; Peters, Thomas M.

2016-01-01

The performance of a recirculating ventilation system with dust filtration was evaluated to determine its effectiveness to improve the air quality in a swine farrowing room of a concentrated animal feeding operation (CAFO). Air was exhausted from the room (0.47 m3sec−1; 1000 cfm), treated with a filtration unit (Shaker-Dust Collector), and returned to the farrowing room to reduce dust concentrations while retaining heat necessary for livestock health. The air quality in the room was assessed over a winter, during which time limited fresh air is traditionally brought into the building. Over the study period, dust concentrations ranged from 0.005 to 0.31 mg m−3 (respirable) and 0.17 to 2.09 mg m−3 (inhalable). In-room dust concentrations were reduced (41% for respirable and 33% for inhalable) with the system in operation, while gas concentrations (ammonia [NH3], hydrogen sulfide [H2S], carbon monoxide [CO], carbon dioxide [CO2]) were unchanged. The position of the exhaust and return air systems provided reasonably uniform contaminant distributions, although the respirable dust concentrations nearest one of the exhaust ducts was statistically higher than other locations in the room, with differences averaging only 0.05 mg m−3. Throughout the study, CO2 concentrations consistently exceeded 1540 ppm (industry recommendations) and on eight of the 18 study days it exceeded 2500 ppm (50% of the ACGIH TLV), with significantly higher concentrations near a door to a temperature-controlled hallway that was typically often left open. Alternative heaters are recommended to reduce CO2 concentrations in the room. Contaminant concentrations were modeled using production and environmental factors, with NH3 related to the number of sow in the room and outdoor temperatures and CO2 related to the number of piglets and outdoor temperatures. The recirculating ventilation system provided dust reduction without increasing concentrations of hazardous gases. PMID:25950713

The Impact of Different Postgraduate Year Training in Neurosurgery Residency on 30-Day Return to Operating Room: A National Surgical Quality Improvement Program Study.

PubMed

Macki, Mohamed; Fakih, Mohamed; Kandagatla, Pridvi; Rubinfeld, Ilan; Chang, Victor

2018-06-01

Because of the health care initiative on quality improvement projects in academic medicine, this study explores the impact of different postgraduate years (PGYs) on unexpected re-operation rates. Using the National Surgical Quality Improvement Program 2005-2014, adult neurosurgical cases were divided into subspecialties: spine, open vascular, cranial, and functional. Comparison groups were cases involving junior residents (PGY 1-PGY 3), mid-level residents (PGY 4 + PGY 5), and senior residents (PGY 6 + PGY 7). Comorbidity disease burden was measured by frailty index. The primary outcome measure was 30-day unintended return to the operating room. Of the 9782 cases, re-operations were higher for those cases featuring a senior resident (5.6%) compared with mid-level resident (4.1%) and junior resident (3.8%) (P = 0.001). Although senior residents operated on patients with a statistically significantly higher neurologic disease burden, greater relative value units, longer operative times, and more 30-day postoperative adverse events, the level of resident training did not have an impact on revision surgery after multivariable logistical regression. The strongest predictors of return to the operating room included the frailty index (adjusted odds ratio [OR adj ] = 5.18, P < 0.001), functional subspecialty (OR adj  = 2.65, P < 0.001), and Wound Class 4 - dirty/infected wound (OR adj  = 2.33, P = 0.016). Resident participation in neurosurgical cases does not affect 30-day unplanned re-operation rates, which were affected by frailty index, functional subspecialty, and wound class. Copyright © 2018 Elsevier Inc. All rights reserved.

PT-SAFE: a software tool for development and annunciation of medical audible alarms.

PubMed

Bennett, Christopher L; McNeer, Richard R

2012-03-01

Recent reports by The Joint Commission as well as the Anesthesia Patient Safety Foundation have indicated that medical audible alarm effectiveness needs to be improved. Several recent studies have explored various approaches to improving the audible alarms, motivating the authors to develop real-time software capable of comparing such alarms. We sought to devise software that would allow for the development of a variety of audible alarm designs that could also integrate into existing operating room equipment configurations. The software is meant to be used as a tool for alarm researchers to quickly evaluate novel alarm designs. A software tool was developed for the purpose of creating and annunciating audible alarms. The alarms consisted of annunciators that were mapped to vital sign data received from a patient monitor. An object-oriented approach to software design was used to create a tool that is flexible and modular at run-time, can annunciate wave-files from disk, and can be programmed with MATLAB by the user to create custom alarm algorithms. The software was tested in a simulated operating room to measure technical performance and to validate the time-to-annunciation against existing equipment alarms. The software tool showed efficacy in a simulated operating room environment by providing alarm annunciation in response to physiologic and ventilator signals generated by a human patient simulator, on average 6.2 seconds faster than existing equipment alarms. Performance analysis showed that the software was capable of supporting up to 15 audible alarms on a mid-grade laptop computer before audio dropouts occurred. These results suggest that this software tool provides a foundation for rapidly staging multiple audible alarm sets from the laboratory to a simulation environment for the purpose of evaluating novel alarm designs, thus producing valuable findings for medical audible alarm standardization.

Evaluation of the disruptive behaviors among treatment teams and its reflection on the therapy process of patients in the operating room: The impact of personal conflicts

PubMed Central

Maddineshat, Maryam; Hashemi, Mitra; Tabatabaeichehr, Mahbubeh

2017-01-01

INTRODUCTION: Understanding the development and distribution of disruptive behaviour among members of a health-care team is critical to the safety and quality of patient care in high-risk environments such as operating rooms. The present study identified disruptive behaviour and its effect on the treatment of patients in the operating room environment. SUBJECTS AND METHODS: This cross-sectional study used the convenience sampling method to select 144 operating room physicians and nurses (91 women and 53 men). The study was conducted in the operating rooms of four academic hospitals with different specialties in North Khorasan province in Iran from December 2013 to September 2014. The data were collected using a translated, modified, and validated questionnaire to investigate the prevalence and consequences of disruptive behaviour, the response of the health care system to the behaviour, factors affecting the creation of conflict and the spread of disruptive behaviour. Statistical analysis of the data was performed using SPSS 18. RESULTS: Disruptive behaviour was reported by 82.95% physicians and nurses. On average, 39% of physicians and 21% of operating room nurses exhibited disruptive behaviour. Disruptive behaviour is associated with psychological and clinical consequences. Factors such as fear of retaliation (8%), lack of change (43.8%), lack of security (18.1%) and attitude of the organization (14.6%) are significant reasons for the failure to report these behaviours. CONCLUSIONS: The findings suggest that disruptive behaviour occurs and affects treatment and workflow of treatment teams in the operating room. Interpersonal conflict contributes to the growth of such behaviour; thus, more research should focus on this subject in the future. PMID:28852659

Evaluation of the disruptive behaviors among treatment teams and its reflection on the therapy process of patients in the operating room: The impact of personal conflicts.

PubMed

Maddineshat, Maryam; Hashemi, Mitra; Tabatabaeichehr, Mahbubeh

2017-01-01

Understanding the development and distribution of disruptive behaviour among members of a health-care team is critical to the safety and quality of patient care in high-risk environments such as operating rooms. The present study identified disruptive behaviour and its effect on the treatment of patients in the operating room environment. This cross-sectional study used the convenience sampling method to select 144 operating room physicians and nurses (91 women and 53 men). The study was conducted in the operating rooms of four academic hospitals with different specialties in North Khorasan province in Iran from December 2013 to September 2014. The data were collected using a translated, modified, and validated questionnaire to investigate the prevalence and consequences of disruptive behaviour, the response of the health care system to the behaviour, factors affecting the creation of conflict and the spread of disruptive behaviour. Statistical analysis of the data was performed using SPSS 18. Disruptive behaviour was reported by 82.95% physicians and nurses. On average, 39% of physicians and 21% of operating room nurses exhibited disruptive behaviour. Disruptive behaviour is associated with psychological and clinical consequences. Factors such as fear of retaliation (8%), lack of change (43.8%), lack of security (18.1%) and attitude of the organization (14.6%) are significant reasons for the failure to report these behaviours. The findings suggest that disruptive behaviour occurs and affects treatment and workflow of treatment teams in the operating room. Interpersonal conflict contributes to the growth of such behaviour; thus, more research should focus on this subject in the future.

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

NASA Technical Reports Server (NTRS)

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.

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

PubMed

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

2017-12-01

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

The Effects of Scavenging on Waste Methoxyflurane Concentrations in Veterinary Operating Room Air

DTIC Science & Technology

1981-01-01

Afl-AO5 572 AIR FORCE OCCUPATIONAL AND ENVIRONMENTAL H4EALTH LAS -ETC F/S 6120 TIE EFFECTS OF SCAVENGING ON WASTE METHOXYFLURANE CONCENTRATIOH-ETC...REPRINT The Effects of Scavenging on Waste Methoxyflurane Concentrations in Veterinary Operating Room Air Approved for public release; distribution...Waste Methoxyflurane Fnal y t Concentrations ir Veterinary Operating Room Air, 6.PROMN _6._PERFORMIN oIG. REPORT NUMBER 7. AUTOR~s)B. CONTRACT OR GRANT

Computer-Aided Surgical Simulation in Head and Neck Reconstruction: A Cost Comparison among Traditional, In-House, and Commercial Options.

PubMed

Li, Sean S; Copeland-Halperin, Libby R; Kaminsky, Alexander J; Li, Jihui; Lodhi, Fahad K; Miraliakbari, Reza

2018-06-01

 Computer-aided surgical simulation (CASS) has redefined surgery, improved precision and reduced the reliance on intraoperative trial-and-error manipulations. CASS is provided by third-party services; however, it may be cost-effective for some hospitals to develop in-house programs. This study provides the first cost analysis comparison among traditional (no CASS), commercial CASS, and in-house CASS for head and neck reconstruction.  The costs of three-dimensional (3D) pre-operative planning for mandibular and maxillary reconstructions were obtained from an in-house CASS program at our large tertiary care hospital in Northern Virginia, as well as a commercial provider (Synthes, Paoli, PA). A cost comparison was performed among these modalities and extrapolated in-house CASS costs were derived. The calculations were based on estimated CASS use with cost structures similar to our institution and sunk costs were amortized over 10 years.  Average operating room time was estimated at 10 hours, with an average of 2 hours saved with CASS. The hourly cost to the hospital for the operating room (including anesthesia and other ancillary costs) was estimated at $4,614/hour. Per case, traditional cases were $46,140, commercial CASS cases were $40,951, and in-house CASS cases were $38,212. Annual in-house CASS costs were $39,590.  CASS reduced operating room time, likely due to improved efficiency and accuracy. Our data demonstrate that hospitals with similar cost structure as ours, performing greater than 27 cases of 3D head and neck reconstructions per year can see a financial benefit from developing an in-house CASS program. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

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

PubMed

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.

Are we fully utilizing the functionalities of modern operating room ventilators?

PubMed

Liu, Shujie; Kacmarek, Robert M; Oto, Jun

2017-12-01

The modern operating room ventilators have become very sophisticated and many of their features are comparable with those of an ICU ventilator. To fully utilize the functionality of modern operating room ventilators, it is important for clinicians to understand in depth the working principle of these ventilators and their functionalities. Piston ventilators have the advantages of delivering accurate tidal volume and certain flow compensation functions. Turbine ventilators have great ability of flow compensation. Ventilation modes are mainly volume-based or pressure-based. Pressure-based ventilation modes provide better leak compensation than volume-based. The integration of advanced flow generation systems and ventilation modes of the modern operating room ventilators enables clinicians to provide both invasive and noninvasive ventilation in perioperative settings. Ventilator waveforms can be used for intraoperative neuromonitoring during cervical spine surgery. The increase in number of new features of modern operating room ventilators clearly creates the opportunity for clinicians to optimize ventilatory care. However, improving the quality of ventilator care relies on a complete understanding and correct use of these new features. VIDEO ABSTRACT: http://links.lww.com/COAN/A47.

Integrating medical devices in the operating room using service-oriented architectures.

PubMed

Ibach, Bastian; Benzko, Julia; Schlichting, Stefan; Zimolong, Andreas; Radermacher, Klaus

2012-08-01

Abstract With the increasing documentation requirements and communication capabilities of medical devices in the operating room, the integration and modular networking of these devices have become more and more important. Commercial integrated operating room systems are mainly proprietary developments using usually proprietary communication standards and interfaces, which reduce the possibility of integrating devices from different vendors. To overcome these limitations, there is a need for an open standardized architecture that is based on standard protocols and interfaces enabling the integration of devices from different vendors based on heterogeneous software and hardware components. Starting with an analysis of the requirements for device integration in the operating room and the techniques used for integrating devices in other industrial domains, a new concept for an integration architecture for the operating room based on the paradigm of a service-oriented architecture is developed. Standardized communication protocols and interface descriptions are used. As risk management is an important factor in the field of medical engineering, a risk analysis of the developed concept has been carried out and the first prototypes have been implemented.

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

PubMed Central

Bennett, Christopher L.; Horn, Danielle Bodzin; Dudaryk, Roman

2017-01-01

INTRODUCTION: 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. METHODS: 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. RESULTS: 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 m3 (average VR = 131.1 [34.2] m3). 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 (R2 = 0.666, F(2, 37) = 39.9, P < .0001). For Dmax (maximum distance where there is <15% loss of consonant articulation), both VR and VC β coefficients were significant. For RT60 and Dmax, after controlling for VC, partial correlations were 0.825 (P < .0001) and 0.718 (P < .0001), respectively, while after controlling for VR, partial correlations were −0.322 (P = .169) and 0.381 (P < .05), respectively. CONCLUSIONS: Our results suggest that 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 correlated with improved speech intelligibility. This study provides valuable descriptive data and a predictive method for identifying existing ORs that may benefit from acoustic modifiers (eg, sound absorption panels). Additionally, it suggests that room dimensions and projected clinical use should be considered during the design phase of OR suites to optimize acoustic performance. PMID:28525511

An expert system for benzole recovery plant

DOE Office of Scientific and Technical Information (OSTI.GOV)

Ishiguro, H.; Matsumura, S.; Kawashima, A.

1993-01-01

In the By-Product Plant of NKK's Keihin Works, systematization efforts were made in 1988, including integration of the control rooms, introduction of computers and installation of automatic analyzers. This has however increased the burden on operators with a huge volume of data, and a delay in coping with an operational abnormality might expand risk and extent of damages. There is, on the other hand, a pressing need to take measures to accommodate sophisticated operations resulting from the pursuit of high productivity operation. For the purpose of avoiding these possible inconveniences, development of a real-time operation system has been tried inmore » an attempt to improve safety and operating techniques and productivity in the benzole recovery plant. An offline system based on manual entry of operating data for diagnosis of operation and abnormality was developed in 1990, and an online real-time system operating by incorporating real-time operating data was developed in 1991, which is now smoothly operating in commercial operations. This report presents an outline of the benzole recovery operation diagnosis control expert system.« less

The impact of service-specific staffing, case scheduling, turnovers, and first-case starts on anesthesia group and operating room productivity: a tutorial using data from an Australian hospital.

PubMed

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

2006-12-01

In this tutorial, we consider the impact of operating room (OR) management on anesthesia group and OR labor productivity and costs. Most of the tutorial focuses on the steps required for each facility to refine its OR allocations using its own data collected during patient care. Data from a hospital in Australia are used throughout to illustrate the methods. OR allocation is a two-stage process. During the initial tactical stage of allocating OR time, OR capacity ("block time") is adjusted. For operational decision-making on a shorter-term basis, the existing workload can be considered fixed. Staffing is matched to that workload based on maximizing the efficiency of use of OR time. Scheduling cases and making decisions on the day of surgery to increase OR efficiency are worthwhile interventions to increase anesthesia group productivity. However, by far, the most important step is the appropriate refinement of OR allocations (i.e., planning service-specific staffing) 2-3 mo before the day of surgery. Reducing surgical and/or turnover times and delays in first-case-of-the-day starts generally provides small reductions in OR labor costs. Results vary widely because they are highly sensitive both to the OR allocations (i.e., staffing) and to the appropriateness of those OR allocations.

Time-driven activity-based costing to identify opportunities for cost reduction in pediatric appendectomy.

PubMed

Yu, Yangyang R; Abbas, Paulette I; Smith, Carolyn M; Carberry, Kathleen E; Ren, Hui; Patel, Binita; Nuchtern, Jed G; Lopez, Monica E

2016-12-01

As reimbursement programs shift to value-based payment models emphasizing quality and efficient healthcare delivery, there exists a need to better understand process management to unearth true costs of patient care. We sought to identify cost-reduction opportunities in simple appendicitis management by applying a time-driven activity-based costing (TDABC) methodology to this high-volume surgical condition. Process maps were created using medical record time stamps. Labor capacity cost rates were calculated using national median physician salaries, weighted nurse-patient ratios, and hospital cost data. Consumable costs for supplies, pharmacy, laboratory, and food were derived from the hospital general ledger. Time-driven activity-based costing resulted in precise per-minute calculation of personnel costs. Highest costs were in the operating room ($747.07), hospital floor ($388.20), and emergency department ($296.21). Major contributors to length of stay were emergency department evaluation (270min), operating room availability (395min), and post-operative monitoring (1128min). The TDABC model led to $1712.16 in personnel costs and $1041.23 in consumable costs for a total appendicitis cost of $2753.39. Inefficiencies in healthcare delivery can be identified through TDABC. Triage-based standing delegation orders, advanced practice providers, and same day discharge protocols are proposed cost-reducing interventions to optimize value-based care for simple appendicitis. II. Copyright © 2016 Elsevier Inc. All rights reserved.

[Working conditions in operating rooms].

PubMed

Kułagowska, Ewa

2007-01-01

The aim of this study was to get acquainted with the opinions of the nursing staff on working conditions at their workplace. The study was carried out in a group of 398 nurses working in various kinds of operating rooms at 11 public hospitals. A questionnaire was used as a major tool of this study. The questionnaires were filled in by 259 operating room nurses (circulating nurses) and 139 nurse-anesthetists. The collected data show that working conditions in operating rooms do not ensure safety of the nursing staff at work. The main sources of problems are: work organization, technical factors, work equipment, work space, knowledge of hazards and strenuous factors among nurses, ways of preventing and/or limiting them. These elements are serious occupational risk factors influencing the work process and health status of nurses.

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

PubMed

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.

Safety in the operating theatre--a transition to systems-based care.

PubMed

Weiser, Thomas G; Porter, Michael P; Maier, Ronald V

2013-03-01

All surgeons want the best, safest care for their patients, but providing this requires the complex coordination of multiple disciplines to ensure that all elements of care are timely, appropriate, and well organized. Quality-improvement initiatives are beginning to lead to improvements in the quality of care and coordination amongst teams in the operating room. As the population ages and patients present with more complex disease pathology, the demands for efficient systematization will increase. Although evidence suggests that postoperative mortality rates are declining, there is substantial room for improvement. Multiple quality metrics are used as surrogates for safe care, but surgical teams--including surgeons, anaesthetists, and nurses--must think beyond these simple interventions if they are to effectively communicate and coordinate in the face of increasing demands.

The Aircraft Simulation Role in Improving Flight Safety Through Control Room Training

NASA Technical Reports Server (NTRS)

Shy, Karla S.; Hageman, Jacob J.; Le, Jeanette H.; Sitz, Joel (Technical Monitor)

2002-01-01

NASA Dryden Flight Research Center uses its six-degrees-of-freedom (6-DOF) fixed-base simulations for mission control room training to improve flight safety and operations. This concept is applied to numerous flight projects such as the F-18 High Alpha Research Vehicle (HARV), the F-15 Intelligent Flight Control System (IFCS), the X-38 Actuator Control Test (XACT), and X-43A (Hyper-X). The Dryden 6-DOF simulations are typically used through various stages of a project, from design to ground tests. The roles of these simulations have expanded to support control room training, reinforcing flight safety by building control room staff proficiency. Real-time telemetry, radar, and video data are generated from flight vehicle simulation models. These data are used to drive the control room displays. Nominal static values are used to complete information where appropriate. Audio communication is also an integral part of training sessions. This simulation capability is used to train control room personnel and flight crew for nominal missions and emergency situations. Such training sessions are also opportunities to refine flight cards and control room display pages, exercise emergency procedures, and practice control room setup for the day of flight. This paper describes this technology as it is used in the X-43A and F-15 IFCS and XACT projects.

Dedicated operating room for emergency surgery generates more utilization, less overtime, and less cancellations.

PubMed

van Veen-Berkx, Elizabeth; Elkhuizen, Sylvia G; Kuijper, Bart; Kazemier, Geert

2016-01-01

Two approaches prevail for reserving operating room (OR) capacity for emergency surgery: (1) dedicated emergency ORs and (2) evenly allocating capacity to all elective ORs, thereby creating a virtual emergency team. Previous studies contradict which approach leads to the best performance in OR utilization. Quasi-experimental controlled time-series design with empirical data from 3 university medical centers. Four different time periods were compared with analysis of variance with contrasts. Performance was measured based on 467,522 surgical cases. After closing the dedicated emergency OR, utilization slightly increased; overtime also increased. This was in contrast to earlier simulated results. The 2 control centers, maintaining a dedicated emergency OR, showed a higher increase in utilization and a decrease in overtime, along with a smaller ratio of case cancellations because of emergency surgery. This study shows that in daily practice a dedicated emergency OR is the preferred approach in performance terms regarding utilization, overtime, and case cancellations. Copyright © 2016 Elsevier Inc. All rights reserved.

Immersive virtual reality used as a platform for perioperative training for surgical residents.

PubMed

Witzke, D B; Hoskins, J D; Mastrangelo, M J; Witzke, W O; Chu, U B; Pande, S; Park, A E

2001-01-01

Perioperative preparations such as operating room setup, patient and equipment positioning, and operating port placement are essential to operative success in minimally invasive surgery. We developed an immersive virtual reality-based training system (REMIS) to provide residents (and other health professionals) with training and evaluation in these perioperative skills. Our program uses the qualities of immersive VR that are available today for inclusion in an ongoing training curriculum for surgical residents. The current application consists of a primary platform for patient positioning for a laparoscopic cholecystectomy. Having completed this module we can create many different simulated problems for other procedures. As a part of the simulation, we have devised a computer-driven real-time data collection system to help us in evaluating trainees and providing feedback during the simulation. The REMIS program trains and evaluates surgical residents and obviates the need to use expensive operating room and surgeon time. It also allows residents to train based on their schedule and does not put patients at increased risk. The method is standardized, allows for repetition if needed, evaluates individual performance, provides the possible complications of incorrect choices, provides training in 3-D environment, and has the capability of being used for various scenarios and professions.

Double gloves: a randomized trial to evaluate a simple strategy to reduce contamination in the operating room.

PubMed

Birnbach, David J; Rosen, Lisa F; Fitzpatrick, Maureen; Carling, Philip; Arheart, Kristopher L; Munoz-Price, L Silvia

2015-04-01

Oral flora, blood-borne pathogens, and bacterial contamination pose a direct risk of infection to patients and health care workers. We conducted a study in a simulated operating room using a newly validated technology to determine whether the use of 2 sets of gloves, with the outer set removed immediately after endotracheal intubation, may reduce this risk. Forty-one anesthesiology residents (PGY 2-4) were enrolled in a study consisting of individual or group simulation sessions. On entry to the simulated operating room, the residents were asked to perform an anesthetic induction and tracheal intubation timed to approximately 6 minutes; they were unaware of the study design. Of the 22 simulation sessions, 11 were conducted with the intubating resident wearing single gloves, and 11 with the intubating resident using double gloves with the outer pair removed after verified intubation. Before the start of the scenario, we coated the lips and inside of the mouth of the mannequin with a fluorescent marking gel as a surrogate pathogen. After the simulation, an observer examined 40 different sites using a handheld ultraviolet light in the operating room to determine the transfer of surrogate pathogens to the patient and the patient's environment. Residents who wore double gloves were instructed by a confederate nurse to remove the outer set immediately after completion of the intubation. Forty sites of potential intraoperative pathogen spread were identified and assigned a score. The difference in the rate of contamination between anesthesiology residents who wore single gloves versus those with double gloves was clinically and statistically significant. The number of sites that were contaminated in the operating room when the intubating resident wore single gloves was 20.3 ± 1.4 (mean ± SE); the number of contaminated sites when residents wore double gloves was 5.0 ± 0.7 (P < 0.001). The results of this study suggest that when an anesthesiologist wears 2 sets of gloves during laryngoscopy and intubation and then removes the outer set immediately after intubation, the contamination of the intraoperative environment is dramatically reduced.

How to optimize the economic viability of thyroid surgery in a French public hospital?

PubMed

D'Hubert, E; Proske, J-M

2010-08-01

Physicians in France have been asked to change their day-to-day medical practice to reduce overall costs. We examine ways to achieve this goal in thyroid surgery. We defined and implemented a clinical pathway to optimize the economic viability of thyroid surgery by increasing revenues and lowering expenses. An increase in revenue was achieved by decreasing patient length of stay (LOS) through the use of a fast-track rehabilitation protocol. Expenses were decreased by performing all pre-operative work-up in the out-patient setting and by decreasing costs in the operating room. For 292 consecutive patients who underwent thyroidectomy, the average LOS has been decreased over time to a mean of 2.03 days in 2008; 96% of patients were discharged on the first postoperative day. These results were primarily achieved by using a fast-track rehabilitation clinical pathway, and no increase in postoperative morbidity was noted. Operating time was decreased by 20% through the use of a second surgical assistant and hemostatic scissors but this improvement did not translate into better daily utilization of the operating room. The economic profitability of thyroid surgery is improved when mean LOS is reduced to 2 days through a fast-track protocol. Decreasing the duration of hospitalization was more effective than decreasing operative duration in controlling overall costs. Copyright © 2010 Elsevier Masson SAS. All rights reserved.

[Possible Instrument Contamination in the Operating Room During Implantation of Knee and Hip Arthroplasty].

PubMed

Quint, U; Benen, T

2016-04-01

Integrated ventilation systems with low turbulence displacement flow (TAV) are generally legally required in the architectural structure of operating theatres. However, it seems that the instruments laid out on sterile covered tables do not have the best possible protection from bacteria. Within an operating theatre, different bacteria counts are possible on the instruments. This prospective controlled study was conducted to demonstrate the influence of instrument tables with integrated horizontal flow on contamination with pathogens in comparison with conventional tables. In an operating theatre (OT) with a ceiling legally appropriate for TAV (2.40 m × 1.20 m), microbiological samples were placed on a table with integrated TAV flow (n = 100) and on a conventional instrument table (n = 100). The routine qualification of the OT was on an ongoing basis and was in accordance with DIN 1946-4: 1999 standards (in accordance with DIN measurement of recovery time 1946-4: 12-2008). This corresponds to the OT of the room class Ib. The results show significant differences between the two tables. The bacteria count and the percentage of contamination were many times higher on the conventional table. It is important to understand that the instruments are not completely protected against contamination after opening the pack and during the operation. Remedial measures are possible to optimise the sterility the instrument table. Georg Thieme Verlag KG Stuttgart · New York.

[The endoscopic operating room OR 1].

PubMed

Dubuisson, J B; Chapron, C

2003-04-01

During the last few years, the development of surgical laparoscopy has been the major turning point, and the most important progress in the field of surgery. The specific installation requirements of surgical laparoscopy, as well as the technological progress proper to this surgical technique, justify the need of a new organization of the operating theatre. The new operating room OR 1 is especially designed to fit and satisfy the requirements of a modern operating theatre, where surgical laparoscopy plays a major role. The organization and the design of this new operating room (OR 1) rely on 2 main concepts: architectural, and computerized, through 2 PC systems SCB and AIDA. The main objectives of this new concept are: allowing the surgeon to control and command all the functions and the instruments, as well as the lighting of the room and the operating field; managing the surgical data and images required for medical files; establishing a communication network either from the inside or outside the sterile zone.

One size fits all? Mixed methods evaluation of the impact of 100% single-room accommodation on staff and patient experience, safety and costs

PubMed Central

Maben, Jill; Penfold, Clarissa; Simon, Michael; Anderson, Janet E; Robert, Glenn; Pizzo, Elena; Hughes, Jane; Murrells, Trevor; Barlow, James

2016-01-01

Background and objectives There is little strong evidence relating to the impact of single-room accommodation on healthcare quality and safety. We explore the impact of all single rooms on staff and patient experience; safety outcomes; and costs. Methods Mixed methods pre/post ‘move’ comparison within four nested case study wards in a single acute hospital with 100% single rooms; quasi-experimental before-and-after study with two control hospitals; analysis of capital and operational costs associated with single rooms. Results Two-thirds of patients expressed a preference for single rooms with comfort and control outweighing any disadvantages (sense of isolation) felt by some. Patients appreciated privacy, confidentiality and flexibility for visitors afforded by single rooms. Staff perceived improvements (patient comfort and confidentiality), but single rooms were worse for visibility, surveillance, teamwork, monitoring and keeping patients safe. Staff walking distances increased significantly post move. A temporary increase of falls and medication errors in one ward was likely to be associated with the need to adjust work patterns rather than associated with single rooms per se. We found no evidence that single rooms reduced infection rates. Building an all single-room hospital can cost 5% more with higher housekeeping and cleaning costs but the difference is marginal over time. Conclusions Staff needed to adapt their working practices significantly and felt unprepared for new ways of working with potentially significant implications for the nature of teamwork in the longer term. Staff preference remained for a mix of single rooms and bays. Patients preferred single rooms. PMID:26408568

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

PubMed

Dexter, Franklin; Ledolter, Johannes

2003-07-01

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

8. VIEW OF SLC3W CONTROL ROOM (ROOM 105) FROM ITS ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

8. VIEW OF SLC-3W CONTROL ROOM (ROOM 105) FROM ITS NORTHEAST CORNER. TELEMETRY ROOM VISIBLE THROUGH WINDOWS IN SOUTH WALL. - Vandenberg Air Force Base, Space Launch Complex 3, Launch Operations Building, Napa & Alden Roads, Lompoc, Santa Barbara County, CA

7. VIEW OF SLC3W CONTROL ROOM (ROOM 105) FROM ITS ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

7. VIEW OF SLC-3W CONTROL ROOM (ROOM 105) FROM ITS SOUTHWEST CORNER. NOTE RAISED FLATFORM IN CENTER OF ROOM. - Vandenberg Air Force Base, Space Launch Complex 3, Launch Operations Building, Napa & Alden Roads, Lompoc, Santa Barbara County, CA

Impact of surface disinfection and sterile draping of furniture on room air quality in a cardiac procedure room with a ventilation and air-conditioning system (extrusion airflow, cleanroom class 1b (DIN 1946-4)).

PubMed

Below, Harald; Ryll, Sylvia; Empen, Klaus; Dornquast, Tina; Felix, Stefan; Rosenau, Heike; Kramer, Sebastian; Kramer, Axel

2010-09-21

In a cardiac procedure room, ventilated by a ventilation and air-conditioning system with turbulent mixed airflow, a protection zone in the operating area could be defined through visualization of airflows. Within this protection zone, no turbulence was detectable in the room air.Under the given conditions, disinfection of all surfaces including all furniture and equipment after the last operation and subsequent draping of furniture and all equipment that could not be removed from the room with sterile surgical drapes improved the indoor room air quality from cleanroom class C to cleanroom class B. This also allows procedures with elevated requirements to be performed in room class 1b.

Identifying Variability in Mental Models Within and Between Disciplines Caring for the Cardiac Surgical Patient.

PubMed

Brown, Evans K H; Harder, Kathleen A; Apostolidou, Ioanna; Wahr, Joyce A; Shook, Douglas C; Farivar, R Saeid; Perry, Tjorvi E; Konia, Mojca R

2017-07-01

The cardiac operating room is a complex environment requiring efficient and effective communication between multiple disciplines. The objectives of this study were to identify and rank critical time points during the perioperative care of cardiac surgical patients, and to assess variability in responses, as a correlate of a shared mental model, regarding the importance of these time points between and within disciplines. Using Delphi technique methodology, panelists from 3 institutions were tasked with developing a list of critical time points, which were subsequently assigned to pause point (PP) categories. Panelists then rated these PPs on a 100-point visual analog scale. Descriptive statistics were expressed as percentages, medians, and interquartile ranges (IQRs). We defined low response variability between panelists as an IQR ≤ 20, moderate response variability as an IQR > 20 and ≤ 40, and high response variability as an IQR > 40. Panelists identified a total of 12 PPs. The PPs identified by the highest number of panelists were (1) before surgical incision, (2) before aortic cannulation, (3) before cardiopulmonary bypass (CPB) initiation, (4) before CPB separation, and (5) at time of transfer of care from operating room (OR) to intensive care unit (ICU) staff. There was low variability among panelists' ratings of the PP "before surgical incision," moderate response variability for the PPs "before separation from CPB," "before transfer from OR table to bed," and "at time of transfer of care from OR to ICU staff," and high response variability for the remaining 8 PPs. In addition, the perceived importance of each of these PPs varies between disciplines and between institutions. Cardiac surgical providers recognize distinct critical time points during cardiac surgery. However, there is a high degree of variability within and between disciplines as to the importance of these times, suggesting an absence of a shared mental model among disciplines caring for cardiac surgical patients during the perioperative period. A lack of a shared mental model could be one of the factors contributing to preventable errors in cardiac operating rooms.

Maximizing time from the constraining European Working Time Directive (EWTD): The Heidelberg New Working Time Model.

PubMed

Schimmack, Simon; Hinz, Ulf; Wagner, Andreas; Schmidt, Thomas; Strothmann, Hendrik; Büchler, Markus W; Schmitz-Winnenthal, Hubertus

2014-01-01

The introduction of the European Working Time Directive (EWTD) has greatly reduced training hours of surgical residents, which translates into 30% less surgical and clinical experience. Such a dramatic drop in attendance has serious implications such compromised quality of medical care. As the surgical department of the University of Heidelberg, our goal was to establish a model that was compliant with the EWTD while avoiding reduction in quality of patient care and surgical training. We first performed workload analyses and performance statistics for all working areas of our department (operation theater, emergency room, specialized consultations, surgical wards and on-call duties) using personal interviews, time cards, medical documentation software as well as data of the financial- and personnel-controlling sector of our administration. Using that information, we specifically designed an EWTD-compatible work model and implemented it. Surgical wards and operating rooms (ORs) were not compliant with the EWTD. Between 5 pm and 8 pm, three ORs were still operating two-thirds of the time. By creating an extended work shift (7:30 am-7:30 pm), we effectively reduced the workload to less than 49% from 4 pm and 8 am, allowing the combination of an eight-hour working day with a 16-hour on call duty; thus, maximizing surgical resident training and ensuring patient continuity of care while maintaining EDTW guidelines. A precise workload analysis is the key to success. The Heidelberg New Working Time Model provides a legal model, which, by avoiding rotating work shifts, assures quality of patient care and surgical training.

31. Fourth floor attic, operating room with skylight, view to ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

31. Fourth floor attic, operating room with skylight, view to south - Portsmouth Naval Hospital, Hospital Building, Rixey Place, bounded by Williamson Drive, Holcomb Road, & The Circle, Portsmouth, Portsmouth, VA

6. VIEW OF SLC3W CONTROL ROOM (ROOM 105) FROM ITS ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

6. VIEW OF SLC-3W CONTROL ROOM (ROOM 105) FROM ITS SOUTHEAST CORNER - Vandenberg Air Force Base, Space Launch Complex 3, Launch Operations Building, Napa & Alden Roads, Lompoc, Santa Barbara County, CA

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

PubMed

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.

Using clinical simulation centers to test design interventions: a pilot study of lighting and color modifications.

PubMed

Gray, Whitney Austin; Kesten, Karen S; Hurst, Stephen; Day, Tama Duffy; Anderko, Laura

2012-01-01

The aim of this pilot study was to test design interventions such as lighting, color, and spatial color patterning on nurses' stress, alertness, and satisfaction, and to provide an example of how clinical simulation centers can be used to conduct research. The application of evidence-based design research in healthcare settings requires a transdisciplinary approach. Integrating approaches from multiple fields in real-life settings often proves time consuming and experimentally difficult. However, forums for collaboration such as clinical simulation centers may offer a solution. In these settings, identical operating and patient rooms are used to deliver simulated patient care scenarios using automated mannequins. Two identical rooms were modified in the clinical simulation center. Nurses spent 30 minutes in each room performing simulated cardiac resuscitation. Subjective measures of nurses' stress, alertness, and satisfaction were collected and compared between settings and across time using matched-pair t-test analysis. Nurses reported feeling less stressed after exposure to the experimental room than nurses who were exposed to the control room (2.22, p = .03). Scores post-session indicated a significant reduction in stress and an increase in alertness after exposure to the experimental room as compared to the control room, with significance levels below .10. (Change in stress scores: 3.44, p = .069); (change in alertness scores: 3.6, p = .071). This study reinforces the use of validated survey tools to measure stress, alertness, and satisfaction. Results support human-centered design approaches by evaluating the effect on nurses in an experimental setting.

Maintaining reduced noise levels in a resource-constrained neonatal intensive care unit by operant conditioning.

PubMed

Ramesh, A; Denzil, S B; Linda, R; Josephine, P K; Nagapoornima, M; Suman Rao, P N; Swarna Rekha, A

2013-03-01

To evaluate the efficacy of operant conditioning in sustaining reduced noise levels in the neonatal intensive care unit (NICU). Quasi-experimental study on quality of care. Level III NICU of a teaching hospital in south India. 26 staff employed in the NICU. (7 Doctors, 13 Nursing staff and 6 Nursing assistants). Operant conditioning of staff activity for 6 months. This method involves positive and negative reinforcement to condition the staff to modify noise generating activities. Comparing noise levels in decibel: A weighted [dB (A)] before conditioning with levels at 18 and 24 months after conditioning. Decibel: A weighted accounts for noise that is audible to human ears. Operant conditioning for 6 months sustains the reduced noise levels to within 62 dB in ventilator room 95% CI: 60.4 - 62.2 and isolation room (95% CI: 55.8 - 61.5). In the preterm room, noise can be maintained within 52 dB (95% CI: 50.8 - 52.6). This effect is statistically significant in all the rooms at 18 months (P = 0.001). At 24 months post conditioning there is a significant rebound of noise levels by 8.6, 6.7 and 9.9 dB in the ventilator, isolation and preterm room, respectively (P =0.001). Operant conditioning for 6 months was effective in sustaining reduced noise levels. At 18 months post conditioning, the noise levels were maintained within 62 dB (A), 60 dB (A) and 52 dB (A) in the ventilator, isolation and pre-term room, respectively. Conditioning needs to be repeated at 12 months in the ventilator room and at 18 months in the other rooms.

Greening of orthopedic surgery.

PubMed

Lee, Rushyuan J; Mears, Simon C

2012-06-01

Every year, 4 billion pounds of waste are produced by health care facilities, and the amount continues to increase annually. In response, a movement toward greening health care has been building, with a particular focus on the operating room. Between 20% and 70% of health care waste originates from a hospital's operating room, and up to 90% of operating room waste is improperly sorted and sent for costly and unneeded hazardous waste processing. Recent successful changes include segregation of hospital waste, substitution of the ubiquitous polypropylene plastic wrap used for the sterilization and handling of surgical equipment with metal cases, and the reintroduction of reusable surgical gowns. Orthopedic-related changes include the successful reprocessing and reuse of external fixators, shavers, blades, burs, and tourniquets. These changes have been shown to be environmentally and economically beneficial. Early review indicates that these changes are feasible, but a need exists for further evaluation of the effect on the operating room and flow of the surgical procedure and of the risks to the surgeons and operating room staff. Other key considerations are the effects of reprocessed and reused equipment on patient care and outcome and the role of surgeons in helping patients make informed decisions regarding surgical care. The goals of this study were to summarize the amount and types of waste produced in hospitals and operating rooms, highlight the methods of disposal used, review disposal methods that have been developed to reduce waste and improve recycling, and explore future developments in greening health care. Copyright 2012, SLACK Incorporated.

Traffic in the operating room during joint replacement is a multidisciplinary problem

PubMed Central

Bédard, Martin; Pelletier-Roy, Rémi; Angers-Goulet, Mathieu; Leblanc, Pierre-Alexandre; Pelet, Stéphane

2015-01-01

Background Door openings disrupt the laminar air flow and increase the bacterial count in the operating room (OR). We aimed to define the incidence of door openings in the OR during primary total joint arthroplasty (TJA) surgeries and determine whether measures were needed and/or possible to reduce OR staff traffic. Methods We recorded the number of door openings during 100 primary elective TJA surgeries; the OR personnel were unaware of the observer’s intention. Operating time was divided into the preincision period, defined as the time from the opening of surgical trays to skin incision, and the postincision period, defined as time from incision to dressing application. Results The mean number of door openings during primary TJA was 71.1 (range 35–176) with a mean operative time of 111.9 (range 53–220) minutes, for an average of 0.64 (range 0.36–1.05) door openings/min. Nursing staff were responsible for 52.2% of total door openings, followed by anesthesia staff at 23.9% and orthopedic staff at 12.7%. In the preincision period, we observed an average of 0.84 door openings/min, with nursing and orthopedic personnel responsible for most of the door openings. The postincision period yielded an average of 0.54 door openings/min, with nursing and anesthesia personnel being responsible for most of the door openings. Conclusion There is a high incidence of door openings during TJA. Because we observed a range in the number of door openings per surgery, we believe it is possible to reduce this number during TJA. PMID:26022153

Polyaniline-Cadmium Ferrite Nanostructured Composite for Room-Temperature Liquefied Petroleum Gas Sensing

NASA Astrophysics Data System (ADS)

Kotresh, S.; Ravikiran, Y. T.; Tiwari, S. K.; Vijaya Kumari, S. C.

2017-08-01

We introduce polyaniline-cadmium ferrite (PANI-CdFe2O4) nanostructured composite as a room-temperature-operable liquefied petroleum gas (LPG) sensor. The structure of PANI and the composite prepared by chemical polymerization was characterized by Fourier-transform infrared (FT-IR) spectroscopy, x-ray diffraction (XRD) analysis, and field-emission scanning electron microscopy. Comparative XRD and FT-IR analysis confirmed CdFe2O4 embedded in PANI matrix with mutual interfacial interaction. The nanostructure of the composite was confirmed by transmission electron microscopy. A simple LPG sensor operable at room temperature, exclusively based on spin-coated PANI-CdFe2O4 nanocomposite, was fabricated with maximum sensing response of 50.83% at 1000 ppm LPG. The response and recovery time of the sensor were 50 s and 110 s, respectively, and it was stable over a period of 1 month with slight degradation of 4%. The sensing mechanism is discussed on the basis of the p- n heterojunction barrier formed at the interface of PANI and CdFe2O4.

Case review analysis of operating room decisions to cancel surgery.

PubMed

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.

Molecular Functionalization of Graphene Oxide for Next-Generation Wearable Electronics.

PubMed

Zarrin, Hadis; Sy, Serubbabel; Fu, Jing; Jiang, Gaopeng; Kang, Keunwoo; Jun, Yun-Seok; Yu, Aiping; Fowler, Michael; Chen, Zhongwei

2016-09-28

Acquiring reliable and efficient wearable electronics requires the development of flexible electrolyte membranes (EMs) for energy storage systems with high performance and minimum dependency on the operating conditions. Herein, a freestanding graphene oxide (GO) EM is functionalized with 1-hexyl-3-methylimidazolium chloride (HMIM) molecules via both covalent and noncovalent bonds induced by esterification reactions and electrostatic πcation-π stacking, respectively. Compared to the commercial polymeric membrane, the thin HMIM/GO membrane demonstrates not only slightest performance sensitivity to the operating conditions but also a superior hydroxide conductivity of 0.064 ± 0.0021 S cm(-1) at 30% RH and room temperature, which was 3.8 times higher than that of the commercial membrane at the same conditions. To study the practical application of the HMIM/GO membranes in wearable electronics, a fully solid-state, thin, flexible zinc-air battery and supercapacitor are made exhibiting high battery performance and capacitance at low humidified and room temperature environment, respectively, favored by the bonded HMIM molecules on the surface of GO nanosheets. The results of this study disclose the strong potential of manipulating the chemical structure of GO to work as a lightweight membrane in wearable energy storage devices, possessing highly stable performance at different operating conditions, especially at low relative humidity and room temperature.

EPRR

Science.gov Websites

Electronic Public Reading Room Operational Reading Room & Environmental Cleanup through April 2018 Los Alamos Legacy Cleanup Electronic Public Reading Room Environmental Cleanup from May 2018

12. INTERIOR VIEW OF GATE OPERATOR ROOM, SHOWING SLIDES GATE ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

12. INTERIOR VIEW OF GATE OPERATOR ROOM, SHOWING SLIDES GATE OPERATORS, LOOKING NORTHWEST. - Sacramento River Water Treatment Plant Intake Pier & Access Bridge, Spanning Sacramento River approximately 175 feet west of eastern levee on river; roughly .5 mile downstream from confluence of Sacramento & American Rivers, Sacramento, Sacramento County, CA

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

DTIC Science & Technology

2008-05-01

or CRNA in training. The training of staff and the use of advanced technology, such as the Davinci Surgical Robot, may lead to an increase in time...gynecology performed during block-time will involve the use of the Davinci robot. When using the robot for a case, the set-up and prep-time before...1999). It is because of the cost of surgical staff that block-time lost to delays is concerning. MCA implemented block-time because it provides a tool

Potential time savings to radiology department personnel in a PACS-based environment

NASA Astrophysics Data System (ADS)

Saarinen, Allan O.; Wilson, M. C.; Iverson, Scott C.; Loop, John W.

1990-08-01

A purported benefit of digital imaging and archiving of radiographic procedures is the presumption of time savings to radiologists, radiology technologists, and radiology departmentpersonnel involved with processingfilms and managing theflimfile room. As part of the University of Washington's evaluation of Picture Archiving and Communication Systems (PACS)for the U.S. Army Medical Research and Development Command, a study was performed which evaluated the current operationalpractices of the film-based radiology department at the University of Washington Medical Center (UWMC). Industrial engineering time and motion studies were conducted to document the length of time requiredforfilm processing in various modalities, the proportion of the total exam time usedforfilm processing, the amount of time radiologists spent searchingfor and looking at images, and the amount of time file room personnel spent collating reports, making loans, updatingfilm jacket information, and purging files. This evaluation showed that better than one-half of the tasks in the file room may be eliminated with PACS and radiologists may save easily 10 percent of the time they spend reading films by no longer having to searchforfilms. Radiology technologists may also save as much as 10 percent of their time with PACS, although this estimate is subject to significant patient mix aberrations and measurement error. Given that the UWMC radiology department operates efficiently, similar improvements are forecast for other radiology departments and larger improvements areforecastfor less efficient departments.

Quality of Communication in Robotic Surgery and Surgical Outcomes.

PubMed

Schiff, Lauren; Tsafrir, Ziv; Aoun, Joelle; Taylor, Andrew; Theoharis, Evan; Eisenstein, David

2016-01-01

Robotic surgery has introduced unique challenges to surgical workflow. The association between quality of communication in robotic-assisted laparoscopic surgery and surgical outcomes was evaluated. After each gynecologic robotic surgery, the team members involved in the surgery completed a survey regarding the quality of communication. A composite quality-of-communication score was developed using principal component analysis. A higher composite quality-of-communication score signified poor communication. Objective parameters, such as operative time and estimated blood loss (EBL), were gathered from the patient's medical record and correlated with the composite quality-of-communication scores. Forty robotic cases from March through May 2013 were included. Thirty-two participants including surgeons, circulating nurses, and surgical technicians participated in the study. A higher composite quality-of-communication score was associated with greater EBL (P = .010) and longer operative time (P = .045), after adjustment for body mass index, prior major abdominal surgery, and uterine weight. Specifically, for every 1-SD increase in the perceived lack of communication, there was an additional 51 mL EBL and a 31-min increase in operative time. The most common reasons reported for poor communication in the operating room were noise level (28/36, 78%) and console-to-bedside communication problems (23/36, 64%). Our study demonstrates a significant association between poor intraoperative team communication and worse surgical outcomes in robotic gynecologic surgery. Employing strategies to decrease extraneous room noise, improve console-to-bedside communication and team training may have a positive impact on communication and related surgical outcomes.

Fungal endophthalmitis caused by Paecilomyces variotii following cataract surgery: a presumed operating room air-conditioning system contamination.

PubMed

Tarkkanen, Ahti; Raivio, Virpi; Anttila, Veli-Jukka; Tommila, Petri; Ralli, Reijo; Merenmies, Lauri; Immonen, Ilkka

2004-04-01

To report a case of delayed fungal endophthalmitis by Paecilomyces variotii following uncomplicated cataract surgery. To our knowledge this is the first reported case of postoperative endophthalmitis by this species. We report the longterm clinical follow-up of an 83-year-old female who underwent uncomplicated sutureless, small-incision cataract surgery. She developed recurring uveitis 4 months after surgery. Vitreous tap and finally complete vitrectomy with removal of the capsular bag including the intraocular lens were performed. Fungi were studied by histopathology and culture. At histopathological examination, the fungi were found to be closely related with the capsular bag. A few mononuclear inflammatory cells were encountered. At culture, Paecilomyces variotii, a common ubiquitous non-pathogenic saprophyte, was identified. Despite systemic, intravitreal and topical antifungal therapy after vitrectomy the uveitis recurred several times, but no fungal organisms were isolated from the repeat intraocular specimen. At 18 months postoperatively the subject's visual acuity was finger counting at 2 metres. At the time of surgery the operating room air-conditioning system was undergoing repairs. Cases of fungal endophthalmitis after contamination from air-conditioning ventilation systems have been reported before, but none of the cases reported have been caused by P. variotii. P. variotii, a non-pathogenic environmental saprophyte, may be disastrous if introduced into the eye. International recommendations on the environmental control of the operating room air-conditioning ventilation system should be strictly followed. No intraoperative surgery should be undertaken while the air-conditioning system is undergoing repairs or service.

Simulator training to automaticity leads to improved skill transfer compared with traditional proficiency-based training: a randomized controlled trial.

PubMed

Stefanidis, Dimitrios; Scerbo, Mark W; Montero, Paul N; Acker, Christina E; Smith, Warren D

2012-01-01

We hypothesized that novices will perform better in the operating room after simulator training to automaticity compared with traditional proficiency based training (current standard training paradigm). Simulator-acquired skill translates to the operating room, but the skill transfer is incomplete. Secondary task metrics reflect the ability of trainees to multitask (automaticity) and may improve performance assessment on simulators and skill transfer by indicating when learning is complete. Novices (N = 30) were enrolled in an IRB-approved, blinded, randomized, controlled trial. Participants were randomized into an intervention (n = 20) and a control (n = 10) group. The intervention group practiced on the FLS suturing task until they achieved expert levels of time and errors (proficiency), were tested on a live porcine fundoplication model, continued simulator training until they achieved expert levels on a visual spatial secondary task (automaticity) and were retested on the operating room (OR) model. The control group participated only during testing sessions. Performance scores were compared within and between groups during testing sessions. : Intervention group participants achieved proficiency after 54 ± 14 and automaticity after additional 109 ± 57 repetitions. Participants achieved better scores in the OR after automaticity training [345 (range, 0-537)] compared with after proficiency-based training [220 (range, 0-452; P < 0.001]. Simulator training to automaticity takes more time but is superior to proficiency-based training, as it leads to improved skill acquisition and transfer. Secondary task metrics that reflect trainee automaticity should be implemented during simulator training to improve learning and skill transfer.

Demonstration of charge breeding in a compact room temperature electron beam ion trap

DOE Office of Scientific and Technical Information (OSTI.GOV)

Vorobjev, G.; Sokolov, A.; Herfurth, F.

2012-05-15

For the first time, a small room-temperature electron beam ion trap (EBIT), operated with permanent magnets, was successfully used for charge breeding experiments. The relatively low magnetic field of this EBIT does not contribute to the capture of the ions; single-charged ions are only caught by the space charge potential of the electron beam. An over-barrier injection method was used to fill the EBIT's electrostatic trap with externally produced, single-charged potassium ions. Charge states as high as K{sup 19+} were reached after about a 3 s breeding time. The capture and breeding efficiencies up to 0.016(4)% for K{sup 17+} havemore » been measured.« less

Impact of surface disinfection and sterile draping of furniture on room air quality in a cardiac procedure room with a ventilation and air-conditioning system (extrusion airflow, cleanroom class 1b (DIN 1946-4))

PubMed Central

Below, Harald; Ryll, Sylvia; Empen, Klaus; Dornquast, Tina; Felix, Stefan; Rosenau, Heike; Kramer, Sebastian; Kramer, Axel

2010-01-01

In a cardiac procedure room, ventilated by a ventilation and air-conditioning system with turbulent mixed airflow, a protection zone in the operating area could be defined through visualization of airflows. Within this protection zone, no turbulence was detectable in the room air. Under the given conditions, disinfection of all surfaces including all furniture and equipment after the last operation and subsequent draping of furniture and all equipment that could not be removed from the room with sterile surgical drapes improved the indoor room air quality from cleanroom class C to cleanroom class B. This also allows procedures with elevated requirements to be performed in room class 1b. PMID:20941336

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

PubMed

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.

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

PubMed

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.

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

PubMed

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 < 0.0001) and 5.4 times more voice behaviors (p = 0.0005) among the team. With each 1-point increase in transformational score, leaders displayed 10 times more supportive behaviors (p < 0.0001) and displayed poor behaviors 12.5 times less frequently (p < 0.0001). Excerpts of representative dialogue are included for illustration. We provide a framework for evaluating surgeons' 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.

CLEAR: Communications Link Expert Assistance Resource

NASA Technical Reports Server (NTRS)

Hull, Larry G.; Hughes, Peter M.

1987-01-01

Communications Link Expert Assistance Resource (CLEAR) is a real time, fault diagnosis expert system for the Cosmic Background Explorer (COBE) Mission Operations Room (MOR). The CLEAR expert system is an operational prototype which assists the MOR operator/analyst by isolating and diagnosing faults in the spacecraft communication link with the Tracking and Data Relay Satellite (TDRS) during periods of realtime data acquisition. The mission domain, user requirements, hardware configuration, expert system concept, tool selection, development approach, and system design were discussed. Development approach and system implementation are emphasized. Also discussed are system architecture, tool selection, operation, and future plans.

Discrepancies Between Planned and Actual Operating Room Turnaround Times at a Large Rural Hospital in Germany

PubMed Central

Morgenegg, Regula; Heinze, Franziska; Wieferich, Katharina; Schiffer, Ralf; Stueber, Frank; Luedi, Markus M.; Doll, Dietrich

2017-01-01

Objectives While several factors have been shown to influence operating room (OR) turnaround times, few comparisons of planned and actual OR turnaround times have been performed. This study aimed to compare planned and actual OR turnaround times at a large rural hospital in Northern Germany. Methods This retrospective study examined the OR turnaround data of 875 elective surgery cases scheduled at the Marienhospital, Vechta, Germany, between July and October 2014. The frequency distributions of planned and actual OR turnaround times were compared and correlations between turnaround times and various factors were established, including the time of day of the procedure, patient age and the planned duration of the surgery. Results There was a significant difference between mean planned and actual OR turnaround times (0.32 versus 0.64 hours; P <0.001). In addition, significant correlations were noted between actual OR turnaround times and the time of day of the surgery, patient age, actual duration of the procedure and staffing changes affecting the surgeon or the medical specialty of the surgery (P <0.001 each). The quotient of actual/planned OR turnaround times ranged from 1.733–3.000. Conclusion Significant discrepancies between planned and actual OR turnaround times were noted during the study period. Such findings may be potentially used in future studies to establish a tool to improve OR planning, measure OR management performance and enable benchmarking. PMID:29372083

Refinement of the Hybrid Neuroendovascular Operating Suite: Current and Future Applications.

PubMed

Ashour, Ramsey; See, Alfred P; Dasenbrock, Hormuzdiyar H; Khandelwal, Priyank; Patel, Nirav J; Belcher, Bianca; Aziz-Sultan, Mohammad Ali

2016-07-01

In early-generation hybrid biplane endovascular operating rooms, switching from surgical to angiographic position is cumbersome. In this report, we highlight the unique design of a new hybrid neuroendovascular operating suite that allows surgical access to the head while keeping the biplane system over the lower body of the patient. Current and future hybrid neuroendovascular operating suite applications are discussed. We collaborated with engineers to implement the following modifications to the design of the angiographic system: translation of the bed toward the feet to allow biplane cerebral imaging in the head-side position and the biplane left-side position; translation of the base of the A-plane C-arm away from the feet to allow increased operator space at the head of the bed and to allow cerebral imaging in both the head-side and left-side positions; use of a specialized boom mount for the display panel to increase mobility; and use of a radiolucent tabletop with attachments for the headrest or radiolucent head clamp system. The modified hybrid neuroendovascular operating suite allows for seamless transition between surgical and angiographic positions within seconds, improving workflow efficiency and decreasing procedure time as compared with early-generation hybrid rooms. Combined endovascular and surgical applications are facilitated by co-locating their respective technologies and refining the ergonomics of the system to ease transition between both sets of technologies. In so doing, hybrid neuroendovascular operating suites can be anticipated to improve patient outcomes, generate novel treatment paradigms, and improve time and cost efficiency. Copyright © 2016. Published by Elsevier Inc.

The role of an open-space CCTV system in limiting alcohol-related assault injuries in a late-night entertainment precinct in a tropical Queensland city, Australia.

PubMed

Pointing, Shane; Hayes-Jonkers, Charmaine; Bohanna, India; Clough, Alan

2012-02-01

Closed circuit television (CCTV) systems which incorporate real-time communication links between camera room operators and on-the-ground security may limit injuries resulting from alcohol-related assault. This pilot study examined CCTV footage and operator records of security responses for two periods totalling 22 days in 2010-2011 when 30 alcohol-related assaults were recorded. Semistructured discussions were conducted with camera room operators during 18 h of observation. Camera operators were proactive, efficiently directing street security to assault incidents. The system intervened in 40% (n=12) of alcohol-related assaults, limiting possible injury. This included three incidents judged as potentially preventable. A further five (17%) assault incidents were also judged as potentially preventable, while 43% (n=13) happened too quickly for intervention. Case studies describe security intervention in each category. Further research is recommended, particularly to evaluate the effects on preventing injuries through targeted awareness training to improve responsiveness and enhance the preventative capacity of similar CCTV systems.

Impact of the BALLOTS Shared Cataloging System on the Amount of Change in the Library Technical Processing Department.

ERIC Educational Resources Information Center

Kershner, Lois M.

The amount of change resulting from the implementation of the Bibliographic Automation of Large Library Operations using a Time-sharing System (BALLOTS) is analyzed, in terms of (1) physical room arrangement, (2) work procedure, and (3) organizational structure. Also considered is the factor of amount of time the new system has been in use.…

Compact wearable dual-mode imaging system for real-time fluorescence image-guided surgery.

PubMed

Zhu, Nan; Huang, Chih-Yu; Mondal, Suman; Gao, Shengkui; Huang, Chongyuan; Gruev, Viktor; Achilefu, Samuel; Liang, Rongguang

2015-09-01

A wearable all-plastic imaging system for real-time fluorescence image-guided surgery is presented. The compact size of the system is especially suitable for applications in the operating room. The system consists of a dual-mode imaging system, see-through goggle, autofocusing, and auto-contrast tuning modules. The paper will discuss the system design and demonstrate the system performance.

[How many patient transfer rooms are necessary for my OR suite? : Effect of the number of OR transfer rooms on waiting times and patient throughput in the OR - analysis by simulation].

PubMed

Messer, C; Zander, A; Arnolds, I V; Nickel, S; Schuster, M

2015-12-01

In most hospitals the operating rooms (OR) are separated from the rest of the hospital by transfer rooms where patients have to pass through for reasons of hygiene. In the OR transfer room patients are placed on the OR table before surgery and returned to the hospital bed after surgery. It could happen that the number of patients who need to pass through a transfer room at a certain point in time exceed the number of available transfer rooms. As a result the transfer rooms become a bottleneck where patients have to wait and which, in turn, may lead to delays in the OR suite. In this study the ability of a discrete event simulation to analyze the effect of the duration of surgery and the number of ORs on the number of OR transfer rooms needed was investigated. This study was based on a discrete event simulation model developed with the simulation software AnyLogic®. The model studied the effects of the number of OR transfer rooms on the processes in an OR suite of a community hospital by varying the number of ORs from one to eight and using different surgical portfolios. Probability distributions for the process duration of induction, surgery and recovery and transfer room processes were calculated on the basis of real data from the community hospital studied. Furthermore, using a generic simulation model the effect of the average duration of surgery on the number of OR transfer rooms needed was examined. The discrete event simulation model enabled the analysis of both quantitative as well as qualitative changes in the OR process and setting. Key performance indicators of the simulation model were patient throughput per day, the probability of waiting and duration of waiting time in front of OR transfer rooms. In the case of a community hospital with 1 transfer room the average proportion of patients waiting before entering the OR was 17.9 % ± 9.7 % with 3 ORs, 37.6 % ± 9.7 % with 5 ORs and 62.9 % ± 9.1 % with 8 ORs. The average waiting time of patients in the setting with 3 ORs was 3.1 ± 2.7 min, with 5 ORs 5.0 ± 5.8 min and with 8 ORs 11.5 ± 12.5 min. Based on this study the community hospital needs a second transfer room starting from 4 ORs so that there is no bottleneck for the subsequent OR processes. The average patient throughput in a setting with 4 ORs increased significantly by 0.3 patients per day when a second transfer room is available. The generic model showed a strong effect of the average duration of surgery on the number of transfer rooms needed. There was no linear correlation between the number of transfer rooms and the number of ORs. The shorter the average duration of surgery, the earlier an additional transfer room is required. Thus, hospitals with shorter duration of surgery and fewer ORs may need the same or more transfer rooms than a hospital with longer duration of surgery and more ORs. However, with respect to an economic analysis, the costs and benefits of installing additional OR transfer rooms need to be calculated using the profit margins of the specific hospital.

Front view of bldg 30 which houses mission control

NASA Image and Video Library

1984-08-30

41D-3072 (30 Aug 1984) --- A 41-D shift change is taking place in the Johnson Space Center's Building 30. In its twenty years of operation, the mission control center has been the scene of many such changes. The windowless wing at left houses three floors, including rooms supporting flight control rooms 1 & 2 (formerly called mission operations control rooms 1 & 2).

Mission Control Center (MCC) - Apollo 15 Launch - MSC

NASA Image and Video Library

1971-07-26

S71-41357 (26 July 1971) --- An overall, wide-angle lens view of activity in the Mission Operations Control Room in the Mission Control Center minutes after the launch of the Apollo 15 lunar landing mission. Ground elapsed time was 45 minutes and 42 seconds when this photograph was taken.

76 FR 2688 - Sunshine Act Notice

Federal Register 2010, 2011, 2012, 2013, 2014

2011-01-14

... FEDERAL MINE SAFETY AND HEALTH REVIEW COMMISSION Sunshine Act Notice TIME AND DATE: 10 a.m., Thursday, January 20, 2011. PLACE: The Richard V. Backley Hearing Room, 9th Floor, 601 New Jersey Avenue...-0693-M. (Issues include whether a non- production operator may be strictly liable for a violation...

The application of a "6S Lean" initiative to improve workflow for emergency eye examination rooms.

PubMed

Nazarali, Samir; Rayat, Jaspreet; Salmonson, Hilary; Moss, Theodora; Mathura, Pamela; Damji, Karim F

2017-10-01

Ophthalmology residents on call at the Royal Alexandra Hospital identified workplace disorganization and lack of standardization in emergency eye examination rooms as an impediment to efficient patient treatment. The aim of the study was to use the "6S Lean" model to improve workflow in eye examination rooms at the Royal Alexandra Hospital. With the assistance of quality improvement consultants, the "6S Lean" model was applied to the current operation of the emergency eye clinic examination rooms. This model, considering 8 waste categories, was then used to recommend and implement changes to the examination rooms and to workplace protocols to enhance efficiency and safety. Eye examination rooms were improved with regards to setup, organization of supplies, inventory control, and maintenance. All targets were achieved, and the 5S audit checklist score increased by 33 points from 44 to 77. Implementation of the 6S methodology is a simple approach that removes inefficiencies from the workplace. The ophthalmology clinic removed waste from all 8 waste categories, increased audit results, mitigated patient and resident safety risks, and ultimately redirected resident time back to patient care delivery. Copyright © 2017 Canadian Ophthalmological Society. Published by Elsevier Inc. All rights reserved.

Coordination of appointments for anesthesia care outside of operating rooms using an enterprise-wide scheduling system.

PubMed

Dexter, Franklin; Xiao, Yan; Dow, Angella J; Strader, Melissa M; Ho, Danny; Wachtel, Ruth E

2007-12-01

An anesthesia department implemented scheduling of anesthetics outside of operating rooms (non-OR) by clerks and nurses from other departments using its hospital's enterprise-wide scheduling system. Observational studies chronicled the change over 2 yr as non-OR time was allocated by specialty, and nonanesthesia clerks and nurses scheduled anesthesia teams. Experimental studies investigated how tabular and graphical displays affected the scheduling of milestones (e.g., NPO times) and appointments before anesthetics. Anesthetics performed in allocated time increased progressively from 0% to 75%. Scheduling of anesthetics by nonanesthesia clerks and nurses increased progressively from 0% to 77%. Consistency of patient instructions was improved. The quality of resulting schedules was good. Implementation was not associated with worsening of multiple operational measures of performance such as cancellation rates, turnover times, or complaints. However, schedulers struggled to understand fasting and arrival times of patients, despite using a web site with statistically generated values in tabular formats. Experiments revealed that people ignored their knowledge that anesthetics can start earlier than scheduled. Participants made good decisions with both tabular and graphical displays when scheduling appointments preceding anesthesia. Enterprise-wide scheduling can coordinate anesthetics with other appointments on the same date and improve consistency and accuracy of patient instructions customized to the probability of an anesthetic starting early. The usefulness of implementation depends on the value in having more patient-centered care and/or in having patients arrive just in time for non-OR anesthesia, surgery, or regional block placement (e.g., at facilities with limited physical space).

Using the Transient Response of WO₃ Nanoneedles under Pulsed UV Light in the Detection of NH₃ and NO₂.

PubMed

Gonzalez, Oriol; Welearegay, Tesfalem G; Vilanova, Xavier; Llobet, Eduard

2018-04-26

Here we report on the use of pulsed UV light for activating the gas sensing response of metal oxides. Under pulsed UV light, the resistance of metal oxides presents a ripple due to light-induced transient adsorption and desorption phenomena. This methodology has been applied to tungsten oxide nanoneedle gas sensors operated either at room temperature or under mild heating (50 °C or 100 °C). It has been found that by analyzing the rate of resistance change caused by pulsed UV light, a fast determination of gas concentration is achieved (ten-fold improvement in response time). The technique is useful for detecting both oxidizing (NO₂) and reducing (NH₃) gases, even in the presence of different levels of ambient humidity. Room temperature operated sensors under pulsed UV light show good response towards ammonia and nitrogen dioxide at low power consumption levels. Increasing their operating temperature to 50 °C or 100 °C has the effect of further increasing sensitivity.

Hybrid systems of AlInP microdisks and colloidal CdSe nanocrystals showing whispering-gallery modes at room temperature

DOE Office of Scientific and Technical Information (OSTI.GOV)

Strelow, Christian; Weising, Simon; Bonatz, Dennis

2014-09-01

We report on the realization of hybrid systems composed of passive optical microdisk resonators prepared from epitaxial layer systems and nanocrystal quantum emitters synthesized by colloidal chemistry. The AlInP disk material allows for the operation in the visible range, as probed by CdSe-based nanocrystals. Photoluminescence spectra at room temperature reveal sets of whispering-gallery modes consistent with finite-difference time-domain simulations. In the experiments, a special sample geometry renders it possible to detect resonant optical modes perpendicular to the disk plane.

Application of total care time and payment per unit time model for physician reimbursement for common general surgery operations.

PubMed

Chatterjee, Abhishek; Holubar, Stefan D; Figy, Sean; Chen, Lilian; Montagne, Shirley A; Rosen, Joseph M; Desimone, Joseph P

2012-06-01

The relative value unit system relies on subjective measures of physician input in the care of patients. A payment per unit time model incorporates surgeon reimbursement to the total care time spent in the operating room, postoperative in-house, and clinic time to define payment per unit time. We aimed to compare common general surgery operations by using the total care time and payment per unit time method in order to demonstrate a more objective measurement for physician reimbursement. Average total physician payment per case was obtained for 5 outpatient operations and 4 inpatient operations in general surgery. Total care time was defined as the sum of operative time, 30 minutes per hospital day, and 30 minutes per office visit for each operation. Payment per unit time was calculated by dividing the physician reimbursement per case by the total care time. Total care time, physician payment per case, and payment per unit time for each type of operation demonstrated that an average payment per time spent for inpatient operations was $455.73 and slightly more at $467.51 for outpatient operations. Partial colectomy with primary anastomosis had the longest total care time (8.98 hours) and the least payment per unit time ($188.52). Laparoscopic gastric bypass had the highest payment per time ($707.30). The total care time and payment per unit time method can be used as an adjunct to compare reimbursement among different operations on an institutional level as well as on a national level. Although many operations have similar payment trends based on time spent by the surgeon, payment differences using this methodology are seen and may be in need of further review. Copyright © 2012 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

Prostate implant nomograms for the North American scientific {sup 103}Pd seed

DOE Office of Scientific and Technical Information (OSTI.GOV)

Zheng, Jay J.; Stevens, Ritchie N

Palladium-103-({sup 103}Pd) seed has been increasingly used in prostate implantation as either definitive or boost therapy because of its shorter half-life and higher initial dose rate. Because a growing number of radiation oncologists prefer real-time implantation in the operating room, it will be helpful if the total activity of the seeds can be determined based on the gland size before the patient is taken to the operating room. Based on our clinic data, nomograms have therefore been developed for one of the widely used {sup 103}Pd seeds, the MED3633 seed, which is produced by North American Scientific, Inc. (NASI). Themore » total activities for implant volume ranging from 15 cc to 55 cc are provided for both seed 'monotherapy' and seed boost.« less

Team Training in the Perioperative Arena: A Methodology for Implementation and Auditing Behavior.

PubMed

Rhee, Amanda J; Valentin-Salgado, Yessenia; Eshak, David; Feldman, David; Kischak, Pat; Reich, David L; LoPachin, Vicki; Brodman, Michael

Preventable medical errors in the operating room are most often caused by ineffective communication and suboptimal team dynamics. TeamSTEPPS is a government-funded, evidence-based program that provides tools and education to improve teamwork in medicine. The study hospital implemented TeamSTEPPS in the operating room and merged the program with a surgical safety checklist. Audits were performed to collect both quantitative and qualitative information on time out (brief) and debrief conversations, using a standardized audit tool. A total of 1610 audits over 6 months were performed by live auditors. Performance was sustained at desired levels or improved for all qualitative metrics using χ 2 and linear regression analyses. Additionally, the absolute number of wrong site/side/person surgery and unintentionally retained foreign body counts decreased after TeamSTEPPS implementation.

21 CFR 20.120 - Records available in Food and Drug Administration Public Reading Rooms.

Code of Federal Regulations, 2011 CFR

2011-04-01

... Public Reading Rooms. 20.120 Section 20.120 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF....120 Records available in Food and Drug Administration Public Reading Rooms. (a) The Food and Drug Administration operates two public reading rooms. The Freedom of Information Staff's Public Reading Room is...

21 CFR 20.120 - Records available in Food and Drug Administration Public Reading Rooms.

Code of Federal Regulations, 2010 CFR

2010-04-01

... Public Reading Rooms. 20.120 Section 20.120 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF....120 Records available in Food and Drug Administration Public Reading Rooms. (a) The Food and Drug Administration operates two public reading rooms. The Freedom of Information Staff's Public Reading Room is...

Low-temperature operation of a Buck DC/DC converter

NASA Technical Reports Server (NTRS)

Ray, Biswajit; Gerber, Scott S.; Patterson, Richard L.; Myers, Ira T.

1995-01-01

Low-temperature (77 K) operation of a 42/28 V, 175 W, 50 kHz PWM Buck DC/DC converter designed with commercially available components is reported. Overall, the converter losses decreased at 77 K compared to room temperature operation. A full-load efficiency of 97 percent was recorded at liquid-nitrogen temperature, compared to 95.8 percent at room temperature. Power MOSFET operation improved significantly where as the output rectifier operation deteriorated at low-temperature. The performance of the output filter inductor and capacitor did not change significantly at 77 K compared to room temperature performance. It is possible to achieve high-density and high efficiency power conversion at low-temperatures due to improved electronic, electrical and thermal properties of materials.

13. INTERIOR VIEW OF GATE OPERATOR ROOM, SHOWING UNFINISHED CONCRETE ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

13. INTERIOR VIEW OF GATE OPERATOR ROOM, SHOWING UNFINISHED CONCRETE WALLS AND SLIDE GATE OPERATORS, LOOKING NORTH. - Sacramento River Water Treatment Plant Intake Pier & Access Bridge, Spanning Sacramento River approximately 175 feet west of eastern levee on river; roughly .5 mile downstream from confluence of Sacramento & American Rivers, Sacramento, Sacramento County, CA

OR2020: The Operating Room of the Future

DTIC Science & Technology

2004-05-01

25 3.3 Technical Requirements: Standards and Tools for Improved Operating R oom Process Integration...Image processing and visualization tools must be made available to the operating room. 5. Communications issues must be addressed and aim toward...protocols for effectively performing advanced surgeries and using telecommunications-ready tools as needed. The following recommendations were made

76 FR 53714 - Notice of Request for the Approval of a New Information Collection

Federal Register 2010, 2011, 2012, 2013, 2014

2011-08-29

... Transportation, 1200 New Jersey Avenue, SE., Docket Operations, M-30, West Building, Ground Floor, Room W12- 140...., Docket Operations, M-30, West Building, Ground Floor, Room W12-140, Washington, DC 20590-0001 between 9 a... New Jersey Avenue, SE., Docket Operations, M-30, West Building, [[Page 53715

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

ERIC Educational Resources Information Center

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

2010-01-01

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

Comparison of three distinct surgical clothing systems for protection from air-borne bacteria: A prospective observational study

PubMed Central

2012-01-01

Background To prevent surgical site infection it is desirable to keep bacterial counts low in the operating room air during orthopaedic surgery, especially prosthetic surgery. As the air-borne bacteria are mainly derived from the skin flora of the personnel present in the operating room a reduction could be achieved by using a clothing system for staff made from a material fulfilling the requirements in the standard EN 13795. The aim of this study was to compare the protective capacity between three clothing systems made of different materials – one mixed cotton/polyester and two polyesters - which all had passed the tests according to EN 13795. Methods Measuring of CFU/m3 air was performed during 21 orthopaedic procedures performed in four operating rooms with turbulent, mixing ventilation with air flows of 755 – 1,050 L/s. All staff in the operating room wore clothes made from the same material during each surgical procedure. Results The source strength (mean value of CFU emitted from one person per second) calculated for the three garments were 4.1, 2.4 and 0.6 respectively. In an operating room with an air flow of 755 L/s both clothing systems made of polyester reduced the amount of CFU/m3 significantly compared to the clothing system made from mixed material. In an operating room with air intake of 1,050 L/s a significant reduction was only achieved with the polyester that had the lowest source strength. Conclusions Polyester has a better protective capacity than cotton/polyester. There is need for more discriminating tests of the protective efficacy of textile materials intended to use for operating garment. PMID:23068884

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

PubMed

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

2018-04-01

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 objective was to determine the incidence of adverse events related to technical equipment and logistics. The secondary objective was to evaluate the consequences of these adverse events. We completed a cross-sectional observational study to assess the incidence, consequences and preventability of adverse events related to technical equipment and logistics during orthopedic trauma surgery. During a 10 week period, all orthopedic trauma operations were evaluated by an observer. Six types of procedures were differentiated: osteosynthesis; arthroscopy; removal of hardware; joint replacement; bone grafting and other. Adverse events were divided in six categories: staff dependent factors; patient dependent factors; anaesthesia; imaging equipment; operation room equipment and instruments and implants. Adverse events were defined as any factor affecting the surgical procedure in a negative way. Hundred-fifty operative procedures were included. In 54% of the procedures, at least one adverse event occurred. In total, 147 adverse events occurred, with a range of 1-5 per procedure. Most adverse events occurred during joint replacement procedures. Thirty-seven percent of the incidents concerned defect, incorrect connected or absent instruments. In 36% of the procedures adverse events resulted in a prolonged operation time with a median prolongation of 10.0 min. In more than half of orthopedic trauma surgical procedures adverse events related to technical equipment and logistics occurred, most of them could easily be prevented. These adverse events could endanger the safety of the patient and staff and should therefore be reduced. 4.

Radiation exposure to eye lens and operator hands during endovascular procedures in hybrid operating rooms.

PubMed

Attigah, Nicolas; Oikonomou, Kyriakos; Hinz, Ulf; Knoch, Thomas; Demirel, Serdar; Verhoeven, Eric; Böckler, Dittmar

2016-01-01

The purpose of this study was to evaluate the radiation exposure of vascular surgeons' eye lens and fingers during complex endovascular procedures in modern hybrid operating rooms. Prospective, nonrandomized multicenter study design. One hundred seventy-one consecutive patients (138 male; median age, 72.5 years [interquartile range, 65-77 years]) underwent an endovascular procedure in a hybrid operating room between March 2012 and July 2013 in two vascular centers. The dose-area product (DAP), fluoroscopy time, operating time, and amount of contrast dye were registered prospectively. For radiation dose recordings, single-use dosimeters were attached at eye level and to the ring finger of the hand next to the radiation field of the operator for each endovascular procedure. Dose recordings were evaluated by an independent institution. Before the study, precursory investigations were obtained to simulate the radiation dose to eye lens and fingers with an Alderson phantome (RSD, Long Beach, Calif). Interventions were classified into six treatment categories: endovascular repair of infrarenal abdominal aneurysm (n = 65), thoracic endovascular aortic repair (n = 32), branched endovascular aortic repair for thoracoabdominal aneurysms (n = 17), fenestrated endovascular aortic repair for complex abdominal aortic aneurysm, (n = 25), iliac branched device (n = 8), and peripheral interventions (n = 24). There was a significant correlation in DAP between both lens (P < .01; r = 0.55) and finger (P < .01; r = 0.56) doses. The estimated fluoroscopy time to reach a radiation threshold of 20 mSv/y was 1404.10 minutes (90% confidence limit, 1160, 1650 minutes). According to correlation of the lens dose with the DAP an estimated cumulative DAP of 932,000 mGy/m(2) (90% confidence limit, 822,000, 1,039,000) would be critical for a threshold of 20 mSv/y for the eyes. Radiation protection is a serious issue for vascular surgeons because most complex endovascular procedures are delivering measurable radiation to the eyes. With the correlation of the DAP obtained in standard endovascular procedures a critical threshold of 20 mSv/y to the eyes can be predicted and thus an estimate of a potential harmful exposure to the eyes can be obtained. Copyright © 2016 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.

Practices and impacts post-exposure to blood and body fluid in operating room nurses: A cross-sectional study.

PubMed

Kasatpibal, Nongyao; Whitney, JoAnne D; Katechanok, Sadubporn; Ngamsakulrat, Sukanya; Malairungsakul, Benjawan; Sirikulsathean, Pinyo; Nuntawinit, Chutatip; Muangnart, Thanisara

2016-05-01

Improper or inadequate actions taken after blood and body fluid exposures place individuals at risk for infection with bloodborne pathogens. This has potential, significant impact for health and well-being. To evaluate the practices and the personal impact experienced following blood and body fluid exposures among operating room nurses. A cross-sectional, multi-center study. Government and private hospitals from all parts of Thailand. Operating room nurses from 247 hospitals. A questionnaire eliciting responses on characteristics, post-exposure practices, and impacts was sent to 2500 operating room nurses. Usable questionnaires were returned by 2031 operating room nurses (81.2%). Of these 1270 had experience with blood and body fluid exposures (62.5%). Most operating room nurses did not report blood and body fluid exposures (60.9%). The major reasons of underreporting were low risk source (40.2%) and belief that they were not important to report (16.3%). Improper post-exposure practices were identified, 9.8% did not clean exposure area immediately, 18.0% squeezed out the wound, and 71.1% used antiseptic solution for cleansing a puncture wound. Post-exposure, 58.5% of them sought counseling, 16.3% took antiretroviral prophylaxis, 23.8% had serologic testing for hepatitis B and 43.1% for hepatitis C. The main personal impacts were anxiety (57.7%), stress (24.2%), and insomnia (10.2%). High underreporting, inappropriate post-exposure practices and impacts of exposure were identified from this study. Comprehensive education and effective training of post-exposure management may be keys to resolving these important problems. Copyright © 2016 Elsevier Ltd. All rights reserved.

Routine intraoperative completion angiography after coronary artery bypass grafting and 1-stop hybrid revascularization results from a fully integrated hybrid catheterization laboratory/operating room.

PubMed

Zhao, David X; Leacche, Marzia; Balaguer, Jorge M; Boudoulas, Konstantinos D; Damp, Julie A; Greelish, James P; Byrne, John G; Ahmad, Rashid M; Ball, Stephen K; Cleator, John H; Deegan, Robert J; Eagle, Susan S; Fong, Pete P; Fredi, Joseph L; Hoff, Steven J; Jennings, Henry S; McPherson, John A; Piana, Robert N; Pretorius, Mias; Robbins, Mark A; Slosky, David A; Thompson, Annemarie

2009-01-20

This study sought to report our experience with a routine completion angiogram after coronary artery bypass surgery (CABG) and simultaneous (1-stop) percutaneous coronary intervention (PCI) at the time of CABG performed in the hybrid catheterization laboratory/operating room. The value of a routine completion angiogram after CABG and 1-stop hybrid CABG/PCI remains unresolved. Between April 2005 and July 2007, 366 consecutive patients underwent CABG surgery, with (n = 112) or without (n = 254) concomitant 1-stop PCI (hybrid), all with completion angiography before chest closure. Among the 112 1-stop hybrid CABG/PCI patients, 67 (60%) underwent a planned hybrid procedure based on pre-operative assessment, whereas 45 (40%) underwent open-chest PCI (unplanned hybrid) based on intraoperative findings. Among the 796 CABG grafts (345 left internal mammary artery, 12 right internal mammary artery/radial, and 439 veins), 97 (12%) angiographic defects were identified. Defects were repaired with either a minor adjustment of the graft (n = 22, 2.8%), with intraoperative open-chest PCI (unplanned hybrid, n = 48, 6%) or with traditional surgical revision (n = 27, 3.4%). Hybrid patients had clinical outcomes similar to standard CABG patients. Routine completion angiography detected 12% of grafts with important angiographic defects. One-stop hybrid coronary revascularization is reasonable, safe, and feasible. Combining the tools of the catheterization laboratory and operating room greatly enhances the options available to the surgeon and cardiologist for patients with complex coronary artery disease.

12. VIEW OF OPERATING ROOMRCA COMMUNICATION REC STATION (THIS ROOM ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

12. VIEW OF OPERATING ROOM-RCA COMMUNICATION REC STATION (THIS ROOM WAS ORIGINALLY A MOTOR GENERATOR FACILITY AND SUPPLIED DC POWER TO AN EARLIER GENERATION OF POINT-TO-POINT RECEIVERS ON SECOND FLOOR). VIEW SHOWS TRANSMITTER CONTROL STATION AND AUDIO CONTROL STATION (LEFT, WATKINS-JOHNSON WJ-8718-23. HP RECEIVERS AND KENWOOD R-5000 COMMUNICATIONS RECEIVERS (220 DEGREES). - Marconi Radio Sites, Receiving, Point Reyes Station, Marin County, CA

[The use of an opect optic system in neurosurgical practice].

PubMed

Kalinovskiy, A V; Rzaev, D A; Yoshimitsu, K

2018-01-01

Modern neurosurgical practice is impossible without access to various information sources. The use of MRI and MSCT data during surgery is an integral part of the neurosurgeon's daily practice. Devices capable of managing an image viewer system without direct contact with equipment simplify working in the operating room. To test operation of a non-contact MRI and MSCT image viewer system in the operating room and to evaluate the system effectiveness. An Opect non-contact image management system developed at the Tokyo Women's Medical University was installed in one of the operating rooms of the Novosibirsk Federal Center of Neurosurgery in 2014. In 2015, the Opect system was used by operating surgeons in 73 surgeries performed in the same operating room. The system effectiveness was analyzed based on a survey of surgeons. The non-contact image viewer system occurred to be easy-to-learn for the personnel to operate this system, easy-to-manage it, and easy-to-present visual information during surgery. Application of the Opect system simplifies work with neuroimaging data during surgery. The surgeon can independently view series of relevant MRI and MSCT scans without any assistance.

Reducing the anxiety of surgical patient's families access short message service.

PubMed

Huang, Fanpin; Liu, Shuo-Chi; Shih, Su-Mei; Tao, Yao-Hua; Wu, Jeng-Yuan; Jeng, Shaw-Yeu; Chang, Polun

2006-01-01

This study was to build a web-based short messaging service (SMS) system in operating room. We approached the efficiency of SMS for patient's families during the time series (pre-, intra-, and post-operation). In this study, 322 participants received 685 text messages. The findings show the usability of SMS that applied to the clinical care, especially for reducing family anxiety, improved their satisfaction. Therefore, it is suggested to exploit the effectiveness of personal medical care.

Image-guided surgery and therapy: current status and future directions

NASA Astrophysics Data System (ADS)

Peters, Terence M.

2001-05-01

Image-guided surgery and therapy is assuming an increasingly important role, particularly considering the current emphasis on minimally-invasive surgical procedures. Volumetric CT and MR images have been used now for some time in conjunction with stereotactic frames, to guide many neurosurgical procedures. With the development of systems that permit surgical instruments to be tracked in space, image-guided surgery now includes the use of frame-less procedures, and the application of the technology has spread beyond neurosurgery to include orthopedic applications and therapy of various soft-tissue organs such as the breast, prostate and heart. Since tracking systems allow image- guided surgery to be undertaken without frames, a great deal of effort has been spent on image-to-image and image-to- patient registration techniques, and upon the means of combining real-time intra-operative images with images acquired pre-operatively. As image-guided surgery systems have become increasingly sophisticated, the greatest challenges to their successful adoption in the operating room of the future relate to the interface between the user and the system. To date, little effort has been expended to ensure that the human factors issues relating to the use of such equipment in the operating room have been adequately addressed. Such systems will only be employed routinely in the OR when they are designed to be intuitive, unobtrusive, and provide simple access to the source of the images.

Thoracic robotics at the Heart Hospital Baylor Plano: the first 20 cases

PubMed Central

2012-01-01

A da Vinci Robotic Surgical System was purchased for The Heart Hospital Baylor Plano in fall 2011 and a program for robotic-assisted thoracic surgery commenced at the facility. Successive thoracic patients were offered and accepted a robotic-assisted operation. No patient was excluded because of age, height, weight, or comorbidities. The first 20 patients are summarized herein. Of the first 10 operations, only one was a lobectomy. As the program staff gained experience, seven of the latter 10 procedures were lobectomies. The average length of stay was 2.6 days (longest, 4 days). The average operating room time was 147 minutes overall and 200 minutes for lobectomies. The longest operating room time was 337 minutes in a patient who underwent a right middle lobectomy that was converted to a video-assisted thoracic surgery. Two patients developed atrial fibrillation, one of whom had a pacemaker and a history of paroxysmal atrial fibrillation. One patient developed a bronchopleural fistula on the first postoperative day, following a coughing episode. One patient was readmitted 6 days after hospital discharge with a pneumothorax, which was successfully treated with a small-bore catheter. In conclusion, robotic-assisted thoracic surgery has many advantages. Decreased complications can lead to improved outcomes, and hospitals can achieve cost savings as a result of reduced length of stay. PMID:23077378

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

NASA Technical Reports Server (NTRS)

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.

Laparoscopic resection for diverticular disease.

PubMed

Bruce, C J; Coller, J A; Murray, J J; Schoetz, D J; Roberts, P L; Rusin, L C

1996-10-01

The role of laparoscopic surgery in treatment of patients with diverticulitis is unclear. A retrospective comparison of laparoscopic with conventional surgery for patients with chronic diverticulitis was performed to assess morbidity, recovery from surgery, and cost. Records of patients undergoing elective resection for uncomplicated diverticulitis from 1992 to 1994 at a single institution were reviewed. Laparoscopic resection involved complete intracorporeal dissection, bowel division, and anastomosis with extracorporeal placement of an anvil. Sigmoid and left colon resections were performed laparoscopically in 25 patients and by open technique in 17 patients by two independent operating teams. No significant differences existed in age, gender, weight, comorbidities, or operations performed. In the laparoscopic group, three operations were converted to open laparotomy (12 percent) because of unclear anatomy. Major complications occurred in two patients who underwent laparoscopic resection, both requiring laparotomy, and in one patient in the conventional surgery group who underwent computed tomographic-guided drainage of an abscess. Patients who underwent laparoscopic resection tolerated a regular diet sooner than patients who underwent conventional surgery (3.2 +/- 0.9 vs. 5.7 +/- 1.1 days; P < 0.001) and were discharged from the hospital earlier (4.2 +/- 1.1 vs. 6.8 +/- 1.1 days; P < 0.001). Overall costs were higher in the laparoscopic group than the open surgery group ($10,230 +/- 49.1 vs. $7,068 +/- 37.1; P < 0.001) because of a significantly longer total operating room time (397 +/- 9.1 vs. 115 +/- 5.1 min; P < 0.001). Follow-up studies with a mean of one year revealed two port site infections in the laparoscopic group and one wound infection in the open group. Of patients undergoing conventional resection, one patient experienced a postoperative bowel obstruction that was managed nonoperatively, and, in one patient, an incarcerated incisional hernia developed that required urgent laparotomy. Laparoscopic resection in patients with chronic diverticulitis is safe, with faster recovery and shorter hospital stay compared with conventional open surgery. Higher cost of operating room usage time makes the laparoscopic technique difficult to justify economically. Simplification of operating room use and better case selection may improve cost-effectiveness of the laparoscopic approach.

Maximizing time from the constraining European Working Time Directive (EWTD): The Heidelberg New Working Time Model

PubMed Central

2014-01-01

Background The introduction of the European Working Time Directive (EWTD) has greatly reduced training hours of surgical residents, which translates into 30% less surgical and clinical experience. Such a dramatic drop in attendance has serious implications such compromised quality of medical care. As the surgical department of the University of Heidelberg, our goal was to establish a model that was compliant with the EWTD while avoiding reduction in quality of patient care and surgical training. Methods We first performed workload analyses and performance statistics for all working areas of our department (operation theater, emergency room, specialized consultations, surgical wards and on-call duties) using personal interviews, time cards, medical documentation software as well as data of the financial- and personnel-controlling sector of our administration. Using that information, we specifically designed an EWTD-compatible work model and implemented it. Results Surgical wards and operating rooms (ORs) were not compliant with the EWTD. Between 5 pm and 8 pm, three ORs were still operating two-thirds of the time. By creating an extended work shift (7:30 am-7:30 pm), we effectively reduced the workload to less than 49% from 4 pm and 8 am, allowing the combination of an eight-hour working day with a 16-hour on call duty; thus, maximizing surgical resident training and ensuring patient continuity of care while maintaining EDTW guidelines. Conclusion A precise workload analysis is the key to success. The Heidelberg New Working Time Model provides a legal model, which, by avoiding rotating work shifts, assures quality of patient care and surgical training. PMID:25984433

Physical-layer encryption on the public internet: A stochastic approach to the Kish-Sethuraman cipher

NASA Astrophysics Data System (ADS)

Gunn, Lachlan J.; Chappell, James M.; Allison, Andrew; Abbott, Derek

2014-09-01

While information-theoretic security is often associated with the one-time pad and quantum key distribution, noisy transport media leave room for classical techniques and even covert operation. Transit times across the public internet exhibit a degree of randomness, and cannot be determined noiselessly by an eavesdropper. We demonstrate the use of these measurements for information-theoretically secure communication over the public internet.

Compact wearable dual-mode imaging system for real-time fluorescence image-guided surgery

PubMed Central

Zhu, Nan; Huang, Chih-Yu; Mondal, Suman; Gao, Shengkui; Huang, Chongyuan; Gruev, Viktor; Achilefu, Samuel; Liang, Rongguang

2015-01-01

Abstract. A wearable all-plastic imaging system for real-time fluorescence image-guided surgery is presented. The compact size of the system is especially suitable for applications in the operating room. The system consists of a dual-mode imaging system, see-through goggle, autofocusing, and auto-contrast tuning modules. The paper will discuss the system design and demonstrate the system performance. PMID:26358823

A Miracle That Accelerates Operating Room Functionality: Sugammadex

PubMed Central

Dogan, Erdal; Akdemir, Mehmet Salim; Guzel, Abdulmenap; Yildirim, Mehmet Besir; Baysal Yildirim, Zeynep; Kuyumcu, Mahir; Gümüş, Abdurrahman; Akelma, Hakan

2014-01-01

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. PMID:25202709

A Protocol for a Prospective Study of Pregnancy Outcomes of Operating Room Nurses and Nurse Anesthetists Occupationally Exposed to Waste Anesthetic Gases as Compared to Psychiatric Nurses in the United States Air Force.

DTIC Science & Technology

1980-06-01

PROSPECTIVE STUDY OF PREGNANCY’ OUTCOMES OF OPERATING ROOM NURSES AND NURSE ANESTHETISTS OCCUPATIONALLY EXPOSED TO WASTE ANESTHETIC GASES AS COMPARED O TO...tionally Exposed to Waste Anesthetic Gases 6 Pt NFONMING 0 i REP"ORT NUMBER as Cor - p4~~ oP ciar~_Njssi Ruth L. Nancarrow 9 PERFONMtNG OI-GANIZATION...human factors involved in the control of waste anesthetic gases in the operating room; Lt. Colonel Phyllis Goins, Chief, Educa- tional Methodology

Applications for a hybrid operating room in thoracic surgery: from multidisciplinary procedures to ­­image-guided video-assisted thoracoscopic surgery

PubMed Central

Terra, Ricardo Mingarini; Andrade, Juliano Ribeiro; Mariani, Alessandro Wasum; Garcia, Rodrigo Gobbo; Succi, Jose Ernesto; Soares, Andrey; Zimmer, Paulo Marcelo

2016-01-01

ABSTRACT The concept of a hybrid operating room represents the union of a high-complexity surgical apparatus with state-of-the-art radiological tools (ultrasound, CT, fluoroscopy, or magnetic resonance imaging), in order to perform highly effective, minimally invasive procedures. Although the use of a hybrid operating room is well established in specialties such as neurosurgery and cardiovascular surgery, it has rarely been explored in thoracic surgery. Our objective was to discuss the possible applications of this technology in thoracic surgery, through the reporting of three cases. PMID:27812640

Optimizing Anesthesia-Related Waste Disposal in the Operating Room: A Brief Report.

PubMed

Hubbard, Richard M; Hayanga, Jeremiah A; Quinlan, Joseph J; Soltez, Anita K; Hayanga, Heather K

2017-10-01

Misappropriation of noncontaminated waste into regulated medical waste (RMW) containers is a source of added expense to health care facilities. The operating room is a significant contributor to RMW waste production. This study sought to determine whether disposing of anesthesia-related waste in standard waste receptacles before patient entry into the operating room would produce a reduction in RMW. A median of 0.35 kg of waste was collected from 51 cases sampled, with a potential annual reduction of 13,800 kg of RMW to the host institution, and a cost savings of $2200.

Determining high touch areas in the operating room with levels of contamination.

PubMed

Link, Terri; Kleiner, Catherine; Mancuso, Mary P; Dziadkowiec, Oliwier; Halverson-Carpenter, Katherine

2016-11-01

The Centers for Disease Control and Prevention put forth the recommendation to clean areas considered high touch more frequently than minimal touch surfaces. The operating room was not included in these recommendations. The purpose of this study was to determine the most frequently touched surfaces in the operating room and their level of contamination. Phase 1 was a descriptive study to identify high touch areas in the operating room. In phase 2, high touch areas determined in phase 1 were cultured to determine if high touch areas observed were also highly contaminated and if they were more contaminated than a low touch surface. The 5 primary high touch surfaces in order were the anesthesia computer mouse, OR bed, nurse computer mouse, OR door, and anesthesia medical cart. Using the OR light as a control, this study demonstrated that a low touch area was less contaminated than the high touch areas with the exception of the OR bed. Based on information and data collected in this study, it is recommended that an enhanced cleaning protocol be established based on the most frequently touched surfaces in the operating room. Copyright © 2016 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

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

PubMed

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

2011-01-01

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

Operators in the Plum Brook Reactor Facility Control Room

NASA Image and Video Library

1970-03-21

Donald Rhodes, left, and Clyde Greer, right, monitor the operation of the National Aeronautics and Space Administration’s (NASA) Plum Brook Reactor Facility from the control room. The 60-megawatt test reactor, NASA’s only reactor, was the eighth largest test reactor in the world. The facility was built by the Lewis Research Center in the late 1950s to study the effects of radiation on different materials that could be used to construct nuclear propulsion systems for aircraft or rockets. The reactor went critical for the first time in 1961. For the next two years, two operators were on duty 24 hours per day working on the fission process until the reactor reached its full-power level in 1963. Reactor Operators were responsible for monitoring and controlling the reactor systems. Once the reactor was running under normal operating conditions, the work was relatively uneventful. Normally the reactor was kept at a designated power level within certain limits. Occasionally the operators had to increase the power for a certain test. The shift supervisor and several different people would get together and discuss the change before boosting the power. All operators were required to maintain a Reactor Operator License from the Atomic Energy Commission. The license included six months of training, an eight-hour written exam, a four-hour walkaround, and testing on the reactor controls.

Technical Note: Mobile accelerator guidance using an optical tracker during docking in IOERT procedures.

PubMed

Marinetto, Eugenio; Victores, Juan González; García-Sevilla, Mónica; Muñoz, Mercedes; Calvo, Felipe Ángel; Balaguer, Carlos; Desco, Manuel; Pascau, Javier

2017-10-01

Intraoperative electron radiation therapy (IOERT) involves the delivery of a high radiation dose during tumor resection in a shorter time than other radiation techniques, thus improving local control of tumors. However, a linear accelerator device is needed to produce the beam safely. Mobile linear accelerators have been designed as dedicated units that can be moved into the operating room and deliver radiation in situ. Correct and safe dose delivery is a key concern when using mobile accelerators. The applicator is commonly fixed to the patient's bed to ensure that the dose is delivered to the prescribed location, and the mobile accelerator is moved to dock the applicator to the radiation beam output (gantry). In a typical clinical set-up, this task is time-consuming because of safety requirements and the limited degree of freedom of the gantry. The objective of this study was to present a navigation solution based on optical tracking for guidance of docking to improve safety and reduce procedure time. We used an optical tracker attached to the mobile linear accelerator to track the prescribed localization of the radiation collimator inside the operating room. Using this information, the integrated navigation system developed computes the movements that the mobile linear accelerator needs to perform to align the applicator and the radiation gantry and warns the physician if docking is unrealizable according to the available degrees of freedom of the mobile linear accelerator. Furthermore, we coded a software application that connects all the necessary functioning elements and provides a user interface for the system calibration and the docking guidance. The system could safeguard against the spatial limitations of the operating room, calculate the optimal arrangement of the accelerator and reduce the docking time in computer simulations and experimental setups. The system could be used to guide docking with any commercial linear accelerator. We believe that the docking navigator we present is a major contribution to IOERT, where docking is critical when attempting to reduce surgical time, ensure patient safety and guarantee that the treatment administered follows the radiation oncologist's prescription. © 2017 American Association of Physicists in Medicine.

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

PubMed

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.

Informatics in radiology: use of a C-arm fluoroscopy simulator to support training in intraoperative radiography.

PubMed

Bott, Oliver Johannes; Dresing, Klaus; Wagner, Markus; Raab, Björn-Werner; Teistler, Michael

2011-01-01

Mobile image intensifier systems (C-arms) are used frequently in orthopedic and reconstructive surgery, especially in trauma and emergency settings, but image quality and radiation exposure levels may vary widely, depending on the extent of the C-arm operator's knowledge and experience. Current training programs consist mainly of theoretical instruction in C-arm operation, the physical foundations of radiography, and radiation avoidance, and are largely lacking in hands-on application. A computer-based simulation program such as that tested by the authors may be one way to improve the effectiveness of C-arm training. In computer simulations of various scenarios commonly encountered in the operating room, trainees using the virtX program interact with three-dimensional models to test their knowledge base and improve their skill levels. Radiographs showing the simulated patient anatomy and surgical implants are "reconstructed" from data computed on the basis of the trainee's positioning of models of a C-arm, patient, and table, and are displayed in real time on the desktop monitor. Trainee performance is signaled in real time by color graphics in several control panels and, on completion of the exercise, is compared in detail with the performance of an expert operator. Testing of this computer-based training program in continuing medical education courses for operating room personnel showed an improvement in the overall understanding of underlying principles of intraoperative radiography performed with a C-arm, with resultant higher image quality, lower overall radiation exposure, and greater time efficiency. Supplemental material available at http://radiographics.rsna.org/lookup/suppl/doi:10.1148/rg.313105125/-/DC1. Copyright © RSNA, 2011.

Spectral purity and tunability of terahertz quantum cascade laser sources based on intracavity difference-frequency generation.

PubMed

Consolino, Luigi; Jung, Seungyong; Campa, Annamaria; De Regis, Michele; Pal, Shovon; Kim, Jae Hyun; Fujita, Kazuue; Ito, Akio; Hitaka, Masahiro; Bartalini, Saverio; De Natale, Paolo; Belkin, Mikhail A; Vitiello, Miriam Serena

2017-09-01

Terahertz sources based on intracavity difference-frequency generation in mid-infrared quantum cascade lasers (THz DFG-QCLs) have recently emerged as the first monolithic electrically pumped semiconductor sources capable of operating at room temperature across the 1- to 6-THz range. Despite tremendous progress in power output, which now exceeds 1 mW in pulsed and 10 μW in continuous-wave regimes at room temperature, knowledge of the major figure of merits of these devices for high-precision spectroscopy, such as spectral purity and absolute frequency tunability, is still lacking. By exploiting a metrological grade system comprising a terahertz frequency comb synthesizer, we measure, for the first time, the free-running emission linewidth (LW), the tuning characteristics, and the absolute center frequency of individual emission lines of these sources with an uncertainty of 4 × 10 -10 . The unveiled emission LW (400 kHz at 1-ms integration time) indicates that DFG-QCLs are well suited to operate as local oscillators and to be used for a variety of metrological, spectroscopic, communication, and imaging applications that require narrow-LW THz sources.

Microbial Load in Septic and Aseptic Procedure Rooms.

PubMed

Harnoss, Julian-Camill; Assadian, Ojan; Diener, Markus Karl; Müller, Thomas; Baguhl, Romy; Dettenkofer, Markus; Scheerer, Lukas; Kohlmann, Thomas; Heidecke, Claus-Dieter; Gessner, Stephan; Büchler, Markus Wolfgang; Kramer, Axel

2017-07-10

Highly effective measures to prevent surgical wound infections have been established over the last two decades. We studied whether the strict separation of septic and aseptic procedure rooms is still necessary. In an exploratory, prospective observational study, the microbial concentration in an operating room without a room ventilating system (RVS) was analyzed during 16 septic and 14 aseptic operations with the aid of an air sampler (50 cm and 1 m from the operative field) and sedimentation plates (1 m from the operative field, and contact culture on the walls). The means and standard deviations of the microbial loads were compared with the aid of GEE models (generalized estimation equations). In the comparison of septic and aseptic operations, no relevant differences were found with respect to the overall microbial concentration in the room air (401.7 ± 176.3 versus 388.2 ± 178.3 CFU/m 3 ; p = 0.692 [CFU, colony-forming units]) or sedimentation 1 m from the operative field (45.3 ± 22.0 versus 48.7 ± 18.5 CFU/m 2 /min; p = 0.603) and on the walls (35.7 ± 43.7 versus 29.0 ± 49.4 CFU/m 2 /min; p = 0.685). The only relevant differences between the microbial spectra associated with the two types of procedure were a small amount of sedimentation of Escherichia coli and Enterococcus faecalis in septic operations, and of staphylococcus aureus and pseudomonas stutzeri in aseptic operations, up to 30 minutes after the end of the procedure. These data do not suggest that septic and aseptic procedure rooms need to be separated. In interpreting the findings, one should recall that the study was not planned as an equivalence or non-inferiority study. Wherever patient safety is concerned, high-level safety concepts should only be demoted to lower levels if new and convincing evidence becomes available.

49 CFR 195.446 - Control room management.

Code of Federal Regulations, 2010 CFR

2010-10-01

... written control room management procedures that implement the requirements of this section. The procedures... define the roles and responsibilities of a controller during normal, abnormal, and emergency operating... operator must define each of the following: (1) A controller's authority and responsibility to make...

Planning for operating room efficiency and faster anesthesia wake-up time in open major upper abdominal surgery.

PubMed

Lai, Hou-Chuan; Chan, Shun-Ming; Lu, Chueng-He; Wong, Chih-Shung; Cherng, Chen-Hwan; Wu, Zhi-Fu

2017-02-01

Reducing anesthesia-controlled time (ACT) may improve operation room (OR) efficiency result from different anesthetic techniques. However, the information about the difference in ACT between desflurane (DES) anesthesia and propofol-based total intravenous anesthesia (TIVA) techniques for open major upper abdominal surgery under general anesthesia (GA) is not available in the literature.This retrospective study uses our hospital database to analyze the ACT of open major upper abdominal surgery without liver resection after either desflurane/fentanyl-based anesthesia or TIVA via target-controlled infusion with fentanyl/propofol from January 2010 to December 2011. The various time intervals including waiting for anesthesia time, anesthesia time, surgical time, extubation time, exit from OR after extubation, total OR time, and postanesthetic care unit (PACU) stay time and percentage of prolonged extubation (≥15 minutes) were compared between these 2 anesthetic techniques.We included data from 343 patients, with 159 patients receiving TIVA and 184 patients receiving DES. The only significant difference is extubation time, TIVA was faster than the DES group (8.5 ± 3.8 vs 9.4 ± 3.7 minutes; P = 0.04). The factors contributed to prolonged extubation were age, gender, body mass index, DES anesthesia, and anesthesia time.In our hospital, propofol-based TIVA by target-controlled infusion provides faster emergence compared with DES anesthesia; however, it did not improve OR efficiency in open major abdominal surgery. Older, male gender, higher body mass index, DES anesthesia, and lengthy anesthesia time were factors that contribute to extubation time.

A strategy to decide whether to move the last case of the day in an operating room to another empty operating room to decrease overtime labor costs.

PubMed

Dexter, F

2000-10-01

We examined how to program an operating room (OR) information system to assist the OR manager in deciding whether to move the last case of the day in one OR to another OR that is empty to decrease overtime labor costs. We first developed a statistical strategy to predict whether moving the case would decrease overtime labor costs for first shift nurses and anesthesia providers. The strategy was based on using historical case duration data stored in a surgical services information system. Second, we estimated the incremental overtime labor costs achieved if our strategy was used for moving cases versus movement of cases by an OR manager who knew in advance exactly how long each case would last. We found that if our strategy was used to decide whether to move cases, then depending on parameter values, only 2.0 to 4.3 more min of overtime would be required per case than if the OR manager had perfect retrospective knowledge of case durations. The use of other information technologies to assist in the decision of whether to move a case, such as real-time patient tracking information systems, closed-circuit cameras, or graphical airport-style displays can, on average, reduce overtime by no more than only 2 to 4 min per case that can be moved. The use of other information technologies to assist in the decision of whether to move a case, such as real-time patient tracking information systems, closed-circuit cameras, or graphical airport-style displays, can, on average, reduce overtime by no more than only 2 to 4 min per case that can be moved.

Operating room fire prevention: creating an electrosurgical unit fire safety device.

PubMed

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 < 0.0001). The exact 95% confidence interval for absolute risk reduction of 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.

Multiple video sequences synchronization during minimally invasive surgery

NASA Astrophysics Data System (ADS)

Belhaoua, Abdelkrim; Moreau, Johan; Krebs, Alexandre; Waechter, Julien; Radoux, Jean-Pierre; Marescaux, Jacques

2016-03-01

Hybrid operating rooms are an important development in the medical ecosystem. They allow integrating, in the same procedure, the advantages of radiological imaging and surgical tools. However, one of the challenges faced by clinical engineers is to support the connectivity and interoperability of medical-electrical point-of-care devices. A system that could enable plug-and-play connectivity and interoperability for medical devices would improve patient safety, save hospitals time and money, and provide data for electronic medical records. In this paper, we propose a hardware platform dedicated to collect and synchronize multiple videos captured from medical equipment in real-time. The final objective is to integrate augmented reality technology into an operation room (OR) in order to assist the surgeon during a minimally invasive operation. To the best of our knowledge, there is no prior work dealing with hardware based video synchronization for augmented reality applications on OR. Whilst hardware synchronization methods can embed temporal value, so called timestamp, into each sequence on-the-y and require no post-processing, they require specialized hardware. However the design of our hardware is simple and generic. This approach was adopted and implemented in this work and its performance is evaluated by comparison to the start-of-the-art methods.

Full immersion simulation: validation of a distributed simulation environment for technical and non-technical skills training in Urology.

PubMed

Brewin, James; Tang, Jessica; Dasgupta, Prokar; Khan, Muhammad S; Ahmed, Kamran; Bello, Fernando; Kneebone, Roger; Jaye, Peter

2015-07-01

To evaluate the face, content and construct validity of the distributed simulation (DS) environment for technical and non-technical skills training in endourology. To evaluate the educational impact of DS for urology training. DS offers a portable, low-cost simulated operating room environment that can be set up in any open space. A prospective mixed methods design using established validation methodology was conducted in this simulated environment with 10 experienced and 10 trainee urologists. All participants performed a simulated prostate resection in the DS environment. Outcome measures included surveys to evaluate the DS, as well as comparative analyses of experienced and trainee urologist's performance using real-time and 'blinded' video analysis and validated performance metrics. Non-parametric statistical methods were used to compare differences between groups. The DS environment demonstrated face, content and construct validity for both non-technical and technical skills. Kirkpatrick level 1 evidence for the educational impact of the DS environment was shown. Further studies are needed to evaluate the effect of simulated operating room training on real operating room performance. This study has shown the validity of the DS environment for non-technical, as well as technical skills training. DS-based simulation appears to be a valuable addition to traditional classroom-based simulation training. © 2014 The Authors BJU International © 2014 BJU International Published by John Wiley & Sons Ltd.

Example of cost calculations for an operating room and a post-anaesthesia care unit.

PubMed

Raft, J; Millet, F; Meistelman, C

2015-08-01

The aim of this study was to evaluate the cost of an operating room using data from our hospital. Using an accounting-based method helped us. Over the year 2012, the sum of direct and indirect expenses with cost sharing expenses allowed us to calculate the cost of the operating room (OR) and of the post-anaesthesia care unit (PACU). The cost of the OR and PACU was €10.8 per minute of time offered. Two thirds of the direct expenses were allocated to surgery and one third to anaesthesia. Indirect expenses were 25% of the direct expenses. The cost of medications and single use medical devises was €111.45 per anaesthesia. The total cost of anaesthesia (taking into account wages and indirect expenses) was €753.14 per anaesthesia as compared to the total cost of the anaesthesia. The part of medications and single use devices for anaesthesia was 14.8% of the total cost. Despite the difficulties facing cost evaluation, this model of calculation, assisted by the cost accounting controller, helped us to have a concrete financial vision. It also shows that a global reflexion is necessary during financial decision-making. Copyright © 2015 Société française d’anesthésie et de réanimation (Sfar). Published by Elsevier Masson SAS. All rights reserved.

[Environmental hygiene of the surgery suites for the control of surgical wound infection: Italian legislation and international guidelines].

PubMed

Charrier, L; Castella, A; Di Legami, V; Pastorino, F; Farina, E C; Argentero, P A; Zotti, C M

2006-01-01

Aim of the study is to describe the application of surgical site infection (SSI) control procedures in general surgery operating rooms of Piedmont region hospitals. A specific data collection form was designed to record information. 54 questionnaires were compiled. Piedmont legislation related to operating rooms' equipment is obeyed in more than 90% of hospitals. Nevertheless, there are some critical aspects than could be risk factors for SSI or that are not useful in order to prevent them: use of UV radiation (11.3%), use of tacky mats at the entrance of the operating room (5.7%), special cleaning of operating rooms after contaminated or dirty operations (73.6%) and routine environmental sampling (10%) that is strongly recommended by ISPESL guideline in disagreement with international recommendations. Steam autoclave is used for surgical instruments sterilization by 100% of hospitals, but only 50% of them performs an annual validation of both autoclave performance and sterilization procedures. The study gave useful information in order to promote some structural modifications and personnel education for efficacious SSI prevention and control.

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

NASA Astrophysics Data System (ADS)

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

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

Compliance with clothing regulations and traffic flow in the operating room: a multi-centre study of staff discipline during surgical procedures.

PubMed

Loison, G; Troughton, R; Raymond, F; Lepelletier, D; Lucet, J-C; Avril, C; Birgand, G

2017-07-01

This multi-centre study assessed operating room (OR) staff compliance with clothing regulations and traffic flow during surgical procedures. Of 1615 surgical attires audited, 56% respected the eight clothing measures. Lack of compliance was mainly due to inappropriate wearing of jewellery (26%) and head coverage (25%). In 212 procedures observed, a median of five people [interquartile range (IQR) 4-6] were present at the time of incision. The median frequency of entries to/exits from the OR was 10.6/h (IQR 6-29) (range 0-93). Reasons for entries to/exits from the OR were mainly to obtain materials required in the OR (N=364, 44.5%). ORs with low compliance with clothing regulations tended to have higher traffic flows, although the difference was not significant (P=0.12). Copyright © 2017 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.

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

PubMed

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.

Heat-sink free CW operation of injection microdisk lasers grown on Si substrate with emission wavelength beyond 1.3  μm.

PubMed

Kryzhanovskaya, Natalia; Moiseev, Eduard; Polubavkina, Yulia; Maximov, Mikhail; Kulagina, Marina; Troshkov, Sergey; Zadiranov, Yury; Guseva, Yulia; Lipovskii, Andrey; Tang, Mingchu; Liao, Mengya; Wu, Jiang; Chen, Siming; Liu, Huiyun; Zhukov, Alexey

2017-09-01

High-performance injection microdisk (MD) lasers grown on Si substrate are demonstrated for the first time, to the best of our knowledge. Continuous-wave (CW) lasing in microlasers with diameters from 14 to 30 μm is achieved at room temperature. The minimal threshold current density of 600  A/cm 2 (room temperature, CW regime, heatsink-free uncooled operation) is comparable to that of high-quality MD lasers on GaAs substrates. Microlasers on silicon emit in the wavelength range of 1320-1350 nm via the ground state transition of InAs/InGaAs/GaAs quantum dots. The high stability of the lasing wavelength (dλ/dI=0.1  nm/mA) and the low specific thermal resistance of 4×10 -3 °C×cm 2 /W are demonstrated.

Laparoscopic versus robotic-assisted Roux-en-Y gastric bypass: a retrospective, single-center study of early perioperative outcomes at a community hospital.

PubMed

Ahmad, Arif; Carleton, Jared D; Ahmad, Zoha F; Agarwala, Ashish

2016-09-01

The purpose of this study was to compare the operative and early perioperative outcomes of laparoscopic versus robotic-assisted Roux-en-Y gastric bypass procedures performed in a community hospital setting. The study was a chart review and analysis of the early perioperative outcomes of a total of 345 Roux-en-Y gastric bypass procedures performed by a single surgeon in a community hospital setting from January 2011 to October 2014. Of these, 173 procedures were performed laparoscopically and 172 were performed with robotic assistance utilizing the daVinci(®) surgical platform. Factors such as baseline patient characteristics, operative time, estimated blood loss (EBL), conversions to open procedure, complication rates, adverse events, length of stay (LOS), and return to the operating room for the two groups were retrospectively analyzed from a prospectively maintained database. Student's t test with unequal variances was used for statistical analysis, and a p value <0.05 was used for significance. There were no statistically significant differences in complication rates, EBL, or LOS between the two groups. There was a significant difference between the total operative times (135.30 ± 37.60 min for the laparoscopic procedure versus 154.84 ± 38.44 min for the robotic procedure, p < 0.05). There were no adverse intraoperative events, conversions to open procedures, leaks, strictures, returns to the operating room within 30 days, or mortalities in either group. Our study, which is the first of its kind to analyze the operative and early perioperative outcomes between laparoscopic and robotic-assisted Roux-en-Y gastric bypass procedures in the US community hospital setting, indicates that both are comparable in terms of safety, efficacy, and operative and early perioperative outcomes.

Engine Research Building’s Central Control Room

NASA Image and Video Library

1948-07-21

Operators in the Engine Research Building’s Central Control Room at the National Advisory Committee for Aeronautics (NACA) Lewis Flight Propulsion Laboratory. The massive 4.25-acre Engine Research Building contains dozens of test cells, test stands, and altitude chambers. A powerful collection of compressors and exhausters located in the central portion of the basement provided process air and exhaust for these test areas. This system is connected to similar process air systems in the laboratory’s other large test facilities. The Central Control Room coordinates this activity and communicates with the local utilities. This photograph was taken just after a major upgrade to the control room in 1948. The panels on the wall contain rudimentary floor plans of the different Engine Research Building sections with indicator lights and instrumentation for each test cell. The process air equipment included 12 exhausters, four compressors, a refrigeration system, cooling water, and an exhaust system. The operators in the control room kept in contact with engineers running the process air system and those conducting the tests in the test cells. The operators also coordinated with the local power companies to make sure enough electricity was available to operate the powerful compressors and exhausters.

Conceptual Inquiry of the Space Shuttle and International Space Station GNC Flight Controllers

NASA Technical Reports Server (NTRS)

Kranzusch, Kara

2007-01-01

The concept of Mission Control was envisioned by Christopher Columbus Kraft in the 1960's. Instructed to figure out how to operate human space flight safely, Kraft envisioned a room of sub-system experts troubleshooting problems and supporting nominal flight activities under the guidance of one Flight Director who is responsible for the success of the mission. To facilitate clear communication, MCC communicates with the crew through a Capsule Communicator (CAPCOM) who is an astronaut themselves. Gemini 4 was the first mission to be supported by such a MCC and successfully completed the first American EVA. The MCC seen on television is called the Flight Control Room (FCR, pronounced ficker) or otherwise known as the front room. While this room is the most visible aspect, it is a very small component of the entire control center. The Shuttle FCR is known as the White FCR (WFCR) and Station's as FCR-1. (FCR-1 was actually the first FCR built at JSC which was used through the Gemini, Apollo and Shuttle programs until the WFCR was completed in 1992. Afterwards FCR-1 was refurbished first for the Life Sciences Center and then for the ISS in 2006.) Along with supporting the Flight Director, each FCR operator is also the supervisor for usually two or three support personnel in a back room called the Multi-Purpose Support Room (MPSR, pronounced mipser). MPSR operators are more deeply focused on their specific subsystems and have the responsible to analyze patterns, and diagnose and assess consequences of faults. The White MPSR (WMPSR) operators are always present for Shuttle operations; however, ISS FCR controllers only have support from their Blue MPSR (BMPSR) while the Shuttle is docked and during critical operations. Since ISS operates 24-7, the FCR team reduces to a much smaller Gemini team of 4-5 operators for night and weekend shifts when the crew is off-duty. The FCR is also supported by the Mission Evaluation Room (MER) which is a collection of contractor engineers who provide analysis and long-term troubleshooting support. Each MER operator is an expert in a very small portion of a sub-system and each FCR console usually interfaces with several MER positions.

Treatment of chronic subdural hematomas with subdural evacuating port system placement in the intensive care unit: evolution of practice and comparison with bur hole evacuation in the operating room.

PubMed

Flint, Alexander C; Chan, Sheila L; Rao, Vivek A; Efron, Allen D; Kalani, Maziyar A; Sheridan, William F

2017-12-01

OBJECTIVE The aims of this study were to evaluate a multiyear experience with subdural evacuating port system (SEPS) placement for chronic subdural hematoma (cSDH) in the intensive care unit at a tertiary neurosurgical center and to compare SEPS placement with bur hole evacuation in the operating room. METHODS All cases of cSDH evacuation were captured over a 7-year period at a tertiary neurosurgical center within an integrated health care delivery system. The authors compared the performance characteristics of SEPS and bur hole placement with respect to recurrence rates, change in recurrence rates over time, complications, length of stay, discharge disposition, and mortality rates. RESULTS A total of 371 SEPS cases and 659 bur hole cases were performed (n = 1030). The use of bedside SEPS placement for cSDH treatment increased over the 7-year period, from 14% to 80% of cases. Reoperation within 6 months was higher for the SEPS (15.6%) than for bur hole drainage (9.1%) across the full 7-year period (p = 0.002). This observed overall difference was due to a higher rate of reoperation during the same hospitalization (7.0% for SEPS vs 3.2% for bur hole; p = 0.008). Over time, as the SEPS procedure became more common and modifications of the SEPS technique were introduced, the rate of in-hospital reoperation after SEPS decreased to 3.3% (p = 0.02 for trend), and the difference between SEPS and bur hole recurrence was no longer significant (p = 0.70). Complications were uncommon and were similar between the groups. CONCLUSIONS Overall performance characteristics of bedside SEPS and bur hole drainage in the operating room were similar. Modifications to the SEPS technique over time were associated with a reduced reoperation rate.

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

PubMed

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.

[Hybrid operating room: For what?

PubMed

Benoit, M; Bouvier, A; Bigot, P

2017-11-01

Hybrid operating rooms (HOR) are rooms that mix interventional radiology and surgical equipments. They are usually used in heart, vascular, orthopedic and neurosurgery, and make it possible to consider new minimally invasive procedures in urology. Thanks to these, we developed a new partial nephrectomy technique without renal pedicle clamping and without ischemia. Renal cancer is now diagnosed at localized stage in most of the cases, and its treatment is mostly based on nephron sparing surgery. However, the hemorrhagic character of this intervention requires a renal pedicle clamping whose long-term consequences on renal function are discussed. It also exposes to a classical complication: the renal artery pseudoaneurysm. Therefore, we developed a new laparoscopic partial nephrectomy technique without clamping or approach of renal pedicle, by a selective embolization of tumor vessels through an endovascular route, immediately before the surgery. HOR allowed the combination of the two procedures in the same time and space unit. Tumor staining by Bleu Patenté also aids the surgeon in its spotting. HOR allow a new approach in localized renal cancer management, and should be used in many other urologic surgeries in years to come. They represent a technological advancement by combining interventional radiologists and surgeons' expertise. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

Housing and testing in mixed-sex rooms increases motivation and accuracy during operant testing in both male and female mice.

PubMed

Lloyd, Kelsey R; Yaghoubi, Sarah K; Makinson, Ryan A; McKee, Sarah E; Reyes, Teresa M

2018-04-01

Operant behavior tasks are widely used in neuroscience research, but little is known about how variables such as housing and testing conditions affect rodent operant performance. We have previously observed differences in operant performance in male and female mice depending on whether mice were housed and tested in rooms containing only one sex versus rooms containing both sexes. Here, male and female mice in either single-sex or mixed sex housing rooms were trained on fixed ratio 1 (FR1) and progressive ratio (PR) tasks. For both sexes, animals in the mixed sex room had more accurate performance in FR1 and were more motivated in the PR task. We then moved the single sex housed animals to the mixed sex room and vice versa. Animals that started in mixed sex housing had no change to PR, but both sexes who started in single sex housing were more motivated after the switch. Additionally, the females that moved into single-sex housing performed less accurately in FR1. We conclude that housing and testing conditions can affect performance on FR1 and PR tasks. As these tasks are commonly used as training steps to more complex tasks, housing and testing conditions should be carefully considered during experiment design and reported in publications. Copyright © 2018 Elsevier Inc. All rights reserved.

The addition of a regional block team to the orthopedic operating rooms does not improve anesthesia-controlled times and turnover time in the setting of long turnover times.

PubMed

Eappen, Sunil; Flanagan, Hugh; Lithman, Rachel; Bhattacharyya, Neil

2007-03-01

To determine whether a regional block team with a dedicated space for performance of regional anesthetics would decrease turnover time and shorten the working day in a busy orthopedic practice with lengthy turnover times. Prospective, randomized study. Tertiary-care teaching hospital. 927 orthopedic procedures over a three-month period. The randomized placement of a regional block team to the orthopedic operating room (OR) suite. We evaluated the differences in anesthesia-controlled times, first-case start times, turnover times, and OR end times using a computerized OR information system. We also surveyed the surgeons regarding their perceptions of changes in turnover time and anesthesia-controlled times during the study period. Standard descriptive statistics were computed. Of a total of 927 cases, 398 cases were cared for by a regional block team and 529 cases received care in the usual manner, with the OR team providing the regional block. There was no difference between the study and control groups for on-time, first-case starts (57.73% vs 42.27%), induction time (13.2 vs 14.2 min), emergence time (8.1 vs 9.0 min), turnover time (70.3 vs 77.8 min), and OR end times. Most of the surgeons surveyed felt that the regional block team reduced turnover time significantly. A regional block team in this environment does not reduce anesthesia-controlled times and turnover times in an orthopedic OR suite with long turnover times, and it would be virtually impossible to recover the associated extra cost. The surgeons' perspective of turnover time is inaccurate.

Comfort in High-Performance Homes in a Hot-Humid Climate

DOE Office of Scientific and Technical Information (OSTI.GOV)

Poerschke, A.; Beach, R.

2016-01-22

"9IBACOS monitored 37 homes during the late summer and early fall of 2014 in a hot and humid climate to better understand indoor comfort conditions. These homes were constructed in the last several years by four home builders that offered a comfort and performance guarantee for the homes. The homes were located in one of four cities: Tampa, Florida; Orlando, Florida; Houston, Texas; and San Antonio, Texas. Temperature and humidity data were collected from the thermostat and each room of the house using small, battery-powered data loggers. To understand system runtime and its impact on comfort, supply air temperature alsomore » was measured on a 1-minute interval. Overall, the group of homes only exceeded a room-to-room temperature difference of 6 degrees F for 5% of the time. For 80% of the time, the rooms in each house were within 4 degrees F of each other. Additionally, the impact of system runtime on comfort is discussed. Finally, measurements made at the thermostat were used to better understand the occupant operation of each cooling system's thermostat setpoint. Builders were questioned on their perceived impact of offering a comfort and performance guarantee. Their feedback, which generally indicates a positive perception, has been summarized in the report.« less

Effect of air-conditioner on fungal contamination

NASA Astrophysics Data System (ADS)

Hamada, Nobuo; Fujita, Tadao

Air-conditioners (AC) produce much dew and wet conditions inside their apparatus, when in operation. We studied the fungal contamination in AC and found that the average fungal contamination of AC filters was about 5-fold greater than that of a carpet, and Cladosporium and Penicillium were predominant in AC filters. The fungal contamination inside AC, which were used everyday, increased more markedly than those not used daily, e.g. a few days per week or rarely. Moreover, the airborne fungal contamination in rooms during air-conditioning was about 2-fold greater than one in rooms without AC, and was highest when air-conditioning started and decreased gradually with time. We recognized that the airborne fungal contamination was controlled by the environmental condition of the rooms, in which AC were used. It is suggested that AC might promote mold allergies in users via airborne fungal spores derived from the AC. On the other hand, AC was estimated to remove moisture in the room atmosphere and carpets, and reduce the relative humidity in rooms. It was found that the average fungal contamination in the house dust of carpets with AC was suppressed by two-third of that in rooms without AC. The use of AC for suppressing fungal hazards was discussed.

Preliminary Investigation of Time Remaining Display on the Computer-based Emergency Operating Procedure

NASA Astrophysics Data System (ADS)

Suryono, T. J.; Gofuku, A.

2018-02-01

One of the important thing in the mitigation of accidents in nuclear power plant accidents is time management. The accidents should be resolved as soon as possible in order to prevent the core melting and the release of radioactive material to the environment. In this case, operators should follow the emergency operating procedure related with the accident, in step by step order and in allowable time. Nowadays, the advanced main control rooms are equipped with computer-based procedures (CBPs) which is make it easier for operators to do their tasks of monitoring and controlling the reactor. However, most of the CBPs do not include the time remaining display feature which informs operators of time available for them to execute procedure steps and warns them if the they reach the time limit. Furthermore, the feature will increase the awareness of operators about their current situation in the procedure. This paper investigates this issue. The simplified of emergency operating procedure (EOP) of steam generator tube rupture (SGTR) accident of PWR plant is applied. In addition, the sequence of actions on each step of the procedure is modelled using multilevel flow modelling (MFM) and influenced propagation rule. The prediction of action time on each step is acquired based on similar case accidents and the Support Vector Regression. The derived time will be processed and then displayed on a CBP user interface.

[Preventive measures for drug addiction in the middle scale hospital--our challenge for ideal drug management system in the operating rooms].

PubMed

Nakasuji, Masato; Tanaka, Masuji; Imanaka, Norie; Kawashima, Hiroko; Asada, Akira

2007-09-01

Drug addiction of doctors has become social problems recently due to inappropriate drug management system in the operating theater. It goes without saying that we must behave ourselves as doctors. In addition, current drug management system should be improved and all drugs stocked in the operating theater should be counted by pharmacists after surgery. Kansai Denryoku Hospital with four hundred beds started new drug management system in December 2005. Drug sets for each surgical patient in the cart are delivered from the pharmacy every morning. A drug set is carried to the each operating room by an anesthesiologist or a nurse and they write down administered drugs in the document after surgery. Pharmacists collect the drug cart the following morning and check each drug set and document in the pharmacy. All drugs can not be carried out from the operating theater without permission, and anesthesiologists and nurses do not have to spend too much time on drug management. Extra one hour is needed for pharmacists to check the drug set in the pharmacy. We consider that our new drug management system can substitute a satellite pharmacy, which is recognized currently as ideal drug management system in the operating theater, in the middle scale hospitals without enough pharmacists assigned exclusively to the operating theater.

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

PubMed

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.

Case-control study of surgical site infections associated with pacemakers and implantable cardioverter-defibrillators.

PubMed

Marschall, Jonas; Hopkins-Broyles, Diane; Jones, Marilyn; Fraser, Victoria J; Warren, David K

2007-11-01

In 2000, the rate of surgical site infections (SSIs) associated with pacemaker and implantable cardioverter-defibrillator (ICD) procedures performed in the cardiothoracic operating rooms of hospital A was 16% (19 of 116 procedures resulted in infections). This study investigates risks for SSI associated with these procedures in the cardiothoracic operating room. Unmatched 1 : 3 case-control study performed over a 12-month period among patients who had undergone implantation of a pacemaker and/or ICD. A standardized observation scrutinized infection control practices in the area where the procedures were performed. The cardiothoracic operating rooms of hospital A, which belongs to a hospital consortium in the midwestern United States. Patients with SSI were identified as case patients. Control patients were chosen from the group of uninfected patients who had procedures performed during the same period as case patients. A total of 19 SSIs associated with pacemaker and ICD procedures were retrospectively identified among the patients who underwent procedures in these cardiothoracic operating rooms. Culture samples were obtained from 7 patients; 2 yielded coagulase-negative Staphylococcus on culture, 2 yielded Staphylococcus aureus, 1 yielded Serratia marcescens, and 2 showed no growth. In the case-control study, age, race, sex, diabetes mellitus, smoking history, timing of antibiotic therapy, and hair removal did not differ significantly between case patients and control patients. Case patients were more likely to have an abdominal device in place (odds ratio [OR], 5.5 [95% confidence interval {CI}, 1.6-19.3]; P=.006) and less likely to have received a new implant (OR 0.3 [95% CI, 0.1-0.8]; P=.02) or to have had new leads placed (OR, 0.2 [95% CI, 0.1-0.6]; P=.003). Abdominal placement of implanted devices was associated with occurrence of an SSI after pacemaker and/or ICD procedures.

Clean room technology in surgery suites

NASA Technical Reports Server (NTRS)

1971-01-01

The principles of clean room technology and the criteria for their application to surgery are discussed. The basic types of surgical clean rooms are presented along with their advantages and disadvantages. Topics discussed include: microbiology of surgery suites; principles of laminar airflow systems, and their use in surgery; and asepsis and the operating room.

Microbiological aspects of clean room technology as applied to surgery, with special reference to unidirectional airflow systems

NASA Technical Reports Server (NTRS)

Wardle, M. D.

1974-01-01

The microbiological aspects of clean room technology as applied to surgery were reviewed. The following pertinent subject areas were examined: (1) clean room technology per se and its utilization for surgery, (2) microbiological monitoring of the clean room surgical environment, (3) clean rooms and their impact on operating room environmental microbiology, and (4) the effect of the technology on surgical wound infection rates. Conclusions were drawn for each topic investigated.

High-quality remote interactive imaging in the operating theatre

NASA Astrophysics Data System (ADS)

Grimstead, Ian J.; Avis, Nick J.; Evans, Peter L.; Bocca, Alan

2009-02-01

We present a high-quality display system that enables the remote access within an operating theatre of high-end medical imaging and surgical planning software. Currently, surgeons often use printouts from such software for reference during surgery; our system enables surgeons to access and review patient data in a sterile environment, viewing real-time renderings of MRI & CT data as required. Once calibrated, our system displays shades of grey in Operating Room lighting conditions (removing any gamma correction artefacts). Our system does not require any expensive display hardware, is unobtrusive to the remote workstation and works with any application without requiring additional software licenses. To extend the native 256 levels of grey supported by a standard LCD monitor, we have used the concept of "PseudoGrey" where slightly off-white shades of grey are used to extend the intensity range from 256 to 1,785 shades of grey. Remote access is facilitated by a customized version of UltraVNC, which corrects remote shades of grey for display in the Operating Room. The system is successfully deployed at Morriston Hospital, Swansea, UK, and is in daily use during Maxillofacial surgery. More formal user trials and quantitative assessments are being planned for the future.

A patient who was burned in the operative field: a case report.

PubMed

Chung, Soo Ho; Lee, Hae Hyeog; Kim, Tae Hee; Kim, Jeong Sig

2012-05-01

Operating room fires occur very rarely. Nevertheless, a disaster can complicate almost any kind of surgery. The majority of operating room fires result from the use of alcohol- based surgical preparation solutions, electro-surgical equipment, or flammable drapes in an oxygen-rich environment. We report a patient with an ovarian cyst and uterine myomas who suffered a flame burn while undergoing gynecological surgery.

Looking east along the operating deck above the intake toward ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

Looking east along the operating deck above the intake toward the Main Control Room. An evaporative-cooling system is to the left of the Control Room, and a motor-operated, geared trolly hoist and rake for removing debris from the trash rack is in the foreground - Wellton-Mohawk Irrigation System, Pumping Plant No. 1, Bounded by Gila River & Union Pacific Railroad, Wellton, Yuma County, AZ

Mobile gastrointestinal and endoscopic surgery in rural Ecuador: 20 years' experience of Cinterandes.

PubMed

Shalabi, H T; Price, M D; Shalabi, S T; Rodas, E B; Vicuña, A L; Guzhñay, B; Price, R R; Rodas, E

2017-12-01

Five billion people worldwide do not have timely access to surgical care. Cinterandes is one of the only mobile surgical units in low- and middle-income countries. This paper examines the methodology that Cinterandes uses to deliver mobile surgery. Founding and core staff were interviewed, four missions were participated in, and internal documents and records were analysed between 1 May and 1 July 2014. Cinterandes performed 7641 operations over the last 20 years (60% gastrointestinal/laparoscopic), travelling 300,000 km to remote areas of Ecuador. The mobile surgery programme was initiated by a local Ecuadorian surgeon in 1980. Funding was acquired from businesses, private hospitals, and individuals, to fund a low-cost surgical truck, simple equipment, and running costs. The mobile surgical unit is a 24-foot modified Isuzu truck containing a preparation room with general equipment storage and running water, together with an operating room including the operating table, anaesthetic and surgical equipment. Mission structure includes: patient identification by a network of local medical personnel in remote regions; pre-operative assessment at 1 week by core team via teleconsultations; four-day surgical missions; post-operative recovery in tents or a local clinic; post-operative follow-up care by local personnel and remote teleconsultations. The permanent core team includes seven members; lead surgeon, lead anaesthetist, operating-room technician, medical coordinator, driver, general coordinator, and receptionist. Additional support members include seven regular surgeons, residents, medical students, and volunteers. Surgery is a very effective way to gain the trust of the community, due to immediate results. Trust opens doors to other programmes (e.g. family medicine). Surgery can be incorporated with all other aspects of health care, which can in turn be incorporated with all other aspects of human development, education, food production and nutrition, housing, work and productivity, communication, and recreation.

Intrahospital teleradiology from the emergency room

NASA Astrophysics Data System (ADS)

Fuhrman, Carl R.; Slasky, B. S.; Gur, David; Lattner, Stefanie; Herron, John M.; Plunkett, Michael B.; Towers, Jeffrey D.; Thaete, F. Leland

1993-09-01

Off-hour operations of the modern emergency room presents a challenge to conventional image management systems. To assess the utility of intrahospital teleradiology systems from the emergency room (ER), we installed a high-resolution film digitizer which was interfaced to a central archive and to a workstation at the main reading room. The system was designed to allow for digitization of images as soon as the films were processed. Digitized images were autorouted to both destinations, and digitized images could be laser printed (if desired). Almost real time interpretations of nonselected cases were performed at both locations (conventional film in the ER and a workstation in the main reading room), and an analysis of disagreements was performed. Our results demonstrate that in spite of a `significant' difference in reporting, `clinically significant differences' were found in less than 5% of cases. Folder management issues, preprocessing, image orientation, and setting reasonable lookup tables for display were identified as the main limitations to the systems' routine use in a busy environment. The main limitation of the conventional film was the identification of subtle abnormalities in the bright regions of the film. Once identified on either system (conventional film or soft display), all abnormalities were visible and detectable on both display modalities.

The impact of preventable disruption on the operative time for minimally invasive surgery.

PubMed

Al-Hakim, Latif

2011-10-01

Current ergonomic studies show that disruption exposes surgical teams to stress and musculoskeletal disorders. This study considers minimally invasive surgery as a sociotechnical process subjected to a variety of disruption events other than those recognized by ergonomic science. The research takes into consideration the impact of preventable disruption on operating time rather than on the physical and emotional status of the surgical team. Events inside operating rooms that disturbed operative time were recorded for 17 minimally invasive surgeries. The disruption events were classified into four main areas: prerequisite requirements, work design, communication during surgery, and other. Each area was further classified according to sources of disruption. Altogether, 11 sources of disruption were identified: patient record, protocol and policy, surgical requirements and surgeon preferences, operating table and patient positioning, arrangement of instruments, lighting, monitor, clothing, surgical teamwork, coordination, and other. Disruption prolonged operative time by more than 32%. Teamwork forms the main source of disruption followed by operating table and patient positioning and arrangement of instruments. These three sources represented approximately 20% of operative time. Failure to follow principles of work design had a significant negative impact, lengthening operative time by approximately 15%. Although lighting and monitors had a relatively small impact on operative time, these factors could create inconvenience and stress within the surgical teams. In addition, the effect of failure to follow surgical protocols and policies or having incomplete patient records may have a limited effect on operative time but could have serious consequences. This report demonstrates that preventable disruption caused an increase in operative time and forced surgeons and patients to endure unnecessary delay of more than 32%. Such additional time could be used to deal with the pressure of emergency cases and to reduce waiting lists for elective surgery.

Shared-resource computing for small research labs.

PubMed

Ackerman, M J

1982-04-01

A real time laboratory computer network is described. This network is composed of four real-time laboratory minicomputers located in each of four division laboratories and a larger minicomputer in a centrally located computer room. Off the shelf hardware and software were used with no customization. The network is configured for resource sharing using DECnet communications software and the RSX-11-M multi-user real-time operating system. The cost effectiveness of the shared resource network and multiple real-time processing using priority scheduling is discussed. Examples of utilization within a medical research department are given.

Intra-operative label-free multimodal multiphoton imaging of breast cancer margins and microenvironment (Conference Presentation)

NASA Astrophysics Data System (ADS)

Sun, Yi; You, Sixian; Tu, Haohua; Spillman, Darold R.; Marjanovic, Marina; Chaney, Eric J.; Liu, George Z.; Ray, Partha S.; Higham, Anna; Boppart, Stephen A.

2017-02-01

Label-free multi-photon imaging has been a powerful tool for studying tissue microstructures and biochemical distributions, particularly for investigating tumors and their microenvironments. However, it remains challenging for traditional bench-top multi-photon microscope systems to conduct ex vivo tumor tissue imaging in the operating room due to their bulky setups and laser sources. In this study, we designed, built, and clinically demonstrated a portable multi-modal nonlinear label-free microscope system that combined four modalities, including two- and three- photon fluorescence for studying the distributions of FAD and NADH, and second and third harmonic generation, respectively, for collagen fiber structures and the distribution of micro-vesicles found in tumors and the microenvironment. Optical realignments and switching between modalities were motorized for more rapid and efficient imaging and for a light-tight enclosure, reducing ambient light noise to only 5% within the brightly lit operating room. Using up to 20 mW of laser power after a 20x objective, this system can acquire multi-modal sets of images over 600 μm × 600 μm at an acquisition rate of 60 seconds using galvo-mirror scanning. This portable microscope system was demonstrated in the operating room for imaging fresh, resected, unstained breast tissue specimens, and for assessing tumor margins and the tumor microenvironment. This real-time label-free nonlinear imaging system has the potential to uniquely characterize breast cancer margins and the microenvironment of tumors to intraoperatively identify structural, functional, and molecular changes that could indicate the aggressiveness of the tumor.

Microorganisms in Confined Habitats: Microbial Monitoring and Control of Intensive Care Units, Operating Rooms, Cleanrooms and the International Space Station

PubMed Central

Mora, Maximilian; Mahnert, Alexander; Koskinen, Kaisa; Pausan, Manuela R.; Oberauner-Wappis, Lisa; Krause, Robert; Perras, Alexandra K.; Gorkiewicz, Gregor; Berg, Gabriele; Moissl-Eichinger, Christine

2016-01-01

Indoor environments, where people spend most of their time, are characterized by a specific microbial community, the indoor microbiome. Most indoor environments are connected to the natural environment by high ventilation, but some habitats are more confined: intensive care units, operating rooms, cleanrooms and the international space station (ISS) are extraordinary living and working areas for humans, with a limited exchange with the environment. The purposes for confinement are different: a patient has to be protected from infections (intensive care unit, operating room), product quality has to be assured (cleanrooms), or confinement is necessary due to extreme, health-threatening outer conditions, as on the ISS. The ISS represents the most secluded man-made habitat, constantly inhabited by humans since November 2000 – and, inevitably, also by microorganisms. All of these man-made confined habitats need to be microbiologically monitored and controlled, by e.g., microbial cleaning and disinfection. However, these measures apply constant selective pressures, which support microbes with resistance capacities against antibiotics or chemical and physical stresses and thus facilitate the rise of survival specialists and multi-resistant strains. In this article, we summarize the available data on the microbiome of aforementioned confined habitats. By comparing the different operating, maintenance and monitoring procedures as well as microbial communities therein, we emphasize the importance to properly understand the effects of confinement on the microbial diversity, the possible risks represented by some of these microorganisms and by the evolution of (antibiotic) resistances in such environments – and the need to reassess the current hygiene standards. PMID:27790191

Microorganisms in Confined Habitats: Microbial Monitoring and Control of Intensive Care Units, Operating Rooms, Cleanrooms and the International Space Station.

PubMed

Mora, Maximilian; Mahnert, Alexander; Koskinen, Kaisa; Pausan, Manuela R; Oberauner-Wappis, Lisa; Krause, Robert; Perras, Alexandra K; Gorkiewicz, Gregor; Berg, Gabriele; Moissl-Eichinger, Christine

2016-01-01

Indoor environments, where people spend most of their time, are characterized by a specific microbial community, the indoor microbiome. Most indoor environments are connected to the natural environment by high ventilation, but some habitats are more confined: intensive care units, operating rooms, cleanrooms and the international space station (ISS) are extraordinary living and working areas for humans, with a limited exchange with the environment. The purposes for confinement are different: a patient has to be protected from infections (intensive care unit, operating room), product quality has to be assured (cleanrooms), or confinement is necessary due to extreme, health-threatening outer conditions, as on the ISS. The ISS represents the most secluded man-made habitat, constantly inhabited by humans since November 2000 - and, inevitably, also by microorganisms. All of these man-made confined habitats need to be microbiologically monitored and controlled, by e.g., microbial cleaning and disinfection. However, these measures apply constant selective pressures, which support microbes with resistance capacities against antibiotics or chemical and physical stresses and thus facilitate the rise of survival specialists and multi-resistant strains. In this article, we summarize the available data on the microbiome of aforementioned confined habitats. By comparing the different operating, maintenance and monitoring procedures as well as microbial communities therein, we emphasize the importance to properly understand the effects of confinement on the microbial diversity, the possible risks represented by some of these microorganisms and by the evolution of (antibiotic) resistances in such environments - and the need to reassess the current hygiene standards.

Ropivacaine for unilateral spinal anesthesia; hyperbaric or hypobaric?

PubMed

Cantürk, Mehmet; Kılcı, Oya; Ornek, Dilşen; Ozdogan, Levent; Pala, Yasar; Sen, Ozlem; Dikmen, Bayazit

2012-01-01

The aim of this study was to compare the unilaterality of subarachnoid block achieved with hyperbaric and hypobaric ropivacaine. The prospective, randomized trial was conducted in an orthopedics surgical suite. In all, 60 ASA I-III patients scheduled for elective total knee arthroplasty were included in the study. Group Hypo (n=30) received 11.25mg of ropivacaine (7.5mg.mL(-1)) + 2mL of distilled water (density at room temperature was 0.997) and group Hyper (n=30) received 11.25mg of ropivacaine (7.5mg.mL(-1)) + 2mL (5mg.mL(-1)) of dextrose (density at room temperature was 1,015). Patients in the hyperbaric group were positioned with the operated side down and in the 15° Fowler position, versus those in the hypobaric group with the operated side facing up and in the 15° Trendelenburg position. Combined spinal epidural anesthesia was performed midline at the L(3-4) lumbar interspace. Hemodynamic and spinal block parameters, regression time, success of unilateral spinal anesthesia, patient comfort, surgical comfort, surgeon comfort, first analgesic requirement time, and adverse effects were assessed. Time to reach the T10 dermatome level on the operated side was shorter in group Hyper (612.00±163.29s) than in group Hypo (763.63±208.35s) (p<0.05). Time to 2-segment regression of the sensory block level on both the operated and non-operated sides was shorter in group Hypo than in group Hyper. Both hyperbaric and hypobaric ropivacaine (11.25mg) provided adequate and dependable anesthesia for total knee replacement surgery, with a high level of patient and surgeon comfort. Hypobaric local anesthetic solutions provide a high level of unilateral anesthesia, with rapid recovery of both sensory and motor block, and therefore may be preferable in outpatient settings. Copyright © 2012 Elsevier Editora Ltda. All rights reserved.

Determinants, associations, and psychometric properties of resident assessments of anesthesiologist operating room supervision.

PubMed

Hindman, Bradley J; Dexter, Franklin; Kreiter, Clarence D; Wachtel, Ruth E

2013-06-01

A study by de Oliveira Filho et al. reported a validated set of 9 questions by which Brazilian anesthesia residents assessed faculty supervision in the operating room. The aim of this study was to use this question set to determine whether faculty operating room supervision scores were associated with residents' year of clinical anesthesia training and/or number of specific resident-faculty interactions. We also characterized associations between faculty operating room supervision scores and resident assessments of: (1) faculty supervision in settings other than operating rooms, (2) faculty clinical ability (family choice), and (3) faculty teaching effectiveness. Finally, we characterized the psychometric properties of the de Oliveira Filho etal. question set in an United States anesthesia residency program. All 39 residents in the Department of Anesthesia of the University of Iowa in their first (n = 14), second (n = 13), or third (n = 12) year of clinical anesthesia training evaluated the supervision provided by all anesthesia faculty who staffed in at least 1 of 3 clinical settings (operating room [n = 49], surgical intensive care unit [n = 10], pain clinic [n = 6]). For all resident-faculty pairs, departmental billing data were used to quantitate the number of resident-faculty interactions and the interval between the last interaction and the assessment. A generalizability study was performed to determine the minimum number of resident evaluations needed for high reliability and dependability. There were no significant associations between faculty mean operating room supervision scores and: (1) resident-faculty patient encounters (Kendall τb = 0.01; 95% confidence interval [CI], -0.02 to +0.04; P = 0.71), (2) resident-faculty days of interaction (τb = -0.01; 95% CI, -0.05 to +0.02; P = 0.46), and (3) days since last resident-faculty interaction (τb = 0.01; 95% CI, -0.02 to 0.05; P = 0.49). Supervision scores for the operating room and surgical intensive care unit were highly correlated (τb = 0.71; 95% CI, 0.63 to 0.78; P < 0.0001). Supervision scores for the operating room also were highly correlated with family choice scores (τb = 0.77; 95% CI, 0.70 to 0.84; P < 0.0001) and teaching scores (τb = 0.87; 95% CI, 0.82 to 0.92; P < 0.0001). High reliability and dependability (both G- and ϕ-coefficients > 0.80) occurred when individual faculty anesthesiologists received assessments from 15 or more different residents. Supervision scores provided by all residents can be given equal weight when calculating an individual faculty anesthesiologist's mean supervision score. Assessments of supervision, teaching, and quality of clinical care are highly correlated. When the de Oliveira Filho et al. question set is used in a United States anesthesia residency program, supervision scores are highly reliable and dependable when at least 15 residents assess each faculty.

77 FR 44113 - Airworthiness Directives; Gulfstream Aerospace LP (Type Certificate Previously Held by Israel...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-07-27

... for comments. SUMMARY: We are adopting a new airworthiness directive (AD) for certain Gulfstream.... This AD requires a one-time detailed or borescope inspection of the left- and right-hand inboard vent... Transportation, Docket Operations, M-30, West Building Ground Floor, Room W12-140, 1200 New Jersey Avenue SE...

Resident Autonomy in the Operating Room: How Faculty Assess Real-time Entrustability.

PubMed

Chen, Xiaodong Phoenix; Sullivan, Amy M; Smink, Douglas S; Alseidi, Adnan; Bengtson, Joan M; Kwakye, Gifty; Dalrymple, John L

2018-02-20

This study aimed to identify the empirical processes and evidence that expert surgical teachers use to determine whether to take over certain steps or entrust the resident with autonomy to proceed during an operation. Assessing real-time entrustability is inherent in attending surgeons' determinations of residents' intraoperative autonomy in the operating room. To promote residents' autonomy, it is necessary to understand how attending surgeons evaluate residents' performance and support opportunities for independent practice based on the assessment of their entrustability. We conducted qualitative semi-structured interviews with 43 expert surgical teachers from 21 institutions across 4 regions of the United States, using purposeful and snowball sampling. Participants represented a range of program types, program size, and clinical expertise. We applied the Framework Method of content analysis to iteratively analyze interview transcripts and identify emergent themes. We identified a 3-phase process used by most expert surgical teachers in determining whether to take over intraoperatively or entrust the resident to proceed, including 1) monitoring performance and "red flags," 2) assessing entrustability, and 3) granting autonomy. Factors associated with individual surgeons (eg, level of comfort, experience, leadership role) and the context (eg, patient safety, case, and time) influenced expert surgical teachers' determinations of entrustability and residents' final autonomy. Expert surgical teachers' 3-phase process of decisions on take-over provides a potential framework that may help surgeons identify appropriate opportunities to develop residents' progressive autonomy by engaging the resident in the determination of entrustability before deciding to take over.

Perceptions, training experiences, and preferences of surgical residents toward laparoscopic simulation training: a resident survey.

PubMed

Shetty, Shohan; Zevin, Boris; Grantcharov, Teodor P; Roberts, Kurt E; Duffy, Andrew J

2014-01-01

Simulation training for surgical residents can shorten learning curves, improve technical skills, and expedite competency. Several studies have shown that skills learned in the simulated environment are transferable to the operating room. Residency programs are trying to incorporate simulation into the resident training curriculum to supplement the hands-on experience gained in the operating room. Despite the availability and proven utility of surgical simulators and simulation laboratories, they are still widely underutilized by surgical trainees. Studies have shown that voluntary use leads to minimal participation in a training curriculum. Although there are several simulation tools, there is no clear evidence of the superiority of one tool over the other in skill acquisition. The purpose of this study was to explore resident perceptions, training experiences, and preferences regarding laparoscopic simulation training. Our goal was to profile resident participation in surgical skills simulation, recognize potential barriers to voluntary simulator use, and identify simulation tools and tasks preferred by residents. Furthermore, this study may help to inform whether mandatory/protected training time, as part of the residents' curriculum is essential to enhance participation in the simulation laboratory. A cross-sectional study on general surgery residents (postgraduate years 1-5) at Yale University School of Medicine and the University of Toronto via an online questionnaire was conducted. Overall, 67 residents completed the survey. The institutional review board approved the methods of the study. Overall, 95.5% of the participants believed that simulation training improved their laparoscopic skills. Most respondents (92.5%) perceived that skills learned during simulation training were transferrable to the operating room. Overall, 56.7% of participants agreed that proficiency in a simulation curriculum should be mandatory before operating room experience. The simulation laboratory was most commonly used during work hours; lack of free time during work hours was most commonly cited as a reason for underutilization. Factors influencing use of the simulation laboratory in order of importance were the need for skill development, an interest in minimally invasive surgery, mandatory/protected time in a simulation environment as part of the residency program curriculum, a recommendation by an attending surgeon, and proximity of the simulation center. The most preferred simulation tool was the live animal model followed by cadaveric tissue. Virtual reality simulators were among the least-preferred (25%) simulation tools. Most residents (91.0%) felt that mandatory/protected time in a simulation environment should be introduced into resident training protocols. Mandatory and protected time in a simulation environment as part of the resident training curriculum may improve participation in simulation training. A comprehensive curriculum, which includes the use of live animals, cadaveric tissue, and virtual reality simulators, may enhance the laparoscopic training experience and interest level of surgical trainees. Copyright © 2014 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

Potential Operating Room Fire Hazard of Bone Cement.

PubMed

Sibia, Udai S; Connors, Kevin; Dyckman, Sarah; Zahiri, Hamid R; George, Ivan; Park, Adrian E; MacDonald, James H

Approximately 600 cases of operating room (OR) fires are reported annually. Despite extensive fire safety education and training, complete elimination of OR fires still has not been achieved. Each fire requires an ignition source, a fuel source, and an oxidizer. In this case report, we describe the potential fire hazard of bone cement in the OR. A total knee arthroplasty was performed with a standard medial parapatellar arthrotomy. Tourniquet control was used. After bone cement was applied to the prepared tibial surface, the surgeon used an electrocautery device to resect residual lateral meniscus tissue-and started a fire in the operative field. The surgeon suffocated the fire with a dry towel and prevented injury to the patient. We performed a PubMed search with a cross-reference search for relevant papers and found no case reports outlining bone cement as a potential fire hazard in the OR. To our knowledge, this is the first case report identifying bone cement as a fire hazard. OR fires related to bone cement can be eliminated by correctly assessing the setting time of the cement and avoiding application sites during electrocautery.

Health-hazard evaluation report HETA 87-063-1808, Presbyterian Day Surgery Center, Albuquerque, New Mexico

DOE Office of Scientific and Technical Information (OSTI.GOV)

Daniels, W.J.; Gunter, B.

1987-07-01

In response to a request from employees to evaluate exposures to waste anesthetic gases and vapors at the Presbyterian Day Surgery Unit, located in Albuquerque, New Mexico, personal and area air-sampling and leak-detection testing was carried out for nitrous oxide (N/sub 2/O) and halogenated anesthetic agents in the six operating rooms at the facility. Nitrous oxide concentrations ranged from not detectable to 95 parts per million (ppm) with a mean of 20ppm. Five of the samples exceeded the NIOSH limit of 25ppm for N/sub 2/O during anesthetic administration. Ethrane levels in 14 personal and area air samples ranged from lessmore » than the limit of detection to 3.63ppm with a mean of 0.31ppm. Isoflurane and halothane were below the limits of detection. The ventilation system in use changed the air in excess of 20 times per hour. However, during a portion of surgical procedures the system was not operating, resulting in a higher than normal exposure level in three of the operating rooms.« less

78 FR 73744 - Airworthiness Directives; The Boeing Company Airplanes

Federal Register 2010, 2011, 2012, 2013, 2014

2013-12-09

.... Mail: U.S. Department of Transportation, Docket Operations, M-30, West Building Ground Floor, Room W12... Transportation, Docket Operations, M-30, West Building Ground Floor, Room W12-140, 1200 New Jersey Avenue SE... information identified in this proposed AD, contact Boeing Commercial Airplanes, Attention: Data & Services...

62. (Credit CBF) Operating floor of filter room, c1912. The ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

62. (Credit CBF) Operating floor of filter room, c1912. The remodeled New York horizontal pressure filters (now gravity filters) are in the foreground; the remodelled Hyatt tub filters are in the background. - McNeil Street Pumping Station, McNeil Street & Cross Bayou, Shreveport, Caddo Parish, LA

46 CFR 69.121 - Engine room deduction.

Code of Federal Regulations, 2011 CFR

2011-10-01

... necessary for the safe operation and maintenance of the propelling machinery, the entire space, or, if... machinery space is not bulkheaded off or is larger than necessary for the safe operation and maintenance of... room deduction is either a percentage of the vessel's total propelling machinery spaces or a percentage...

A Foot Operated Timeout Room Door Latch.

ERIC Educational Resources Information Center

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)

An empirical examination of the impacts of decentralized nursing unit design.

PubMed

Pati, Debajyoti; Harvey, Thomas E; Redden, Pamela; Summers, Barbara; Pati, Sipra

2015-01-01

The objective of the study was to examine the impact of decentralization on operational efficiency, staff well-being, and teamwork on three inpatient units. Decentralized unit operations and the corresponding physical design solution were hypothesized to positively affect several concerns-productive use of nursing time, staff stress, walking distances, and teamwork, among others. With a wide adoption of the concept, empirical evidence on the impact of decentralization was warranted. A multimethod, before-and-after, quasi-experimental design was adopted for the study, focusing on five issues, namely, (1) how nurses spend their time, (2) walking distance, (3) acute stress, (4) productivity, and (5) teamwork. Data on all five issues were collected on three older units with centralized operational model (before move). The same set of data, with identical tools and measures, were collected on the same units after move in to new physical units with decentralized operational model. Data were collected during spring and fall of 2011. Documentation, nurse station use, medication room use, and supplies room use showed consistent change across the three units. Walking distance increased (statistically significant) on two of the three units. Self-reported level of collaboration decreased, although assessment of the physical facility for collaboration increased. Decentralized nursing and physical design models potentially result in quality of work improvements associated with documentation, medication, and supplies. However, there are unexpected consequences associated with walking, and staff collaboration and teamwork. The solution to the unexpected consequences may lie in operational interventions and greater emphasis on culture change. © The Author(s) 2015.

Room temperature sterilization of surfaces and fabrics with a one atmosphere uniform glow discharge plasma.

PubMed

Kelly-Wintenberg, K; Montie, T C; Brickman, C; Roth, J R; Carr, A K; Sorge, K; Wadsworth, L C; Tsai, P P

1998-01-01

We report the results of an interdisciplinary collaboration formed to assess the sterilizing capabilities of the One Atmosphere Uniform Glow Discharge Plasma (OAUGDP). This newly-invented source of glow discharge plasma (the fourth state of matter) is capable of operating at atmospheric pressure in air and other gases, and of providing antimicrobial active species to surfaces and workpieces at room temperature as judged by viable plate counts. OAUGDP exposures have reduced log numbers of bacteria, Staphylococcus aureus and Escherichia coli, and endospores from Bacillus stearothermophilus and Bacillus subtilis on seeded solid surfaces, fabrics, filter paper, and powdered culture media at room temperature. Initial experimental data showed a two-log10 CFU reduction of bacteria when 2 x 10(2) cells were seeded on filter paper. Results showed > or = 3 log10 CFU reduction when polypropylene samples seeded with E. coli (5 x 10(4)) were exposed, while a 30 s exposure time was required for similar killing with S. aureus-seeded polypropylene samples. The exposure times required to effect > or = 6 log10 CFU reduction of E. coli and S. aureus on polypropylene samples were no longer than 30 s. Experiments with seeded samples in sealed commercial sterilization bags showed little or no differences in exposure times compared to unwrapped samples. Plasma exposure times of less than 5 min generated > or = 5 log10 CFU reduction of commercially prepared Bacillus subtilis spores (1 x 10(5)); 7 min OAUGDP exposures were required to generate a > or = 3 log10 CFU reduction for Bacillus stearothermophilus spores. For all microorganisms tested, a biphasic curve was generated when the number of survivors vs time was plotted in dose-response cures. Several proposed mechanisms of killing at room temperature by the OAUGDP are discussed.

Staff Radiation Doses in a Real-Time Display Inside the Angiography Room

DOE Office of Scientific and Technical Information (OSTI.GOV)

Sanchez, Roberto, E-mail: rmsanchez.hcsc@salud.madrid.org; Vano, E.; Fernandez, J. M.

MethodsThe evaluation of a new occupational Dose Aware System (DAS) showing staff radiation doses in real time has been carried out in several angiography rooms in our hospital. The system uses electronic solid-state detectors with high-capacity memory storage. Every second, it archives the dose and dose rate measured and is wirelessly linked to a base-station screen mounted close to the diagnostic monitors. An easy transfer of the values to a data sheet permits further analysis of the scatter dose profile measured during the procedure, compares it with patient doses, and seeks to find the most effective actions to reduce operatormore » exposure to radiation.ResultsThe cumulative occupational doses measured per procedure (shoulder-over lead apron) ranged from 0.6 to 350 {mu}Sv when the ceiling-suspended screen was used, and DSA (Digital Subtraction Acquisition) runs were acquired while the personnel left the angiography room. When the suspended screen was not used and radiologists remained inside the angiography room during DSA acquisitions, the dose rates registered at the operator's position reached up to 1-5 mSv/h during fluoroscopy and 12-235 mSv/h during DSA acquisitions. In such case, the cumulative scatter dose could be more than 3 mSv per procedure.ConclusionReal-time display of doses to staff members warns interventionists whenever the scatter dose rates are too high or the radiation protection tools are not being properly used, providing an opportunity to improve personal protection accordingly.« less

Occupational exposure to nitrous oxide - the role of scavenging and ventilation systems in reducing the exposure level in operating rooms.

PubMed

Krajewski, Wojciech; Kucharska, Malgorzata; Wesolowski, Wiktor; Stetkiewicz, Jan; Wronska-Nofer, Teresa

2007-03-01

The aim of this study was to assess the level of occupational exposure to nitrous oxide (N(2)O) in operating rooms (ORs), as related to different ventilation and scavenging systems used to remove waste anaesthetic gases from the work environment. The monitoring of N(2)O in the air covered 35 ORs in 10 hospitals equipped with different systems for ventilation and anaesthetic scavenging. The examined systems included: natural ventilation with supplementary fresh air provided by a pressure ventilation system (up to 6 air changes/h); pressure and exhaust ventilation systems equipped with ventilation units supplying fresh air to and discharging contaminated air outside the working area (more than 10 air changes/h); complete air-conditioning system with laminar air flow (more than 15 air changes/h). The measurements were carried out during surgical procedures (general anaesthesia induced intravenously and maintained with inhaled N(2)O and sevofluran delivered through cuffed endotracheal tubes) with connected or disconnected air scavenging. Air was collected from the breathing zone of operating personnel continuously through the whole time of anaesthesia to Tedlar((R)) bags, and N(2)O concentrations in air samples were analyzed by adsorption gas chromatography/mass spectrometry. N(2)O levels in excess of the occupational exposure limit (OEL) value of 180mg/m(3) were registered in all ORs equipped with ventilation systems alone. The OEL value was exceeded several times in rooms with natural ventilation plus supplementary pressure ventilations and twice or less in those with pressure/exhaust ventilation systems or air conditioning. N(2)O levels below or within the OEL value were observed in rooms where the system of air conditioning or pressure/exhaust ventilation was combined with scavenging systems. Systems combining natural/pressure ventilation with scavenging were inadequate to maintain N(2)O concentration below the OEL value. Air conditioning and an efficient pressure/exhaust ventilation (above 12 air exchanges/h) together with efficient active scavenging systems are sufficient to sustain N(2)O exposure in ORs at levels below or within the OEL value of 180mg/m(3).

Outcomes of in-hospital, out of intensive care and operation theatre cardiac arrests in a tertiary referral hospital

PubMed Central

Chakravarthy, Murali; Mitra, Sona; Nonis, Latha

2012-01-01

Objective Cardiac arrest in the hospital wards may not receive as much attention as it does in the operation theatre and intensive care unit (ICU). The experience and the qualifications of personnel in the ward may not be comparable to those in the other vital areas of the hospital. The outcome of cardiac arrest from the ward areas is a reasonable surrogate of training of the ward nurses and technicians in cardiopulmonary resuscitation. We conducted an audit to assess the issues surrounding the resuscitation of cardiac arrest in areas other than operation theatre and ICU in a tertiary referral hospital. Aims of the audit To assess the outcomes of cardiac arrest in a tertiary referral hospital. Areas such as wards, dialysis room and emergency room were considered for the audit. Methods This is a retrospective observational audit of the case records of all the adult patients who were resuscitated from ‘code blue’. Data for 2 years from 2007 was analysed by a research fellow unconnected with the resuscitations. Results Twenty-two thousand three hundred and forty-four patients were admitted as in-patients to the hospital during the 2 years, starting May 2007 through May 2009. One hundred code blue calls were received during this time. Twenty-two of the total calls received were false. Among the 78 confirmed cardiac arrests 69 occurred in the wards, 2 in emergency room, 1 in cardiac catheterisation laboratory and 3 in dialysis room. Twenty-eight patients were declared dead after unsuccessful cardiopulmonary resuscitation. Among the 50 who were resuscitated with a return of spontaneous rhythm 26 died. Twenty-four patients were discharged (survival rate of 30%). The survival decreased significantly as the age progressed beyond 60. The resuscitation rates were better in day shifts in contrast to the night. Higher survival was noted in patients who received resuscitation in less than a minute. Conclusion A overall survival to discharge rate of 30% was noted in this audit. Higher survival rates might be attributable to high rate and degree of training at the time of their employment, which was repeated at yearly interval. PMID:22572417

Radiation-acoustic treatment of gallium phosphide light diodes

NASA Astrophysics Data System (ADS)

Tartachnik, Volodimir P.; Gontaruk, Olexsandr M.; Vernydub, Roman M.; Kryvutenko, Anatoly M.; Olikh, Yaroslav M.; Opilat, Vitalij Y.; Petrenko, Igor V.; Pinkovska, Myroslava B.

1999-11-01

The ultrasound influence on the defects of technological and radiation origin of GaP light diodes has been investigated. GaP light diodes were treated by ultrasound wave in different operating modes. Electroluminescence spectra were measured at room and low temperatures, integrated luminosity of devices was checked by solar cell. In order to find out the radiation field influence on non-equilibrium defects of acoustic origin samples were irradiated at room temperature by gamma rays of Co60. It has been discovered that in GaP light diodes treated by ultrasound unstable at room temperature dislocation networks occur at the volume of crystal. Ultrasound dose increase causes the creation of complex defects with high relaxation time and appearing of a part of more mobile defect,s which relax quicker. The nature of effects discovered has been discussed. The method of the emissive capacity restoring of samples degraded after irradiation have been proposed.

Experimental system, and its evaluation for the control of surgically inducted infections

NASA Technical Reports Server (NTRS)

Tevebaugh, M. D.; Nelson, J. P.

1972-01-01

The effect is reported to design, fabricate, test and evaluate a prototype experimental system for the control of surgically induced infections. The purpose is to provide the cleanest possible environment within a hospital surgery room and eliminate contamination sources that could cause infections during surgery. The system design is described. The system provides for a portable laminar flow clean room, a full bubble helmet system with associated communications and ventilation subsystems for operating room personnel, and surgical gowns that minimize the migration of bacteria. The development test results consisting of portability, laminar flowrate, air flow pattern, electrostatic buildup, noise level, ventilation, human factors, electrical and material compatibility tests are summarized. The conclusions are that the experimental system is effective in reducing the airborne and wound contamination although the helmets and gowns may not be a significant part of this reduction. Definitive conclusions with regard to the infection rate cannot be made at this time.

Do surgeons and surgical facilities disturb the clean air distribution close to a surgical patient in an orthopedic operating room with laminar airflow?

PubMed

Cao, Guangyu; Storås, Madeleine C A; Aganovic, Amar; Stenstad, Liv-Inger; Skogås, Jan Gunnar

2018-05-04

Airflow distribution in the operating room plays an important role in ensuring a clean operating microenvironment and preventing surgical site infections (SSIs) caused by airborne contaminations. The objective of this study was to characterize the airflow distribution in proximity to a patient in an orthopedic operating room. Experimental measurements were conducted in a real operating room at St. Olav's Hospital, Norway, with a laminar airflow system. Omnidirectional anemometers were used to investigate the air distribution in the operating zone, and 4 different cases were examined with a real person and a thermal manikin. This study showed that the downward airflow from the laminar airflow system varies in each case with different surgical arrangement, such as the position of the operating lamp. The results indicate that the interaction of thermal plumes from a patient and the downward laminar airflow may dominate the operating microenvironment. The airflow distribution in proximity to a patient is influenced by both the surgical facility and the presence of medical staff. A thermal manikin may be an economical and practical way to study the interaction of thermal plumes and downward laminar airflow. The provision of higher clean airflow rate in the operating microenvironment may be an effective way to prevent the development of SSIs caused by indoor airborne contamination. Copyright © 2018 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

16. DINING ROOM INTERIOR SHOWING DOUBLE DOOR ARCHWAY INTO LIVING ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

16. DINING ROOM INTERIOR SHOWING DOUBLE DOOR ARCHWAY INTO LIVING ROOM AND DOUBLE FRENCH DOORS INTO SOUTH END SCREENED PORCH. VIEW TO SOUTHWEST. - Big Creek Hydroelectric System, Powerhouse 8, Operator Cottage, Big Creek, Big Creek, Fresno County, CA

Transactive control of fast-acting demand response based on thermostatic loads in real-time retail electricity markets

DOE Office of Scientific and Technical Information (OSTI.GOV)

Behboodi, Sahand; Chassin, David P.; Djilali, Ned

Coordinated operation of distributed thermostatic loads such as heat pumps and air conditioners can reduce energy costs and prevents grid congestion, while maintaining room temperatures in the comfort range set by consumers. This paper furthers efforts towards enabling thermostatically controlled loads (TCLs) to participate in real-time retail electricity markets under a transactive control paradigm. An agent-based approach is used to develop an effective and low complexity demand response control scheme for TCLs. The proposed scheme adjusts aggregated thermostatic loads according to real-time grid conditions under both heating and cooling modes. Here, a case study is presented showing the method reducesmore » consumer electricity costs by over 10% compared to uncoordinated operation.« less

Transactive control of fast-acting demand response based on thermostatic loads in real-time retail electricity markets

DOE PAGES

Behboodi, Sahand; Chassin, David P.; Djilali, Ned; ...

2017-07-29

Coordinated operation of distributed thermostatic loads such as heat pumps and air conditioners can reduce energy costs and prevents grid congestion, while maintaining room temperatures in the comfort range set by consumers. This paper furthers efforts towards enabling thermostatically controlled loads (TCLs) to participate in real-time retail electricity markets under a transactive control paradigm. An agent-based approach is used to develop an effective and low complexity demand response control scheme for TCLs. The proposed scheme adjusts aggregated thermostatic loads according to real-time grid conditions under both heating and cooling modes. Here, a case study is presented showing the method reducesmore » consumer electricity costs by over 10% compared to uncoordinated operation.« less

Impact of environmental factors on efficacy of upper-room air ultraviolet germicidal irradiation for inactivating airborne mycobacteria.

PubMed

Xu, Peng; Kujundzic, Elmira; Peccia, Jordan; Schafer, Millie P; Moss, Gene; Hernandez, Mark; Miller, Shelly L

2005-12-15

This study evaluated the efficacy of an upper-room air ultraviolet germicidal irradiation (UVGI) system for inactivating airborne bacteria, which irradiates the upper part of a room while minimizing radiation exposure to persons in the lower part of the room. A full-scale test room (87 m3), fitted with a UVGI system consisting of 9 louvered wall and ceiling fixtures (504 W all lamps operating) was operated at 24 and 34 degrees C, between 25 and 90% relative humidity, and at three ventilation rates. Mycobacterium parafortuitum cells were aerosolized into the room such that their numbers and physiologic state were comparable both with and without the UVGI system operating. Airborne bacteria were collected in duplicate using liquid impingers and quantified with direct epifluorescent microscopy and standard culturing assay. Performance of the UVGI system degraded significantly when the relative humidity was increased from 50% to 75-90% RH, the horizontal UV fluence rate distribution was skewed to one side compared to being evenly dispersed, and the room air temperature was stratified from hot at the ceiling to cold at the floor. The inactivation rate increased linearly with effective UV fluence rate up to 5 microW cm(-2); an increase in the fluence rate above this level did not yield a proportional increase in inactivation rate.

A Comparison of Two Fat Grafting Methods on Operating Room Efficiency and Costs.

PubMed

Gabriel, Allen; Maxwell, G Patrick; Griffin, Leah; Champaneria, Manish C; Parekh, Mousam; Macarios, David

2017-02-01

Centrifugation (Cf) is a common method of fat processing but may be time consuming, especially when processing large volumes. To determine the effects on fat grafting time, volume efficiency, reoperations, and complication rates of Cf vs an autologous fat processing system (Rv) that incorporates fat harvesting and processing in a single unit. We performed a retrospective cohort study of consecutive patients who underwent autologous fat grafting during reconstructive breast surgery with Rv or Cf. Endpoints measured were volume of fat harvested (lipoaspirate) and volume injected after processing, time to complete processing, reoperations, and complications. A budget impact model was used to estimate cost of Rv vs Cf. Ninety-eight patients underwent fat grafting with Rv, and 96 patients received Cf. Mean volumes of lipoaspirate (506.0 vs 126.1 mL) and fat injected (177.3 vs 79.2 mL) were significantly higher (P < .0001) in the Rv vs Cf group, respectively. Mean time to complete fat grafting was significantly shorter in the Rv vs Cf group (34.6 vs 90.1 minutes, respectively; P < .0001). Proportions of patients with nodule and cyst formation and/or who received reoperations were significantly less in the Rv vs Cf group. Based on these outcomes and an assumed per minute operating room cost, an average per patient cost savings of $2,870.08 was estimated with Rv vs Cf. Compared to Cf, the Rv fat processing system allowed for a larger volume of fat to be processed for injection and decreased operative time in these patients, potentially translating to cost savings. LEVEL OF EVIDENCE 3. © 2016 The American Society for Aesthetic Plastic Surgery, Inc.

Use of linear programming to estimate impact of changes in a hospital's operating room time allocation on perioperative variable costs.

PubMed

Dexter, Franklin; Blake, John T; Penning, Donald H; Sloan, Brian; Chung, Patricia; Lubarsky, David A

2002-03-01

Administrators at hospitals with a fixed annual budget may want to focus surgical services on priority areas to ensure its community receives the best health services possible. However, many hospitals lack the detailed managerial accounting data needed to ensure that such a change does not increase operating costs. The authors used a detailed hospital cost database to investigate by how much a change in allocations of operating room (OR) time among surgeons can increase perioperative variable costs. The authors obtained financial data for all patients who underwent outpatient or same-day admit surgery during a year. Linear programming was used to determine by how much changing the mix of surgeons can increase total variable costs while maintaining the same total hours of OR time for elective cases. Changing OR allocations among surgeons without changing total OR hours allocated will likely increase perioperative variable costs by less than 34%. If, in addition, intensive care unit hours for elective surgical cases are not increased, hospital ward occupancy is capped, and implant use is tracked and capped, perioperative costs will likely increase by less than 10%. These four variables predict 97% of the variance in total variable costs. The authors showed that changing OR allocations among surgeons without changing total OR hours allocated can increase hospital perioperative variable costs by up to approximately one third. Thus, at hospitals with fixed or nearly fixed annual budgets, allocating OR time based on an OR-based statistic such as utilization can adversely affect the hospital financially. The OR manager can reduce the potential increase in costs by considering not just OR time, but also the resulting use of hospital beds and implants.

61. (Credit CBF) Operating floor of filter room, c1912. A ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

61. (Credit CBF) Operating floor of filter room, c1912. A remodeled Hyatt pressure filter, now operating as a tub, gravity, rapid sand filter, is in the foreground (the remodeling took place c1908-1909). The remodeled New York horizontal pressure filters (installed 01900, remodeled c1908-1909) are in the background. - McNeil Street Pumping Station, McNeil Street & Cross Bayou, Shreveport, Caddo Parish, LA

Virtual environment for training in microsurgery

NASA Astrophysics Data System (ADS)

Montgomery, Kevin N.; Stephanides, Michael; Brown, Joel; Latombe, Jean-Claude; Schendel, Stephen A.

1999-05-01

Microsurgery is a well-established medical field, and involves repair of approximately 1mm vessels and nerves under an operating microscope in order to reattach severed fingers or transfer tissue for reconstruction. Initial skill sin microvascular surgery are usually developed in the animal lab and subsequently in the operating room. Development of these skills typically requires about 6 months of animal based training before additional learning takes place in the operating room.

Ergonomic assessment of neck posture in the minimally invasive surgery suite during laparoscopic cholecystectomy.

PubMed

van Det, M J; Meijerink, W J H J; Hoff, C; van Veelen, M A; Pierie, J P E N

2008-11-01

With the expanding implementation of minimally invasive surgery, the operating team is confronted with challenges in the field of ergonomics. Visual feedback is derived from a monitor placed outside the operating field. This crossover trial was conducted to evaluate and compare neck posture in relation to monitor position in a dedicated minimally invasive surgery (MIS) suite and a conventional operating room. Assessment of the neck was conducted for 16 surgeons, assisting surgeons, and scrub nurses performing a laparoscopic cholecystectomy in both types of operating room. Flexion and rotation of the cervical spine were measured intraoperatively using a video analysis system. A two-question visual analog scale (VAS) questionnaire was used to evaluate posture in relation to the monitor position. Neck rotation was significantly reduced in the MIS suite for the surgeon (p = 0.018) and the assisting surgeon (p < 0.001). Neck flexion was significantly improved in the MIS suite for the surgeon (p < 0.001) and the scrub nurse (p = 0.018). On the questionnaire, the operating room team scored their posture significantly higher in the MIS suite and also indicated fewer musculoskeletal complaints. The ergonomic quality of the neck posture is significantly improved in the MIS suite for the entire operating room team.