Pub Date : 2024-10-02DOI: 10.1016/j.pcorm.2024.100438
Abner M.P. Barbosa , Mark J. Saari , Peter F. Nichol
Background
Errors in sterile processing of surgical instruments result in wasted chargeable operating room minutes. Data delineating this problem have been generated primarily through human observation and reporting. Given the inherent error rate in human tasks, we hypothesized that the observed rate of surgical instrument errors per case per day would increase over a six-week longitudinal study as observers became more familiar with their environment and more comfortable identifying errors.
Methods
A previously published dataset on surgical instrument errors was analyzed for the average errors per case per day over six weeks. Errors per case per day were compared to the percentage of inpatient cases for each respective date since the error rate in inpatient cases is twice that of outpatient cases.
Results
While the average errors per case per day increases from 0.28 to 0.62, indicating a potential increase over time, no statistically significant trend was found (p = 0.157). A positive but modest correlation was observed between inpatient percentage and error rates (Pearson correlation = 0.344), nearing statistical significance (p = 0.068). The inpatient case percentage remained stable over time, with no significant trend detected (p = 0.284).
Conclusions
Human observation is a critical tool for defining waste arising from sterile processing errors. While the gradual increase in errors per case per day increases, the variability cannot be attributed to the initial adaptation the observer's environment. Future studies should assess inter-rated reliability and explore alternative automated observation methods to have a more accurate measurement of the number of errors observed.
{"title":"The fault in our nature: Error rates in a human observation study on surgical instrument errors in the OR","authors":"Abner M.P. Barbosa , Mark J. Saari , Peter F. Nichol","doi":"10.1016/j.pcorm.2024.100438","DOIUrl":"10.1016/j.pcorm.2024.100438","url":null,"abstract":"<div><h3>Background</h3><div>Errors in sterile processing of surgical instruments result in wasted chargeable operating room minutes. Data delineating this problem have been generated primarily through human observation and reporting. Given the inherent error rate in human tasks, we hypothesized that the observed rate of surgical instrument errors per case per day would increase over a six-week longitudinal study as observers became more familiar with their environment and more comfortable identifying errors.</div></div><div><h3>Methods</h3><div>A previously published dataset on surgical instrument errors was analyzed for the average errors per case per day over six weeks. Errors per case per day were compared to the percentage of inpatient cases for each respective date since the error rate in inpatient cases is twice that of outpatient cases.</div></div><div><h3>Results</h3><div>While the average errors per case per day increases from 0.28 to 0.62, indicating a potential increase over time, no statistically significant trend was found (<em>p</em> = 0.157). A positive but modest correlation was observed between inpatient percentage and error rates (Pearson correlation = 0.344), nearing statistical significance (<em>p</em> = 0.068). The inpatient case percentage remained stable over time, with no significant trend detected (<em>p</em> = 0.284).</div></div><div><h3>Conclusions</h3><div>Human observation is a critical tool for defining waste arising from sterile processing errors. While the gradual increase in errors per case per day increases, the variability cannot be attributed to the initial adaptation the observer's environment. Future studies should assess inter-rated reliability and explore alternative automated observation methods to have a more accurate measurement of the number of errors observed.</div></div>","PeriodicalId":53468,"journal":{"name":"Perioperative Care and Operating Room Management","volume":"37 ","pages":"Article 100438"},"PeriodicalIF":0.0,"publicationDate":"2024-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142416043","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-21DOI: 10.1016/j.pcorm.2024.100435
Kenneth A Lipshy , Jessica Feinleib , Brooke Trainer
<div><h3>Introduction</h3><div>Our facility leadership posed questions to the perioperative leadership team regarding the presence of collaborative communication during the reconciliation of events occurring in several perioperative care areas (operating rooms {OR}, clinic procedure areas, Intensive Care Unit {ICU}). Our team* collaborated to pilot a rapid cycle performance improvement project focused on improving the effectiveness of debriefings and handoffs that could conceivably lead to more effective after-action reviews following events which were complicated by multiple simultaneous unexpected factors. We proposed we could implement standardized abbreviated low-fidelity point of care (in-situ) inter-professional simulation training across the healthcare system with minimal impact on clinical schedules. We believed this would improve the perception of teamwork and collaboration among surgical team members.</div></div><div><h3>Methods</h3><div>Inter-professional in-situ simulation training exercises were designed and performed in perioperative care areas systemwide at our three major facilities (Main hospital and two Healthcare Community Centers [HCC]). Multiple iterations of styles of training were conceived and trialed. In the end, preconstructed videos were used to standardize the processes that framed the simulation role-playing of a debriefing after a complex situation. These videos contain the pre-simulation pre-briefings, the clinical situation that preceded the clinical debriefing and the simulation debriefing. Successful reconciliation of the multiple events required team members to exercise closed-loop communication, mutual trust, reengagement, and de-escalation of disengaged team members. Anonymous institutional review board reviewed, and Association of Federal Government Employees (AFGE) approved retrospective pre/post implementation surveys were made available to participants immediately after and sixty to ninety days following simulation exercises.</div></div><div><h3>Results</h3><div>Between July 2023 and March 2024, one hundred and six staff in the perioperative care areas participated in twenty-two inter-professional simulation trainings (eleven OR, eight clinic, and three ICU simulations). Fourteen simulation scenarios in seven surgical disciplines were created. Eleven videos were produced covering cases in the O.R., clinic and ICU. Ultimately, the simulations were completed within twenty minutes in the three perioperative care clinical areas. Seventy-nine staff responded to the initial surveys after the simulation training. Eighty percent of the respondents gave favorable assessments regarding the effectiveness of the training in improving components of teamwork and agreed this program should continue.</div></div><div><h3>Conclusions</h3><div>The pilot program affirmed that we could implement simulations across the healthcare system in a format that minimally impacted the staffs’ clinical schedule. The process was standardi
{"title":"Abbreviated in-situ inter-professional debriefing simulation training in peri-operative care environments: Minimizing the impact on clinical care using standardized videos","authors":"Kenneth A Lipshy , Jessica Feinleib , Brooke Trainer","doi":"10.1016/j.pcorm.2024.100435","DOIUrl":"10.1016/j.pcorm.2024.100435","url":null,"abstract":"<div><h3>Introduction</h3><div>Our facility leadership posed questions to the perioperative leadership team regarding the presence of collaborative communication during the reconciliation of events occurring in several perioperative care areas (operating rooms {OR}, clinic procedure areas, Intensive Care Unit {ICU}). Our team* collaborated to pilot a rapid cycle performance improvement project focused on improving the effectiveness of debriefings and handoffs that could conceivably lead to more effective after-action reviews following events which were complicated by multiple simultaneous unexpected factors. We proposed we could implement standardized abbreviated low-fidelity point of care (in-situ) inter-professional simulation training across the healthcare system with minimal impact on clinical schedules. We believed this would improve the perception of teamwork and collaboration among surgical team members.</div></div><div><h3>Methods</h3><div>Inter-professional in-situ simulation training exercises were designed and performed in perioperative care areas systemwide at our three major facilities (Main hospital and two Healthcare Community Centers [HCC]). Multiple iterations of styles of training were conceived and trialed. In the end, preconstructed videos were used to standardize the processes that framed the simulation role-playing of a debriefing after a complex situation. These videos contain the pre-simulation pre-briefings, the clinical situation that preceded the clinical debriefing and the simulation debriefing. Successful reconciliation of the multiple events required team members to exercise closed-loop communication, mutual trust, reengagement, and de-escalation of disengaged team members. Anonymous institutional review board reviewed, and Association of Federal Government Employees (AFGE) approved retrospective pre/post implementation surveys were made available to participants immediately after and sixty to ninety days following simulation exercises.</div></div><div><h3>Results</h3><div>Between July 2023 and March 2024, one hundred and six staff in the perioperative care areas participated in twenty-two inter-professional simulation trainings (eleven OR, eight clinic, and three ICU simulations). Fourteen simulation scenarios in seven surgical disciplines were created. Eleven videos were produced covering cases in the O.R., clinic and ICU. Ultimately, the simulations were completed within twenty minutes in the three perioperative care clinical areas. Seventy-nine staff responded to the initial surveys after the simulation training. Eighty percent of the respondents gave favorable assessments regarding the effectiveness of the training in improving components of teamwork and agreed this program should continue.</div></div><div><h3>Conclusions</h3><div>The pilot program affirmed that we could implement simulations across the healthcare system in a format that minimally impacted the staffs’ clinical schedule. The process was standardi","PeriodicalId":53468,"journal":{"name":"Perioperative Care and Operating Room Management","volume":"37 ","pages":"Article 100435"},"PeriodicalIF":0.0,"publicationDate":"2024-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142535422","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-20DOI: 10.1016/j.pcorm.2024.100434
David F Nelson , Carla Palomino , Marc C Torjman , Gavyn Ooi , Michael S Green
Background
Bottlenecks in PACU throughput are frequently encountered challenges that OR managers must face. This study seeks to examine the impact of extended PACU stay (e.g. boarding) on both total hospital length of stay and overall cost of care.
Methods
A total of 4,740 patients were studied having same-day admit surgeries for seven procedure types including: arthroplasty total knee, arthroplasty total hip, fusion spine transforaminal interbody lumbar, revision arthroplasty total knee, revision arthroplasty total hip, posterior cervical fusion, and anterior cervical fusion. 4,471 were identified as non-PACU boarders and 269 as PACU boarders (>6 h in PACU). Included in the analysis were demographics, date of admission, surgical procedure, PACU and hospital length of stay (HLOS), hospital direct costs, case mix index (CMI), and ASA status.
Results
The median (IQR) PACU times in minutes were 57.00 (80) and 488.00 (453.50) minutes for PACU non-boarders and boarders (p < 0.001). HLOS was significantly (p < 0.001) more elevated in PACU Boarders compared to PACU Non-boarders: median (IQR) 2.00 (2.00) and 2.00 (3.00), (mean HLOS 3.16±2.83 vs 2.60±2.71 days). Median direct costs were ≈14.36% higher (p = 0.008) for the PACU boarders compared to Non-boarders. Direct costs were also not significantly different when using a 4-hour criteria for PACU boarders (14.39% higher median direct costs, p = 0.004).
Conclusions
PACU boarding (>4 h) is associated with a statistically significant increased length of stay as well as direct costs compared with non-boarders across a variety of elective orthopedic and spine procedures. Thus, when frequent PACU boarding occurs, OR managers should consider the potential impact to patient care and hospital margins.
{"title":"Length of stay and cost of care differences between postoperative patients who board in PACU and those that proceed directly to inpatient bed","authors":"David F Nelson , Carla Palomino , Marc C Torjman , Gavyn Ooi , Michael S Green","doi":"10.1016/j.pcorm.2024.100434","DOIUrl":"10.1016/j.pcorm.2024.100434","url":null,"abstract":"<div><h3>Background</h3><div>Bottlenecks in PACU throughput are frequently encountered challenges that OR managers must face. This study seeks to examine the impact of extended PACU stay (e.g. boarding) on both total hospital length of stay and overall cost of care.</div></div><div><h3>Methods</h3><div>A total of 4,740 patients were studied having same-day admit surgeries for seven procedure types including: arthroplasty total knee, arthroplasty total hip, fusion spine transforaminal interbody lumbar, revision arthroplasty total knee, revision arthroplasty total hip, posterior cervical fusion, and anterior cervical fusion. 4,471 were identified as non-PACU boarders and 269 as PACU boarders (>6 h in PACU). Included in the analysis were demographics, date of admission, surgical procedure, PACU and hospital length of stay (HLOS), hospital direct costs, case mix index (CMI), and ASA status.</div></div><div><h3>Results</h3><div>The median (IQR) PACU times in minutes were 57.00 (80) and 488.00 (453.50) minutes for PACU non-boarders and boarders (<em>p</em> < 0.001). HLOS was significantly (<em>p</em> < 0.001) more elevated in PACU Boarders compared to PACU Non-boarders: median (IQR) 2.00 (2.00) and 2.00 (3.00), (mean HLOS 3.16±2.83 vs 2.60±2.71 days). Median direct costs were ≈14.36% higher (<em>p</em> = 0.008) for the PACU boarders compared to Non-boarders. Direct costs were also not significantly different when using a 4-hour criteria for PACU boarders (14.39% higher median direct costs, <em>p</em> = 0.004).</div></div><div><h3>Conclusions</h3><div>PACU boarding (>4 h) is associated with a statistically significant increased length of stay as well as direct costs compared with non-boarders across a variety of elective orthopedic and spine procedures. Thus, when frequent PACU boarding occurs, OR managers should consider the potential impact to patient care and hospital margins.</div></div>","PeriodicalId":53468,"journal":{"name":"Perioperative Care and Operating Room Management","volume":"37 ","pages":"Article 100434"},"PeriodicalIF":0.0,"publicationDate":"2024-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142357627","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-07DOI: 10.1016/j.pcorm.2024.100433
Deepali Valecha , K K Arora , Swapnil Kumar Barasker
Introduction
Shivering is a common and distressing complication that can occur after subarachnoid block (SAB) in patients, particularly those undergoing transurethral resection of the prostate (TURP) due to the use of irrigating fluid and older age group. This study aims to compare the effectiveness of nefopam and tramadol in reducing intraoperative shivering compared to a control group, in Indian patients.
Methodology
This study is a double-blinded randomized control trial with a total of 99 patients undergoing elective TURP under SAB were enrolled. The patients were randomly divided into three groups (GT, GN, and GC): GT received tramadol (0.5 mg kg-1) and GN received nefopam (0.15 mg kg-1). Both tramadol and nefopam were premixed into 100 ml of normal saline (NS) and GC received 100 ml NS, given over 15 min just before SAB. The induction protocol was the same for all groups, and shivering score, hemodynamic parameters, and body temperature (BT) were recorded.
Results
The overall incidence of shivering was 29.67 % (27/91), with the lowest incidence being in GN (16.67 %, 5/30), followed by GT (22.58 %, 7/31) and GC (50 %, 15/30). Both nefopam and tramadol resulted in a significant (p < 0.05) decrease in the incidence of shivering compared to control. Among the hemodynamic parameters and BT, no significant difference was seen between GT, GN, and GC (p > 0.05).
Conclusion
Both nefopam and tramadol were effective in reducing the incidence but the severity was controlled better with nefopam during TURP under SAB.
{"title":"A double blinded randomized prospective trial of comparison between control and study group, nefopam versus tramadol on shivering scores after spinal anesthesia in patients undergoing Transurethral resection of prostate","authors":"Deepali Valecha , K K Arora , Swapnil Kumar Barasker","doi":"10.1016/j.pcorm.2024.100433","DOIUrl":"10.1016/j.pcorm.2024.100433","url":null,"abstract":"<div><h3>Introduction</h3><p>Shivering is a common and distressing complication that can occur after subarachnoid block (SAB) in patients, particularly those undergoing transurethral resection of the prostate (TURP) due to the use of irrigating fluid and older age group. This study aims to compare the effectiveness of nefopam and tramadol in reducing intraoperative shivering compared to a control group, in Indian patients.</p></div><div><h3>Methodology</h3><p>This study is a double-blinded randomized control trial with a total of 99 patients undergoing elective TURP under SAB were enrolled. The patients were randomly divided into three groups (GT, GN, and GC): GT received tramadol (0.5 mg kg<sup>-1</sup>) and GN received nefopam (0.15 mg kg<sup>-1</sup>). Both tramadol and nefopam were premixed into 100 ml of normal saline (NS) and GC received 100 ml NS, given over 15 min just before SAB. The induction protocol was the same for all groups, and shivering score, hemodynamic parameters, and body temperature (BT) were recorded.</p></div><div><h3>Results</h3><p>The overall incidence of shivering was 29.67 % (27/91), with the lowest incidence being in GN (16.67 %, 5/30), followed by GT (22.58 %, 7/31) and GC (50 %, 15/30). Both nefopam and tramadol resulted in a significant (<em>p</em> < 0.05) decrease in the incidence of shivering compared to control. Among the hemodynamic parameters and BT, no significant difference was seen between GT, GN, and GC (<em>p</em> > 0.05).</p></div><div><h3>Conclusion</h3><p>Both nefopam and tramadol were effective in reducing the incidence but the severity was controlled better with nefopam during TURP under SAB.</p></div>","PeriodicalId":53468,"journal":{"name":"Perioperative Care and Operating Room Management","volume":"37 ","pages":"Article 100433"},"PeriodicalIF":0.0,"publicationDate":"2024-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142168112","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-01DOI: 10.1016/j.pcorm.2024.100432
Christopher H. Stucky , Felichism W. Kabo , Marla J. De Jong , Sherita L. House , Chandler H. Moser , Donald E. Kimbler
Background
Accurate estimation of surgical procedure times, crucial for optimizing healthcare access, patient outcomes, and cost-effectiveness, is essential for operating room efficiency. Surgical control time (SCT) is a preoperative estimate by surgeons representing their predicted time to complete the surgery, spanning from completion of anesthesia induction to surgical site closure.
Methods
In this within-subjects, longitudinal study, we examined the differences between predicted surgical control times versus actual SCTs and determined variability by surgical specialty. We included cases regardless of classification (i.e., outpatient or inpatient), type of surgery (i.e., elective, urgent, or emergent), or level of complexity (i.e., major or minor). We ran Shapiro–Wilk tests to assess the normality of the difference in actual versus predicted surgical control times (dSCT) by surgical specialty. We used a generalized linear model (GLM) with robust clustered variance and pairwise comparisons of surgical specialties (with Bonferroni adjustment for family-wise error rate) to assess differences in the prediction accuracy of SCTs by specialty.
Results
We analyzed 14,438 surgical cases performed by 168 surgeons across 13 specialties from January 2019 to January 2023. 11 of 13 specialties had higher actual than predicted times, suggesting an overall pattern of underestimating SCTs. On average, surgeries took 12.3 % longer than predicted, with surgeons underestimating SCTs by an average of 10.4 min. SCTs comprised 78 % of the total operative time. The four specialties with the largest underestimations of SCTs were neurosurgery (27.04 min), orthopedics (22.75 min), urology (19.4 min, and plastic surgery (18.67 min), while two specialties exhibited overestimations, namely ear nose and throat (11.14 min) and pediatrics (–3.21 min). GLM results and pairwise comparisons showed that surgeons significantly differed in their SCT prediction by surgical specialty.
Conclusions
Our findings showed significant differences across surgical specialties in the accuracy of predicting surgical control times. These results have implications for integrating evolving technologies such as artificial intelligence and machine learning models to assist surgical administrators in accurately predicting surgical case durations and optimizing resource allocation.
{"title":"Surgical control time estimation variability: Implications for medical systems and the future integration of AI and ML models","authors":"Christopher H. Stucky , Felichism W. Kabo , Marla J. De Jong , Sherita L. House , Chandler H. Moser , Donald E. Kimbler","doi":"10.1016/j.pcorm.2024.100432","DOIUrl":"10.1016/j.pcorm.2024.100432","url":null,"abstract":"<div><h3>Background</h3><p>Accurate estimation of surgical procedure times, crucial for optimizing healthcare access, patient outcomes, and cost-effectiveness, is essential for operating room efficiency. Surgical control time (SCT) is a preoperative estimate by surgeons representing their predicted time to complete the surgery, spanning from completion of anesthesia induction to surgical site closure.</p></div><div><h3>Methods</h3><p>In this within-subjects, longitudinal study, we examined the differences between predicted surgical control times versus actual SCTs and determined variability by surgical specialty. We included cases regardless of classification (i.e., outpatient or inpatient), type of surgery (i.e., elective, urgent, or emergent), or level of complexity (i.e., major or minor). We ran Shapiro–Wilk tests to assess the normality of the difference in actual versus predicted surgical control times (dSCT) by surgical specialty. We used a generalized linear model (GLM) with robust clustered variance and pairwise comparisons of surgical specialties (with Bonferroni adjustment for family-wise error rate) to assess differences in the prediction accuracy of SCTs by specialty.</p></div><div><h3>Results</h3><p>We analyzed 14,438 surgical cases performed by 168 surgeons across 13 specialties from January 2019 to January 2023. 11 of 13 specialties had higher actual than predicted times, suggesting an overall pattern of underestimating SCTs. On average, surgeries took 12.3 % longer than predicted, with surgeons underestimating SCTs by an average of 10.4 min. SCTs comprised 78 % of the total operative time. The four specialties with the largest underestimations of SCTs were neurosurgery (27.04 min), orthopedics (22.75 min), urology (19.4 min, and plastic surgery (18.67 min), while two specialties exhibited overestimations, namely ear nose and throat (11.14 min) and pediatrics (–3.21 min). GLM results and pairwise comparisons showed that surgeons significantly differed in their SCT prediction by surgical specialty.</p></div><div><h3>Conclusions</h3><p>Our findings showed significant differences across surgical specialties in the accuracy of predicting surgical control times. These results have implications for integrating evolving technologies such as artificial intelligence and machine learning models to assist surgical administrators in accurately predicting surgical case durations and optimizing resource allocation.</p></div>","PeriodicalId":53468,"journal":{"name":"Perioperative Care and Operating Room Management","volume":"37 ","pages":"Article 100432"},"PeriodicalIF":0.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142163382","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-30DOI: 10.1016/j.pcorm.2024.100431
Mohsen Waheb, Wael El-Siory, Ahmed K Mohammed, Nagy Malak, Sahar El-Shall, Mahmoud Sewilam, Ayman M. Hussam
Background
The study aims to assess efficacy of superficial cervical plexus (SCP) block on Postoperative nausea and vomiting (PONV) incidence and severity in adults undergoing tympanomastoid operations.
Methods
Adult Patients American Society of Anesthesiologists (ASA) I-II in the age group 20–45 years, of both sex undergoing tympanomastoid operation under General Anesthesia (GA) scheduled for operation time from 30 min to 4 h. Ninety consenting patients were randomly allocated to two groups; saline or control group (n = 45) and SCP block (n = 45) received GA with SCP block. The primary outcome is incidence and severity of PONV over 24 h. other outcomes include number of patients required rescue antiemetic, hemodynamics, postoperative pain, first analgesic request, side effects of drugs used and incidence of complications related to the block.
Results
PONV incidence was lower in block group compared to control group {9 (20%) versus 17 (37.8%)}, p value 0.063, odds ratio (95% confidence interval 0.78 (0.59–1.01)). Need for rescue antiemetic was significantly lower in block group 14 patients (31.1%) compared to control group 34 patients (75.6%) (pvalue <0.001). Total intra operative opoids consumption was significantly lower in block group compared to control group (p value 0.002).There was no significant statistical difference between groups regarding need for postoperative analgesia and pain assessment times using visual analogue scale (VAS) score.There were no recorded complications related to the blocks in both groups.
Conclusion
Among adult patients undergoing tympanomastoid operations, the use of ultrasound (US) guided SCP block reduced the severity of PONV in early postoperative period. The overall incidence of PONV during 24 h was slightly lower in SCP block group however it was not statistically significant.
{"title":"Effect of ultrasound guided superficial cervical plexus block on incidence and severity of postoperative nausea and vomiting in tympanomastoid operations in adults: Randomized controlled study","authors":"Mohsen Waheb, Wael El-Siory, Ahmed K Mohammed, Nagy Malak, Sahar El-Shall, Mahmoud Sewilam, Ayman M. Hussam","doi":"10.1016/j.pcorm.2024.100431","DOIUrl":"10.1016/j.pcorm.2024.100431","url":null,"abstract":"<div><h3>Background</h3><p>The study aims to assess efficacy of superficial cervical plexus (SCP) block on Postoperative nausea and vomiting (PONV) incidence and severity in adults undergoing tympanomastoid operations.</p></div><div><h3>Methods</h3><p>Adult Patients American Society of Anesthesiologists (ASA) I-II in the age group 20–45 years, of both sex undergoing tympanomastoid operation under General Anesthesia (GA) scheduled for operation time from 30 min to 4 h. Ninety consenting patients were randomly allocated to two groups; saline or control group (<em>n</em> = 45) and SCP block (<em>n</em> = 45) received GA with SCP block. The primary outcome is incidence and severity of PONV over 24 h. other outcomes include number of patients required rescue antiemetic, hemodynamics, postoperative pain, first analgesic request, side effects of drugs used and incidence of complications related to the block.</p></div><div><h3>Results</h3><p>PONV incidence was lower in block group compared to control group {9 (20%) versus 17 (37.8%)}, p value 0.063, odds ratio (95% confidence interval 0.78 (0.59–1.01)). Need for rescue antiemetic was significantly lower in block group 14 patients (31.1%) compared to control group 34 patients (75.6%) (pvalue <0.001). Total intra operative opoids consumption was significantly lower in block group compared to control group (p value 0.002).There was no significant statistical difference between groups regarding need for postoperative analgesia and pain assessment times using visual analogue scale (VAS) score.There were no recorded complications related to the blocks in both groups.</p></div><div><h3>Conclusion</h3><p>Among adult patients undergoing tympanomastoid operations, the use of ultrasound (US) guided SCP block reduced the severity of PONV in early postoperative period. The overall incidence of PONV during 24 h was slightly lower in SCP block group however it was not statistically significant.</p></div>","PeriodicalId":53468,"journal":{"name":"Perioperative Care and Operating Room Management","volume":"37 ","pages":"Article 100431"},"PeriodicalIF":0.0,"publicationDate":"2024-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142129480","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-30DOI: 10.1016/j.pcorm.2024.100428
Amarjeet Kumar, Athira Ramesh
Non-analgesic properties of regional nerve blocks aid in the management of symptoms or diseases which are difficult to cure by conventional methods. Nerve blocks are one of the major analgesic modalities in the management of surgical patients. The non-analgesic effects of nerve block effects has been being explored in recent times. We have postulated systematically the non-analgesic benefits of different nerve block techniques and their mechanism of nerve block in management of multisystem diseases or symptoms. Diseases that are managed by non-analgesic effects of nerve blocks include postoperative cognitive dysfunction, posttraumatic stress disorder, postoperative nausea and vomiting, refractory arrhythmias, heart failure, hypertension, pulmonary hypertension, postoperative pulmonary complications and immune function.
{"title":"Non-analgesic uses of regional anesthetic blocks: A minireview","authors":"Amarjeet Kumar, Athira Ramesh","doi":"10.1016/j.pcorm.2024.100428","DOIUrl":"10.1016/j.pcorm.2024.100428","url":null,"abstract":"<div><p>Non-analgesic properties of regional nerve blocks aid in the management of symptoms or diseases which are difficult to cure by conventional methods. Nerve blocks are one of the major analgesic modalities in the management of surgical patients. The non-analgesic effects of nerve block effects has been being explored in recent times. We have postulated systematically the non-analgesic benefits of different nerve block techniques and their mechanism of nerve block in management of multisystem diseases or symptoms. Diseases that are managed by non-analgesic effects of nerve blocks include postoperative cognitive dysfunction, posttraumatic stress disorder, postoperative nausea and vomiting, refractory arrhythmias, heart failure, hypertension, pulmonary hypertension, postoperative pulmonary complications and immune function.</p></div>","PeriodicalId":53468,"journal":{"name":"Perioperative Care and Operating Room Management","volume":"37 ","pages":"Article 100428"},"PeriodicalIF":0.0,"publicationDate":"2024-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142147896","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-28DOI: 10.1016/j.pcorm.2024.100427
Cory James Williams , Jed Duff
Background
Surgery accounts for 30 % of the global disease burden, but healthcare systems struggle with managing surgical waitlists, optimising operations, and minimising cancellations, leading to poor patient outcomes and financial strain. E-health technologies offer promising solutions to enhance perioperative care and improve surgical outcomes, yet their integration faces significant organisational and structural challenges. This paper aims to explore and analyse the perspectives of decision-making personnel regarding the challenges and opportunities of implementing a surgery support e-health application.
Methods
This study utilised an explorative qualitative approach, employing a rapid cycle qualitative evaluation informed by the NASSS framework. Data were collected through individual semi-structured interviews with decision-making personnel conducted. Framework analysis guided by the NASSS framework was used to analyse the interview transcripts.
Results
A total of 15 participants from public health and external organisations participated in the study. The analysis, framed by the seven domains of the NASSS framework, critical challenges in integrating new health technologies, emphasising the need for compatibility, cybersecurity, and demonstrating clear benefits. Key factors for successful adoption included early and continuous stakeholder engagement, organisational readiness, and ongoing support. Additionally, participants highlighted the importance of centralised information systems and continuous adaptation of health IT solutions to meet evolving needs.
Conclusion
This paper reveals that implementing surgical e-health interventions is a complex process fraught with organisational, technical, financial, and political challenges, particularly due to insufficient end-user involvement and the intricate healthcare landscape. Despite the recognised benefits, successful implementation necessitates comprehensive stakeholder engagement and co-design approaches. Additionally, while a partnership between commercial vendors and public health developers presents an attractive solution, significant obstacles such as intellectual property disputes and resource allocation must be overcome.
{"title":"The roadblocks to success – Identifying challenges in implementing a surgery support E-health solution: A qualitative interview study","authors":"Cory James Williams , Jed Duff","doi":"10.1016/j.pcorm.2024.100427","DOIUrl":"10.1016/j.pcorm.2024.100427","url":null,"abstract":"<div><h3>Background</h3><p>Surgery accounts for 30 % of the global disease burden, but healthcare systems struggle with managing surgical waitlists, optimising operations, and minimising cancellations, leading to poor patient outcomes and financial strain. E-health technologies offer promising solutions to enhance perioperative care and improve surgical outcomes, yet their integration faces significant organisational and structural challenges. This paper aims to explore and analyse the perspectives of decision-making personnel regarding the challenges and opportunities of implementing a surgery support e-health application.</p></div><div><h3>Methods</h3><p>This study utilised an explorative qualitative approach, employing a rapid cycle qualitative evaluation informed by the NASSS framework. Data were collected through individual semi-structured interviews with decision-making personnel conducted. Framework analysis guided by the NASSS framework was used to analyse the interview transcripts.</p></div><div><h3>Results</h3><p>A total of 15 participants from public health and external organisations participated in the study. The analysis, framed by the seven domains of the NASSS framework, critical challenges in integrating new health technologies, emphasising the need for compatibility, cybersecurity, and demonstrating clear benefits. Key factors for successful adoption included early and continuous stakeholder engagement, organisational readiness, and ongoing support. Additionally, participants highlighted the importance of centralised information systems and continuous adaptation of health IT solutions to meet evolving needs.</p></div><div><h3>Conclusion</h3><p>This paper reveals that implementing surgical e-health interventions is a complex process fraught with organisational, technical, financial, and political challenges, particularly due to insufficient end-user involvement and the intricate healthcare landscape. Despite the recognised benefits, successful implementation necessitates comprehensive stakeholder engagement and co-design approaches. Additionally, while a partnership between commercial vendors and public health developers presents an attractive solution, significant obstacles such as intellectual property disputes and resource allocation must be overcome.</p></div>","PeriodicalId":53468,"journal":{"name":"Perioperative Care and Operating Room Management","volume":"37 ","pages":"Article 100427"},"PeriodicalIF":0.0,"publicationDate":"2024-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S240560302400061X/pdfft?md5=8043e8a3133bdf629252a8d938499a91&pid=1-s2.0-S240560302400061X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142117718","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-28DOI: 10.1016/j.pcorm.2024.100424
Reine Zbeidy, Patricia Pozo, Fouad Ghazi Souki
Background
The operating room (OR) is a pivotal financial hub in modern healthcare, accounting for up to 40 % of hospital costs and generating 60–70 % of revenue. Optimizing OR efficiency is crucial for financial sustainability, patient safety, OR throughput, and satisfaction among patients, surgeons, and staff.
Objective
This Quality Improvement (QI) project aims to evaluate whether pre-procedure neuraxial ultrasound can enhance obstetric OR efficiency by reducing the time and attempts needed for epidural placement. The secondary objective is to assess improvements in patient comfort, safety, and satisfaction.
Methods
Conducted at a tertiary hospital in Miami from January to March 2022, the study included 98 parturients undergoing elective cesarean delivery. Patients were randomized into two groups: one receiving preoperative ultrasound (n = 49) and the other not (n = 49). Key metrics recorded included patient demographics, procedural times, number of attempts, pain scores, and patient satisfaction.
Results
The ultrasound group demonstrated significant improvements in OR efficiency: shorter epidural placement times (median 9 vs. 13 min, p < 0.001), fewer attempts (median 1 vs. 2, p < 0.001), reduced anesthesia ready times (median 22 vs. 31 min, p < 0.001), and decreased total OR times (median 122 vs. 140 min, p = 0.004). Patients in the ultrasound group reported less back pain (median score 0 vs. 1, p < 0.001) and higher satisfaction (median score 10 vs. 9, p < 0.001).
Conclusion
Preoperative neuraxial ultrasound significantly improves OR case duration and enhances patient outcomes in obstetric anesthesia. While the study's single-site data and lack of blinding are limitations, the findings support larger, multi-institutional studies to confirm these benefits and explore further efficiency improvements.
{"title":"Enhancing operating room efficiency and patient outcomes: The impact of preoperative neuraxial ultrasound in cesarean deliveries","authors":"Reine Zbeidy, Patricia Pozo, Fouad Ghazi Souki","doi":"10.1016/j.pcorm.2024.100424","DOIUrl":"10.1016/j.pcorm.2024.100424","url":null,"abstract":"<div><h3>Background</h3><p>The operating room (OR) is a pivotal financial hub in modern healthcare, accounting for up to 40 % of hospital costs and generating 60–70 % of revenue. Optimizing OR efficiency is crucial for financial sustainability, patient safety, OR throughput, and satisfaction among patients, surgeons, and staff.</p></div><div><h3>Objective</h3><p>This Quality Improvement (QI) project aims to evaluate whether pre-procedure neuraxial ultrasound can enhance obstetric OR efficiency by reducing the time and attempts needed for epidural placement. The secondary objective is to assess improvements in patient comfort, safety, and satisfaction.</p></div><div><h3>Methods</h3><p>Conducted at a tertiary hospital in Miami from January to March 2022, the study included 98 parturients undergoing elective cesarean delivery. Patients were randomized into two groups: one receiving preoperative ultrasound (<em>n</em> = 49) and the other not (<em>n</em> = 49). Key metrics recorded included patient demographics, procedural times, number of attempts, pain scores, and patient satisfaction.</p></div><div><h3>Results</h3><p>The ultrasound group demonstrated significant improvements in OR efficiency: shorter epidural placement times (median 9 vs. 13 min, <em>p</em> < 0.001), fewer attempts (median 1 vs. 2, <em>p</em> < 0.001), reduced anesthesia ready times (median 22 vs. 31 min, <em>p</em> < 0.001), and decreased total OR times (median 122 vs. 140 min, <em>p</em> = 0.004). Patients in the ultrasound group reported less back pain (median score 0 vs. 1, <em>p</em> < 0.001) and higher satisfaction (median score 10 vs. 9, <em>p</em> < 0.001).</p></div><div><h3>Conclusion</h3><p>Preoperative neuraxial ultrasound significantly improves OR case duration and enhances patient outcomes in obstetric anesthesia. While the study's single-site data and lack of blinding are limitations, the findings support larger, multi-institutional studies to confirm these benefits and explore further efficiency improvements.</p></div>","PeriodicalId":53468,"journal":{"name":"Perioperative Care and Operating Room Management","volume":"37 ","pages":"Article 100424"},"PeriodicalIF":0.0,"publicationDate":"2024-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142095421","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
This study assessed the perception, attitude and willingness of nursing undergraduates to specialise in perioperative nursing.
Background
The field of perioperative nursing is currently facing a significant shortage of trained perioperative nurses. This has great implications for patients’ care and surgical outcomes. Nursing students are the future workforce and their perception, attitude and willingness to join the perioperative nurses’ workforce will go a long way in averting this dangerous trend.
Design
The study adopted a descriptive cross-sectional research design.
Method
The study that was conducted in July, 2023, employed proportionate stratified random sampling technique to select a sample size of 271 nursing students across selected universities. Data collection was done with the aid of a structured questionnaire. Data collected was analysed using descriptive and inferential statistics, with p value set at 0.05 level of significance.
Results
Findings revealed that less than half (39.5 %) of the respondents possessed positive perception towards the specialty of perioperative nursing while the majority (60.5 %) had negative perception. Similarly, majority (51.3 %) of the respondents had a negative attitude to the field of perioperative nursing. Results further showed that majority (54.2 %) of the respondents exhibited low level of willingness to specialise in perioperative nursing. Data generated for the hypothesis showed a significant association between respondents’ attitude, willingness and their perception of perioperative nursing specialty.
Conclusion
The study concluded that nursing undergraduates are not that willing to specialise in perioperative nursing. Therefore, plans must be put in place to heighten the nursing students’ interest in perioperative nursing. This is with a view to boosting enrolment in perioperative nursing and resultant increase in recruitment and retention of perioperative nurses.
{"title":"Willingness of undergraduate nursing students to specialise in perioperative nursing in selected universities, Southwestern Nigeria","authors":"Olufemi Oyebanji Oyediran , Olamide Emmanuella Akinfala , Emmanuel Olufemi Ayandiran , Iyanuoluwa Oreofe Ojo","doi":"10.1016/j.pcorm.2024.100425","DOIUrl":"10.1016/j.pcorm.2024.100425","url":null,"abstract":"<div><h3>Aim</h3><p>This study assessed the perception, attitude and willingness of nursing undergraduates to specialise in perioperative nursing.</p></div><div><h3>Background</h3><p>The field of perioperative nursing is currently facing a significant shortage of trained perioperative nurses. This has great implications for patients’ care and surgical outcomes. Nursing students are the future workforce and their perception, attitude and willingness to join the perioperative nurses’ workforce will go a long way in averting this dangerous trend.</p></div><div><h3>Design</h3><p>The study adopted a descriptive cross-sectional research design.</p></div><div><h3>Method</h3><p>The study that was conducted in July, 2023, employed proportionate stratified random sampling technique to select a sample size of 271 nursing students across selected universities. Data collection was done with the aid of a structured questionnaire. Data collected was analysed using descriptive and inferential statistics, with p value set at 0.05 level of significance.</p></div><div><h3>Results</h3><p>Findings revealed that less than half (39.5 %) of the respondents possessed positive perception towards the specialty of perioperative nursing while the majority (60.5 %) had negative perception. Similarly, majority (51.3 %) of the respondents had a negative attitude to the field of perioperative nursing. Results further showed that majority (54.2 %) of the respondents exhibited low level of willingness to specialise in perioperative nursing. Data generated for the hypothesis showed a significant association between respondents’ attitude, willingness and their perception of perioperative nursing specialty.</p></div><div><h3>Conclusion</h3><p>The study concluded that nursing undergraduates are not that willing to specialise in perioperative nursing. Therefore, plans must be put in place to heighten the nursing students’ interest in perioperative nursing. This is with a view to boosting enrolment in perioperative nursing and resultant increase in recruitment and retention of perioperative nurses.</p></div>","PeriodicalId":53468,"journal":{"name":"Perioperative Care and Operating Room Management","volume":"37 ","pages":"Article 100425"},"PeriodicalIF":0.0,"publicationDate":"2024-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142157638","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
扫码关注我们
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号