Perioperative Care and Operating Room Management最新文献

Background

Data regarding the postoperative recovery experience are limited. Perioperative clinicians focus on improving patients’ postoperative discomfort. However, the types of postoperative discomfort experienced by patients are unclear.

Methods

This descriptive, qualitative study explored the perception of discomfort in 12 postoperative patients by conducting semi-structured, face-to-face interviews. Interviews were digitally recorded, transcribed and analysed using inductive content analysis.

Results

Data analysis revealed two themes ‘physical sensation’ and ‘psychological feelings’ and six categories, ‘restrictions imposed after surgery’, ‘symptoms related to surgery and anaesthesia’, ‘indescribable physical discomfort’, helplessness towards oneself’, ‘lack of privacy’ and ‘noisy medical environment’.

Conclusion

Healthcare workers should consider psychological and physical factors to improve postoperative discomfort, particularly focusing on identifying the cause of discomfort and alleviating psychological and physical discomfort.

Background

The importance of patient safety and the development of safety cultures to protect patients from harm have gradually gained attention in quality improvement efforts. These initiatives play a significant role in ensuring patient safety and have an impact on healthcare outcomes. Even though health interventions are intended to benefit the public, there is an inevitable risk that adverse events will occur owing to the complex combination of processes, technologies, and human interactions. While there is a substantial body of evidence regarding risks in hospitals; however, information about adverse events occurring in healthcare settings, such as physicians’ offices, nursing homes, pharmacies, and patients’ homes, is not well documented. This research was aimed to assess the patient safety culture and identify associated factors among healthcare workers in public hospitals.

Method

A facility-based cross-sectional study using quantitative and qualitative methods was conducted from May to June 2021 in public hospitals in the South Wollo Zone. Quantitative data was collected using a self-administered questionnaire, while qualitative data was analyzed through in-depth interviews. The collected data was analyzed using Epi-data 4.6, SPSS version 25, and thematically for organizational and healthcare worker-related factors. Bivariate and multivariable logistic regression analyses were conducted, estimating the AOR and 95 % CI, with significance set at a P-value of less than 0.05.

Results

The overall level of positive patient safety culture was 50.1 % (95 % CI: 49, 50.9). Age 30–34 years (AOR = 0.24, 95 % CI: 0.10–0.61), work experience >= 11 (AOR = 0.07, 95 % CI: 0.02, 0.32), education level as diploma (AOR = 0.14, 95 % CI: 0.32, 0.65), training (AOR = 4.17, 95 % CI: 2.06, 8.44), working units in OR (AOR = 4.54, 95 % CI: 1.10, 18.68), and working units in emergency (AOR = 4.05, 95 % CI: 1.29, 12.69) were factors significantly associated with the patient safety culture. The in-depth interviews indicated that training, continuous professional development, level of education, and teamwork are crucial for fostering a positive patient culture.

Conclusion

The overall level of a positive patient safety culture was high. Age, work experience, education level, training, and working units significantly influenced the patient safety culture. Healthcare managers should consider patient safety culture a top priority.

Background

Malnutrition is a common and underdiagnosed comorbidity in surgical patients. It negatively impacts wound healing, maintenance of muscle mass, survival rate, length of stay, and subsequent hospitalization costs in post-operative patients. Early diagnosis and treatment of malnutrition can potentially mitigate these complications. Our study looked at the feasibility of screening for malnutrition in a preoperative clinic, with subsequent dietician evaluation of patients with positive screens. We also examined the effect of diagnosis on reimbursement associated with these patients who incur increased hospital costs.

Methods

This prospective observational study included all surgical patients seen in the preoperative clinic at a large academic hospital in 2022. Patients were screened for malnutrition as part of the preoperative nursing assessment. Based on malnutrition score or surgical procedure, patients were referred to an in-clinic dietitian for preoperative evaluation and treatment. We tracked the number of patients screened, evaluated, and diagnosed with moderate or severe malnutrition. A financial analysis was undertaken to determine the reimbursement benefit of the diagnosis and documentation of malnutrition in the preoperative setting. Standard Medicare reimbursement coding rates were used to calculate the This may be Funding Agency. Please check.financial impact.

Results

17,464 patients were screened for malnutrition by preoperative clinic nurses during the study period. Among these patients, 1,366 underwent in-person or virtual evaluation by the dietitian based on screening results or surgical procedure. 309 patients were identified with moderate or severe malnutrition by a registered dietitian. In the financial analysis, documentation of moderate or severe malnutrition in 25 Medicare patients resulted in $441,635.37 in additional hospital reimbursement. Additionally, there were 6 Medicare patients where malnutrition was documented but not captured by the coding department, resulting in a missed opportunity of $86,273.61.

Conclusions

Preoperative malnutrition is common and underdiagnosed. Preoperative malnutrition screening and intervention is feasible using a simple preoperative workflow. Improved documentation of malnutrition may also have positive financial implications for health systems, making this a cost-effective intervention program.

Background

The objective is to determine the surgical productivity changes between morning and afternoon surgery using the Malmquist index (MI) model. We hypothesized that the late-in-the-day scheduling of surgery significantly reduced the surgical total factor productivity.

Methods

This is a retrospective observational study conducted at a university hospital. 1,463 surgical procedures performed by fifty surgeons were analyzed during the study period of 2023. A non-radial and non-oriented MI model under the variable return-to-scale assumptions was employed. The decision-making unit (DMU) was defined as a surgeon with the highest academic rank in surgery. Inputs were defined as (1) the number of medical doctors who assisted surgery, and (2) the duration of surgical operation from skin incision to closure. The output was defined as the surgical fee for each surgery. Surgical procedures that started between 8 and 11 am were defined as morning surgery, and those that started between 2 and 5 pm were afternoon surgery. The authors added all the inputs and outputs for each DMU during morning and afternoon surgery. The primary outcome measure is MI index, and the secondary outcome measures are the catch-up and frontier-shift effects.

Results

The productivity change from the morning to the afternoon of all surgical procedures was significantly negative. The catch-up effect was not significantly different from zero, while the frontier-shift effect significantly negative.

Conclusions

The surgeons were less productive in the afternoon than in the morning. This productivity regress was likely to be due to reduced availability of hospital resources.

Trial Registration

None.

Objective

In order to meet the needs of patients in modern medicine for lean nursing mode, the author proposes a method of lean nursing combining Da Vinci robot-assisted surgery and laparoscopic-assisted surgery, using the data analysis system, the authors retrospectively analyzed the differences in the basic conditions, medical safety, short-term efficacy, hospitalization time, and hospitalization costs of the patients in the Da Vinci robot group and the laparoscopy group.

Results

The results showed that: Compared with the general nursing group, the lean nursing group combined with DaVinci robot technology had a significantly higher nursing compliance score (96.14 points vs. 82.23 points, P<0.05); The nursing job satisfaction score was significantly improved (47.26 points vs. 41.19 points, P<0.05). The postoperative hospital stay was significantly shortened (4.46 d vs 6.02 d, P<0.05); Karnofsky physical condition score at 1 week after operation (88.62 points vs 83.47 points, P<0.05) and EORTC QLQ-C30 quality of life evaluation system overall health standardization score at 1 week after operation (73.79 points and 68.02 points, P<0.05) were also significant improve.

Conclusion

: Lean nursing combined with the DaVinci robot has a great effect and help in the operation and after operation of the surgical patient, and the patient also has a high evaluation of the author's method.

Background & Aim

The competence of anesthesia nurse has a significant association with patient health and safety, reduction of medical errors, hospital infections, and postoperative complications. However, there is no instrument available to measure the competence of anesthesia nurse Iran. Anesthesia Nursing Competence Scale (AnestComp) is a self-assessment tool that measures the competence level of anesthesia Personnel. The present study sought to assess the psychometric properties of the Persian version of AnestComp in the Iranian anesthesiology community.

Materials & Methods

This cross-sectional study aimed to assess the psychometric properties of the Persian version of AnestComp in a sample of 362 anesthesia nurse from hospitals affiliated with the University of Medical Sciences. After translating the original version of the scale, the face, content, and structural validity as well as the reliability of the scale were evaluated. Data analysis was performed using SPSS-16 and AMOS-24 software.

Results

The assessment of the face validity of AnestComp showed that the impact score for each item was greater than 3.13. Moreover, the average content validity ratio (CVR) for 38 items was 0.91 and the corresponding value for each item was greater than 0.54. The average content validity index (CVI) for 38 items was 0.93 and the related value for each item was greater than 0.73. In addition, item 39 was removed due to low CVR and CVI values. The construct validity of the scale was checked using confirmatory factor analysis and the factor loading values for the items varied from 0.82 to 0.91, confirming that the seven factors of the scale were within acceptable ranges. Moreover, the reliability of the scale was confirmed with Cronbach's alpha of 0.981 and the correlation of 0.94 between the scores from the re-administration of the scale, indicating that the scale has acceptable internal consistency.

Conclusion

The Persian version of AnestComp has acceptable psychometric properties and it can be used as a valid tool to measure the competencies of anesthesia Personnel.

Esophageal malignancy causing tracheal stenosis is commonly reported in the elderly population. Life-threatening tracheal stenosis by an esophageal mass at a young age, is a rare presentation. A 25-year-old female presented in the emergency room with complaints of difficulty in breathing and was in stridor. She was intubated with a 6 mm internal diameter endotracheal tube on the third attempt, and ventilation of the lung was only possible by the use of a self-inflating resuscitation bag. The blood gas report was suggestive of severe respiratory acidosis and emergency surgery was planned. During a thoracotomy, the lung was ventilated with the help of a self-inflating resuscitation bag under general anesthesia. With the relief of tracheal compression, lung compliance improved, and patient could be discharged from the intensive care unit after 7 days. Tracheal compression caused by esophageal mass is an emergency condition. Stent implantation or surgical removal of such tracheal obstructions can provide immediate relief and should be evaluated by a multidisciplinary team.

Purpose

Upper limb surgeries can be performed with axillary brachial plexus block (ABPB). In some situations, it is not possible to obtain the adequate position for the blockade, so the costoclavicular approach can be used. In this case report, an 83-year-old patient had a movement restriction that made axillary anesthesia impossible. After the costoclavicular block, there was relaxation of the upper limb muscles, making it possible to perform the axillary block.

Clinical features

An 83-year-old patient with osteomyelitis of the distal end of the proximal phalanx and proximal interphalangeal joint of the 5th right finger was admitted for collection of soft tissue material and bone fragments for culture. He had a vicious semi-flexed position of the right upper limb, making it impossible to perform ABPB, due to the impossibility of accessing the needle insertion surface. Thus, the brachial plexus block was performed through the costoclavicular block (CCB) with less than half of the dose foreseen for the procedure. With the relaxation provided by the blockade, it was then possible to perform the brachial plexus blockade through the axillary route with the remainder of the dose. The procedure was performed uneventfully with good recovery of the patient.

Conclusion

Performing a concomitant brachial plexus block may make it possible to perform procedures at the distal end of the upper limb in patients with a semi-flexed vicious position.

It is well established that patients with a personal history of a cerebrovascular accident (stroke or transient ischemic attack) are at increased risk for perioperative cardiovascular complications, including recurrent stroke. Although the individual patient risk for perioperative stroke is typically low, the overall prevalence is significant, appears to be increasing, and has the potential for devastating complications including death. The perioperative provider must not only be knowledgeable of the elevated risk for patients with a history of stroke undergoing surgery, but also be familiar with perioperative risk reduction strategies. This article provides a general overview of cerebrovascular disease in surgical patients with much of the content being presented at the 2023 Perioperative Medicine Summit in Orlando, Florida.

Background

Postoperative low back pain is frequently observed in patients undergoing general anesthesia. Having LBP in the first week after surgery affects the mobilization process of the patients. Placing an anti-pressure position gel pad on the lumbar region during surgery may improve patient outcomes.

Methods

The aim of this single-blind quasi-experimental study was to evaluate the effect of the anti-pressure lumbar gel pad on postoperative LBP and mobilization time at the first mobilization following surgeries performed in the supine position under general anesthesia. The study was carried out in the general surgery operation room. A total of 168 patients were included in the study. In the experimental group, after induction of general anesthesia a small size anti-pressure gel pad was placed on the lumbar region of ​​patients with BMI ˂18.5, medium size for those with a BMI of 18.5–24.9, and a large size anti-pressure gel pad for patients with a BMI of 25–29.9. We collected sociodemographic information and measured postoperative LBP and walking time using the Numeric Pain Rating Scale and a stopwatch.

Results

In the experimental group, the mean LBP severity score was 2.63 ± 1.10 on admission to the general surgery clinic after surgery (day 0), 2.58 ± 0.98 after surgery before the first mobilization, 1.43 ± 1.07 on postoperative day 1, 0.87 ± 1.05 on day 2, and 0.21 ± 0.58 on day 6. In the control group, the mean LBP severity score at these time points was 4.29 ± 1.47, 4.58 ± 1.49, 3.99 ± 1.43, 3.61 ± 1.47, and 2.92 ± 1.43, respectively. A significant difference was observed between the groups in terms of the LBP severity mean scores (F = 58.913, p ˂ 0.05) The mean walking time at the first mobilization in experimental and control groups was 12.08 ± 2.82 and 9.88 ± 2.90 min, respectively. A significant difference was observed between the groups in terms of the mean walking time (t = 4.988, p ˂ 0.001).

Conclusion

The use of an anti-pressure lumbar gel pad improved postoperative LBP and the length of time spent walking at the first mobilization.