In-House Anesthesia and Interventional Radiology Technologist Support Optimize Mechanical Thrombectomy Workflow after Hours.

BACKGROUND AND PURPOSE: Prior literature suggests after-hours delay leads to poor functional outcomes in stroke patients undergoing thrombectomy. We aimed to evaluate the impact of time of presentation on mechanical thrombectomy (MT) metrics and its association with long-term functional outcome in an Interventional Radiology (IR) suite equipped operating room (OR) setting. METHODS: Retrospective review of prospectively maintained database on all stroke patients undergoing mechanical thrombectomy between January 2015 and December 2018 at our CSC. Work hours were defined by official OR work hours (Monday-Friday 7 AM and 5 PM) and after-hours as between 5 PM and 7 AM during weekdays and weekends as well as official hospital holidays. Primary outcome was 90-day modified Rankin Scale (mRS). Secondary outcomes included door to groin puncture time and procedural complications. RESULTS: A total of 315 patients were included in the analyses. 209 (66.4%) received mechanical thrombectomy after hours and 106 (33.6%) during work hours. There was no difference in the shift distribution of functional outcome on the mRS at 90 days (OR: 1.14, CI: 0.72-1.78, p=0.58) and the percentage of patients achieving functional independence (mRS 0-2) at 90 days (43.1% vs. 41.3%; p=0.83) between the after hour and work hour groups respectively. Similarly, there was no difference in median door to groin times and procedural complications among both groups, with significant year on year improvement in overall time metrics. CONCLUSIONS: Our study showed that undergoing MT during off-hours had similar functional outcomes when compared to MT during working hours in an OR setting. The after-hours deleterious effect might disappear when MT is performed in a system with 24-hours in-house Anesthesia and IR tech services.

The Role of the RN Circulator in a Navigated Posterior Spinal Fusion: 1.3 www.aornjournal.org/content/cme.

The RN circulator plays a vital role in preparing for a minimally invasive spinal fusion with navigation by confirming that the necessary equipment and stakeholders are available and ensuring that the amount of equipment and the number of people in the room do not compromise patient safety or the sterility of the surgical field. Patients who undergo minimally invasive spinal fusion experience less blood loss, shorter hospital stays, and reduced costs than those who undergo open spinal fusion procedures. The overall successful fusion rates and improvement in patient quality of life are equivalent between the two approaches. Using navigation during minimally invasive and open spinal fusion procedures decreases radiation exposure to the patient and surgical team and helps ensure a more accurate placement of pedicle screws compared with nonnavigated minimally invasive or open spinal fusions.

Perceptions of the assistant theatre practitioner role: a view from my ivory tower.

At a recent AfPP event, during a debating session amongst fellow perioperative practitioners, the role and remit of assistant theatre practitioner (ATP) was raised. The debating panel's views were sought from several quarters and the subject seemed to spark discussion and much 'harrumphing' in the audience. A recently qualified ATP, who, having spent an intensive two years studying for a foundation degree, expressed his frustration about on-going role ambiguity and the struggle to have his newly acquired knowledge and skills recognised in practice. As a heated discussion went around the room, polarised views were emergent, in particular themed around concerns about delegation, accountability and scope of practice.

Assessing scrub practitioner non-technical skills: a literature review.

A review by Catchpole et al (2009) into the causes and types of harm experienced by the surgical patient emphasised the high risk nature of the perioperative period. Investigations into recent failures at NHS organisations have emphasised the relevance of non-technical skills education in improving clinical performance and patient outcomes. However, scrub practitioner non-technical skills are often developed on a tacit basis, making assessment of performance difficult. This literature review identifies strategies that facilitate assessment of non-technical skills during surgery. Recommendations are made that will assist scrub practitioners in using a validated scrub practitioner non-technical skills assessment framework reliably.

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

PURPOSE: To evaluate the effect of orthopedic and nonorthopedic operating room (OR) staff on the efficiency of turnover time in a hand surgery practice. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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. TYPE OF STUDY/LEVEL OF EVIDENCE: Economic/Decision Analysis III.

Professionalization and its discontents.

The sociology of professions has generally considered professionalization as a desirable outcome for occupational groups. This case study of professionalization in the UK National Health Service, based on an analysis of documents, presents a challenge to that view. For many groups, the state is now so comprehensively dominant in the process of professionalization that it can effectively dictate professional status on its own terms. Many of the advantages that accrued to professions that developed historically will not be available to groups that professionalize under this new regime. Though elite groups within the profession studied (Operating Department Practice) were strongly in favour of professionalization, throughout the process there were also dissenting voices. This case study will show how professionalization, despite being described as the 'Holy Grail' by those in favour of it, turned out to be, at best, a mixed blessing. While medicine may still be able to negotiate with the state for other groups, professionalization can in the future be equated with regulation.

Assessing the performance of surgical teams.

BACKGROUND: High-performing and high-reliability teams are an important component of service delivery. With a focused emphasis on safety in acute care hospitals, understanding the nature of surgical teams and team performance is an essential component to achieving high-quality surgical care. More information is needed about the challenges to effective team functioning in the operating room, the influence of working conditions, and the environmental context on surgical team performance. PURPOSE: The purpose of this study is to describe the nature of surgical teams and how they perform in the operating room to contribute to a broader knowledge about high-performing and high-reliability teams in health care settings. METHODOLOGY/APPROACH: We conducted a qualitative study involving direct observation and semistructured interviews. Field observations of 10 high-complexity surgeries and face-to-face interviews with 26 members of surgical teams were completed at one university medical center. A conceptual framework derived from the literature was developed to guide the selection of surgeries and surgical teams to be observed. Data were transcribed and analyzed to identify the factors and different conditions that influence the performance of these surgical teams. FINDINGS: The type of coordination and the degree of independent and interdependent coordination vary among the seven observed stages of the surgical process. Most of the surgical teams were ad hoc teams and as such, further challenged by consistently frequent "hand-offs" for break relief. Additional role demands influence the situational dynamics which can alter the adaptive capacity of the team. PRACTICE IMPLICATIONS: The surgical event evokes a changing degree of coordination and adaptation to complexity and uncertainty. In such environments, relational coordination through leadership can contribute to a successful surgical result, improvement of the overall process, including error reduction, and enhanced knowledge creation and dissemination, particularly germane in research university teaching hospitals.

Global interprofessional perioperative education: discussing the reality.

Many countries of the world have outlined clearly defined and distinct roles, for the perioperative environment, that are played by various individuals from a range of professions. Each of these professions tends to educate its practitioners in an environment that is almost completely isolated from the other perioperative professions and from its peers in other countries. One can only, currently, imagine the potential benefits to be gained from the sharing of educational and clinical experience between countries and between nursing and non-nursing perioperative team members, for both patient and the entire perioperative team. If such a level of sharing existed then the entire global perioperative community would benefit. The transfer of education and clinical practice, however, between countries needs careful thought. Many educational and professional disciplines have conducted research into ways of transferring/borrowing good practice between established systems and those just commencing similar practices. Perioperative practice needs a similar research base that has explored the dilemmas of transfer and borrowing between countries. It is important to determine what information should be shared, in the best interest of the patients, what sharing is affordable, and what method of sharing will fit in to an overall, global, strategy for perioperative practice. This paper seeks to use a recent example of multi-professional perioperative learning undertaken by Advanced Scrub Practitioners to provide a possible first glance in to the "crystal ball" of future practice. The aim of the discussion is to stimulate further discussion and effective research that, if carried out correctly, will seek to encourage interprofessional and international co-operation between perioperative professionals worldwide.

Newly-registered ODPs: what support do they receive?

This study used a quantitative, descriptive survey design to examine the level and nature of support that newly-registered Operating Department Practitioners (ODPs) receive in the clinical area. The findings suggest that support provided directly by people, such as preceptorship/mentorship and peer support, is rated as being more useful than suppor from systems, such as orientation programmes. Overall, 73.33% of the sample were either very or moderately satisfied with the support that they received.

Anaesthetic assistant competencies: our experience.

The purpose of this article is to share our findings since introducing the recently-developed anaesthetic assistant competencies (NHS Education for Scotland 2006). The term 'anaesthetic assistant' will be used throughout this article to refer to those who support the anaesthetist during anaesthesia. It is in no way meant to be derogatory to any person practising currently in this speciality.

Support staff roles in the operating department: a survey of staff opinion.

The expansion of support staff roles throughout the NHS was identified as a key element in the drive for service improvements set out in the NHS plan (Department of Health 2000). However, while examination of the literature identified the opinions of professional representative bodies (Perioperative Care Collaborative 2002a&b), little published data is available of the opinions of staff 'on the shop floor'.

Inter-professional education: registered nurses + ODPS = theatre practitioners.

The structure of theatre management should ensure that the patient receives the most appropriate care available, with every team member knowing their role and their expected contribution in order to meet the needs of the patient. Inter-professional healthcare is an integral feature of the NHS and this article will focus on the interaction and teamwork experienced in the theatre department between qualified nurses and qualified operating department practitioners (ODPs) and the perceived differences and similarities in their roles both historically and in future practice. Taylor and Campbell (1999) state the operating department is unique in that various members of the multidisciplinary teams are all present at the same time and work together for the successful completion of the perioperative period of care. Anonymous clinical examples have been used to highlight certain points and to illustrate the differing roles of the perioperative staff.

A common body of care: the ethics and politics of teamwork in the operating theater are inseparable.

In the operating theater, the micro-politics of practice, such as interpersonal communications, are central to patient safety and are intimately tied with values as well as knowledge and skills. Team communication is a shared and distributed work activity. In an era of "professionalism," that must now encompass "interprofessionalism," a virtue ethics framework is often invoked to inform practice choices, with reference to phronesis or practical wisdom. However, such a framework is typically cast in individualistic terms as a character trait, rather than in terms of a distributed quality that may be constituted through intentionally collaborative practice, or is an emerging property of a complex, adaptive system. A virtue ethics approach is a necessary but not sufficient condition for a collaborative bioethics within the operating theater. There is also an ecological imperative-the patient's entry into the household (oikos) of the operating theater invokes the need for "hospitality" as a form of ethical practice.