Intraoperative scrub nurse turnover in orthopaedic surgery procedures: An opportunity for improved operating room efficiency.

BACKGROUND: Scrub nurses play a crucial role in facilitating orthopaedic surgeries, and thus intraoperative scrub nurse turnover may disrupt the workflow of the surgical team and prolong duration of surgery (DOS). The purpose of this study was to quantify the impact of intraoperative scrub nurse turnover on operative time of orthopaedic surgeries lasting less than 3h in duration. METHODS: Prospectively collected databases from two institutions were retrospectively queried to identify all orthopaedic procedures of maximum mean duration of 180min from March 4th, 2018 to August 31st, 2022. Cases were divided into two groups, those with scrub nurse turnover and those without. Propensity score matching was conducted to match groups by surgeon, hospital, patient age, gender, and ASA classification. Unpaired t-tests were used to compare mean DOS for each surgical procedure. Average treatment effect on treated (ATET) with 95% confidence intervals (CIs) were calculated. RESULTS: Scrub nurse turnover significantly prolonged DOS for both bone forearm facture open reduction and internal fixation (ORIF) (ATET=21.08, p=0.001), ankle ORIF (ATET=21.26, p<0.001), clavicle ORIF (ATET=16.16, p=0.028), femur intramedullary nail (ATET=11.52, p=0.003), rotator cuff repair (ATET=16.88, p<0.001), partial discectomy (ATET=10.52, p=0.001), total knee arthroplasty (TKA) (ATET=5.69, p<0.001), anterior total hip arthroplasty (THA) (ATET=8.80, p<0.001), lateral THA (ATET=7.02, p<0.001), and uncemented hip hemiarthroplasty (ATET=16.79, p=0.049). CONCLUSION: Intraoperative scrub nurse turnover significantly prolongs surgical times in orthopaedic surgeries lasting up to 3h in duration. This highlights the importance of developing strategies to prevent intraoperative scrub nurse turnover to improve OR efficiency and decrease healthcare costs.

Razón enfermero - paciente y razón auxiliar de enfermería- paciente y su relación con los indicadores de calidad sensibles a enfermería en una unidad de cuidado intensivo adulto en una IPS de Bogotá / Nurse-patient ratio and nursing assistant-patient ratio and their relationship with nursing-sensitive quality indicators in an adult intensive care unit in an IPS in Bogotá

La literatura mundial ha demostrado que la razón adecuada enfermero ­ paciente tiene impacto a nivel de menores complicaciones, menor estancia hospitalaria, eventos adversos, morbilidad y mortalidad, permitiendo ofrecer a los pacientes mayor garantía de calidad en su atención. Este trabajo investiga si existe o no relación entre el cociente resultante entre los pacientes asignados y cada enfermero, y los pacientes asignados y cada auxiliar de enfermería, con la probabilidad de que se presenten casos de shock, caídas, flebitis, infecciones nosocomiales o muertes. Objetivo: Establecer la relación entre la razón paciente-enfermero y la razón paciente ­ auxiliar de enfermería con los indicadores de calidad sensibles a enfermería en una unidad de Cuidado intensivo adulto de Bogotá, Colombia. Métodos, muestra y escenario: Estudio cuantitativo, descriptivo correlacional; con una dimensión longitudinal; muestra de 549 turnos en una unidad de cuidado intensivo de Bogotá. Resultados: No se encuentra asociación entre la razón paciente-enfermera y la razón paciente-auxiliar de enfermería a través de la correlación biserial; se evidencia desde el enfoque descriptivo, diferencias entre los grupos de razones tanto de enfermeras, como de auxiliares, en los turnos en donde se presentan y no se presentan casos de shock o paro cardiorespiratorio, con significancia asintótica de 0.000, a través de la prueba de U de Mann-Whitney. Conclusiones: La razón paciente- enfermera y paciente - auxiliar de enfermería no presenta para este estudio una asociación estadística con las variables muerte, paro cardiorrespiratorio o shock e Infecciones nosocomiales, esto debido a falta de peso estadístico de la muestra del estudio.

World literature has shown that an adequate ratio nurse-patient has impact at levels of fewer complications, shorter hospitalization times, fewer adverse events, lower morbidity and mortality, allowing offering the patient greater guarantee of quality in their care. This work investigates if whether exists or not a relationship with the resulting quotient between assigned patients and each nurse, assigned patients and each assistant with the probability of occurrence of shocks, falls, phlebitis, nosocomial infections or deaths. Objectives: Establish the relationship between the nurse-patient and assistant-patient ratio with the nursing quality indicators in an intensive care unit in Bogotá, Colombia. Design, samples and scenario: Quantitative studio, descriptive correlational; with longitudinal dimension; sample of 549 shifts in an intensive care unit. Results: No association was found between nurse-patient and assistant-patient ratio through biserial correlations; evidence of differences from a descriptive focus have been found between ratio groups of nurses and assistants in shifts where shock or cardiopulmonary arrests were or were not present, with asymptotic significance of 0.000, through U test from Mann-Whitney. Conclusions: Nurse-Patient and Assistant-Patient ratios do not present for this study a statistical association with death, cardiopulmonary arrest or shock and nosocomial infection variables due to a lack of statistical weight of the study sample.

Razón enfermero(a)/ paciente y auxiliar de enfermería/paciente y su relación con la incidencia de eventos adversos en unidades de cuidado intensivo / Nurse/patient and nursing assistant/patient ratio and its relationship with the incidence of adverse events in intensive care units

Estudios realizados a finales de los 90 alertaron sobre un riesgo inevitable de ocurrencia de Eventos Adversos (EA) que fueron definidos como acontecimientos relacionados con la atención en salud recibida más que con la enfermedad subyacente y que ocasionan fallecimiento, lesión, incapacidad o prolongación de la estancia hospitalaria de los pacientes. Este trabajo analiza la posible relación entre el número de pacientes asignados a cada enfermero(a) y a cada auxiliar de enfermería y la probabilidad ocurrencia o no de eventos adversos derivados de tal distribución. Objetivo: Establecer si existe o no relación entre la distribución de pacientes por enfermero(a)s y auxiliares de enfermería y la probabilidad de incidencia de eventos adversos en tres unidades de cuidado intensivo de la ciudad de Ibagué, Colombia. Métodos:Estudio ecológico, longitudinal, correlacionar desarrollado en tres unidades de cuidado intensivo. Resultados:Hubo asociación entre la distribución de enfermero(a)s / paciente E/P y la probabilidad de incidencia demortalidad 1/5. (OR:1.1) IC 95%, paro cardiorrespiratorio.1/5 (OR 1.38) IC 95% Infecciones derivadas de la atención en salud 1/5 (OR: 1.10) IC 95%.Las dos primeras variables se estudiaron como generales debido a la limitación que impuso el subregistro evidenciado durante el tiempo del estudio. Se evidenció como única variable, de las analizadas en el estudio, sensiblemente relacionada con la razón de auxiliares de enfermería / paciente AE/P. La incidencia de escaras por decúbito 1/4 (OR:1.272) IC:95%. Conclusiones: La razónenfermero(a) / paciente y auxiliar de enfermería / paciente presenta para este estudio una asociación estadísticamente no significativa con las variables muerte, paro cardiorrespiratorio, Infecciones derivadas de la atención en salud y para los auxiliares de enfermería incidencia de escaras, esto debido al subregistro evidenciado durante todo el estudio.

Some studies performed at the end of the 90s stated that the healthcare attention system could provide benefits for the caretaking process. They also noticed an unavoidable Side Effect occurrence risk (EA, for its acronym in Spanish) that was defined as events more closely related with care and attention received than with the underlying illness and that cause decease, injuries, incapacities or the extension of their stay in the hospitals. This paper analyses the possible relationship between the number of patients assigned to each nurse and each assistant nurse and the appearance or not of side effects result of such distribution. Objective: To establish whether there is a relationship between the patient ­ nurse/assistant nurse distribution and the incidence of side effects in three intensive care units of Ibague, Colombia. Methods: Ecological, longitudinal and equivalent study developed in three intensive care units. Results:There was an association between the distribution of nurses (a) s / patient E / P and the probability of incidence of mortality 1/5. (OR: 1.1) 95%, unemployment cardiorrespiratorio.1 / 5 (OR 1.38) 95% Infections resulting from healthcare 1/5(OR: 1.10) 95%. The first two variables were studied as generals because the limitation imposed by the underreporting demonstrated during the study period. It was shown only variable, of those analyzed in the study, significantly related to the reason for nursing assistants / patient AE / P. The incidence of pressure sores 1/4 (OR: 1.272) CI: 95%. Conclusions: The reason patient / nurse and patient / nursing assistant for this study shows a statistically not significant variables with death, cardiac arrest, infections resulting from health care and nursing assistants incidence of bedsores, this due to underreporting.

Diseño de un programa psicoeducativo para el cuidado de pacientes con herpes simple genital / Design of a psycho-educational program for the care of genital herpes simplex

Introducción: En Cuba, se reporta alta incidencia y prevalencia de herpes simple genital. Sin embargo, los/as enfermeros/as encuestadores carecen de una herramienta metodológica para el cuidado de estos pacientes en la Atención Primaria de Salud. Objetivos: Por tal motivo, se realizó un estudio que respondió a un proyecto de desarrollo con el objetivo de diseñar un programa psicoeducativo para disminuir el riesgo en la salud sexual y los problemas psicosociales de los pacientes con diagnóstico clínico de herpes simple genital. Métodos: Para el diseño del programa psicoeducativo se utilizaron las tres primeras etapas del modelo de Giordan. En este sentido, se realizó un estudio fenomenológico en 8 pacientes con diagnóstico de herpes simple genital, para determinar las necesidades de aprendizaje y se sometió a criterio de expertos para establecer los objetivos, métodos y contenidos del programa psicoeducativo. Resultados: El programa quedó conformado por seis sesiones encaminadas a disminuir los problemas psicosociales, incrementar la autoeficacia en el uso del condón, el conocimiento sobre la enfermedad, la eficacia para tener sexo seguro y la eficacia para comunicar la enfermedad. Conclusiones Se diseñó un programa psicoeducativo que incorporó cinco ejes (problemas psicológicos, conocimientos sobre la enfermedad, uso del condón, sexo seguro y revelado de la enfermedad)(AU)

Introduction: In Cuba a high incidence and prevalence of genital herpes simplex is reported. However, nurses and pollters have not available a methodological means for the care of these patients in Primary Health Care. Objectives: Thus, authors conducted an study that is in keeping with to a project of development to design a psycho-educational program to decrease the risk in sexual health and the psychosocial problems of patients clinically diagnosed with genital herpes simplex. Methods: For design of above mentioned program the three stages of the Giordan form were used. In this sense, a phenomenology study was conducted in 8 patients diagnosed with genital herpes simplex, to determine the needs of learning submitting to expert's criteria to establish the objectives, methods and contents of psycho-educational program. Results: The program included six sessions aimed to decrease the psychosocial problems, to increase the self-effectiveness in the use of condom, the knowledge on disease, a safe intercourse and the efficiency to communicate the disease. Conclusions: A psycho-educational program was designed incorporating five key features (psychological problems, knowledges on disease, use of condom, safe intercourse and developing of disease)(AU)