RESUMO
BACKGROUND: Surgical instrument tray reduction attempts to minimize intraoperative inefficiency and processing costs. Previous reduction methods relied on trained observers manually recording instrument use (i.e. human ethnography), and surgeon and/or staff recall, which are imprecise and inherently limited. We aimed to determine the feasibility of radiofrequency identification (RFID)-based intraoperative instrument tracking as an effective means of instrument reduction. METHODS: Instrument trays were tagged with unique RFID tags. A RFID reader tracked instruments passing near RFID antennas during 15 breast operations performed by a single surgeon; ethnography was performed concurrently. Instruments without recorded use were eliminated, and 10 additional cases were performed utilizing the reduced tray. Logistic regression was used to estimate odds of instrument use across cases. Cohen's Kappa estimated agreement between RFID and ethnography. RESULTS: Over 15 cases, 37 unique instruments were used (median 23 instruments/case). A mean 0.64 (median = 0, range = 0-3) new instruments were added per case; odds of instrument use did not change between cases (OR = 1.02, 95%CI 1.00-1.05). Over 15 cases, all instruments marked as used by ethnography were recorded by RFID tracking; 7 RFID-tracked instruments were never recorded by ethnography. Tray size was reduced 40%. None of the 25 eliminated instruments were required in 10 subsequent cases. Cohen's Kappa comparing RFID data and ethnography over all cases was 0.82 (95%CI 0.79-0.86), indicating near perfect agreement between methodologies. CONCLUSIONS: Intraoperative RFID instrument tracking is a feasible, data-driven method for surgical tray reduction. Overall, RFID tracking represents a scalable, systematic, and efficient method of optimizing instrument supply across procedures.
Assuntos
Salas Cirúrgicas/provisão & distribuição , Dispositivo de Identificação por Radiofrequência , Instrumentos Cirúrgicos/provisão & distribuição , Oncologia Cirúrgica/organização & administração , Redução de Custos , Estudos de Viabilidade , Humanos , Salas Cirúrgicas/economia , Salas Cirúrgicas/organização & administração , Projetos Piloto , Instrumentos Cirúrgicos/economia , Oncologia Cirúrgica/economia , Oncologia Cirúrgica/instrumentaçãoRESUMO
BACKGROUND: In view of preventing surgical site infection (SSI) in the orthopedic operating room (OR), evidence concerning types of footwear and clothing is limited. This study aimed to investigate how different footwear and clothing affect the cleanliness of the OR environment. METHODS: The airborne dust concentration in a bioclean room (NASA class 100) was measured around an operator by using a handheld particle counter under the following conditions: (I) wearing a sterilized full-type space suit with OR dedicated clean sandals; (II) wearing a sterilized full-type space suit with non-dedicated (outside) shoes or severely contaminated outside shoes with surgical glove powder (2 µm mean particle size); and (III) wearing an unsterilized medical scrub uniform with OR dedicated sandals. The participant was standing still or stepping in place at 1 Hz during the testing. RESULTS: The concentrations of airborne dusts in the operative field were independent of footwear and clothing types under the stand-still condition. However, these values significantly increased 1.96- to 16.23-fold after simple stepping motion in all the test conditions, and often became dissatisfaction level with the NASA100 requirement for the OR cleanliness. The worst contamination occurred when an operator wore the powder-contaminated shoes and also the unsterilized scrub uniform. CONCLUSION: The present study showed that the stepping motion triggered a considerable contamination in the operative field (beyond the level of NASA100 threshold) particularly when an operator used the outside shoes or unsterilized scrub uniform. Therefore, these results tell us that the one-footwear system (i.e., no use of OR dedicated clean shoes) and unsterilized scrub are likely to be a potential risk factor for SSI. Nevertheless, further studies are necessary to conclude the real efficacy of OR dedicated shoes and sterilized clothes on the SSI prevention.
Assuntos
Salas Cirúrgicas/provisão & distribuição , Sapatos , Posição Ortostática , Infecção da Ferida Cirúrgica/prevenção & controle , Humanos , Período Intraoperatório , Fatores de RiscoRESUMO
BACKGROUND: To mitigate the effects of coronavirus disease 2019 (COVID-19), jurisdictions worldwide ramped down nonemergent surgeries, creating a global surgical backlog. We sought to estimate the size of the nonemergent surgical backlog during COVID-19 in Ontario, Canada, and the time and resources required to clear the backlog. METHODS: We used 6 Ontario or Canadian population administrative sources to obtain data covering part or all of the period between Jan. 1, 2017, and June 13, 2020, on historical volumes and operating room throughput distributions by surgery type and region, and lengths of stay in ward and intensive care unit (ICU) beds. We used time series forecasting, queuing models and probabilistic sensitivity analysis to estimate the size of the backlog and clearance time for a +10% (+1 day per week at 50% capacity) surge scenario. RESULTS: Between Mar. 15 and June 13, 2020, the estimated backlog in Ontario was 148 364 surgeries (95% prediction interval 124 508-174 589), an average weekly increase of 11 413 surgeries. Estimated backlog clearance time is 84 weeks (95% confidence interval [CI] 46-145), with an estimated weekly throughput of 717 patients (95% CI 326-1367) requiring 719 operating room hours (95% CI 431-1038), 265 ward beds (95% CI 87-678) and 9 ICU beds (95% CI 4-20) per week. INTERPRETATION: The magnitude of the surgical backlog from COVID-19 raises serious implications for the recovery phase in Ontario. Our framework for modelling surgical backlog recovery can be adapted to other jurisdictions, using local data to assist with planning.
Assuntos
Procedimentos Cirúrgicos Cardíacos/estatística & dados numéricos , Infecções por Coronavirus , Neoplasias/cirurgia , Transplante de Órgãos/estatística & dados numéricos , Pandemias , Pneumonia Viral , Procedimentos Cirúrgicos Vasculares/estatística & dados numéricos , Betacoronavirus , COVID-19 , Procedimentos Cirúrgicos Eletivos/estatística & dados numéricos , Previsões , Número de Leitos em Hospital/estatística & dados numéricos , Humanos , Unidades de Terapia Intensiva/provisão & distribuição , Tempo de Internação/estatística & dados numéricos , Modelos Estatísticos , Ontário , Salas Cirúrgicas/provisão & distribuição , Pediatria/estatística & dados numéricos , SARS-CoV-2 , Fatores de TempoRESUMO
Cataract surgery is the most common operation performed in most developed countries, including Canada. Nuanced, evidence-driven policies are needed to ensure appropriate access to this sight-saving operation while maintaining the highest standards in quality of care. The Vision Health Services Research Program at Queen's University, in partnership with members of the Ontario Provincial Vision Task Force, has developed evidence to inform policies aimed at optimizing both access and quality across the eye care spectrum.
Assuntos
Extração de Catarata/normas , Cirurgiões/provisão & distribuição , Mobilidade Ocupacional , Extração de Catarata/efeitos adversos , Extração de Catarata/estatística & dados numéricos , Política de Saúde , Humanos , Ontário , Salas Cirúrgicas/provisão & distribuição , Oftalmologia/educação , Oftalmologia/normas , Complicações Pós-Operatórias/epidemiologiaRESUMO
The efficiency of trauma lists when compared with elective orthopaedic lists is a frustration of many orthopaedic departments. At the Royal Gwent Hospital, late start times affecting total operating capacity of the trauma list were recognised as a problem within the department. The design team aimed to improve the start time of the list with the introduction of the 'golden patient' initiative. A protocol was agreed between the orthopaedic, anaesthetic and theatre staff where a 'golden patient' was selected for preoperative anaesthetic assessment by 14:00 the day before surgery and sent for at 08:15 as the first case on the trauma list. Baseline data was collected over a month. Two Plan-Do-Study-Act (PDSA) cycles were completed, one on the month the 'golden patient' initiative was implemented and one 4 months after the change. All data was collected from the Operating Room Management Information Service theatre system for the trauma theatre at the Royal Gwent Hospital. Results demonstrated significant improvement in patient arrival time in the theatre suite; PDSA1 by 33 min (p≤0.001) and PDSA2 by 29 min (p≤0.001) and an earlier start of the first procedure; PDSA1 by 19 min (p=0.018) and PDSA2 by 26 min (p≤0.001). There was also increased mean operating time per list (PDSA1 +16 min and PDSA2 +33 min), increased total case number (PDSA1 +20 cases and PDSA2 +36 cases) and reduced cancellations (PDSA1 -2 cases and PDSA -5 cases) compared with our baseline data. We demonstrated that the introduction of a 'golden patient' to the trauma theatre list improved the start time and overall operating capacity for the trauma list. Continuing this project, we plan to introduce assessment of all patients with fractured neck of femur in a similar way to the 'golden patient' to continue improving trauma theatre efficiency and reduce case cancellations.
Assuntos
Eficiência Organizacional/estatística & dados numéricos , Salas Cirúrgicas/provisão & distribuição , Duração da Cirurgia , Gerenciamento do Tempo , Adulto , Procedimentos Cirúrgicos Eletivos , Feminino , Hospitais , Humanos , Pessoa de Meia-Idade , Ortopedia , Melhoria de Qualidade , Reino Unido , Ferimentos e LesõesRESUMO
BACKGROUND: With the improvement of sensor technology, the trend of Internet of Things (IoT) is affecting the medical devices. The aim of this study is to verify whether it is possible to "visualize instrument usage in specific procedures" by automatically accumulating the digital data related to the behavior of surgical instruments/forceps in laparoscopic surgery. METHODS: Five board-certified surgeons (PGY 9-24 years) performed laparoscopic cholecystectomy on 35-kg porcine (n = 5). Radio frequency identifier (RFID) was attached to each forceps with RFID readers installed on the left/right of the operating table. We automatically recorded the behavior by tracking the operator's right/left hands' forceps with RFID. The output sensor was installed in the electrocautery circuit for automatic recordings of the ON/OFF times and the activation time. All data were collected in dedicated software and used for analysis. RESULTS: In all cases, the behaviors of forceps and electrocautery were successfully recorded. The median operation time was 1828 s (range 1159-2962 s), of which the electrocautery probe was the longest held on the right hand (1179 s, 75%), followed by Maryland dissectors (149 s, 10%), then clip appliers (91 s, 2%). In contrast, grasping forceps were mainly used in the left hand (1780 s, 93%). The activation time of electrocautery was only 8% of the total use and the remaining was mainly used for dissection. These situations were seen in common by all operators, but as a mentor surgeon, there was a tendency to change the right hand's instruments more frequently. The median activation time of electrocautery was 0.41 s, and these were confirmed to be 0.14-0.57 s among the operators. CONCLUSION: By utilization of IoT for surgery, surgical procedure could be "visualized." This will improve the safety on surgery such as optimal usage of surgical devices, proper use of electrocautery, and standardization of the surgical procedures.
Assuntos
Colecistectomia Laparoscópica/instrumentação , Internet das Coisas , Salas Cirúrgicas , Dispositivo de Identificação por Radiofrequência , Animais , Colecistectomia Laparoscópica/métodos , Colecistectomia Laparoscópica/normas , Teste de Materiais , Informática Médica/instrumentação , Salas Cirúrgicas/organização & administração , Salas Cirúrgicas/provisão & distribuição , Duração da Cirurgia , Melhoria de Qualidade , Instrumentos Cirúrgicos , SuínosAssuntos
Arritmias Cardíacas/terapia , Procedimentos Cirúrgicos Cardíacos/métodos , Desfibriladores Implantáveis/efeitos adversos , Remoção de Dispositivo/métodos , Fluoroscopia/métodos , Salas Cirúrgicas/provisão & distribuição , Cirurgia Assistida por Computador/métodos , Adolescente , Adulto , Falha de Equipamento , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
The hybrid emergency room (hybrid ER) system was first established in 2011 in Japan. It is defined as an integrated system including an ER, emergency computed tomography (CT) and interventional radiology (IVR) rooms, and operating rooms. Severe trauma patients can undergo emergency CT examinations and therapies (surgeries) without being transferred. The hybrid ER system is attracting attention because trauma resuscitation using this system has been reported to potentially improve the mortality rate in severe trauma patients. In August 2017, we established a new table-rotated-type hybrid ER to facilitate surgical functions. Herein, we introduce a new table-rotated-type hybrid ER consisting of an IVR-CT-operating room system and discuss its efficiency and feasibility for trauma resuscitation, including surgery and IVR. This system includes four new concepts: (1) to secure a wide working space during trauma resuscitation by reconsidering the arrangement of the C-arm, (2) ensure an air-conditioned operating room in the hybrid ER, (3) adopt an operating table but not interventional radiology table, and (4) prepare a trauma bay with three additional beds for multiple victims. This hybrid ER system also adopted the rotated-type table to secure a wide working space during the resuscitation phase. The C-arm was located away from the patients and placed on the wall opposite to the CT gantry, in contrast to that in previous systems. If patients needed an emergency IVR, the table was just rotated, and the IVR could be conducted immediately. This improvement can secure a wide working space in the hybrid ER. Moreover, the patient table was also a surgical operating table, and the hybrid ER system had an air-conditioned operating room (class 10,000). In the anticipation of many trauma patients being transported to the ER, a new trauma bay with three additional beds next to the hybrid ER was established, which also had an air-conditioned operating room. This new rotated-type hybrid ER system facilitates efficient surgical functions during trauma resuscitation and can secure a wide working space for the medical team to immediately perform resuscitative procedures and IVRs without delay.
Assuntos
Serviço Hospitalar de Emergência/organização & administração , Salas Cirúrgicas/provisão & distribuição , Mesas Cirúrgicas , Ressuscitação/instrumentação , Desenho de Equipamento , Humanos , JapãoRESUMO
The potential challenges encountered for setting up a robotic assisted surgical facility in developing country like India are many. We describe the initial hurdles and troubleshooting in establishing a facility of such kind. This experience might help to decrease initial hiccups in setting up such an innovative technology at other institutes.
Assuntos
Países em Desenvolvimento , Salas Cirúrgicas/organização & administração , Procedimentos Cirúrgicos Robóticos/estatística & dados numéricos , Centros Cirúrgicos/organização & administração , Custos e Análise de Custo , Retroalimentação Sensorial , Humanos , Salas Cirúrgicas/provisão & distribuição , Equipe de Assistência ao Paciente/organização & administração , Procedimentos Cirúrgicos Robóticos/economia , Procedimentos Cirúrgicos Robóticos/educação , Treinamento por Simulação , Esterilização , TatoRESUMO
Hybrid operating room Dyna-computed tomography imaging is increasingly recognized as an important adjunct for management of small pulmonary lesions, either for biopsy or for localization to guide surgical resection. We describe for the first time the combined hybrid operating room Dyna-computed tomography image-guided electromagnetic navigation bronchoscopy dye marking and hookwire localization approach to localize multiple sub-centimetre nodules for video-assisted thoracic surgery metastasectomy. Furthermore, such complex set of procedures can be safely and effectively performed within one operating environment, maximizing work efficiency and minimizing the potential for complications.
Assuntos
Broncoscopia/métodos , Biópsia Guiada por Imagem/métodos , Neoplasias Pulmonares/cirurgia , Metastasectomia/métodos , Salas Cirúrgicas/provisão & distribuição , Cirurgia Torácica Vídeoassistida/métodos , Tomografia Computadorizada por Raios X/métodos , Fenômenos Eletromagnéticos , Feminino , Humanos , Leiomiossarcoma/diagnóstico , Leiomiossarcoma/secundário , Leiomiossarcoma/cirurgia , Neoplasias Pulmonares/diagnóstico , Neoplasias Pulmonares/secundário , Pessoa de Meia-Idade , Neoplasias de Tecido Muscular/diagnóstico , Neoplasias de Tecido Muscular/secundário , Neoplasias de Tecido Muscular/cirurgiaRESUMO
OBJECTIVE: This study examined the associations between trauma mortality and quality of care indicators currently used in Japan. DESIGN: This is a retrospective two-level discrete-time survival analysis. Quality indicators were derived from the 2012-2013 annual hospital survey conducted by the Ministry of Health, Labour and Welfare. Trauma mortality data were derived from the Japan Trauma Data Bank for the period of April 2012 to March 2013. SETTING: Tertiary care centers designated as emergency and critical care centers (ECCCs) in Japan. PARTICIPANTS: The analysis included 12 378 patients aged ≥15 years with blunt trauma and an Injury Severity Score ≥9, registered to the data bank from 91 ECCCs. INTERVENTION: Quality of care indicators examined in the annual hospital survey. MAIN OUTCOME MEASURES: Deaths within 30 days. RESULTS: Of the 12 378 patients, 660 (5%) died within 30 days. Higher indicator score was significantly associated with lower mortality risk (hazard ratio [HR] for the second, third and fourth quartiles vs. lowest quartile 0.61, 0.55 and 0.52, respectively). Factors significantly associated with lower mortality risk were, higher patient volume (HR for the highest vs. lowest quartile, 0.74), director's qualification as specialist (HR 0.57) or consultant (HR 0.58), review of patient arrival process (HR 0.68), triage functions (HR 0.69), availability of psychiatrists (HR 0.75) and operating room being ready 24-h (HR 0.81). CONCLUSIONS: The study identified certain indicators associated with trauma patient mortality. Further refinement of indicators is required to specifically identify what needs changing.
Assuntos
Indicadores de Qualidade em Assistência à Saúde/normas , Centros de Traumatologia/organização & administração , Ferimentos e Lesões/mortalidade , Adolescente , Adulto , Idoso , Ambulâncias/estatística & dados numéricos , Feminino , Humanos , Escala de Gravidade do Ferimento , Japão , Masculino , Pessoa de Meia-Idade , Salas Cirúrgicas/provisão & distribuição , Avaliação de Resultados em Cuidados de Saúde , Psiquiatria , Indicadores de Qualidade em Assistência à Saúde/estatística & dados numéricos , Estudos Retrospectivos , Centros de Atenção Terciária/estatística & dados numéricos , Centros de Traumatologia/estatística & dados numéricos , Triagem/estatística & dados numéricos , Recursos Humanos , Ferimentos e Lesões/classificaçãoAssuntos
Agendamento de Consultas , Procedimentos Cirúrgicos Cardíacos , Necessidades e Demandas de Serviços de Saúde , Hospitais de Ensino/organização & administração , Salas Cirúrgicas/organização & administração , Eficiência Organizacional , Heurística , Hospitais de Ensino/provisão & distribuição , Humanos , Salas Cirúrgicas/provisão & distribuição , Fatores de TempoRESUMO
Hip fractures are a major cause of morbidity and mortality1. Surgery performed on the day of or after admission is associated with improved outcome2,3. An audit cycle was performed examining time to surgery for hip fracture patients. Our initial audit identified lack of theatre space as one factor delaying surgery. A dedicated daytime emergency theatre was subsequently opened and a re-audit was performed to assess its impact on time to surgery. Following the opening of the theatre, the proportion of patients with a delay to hip fracture surgery greater than 36 hours was reduced from 49% to 26% with lack of theatre space accounting for 23% (3 of 13) of delayed cases versus 28.6% (9 of 32) previously. 44% of hip fracture surgeries were performed in the emergency theatre during daytime hours, whilst in-hospital mortality rose from 4.6% to 6%. We conclude that access to an emergency theatre during daytime hours reduced inappropriate delays to hip fracture surgery.
Assuntos
Emergências , Fraturas do Quadril/cirurgia , Salas Cirúrgicas/provisão & distribuição , Tempo para o Tratamento/normas , Auditoria Clínica , Fraturas do Quadril/mortalidade , Mortalidade Hospitalar , Humanos , Fatores de TempoRESUMO
New technologies and innovations are common in the delivery of modern health care. Google Glass is one such device gaining increased attention in medical specialties. The authors surveyed residents and attending physicians in the Department of Plastic Surgery, MedStar Georgetown University Hospital, on their experience using Google Glass in the operating room. Ease of use, quality of images, gaze disruption, and distraction during surgery were measured. Overall, subjects found the device to be comfortable and satisfying to wear and use during surgery to capture images of good quality. Despite some identified weaknesses, Google Glass is a unique technology with a promising plastic surgical application in the operating room.
Assuntos
Internet/instrumentação , Salas Cirúrgicas/provisão & distribuição , Procedimentos de Cirurgia Plástica/métodos , Smartphone , Cirurgiões , Gravação em Vídeo/instrumentação , Humanos , Inquéritos e QuestionáriosRESUMO
INTRODUCTION: The aim of this study was to estimate the prevalence and risk factors of hypothermia under general anesthesia in a large domestic hospital. METHOD: All of the consecutive 1840 patients who underwent scheduled surgery between August and December 2013 were admitted to the study. The nasopharyngeal temperature was measured, and the following variables were also recorded: sex, age, type of surgery, duration of anesthesia, active warming devices and type of operating room. Univariate and multiple regression binary logistic analyses with odds ratios (ORs) and 95% confidence intervals (95% CIs) were used to assess the relationship between each clinical risk factor and hypothermia. RESULTS: The prevalence of hypothermia under general anesthesia was 25.7%. In the univariate analysis, the risk factors of hypothermia were age, the duration of anesthesia, the type of operating room and the type of surgery. Sex was not included. In the multiple logistic regression analysis, the significant risk factors of hypothermia were advanced age, laminar airflow operating rooms and general surgeries. CONCLUSION: Intraoperative hypothermia is still common and should therefore receive serious attention. Advanced age, the use of a laminar airflow operating room and general surgeries are high risk factors of hypothermia.
Assuntos
Anestesia Geral/efeitos adversos , Hipotermia/etiologia , Salas Cirúrgicas/provisão & distribuição , Adolescente , Adulto , Anestesia Geral/métodos , Temperatura Corporal/fisiologia , Criança , Pré-Escolar , China/epidemiologia , Feminino , Seguimentos , Humanos , Hipotermia/epidemiologia , Masculino , Pessoa de Meia-Idade , Razão de Chances , Prevalência , Estudos Prospectivos , Fatores de Risco , Adulto JovemRESUMO
BACKGROUND: Efficiency in the operating room has become a topic of great interest. This study aimed to quantify the percent use of instruments among common instrument trays across 4 busy surgical services: Otolaryngology, Plastic Surgery, Bariatric Surgery, and Neurosurgery. We further aimed to calculate the costs associated with tray and instrument sterilization, as well as the implications of missing or damaged instruments. STUDY DESIGN: This was a single-site, observational study conducted on the surgical instrumentation at a large academic medical center in Chicago. Data were collected through direct observation by a trained investigator. Operating room instrument use and labor time required for cleaning and repacking instrument trays in central sterile processing (CSP) were analyzed using descriptive statistics and linear regression. Institutional data on volume and expenses were gathered from hospital leadership. RESULTS: Forty-nine procedures and 237 individual trays were observed. Average instrument (±SD)use rates were 13.0% for Otolaryngology (±4.2%), 15.5% for Plastic Surgery (±2.9%), 18.2% for Bariatric Surgery (±5.0%), and 21.9% for Neurosurgery (±1.7%). An increasing number of instruments per tray was associated with decreased use and increased instrument error rate. Using recorded labor time, the cost of cleaning and repackaging an individual instrument was calculated to be $0.10. Adding in CSP operating expenses and instrument depreciation per use, total processing cost per instrument increases to $0.51 or more. CONCLUSIONS: Our study demonstrates that the percent use of instruments across surgical specialties and multiple tray types is low. Attention to tray composition may result in immediate and significant cost savings.
Assuntos
Centros Médicos Acadêmicos/economia , Salas Cirúrgicas/provisão & distribuição , Esterilização/economia , Instrumentos Cirúrgicos/economia , Procedimentos Cirúrgicos Operatórios/economia , Centros Médicos Acadêmicos/provisão & distribuição , Chicago , Redução de Custos , Custos Hospitalares/estatística & dados numéricos , Humanos , Salas Cirúrgicas/economia , Esterilização/normasRESUMO
Objetivo: Descrever a criação e a implantação do processo de "Giro de Sala", visando à otimização de Salas Operatórias (SO) em um hospital privado de São Paulo, além de relatar a experiência do profissional de Enfermagem, destacando os pontos positivos deste processo. Método: Trata-se de um relato de experiência no qual se descreve o processo criado e implantado para otimizar a utilização das SO. Resultados: Após a implementação do projeto, houve redução de 36% no tempo de setup e redução de 40% no percentual de cirurgias com atraso para início superior a uma hora, considerando-se como referência o horário de agendamento. Conclusão: Com o ganho na produtividade, houve expansão do projeto, sendo contratados 13 Auxiliares de Enfermagem, e realizando treinamento com as áreas de apoio, proporcionado vantagens a todos os envolvidos...