Ethological observations of social behavior in the operating room.

Operating rooms (ORs) are inhabited by hierarchical, mixed-gender clinical teams that are often prone to conflict. In evolutionary terms, one expects more within- than between-gender rivalries, especially since the OR is a place where all sorts of social interactions occur, not merely technical communications. To document the full range of behavior, the present study used ethological observation techniques, recording live all social behavior by the team. Using an ethogram, 6,348 spontaneous social interactions and nontechnical communications were timestamped during 200 surgical procedures. Cooperation sequences (59.0%) were more frequent than conflict sequences (2.8%), which ranged from constructive differences of opinion to discord and distraction that could jeopardize patient safety. Behavior varied by clinical role and with the gender composition in the OR. Conflict was initiated mostly down the hierarchy between individuals several ranks apart. Cooperation tended to increase with a rising proportion of females in the OR, but the most pronounced effect concerned the interaction between both genders. If the attending surgeon's gender differed from that of the majority of other personnel in the OR, cooperation was significantly more common.

An Ethogram to Quantify Operating Room Behavior.

BACKGROUND: The operating room (OR) is a highly social and hierarchical setting where interprofessional team members must work interdependently under pressure. Due primarily to methodological challenges, the social and behavioral sciences have had trouble offering insight into OR dynamics. PURPOSE: We adopted a method from the field of ethology for observing and quantifying the interpersonal interactions of OR team members. METHODS: We created and refined an ethogram, a catalog of all our subjects' observable social behaviors. The ethogram was then assessed for its feasibility and interobserver reliability. RESULTS: It was feasible to use an ethogram to gather data in the OR. The high interobserver reliability (Cohen's Kappa coefficients of 81 % and higher) indicates its utility for yielding largely objective, descriptive, quantitative data on OR behavior. CONCLUSIONS: The method we propose has potential for social research conducted in healthcare settings as complex as the OR.

Comparing the information seeking strategies of residents, nurse practitioners, and physician assistants in critical care settings.

OBJECTIVE: Critical care environments are information-intensive environments where effective decisions are predicated on successfully finding and using the 'right information at the right time'. We characterize the differences in processes and strategies of information seeking between residents, nurse practitioners (NPs), and physician assistants (PAs). METHOD: We conducted an exploratory study in the cardiothoracic intensive care units of two large academic hospitals within the same healthcare system. Clinicians (residents (n=5), NPs (n=5), and PAs (n=5)) were shadowed as they gathered information on patients in preparation for clinical rounds. Information seeking activities on 96 patients were collected over a period of 3 months (NRes=37, NNP=24, NPA=35 patients). The sources of information and time spent gathering the information at each source were recorded. Exploratory data analysis using probabilistic sequential approaches was used to analyze the data. RESULTS: Residents predominantly used a patient-based information seeking strategy in which all relevant information was aggregated for one patient at a time. In contrast, NPs and PAs primarily utilized a source-based information seeking strategy in which similar (or equivalent) information was aggregated for multiple patients at a time (eg, X-rays for all patients). CONCLUSIONS: The differences in the information seeking strategies are potentially a result of the differences in clinical training, strategies of managing cognitive load, and the nature of the use of available health IT tools. Further research is needed to investigate the effects of these differences on clinical and process outcomes.

Valuation of tobacco control policies by the public in North Carolina: comparing perceived benefit with projected cost of implementation.

BACKGROUND: After 40 years of continuous decline, smoking rates in the United States have stabilized signaling a challenge for tobacco control. Renewed decline may be guided by public opinion where support for tobacco control is strong. This study sought the public's preferences about tobacco control strategies. METHODS: This contingent valuation study investigated whether the public's valuations of 2 tobacco control policies outweighed their implementation costs. In a hypothetical referendum, a representative sample of North Carolinians aged 45-64 years (n = 644) was asked to indicate whether they would prefer a policy that would halve the youth smoking rate or one that would reduce smoking-related deaths by 10%, and to indicate how much additional tax they would be willing to pay to implement their preferred policy. This willingness-to-pay value formed the perceived "benefit" component in a cost-benefit analysis. Costs to halve youth smoking were calculated from evidence about the resources required to increase the state tobacco excise tax. Costs to reduce tobacco-related deaths were based on evidence about the resources required for a counseling quitline offering free nicotine replacement therapy. RESULTS: The majority (85%) of respondents voted to halve the youth smoking rate. The mean maximum amount per person that voters were willing to pay in 1 year to do that was $14.90 (95% CI, $10.10-$19.60), and the maximum amount per person they were willing to pay in 1 year to reduce smoking-related deaths was $13.70 (95% CI, $2.10-$25.40). When aggregated to the North Carolina population aged 45-64 years (N = 2,400,144), the perceived benefit of halving youth smoking was $35.8 million. Implementation of a program to achieve this outcome would cost $109.8 million. Aggregating to the same population, the perceived benefit of a 10% reduction in tobacco-related deaths was $32.9 million, an amount that exceeds the $12.8 million estimated cost of achieving the outcome. CONCLUSION: A counseling quitline with free nicotine replacement therapy would achieve a positive net benefit.

Air quality in and around airport enclosed smoking rooms.

INTRODUCTION: Smoking rooms have been installed in some airports to allow indoor smoking. There have been few field studies to measure fine particle leakage in operational smoking rooms. The objective of the research was to assess air quality inside and outside the 4 smoking rooms located within a medium-sized, regional commercial airport. METHODS: Particulate matter less than 2.5-microm (PM(2.5)) concentrations were simultaneously measured inside and outside the 4 smoking rooms in the airport and in the public lobby. The monitoring was conducted during normal hours of operation. Numbers of people and smokers were counted. The airport had separate ventilation systems for all 4 rooms checked by the airport prior to monitoring, and they were operating properly. RESULTS: Although there were few smokers in each room, average PM(2.5) concentrations inside the smoking rooms were significantly higher than the National Ambient Air Quality Standard for 24 hr (35 microg/m(3)). Fine particles from secondhand smoke (SHS) leaked to the outside in 3 of the 4 smoking rooms, exposing workers and the public. DISCUSSION: Although the ventilation systems in the smoking rooms were operating properly, fine particles from SHS leaked to the surrounding smoke-free areas in the airport. Indoor space inside airports should be completely nonsmoking, and enclosed smoking rooms are not recommended.