Entrustment, autonomy, and performance in the operating room

The occurrence of cardiac arrest during anesthesia and surgery is nowadays associated with many challenges imposed by 21st century medicine. On the one hand, good education of healthcare practitioners, sophisticated anesthetic techniques and equipment, along with safer anesthetics and improved surgical techniques have significantly reduced the risk of cardiac arrest during the perioperative period. Still, the introduction of new, invasive diagnostic and therapeutic procedures in the aging patients and those with comorbidities carries along new risk and challenges. Epidemiological data indicate that intraoperative cardiac arrest is an extremely rare event. Due to variety of moral and ethical prejudices, intraoperative cardiac arrest is frequently presented as if it has happened in the immediate postoperative period, following surgery and anesthesia. The preventive measures, the etiology and diagnosis of cardiac arrest, as well as the specificities regarding organization and performance of cardiopulmonary resuscitation in the operating room, result in a better prognosis compared to other hospital departments. The article also describes the specifics of cardiopulmonary resuscitation in the catheterization laboratory, while a separate section is dedicated to cardiopulmonary resuscitation following systemic toxicity of local anesthetics. Since intraoperative cardiac arrest and death represent very rare complications, European Resuscitation Council has only recently published Guidelines for Resuscitation for performing cardiopulmonary resuscitation in the operating room ? in 2015.

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Supporting Surgical Teams: Identifying Needs and Barriers for Exoskeleton Implementation in the Operating Room

Human Factors The Journal of the Human Factors and Ergonomics Society ◽

10.1177/0018720819879271 ◽

2019 ◽

Vol 62 (3) ◽

pp. 377-390 ◽

Cited By ~ 1

Author(s):

Jackie S. Cha ◽

Sara Monfared ◽

Dimitrios Stefanidis ◽

Maury A. Nussbaum ◽

Denny Yu

Keyword(s):

Operating Room ◽

Early Career ◽

Upper Body ◽

Surgical Team ◽

Team Members ◽

Societal Factors ◽

Effective Interventions ◽

System Usability Scale ◽

And Performance ◽

Surgical Teams

Objective The objective of this study was to identify potential needs and barriers related to using exoskeletons to decrease musculoskeletal (MS) symptoms for workers in the operating room (OR). Background MS symptoms and injuries adversely impact worker health and performance in surgical environments. Half of the surgical team members (e.g., surgeons, nurses, trainees) report MS symptoms during and after surgery. Although the ergonomic risks in surgery are well recognized, little has been done to develop and sustain effective interventions. Method Surgical team members ( n = 14) participated in focus groups, performed a 10-min simulated surgical task with a commercial upper-body exoskeleton, and then completed a usability questionnaire. Content analysis was conducted to determine relevant themes. Results Four themes were identified: (1) characteristics of individuals, (2) perceived benefits, (3) environmental/societal factors, and (4) intervention characteristics. Participants noted that exoskeletons would benefit workers who stand in prolonged, static postures (e.g., holding instruments for visualization) and indicated that they could foresee a long-term decrease in MS symptoms with the intervention. Specifically, raising awareness of exoskeletons for early-career workers and obtaining buy-in from team members may increase future adoption of this technology. Mean participant responses from the System Usability Scale was 81.3 out of 100 ( SD = 8.1), which was in the acceptable range of usability. Conclusion Adoption factors were identified to implement exoskeletons in the OR, such as the indicated need for exoskeletons and usability. Exoskeletons may be beneficial in the OR, but barriers such as maintenance and safety to adoption will need to be addressed. Application Findings from this work identify facilitators and barriers for sustained implementation of exoskeletons by surgical teams.

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Cardiac surgery simulation - Part 1: Basic Surgical Skills

10.1510/mmcts.2020.073 ◽

2020 ◽

Keyword(s):

Cardiac Surgery ◽

Surgical Technique ◽

Operating Room ◽

Surgical Skills ◽

Surgery Simulation ◽

Knot Tying ◽

Video Tutorial ◽

Do It Yourself ◽

And Performance ◽

Surgery Simulator

Simulation and dedicated practice outside the operating room can improve surgical technique and enhance intraoperative learning and performance. We designed a "do-it-yourself" simulator for use at home made from inexpensive, readily accessible materials that faithfully recreates multiple operative scenarios in cardiac surgery. This video tutorial demonstrates how to build our modular cardiac surgery simulator and to practice drills using our Basic Surgical Skills Module, which helps hone basic linear suturing, needle angles, and knot tying.

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Intra-Operative Pulse Oximetry

Journal of Medical Devices ◽

10.1115/1.3147487 ◽

2009 ◽

Vol 3 (2) ◽

Cited By ~ 1

Author(s):

L. Oliveira ◽

E. Servais ◽

N. Rizk ◽

P. Adusumilli ◽

M. Bikson

Keyword(s):

Signal Processing ◽

Pulse Oximetry ◽

Operating Room ◽

Array Signal Processing ◽

Bowel Resection ◽

Tissue Oxygen Saturation ◽

Handheld Device ◽

Bowel Surgery ◽

Led Array ◽

And Performance

Bowel resection surgery is a commonly performed operation used to treat a variety of gastro-intestinal tract disorders, including cancer. The surgery entails excising the diseased portion of intestine, and then creating a surgical anastomosis, or reattachment of the remaining ends. One of the major complications following bowel resection surgery is breakdown or leakage from the anastomosis, which affects 20% of patients, with an associated 10-15% mortality rate. The surgical creation of anastomosis frequently involves dividing blood vessels and can introduce unrecognized twists and tension on the intestine. As a result, the blood supply to the site of anastomosis is often hampered, limiting the oxygen supply that is essential for adequate anastomotic healing. We are proposing a device that enables surgeons to obtain real-time feedback on local tissue oxygen saturation (SpO2) during operative procedures. Such data will not only help surgeons realize any bowel oxygenation compromising maneuvers, but also help perform an anastomosis at the site of maximal tissue oxygenation, thus minimizing the occurrence of postoperative anastomotic leakage and improve patient outcomes. This report details the specifications, fabrication, operation and performance of a handheld wireless pulse oximeter suitable for the intraoperative measurement of tissue SpO2 during bowel surgery. The device adapts principles and technology developed for non-invasive pulse oximetry, and introduces tissue interface, physician tools, and signal processing algorithms for intra-operative application. The handheld device includes local display of SpO2 level (<1 s refresh) at the contacted tissue, and signals the operator on degraded signal quality/faults. An onboard micro-controller digitizes and processes signals transduced through a controlled LED array. Signal processing and display parameters were optimized for operating room conditions. A disposable functionally-transparent cover provides both device and tissue protection. Through serial or Bluetooth wireless transmission (250 Kbps), SpO2 and pulse signals can be processed on a PC or operating room VI. The incorporation of a pressure sensor to increase accuracy and robustness is explored. The device was validated intra-operatively on rodent and bovine surgical models.

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The Limbo Atmosphere in operating room settings Caused by Disruptive Behaviors: A Qualitative Study

10.21203/rs.3.rs-28425/v1 ◽

2020 ◽

Author(s):

Sahar Mirzaei ◽

Marzieh Pazokian ◽

Foroozan Atashzadeh-Shoorideh ◽

Seyed Amir Hosein Pishgooie

Keyword(s):

Qualitative Study ◽

Operating Room ◽

Disruptive Behaviors ◽

University Hospitals ◽

Structured Interviews ◽

Negative Effects ◽

Team Working ◽

Operating Room Nurses ◽

Great Pressure ◽

And Performance

Abstract Background Operating room nurses are one of the groups frequently expose to Disruptive Behaviors in different situations in the operating rooms that have different impacts on them and their performance. Recognition of DBs and their effects can help to offer strategies for better management of these behaviors. This study aimed to explore the experiences of Iranian operating room nurses regarding Disruptive Behaviors in operating room settings.Methods This is a descriptive qualitative study conducted in university hospitals in Tehran. The data were collected by deep semi-structured interviews with a total number of 17 operating room nurses selected purposefully. Finally, the data were analyzed with the conventional content analysis approach.Results Five categories were extracted from the study, including "activity in a poisonous atmosphere", "role subtraction", "escape to a safe margin", "adaptation to stay calm", and "Indirect confrontation". Finally, a theme was "struggle in a limbo Atmosphere caused by Disruptive Behaviors".Conclusion Under great pressure of surgeon’s Disruptive Behaviors, operating room nurses were struggling to maintain their balance and performance at possible. Considering the effect of Disruptive Behavior, it seems necessary to take training measures for improving team-working in operation room settings. Besides, monitoring and follow-up such behaviors according to negative effects is necessary.

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Operating room health team knowledge and performance regarcing the application of infection control measures: A suggested policy

Egyptian Journal of Medical Laboratory Sciences ◽

10.4314/ejmls.v9i2.46816 ◽

2009 ◽

Vol 9 (2) ◽

Author(s):

O Reslan ◽

MAE Mohamed ◽

KF Abdullah

Keyword(s):

Infection Control ◽

Operating Room ◽

Control Measures ◽

Health Team ◽

Infection Control Measures ◽

And Performance

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Correlation between Knowledge and Performance of Radiation Protection among Operating Room Nurses

International Journal of Bio-Science and Bio-Technology ◽

10.14257/ijbsbt.2016.8.1.24 ◽

2016 ◽

Vol 8 (1) ◽

pp. 275-284 ◽

Cited By ~ 2

Author(s):

Kyeong Weon Jeong ◽

Hee Jung Jang

Keyword(s):

Operating Room ◽

Radiation Protection ◽

Operating Room Nurses ◽

And Performance

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Moving our Understanding of Team Dynamics from the Simulation Room to the Operating Room

Proceedings of the Human Factors and Ergonomics Society Annual Meeting ◽

10.1177/1071181319631037 ◽

2019 ◽

Vol 63 (1) ◽

pp. 227-229

Author(s):

Trysha Gallowaya ◽

Ron Stevensa ◽

Steven Yulec ◽

Jamie Gormane ◽

Ann Willemsen-Dunlap ◽

...

Keyword(s):

Operating Room ◽

Ecological Validity ◽

Lessons Learned ◽

Healthcare Organizations ◽

Biometric Data ◽

Complex Processes ◽

Macro Scale ◽

Dynamic Perspective ◽

And Performance ◽

Live Patient

Healthcare organizations rely on simulations of complex processes to provide the training required for individuals and teams to evolve their skills and maintain high levels of competence in medical domains. Inherent in this process is the belief, generally founded on macro-scale measures such as observations and workplace-based assessments, that simulations provide the degree of psychological fidelity needed to accomplish this goal. A paradigm shift is underway toward a more dynamic perspective of teamwork to include psycho-physiological measures which will shape the creation of new forms of simulations, performance measures, and practices. Initially it is expected that these dynamic understandings will be derived from simulation studies. However, it is currently unknown at the neural / physiologic/ cognitive level how well simulation training elicits the types of dynamic thinking that is actually used by operating room teams during live-patient surgery, i.e. the ecological validity of simulation environments is unknown for dynamic neural and physiologic measures of team performance. This panel will describe efforts to address this question. Among the questions the panel will consider are: • To what extent do neurodynamic behaviors seen during simulations diverge from those in the operating room? • What are the implications for improving patient safety when communication, cognitive, and neurodynamic analysis become real-time? • Can biometric and communication measures better inform root cause analyses and best practices during live-patient encounters? The topics discussed anticipate the time when dynamic biometric data can contribute to our understanding of how to rapidly determine a team’s functional status, and how to use this information to optimize outcomes and training. The rapid, dynamic and task neutral measures will make the lessons learned in healthcare applicable to other complex group and team environments. They will also provide a foundation for incorporating these models into machines to support the training and performance of teams.

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