The operating-room environment and team approach: pitfalls and technical factors

2013 ◽  
pp. 33-41
Author(s):  
Khaled M. Zamel ◽  
Gloria M. Galloway ◽  
Marc R. Nuwer ◽  
Jaime R. Lopez ◽  
Khaled M. Zamel
Keyword(s):  
Operating Room ◽  
Team Approach ◽  
Technical Factors

Abstract 17362: A Multidisciplinary Heart Team Approach to High Risk Transvenous Pacemaker and Defibrillator Lead Extraction Improves Mortality

Circulation ◽  
2018 ◽  
Vol 138 (Suppl_1) ◽  
Author(s):  
Ryan G Aleong ◽  
Matthew Zipse ◽  
Christine Tompkins ◽  
Tamas Seres ◽  
David Fullerton ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
High Risk ◽  
Operating Room ◽  
Cardiac Electrophysiology ◽  
Lead Extraction ◽  
Team Approach ◽  
Heart Team ◽  
Hybrid Operating Room ◽  
Icd Leads ◽  
The Creation

Introduction: There is a risk of serious complications with high-risk lead extraction (LE) that may increase mortality. Current guidelines do not provide definitive guidance on collaborative involvement of cardiac surgery as compared to other procedures such as TAVR procedures. We report a single center experience of the benefits of a collaborative approach between cardiac surgery and cardiac electrophysiology (EP). Hypothesis: MDHT will improve outcomes in LE Methods: High risk lead extractions had dwell times of at least 4 years for pacemaker leads and 2 years for ICD leads. A multidisciplinary heart team (MDHT) was created based on the TAVR model that includes a combined lead management clinic and a monthly multidisciplinary conference. Prior to MDHT creation, high risk lead extractions were performed either in the hybrid operating room (OR) and cardiology procedure lab with a surgeon on call as needed. After the MDHT creation all cases were performed in the hybrid operating room by a cardiac surgeon, cardiac anesthesiologist and EP together with an interventional radiologist readily available. Results: Prior to MDHT, 169 patients underwent 344 leads extractions. There were six major procedural complications (3.6%) that included 2 procedural deaths (1.2%) during that period (SVC tear, Tricuspid valve avulsion). Following the creation of MDHT, there have been 47 cases performed with 85 leads extracted. There have been two complications requiring surgical repair (one SVC laceration, one RV laceration), which were surgically repaired. With the creation of a MDHT, the rate of major complications was unchanged (Pre vs. Post MDHT 3.6% vs. 4.3%) but there was a lower mortality rate (Pre vs. Post MDHT 1.2% vs. 0%). Conclusions: High risk lead extraction had a fixed complication rate at our institution however a MDHT decreased mortality. A structured multidisciplinary approach, involving EP and cardiac surgery, decreased mortality in a medium sized lead extraction center and should be considered at all centers.

scholarly journals Operating room nurse residency and specialty educators: Paramount in the success of novice nurse retention

2017 ◽  
Vol 8 (5) ◽  
pp. 20 ◽  
Author(s):  
LaSandra Brown ◽  
Debbie Belgard ◽  
Nakeisha Washington ◽  
Sparkle Grueso
Keyword(s):  
Patient Care ◽  
Operating Room ◽  
Residency Program ◽  
Surgical Patients ◽  
Team Approach ◽  
Residency Programs ◽  
Nurse Residency ◽  
Safe Patient Care ◽  
Nursing Curricula ◽  
Nurse Residency Program

Perioperative service is one of the specialties of nursing in which a team approach is vital for optimal patient care. The registered nurse is responsible for coordinating and delivering safe patient care. Operating room (OR) nurses are responsible for applying fundamental applications of the nursing process while formulating plans of care unique to surgical patients. The growing shortage of nurses worldwide especially impacts highly complex areas such as the OR, where skills specialized are needed to care for patients. One of the largest challenges of a graduate nurse (GN) is becoming enculturated to new environments. Traditionally, OR nursing is a paradigm foreign in nursing curricula; this creates challenges in the GN population in applying their practical nursing skills to surgical patients. In an effort to combat ongoing knowledge deficits unique to OR nursing, Houston Methodist Hospital (HMH) created an OR nurse residency program. The literature suggests that specialty-specific nursing residency programs offer GNs essential tools for becoming successful in their transition. Additionally, research suggests reductions in nurse burnout and turnover rate among GNs with adequate training and preparation. The purpose of this article was to provide insight on the importance of introduction to the OR prior to graduating from nursing school and the importance of OR nursing specialty residency programs and specialty educators as they pertain to the ideal nursing transition, sustainability, retention, and favorable patient outcomes. A questionnaire was created to capture successful applicable practices; the questionnaire also provided an opportunity for GNs to suggest opportunities for program improvements. The questionnaire was used to explore feedback from the summer 2014 Operating Room (OR) residency program graduate nurses in an effort to capture improvements needed for future program success.

scholarly journals 799. A Pseudo-Outbreak of Pseudomonas fluorescens Infections

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S494-S495
Author(s):  
Tariq Jaber ◽  
Vikram Saini ◽  
Laura Morris ◽  
James D Como ◽  
Nitin Bhanot ◽  
...  
Keyword(s):  
Pseudomonas Fluorescens ◽  
Operating Room ◽  
Normal Saline ◽  
Laboratory Data ◽  
Retrospective Chart Review ◽  
Team Approach ◽  
Operating Room Personnel ◽  
Sterile Normal Saline ◽  
Specimen Processing ◽  
Tissue Specimens

Abstract Background Pseudomonas fluorescens is a water-borne pathogen that has been associated with outbreaks from transfusion of contaminated blood products or medical equipment. Our institution had a cluster of cultures that grew an uncommonly encountered microbe P. fluorescens within a period of one week. This prompted an internal investigation. We summarize the investigational process that led to the resolution of this pseudo-outbreak. Methods We conducted a retrospective chart review of surgical and non-surgical patients with cultures positive for P. fluorescens from July 2nd to July 8th 2020. Baseline patient characteristics, clinical course, laboratory data, use of blood-associated products, and microbiology cultures were analyzed. Results Eight patients were identified with positive tissue cultures for P. fluorescens. Among those, 5 specimens (62.5%) were from osteoarticular sites (1 prosthetic hip, 1 prosthetic knee, 1 right foot, 1 sternum, and 1 vertebral source). One culture (12.5%) was obtained from a sacral soft tissue wound. Two tissue specimens (25%) were collected from respiratory sites (1 lung tissue and 1 bronchoalveolar lavage). No association with specific surgical personnel or operating room was identified. During routine specimen processing, a small amount of sterile normal saline is added to the conical grinder prior to culture preparation. It was discovered that a non-sterile normal saline had been inadvertently utilized during that step. These eight tissue specimens were subsequently reprocessed with sterile solution; P. fluorescens was not re-isolated. Specimen processing protocols were reinforced. Adjustment of antimicrobial therapy was made accordingly without reported subsequent adverse clinical outcomes. Conclusion A multi-faceted team approach in collaboration with Infection Prevention, Infectious Diseases, Surgery, operating room personnel, and Microbiology identified an unintended breakdown in sterile laboratory protocols which resulted in a cluster of falsely positive cultures. An increased incidence of infection with an uncommon pathogen initiated a prompt investigation that resulted in the identification of a pseudo-outbreak event. Disclosures All Authors: No reported disclosures

Safety in the Operating Room: Team Approach Saves Lives

2010 ◽  
Vol 22 (4) ◽  
pp. 267-268 ◽  
Author(s):  
Thomas Kozhimannil ◽  
Richard C. Prielipp
Keyword(s):  
Operating Room ◽  
Team Approach ◽  
Operating Room Team

scholarly journals Operating Room Efficiency for General Anesthesia Cases in the Department of Ophthalmology in a Public Tertiary Hospital

2021 ◽  
Vol 55 (1) ◽  
Author(s):  
Maria Isabel N. Umali ◽  
Teresita R. Castillo
Keyword(s):  
General Anesthesia ◽  
Operating Room ◽  
Third Party ◽  
Team Approach ◽  
Operating Room Efficiency ◽  
Start Time ◽  
Tertiary Institution ◽  
Cross Sectional ◽  
First Case ◽  
Department Of Ophthalmology

Objective. To determine operating room efficiency for elective ophthalmologic surgeries requiring general anesthesia in a public tertiary institution based on standard efficiency parameters. Methods. Prospective observational cross-sectional study of randomly selected elective cases requiring general anesthesia from April 2019 to June 2019 in the Department of Ophthalmology of the Philippine General Hospital. A single third-party observer recorded operating room milestones from which efficiency parameters were determined and compared with local and international guidelines and efficiency benchmarks. Results. A total of fifty cases from the Retina, Plastic, Orbit, Glaucoma, and Motility services were observed. None started on the specified start time of 6:30 a.m., with surgeries starting an average of 52 ± 11.90 minutes after. Across subspecialties, median surgical preparation time was statistically significant (χ2: 12.01, p: 0.02), with the Retina and Orbit services having the most extended duration. Across age groups, pediatric cases had lower mean anesthesia preparation times (t: 2.15, df: 48, p: 0.04) and median trans-out lag times (χ2: 4.56, p: 0.03) than adults. Overall, more than 60% of cases reached targets for induction and surgical lag time. Turnaround for adult and pediatric patients was 75 ± 22.77 minutes and 71 ± 14.91 minutes, respectively. Benchmarking analysis showed that the first case on time, entry lag, and exit lag were below the 50th percentile while the room turnover time was above the 95th percentile. Conclusion. Ensuring efficiency requires a multidisciplinary team approach. This research can guide administrators in determining interventions to increase operating room efficiency.

The Hybrid Operating Room: A Multidisciplinary Team Approach

2014 ◽  
pp. 107-117
Author(s):  
Natalia V. Solenkova ◽  
Ramanan Umakanthan ◽  
Marzia Leacche ◽  
John G. Byrne
Keyword(s):  
Operating Room ◽  
Multidisciplinary Team ◽  
Team Approach ◽  
Hybrid Operating Room ◽  
Multidisciplinary Team Approach

Biomedical applications: Pitfalls in the practice

1994 ◽  
Vol 52 ◽  
pp. 378-379
Author(s):  
J. D. Shelburne ◽  
Peter Ingram ◽  
Victor L. Roggli ◽  
Ann LeFurgey
Keyword(s):  
Operating Room ◽  
Liquid Nitrogen ◽  
Lung Tissue ◽  
Biomedical Applications ◽  
Microprobe Analysis ◽  
Tissue Sample ◽  
Cellular Level ◽  
Tissue Samples ◽  
Asbestos Fibers

At present most medical microprobe analysis is conducted on insoluble particulates such as asbestos fibers in lung tissue. Cryotechniques are not necessary for this type of specimen. Insoluble particulates can be processed conventionally. Nevertheless, it is important to emphasize that conventional processing is unacceptable for specimens in which electrolyte distributions in tissues are sought. It is necessary to flash-freeze in order to preserve the integrity of electrolyte distributions at the subcellular and cellular level. Ideally, biopsies should be flash-frozen in the operating room rather than being frozen several minutes later in a histology laboratory. Electrolytes will move during such a long delay. While flammable cryogens such as propane obviously cannot be used in an operating room, liquid nitrogen-cooled slam-freezing devices or guns may be permitted, and are the best way to achieve an artifact-free, accurate tissue sample which truly reflects the in vivo state. Unfortunately, the importance of cryofixation is often not understood. Investigators bring tissue samples fixed in glutaraldehyde to a microprobe laboratory with a request for microprobe analysis for electrolytes.

Pharmacology Issues Related to Dementia Syndrome of Depression in Elderly Residents of Long-Term Care Settings

2015 ◽  
Vol 25 (2) ◽  
pp. 61-69
Author(s):  
Angel L. Ball ◽  
Adina S. Gray
Keyword(s):  
Depressive Symptoms ◽  
The Elderly ◽  
Environmental Communication ◽  
Pharmacological Intervention ◽  
Team Approach ◽  
Discussion Paper ◽  
Term Care ◽  
Anticholinergic Medications ◽  
Inappropriate Treatment ◽  
Dementia Syndrome

Pharmacological intervention for depressive symptoms in institutionalized elderly is higher than the population average. Among the patients on such medications are those with a puzzling mix of symptoms, diagnosed as “dementia syndrome of depression,” formerly termed “pseudodementia”. Cognitive-communicative changes, potentially due to medications, complicate the diagnosis even further. This discussion paper reviews the history of the terminology of “pseudodementia,” and examines the pharmacology given as treatment for depressive symptoms in the elderly population that can affect cognition and communication. Clinicians can reduce the risk of misdiagnosis or inappropriate treatment by having an awareness of potential side effects, including decreased attention, memory, and reasoning capacities, particularly due to some anticholinergic medications. A team approach to care should include a cohesive effort directed at caution against over-medication, informed management of polypharmacology, enhancement of environmental/communication supports and quality of life, and recognizing the typical nature of some depressive signs in elderly institutionalized individuals.

Pediatric Benign Vocal Fold Lesions: A Team Approach

2009 ◽  
Vol 19 (3) ◽  
pp. 105-112 ◽  
Author(s):  
Geralyn Harvey Woodnorth ◽  
Roger C. Nuss
Keyword(s):  
Vocal Fold ◽  
Evaluation Process ◽  
Team Approach ◽  
Speech Language Pathologist ◽  
Benign Vocal Fold Lesions ◽  
Different Types ◽  
Team Evaluation ◽  
Surgical Treatments ◽  
Review Current ◽  
Vocal Fold Nodules

Abstract Many children with dysphonia present with benign vocal fold lesions, including bilateral vocal fold nodules, cysts, vocal fold varices, and scarring. Evaluation and treatment of these children are best undertaken in a thoughtful and coordinated manner involving both the speech-language pathologist and the otolaryngologist. The goals of this article are (a) to describe the team evaluation process based on a “whole system” approach; (b) to discuss etiological factors and diagnosis; and (c) to review current medical, behavioral, and surgical treatments for children with different types of dysphonia.

Sign in / Sign up

Export Citation Format

Share Document