scholarly journals A Concern for Intraoperative Distractions and Interference: An Observational Study Identifying, Measuring, and Quantifying Both within the Operating Theatre

2021 ◽  
Vol 2021 ◽  
pp. 1-6
Author(s):  
Shane Keogh ◽  
Deirdre Laski
Keyword(s):  
Operative Time ◽  
Observation Time ◽  
Operating Theatre ◽  
Rigorous Analysis ◽  
Surgical Workflow ◽  
Conference Abstract ◽  
Interference Level ◽  
Irish Hospital ◽  
Operating Theatres ◽  
Disruption Rate

Background. Modern surgical research has broadened to include an interest into the investigation of surgical workflow. Rigorous analysis of the surgical process has a particular focus on distractions. Operating theatres are inherently full of distractions, many not pertinent to the surgical process. Distractions have the potential to increase surgeon stress, operative time, and complications. Our study aims to objectively identify, classify, and quantify distractions during the surgical process. Methods. 46 general surgical procedures were observed within a tertiary Irish hospital between June 2019 and October 2019. An established observational tool was used to apply a structured observation to all operations. Additionally, a nine-point ordinal behaviourally anchor scoring scale was used to assign an interference level to each distraction. Results. The total operative observation time was 4605 minutes (mean = 100.11 minutes, std. deviation: 45.6 minutes). Overall, 855 intraoperative distractions were coded. On average, 18.58 distractions were coded per operation (std. deviation: 6.649; range: 5–34), with 11.14 distractions occurring per hour. Entering/exiting (n = 380, 42.88%) and case irrelevant communication (n = 251, 28.32%) occurred most frequently. Disruption rate was highest within the first (n = 275, 32%) and fourth operative quartiles (n = 342, 41%). Highest interference rates were observed from equipment issue and procedural interruptions. Anaesthetists initiated CIC more frequently (2.72 per operation), compared to nurses (1.57) and surgeons (1.17). Conclusion. Our results confirm that distractions are prevalent within the operating theatre. Distractions contribute to significant interferences of surgical workflow. Steps can be taken to reduce overall prevalence and interference level by drawing upon a systems-based perspective. However, due to the ubiquitous nature of distractions, surgeons may need to develop skills to help them resume interrupted primary tasks so as to negate the effects distraction has on surgical outcomes. Data for the above have been presented as conference abstract in 28th International Congress of the European Association for Endoscopic Surgery (EAES) Virtual Congress, 23–26 June 2020.

Fire in operating theatres: DaSH-ing to the rescue

2018 ◽  
Vol 28 (7-8) ◽  
pp. 188-193
Author(s):  
Liam Wilson ◽  
Omer Farooq
Keyword(s):  
Patient Care ◽  
Fire Safety ◽  
Training Session ◽  
Operating Theatre ◽  
In Situ Simulation ◽  
Safe Patient Care ◽  
Team Interactions ◽  
Operating Theatres ◽  
Theatre Staff ◽  
Safety Officer

Operating theatres are dynamic environments that require multi professional team interactions. Effective team working is essential for efficient delivery of safe patient care. A fire in the operating theatre is a rare but potentially life threatening event for both patients and staff. A rapid and cohesive response from theatre and allied staff including porters, fire safety officer etc is paramount. We delivered a training session that utilised in situ simulation (simulation in workplace). After conducting needs analysis, learning objectives were agreed. After thorough planning, the date and location of the training session were identified. Contingency plans were put in place to ensure that patient care was not compromised at any point. To ensure success, checklists for faculty were devised and adhered to. A medium fidelity manikin with live monitoring was used. The first part of the scenario involved management of a surgical emergency by theatre staff. The second part involved management of a fire in the operating theatre while an emergency procedure was being undertaken. To achieve maximum learning potential, debriefing was provided immediately after each part of the scenario. A fire safety officer was present as a content expert. Latent errors (hidden errors in the workplace, staff knowledge etc) were identified. Malfunctioning of theatre floor windows and staff unawareness about the location of an evacuation site were some of the identified latent errors. Thorough feedback to address these issues was provided to the participants on the day. A detailed report of the training session was given to the relevant departments. This resulted in the equipment faults being rectified. The training session was a very positive experience and helped not only in improving participants’ knowledge, behaviour and confidence but also it made system and environment better equipped.

Report on Sterlitamak Zemsky Hospital

1903 ◽  
Vol 3 (9-10) ◽  
pp. 437-454
Author(s):  
M. I. Ladygin
Keyword(s):  
Infectious Disease ◽  
General Ward ◽  
The Other ◽  
Operating Theatre ◽  
Operating Theatres

The Sterlitamak Zemsky Hospital has 34 beds and in the year under review it had four rooms: an infectious disease room, one for women, and two for men, the smaller of which was intended for clean operated patients, while the other was for purulent and therapeutic patients (the rooms were painted with oil paint); women after the surgeries were transferred to the general ward. The two operating theatres were clean and pusy; they were adjacent, painted with oil paint; in the case of pus, the two operating theatres were carefully fumigated with formalin, followed by soap washout and Sulema 1 : 1000. The rooms and the operating theatre were ventilated in the windows.

Alternating operating theatre utilization is not associated with differences in clinical or economic outcome measures in primary elective knee arthroplasty

2019 ◽  
Vol 101-B (9) ◽  
pp. 1081-1086 ◽  
Author(s):  
William S. Murphy ◽  
Samantha Harris ◽  
Vartan Pahalyants ◽  
Mark M. Zaki ◽  
Ben Lin ◽  
...  
Keyword(s):  
New England ◽  
Knee Arthroplasty ◽  
Operating Time ◽  
Skin Incision ◽  
Operating Theatre ◽  
Patient Specific ◽  
Data Set ◽  
Skilled Nursing ◽  
Operating Theatres ◽  
Total Knee

Aims The practice of alternating operating theatres has long been used to reduce surgeon idle time between cases. However, concerns have been raised as to the safety of this practice. We assessed the payments and outcomes of total knee arthroplasty (TKA) performed during overlapping and nonoverlapping days, also comparing the total number of the surgeon’s cases and the total time spent in the operating theatre per day. Materials and Methods A retrospective analysis was performed on the Centers for Medicare & Medicaid Services (CMS) Limited Data Set (LDS) on all primary elective TKAs performed at the New England Baptist Hospital between January 2013 and June 2016. Using theatre records, episodes were categorized into days where a surgeon performed overlapping and nonoverlapping lists. Clinical outcomes, economic outcomes, and demographic factors were calculated. A regression model controlling for the patient-specific factors was used to compare groups. Total orthopaedic cases and aggregate time spent operating (time between skin incision and closure) were also compared. Results A total of 3633 TKAs were performed (1782 on nonoverlapping days; 1851 on overlapping days). There were no differences between the two groups for length of inpatient stay, payments, mortality, emergency room visits, or readmission during the 90-day postoperative period. The overlapping group had 0.74 fewer skilled nursing days (95% confidence interval (CI) -0.26 to -1.22; p < 0.01), and 0.66 more home health visits (95% CI 0.14 to 1.18; p = 0.01) than the nonoverlapping group. On overlapping days, surgeons performed more cases per day (5.01 vs 3.76; p < 0.001) and spent more time operating (484.55 minutes vs 357.17 minutes; p < 0.001) than on nonoverlapping days. Conclusion The study shows that the practice of alternating operating theatres for TKA has no adverse effect on the clinical outcome or economic utilization variables measured. Furthermore, there is opportunity to increase productivity with alternating theatres as surgeons with overlapping cases perform more cases and spend more time operating per day. Cite this article: Bone Joint J 2019;101-B:1081–1086.

Time to make surgery greener: waste reduction in the operating theatre

2020 ◽  
Vol 26 (8) ◽  
pp. 1-3
Author(s):  
George Winter
Keyword(s):  
Environmental Impact ◽  
Waste Reduction ◽  
Operating Theatre ◽  
Operating Theatres

Sustainability persists as a key issue in all aspects of society, with increasing urgency. George Winter discusses the environmental impact of operating theatres and the initiatives being implemented to reduce surgical waste output.

Customising the length of the Montgomery T-tube whilst retaining a bevelled edge

2015 ◽  
Vol 129 (3) ◽  
pp. 273-275 ◽  
Author(s):  
A Gan ◽  
V Varadarajan ◽  
M P Rothera
Keyword(s):  
Operating Theatre ◽  
Airway Anatomy ◽  
T Tube ◽  
Novel Technique ◽  
Operating Theatres ◽  
Basic Equipment

AbstractBackground:The Montgomery T-tube is used in a number of conditions that require safe tracheal stenting. Specific lengths of T-tube limbs are occasionally needed in patients with complex airway anatomy or differing neck proportions; this requires customisation of the T-tube limbs. This is done either by pre-ordering customised T-tubes from the manufacturer (which needs to be planned ahead of time) or using a tube cutter in the operating theatre. However, the latter does not provide a ‘factory like’ bevelled edge when shortened, which increases the risk of mucosal trauma and granulation formation.Objective:This paper reports a novel technique for customising the length of existing Montgomery T-tubes, with preservation of the bevelled edges. This technique can be easily performed with basic equipment available in operating theatres.

scholarly journals Transfer areas and clean zones in operating suites

1969 ◽  
Vol 67 (3) ◽  
pp. 417-425 ◽  
Author(s):  
G. A. J. Ayliffe ◽  
J. R. Babb ◽  
B. J. Collins ◽  
E. J. L. Lowbury
Keyword(s):  
Staphylococcus Aureus ◽  
Bacterial Contamination ◽  
Operating Theatre ◽  
Significant Difference ◽  
High Street ◽  
Operating Theatres ◽  
The Mean ◽  
Operating Suite ◽  
Total Bacteria

SUMMARYThe value of clean zones and of transfer areas in operating suites was assessed by comparisons of the amounts of contamination on floors, trolleys and footwear in suites with and without a clean zone and a transfer area; counts of Clostridium welchii were used as an index of bacterial contamination introduced into the aseptic zone from outside.The mean counts of Cl. welchii on contact plates from the wheels of trolleys used to convey patients from wards to the operating suite (67·9 ± 7·68 per plate) were significantly higher than those from theatre trolleys (i.e. those used only inside a theatre suite provided with a transfer area) (3·13 ± 0·47 per plate); mean counts of total bacteria were only slightly lower on the wheels of theatre trolleys than on those of hospital trolleys. Other surfaces of hospital trolleys showed counts similar to those found on theatre trolleys.Contact plates from floors showed significantly lower counts of Cl. welchii in the aseptic zone and the clean zone than in the hospital corridor, the protective zone and (when present) the transfer area.The mean counts per 100 cm2 of Cl. welchii were approximately the same on the floor of a theatre with a clean zone and a transfer area (0·83) as in one with a clean zone but no transfer area (0·5). Counts of total bacteria were higher in the latter. A suite with no clean zone or transfer area showed a higher mean count of Cl. welchii on contact plates from the aseptic zone (operating theatre) (20·5 ± 12·33 per 100 cm2). These higher levels of contamination were due to sporadic high counts of Cl. welchii found near the door of the theatre with no clean zone; in another theatre with no clean zone the level of Cl. welchii on the floor was not higher than that in the theatres with clean zones.Theatres with plenum ventilation had lower mean counts of airborne Cl. welchii than those ventilated by windows: there was no significant difference in the levels of Cl. welchii on the floors of theatres with the two forms of ventilation.On sampling with contact plates, theatre footwear yielded fewer total organisms, Staphylococcus aureus and Cl. welchii than outdoor shoes removed before entering the clean zone.The hygienic value of transfer areas and clean zones is discussed. Bacteriological support could not be obtained for the former, but the latter appeared to contribute something to the cleanliness of the theatre by preventing heavy sporadic contamination.We wish to thank Mr M. Wilkins for valuable assistance, the staff of the operating theatres for their co-operation and Alne Engineering Limited, 57 High Street, Henley-in-Arden, Solihull, for supplying disposable contact plates.

scholarly journals A Practical Apparatus for Measuring Average Exposure of Operating Theatre Personnel to Halothane

1975 ◽  
Vol 3 (4) ◽  
pp. 345-347 ◽  
Author(s):  
C. A. J. Dupressoir
Keyword(s):  
Silica Gel ◽  
Operating Theatre ◽  
Breathing Zone ◽  
Operating Theatres ◽  
Working Day

A procedure for the measurement of halothane in the breathing zone of operating theatre personnel is described. This is achieved by sampling air through a U-tube containing silica gel. Concentrations found in operating theatres ranged from less than 0·1 to 8 ppm. The method can be used to evaluate exposure over a full working day.

scholarly journals 448 The Impact of Noise in the Operating Theatre: A Review of the Evidence

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
R J W Mcleod ◽  
L Wilks ◽  
S Davies ◽  
H A Elhassan
Keyword(s):  
Negative Impact ◽  
Noise Pollution ◽  
Operating Theatre ◽  
Task Completion ◽  
Training Environment ◽  
Surgical Performance ◽  
Surgeon Experience ◽  
Operating Theatres ◽  
Team Functioning ◽  
The Impact

Abstract Background Noise has been recognised to have a negative impact on performance and wellbeing in many settings. Average noise levels have been found to range between 51-79 dB in operating theatres. Despite this, there is little research investigating the effect of noise on surgical team functioning. Method A literature review to look at the impact of noise in the operating theatre was performed on MEDLINE which included the search terms ‘noise’ OR ‘distraction’ AND ‘technical skill’ OR ‘Surgical skill’ OR ‘Operating Room’. 10 of 307 articles identified were deemed relevant. Results 8 of 10 studies found noise to be detrimental to communication and surgical performance, particularly regarding total errors and time to task completion. No studies found noise to be beneficial. Two studies found case irrelevant verbal communication to be a frequent form of noise pollution in operating theatres; this is both perceived by surgeons to be distracting and delays patient care. Noise was most harmful to trainees. Conclusions Noise and irrelevant verbal communications were both found to be harmful to surgical performance, surgeon experience and team functioning. The worsened effect on the trainee exposes an urgent need to address noise pollution in the training environment.

The impact of noise in the operating theatre: a review of the evidence

2021 ◽  
Vol 103 (2) ◽  
pp. 83-87
Author(s):  
RWJ Mcleod ◽  
L Myint-Wilks ◽  
SE Davies ◽  
HA Elhassan
Keyword(s):  
Negative Impact ◽  
Noise Pollution ◽  
Operating Theatre ◽  
Task Completion ◽  
Surgical Performance ◽  
Search Terms ◽  
Surgeon Experience ◽  
Operating Theatres ◽  
Team Functioning ◽  
The Impact

Introduction Noise has been recognised to have a negative impact on performance and wellbeing in many settings. Average noise levels have been found to range between 51dB and 79dB in operating theatres. Despite these levels of noise, there is little research investigating their effect on surgical team functioning. Methods A literature review to look at the impact of noise in the operating theatre was performed on MEDLINE, which included the search terms ‘noise’ OR ‘distraction’ AND ‘technical skill’ OR ‘Surgical skill’ OR ‘Operating Room’. Only 10 of 307 articles identified were deemed relevant. Findings Eight of ten studies found noise to be detrimental to communication and surgical performance, particularly regarding total errors and time to task completion. No studies found noise to be beneficial. Two studies found case-irrelevant verbal communication to be a frequent form of noise pollution in operating theatres; this is both perceived by surgeons to be distracting and delays patient care. Conclusion Noise and irrelevant verbal communications were both found to be harmful to surgical performance, surgeon experience and team functioning.

Creating Safety II in the operating theatre: The Durable Dozen!

2018 ◽  
Vol 29 (7-8) ◽  
pp. 210-215
Author(s):  
Jane Carthey
Keyword(s):  
Operating Theatre ◽  
Aviation Industry ◽  
Dirty Dozen ◽  
Operating Theatres ◽  
Team Norms

The aviation industry calls the most frequently recurring factors that lead to incidents ‘the Dirty Dozen.’ The ‘Dirty Dozen’ includes, for example, stress, distractions and interruptions, team norms etc. The article adapts the concept of the Dirty Dozen from aviation to explore resilience in operating theatres. Taking a Safety II perspective, the article introduces the ‘Durable Dozen’: 12 regulatory, organisational, team and individual behaviours that enable theatre teams to resolve safety threats.

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