A stitch in time: Instructing temporality in the operating room

2016 ◽  
Vol 12 (1) ◽  
pp. 85-98 ◽  
Author(s):  
Alan Zemel ◽  
Timothy Koschmann

This paper examines how time is made explicitly relevant in the way the attending surgeon monitors and corrects the performance of a resident during a kidney transplant surgery. In so doing, we observe how the attending constitutes time as a significant and constituent feature of the surgical actions performed by the resident. In order to instruct temporal competence in the performance of surgical procedures, the attending surgeon identifies and makes instructably observable the temporally significant features of the surgical work just as that work is performed, by (a) producing countdowns, pace prompts, and temporal accounts when and as avoidable errors occur, and (b) planning and coordinating current and upcoming actions in relation to other actions. Instructing a trainee in the temporal features of his/her performance occurs when the attending (a) coordinates the production of specific verbal tokens, remarks, and accounts with specific actions performed by the resident as the resident performs them, or (b) anticipates the performance of subsequent actions in relation to current surgical actions underway. This case demonstrates how temporality becomes an observably instructable matter in interaction.

2018 ◽  
Vol 37 (1) ◽  
pp. 3-19 ◽  
Author(s):  
Kerstin H. Wyssusek ◽  
Maggie T. Keys ◽  
André A. J. van Zundert

2011 ◽  
Vol 120 (11) ◽  
pp. 727-731 ◽  
Author(s):  
Neil Bhattacharyya

Objectives: I undertook to determine benchmarks and variability for the surgical times associated with ambulatory otolaryngological procedures in the United States. Methods: I examined the 2006 release of the National Survey of Ambulatory Surgery and extracted all cases of otolaryngological surgery in which one, and only one, otolaryngological procedure was performed. The mean surgical times and operating room times were determined for each procedure that met reliability criteria for their estimates. A secondary analysis was computed for tonsillectomy and for tonsillectomy plus adenoidectomy according to a patient age of greater than 12 years. Results: An estimated 1.68 ± 0.23 million otolaryngological procedures were analyzed as solitary procedures, including 507,000 cases of myringotomy with ventilation tube placement, 136,000 cases of tonsillectomy, and 429,000 cases of tonsillectomy plus adenoidectomy. The mean (±SE) surgical times were 8.0 ± 0.5, 23.9 ± 1.8, and 20.3 ± 0.8 minutes, respectively. The total operating room times were 17.6 ± 0.9, 48.2 ± 2.0, and 40.7 ± 1.1 minutes, respectively. Septoplasty with turbinectomy was the most common rhinologic procedure performed (48,000 cases analyzed) and had surgical and operating room times of 49.6 ± 4.78 and 79.8 ± 5.8 minutes, respectively. The surgical times for tonsillectomy and tonsillectomy plus adenoidectomy did not differ significantly in magnitude according to standard age cutoffs, although the operating room time was slightly (11.7 minutes) longer for tonsillectomy in patients more than 12 years of age (p = 0.034). Conclusions: The surgical times for the performance of the most common otolaryngological ambulatory procedures are remarkably consistent in the United States. Given the volume and consistency of these surgical procedures, they are ideal candidates for studies of cost and efficiency.


2018 ◽  
Vol 55 ◽  
pp. S74-S75
Author(s):  
C. Hamilton ◽  
C. Marshall ◽  
M. Broadbent

Author(s):  
Matthew Read ◽  
Christopher V. Maani

Bedside procedures in the ICU are an integral component of critical care medicine. Anesthesiologists who are assigned to the ICU must adapt principles of safe and effective anesthesia practice to this novel outside-of-the-operating-room environment. There are several reasons for surgical procedures to sometimes be performed at the bedside in the ICU, such as the avoidance of transporting unstable patients from the ICU to the OR, or the lack of adequate time to mobilize resources to perform an urgent procedure in the OR. Readiness of the entire ICU team is essential to avoid compromising care due to production pressure or lack of standards routine to the OR environment. This chapter discusses the types of procedures performed in the ICU and reviews the requirements of performing them successfully.


2009 ◽  
Vol 75 (4) ◽  
pp. 517-523 ◽  
Author(s):  
João Flávio Nogueira Júnior ◽  
Diego Rodrigo Hermann ◽  
Maria Laura Solferini Silva ◽  
Fábio Pires Santos ◽  
Shirley Shizue Nagata Pignatari ◽  
...  
Keyword(s):  
The Web ◽  

2009 ◽  
Vol 75 (4) ◽  
pp. 517-523
Author(s):  
João Flávio Nogueira ◽  
Diego Rodrigo Hermann ◽  
Maria Laura Solferini Silva ◽  
Fábio Pires Santos ◽  
Shirley Shizue Nagata Pignatari ◽  
...  
Keyword(s):  
The Web ◽  

1986 ◽  
Vol 7 (2) ◽  
pp. 54-58 ◽  
Author(s):  
James M. Garvey ◽  
Carol Buffenmyer ◽  
Russel Rule Rycheck ◽  
Robert Yee ◽  
Joanne McVay ◽  
...  

AbstractPostoperative infection rates were determined for gynecologic outpatient surgical procedures performed in a traditional operating room environment and a separate, recently opened, surgicenter within the same hospital. Infections were self-reported by attending surgeons responding to computer-generated line listings of their recent surgical procedures. Responses were obtained on 97.9% (612/625) of women having surgery in the operating room and 99.5% (629/632) of women with surgicenter procedures. The overall infection rate for reported women was 0.9% (11/1,241). The difference between operating room and surgicenter rates was not statistically significant. Postoperative infections occurred in 2.5% (3/118) of diagnostic laparoscopies with tubal lavage and 1.4% (3/214) of voluntary abortions by dilatation and evacuation and curettage (D&E&C). The five other infections were scattered among the remaining 25 procedure categories. Ten of the 11 infections were limited to the “clean-contaminated” wounds. No serious or life-threatening infections were encountered. The computer-assisted surveillance system worked well and was easily incorporated into the existing infection surveillance system. The degree of ascertainment of postoperative wound infections is unknown due to reliance on physician self-reporting. However, no patients requiring readmission for infection went unreported by the attending surgeons.


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