Implications of Surgical Training on Operating Room Throughput at Wilford Hall Medical Center

2008 ◽  
Author(s):  
Jo Marie Kitchens
Keyword(s):  
Operating Room ◽  
Surgical Training ◽  
Medical Center

Blood, Sweat, Toil, and Tears of Surgical Training. Part I: Blood

2007 ◽  
Vol 15 (4) ◽  
pp. 307-309 ◽  
Author(s):  
Andrew J Drain ◽  
Jonathon I Ferguson ◽  
Sharon Wilkinson ◽  
Samer AM Nashef
Keyword(s):  
Adverse Effect ◽  
Blood Loss ◽  
Operating Room ◽  
Clinical Outcomes ◽  
Surgical Training ◽  
Clinical Service ◽  
Significant Difference ◽  
Potential Impact ◽  
The Impact ◽  
Cardiac Operations

There may be conflict between the requirements of surgical training and those of the clinical service if training has an impact on clinical outcomes. One area of potential impact is perioperative blood loss. We compared total and 12-hour blood loss after 2,079 consecutive cardiac operations performed over 2 years by trainees and consultants. One- and two-way analyses of variance with EuroSCORE and surgeon status as factors were carried out to evaluate the impact of surgeon status on blood loss. There was no difference in blood loss between consultants and trainees. We also compared the rates between consultants and trainees of patients returning to the operating room due to bleeding. This showed a significant difference, with trainees having a higher rate of investigation for bleeding. Cardiac surgical training can be achieved without an adverse effect on blood loss, but it may be associated with a higher rate of re-intervention for bleeding.

Strategies for giving feedback in the operating room

2021 ◽  
pp. postgradmedj-2021-141268
Author(s):  
Akos Marton ◽  
James Ashcroft
Keyword(s):  
Operating Room ◽  
Surgical Training ◽  
Learner Performance ◽  
Specific Feedback ◽  
Giving Feedback

Feedback is crucial to learning and is a difficult concept to define, occurring as a consequence of learner performance with the ultimate aim of influencing change in the learner. Here, we discuss strategies for giving feedback in the operating room revolving around the following themes: encouraging a sociocultural process, forming an educational alliance, sharing training goals, finding the appropriate time, giving task-specific feedback, approaching unsatisfactory performance and providing follow-up. It is essential that surgeons understand the fundamental feedback theories at play in the operating room described in this article and how they influence surgical training at all stages.

scholarly journals Lack of impact of nil-per-os (NPO) time on goal-directed fluid delivery in first case versus afternoon case starts: a retrospective cohort study

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
R. Ryan Field ◽  
Tuan Mai ◽  
Samouel Hanna ◽  
Brian Harrington ◽  
Michael-David Calderon ◽  
...  
Keyword(s):  
Operating Room ◽  
Medical Center ◽  
Fluid Administration ◽  
Fluid Replacement ◽  
Primary Study ◽  
Start Time ◽  
Fluid Delivery ◽  
First Case ◽  
Patient Reported ◽  
The Impact

Abstract Background Goal Directed Fluid Therapy (GDFT) represents an objective fluid replacement algorithm. The effect of provider variability remains a confounder. Overhydration worsens perioperative morbidity and mortality; therefore, the impact of the calculated NPO deficit prior to the operating room may reach harm. Methods A retrospective single-institution study analyzed patients at UC Irvine Medical Center main operating rooms from September 1, 2013 through September 1, 2015 receiving GDFT. The primary study question asked if GDFT suggested different fluid delivery after different NPO periods, while reducing inter-provider variability. We created two patient groups distinguished by 0715 surgical start time or start time after 1200. We analyzed fluid administration totals with either a 1:1 crystalloid to colloid ratio or a 3:1 ratio. We performed direct group-wise testing on total administered volume expressed as total ml, total ml/hr., and total ml/kg/hr. between the first case start (AM) and afternoon case (PM) groups. A linear regression model included all baseline covariates that differed between groups as well as plausible confounding factors for differing fluid needs. Finally, we combined all patients from both groups, and created NPO time to total administered fluid scatterplots to assess the effect of patient-reported NPO time on fluid administration. Results Whether reported by total administered volume or net fluid volume, and whether we expressed the sum as ml, ml/hr., or ml/kg/hr., the AM group received more fluid on average than the PM group in all cases. In the general linear models, for all significant independent variables evaluated, AM vs PM case start did not reach significance in both cases at p = 0.64 and p = 0.19, respectively. In scatterplots of NPO time to fluid volumes, absolute adjusted and unadjusted R2 values are < 0.01 for each plot, indicating virtually non-existent correlations between uncorrected NPO time and fluid volumes measured. Conclusions This study showed NPO periods do not influence a patient’s volume status just prior to presentation to the operating room for surgical intervention. We hope this data will influence the practice of providers routinely replacing calculated NPO period volume deficit; particularly with those presenting with later surgical case start times.

Intraoperative Assessment of Breast Cancer Specimens Decreases Cost and Number of Reoperations

2011 ◽  
Vol 77 (3) ◽  
pp. 342-344 ◽  
Author(s):  
John M. Uecker ◽  
Eric H. Bui ◽  
Kelli H. Foulkrod ◽  
John P. Sabra
Keyword(s):  
Breast Cancer ◽  
Operating Room ◽  
Medical Center ◽  
Margin Assessment ◽  
Surgical Interventions ◽  
Intraoperative Assessment ◽  
Surgical Costs ◽  
Operative Costs ◽  
Intraoperative Margin Assessment

It is the aim of our study to determine if the assessment of intraoperative breast cancer margins leads to decreased incidence of repeat operations and decreased cost. We collected data prospectively from two hospitals in Austin, TX, University Medical Center at Brackenridge (UMCB) and Seton Northwest Hospital (SNW), over a 2-year period. Comparison was made to see if intraoperative margin assessment affected total surgical costs and need for reoperation. One hundred and seven cases met criteria for inclusion in the study (UMCB = 45, SNW = 62). Intraoperative margin assessment was used in zero cases at SNW (0%) and in 17 at UMCB (38%). Intraoperative assessment was used in 16 per cent of total cases. Sixty per cent of cases at SNW required subsequent return to the operating room. Twenty-four per cent of cases at UMCB required subsequent reoperation ( P < 0.05). The average number of surgical interventions required was 1 ± 0.3 with intraoperative assessment, 2 ± 0.6 without, ( P < 0.05). Total surgical costs were $15,341 ± $4,328 with intraoperative assessment and $22,013 ± $13,821 without ( P < 0.05). Use of intraoperative margin assessment for breast cancer operations leads to both a decrease in reoperations as well as a decrease in total operative costs.

Relevance of early head CT scans following neurosurgical procedures: an analysis of 892 intracranial procedures at Rush University Medical Center

2014 ◽  
Vol 121 (2) ◽  
pp. 307-312 ◽  
Author(s):  
Ricardo B. V. Fontes ◽  
Adam P. Smith ◽  
Lorenzo F. Muñoz ◽  
Richard W. Byrne ◽  
Vincent C. Traynelis
Keyword(s):  
Operating Room ◽  
Neurological Examination ◽  
Medical Center ◽  
Ct Scanning ◽  
Ct Scans ◽  
Type I ◽  
Type Ii ◽  
Head Ct ◽  
Ct Findings ◽  
Neurological Change

Object Early postoperative head CT scanning is routinely performed following intracranial procedures for detection of complications, but its real value remains uncertain: so-called abnormal results are frequently found, but active, emergency intervention based on these findings may be rare. The authors' objective was to analyze whether early postoperative CT scans led to emergency surgical interventions and if the results of neurological examination predicted this occurrence. Methods The authors retrospectively analyzed 892 intracranial procedures followed by an early postoperative CT scan performed over a 1-year period at Rush University Medical Center and classified these cases according to postoperative neurological status: baseline, predicted neurological change, unexpected neurological change, and sedated or comatose. The interpretation of CT results was reviewed and unexpected CT findings were classified based on immediate action taken: Type I, additional observation and CT; Type II, active nonsurgical intervention; and Type III, surgical intervention. Results were compared between neurological examination groups with the Fisher exact test. Results Patients with unexpected neurological changes or in the sedated or comatose group had significantly more unexpected findings on the postoperative CT (p < 0.001; OR 19.2 and 2.3, respectively) and Type II/III interventions (p < 0.001) than patients at baseline. Patients at baseline or with expected neurological changes still had a rate of Type II/III changes in the 2.2%–2.4% range; however, no patient required an immediate return to the operating room. Conclusions Over a 1-year period in an academic neurosurgery service, no patient who was neurologically intact or who had a predicted neurological change required an immediate return to the operating room based on early postoperative CT findings. Obtaining early CT scans should not be a priority in these patients and may even be cancelled in favor of MRI studies, if the latter have already been planned and can be performed safely and in a timely manner. Early postoperative CT scanning does not assure an uneventful course, nor should it replace accurate and frequent neurological checks, because operative interventions were always decided in conjunction with the neurological examination.

scholarly journals Operating Room Within the Neonatal Intensive Care Unit—Experience of a Medical Center in Taiwan

2015 ◽  
Vol 56 (4) ◽  
pp. 220-225 ◽  
Author(s):  
Ya-Lei Wang ◽  
Suh-Fang Jeng ◽  
Po-Nien Tsao ◽  
Hung-Chieh Chou ◽  
Chien-Yi Chen ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Neonatal Intensive Care Unit ◽  
Operating Room ◽  
Neonatal Intensive Care ◽  
Medical Center

First-case tardiness reduction in a tertiary academic medical center operating room: A lean six sigma perspective

2016 ◽  
Vol 5 ◽  
pp. 7-12 ◽  
Author(s):  
Pedro Ramos ◽  
Eloisa Bonfá ◽  
Patrícia Goulart ◽  
Marion Medeiros ◽  
Nélson Cruz ◽  
...  
Keyword(s):  
Operating Room ◽  
Six Sigma ◽  
Medical Center ◽  
Academic Medical Center ◽  
Lean Six Sigma ◽  
First Case ◽  
Academic Medical
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