Novel do-it-yourself low-cost abdominal laparoscopy entry simulator for gynaecology trainees

The COVID-19 pandemic has affected gynaecology trainees in the United Kingdom by reducing operating theatre experience. Simulators are widely used for operative laparoscopy but not for practising laparoscopic-entry techniques. We devised a low-cost simulator to help trainees achieve the skill. Our aim was to pilot this low-cost simulator to perform Royal College of Obstetricians and Gynaecologists (RCOG) supervised learning events.A single-centre pilot study involving six gynaecology trainees in a structured training session. Interactive PowerPoint teaching was followed by trainees’ demonstration of laparoscopic entry for a supervised learning event and personalized feedback. Participants completed pre- and post-course questionnaires.All the trainees found the training useful to the score of 10 (scale of 1–10) and recommended this to be included in Deanery teaching. Personalized feedback was described as the most useful. The simulator was rated as good as a real-life patient relative to the skill being taught.Gynaecology trainees are affected by lack of hands-on experience in the operating theatre for performing laparoscopic entry. A low-cost abdominal laparoscopy entry simulator can help deliver the RCOG curriculum, enabling trainees to achieve required competencies.

Improving teamwork and communication in the operating room by introducing the theatre cap challenge

Objective One of the steps of the Surgical Safety Checklist is for the team members to introduce themselves. The objective of this study was to implement a tool to help remember and use each other’s names and roles in the operating theatre. Methods This study was part of a pilot study in which a video and medical data recorder was implemented in one operating theatre and used as a tool for postoperative multidisciplinary debriefings. During these debriefings, name recall was evaluated. Following the implementation of the medical data recorder, this study was started by introducing the theatre cap challenge, meaning the use of name (including role) stickers on the surgical cap in the operating theatre. Findings In total, 41% (n = 40 out of 98) of the operating theatre members were able to recall all the names of their team at the team briefings. On average 44.8% (n = 103) was wearing the name sticker. Conclusions The time-out stage of the Surgical Safety Checklist might be inadequate for correctly remembering and using your operating theatre team members’ names. For this, the theatre cap challenge may help.

Anesthesia Immutable Registry of Real-time Vital Signs and Waveforms using Blockchain

Healthcare has become one of the most important emerging application areas of blockchain technology.[1] Although the use of a cryptographic ledger within Anesthesia Information Management Systems (AIMS) remains uncertain. The need for a truly immutable anesthesia record is yet to be established, given that the current AIMS database systems have reliable audit capabilities. Adoption of AIMS has followed Roger's 1962 formulation of the theory of diffusion of innovation. Between 2018 and 2020, adoption was expected to be the 84% of U.S. academic anesthesiology departments.[2] Larger anesthesiology groups with large caseloads, urban settings, and government affiliated or academic institutions are more likely to adopt and implement AIMS solutions, due to the substantial amount of financial resources and dedicated staff to support both the implementation and maintenance that are required. As health care dollars become more scarce, this is the most frequently cited constraint in the adoption and implementation of AIMS.[3] We propose the use of a blockchain database for saving all incoming data from multiparametric monitors at the operating theatre. We present a proof of concept of the use of this technology for electronic anesthesia records even in the absence of an AIMS at site. In this paper we shall discuss its plausibility as well as its feasibility. The Electronic medical records (EMR) in AIMS might contain errors and artifacts that may (or may not) have to be dealt with. Making them immutable is a scary concept. The use of the blockchain for saving raw data directly from medical monitoring equipment and devices in the operating theatre has to be further investigated.

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

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.

Does anyone know how much NHS operating rooms cost? A survey of operating room managers' knowledge of costs and data

Background/Aims Operating theatres represent a large proportion of NHS healthcare resources, so there has been focus on reducing costs in this area. This, in part, relies on managers having knowledge of the relevant costs in operating rooms. This study aimed to gauge the level of familiarity regarding costs among the various tiers of managers of NHS operating theatres, and if this information informed their decision making. Methods A semi-structured interview was administered to 12 finance managers, theatre managers and board members across 16 separate hospitals, representing six NHS trusts. Responses were reviewed through qualitative analysis by the authors. Findings The respondents showed very limited knowledge of operating theatre costs, with nearly all being unable to use cost data to inform either daily or longer-term strategic decision making. In particular, the costs of under- or over-running operating lists were not known. Conclusions The study suggests that heuristics of operating theatre management are, in practice, not influenced by costs. Instead, the resulting cost balance appears to be a passive consequence of decision-making based on other factors. This has significant implications for cost reduction initiatives and suggests an urgent need for improvement.

Early non-excisional debridement of paediatric burns under general anaesthesia reduces time to re-epithelialisation and risk of skin graft

Reported advantages of early excision for larger burn injuries include reduced morbidity, mortality, and hospital length of stay for adult burn patients. However, a paucity of evidence supports the best option for paediatric burns and the advantages of non-excisional (mechanical) debridement. Procedural sedation and analgesia in the emergency department is a popular alternative to debridement in operating theatres under general anaesthesia. This study aims to evaluate the association between early (< 24 h post-injury) non-excisional debridement under general anaesthesia with burn wound re-epithelialisation time and skin graft requirements. Cohort study of children younger than 17 years who presented with burns of five percent total body surface area or greater. Data from January 2013 to December 2019 were extracted from a prospectively collected state-wide paediatric burns’ registry. Time to re-epithelialisation was tested using survival analysis, and binary logistic regression for odds of skin graft requirementto analyse effects of early non-excisional debridement in the operating theatre. Overall, 292 children met eligibility (males 55.5%). Early non-excisional debridement under general anaesthesia in the operating theatre, significantly reduced the time to re-epithelialisation (14 days versus 21 days, p = 0.029)) and the odds of requiring a skin graft in comparison to paediatric patients debrided in the emergency department under Ketamine sedation (OR: 6.97 (2.14–22.67), p < 0.001. This study is the first to demonstrate that early non-excisional debridement under general anaesthesia in the operating theatre significantly reduces wound re-epithelialisation time and subsequent need for a skin graft in paediatric burn patients. Analysis suggests that ketamine procedural sedation and analgesia in the emergency department used for burn wound debridement is not an effective substitute for debridement in the operating theatre.

P-EGS11 The Theatre Training Checklist: A Toolkit to Revive Post Pandemic Operative Training

Background The COVID-19 pandemic has had a significant negative impact on operative surgical training, with trainee logbook numbers reduced by more than 50% compared to 2019. The operating theatre is expensive, costing approximately £1200 per hour to run. It is a crucial learning environment for many different trainees: anaesthetists, surgeons, operation department practitioners and surgical first assistants. For individuals to achieve their training requirements, the operating theatre as a training environment must be shared between all trainees. This requires excellent teamwork and leadership. The recovery phase of the COVID-19 pandemic is a unique opportunity to adopt novel training strategies. Methods The Theatre Training Checklist is a simple framework that aims to facilitate awareness, understanding, coordination and cooperation of training for all members of the team (Figure 1). It is a practical strategy that can be adopted in any setting. Usually, trainers discuss informally with their trainees about their individual Skills, Experience, Expectationsand what is Achievable in a planned theatre list (SEEA). However, there currently is limited opportunity to discuss this between different disciplines and the wider team. This tool aims to refine communication, optimize training, manage expectations and ensure equity across the board. The checklist has been introduced and trialed locally. Results The checklist is completed at the start of the list during the theatre brief. It identifies all trainees and their specific needs within the operating theatre session to the whole team. An agreed strategy is developed on how to achieve identified training goals (figure 2). Sometimes it may not be possible to allow a trainee to perform a particular procedure. However, other opportunities for training in theatre exist, such as: patient positioning, choice of equipment, types of techniques, discussions around consenting and complications etc. Feedback undertaken from the multiprofessional team after local trialing of the checklist has been positive. Conclusions The Theatre Training Checklist aims to create dialogue and shared understanding of training needs among all parties within the operating theatre. The Theatre Training Checklist Toolkit is available for use and consists of the checklist tool and an instructional video. The Theatre Training checklist is being piloted in some centers and we hope to have the opportunity to present some early findings at AUGIS 2021.