A Simulation Study of the Effects of Operating Room Noise on the Performance of Anesthesia Providers

1999 ◽  
Author(s):  
Heather A. Lembo
Keyword(s):  
Operating Room ◽  
Simulation Study ◽  
Anesthesia Providers

Using Standardized Checklists Increase the Completion Rate of Critical Actions in an Evacuation from the Operating Room: A Randomized Controlled Simulation Study

2019 ◽  
Vol 34 (04) ◽  
pp. 393-400
Author(s):  
Yahya A. Acar ◽  
Neil Mehta ◽  
Mary-Ann Rich ◽  
Banu Karakus Yilmaz ◽  
Matthew Careskey ◽  
...  
Keyword(s):  
Operating Room ◽  
Simulation Study ◽  
Rare Event ◽  
Completion Rate ◽  
Evacuation Time ◽  
In Situ Simulation ◽  
Additional Equipment ◽  
Vertical Evacuation ◽  
Preparation Phase ◽  
Patients With Special Needs

AbstractIntroduction:Hospital evacuations of patients with special needs are extremely challenging, and it is difficult to train hospital workers for this rare event.Hypothesis/Problem:Researchers developed an in-situ simulation study investigating the effect of standardized checklists on the evacuation of a patient under general anesthesia from the operating room (OR) and hypothesized that checklists would improve the completion rate of critical actions and decrease evacuation time.Methods:A vertical evacuation of the high-fidelity manikin (SimMan3G; Laerdal Inc.; Norway) was performed and participants were asked to lead the team and evacuate the manikin to the ground floor after a mock fire alarm. Participants were randomized to two groups: one was given an evacuation checklist (checklist group [CG]) and the other was not (non-checklist group [NCG]). A total of 19 scenarios were run with 28 participants.Results:Mean scenario time, preparation phase of evacuation, and time to transport the manikin down the stairs did not differ significantly between groups (P = .369, .462, and .935, respectively). The CG group showed significantly better performance of critical actions, including securing the airway, taking additional drug supplies, and taking additional equipment supplies (P = .047, .001, and .001, respectively). In the post-evacuation surveys, 27 out of 28 participants agreed that checklists would improve the evacuation process in a real event.Conclusion:Standardized checklists increase the completion rate of pre-defined critical actions in evacuations out of the OR, which likely improves patient safety. Checklist use did not have a significant effect on total evacuation time.

Reengineering Intravenous Drug and Fluid Administration Processes in the Operating Room

2002 ◽  
Vol 97 (1) ◽  
pp. 139-147 ◽  
Author(s):  
Deborah B. Fraind ◽  
Jason M. Slagle ◽  
Victor A. Tubbesing ◽  
Samuel A. Hughes ◽  
Matthew B. Weinger
Keyword(s):  
Operating Room ◽  
De Novo ◽  
Significant Proportion ◽  
Cost Of Care ◽  
Fluid Administration ◽  
Intravenous Drug ◽  
Anesthesia Care ◽  
Drug Preparation ◽  
Anesthesia Providers ◽  
Set Up

Background A reengineering approach to intravenous drug and fluid administration processes could improve anesthesia care. In this initial study, current intravenous administration tasks were examined to identify opportunities for improved design. Methods After institutional review board approval was obtained, an observer sat in the operating room and categorized, in real time, anesthesia providers' activities during 35 cases ( approximately 90 h) into 66 task categories focused on drug/fluid tasks. Both initial room set-up at the beginning of a typical workday and cardiac and noncardiac general anesthesia cases were studied. User errors and inefficiencies were noted. The time required to prepare de novo a syringe containing a mock emergency drug was measured using a standard protocol. Results Drug/fluid tasks consumed almost 50 and 75%, respectively, of the set-up time for noncardiac and cardiac cases. In 8 cardiac anesthetics, drug/fluid tasks comprised 27 +/- 6% (mean +/- SD) of all prebypass clinical activities. During 20 noncardiac cases, drug/fluid tasks comprised 20 +/- 8% of induction and 15 +/- 7% of maintenance. Drug preparation far outweighed drug administration tasks. Inefficient or error prone tasks were observed during drug/fluid preparation (e.g., supply acquisition, waste disposal, syringe labeling), administration (infusion device failure, leaking stopcock), and organization (workspace organization and navigation, untangling of intravenous lines). Anesthesia providers (n = 21) required 35 +/- 5 s to prepare a mock emergency drug. Conclusions Intravenous drug and fluid administration tasks account for a significant proportion of anesthesia care, especially in complex cases. Current processes are inefficient and may predispose to medical error. There appears to be substantial opportunity to improve quality and cost of care through the reengineering of anesthesia intravenous drug and fluid administration processes. General design requirements are proposed.

What is the best workflow for an operating room? A simulation study of five scenarios

2008 ◽  
Vol 12 (2) ◽  
pp. 142-146 ◽  
Author(s):  
Riitta A. Marjamaa ◽  
Paulus M. Torkki ◽  
Eero J. Hirvensalo ◽  
Olli A. Kirvelä
Keyword(s):  
Operating Room ◽  
Simulation Study

Anesthesia Outside of the Operating Room

2011 ◽  
Author(s):  
Richard Urman ◽  
Wendy Gross ◽  
Beverly Philip
Keyword(s):  
Quality Assurance ◽  
Patient Care ◽  
Operating Room ◽  
Patient Monitoring ◽  
Patient Care Team ◽  
Anesthetic Techniques ◽  
Anesthesia Care ◽  
Post Procedure ◽  
Anesthesia Providers ◽  
Physical Resources

This is a comprehensive, up-to-date resource that covers all aspects of anesthesia care in OOR settings, from financial considerations to anesthetic techniques to quality assurance. With increasing numbers of procedures such as cardiac catheterization and imaging taking place outside of the main OR, anesthesia providers as well as non-anesthesia members of the patient care team will find this resource critical to their understanding of the principles of anesthesia care in unique settings which may have limited physical resources. Topics include patient monitoring techniques, pre-procedure evaluation and post-procedure care, and procedural sedation performed by non-anesthesia providers.

Radiofrequency Transmission to Monitoring Devices in the Operating Room: A Simulation Study

2001 ◽  
pp. 384-388
Author(s):  
Stephen E. McNulty ◽  
Benjamin Kline ◽  
Joseph Welsh ◽  
Richard Bartkowski
Keyword(s):  
Operating Room ◽  
Simulation Study ◽  
Monitoring Devices

scholarly journals Important but Impractical: Hand Hygiene Among Operating Room Anesthesia Providers

2020 ◽  
Vol 41 (S1) ◽  
pp. s285-s286
Author(s):  
Sadie Mae Moseley ◽  
Andrea Ankrum ◽  
Normidaris Jimenez ◽  
Alyssa Guthrie ◽  
Felicia Scaggs Huang ◽  
...  
Keyword(s):  
Hand Hygiene ◽  
Operating Room ◽  
Likert Scale ◽  
Nurse Anesthetists ◽  
Individual Interviews ◽  
Anesthesia Providers ◽  
Performance Barriers ◽  
High Adherence ◽  
Suboptimal Adherence ◽  
Inductive Thematic Analysis

Background: Use of the WHO 5 Moments of Hand Hygiene (HH) by operating room (OR) anesthesia personnel has been called by some logistically unfeasible, despite evidence that HH can reduce patients’ risk of pathogen acquisition. We developed and implemented a set of 7 moments based on WHO guidance (Fig 1) with high adherence. We conducted this study 6 months later to determine whether the improvement was sustained. In addition, we sought to understand practices, beliefs, barriers, and perceptions among anesthesia providers regarding HH. Methods: We measured HH adherence by direct observation using locally developed 7 moments tailored to the anesthesia workflow during June–August 2019. Adherence was defined as the percentage of observed HH performed when a moment occurred. We used the theory of planned behavior (TPB) as a framework to conduct 11 individual interviews (8 attending anesthesiologists and 3 certified nurse anesthetists) with a semistructured instrument that included Likert scale and open-ended questions. Interview transcripts were reviewed and a codebook of themes was created through inductive thematic analysis. Resultant themes and Likert scale averages were grouped by the 3 key TPB variables. Results: In total, 294 HH moments were observed for 50 anesthesia providers during 36 cases. The average HH adherence was 21.1% with the highest adherence moment being after patient contact (61.7%). Interview participants stated universally that HH was important for patient care, but acknowledged barriers to performance. Barriers cited included interruption in workflow, a lack of evidence, lack of clarity of HH standard, and limited availability of product. Conclusions: Adherence to the 7 moments of HH for anesthesia providers was not sustained after 6 months. Providers identified numerous barriers to HH, including a lack of knowledge of a standard, as reasons for suboptimal adherence. These data suggest future interventions could be designed to address gaps in knowledge and remove barriers to improve HH adherence among OR anesthesia providers.Funding: NoneDisclosures: None

Uncovering the Drape: Observing its Impact on Communication With Anesthesia Providers

2020 ◽  
pp. 001391652090648
Author(s):  
Laura K. Jones ◽  
Bonnie Mowinski Jennings ◽  
Melinda K. Higgins ◽  
Frans B. M. de Waal
Keyword(s):  
Operating Room ◽  
Social Communication ◽  
Social Order ◽  
Anesthesia Provider ◽  
Operating Table ◽  
Anesthesia Workstation ◽  
Anesthesia Providers

In the operating room (OR), opaque drapes are hung between the anesthesia workstation and the operating table. Because OR teams are transient and hierarchical, social order is continuously being negotiated around this partition. We hypothesized that drape transparency, a tool for reimagining the physical and symbolic confines of the OR, might alter behavior. Due to the proximity of anesthesia providers to the drape, we examined how the drape’s transparency affected “social” and “case-related” communication between them and clinicians from surgery and nursing. We observed 58 surgical cases using an OR ethogram to document interprofessional communications (344 exchanges) involving the anesthesia provider. The effect of the type drape showed a statistically significant, GzMLM F(1, 342) = 4.924, p = .027, increase only for “social” communication. The frequency of “social” communication, known to enhance collegiality, was greater when a transparent drape was substituted for the opaque drape (34.9% vs. 21.3%, respectively).

scholarly journals Comparison of Anesthesia for Dental/Oral Surgery by Office-based Dentist Anesthesiologists versus Operating Room-based Physician Anesthesiologists

2017 ◽  
Vol 64 (4) ◽  
pp. 212-220 ◽  
Author(s):  
Mark A. Saxen ◽  
Richard D. Urman ◽  
Juan F. Yepes ◽  
Rodney A. Gabriel ◽  
James E. Jones
Keyword(s):  
Operating Room ◽  
Clinical Outcomes ◽  
Treatment Time ◽  
Oral Surgery ◽  
Anesthesia Care ◽  
General Anesthetic ◽  
Ambulatory Anesthesia ◽  
Overall Treatment Time ◽  
Anesthesia Providers ◽  
Dental Rehabilitation

Few studies have examined the practice characteristics of dentist anesthesiologists and compared them to other anesthesia providers. Using outcomes from the National Anesthesia Clinical Outcomes Registry and the Society for Ambulatory Anesthesia Clinical Outcomes Registry for dental/oral surgery procedures, we compared 7133 predominantly office-based anesthetics by dentist anesthesiologists to 106,420 predominantly operating room anesthetics performed by physician anesthesia providers. These encounters were contrasted with 34,191 previously published encounters from the practices of oral and maxillofacial surgeons. Children younger than 6 years received the greatest proportion of general anesthetic services rendered by both dentist anesthesiologists and hospital-based anesthesia providers. These general anesthesia services were primarily provided for complete dental rehabilitation for early childhood caries. Overall treatment time for complete dental rehabilitation in the office-based setting by dentist anesthesiologists was significantly shorter than comparable care provided in the hospital operating room and surgery centers. The anesthesia care provided by dentist anesthesiologists was found to be separate and distinct from anesthesia care provided by oral and maxillofacial surgeons, which was primarily administered to adults for very brief surgical procedures. Cases performed by dentist anesthesiologists and hospital-based anesthesia providers were for much younger patients and of significantly longer duration when compared with anesthesia administered by oral and maxillofacial surgeons. Despite the limited descriptive power of the current registries, office-based anesthesia rendered by dentist anesthesiologists is clearly a unique and efficient mode of anesthesia care for dentistry.

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