scholarly journals Development and Implementation of the Portable Operating Room Tracker App With Vital Signs Streaming Infrastructure: Operational Feasibility Study

10.2196/13559 ◽  
2019 ◽  
Vol 2 (2) ◽  
pp. e13559
Author(s):  
Matthias Görges ◽  
Nicholas C West ◽  
Christian L Petersen ◽  
J Mark Ansermino
Keyword(s):  
Real Time ◽  
Operating Room ◽  
Information Exchange ◽  
Vital Signs ◽  
Operating Rooms ◽  
Mobile App ◽  
Data Availability ◽  
Major Barrier ◽  
Team Members ◽  
Feasibility Testing

Background In the perioperative environment, a multidisciplinary clinical team continually observes and evaluates patient information. However, data availability may be restricted to certain locations, cognitive workload may be high, and team communication may be constrained by availability and priorities. We developed the remote Portable Operating Room Tracker app (the telePORT app) to improve information exchange and communication between anesthesia team members. The telePORT app combines a real-time feed of waveforms and vital signs from the operating rooms with messaging, help request, and reminder features. Objective The aim of this paper is to describe the development of the app and the back-end infrastructure required to extract monitoring data, facilitate data exchange and ensure privacy and safety, which includes results from clinical feasibility testing. Methods telePORT’s client user interface was developed using user-centered design principles and workflow observations. The server architecture involves network-based data extraction and data processing. Baseline user workload was assessed using step counters and communication logs. Clinical feasibility testing analyzed device usage over 11 months. Results telePORT was more commonly used for help requests (approximately 4.5/day) than messaging between team members (approximately 1/day). Passive operating room monitoring was frequently utilized (34% of screen visits). Intermittent loss of wireless connectivity was a major barrier to adoption (decline of 0.3%/day). Conclusions The underlying server infrastructure was repurposed for real-time streaming of vital signs and their collection for research and quality improvement. Day-to-day activities of the anesthesia team can be supported by a mobile app that integrates real-time data from all operating rooms.

scholarly journals Development and Implementation of the Portable Operating Room Tracker App With Vital Signs Streaming Infrastructure: Operational Feasibility Study (Preprint)

2019 ◽  
Author(s):  
Matthias Görges ◽  
Nicholas C West ◽  
Christian L Petersen ◽  
J Mark Ansermino
Keyword(s):  
Real Time ◽  
Operating Room ◽  
Information Exchange ◽  
Vital Signs ◽  
Operating Rooms ◽  
Mobile App ◽  
Data Availability ◽  
Major Barrier ◽  
Team Members ◽  
Feasibility Testing

BACKGROUND In the perioperative environment, a multidisciplinary clinical team continually observes and evaluates patient information. However, data availability may be restricted to certain locations, cognitive workload may be high, and team communication may be constrained by availability and priorities. We developed the remote Portable Operating Room Tracker app (the telePORT app) to improve information exchange and communication between anesthesia team members. The telePORT app combines a real-time feed of waveforms and vital signs from the operating rooms with messaging, help request, and reminder features. OBJECTIVE The aim of this paper is to describe the development of the app and the back-end infrastructure required to extract monitoring data, facilitate data exchange and ensure privacy and safety, which includes results from clinical feasibility testing. METHODS telePORT’s client user interface was developed using user-centered design principles and workflow observations. The server architecture involves network-based data extraction and data processing. Baseline user workload was assessed using step counters and communication logs. Clinical feasibility testing analyzed device usage over 11 months. RESULTS telePORT was more commonly used for help requests (approximately 4.5/day) than messaging between team members (approximately 1/day). Passive operating room monitoring was frequently utilized (34% of screen visits). Intermittent loss of wireless connectivity was a major barrier to adoption (decline of 0.3%/day). CONCLUSIONS The underlying server infrastructure was repurposed for real-time streaming of vital signs and their collection for research and quality improvement. Day-to-day activities of the anesthesia team can be supported by a mobile app that integrates real-time data from all operating rooms.

Effect of C-Arm Year Model on Radiation Scatter

2015 ◽  
Vol 9 (1) ◽  
Author(s):  
Omar Bakr ◽  
Saam Morshed ◽  
Meir Marmor
Keyword(s):  
Real Time ◽  
Operating Room ◽  
Trauma Surgery ◽  
Image Intensifier ◽  
Operating Rooms ◽  
Phantom Limb ◽  
Orthopaedic Trauma ◽  
Total Radiation ◽  
Set Up ◽  
Radiation Scatter

Since the 1980’s C-arm fluoroscopy has been an integral part of orthopaedic trauma surgery. The advancement in C-arm technology has resulted in different generations of C-arms co-existing in the operating rooms. The purpose of this study was to compare the radiation scatter patterns of different generation C-arms. Three generation of C-arms were tested: GE OEC 9800 Plus (1999/2000), Siemens Arcadis Orbic 3D (2004), Philips BV Pulsera 2.3 (2008). Radiation scatter was measured using six real-time dosimetry badges set up on either side of the surgical table (Mizuho OSI, flat-top). Distance of C-arm was normalized at 20 in. and 10 in. from Image Intensifier. Each device was set to the automatic brightness control (ABC) setting. A phantom limb was irradiated for 120 s and radiation scatter was summed for both AP and lateral positions. At their typical operating room settings there was a reduction in radiation scatter using the newer generation C-arms. Results for total radiation, normalized to Philips, are as follows: Philips 1 (100%), GE 2.4 (240%), and Siemens 1.4 (140%). Newer generation C-arms can be expected to generate lower radiation scatter. Special care should be taken to attempt a lower dose setting, especially when utilizing older generation C-arms to minimize radiation scatter to practitioner.

Concerns About Verbal Communication in the Operating Room: A Field Study

2019 ◽  
Vol 62 (6) ◽  
pp. 940-953 ◽  
Author(s):  
Ehsan Garosi ◽  
Reza Kalantari ◽  
Ahmad Zanjirani Farahani ◽  
Mojgan Zuaktafi ◽  
Esmaeil Hosseinzadeh Roknabadi ◽  
...  
Keyword(s):  
Field Study ◽  
Operating Room ◽  
Poor Performance ◽  
Operating Rooms ◽  
Verbal Communication ◽  
Communication Patterns ◽  
Surgical Team ◽  
Negative Effects ◽  
Cross Sectional ◽  
Team Members

Objective To assess verbal communication patterns which could contribute to poor performance among surgical team members in an operating room. Background There exist certain challenges in communication in health care settings. Poor communication can have negative effects on the performance of a surgical team and patient safety. A communication pattern may be associated with poor performance when the process of sending and receiving information is interrupted or the content of conversation is not useful. Method This cross-sectional field study was conducted with 54 surgical teams working in two Iranian hospitals during 2015. Two observers recorded all verbal communications in an operating room. An in-depth assessment of various annotated transcripts by an expert panel was used to assess verbal communication patterns in the operating room. Results Verbal communication patterns which could contribute to poor performance were observed in 63% of the surgeries, categorized as communication failures (17 events), protests (23 events), and irrelevant conversations (164 events). The anesthesiologists and the circulating nurses had the most concerning communication patterns. The failure of devices and poor planning were important factors that contributed to concerning patterns. Conclusion Concerning patterns of verbal communication are not rare in operating rooms. Analyzing the annotated transcripts of surgeries can conduce to identifying all these patterns, and their causes. Concerning communication patterns can be reduced in the operating room by providing interventions, properly planning for surgeries, and fixing defective devices. Application The method used in this study can be followed to assess communication problems in operating rooms and to find solutions.

scholarly journals Early prediction of hemodynamic interventions in the intensive care unit using machine learning

Critical Care ◽  
2021 ◽  
Vol 25 (1) ◽  
Author(s):  
Asif Rahman ◽  
Yale Chang ◽  
Junzi Dong ◽  
Bryan Conroy ◽  
Annamalai Natarajan ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Systolic Blood Pressure ◽  
Real Time ◽  
Situational Awareness ◽  
Vital Signs ◽  
Stability Index ◽  
Hemodynamic Instability ◽  
Data Availability ◽  
Prediction Confidence ◽  
Physiologic Parameters

Abstract Background Timely recognition of hemodynamic instability in critically ill patients enables increased vigilance and early treatment opportunities. We develop the Hemodynamic Stability Index (HSI), which highlights situational awareness of possible hemodynamic instability occurring at the bedside and to prompt assessment for potential hemodynamic interventions. Methods We used an ensemble of decision trees to obtain a real-time risk score that predicts the initiation of hemodynamic interventions an hour into the future. We developed the model using the eICU Research Institute (eRI) database, based on adult ICU admissions from 2012 to 2016. A total of 208,375 ICU stays met the inclusion criteria, with 32,896 patients (prevalence = 18%) experiencing at least one instability event where they received one of the interventions during their stay. Predictors included vital signs, laboratory measurements, and ventilation settings. Results HSI showed significantly better performance compared to single parameters like systolic blood pressure and shock index (heart rate/systolic blood pressure) and showed good generalization across patient subgroups. HSI AUC was 0.82 and predicted 52% of all hemodynamic interventions with a lead time of 1-h with a specificity of 92%. In addition to predicting future hemodynamic interventions, our model provides confidence intervals and a ranked list of clinical features that contribute to each prediction. Importantly, HSI can use a sparse set of physiologic variables and abstains from making a prediction when the confidence is below an acceptable threshold. Conclusions The HSI algorithm provides a single score that summarizes hemodynamic status in real time using multiple physiologic parameters in patient monitors and electronic medical records (EMR). Importantly, HSI is designed for real-world deployment, demonstrating generalizability, strong performance under different data availability conditions, and providing model explanation in the form of feature importance and prediction confidence.

scholarly journals Current practice and perceptions of safety protocols for the use of intraperitoneal chemotherapy in the operating room: results of the IP-OR international survey

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Daniel Clerc ◽  
Martin Hübner ◽  
K.R. Ashwin ◽  
S.P. Somashekhar ◽  
Beate Rau ◽  
...  
Keyword(s):  
Operating Room ◽  
Intraperitoneal Chemotherapy ◽  
Current Practice ◽  
High Volume ◽  
International Survey ◽  
Protection Measures ◽  
Team Members ◽  
Cleaning Staff ◽  
The Individual ◽  
Or Team

Abstract Objectives To assess the risk perception and the uptake of measures preventing environment-related risks in the operating room (OR) during hyperthermic intraperitoneal chemotherapy (HIPEC) and pressurized intraperitoneal aerosol chemotherapy (PIPAC). Methods A multicentric, international survey among OR teams in high-volume HIPEC and PIPAC centers: Surgeons (Surg), Scrub nurses (ScrubN), Anesthesiologists (Anest), Anesthesiology nurses (AnesthN), and OR Cleaning staff (CleanS). Scores extended from 0–10 (maximum). Results Ten centers in six countries participated in the study (response rate 100%). Two hundred and eleven responses from 68 Surg (32%), 49 ScrubN (23%), 45 Anest (21%), 31 AnesthN (15%), and 18 CleanS (9%) were gathered. Individual uptake of protection measures was 51.4%, similar among professions and between HIPEC and PIPAC. Perceived levels of protection were 7.57 vs. 7.17 for PIPAC and HIPEC, respectively (p<0.05), with Anesth scoring the lowest (6.81). Perceived contamination risk was 4.19 for HIPEC vs. 3.5 for PIPAC (p<0.01). Information level was lower for CleanS and Anesth for HIPEC and PIPAC procedures compared to all other responders (6.48 vs. 4.86, and 6.48 vs. 5.67, p<0.01). Willingness to obtain more information was 86%, the highest among CleanS (94%). Conclusions Experience with the current practice of safety protocols was similar during HIPEC and PIPAC. The individual uptake of protection measures was rather low. The safety perception was better for PIPAC, but the perceived level of protection remained relatively low. The willingness to obtain more information was high. Intensified, standardized training of all OR team members involved in HIPEC and PIPAC is meaningful.

scholarly journals Prehospital triage of patients with acute cardiac complaints: study protocol of HART-c, a multicentre prospective study

BMJ Open ◽  
2021 ◽  
Vol 11 (2) ◽  
pp. e041553
Author(s):  
Enrico de Koning ◽  
Tom E Biersteker ◽  
Saskia Beeres ◽  
Jan Bosch ◽  
Barbra E Backus ◽  
...  
Keyword(s):  
Real Time ◽  
Patient Outcomes ◽  
Medical Records ◽  
Vital Signs ◽  
Hospital Data ◽  
Ed Overcrowding ◽  
Prehospital Triage ◽  
Ed Visits ◽  
Multicentre Prospective Study ◽  
At Home

IntroductionEmergency department (ED) overcrowding is a major healthcare problem associated with worse patient outcomes and increased costs. Attempts to reduce ED overcrowding of patients with cardiac complaints have so far focused on in-hospital triage and rapid risk stratification of patients with chest pain at the ED. The Hollands-Midden Acute Regional Triage—Cardiology (HART-c) study aimed to assess the amount of patients left at home in usual ambulance care as compared with the new prehospital triage method. This method combines paramedic assessment and expert cardiologist consultation using live monitoring, hospital data and real-time admission capacity.Methods and analysisPatients visited by the emergency medical services (EMS) for cardiac complaints are included. EMS consultation consists of medical history, physical examination and vital signs, and ECG measurements. All data are transferred to a newly developed platform for the triage cardiologist. Prehospital data, in-hospital medical records and real-time admission capacity are evaluated. Then a shared decision is made whether admission is necessary and, if so, which hospital is most appropriate. To evaluate safety, all patients left at home and their general practitioners (GPs) are contacted for 30-day adverse events.Ethics and disseminationThe study is approved by the LUMC’s Medical Ethics Committee. Patients are asked for consent for contacting their GPs. The main results of this trial will be disseminated in one paper.DiscussionThe HART-c study evaluates the efficacy and feasibility of a prehospital triage method that combines prehospital patient assessment and direct consultation of a cardiologist who has access to live-monitored data, hospital data and real-time hospital admission capacity. We expect this triage method to substantially reduce unnecessary ED visits.

scholarly journals Design Opportunities to Reduce Waste in Operating Rooms

2021 ◽  
Vol 13 (4) ◽  
pp. 2207
Author(s):  
Charlotte Harding ◽  
Joren Van Loon ◽  
Ingrid Moons ◽  
Gunter De Win ◽  
Els Du Bois
Keyword(s):  
Operating Room ◽  
Circular Economy ◽  
Operating Rooms ◽  
Medical Waste ◽  
Waste Reduction ◽  
Infrastructure Management ◽  
Expert Interviews ◽  
Hospital Waste ◽  
Observation Results ◽  
Taking Care

While taking care of the population’s health, hospitals generate mountains of waste, which in turn causes a hazard to the environment of the population. The operating room is responsible for a disproportionately big amount of hospital waste. This research aims to investigate waste creation in the operating room in order to identify design opportunities to support waste reduction according to the circular economy. Eight observations and five expert interviews were conducted in a large sized hospital. The hospital’s waste infrastructure, management, and sterilization department were mapped out. Findings are that washable towels and operation instruments are reused; paper, cardboard, and specific fabric are being recycled; and (non-)hazardous medical waste is being incinerated. Observation results and literature findings are largely comparable, stating that covering sheets of the operation bed, sterile clothing, sterile packaging, and department-specific products are as well the most used and discarded. The research also identified two waste hotspots: the logistical packaging (tertiary, secondary, and primary) of products and incorrect sorting between hazardous and non-hazardous medical waste. Design opportunities include optimization of recycling and increased use of reusables. Reuse is the preferred method, more specifically by exploring the possibilities of reuse of textiles, consumables, and packaging.

Assessing the potential for real-time urban flood forecasting based on a worldwide survey on data availability

2013 ◽  
Vol 11 (7) ◽  
pp. 573-583 ◽  
Author(s):  
Jeanne-Rose René ◽  
Slobodan Djordjević ◽  
David Butler ◽  
Henrik Madsen ◽  
Ole Mark
Keyword(s):  
Real Time ◽  
Flood Forecasting ◽  
Data Availability ◽  
Urban Flood
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