Efficiency status of the elective non-cardiac surgery operating rooms of the Department of Surgery of the Philippine General Hospital

INTRODUCTION: The operating room (OR) is one of the most cost-intensive units of any health care facility. Hence, OR effeciency has become a priority of many institutions. Delays in the OR lead to poor cost effectiveness and cause frustration both to patients and to OR staff.OBJECTIVES: This study aims to describe the efficiency of the Philippine General Hospital Department of Surgery elective non-cardiac surgery operating room services using established parameters and identify causes of delays.METHODS: A cross-sectional survey was conducted of randomly selected elective cases from October 2011 to January 2012. A framework of elements in the OR process and timing milestones were defined. These times were recorded during the OR process. Mean and median observed times for these elements were calculated and compared with target times based on previous research. Causes of delay were recorded.RESULTS: Once anesthesia was started, target times for most parameters were met in the majority of cases. Delays were most notable between patient entry to the OR complex and start of anesthesia, particularly for first cases. Only 3.9% of cases started at or before the scheduled time; 49.7% of cases started more than one hour late. 54.3% of late starts were caused by surgeons not being in the OR complex on time. Errors in estimating case duration were commonplace: more than one third of cases took more than an hour longer or shorter than estimated. While the mean delay in start for first cases was nearly one hour, the mean delay for second and third cases was nearly two hours.CONCLUSION: The majority of cases start late. The most common cause of delay is the surgeon's tardiness. Considerable discrepancy between the predicted and actual case duration was also observed.

Nutritional assessment of adult cancer patients admitted at the Philippine General Hospital using the scored patient generated subjective global assessment tool (PG-SGA)

OBJECTIVES: Malnutrition is common among cancer patients. The aim of this study was to determine the nutritional status of preoperative cancer patients upon admission at a tertiary hospital in the Philippines. It also aimed to identify common symptoms with adverse impact on nutrition and to correlate the nutritional status to the length of hospital stay and development of post-operative complications. METHODS: A hospital-based prospective cohort study design was conducted among pre-operative adult cancer patients admitted from September to December 2010. Nutritional status assessment was done using the Scored Patient-Generated Subjective Global Assessment (PG-SGA) tool and correlation to their symptoms, length of hospital stay, and post-operative complications were determined using analysis of variance (ANOVA) and Chi-Square tests. RESULT: A total of 103 patients were included for the study amongst whom prevalence of malnutrition was 83%. Symptoms that were significantly associated with severity of malnutrition were early satiety, lack of appetite and alteration in taste perception. Poor nutritional status was associated with increased mean length of hospital stay: 7.5, 14.1 and 15.1 days for well-nourished, moderately malnourished and severely malnourished, respectively (p=0.048). CONCLUSION: Using the Scored PG-SGA tool, this study observed a correlation between severity of nutritional status and increased length of hospital stay among cancer patients. Presence of nutritional impact symptoms such as lack of appetite, early satiety, and alteration of taste perception correlated with the degree of malnutrition on admission. RECOMMENDATIONS: Formal objective assessment of the nutritional status of cancer patients should be done. Addressing the symptoms of lack of appetite, early satiety, and alteration of taste perception should be prioritized to prevent deterioration in nutrition.

A questionnaire survey on the knowledge, attitudes and beliefs regarding vasectomy of male patients consulting in the Philippine General Hospital

OBJECTIVE: This study aimed to determine the knowledge, attitudes and beliefs of adult Filipino males consulting in the Philippine General Hospital on vasectomy, and the affect of marital status, length of marriage, number of children, level of education, economic status, religion and type of mass -media exposure on these attitude and beliefs. MATERIALS AND METHODS: This is a descriptive cross-sectional study. A total of 1120 adult male patients were included in the study. Data were collected using a standardized, self-administered questionnaire. Percentages and means were calculated for all variables. Analysis was done using multiple regression models. RESULTS: The mean age of the participants was 50.7 years (SD 16.5) and the mean number of children was 2.5 (SD 2.2). Of the whole sample, 363 (32.4%) have used or are currently using one from of contraception. Among the 518 (46.2%) of men who knew about vasectomy as a form of contraception, 451(87.1%) knew that vasectomy involves ligation of the vas deferens. Higher educational status, previous or current use of contraceptive and not being a Roman Catholic were shown to be statistically significantly associated with knowing about vasectomy as a form of contraception. Only knowledge about the safety of vasectomy was shown to influence men's willingness to undergo the procedure. CONCLUSION: Improved awareness of the safety and reversibility of vasectomy may lead to increased acceptance of the procedure amongst Filipino men. Physicians play an important role in the dissemination of information about contraception, alongside the mass media, and should make efforts to ensure that adequate and accurate information is made available.

A survey of common biofilm microorganisms in indwelling urinary catheters and their antibiotic sensitivity pattern

OBJECTIVES: The study aimed to determine the biofilm microorganisms colonizing the indwelling urinary catheters, the antibiotic sensitivity pattern of the biofilm microorganisms isolated and the presence, if any, and the nature of the relationship of some clinical factors to the biofilm microorganism isolated and/or the antibiotic sensitivity pattern. MATERIALS AND METHOD: Indwelling catheter tips of urology patients were collected and processed. Biofilm microorganisms were extracted from the catheters and subjected to culture studies. Analysis of its antibiotic resistance and sensitivity pattern was performed. RESULTS: E. coli was the most common microorganism isolated in the biofilms of indwelling catheter. Imipenem and nitrofurantoin showed high sensitivity in all isolated biofilm microorganisms. The presence of co morbidity and the previous use of antibiotics were two factors found to be significantly associated with antibiotic sensitivity/resistance patterns. CONCLUSION: In dealing with catheter related infections, one should consider local antibiotic sensitivity pattern of E. coli. Based on this study, nitrofurantoin or imipenem can be expected to be effective empiric treatment for catheter related urinary track infections.