Reflexiones para optimizar el triaje en cirugía / Reflections to optimize triage in surgery

Introducción: La categorización de las urgencias quirúrgicas es una necesidad en razón al continuo desequilibrio entre la oferta y la demanda de servicios quirúrgicos en la mayoría de las instituciones donde se encuentra habilitada la prestación del servicio. Hay abordajes en el tema, con estrategias de priorización de los casos quirúrgicos, que consideran escalas y flujogramas, pero su ausente validez externa y las particularidades de las instituciones y aseguradores, han limitado una generalización de los resultados. Métodos: Se efectúa una conceptualización del triaje de las urgencias quirúrgicas con planteamientos críticos y reflexivos soportados en la evidencia. Se identifican, asimismo, las posibles oportunidades para la investigación. Discusión: Los beneficios potenciales de un triaje quirúrgico en situaciones de urgencia, son extensivos a todos los actores del sistema de salud, disminuyen la posibilidad de desenlaces y repercusiones económicas negativas para las instituciones y los aseguradores. La teoría de las colas ofrece el soporte para un entendimiento del tema y contribuye en las soluciones. Su adopción es escasa como parte de una estrategia local de priorización quirúrgica en un contexto de urgencia. Conclusión:La creación de estrategias que establezcan el triaje para el paciente con una urgencia quirúrgica están influenciadas por la participación continua y efectiva de los actores involucrados en el proceso y en su impacto en los desenlaces clínicos

Introduction: Categorizing surgical emergencies is necessary due to the continued imbalance between the supply and demand of surgical services in most institutions where the service is enabled. There are approaches to the subject, with strategies for prioritizing surgical cases, which consider scales and flowcharts, but their lack of external validity and the particularities of the institutions and insurers have limited the generalization of the results. Methods: A conceptualization of the triage of surgical emergencies is carried out with critical and reflective approaches supported by evidence. Potential research opportunities are also identified. Discussion: The potential benefits of surgical triage in emergent situations are extensive to all health system actors, reducing the possibility of adverse outcomes and economic repercussions for institutions and insurers. Queuing theory offers support for understanding the issue and contributes to solutions. However, its adoption is scarce in an emergency as part of a local surgical prioritization strategy. Conclusion: The creation of strategies that establish triage for the patient with a surgical emergency is influenced by the continuous and effective participation of the actors involved in the process and its impact on clinical outcomes

Contribution margin per hour of operating room to reallocate unutilized operating room time: a cost-effectiveness analysis

Abstract Background and objectives: Contribution margin per hour (CMH) has been proposed in healthcare systems to increase the profitability of operating suites. The aim of our study is to propose a simple and reproducible model to calculate CMH and to increase cost-effectiveness. Methods: For the ten most commonly performed surgical procedures at our Institution, we prospectively collected their diagnosis-related group (DRG) reimbursement, variable costs and mean procedural time. We quantified the portion of total staffed operating room time to be reallocated with a minimal risk of overrun. Moreover, we calculated the total CMH with a random reallocation on a first come-first served basis. Finally, prioritizing procedures with higher CMH, we ran a simulation by calculating the total CMH. Results: Over a two-months period, we identified 14.5 hours of unutilized operating room to reallocate. In the case of a random ''first come -first serve'' basis, the total earnings were 87,117 United States dollars (USD). Conversely, with a reallocation which prioritized procedures with a high CMH, it was possible to earn 140,444 USD (p < 0.001). Conclusion: Surgical activity may be one of the most profitable activities for hospitals, but a cost-effective management requires a comprehension of its cost profile. Reallocation of unused operating room time according to CMH may represent a simple, reproducible and reliable tool for elective cases on a waiting list. In our experience, it helped improving the operating suite cost-effectiveness.

Adverse events in anesthesia: Analysis of claims against anesthesiologists affiliated to an insurance fund in Colombia. Cross-sectional study / Eventos adversos en anestesia: Análisis de las reclamaciones contra anestesiólogos afiliados a un fondo de aseguramiento en Colombia. Estudio de corte transversal

Abstract Introduction: Prevention, identification, analysis and reduction of adverse events (AEs) are all activities designed to increase safety of care in the clinical setting. Closed claims reviews are a strategy that allows to identify patient safety issues. This study analyzes adverse events resulting in malpractice lawsuits against anesthesiologists affiliated to an insurance fund in Colombia between 2013-2019. Objective: To analyze adverse events in closed medicolegal lawsuits against anesthesiologists affiliated to an insurance fund between 2013-2019. Methods: Cross-sectional observational study. Convenience sampling was used, including all closed claims in which anesthesiologists affiliated to an insurance fund in Colombia were sued during the observation period. Variables associated with the occurrence of AEs were analyzed. Results: Overall, 71 claims were analyzed, of which 33.5% were due to anesthesia-related AEs. Adverse events were found more frequently among ASA I-II patients (78.9%), and in surgical procedures (95.8%). The highest number of adverse events occurred in plastic surgery (29.6%); the event with the highest proportion was patient death (43.7%). Flaws in clinical records and failure to comply with the standards were found in a substantial number of cases. Conclusions: When compared with a previously published study in the same population, an increase in ethical, disciplinary and administrative claims was found, driven by events not directly related to anesthesia. Most of the anesthesia-related events occurred in the operating room during surgical procedures in patients and procedures categorized as low risk, and most of them were preventable.

Resumen Introducción: La prevención, identificación, análisis y reducción de los eventos adversos (EA), son actividades direccionadas a incrementar la seguridad de la atención en el entorno clínico. El estudio de los casos cerrados es una estrategia que permite identificar problemas relacionados con la seguridad del paciente. En este estudio se analizan eventos adversos conducentes a procesos medicolegales cerrados contra anestesiólogos afiliados a un fondo de aseguramiento en Colombia entre 2013-2019. Objetivo: Analizar los eventos adversos en procesos medicolegales cerrados de anestesiólogos afiliados a un fondo de aseguramiento entre 2013-2019. Métodos: Estudio observacional de corte transversal. Se analizó una muestra a conveniencia en la que se incluyeron todos los casos cerrados en los que anestesiólogos afiliados a un fondo de aseguramiento en Colombia fueron objeto de reclamaciones en el período de observación. Se analizaron variables relacionadas con la presentación del EA. Resultados: Se analizaron 71 reclamaciones, de las cuales el 33,5 % fueron por EA relacionado con anestesia. Los eventos adversos se encontraron con mayor frecuencia en pacientes ASA I-II (78,9 %), y en procedimientos quirúrgicos (95,8 %). El mayor número de eventos adversos se presentó en cirugía plástica (29,6 %); el evento de mayor proporción fue el fallecimiento del paciente (43,7 %). En un importante número de casos se demostró fallos en el registro de la historia clínica e incumplimiento de normas. Conclusiones: En relación con un estudio publicado previamente en la misma población, se encuentra un incremento en los procesos éticos, disciplinarios y administrativos, motivados por eventos sin una relación directa con el acto anestésico. La mayoría de eventos adversos relacionados con anestesia se presentan en procedimientos quirúrgicos, en salas de cirugía, en pacientes y procedimientos catalogados como de bajo riesgo, y son en su mayoría prevenibles.

Nursing Care during the Perioperative within the Surgical Context / Cuidado de enfermería durante el perioperatorio dentro del contexto quirúrgico / Cuidados de enfermagem no período perioperatório no contexto cirúrgico

Abstract The study describes basic nursing care during the perioperative. Introduces the origins of perioperative nursing, general care that must be practiced with patient in this context. During the preoperative, care related with risk assessment and preparation of patient from the emotional and physical point of view are important. The trans-operative is related with the anesthesia used, surgical position, preparation of the skin, maintenance of normothermia, among many others. The postoperative depends on the type of anesthesia and surgical procedure, emphasizing on airway permeability, hemodynamic stability, pain, and symptomatology being presented by patients until they are stable and suitable for transfer to another service or their home.

Resumen Se describen los cuidados de enfermería básicos durante el perioperatorio. Se presentan los orígenes de la enfermería perioperatoria, los cuidados generales que se deben tener con el paciente en este contexto. En el preoperatorio es importante los cuidados relacionados con la valoración del riesgo, la preparación del paciente desde el punto de vista emocional y físico. Durante el transoperatorio se relacionan con la anestesia utilizada, la posición quirúrgica, la preparación de la piel, el mantenimiento de la normotermia, entre muchos otros. En el posoperatorio dependen del tipo de anestesia y procedimiento quirúrgico, realizando énfasis en la permeabilidad de la vía aérea, la estabilidad hemodinámica, el dolor, y la sintomatología que va presentando el paciente hasta que este estable y apto para trasladarse a otro servicio o para su casa.

Resumo São descritos os cuidados básicos de enfermagem durante o período perioperatório. São apresentadas as origens da enfermagem perioperatória, bem como os cuidados gerais que devem ser tomados com o paciente nesse contexto. No pré-operatório, são importantes os cuidados relacionados à avaliação de risco e o preparo do paciente do ponto de vista emocional e físico. Durante o transoperatório, estão relacionados à anestesia utilizada, à posição cirúrgica, ao preparo da pele, à manutenção da normotermia, entre muitos outros. No pós-operatório, dependem do tipo de anestesia e procedimento cirúrgico, enfatizando a permeabilidade da via aérea, estabilidade hemodinâmica, dor e os sintomas que o paciente apresenta até que esteja estável e apto a se transferir para outro serviço ou para sua casa.

Research progress on health hazards and occupational protection of prolymethylmethacrylate bone cement in the operating room / 中华劳动卫生职业病杂志

There are many occupational risk factors in operating room work. Polymethyl methacrylate (PMMA) , as a kind of common bone filling and repairing material, is widely used in the fixation of artificial joints, oral braces and orthopedic prosthesis. However, PMMA will release methyl methacrylate (MMA) monomer when it is implanted into human tissues and polymerized to harden, which is toxic to the body. This paper analyzes harmful factors in using PMMA bone cement, and then explores corresponding occupational protection knowledge, in order to reduce the occurrence of occupational hazards related to PMMA bone cement and enhance the self-protection ability of the operation room medical staff.

Evaluation of quality of robot-assisted arthroplasty: a qualitative study from the perspective of medical staff / 中华创伤骨科杂志

Objective:To investigate how medical staff recognize and understand the nursing quality evaluation in robot-assisted arthroplasty so as to provide reference and evidence for construction of a nursing quality evaluation system for robot-assisted arthroplasty.Methods:The descriptive phenomenological research method was used for this qualitative research. From May to October, 2021, 6 doctors and 9 nurses from Operating Room, Laoshan Campus, Hospital Affiliated to Qingdao University were interviewed in a semi-structured way about the nursing quality evaluation for robot-assisted arthroplasty. The data were sorted out by Nvivo12.0 qualitative analysis software, and the interview data were analyzed while the themes and topics refined according to the Colaizzi seven-step analysis of phenomenological data.Results:Three themes were extracted. ① The first theme was related to the quality evaluation of nursing structure, including 2 topics: nursing staff allocation and nursing quality management in operating room. ② The second theme was related to the quality evaluation of nursing process, including 4 topics: environment and facilities, nosocomial infection control, management of patients' operative safety, and specialized operative nursing. ③ The third theme was related to the quality evaluation of nursing outcomes, including 3 topics: satisfaction for operating room nursing, incidence of adverse events and patients' benefits.Conclusion:The themes and topics for nursing quality evaluation in robot-assisted arthroplasty extracted from the perspective of medical staff can provide reference for construction of a reasonable, scientific, efficient and comprehensive nursing quality evaluation index system.

Family supportive supervisor behavior and compassion fatigue of operating room nurses: the chain mediating effect of bidirectional work-family conflict / 中国实用护理杂志

Objective:To explore the relationship between family supportive supervisor behavior and compassion fatigue of operating room nurses and the mediating role of bidirectional work-family conflict, that is, work interference with family and family interference with work.Methods:In November 2021, a total of 350 operating room nurses in Qilu Hospital of Shandong University, the Second Hospital of Shandong University, and the First Affiliated Hospital of Shandong First Medical University were surveyed by convenience sampling method with questionnaires of self-made general information questionnaire, Work-Family Conflict Scale, Family Supportive Supervisor Behavior Short-Form, and Professional Quality of Life Scale.Results:Family supportive supervisor behavior was negatively correlated with work interference with family and compassion fatigue ( r= -0.211, -0.245, both P<0.01). Work interference with family was positively correlated with compassion fatigue and family interference with work ( r=0.383, 0.274, both P<0.01). Family interference with work was positively correlated with compassion fatigue ( r=0.249, P<0.01). There was no correlation between family supportive supervisor behavior and family interference with work ( r=0.040, P>0.05). The structural equation model showed that bidirectional work-family conflict had multiple chain mediating effects between family supportive supervisor behavior and compassion fatigue ( P<0.05), and the mediating effects were -0.082, accounting for 21.6% of the total effect. Conclusions:Family supportive supervisor behavior can directly or indirectly affect compassion fatigue through work-family conflict. Managers can adopt supportive human resource management policies by implementing family supportive supervisor behavior, to help operating room nurses flexibly balance work-family relationships and reduce role conflict, so as to alleviate the compassion fatigue of operating room nurses.

Research progress of surgical smoke / 国际外科学杂志

Surgical smoke is a by-product of aerosol produced by electrosurgical equipment, laser and other energy equipments when cuting tissue or coagulating blood vessels. It contains non-active particles, organic chemicals, pathogens, viable cells and so on. The characteristics of surgical smoke components produced by different types of tissues or using different kinds of energy devices are different. For example, the average diameter of smoke particles produced by electrocautery is smaller, the possibility of viable cells and pathogens in surgical smoke produced by ultrasonic knife is higher. According to the characteristics of its composition, surgical smoke may be an imporant risk factor to the health and safety of operating room staff and patients. The use of surgical masks, suction devices and portable smoke evacuation systems can reduce the risk to some extent. But the most operating room staff don′t take corresponding measures to protect them. In this paper, the characteristics of surgical smoke and the research progress of protective measures will be briefly reviewed.

Fatores que interferem no tempo de intervalo entre cirurgias: estudo observacional / Factors that interfere in the interval time between surgeries: an observational study / Factores que interfieren en el intervalo de tiempo entre cirugías: estudio observacional

RESUMO Objetivo: investigar o tempo de intervalo entre as cirurgias e fatores que podem influenciar esse processo. Método: estudo quantitativo, observacional, transversal, desenvolvido em três centros cirúrgicos de um hospital de grande porte do Sul brasileiro. Coleta em janeiro e fevereiro de 2020, por observação do intervalo entre cirurgias guiadas por roteiro. Análise dos dados por estatística descritiva, correlação e análise fatorial. Resultados: o tempo médio de turnover foi 37 minutos. As variáveis: desmontagem (r=0,540, P<0,001 e r=0,406, P<0,001), limpeza (r=0,584, P<0,001) e montagem (r=0,689, P<0,001) relacionaram-se positiva e moderadamente ao turnover. O intervalo foi maior com pacientes de unidades de internação do que de origem ambulatorial, e após cirurgias de pequeno porte era menor do que médio e grande porte. Conclusão: oportunizam-se reflexões sobre processos do centro cirúrgico. Serão úteis no planejamento, implementação e gestão desse setor.

ABSTRACT Objective: to investigate the interval time between surgeries and factors that can influence this process. Method: a quantitative, observational and cross-sectional study carried out in three surgical centers of a large-sized hospital in southern Brazil. Collection took place in January and February 2020, by observing the interval between script-guided surgeries. Data analysis was performed by means of descriptive statistics, correlation and factor analysis. Results: the mean turnover time was 37 minutes. The disassembly (r=0.540, p<0.001 and r=0.406, p<0.001), cleaning (r=0.584, p<0.001) and assembly (r=0.689, p<0.001) variables were positively and moderately related to turnover. The interval was longer with patients coming from hospitalization units than from outpatient services and, after minor surgeries, the time was shorter than in medium-sized and major surgeries. Conclusion: reflections on surgical center processes are provided. They will be useful in planning, implementing and managing this sector.

RESUMEN Objetivo: investigar el intervalo de tiempo entre las cirugías y los factores que pueden influir en este proceso. Método: estudio cuantitativo, observacional, transversal, realizado en tres centros quirúrgicos de un gran hospital del sur de Brasil. La recolección se realizó en enero y febrero de 2020, mediante la observación del intervalo entre cirugías orientada por una guía. El análisis de datos mediante estadística descriptiva, correlación y análisis factorial. Resultados: el tiempo promedio de turnover fue de 37 minutos. Las variables: desmontaje (r=0,540, P<0,001 y r=0,406, P<0,001), limpieza (r=0,584, P<0,001) y montaje (r=0,689, P<0,001) se relacionaron positiva y moderadamente con el turnover. El intervalo fue mayor con los pacientes de las unidades de hospitalización que con los pacientes ambulatorios, y fue menor después de las cirugías de baja complejidad que de las de mediana y gran complejidad. Conclusión: se aportan reflexiones sobre los procesos del centro quirúrgico. Serán útiles en la planificación, implementación y gestión de este sector.

Predicting nursing leadership roles of patient safety in the operating room / Roles de liderazgo de enfermería que predicen la seguridad del paciente en el quirófano / Papéis de liderança em enfermagem preditores da segurança do doente no bloco operatório

Objective: to identify the leadership perceived by perioperative nurses and to determine the role of leadership predictors of patient safety in the operating room. Method: descriptive and explanatory study in a sample of 1,001 nurses, using the patient safety questionnaire in the operating room and Quinn's leadership instrument adapted to health. The IBM SPSS Statistics application, version 25.0, was used in the data processing. Result: all leadership dimensions were higher than the midpoint of the scale (M>4). A minimum value was observed in the role of Innovator (M=4.63) and maximum in the Producer (M=5.04). The regression models allowed pointing out that leadership roles are predictors of patient safety in the operating room, especially the roles Monitor, Producer and Facilitator. Conclusion: perioperative nurses have moderately positive perception of leadership exercise, indicating the need to promote the development of different leadership roles exercised by perioperative management nurses.

Objetivo: identificar el liderazgo percebido por las enfermeras perioperatorias y determinar el papel de los predictores de liderazgo de la seguridad del paciente en el quirófano. Método: estudio descriptivo y explicativo en una muestra de 1.001 enfermeras, utilizando el cuestionario de seguridad del paciente en el quirófano y el instrumento de liderazgo de Quinn adaptado a la salud. La aplicación IBM SPSS Statistics, versión 25.0, se utilizó en el procesamiento de datos. Resultado: todas las dimensiones de liderazgo fueron superiores al punto medio de la escala (M>4). Se observó un valor mínimo en el rol de Innovador (M=4,63) y máximo en el Productor (M=5,04). Los modelos de regresión permitieron señalar que los roles de liderazgo son predictores de la seguridad del paciente en el quirófano, especialmente los roles Monitor, Productor y Facilitador. Conclusión: las enfermeras perioperatorias tienen una percepción moderadamente positiva del ejercicio de liderazgo, indicando la necesidad de promover el desarrollo de diferentes roles de liderazgo ejercidos por las enfermeras administradoras de quirofano.

Objetivo: identificar a liderança percecionada pelos enfermeiros perioperatórios e determinar os papéis de liderança preditores da segurança do doente no bloco operatório. Método: estudo descritivo e explicativo numa amostra de 1.001 enfermeiros, com recurso ao questionário de segurança do doente no bloco operatório e ao instrumento de liderança de Quinn adaptado à saúde. No tratamento de dados utilizou-se a aplicação IBM SPSS Statistics, versão 25.0. Resultado: todas as dimensões de liderança obtiveram valor superior ao ponto médio da escala (M>4). Observado um valor mínimo no papel de Inovador (M=4,63) e máximo no Produtor (M=5,04). Os modelos de regressão permitiram salientar que os papéis de liderança são preditores da segurança do doente no bloco operatório, destacando-se os papéis Monitor, Produtor e Facilitador. Conclusão: os enfermeiros perioperatórios têm perceção moderadamente positiva do exercício da liderança, indiciando a necessidade de se promover o desenvolvimento dos diferentes papéis de liderança exercidos pelos enfermeiros gestores perioperatórios.

Preparação de um centro cirúrgico do Nordeste do Brasil para cirurgias durante a pandemia da COVID-19 / Preparation of a surgical center in Northeast Brazil for surgeries during the COVID-19 pandemic / Preparación de un centro quirúrgico de Noreste de Brasil para cirugías durante el pandemia de COVID-19

Objetivo: Relatar a experiência da preparação do centro cirúrgico de um hospital universitário brasileiro para o atendimento de cirurgias em pacientes suspeitos e confirmados de COVID-19. Método: Relato da experiência do centro cirúrgico de um hospital universitário do Nordeste do Brasil, em março e abril de 2020, para o atendimento durante a pandemia da COVID-19. Resultados: A implementação do protocolo de atendimento a pacientes suspeitos e confirmados de COVID-19 foi realizada por meio da sua elaboração por um time de profissionais norteados por diretrizes nacionais e internacionais, treinamentos e atualizações. Os ciclos de aprimoramento permitiram que o protocolo fosse aperfeiçoado ao longo dos dois meses relatados. Barreiras e facilitadores para o processo são discutidos e estratégias são elaboradas para adequações possíveis. Conclusão: Houve adequação de protocolos assistenciais relacionados à rotina de fluxo de pacientes e da assistência em sala operatória no intuito de melhor atender os pacientes e reduzir os riscos de contaminação de outros pacientes e profissionais.

Objective: To report the experience of preparing the operating room of a Brazilian university hospital for surgeries for patients suspected and confirmed for COVID-19. Method: Experience report of the operating room of a university hospital in Northeast Brazil, conducted in March and April 2020, for care during the COVID-19 pandemic. Results: The implementation of the care protocol for suspected and confirmed cases of COVID-19 was carried out through its elaboration by a team of professionals based on national and international guidelines, training and updates. Improvement cycles allowed the protocol to be refined over the two months reported. Barriers and facilitators to the process are discussed and strategies are drawn up for possible adjustments. Conclusion: There was an adaptation of care protocols related to the routine of patient flow and care in the operating room to better serve patients and reduce the risk of contamination of other patients and professionals.

Objetivo: Informar la experiencia de la preparación del centro quirúrgico de un hospital universitario brasileño para la atención de cirugías en pacientes sospechosos y confirmados de COVID-19. Método: Informe de la experiencia del centro quirúrgico de un hospital universitario del Noreste del Brasil, en marzo y abril de 2020, para la atención durante la pandemia de COVID-19. Resultados: La implementación del protocolo de la atención a los pacientes sospechosos y confirmados con COVID fue llevada a través de la elaboración por un equipo de profesionales guiados por las directrices nacionales e internacionales, entrenamientos y actualizaciones. Los ciclos de mejora permitieron mejorar el protocolo durante los dos meses informados. Las barreras y los facilitadores para el proceso se discuten, y las estrategias son elaboradas para los ajustes posibles. Conclusión: Se adecuaron protocolos asistenciales relacionados a la rutina del flujo de pacientes y de la asistencia en centro quirúrgico, con la intención de atender mejor a los pacientes y reducir los riesgos de la contaminación de otros pacientes y profesionales.

Damage control surgery for thoracic outlet vascular injuries: the new resuscitative median sternotomy plus REBOA / Cirugía de control de daños para lesiones del opérculo torácico: nuevo abordaje mediante esternotomía mediana y REBOA

Abstract Thoracic vascular trauma is associated with high mortality and is the second most common cause of death in patients with trauma following head injuries. Less than 25% of patients with a thoracic vascular injury arrive alive to the hospital and more than 50% die within the first 24 hours. Thoracic trauma with the involvement of the great vessels is a surgical challenge due to the complex and restricted anatomy of these structures and its association with adjacent organ damage. This article aims to delineate the experience obtained in the surgical management of thoracic vascular injuries via the creation of a practical algorithm that includes basic principles of damage control surgery. We have been able to show that the early application of a resuscitative median sternotomy together with a zone 1 resuscitative endovascular balloon occlusion of the aorta (REBOA) in hemodynamically unstable patients with thoracic outlet vascular injuries improves survival by providing rapid stabilization of central aortic pressure and serving as a bridge to hemorrhage control. Damage control surgery principles should also be implemented when indicated, followed by definitive repair once the correction of the lethal diamond has been achieved. To this end, we have developed a six-step management algorithm that illustrates the surgical care of patients with thoracic outlet vascular injuries according to the American Association of the Surgery of Trauma (AAST) classification.

Resumen El trauma vascular torácico está asociado con una alta mortalidad y es la segunda causa más común de muerte en pacientes con trauma después del trauma craneoencefálico. Se estima que menos del 25% de los pacientes con una lesión vascular torácica alcanzan a llegar con vida para recibir atención hospitalaria y más del 50% fallecen en las primeras 24 horas. El trauma torácico penetrante con compromiso de los grandes vasos es un problema quirúrgico dado a su severidad y la asociación con lesiones a órganos adyacentes. El objetivo de este artículo es presentar la experiencia en el manejo quirúrgico de las lesiones del opérculo torácico con la creación de un algoritmo de manejo quirúrgico en seis pasos prácticos de seguir basados en la clasificación de la AAST. que incluye los principios básicos del control de daños. La esternotomía mediana de resucitación junto con la colocación de un balón de resucitación de oclusión aortica (Resuscitative Endovascular Balloon Occlusion of the Aorta - REBOA) en zona 1 permiten un control primario de la hemorragia y mejoran la sobrevida de los pacientes con trauma del opérculo torácico e inestabilidad hemodinámica.

Hybrid trauma service: on the leading edge of damage Control / Servicio de trauma hibrido: a la vanguardia del control de daños

Abstract Trauma damage control seeks to limit life-threatening bleeding. Sequential diagnostic and therapeutic approaches are the current standard. Hybrid Room have reduced hemostasis time by integrating different specialties and technologies. Hybrid Rooms seek to control bleeding in an operating room equipped with specialized personnel and advanced technology including angiography, tomography, eFAST, radiography, endoscopy, infusers, cell retrievers, REBOA, etc. Trauma Hybrid Service is a concept that describes a vertical work scheme that begins with the activation of Trauma Code when admitting a severely injured patient, initiating a continuous resuscitation process led by the trauma surgeon who guides transfer to imaging, angiography and surgery rooms according to the patient's condition and the need for specific interventions. Hybrid rooms integrate different diagnostic and therapeutic tools in one same room, reducing the attention time and increasing all interventions effectiveness.

Resumen El control de daños en trauma busca limitar el sangrado que amenaza la vida. El enfoque diagnóstico y terapéutico secuenciales son el estándar actual. Las salas híbridas que integran especialidades y tecnologías han reducido el tiempo de hemostasia. Las salas híbridas buscan controlar el sangrado en un quirófano equipado con personal especializado y tecnología de punta como sistemas de angiografía, tomografía, eFAST, radiografía, endoscopia, infusores, recuperadores de células, REBOA, etc. El concepto del servicio hibrido de atención de trauma integra un trabajo vertical que inicia con la activación del código de trauma al admitir un paciente traumatizado grave, iniciando los esfuerzos de reanimación dirigida por el cirujano de trauma que orienta el traslado a salas de imágenes, angiografía y cirugía según la condición del paciente y la necesidad de intervenciones específicas. Las salas hibridas le permite al cirujano de trauma tener todas estas herramientas tanto diagnosticas como terapéuticas al alcance de una sola sala, reduciendo el tiempo de atención y aumentando la efectividad de las intervenciones realizadas.

Clima de seguridad del paciente en cuatro servicios quirúrgicos de Santander / Patient Safety Climate in four Santander surgical units

Resumen Introducción: Conocer la percepción del clima de seguridad al interior de los servicios quirúrgicos es una tarea importante para establecer acciones que reduzcan el riesgo de eventos adversos durante la atención del paciente. Objetivo: Caracterizar el clima de seguridad en los servicios quirúrgicos de cuatro instituciones de salud de Santander. Materiales y métodos: Estudio observacional de corte transversal. Se aplicó el instrumento Hospital Survey on Patient Safety. Los resultados se reportaron como los promedios de repuestas positivas y negativas. Se analizaron las características asociadas a las dimensiones con mayores puntajes de percepción negativa. Resultados: Participaron 164 trabajadores. Las dimensiones con mayor percepción positiva fueron prácticas seguras (84 %), dotación de personal (83,2 %) y aprendizaje organizacional (78,4 %). Las dimensiones con percepción desfavorable fueron respuesta no punitiva al error (40,2 %), carga de trabajo (51,7 %), comunicación (54,3 %) y transiciones y transferencias entre servicios (58,1 %). Se encontró asociación entre una baja percepción en las transiciones y transferencias entre servicios con la contratación por prestación de servicios y con el cargo Médico Especialista y Anestesiólogo. Los bajos puntajes en comunicación se asociaron a la contratación gremial. No se encontraron factores asociados para las dimensiones respuesta no punitiva al error y carga de trabajo. Conclusiones: La percepción sobre clima seguridad en general es considerada positiva, aunque existen oportunidades de mejora. Los factores como tipo de contratación y cargo se asociaron a una percepción negativa de clima de seguridad. Los trabajadores se sienten juzgados al reportar eventos adversos.

Abstract Introduction: Knowing the perception of the safety climate within surgical services has become an important task to establish actions that reduce the risk of suffering adverse events during patient care. Objective: To characterize the safety climate in the surgical services of four health institutions in Santander. Materials and methods: Observational cross-sectional study. The Hospital Survey on Patient Safety instrument was applied. The results were reported as the means of positive and negative responses. The characteristics associated with the dimensions with the highest negative perception scores were analyzed. Results: 164 workers participated. The dimensions with the highest positive perception were safe practices (84 %), staffing (83.2 %) and organizational learning (78.4 %); Dimensions with unfavorable perception were non-punitive response to error (40.2 %), workload (51.7 %), communication (54.3 %) and transitions and transfers between services (58.1 %). Association between a low perception in transitions and transfers between services with contracting for the provision of services and with the position of Specialist (Physician and Anesthesiologist) was found. Low scores in communication were associated with union hiring. No associated factors were found for the non-punitive response to error and workload dimensions. Conclusions In general, the perception of safety climate is considered positive, although there are opportunities for improvement. Factors such as type of hiring and position were more associated with negative perception. Workers feel judged when reporting adverse events.

Avaliação da qualidade do centro cirúrgico na estrutura, processo e resultados / Evaluación de la calidad del centro quirúrgico en relación con la estructura, el proceso y los resultados / Quality assessment of the surgery center regarding structure, process and results

RESUMO Objetivos: avaliar a qualidade dos centros cirúrgicos em hospitais portugueses no que se refere à estrutura, processo e resultado. Método: estudo quantitativo e transversal, realizado entre os meses de janeiro e maio de 2018. A amostra foi constituída por 1.019 profissionais, de 71 hospitais portugueses. Recorreu-se à utilização de três instrumentos distintos para medir a estrutura, o processo e os resultados da qualidade no centro cirúrgico: a Escala Indicadores de Estrutura no Bloco Operatório, a Escala de Processos de Qualidade Assistencial no Bloco Operatório e a Escala para medir os Resultados de Qualidade no Bloco Operatório. Resultados: os fatores "especificidades dos grupos profissionais", "fluxos de comunicação", "controle para a segurança" e "trabalho em equipe" foram considerados de alta qualidade. Conclusão: a avaliação da qualidade do centro cirúrgico nas categorias de estrutura, processo e resultado permite identificar lacunas que podem ser melhoradas e que exigem maior atenção.

RESUMEN: Objetivos: evaluar la calidad de los centros quirúrgicos en hospitales de Portugal en relación con la estructura, el proceso y el resultado. Método: estudio cuantitativo y transversal, realizado entre los meses de enero y mayo de 2018. La muestra estuvo compuesta por 1.019 profesionales de 71 hospitales de Portugal. Se recurrió al uso de tres instrumentos distintos para medir la estructura, el proceso y los resultados de la calidad en el centro quirúrgico, a saber: Escala de Indicadores de Estructura en la Sala Quirúrgica, Escala de Procesos de Calidad Asistencial en la Sala Quirúrgica y Escala para medir los Resultados de Calidad en la la Sala Quirúrgica. Resultados: los factores "especificidades de los grupos profesionales", "flujos de comunicación", "control para la seguridad" y "trabajo en equipo" se consideraron como de alta calidad. Conclusión: la evaluación de la calidad del centro quirúrgico en las categorías de estructura, proceso y resultado permite identificar deficiencias que pueden mejorarse y que exigen mayor atención.

ABSTRACT Objectives: to assess the quality of the surgery centers in Portuguese hospitals regarding structure, process and results. Method: a quantitative and cross-sectional study conducted between January and May 2018. The sample consisted in 1,019 professionals from 71 Portuguese hospitals. Three different instruments were used to assess quality in structure, process and results in the surgery center, namely: the Scale of Structure Indicators in the Operating Room, the Scale of Care Quality Processes in the Operating Room and the Scale to measure the Quality Results in the Operating Room. Results: the "specificities of the professional groups", "communication flows", "control for safety" and "teamwork" factors were considered as of high quality. Conclusion: the quality assessment of the surgery center in the structure, process and results categories allows identifying gaps that can be improved and require greater attention.

Evaluation of different monitoring methods of surface cleanliness in operating rooms / Avaliação dos diferentes métodos de monitoramento de limpeza de superfície em sala operatória / Evaluación de diferentes métodos de monitoreo de limpieza de superficie en sala operatoria

ABSTRACT Objectives: to evaluate different monitoring methods for detecting the presence of organic or biological matter before and after the cleaning and disinfection processes of the operating room. Methods: this is a cross-sectional study based on visual inspection, adenosine triphosphate levels and microbiological culture for the assessment of cleaning and disinfection. Results: 93.3% of the surfaces inspected visually for this study purpose were considered clean, even when high levels of adenosine triphosphate and microbiological analysis detected presence of microorganisms relevant to biofilm formation. Conclusions: the cleaning and disinfection processes reduced the microbial load and organic matter of the inspected surfaces, demonstrated by the values obtained by the adenosine triphosphate bioluminescence assay and microbiological analysis, but the visual inspection as a unique tool to assess the surfaces' cleanliness may give a false impression of clean environment.

RESUMO Objetivos: avaliar diferentes métodos de monitoramento da presença de matéria orgânica ou biológica entre a limpeza e a desinfecção da sala cirúrgica. Métodos: trata-se de um estudo transversal utilizando a inspeção visual, amostras de trifosfato de adenosina e cultura microbiológica como indicadores para avaliação da limpeza e a desinfecção. Resultados: 93,3% das áreas avaliadas visualmente neste estudo apresentavam-se visualmente limpas, mesmo na presença de altos níveis de bioluminescência no resultado de trifosfato de adenosina e análises microbiológicas detectando a presença de microrganismos relevantes para a formação de biofilmes. Conclusões: o processo de limpeza e desinfecção reduziu a carga microbiana e matéria orgânica das superfícies avaliadas, demonstrada pelos resultados obtidos pelo trifosfato de adenosina e avaliação microbiológica, mas a inspeção visual como ferramenta única para avaliar a eficácia da limpeza das superfícies, pode gerar uma falsa impressão de ambiente limpo.

RESUMEN Objetivos: evaluar diferentes métodos de monitoreo de la presencia de materia orgánica o biológica entre la limpieza y desinfección de la sala quirúrgica. Métodos: estudio transversal utilizando la inspección visual, muestras de adenosina trifosfato y cultura microbiológica como indicadores para evaluación de la limpieza y desinfección. Resultados: 93,3% de las áreas evaluadas visualmente en este estudio se presentaban visualmente limpias, mismo en la presencia de altos niveles de bioluminiscencia en el resultado de adenosina trifosfato y análisis microbiológicos detectando la presencia de microorganismos relevantes para la formación de biofilms. Conclusiones: el proceso de limpieza y desinfección redujo la carga microbiana y materia orgánica de las superficies evaluadas, demostrada por los resultados obtenidos por el adenosina trifosfato y evaluación microbiológica, pero la inspección visual como herramienta única para evaluar la eficacia de la limpieza de las superficies, puede generar una falsa impresión de ambiente limpio.

Application of coding navigation index and specialized placement scheme for surgical instruments / 中华医院管理杂志

As the operation volume in hospitals is increasing year by year, surgical instruments are widely used, which pose a great challenge to the daily management of surgical instruments. The authors investigated the existing problems which occurred in the management of surgical instruments, and came out with instruments coding navigation index and specialized placement scheme for the operating room as solutions. The specific measures included dividing sterile items into specialized categories, setting cabinets respectively for specialized and general subjects, building equipment coding and identification, establishing surgical instruments navigation index and carrying out training program, to serve as reference for efficient and fine management of surgical instruments.

Ambiente de prática e a segurança do doente no bloco operatório: dimensões preditoras / Ambiente de trabajo y la seguridad del paciente en el quirófano: dimensiones predictivas / Practice environment and patient safety in the operating room: predictive dimensions

RESUMO Objetivos identificar o ambiente de prática percepcionado pelos enfermeiros perioperatórios e determinar as dimensões do ambiente de prática preditoras da segurança do doente Método estudo descritivo e explicativo, numa amostra de 1.001 enfermeiros de 24 hospitais portugueses (janeiro a outubro de 2018), utilizando o questionário Segurança do Doente no Bloco Operatório e a versão portuguesa do Practice Environment Scale - Work Nursing Index. Recurso à análise descritiva, alfa de Cronbach e método stepwise na análise do modelo de regressão linear Resultados a média global (M=2,49) do ambiente de prática indicia sua classificação como desfavorável. Os modelos de regressão revelam que todas as dimensões do ambiente são preditoras da segurança do doente no bloco operatório, destacando-se a dimensão "Fundamentos de enfermagem para qualidade dos cuidados" Conclusão este estudo permitiu evidenciar a influência do ambiente de prática na segurança do doente no contexto perioperatório e a necessidade de introdução de melhorias

RESUMEN Objetivos identificar el ambiente de trabajo percibido por enfermeras perioperatorias y determinar las dimensiones del ambiente de trabajo que predicen la seguridad del paciente Método estudio descriptivo y explicativo, en una muestra de 1.001 enfermeros de 24 hospitales portugueses (enero a octubre de 2018), utilizando el cuestionario Seguridad del Paciente en el Quirófano y la versión portuguesa de la Escala de Ambiente de Trabajo - Índice de Enfermería Laboral. Utilización de análisis descriptivo, alfa de Cronbach y método paso a paso en el análisis del modelo de regresión lineal Resultados la media global (M = 2,49) del ambiente de trabajo indica su clasificación como desfavorable. Los modelos de regresión revelan que todas las dimensiones del ambiente de trabajo son predictores de la seguridad del paciente en el quirófano, destacando la dimensión "Fundamentos de enfermería para la calidad asistencial" Conclusión este estudio mostró la influencia del ambiente de trabajo en la seguridad del paciente en el contexto perioperatorio y la necesidad de introducir mejoras

ABSTRACT Objectives to identify the practice environment perceived by perioperative nurses and determine the dimensions of the practice environment that predict patient safety Method descriptive and explanatory study, in a sample of 1,001 nurses from 24 Portuguese hospitals (January to October 2018), using the Patient Safety in the Operating Room questionnaire and the Portuguese version of the Practice Environment Scale - Work Nursing Index. Use of descriptive analysis, Cronbach's alpha and stepwise method in the analysis of the linear regression model Results the global average (M=2.49) of the practice environment indicates its classification as unfavorable. Regression models reveal that all dimensions of the environment are predictors of patient safety in the operating room, highlighting the dimension "Nursing fundamentals for quality of care" Conclusion this study highlighted the influence of the practice environment on patient safety in the perioperative context and the need to introduce improvements

Nursing intervention to meet the family members' needs during the surgery waiting time / Intervención de enfermería para satisfacer las necesidades de los familiares durante la espera quirúrgica / Intervenção de enfermagem para satisfazer as necessidades dos familiares durante a espera no centro cirúrgico

Objective: to assess the effect of a care intervention focused on meeting the needs of family members of surgical patients during the surgery waiting time, when compared to conventional care. Method: a study with a quasi-experimental design that was developed from December 2019 to February 2020 and included 313 family members (Intervention Group=149 and Control Group=164) from a private hospital. The intervention consisted in four moments: "knowing the surgical environment and process", "information when the surgery starts", "information when the surgery ends", and "family-patient reunion". The "satisfaction" variable was assessed through the "Patient Satisfaction with Nursing Care Quality Questionnaire" instrument. The data were analyzed using descriptive and analytical statistics. The study observed the ethical principles in research. Results: the family members in the Intervention Group presented greater satisfaction with Nursing care, 90.07(9.8), when compared to the Comparison Group, 78.72(16.38), with an 11.35-point increase(p=0.000). Conclusion: the results showed that the families that received the intervention on the patient's status during the surgery waiting time were more satisfied with Nursing care in comparison to the conventional intervention.

Objetivo: evaluar el efecto de una intervención de cuidado centrada en satisfacer las necesidades de los familiares de pacientes intervenidos quirúrgicamente durante la espera quirúrgica en comparación con el cuidado convencional. Método: diseño cuasi experimental que se desarrolló durante los meses de diciembre de 2019 a febrero de 2020 que incluyó 313 familiares (grupo de intervención = 149 y grupo de control = 164) de un hospital privado. La intervención estuvo compuesta por cuatro momentos: "conocer el ambiente y proceso quirúrgicos", "información sobre el inicio de la cirugía", "información sobre elfin de la cirugía", "reencuentro familia-paciente". La variable de satisfacción se midió a través del instrumento "Cuestionario satisfacción del paciente con la calidad del cuidado de enfermería". Los datos fueron analizados con estadística descriptiva y analítica. El estudio tuvo en cuenta los principios éticos en investigación. Resultados: los familiares del grupo de intervención presentaron una mayor satisfacción con el cuidado de enfermería 90,07 (9,8) comparado con el grupo de comparación 78,72 (16,38), con un aumento de 11,35 puntos (p = 0,000). Conclusión: los resultados demostraron que las familias que recibieron la intervención sobre el estado del paciente durante el tiempo de espera quirúrgico tuvieron una mayor satisfacción con la calidad del cuidado de enfermería en comparación con la intervención convencional.

Objetivo: avaliar o efeito de uma intervenção assistencial voltada para o atendimento das necessidades dos familiares de pacientes operados durante a espera no centro cirúrgico em comparação ao atendimento convencional. Método: estudo quase-experimental desenvolvido entre os meses de dezembro de 2019 e fevereiro de 2020 incluindo 313 familiares (grupo intervenção = 149 e grupo de comparação = 164) de um hospital privado. A intervenção consistiu em quatro momentos: "conhecer o ambiente e o processo cirúrgico", "informações sobre o início da cirurgia", "informações sobre o término da cirurgia", "reunião família-paciente". A variável de satisfação foi medida por meio do instrumento "Questionário de satisfação do paciente com a qualidade dos cuidados de enfermagem". Os dados foram analisados com estatística descritiva e analítica. O estudo levou em consideração os princípios éticos em pesquisa. Resultados: os familiares do grupo intervenção apresentaram maior satisfação com os cuidados de enfermagem 90,07 (9,8) em relação ao grupo de comparação 78,72 (16,38), com aumento de 11,35 pontos (p = 0,000). Conclusão: os resultados demonstraram que as famílias que receberam a intervenção sobre a condição do paciente durante o tempo de espera cirúrgica relataram maior satisfação com a qualidade dos cuidados de enfermagem se comparados à intervenção convencional.