Cancellation on the Day of Surgery in Srinagarind Hospital

Background: Preoperative preparation for elective surgery is time and resource-consuming processes for patients, their families as well as hospital personnel.  Cancellations do have emotional and economic impact.  Knowing the rater and causes is useful for improving hospital service.Objectives: To determine the rate and rationales for cancellation of elective surgery Study design: Prospective Descriptive StudySetting : Srinagarind Hospital, Faculty of Medicine, Khon Kaen UniversitySubjects: Elective surgical patients whom were schedule from September 1, 1999 to January 31, 2000.Main outcome measures: The total number of patients scheduled for  elective surgery as well as the number of cancellation cases was daily recorded.  The reasons for cancellation were explored by interviewing surgeons, anesthesiologists and scrub nurses who were responsible within the same day of cancellation.  The reasons were divided into 3 groups according to the main factors; group 1: doctor’s factor, group 2: patient’s factor and group 3: hospital service’s factor.Results: There were 4, 121 patients scheduled for elective surgery during the study period.  Four hundred and nine cases were cancelled which resulted in 9.9% (95% CI: 9.0%-10.9%) cancellation rate.  Most of the cases were from department of surgery.  The main reasons for cancellation were from doctor 57.4%, from patients 40.1% and from hospital service 2.4%.  Overscheduled cases for surgery in a limited time was the most common reason found in the doctor group while, in the patient group, the reason were associated medical problems which were unsuitable for anesthesia and surgery.Conclusion: The study shows that Srinagarind hospital has 9.9% cancellation rate.  In order to decrease emotional and economic impact for patients and their families as well as to maximize resource utilization, appropriate strategies should be developed to prevent unnecessary 

Incidence of Positive Culture form Catheter Tip after Endotracheal Tube Suctioning Uning Disposable VS. Sterilized Reusable Gloves

Background : The Center for Disease Control Infection of Sringarind Hospital recommended using sterile reusable gloves during tracheal suction to reduce the incidence of infection; however, this method is expensive and requires several steps to make the gloves reusable.Objective : To assess the incidence of positive culture from a catheter tip after endotracheal tube suctioning using disposable gloves (aseptic by not touching the end 6 inches of the catheter tip) vs.  sterile reusable gloves.Study design : Prospective, randomized, double-blind, controlled trial.Method : We included 1}502 patients undergoing general anesthesia with an endotracheal tube.  The patients wetre computer-randomized to two groups : Group 1 was the control performed with sterile gloves; whereas Group 2 was performed with disposable gloves and an aseptic technique.  Tracheal suctioning was performed before extubation.  The catheter tip was removed (using an aseptic technique) and sent for culturing.Results : There was a significantly (P

Evaluation of an ACLS training program for nurse anesthetist aims at role and satisfaction

Background : Anesthesiology patients have a high risk of cardiac arrest and staff must be prepared for CPR.  CPR must be performed quickly and correctly to benefit patients.  Not only do nurses anesthetists need adequate skills and knowledge of CPR but also need an understanding of and satisfaction with their work.   Objective : Compare knowledge with responsibility of CPR before and after an educational campaign among nurses anesthetists.Sample : 27 nurses anesthetists working in OR at Srinagarind Hospital, Khon Kaen.Methods : Descriptive study which assessed nurses anesthetists knowledge and responsibilities before, immediately and three months after training.  Following training nurses were given assigned roles and responsibilities, narrated documents, a video and practical experience before being retested after three months. Results : The study revealed there was a difference in satisfaction levels before and after training.  Satisfaction was divided into six parts. Participation in Hospital Accreditation was a difference in satisfaction levels before and after training. In peer support, personal CPR skills, and practice of CPR, study of practical hindrances and roles and responsibilities, satisfaction over the other five sections did not change over the testing period.Conclusions : Nurses anesthetists must have more information and knowledge about their roles and responsibilities regarding CPR.  Knowledge from the training when coupled with practical experience can last for at least three months.  Keyword : cardiopulmonary resuscitation, role, satisfaction, nurse anesthetist

Surveillance of the Incidence of Urinary Retention following the use of Single Dose Spinal or Epidural Anesthesia in Srinagarind Hospital

Background: Urinary retention is a common postoperative complication associated with multifactorial risk factors such as types of anesthesia, surgery, analgesics, anticholinergics, and underlying medical conditions.Objective: The goal of this study was to surveillance of the incidence of urinary retention following the single use of spinal and epidural anesthesia in Srinagarind Hospital.Methods: A retrospective study was performed by reviewing the medical records of 1,538 surgical patients undergoing spinal or epidural anesthesia from January 1, 2005 to December 31, 2006. We defined urinary retention as occurring when intermittent urinary catheterization was performed after surgery within 24 hours. We collected variables including age, gender, type of surgery and anesthesia. Descriptive analysis was used to determine the incidence and associated risk factors.Results: The overall incidence of urinary retention after the single use of spinal and epidural anesthesia were 11.2% (95%CI, 9.7-12.9). The study showed a positive correlation between male patients with ascending age. The incidence of urinary retention after spinal anesthesia was 9.9% (95%CI 8.4-11.6). Increasing age (odds-ratio [OR] is 1.7; p-value is 0.002) was found to be the only factors significantly associated with postoperative urinary retention. Gender, type of surgery and choice of anesthesia were not found to be significantly associated with urinary retention.Conclusion: In our patient population, male patients and increasing age are at increased risk of developing urinary retention following single dose spinal or epidural anesthesia. Key words: urinary retention, incidence, spinal and epidural anesthesia,