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1.
World J Surg ; 46(12): 2939-2945, 2022 Dec.
Article in English | MEDLINE | ID: covidwho-2148742

ABSTRACT

BACKGROUND: Efficient resource management in the operating room (OR) contributes significantly to healthcare expenditure and revenue generation for health systems. We aim to assess the influence that surgeon, anesthesiology, and nursing team assignments and time of day have on turnover time (TOT) in the OR. METHODS: We performed a retrospective review of elective cases at a single academic hospital that were completed between Monday and Friday between the hours of 0700 and 2359 from July 1, 2017, through March 31, 2018. Emergent cases and unplanned, add-on cases were excluded. Data regarding patient characteristics, OR teams, TOT, and procedure start and end times were collected and analyzed. RESULTS: A total of 2174 total cases across 13 different specialties were included in our study. A multivariate regression of relevant variables affecting TOT was performed. Consecutive specialty (p < 0.0001), consecutive surgeon (p < 0.0001), anesthesiologist (p < 0.0001), and prior case ending before 1400 (p < 0.0001) were independent predictors of lower TOT. A receiver operating characteristic analysis demonstrated an area under the curve of 0.848 and a cutoff of 1400 having the highest sensitivity and specificity for TOT difference. CONCLUSIONS: TOT can be significantly affected by the time of the day the procedure is performed. Staffing availability during late procedures and the differences in how OR team staff are scheduled may affect OR efficiency. Additional studies may be needed to determine the long-term implications of changes implemented to decrease organizational operational costs related to the OR.


Subject(s)
Anesthesiology , Surgeons , Humans , Operating Rooms , Elective Surgical Procedures , Anesthesiologists , Efficiency, Organizational , Operative Time
2.
AORN J ; 113(3): P5-P8, 2021 03.
Article in English | MEDLINE | ID: covidwho-2157685
4.
PLoS One ; 17(10): e0276420, 2022.
Article in English | MEDLINE | ID: covidwho-2079767

ABSTRACT

This study aimed to describe how video laryngoscopy is used outside the operating room within the hospital setting. Specifically, we aimed to summarise the evidence for the use of video laryngoscopy outside the operating room, and detail how it appears in current clinical practice guidelines. A literature search was conducted across two databases (MEDLINE and Embase), and all articles underwent screening for relevance to our aims and pre-determined exclusion criteria. Our results include 14 clinical practice guidelines, 12 interventional studies, 38 observational studies. Our results show that video laryngoscopy is likely to improve glottic view and decrease the incidence of oesophageal intubations; however, it remains unclear as to how this contributes to first-pass success, overall intubation success and clinical outcomes such as mortality outside the operating room. Furthermore, our results indicate that the appearance of video laryngoscopy in clinical practice guidelines has increased in recent years, and particularly through the COVID-19 pandemic. Current COVID-19 airway management guidelines unanimously introduce video laryngoscopy as a first-line (rather than rescue) device.


Subject(s)
COVID-19 , Laryngoscopes , Humans , Laryngoscopy/methods , Operating Rooms , Intubation, Intratracheal/methods , Pandemics , COVID-19/epidemiology , COVID-19/prevention & control , Video Recording
5.
Can J Surg ; 65(5): E675-E682, 2022.
Article in English | MEDLINE | ID: covidwho-2065167

ABSTRACT

BACKGROUND: Studies have estimated that a large backlog of procedures was generated by emergency measures implemented in Ontario, Canada, at the onset of the COVID-19 pandemic, when nonessential and scheduled procedures were postponed. Understanding the impact of the COVID-19 pandemic on the time needed to perform a procedure may help to determine the resources needed to tackle the substantial backlog caused by the deferral of cases. The purpose of this study was to examine the duration of operating room (OR) procedures before and after the onset of the COVID-19 pandemic to inform planning around changes in required resources. METHODS: A population-based, retrospective cohort study was conducted using Ontario Health Insurance Plan claims data and other administrative health care data from Apr. 1, 2019, to Sept. 30, 2020. Statistical analysis was conducted using multivariate regression, with procedure duration as the outcome variable. RESULTS: Results showed that the average duration of nonelective procedures increased by 34 minutes during the COVID-19 period and by 19 minutes after the resumption of scheduled procedures. Controlling for physician, patient and hospital characteristics, and the procedure code submitted, procedure duration increased by 12 minutes in the nonelective COVID-19 period and by 5 minutes when scheduled procedures resumed, compared with the pre-COVID-19 period. CONCLUSION: Procedures may take longer in the COVID-19 period. This will affect wait times, which had already increased because of the deferral of procedures at the beginning of the pandemic, and will have an impact on Ontario's ability to provide patients with timely care.


Subject(s)
COVID-19 , COVID-19/epidemiology , Humans , Ontario/epidemiology , Operating Rooms , Pandemics/prevention & control , Retrospective Studies
7.
Simul Healthc ; 17(1): 66-67, 2022 Feb 01.
Article in English | MEDLINE | ID: covidwho-2042677

ABSTRACT

SUMMARY STATEMENT: Simulation resources offer an opportunity to highlight aerosol dispersion within the operating room environment. We demonstrate our methodology with a supporting video that can offer operating room teams support in their practical understanding of aerosol exposure and the importance of personal protective equipment.


Subject(s)
Operating Rooms , Personal Protective Equipment , Aerosols , Health Personnel , Humans
8.
J Korean Med Sci ; 37(36): e273, 2022 Sep 19.
Article in English | MEDLINE | ID: covidwho-2039654

ABSTRACT

Amid the coronavirus disease 2019 era, concern about the safety of surgical teams related to surgical smoke (SS) is rising. As simple ventilation improvement methods (SVIMs), we replaced 4 of the 8 supply diffusers with a direction-adjustable louver-type, closed 2 of the 4 exhaust grills, and strengthened the sealing of the doorway. Dynamic changes in the concentration of particulate matter (PM) with sizes of < 1.0 µm (PM1.0) were measured using low-cost PM meters (LCPMs) at eight locations in the operating room (OR). SS concentration up to 4 minutes at the location of the surgeon, first assistant, and scrub nurse before and after SVIMs application decreased from 65.4, 38.2, 35.7 µg/m3 to 9.5, 0.1 and 0.7 µg/m3 respectively. A similar decrease was observed in the other 5 locations. SVIMs could effectively control SS and the LCPM was also effective in measuring SS in the OR or other spaces of the hospital.


Subject(s)
COVID-19 , Surgeons , Humans , Operating Rooms , Smoke/adverse effects
9.
Appl Environ Microbiol ; 88(19): e0129722, 2022 Oct 11.
Article in English | MEDLINE | ID: covidwho-2029467

ABSTRACT

After the outbreak of COVID-19, additional protocols have been established to prevent the transmission of the SARS-CoV-2 from the patient to the health personnel and vice versa in health care settings. However, in the case of emergency surgeries, it is not always possible to ensure that the patient is not infected with SARS-CoV-2, assuming a potential source of transmission of the virus to health personnel. This work aimed to evaluate the presence of the SARS-CoV-2 and quantify the viral load in indoor air samples collected inside operating rooms, where emergency and scheduled operations take place. Samples were collected for 3 weeks inside two operating rooms for 24 h at 38 L/min in quartz filters. RNA was extracted from the filters and analyzed using RT-qPCR targeting SARS-CoV-2 genes E, N1 and N2 regions. SARS-CoV-2 RNA was detected in 11.3% of aerosol samples collected in operating rooms, despite with low concentrations (not detected at 13.5 cg/m3 and 10.5 cg/m3 in the scheduled and emergency operating rooms, respectively). Potential sources of airborne SARS-CoV-2 could be aerosolization of the virus during aerosol-generating procedures and in open surgery from patients that might have been recently infected with the virus, despite presenting a negative COVID-19 test. Another source could be related to health care workers unknowingly infected with the virus and exhaling SARS-CoV-2 virions into the air. These results highlight the importance of reinforcing preventive measures against COVID-19 in operating rooms, such as the correct use of protective equipment, screening programs for health care workers, and information campaigns. IMPORTANCE Operating rooms are critical environments in which asepsis must be ensured. The COVID-19 pandemic entailed the implementation of additional preventative measures in health care settings, including operating theaters. Although one of the measures is to operate only COVID-19 free patients, this measure cannot be always implemented, especially in emergency interventions. Therefore, a surveillance campaign was conducted during 3 weeks in two operating rooms to assess the level of SARS-CoV-2 genetic material detected in operating theaters with the aim to assess the risk of COVID-19 transmission during operating procedures. SARS-CoV-2 genetic material was detected in 11% of aerosol samples collected in operating rooms, despite with low concentrations. Plausible SARS-CoV-2 sources have been discussed, including patients and health care personnel infected with the virus. These results highlight the importance of reinforcing preventive measures against COVID-19 in operating rooms, such as the correct use of protective equipment, screening programs for health care workers and information campaigns.


Subject(s)
COVID-19 , SARS-CoV-2 , COVID-19/prevention & control , Genetic Load , Humans , Operating Rooms , Pandemics/prevention & control , Quartz , RNA, Viral/genetics , Respiratory Aerosols and Droplets , SARS-CoV-2/genetics
11.
Anaesthesia ; 77(10): 1097-1105, 2022 10.
Article in English | MEDLINE | ID: covidwho-2008732

ABSTRACT

The ability to measure and track aerosols in the vicinity of patients with suspected or confirmed COVID-19 is highly desirable. At present, there is no way to measure and track, in real time, the sizes, dispersion and dilution/disappearance of aerosols that are generated by airway manipulations such as mask ventilation; tracheal intubation; bronchoscopy; dental and gastro-intestinal endoscopy procedures; or by vigorous breathing, coughing or exercise. We deployed low-cost photoelectric sensors in five operating theatres between surgical cases. We measured and analysed dilution and exfiltration of aerosols we generated to evaluate air handling and dispersion under real-world conditions. These data were used to develop a model of aerosol persistence. We found significant variation between different operating theatres. Equipment placement near air vents affects air flows, impacting aerosol movement and elimination patterns. Despite these impediments, air exchange in operating theatres is robust and prolonged fallow time before theatre turnover may not be necessary. Significant concentrations of aerosols are not seen in adjoining areas outside of the operating theatre. These models and dispersion rates can predict aerosol persistence in operating theatres and other clinical areas and potentially facilitate quantification of risk, with obvious and far-reaching implications for designing, evaluating and confirming air handling in non-medical environments.


Subject(s)
COVID-19 , Cough , Humans , Operating Rooms , Respiratory Aerosols and Droplets , Ventilation
12.
Curr Opin Anaesthesiol ; 35(4): 479-484, 2022 Aug 01.
Article in English | MEDLINE | ID: covidwho-1997083

ABSTRACT

PURPOSE OF REVIEW: As the number and complexity of cases performed in the nonoperating room environment continue to increase to a higher share of all anesthetic procedures, checklists are needed to ensure staff and patient safety. RECENT FINDINGS: Providing anesthesia care in the nonoperating room environment poses specific challenges. Closed claims data base analysis shows a higher morbidity and mortality in this setting. This is driven by the location-related challenges, and critical patients undergoing minimally invasive procedures, as well as a higher percentage of emergency and after-hours procedures. Although adequate case preparation and maintaining the same standard of care as in the main operating room, establishing protocols and checklists for procedures in nonoperating room locations has emerged as a sound strategy in improving care and safety. SUMMARY: Anesthesia in the nonoperating room environment is becoming an increasing share of total anesthesia cases. Establishing protocols and implementing site-specific checklists is emerging as a strategy in improving care in the environment of nonoperating room. VIDEO ABSTRACT: http://links.lww.com/COAN/A89 .


Subject(s)
Anesthesia , Anesthesiology , Anesthetics , Anesthesia/methods , Checklist , Humans , Operating Rooms
13.
J Hosp Infect ; 115: 64-70, 2021 Sep.
Article in English | MEDLINE | ID: covidwho-1271691

ABSTRACT

BACKGROUND: It is difficult to make a lace-up surgical mask fit tightly to the face with conventional wearing methods because of the strings' poor tension, resulting in some air flowing through the gap. We introduced two feasible new wearing methods and obtained satisfactory experimental results. METHODS: The wearing of surgical masks by staff was investigated through observation and interview in operation rooms. The required time to don, close-fitting rates, and satisfaction of the conventional method and the two new recommended methods were counted and compared, according to the subjects' experience. The differences between the three wearing methods on the microbial contamination of the sterile area were explored in a mock operation. RESULTS: In the subjects' experience, the close-fitting rates were 47.0%, 92.0% and 100.0% in the conventional, Three Knots, and Elastic Band groups, respectively (P<0.001); the satisfaction scores evaluated by numerical rating scale from 0 to 10 were 5.06 ± 2.22, 6.89 ± 1.86 and 7.10 ± 1.72, respectively (P<0.001); the required times were 14.32 ± 2.20, 25.76 ± 5.13 and 27.37 ± 5.11 s, respectively (P<0.001). In the mock operation, there were significant differences between the conventional and Three Knots groups (37.5 (13) vs 18 (8) cfu, P<0.001), as well as between the conventional and Elastic Band groups (37.5 (13) vs 17(10) cfu, P<0.001). CONCLUSIONS: The recommended new wearing methods had the advantages of closer fit, higher satisfaction rates, were more comfortable, and resulted in lower contamination of the sterile area; however, the recommended two methods required more time.


Subject(s)
Masks , Operating Rooms , Humans
14.
Anesth Analg ; 131(6): e258-e259, 2020 12.
Article in English | MEDLINE | ID: covidwho-1383716
16.
J Pediatr Urol ; 18(4): 411.e1-411.e7, 2022 Aug.
Article in English | MEDLINE | ID: covidwho-1936864

ABSTRACT

INTRODUCTION: COVID-19 pandemic required that health systems made great efforts to mitigate the impact of high demands of patients requiring treatment. Triaging surgical cases reduced operating room capacity. Immunizations, massive testing, and personal protective equipment enabled re-activation of operating rooms. Delayed and newly added cases has placed stress on the system. We hypothesize that standardization in practice for tasks performed between anesthesia ready and surgery start time, also known as "prepping time", can reduce operative time, improve efficiency and increase capacity. The aim of our project was to create and implement a best practice standardized prepping protocol, to explore its impact on operating room capacity. METHODS: Once local policies allowed re-opening of the operating rooms, our multidisciplinary group developed a working plan following Adaptive Clinical Management (ACM) principles to optimize surgical prepping time. Using electronic medical record (EMR) data, surgeons with the lowest surgical prepping times were identified (positive deviants). Their surgical prepping time workflows were reviewed. A clinical standard work (CSW) protocol was created by the team leader. New CSW protocol was defined and implemented by the leader and then by the rest of the surgeons. Baseline data was automatically extracted from EMR and analyzed by statistical process control (SPC) charts using AdaptX. Balancing measures included "last case end time" and rates of surgical site infections. RESULTS: A total of 2506 patients were included for analysis with 1333 prior to intervention and 1173 after. Team leader implementated the new CSW prepping protocol showing a special cause variation with an average time improvement from 14.6 min to 11.6 min and for all surgeons from 13.8 to 12.0 min. Total cases per month increased from 70 to 90 cases per month. Baseline 'Last Case End Time' was 15.7 min later than the scheduled. New CSW improve end time with an average of 20.8 min before the schedule. Baseline surgical site infection was 0.1% for the study population. No difference was seen after implementation. DISCUSSION: Variations in performance can be quantified using funnel plots showing individual practices allowing best practice to be identified, tested and scaled. Implementation of our surgical prepping time protocol showed a sustainable increase in efficiency without affecting quality, safety or workload. This additional increase is estimated to represent approximately $2-2.5M additional revenue per year. CONCLUSION: Adaptive clinical management is a practical solution to increase OR capacity by improving efficiency to reduce extra burden presented during COVID19 pandemic.


Subject(s)
COVID-19 , Operating Rooms , Humans , Pandemics/prevention & control , Efficiency, Organizational , Operative Time
17.
Urology ; 167: 109-114, 2022 Sep.
Article in English | MEDLINE | ID: covidwho-1907847

ABSTRACT

OBJECTIVE: To understand how the lack of a physical examination during new patient video visits can impact urological surgery planning during the COVID-19 pandemic. METHODS: We retrospectively reviewed 590 consecutive urology patients who underwent new patient video visits from March through May 2020 at a single academic center. Our primary outcome was procedural plan concordance, the proportion of video visit surgical plans that remained the same after the patient was seen in-person, either in clinic or on day of surgery. Median days between video and in-person visits were compared between concordant and discordant cases using the Mann-Whitney U test; P < .05 was significant. RESULTS: Overall, 195 (33%) were evaluated by new patient video visits and had a procedure scheduled, of which, 186 (95%) had concordant plans after in-person evaluation. Further, 99% of plans for in-office procedures and 91% for operating room procedures were unchanged. Four patients (2.1%) had surgical plans altered after changes in clinical course, two (1%) due to additional imaging, and three (1.5%) based on genitourinary examination findings. Days between video visit and in-person evaluation did not differ significantly in concordant cases (median 37.5 [IQR, 16 - 80.5]) as compared to discordant cases (median 58.0 [IQR, 20 - 224]; P = .12). CONCLUSIONS: Most surgical plans developed during new patient video visits remain unchanged after in-person examination. However, changes in clinical course or updated imaging can alter operative plans. Likewise, certain urologic conditions (eg, penile cancer) rely on the genitourinary examination to dictate surgical approach.


Subject(s)
COVID-19 , Telemedicine , COVID-19/epidemiology , COVID-19/prevention & control , Humans , Operating Rooms , Pandemics/prevention & control , Physical Examination , Retrospective Studies
18.
Sante Publique ; Vol. 33(6): 959-970, 2022 Mar 11.
Article in French | MEDLINE | ID: covidwho-1903561

ABSTRACT

Since early 2020, the onset of the COVID-19 pandemic, physicians have continued to report adverse events associated with care. Patients also continued to participate in the hospital satisfaction surveys. To date, no study in France has measured the impact of the pandemic on adverse events and patient satisfaction. We looked at the characteristics of these adverse events in relation to the pandemic and put patients' feelings into perspective. A qualitative and observational retrospective study of the REX and MCO48 databases was carried out. The quantitative study of the REX database was supplemented by a qualitative analysis of the declarations. The adverse events more often affects middle-aged men aged 60 years, while deaths occur in older patients with more complex pathologies and more urgent management. The nature of these events is different depending on the reporting period: Those reported in the first wave are more urgent, occur less frequently in the operating room than in the emergency room, and are considered less preventable than those reported in the second wave. The latter are more similar to the events that usually occur. The implementation of effective barriers, particularly within the teams, has made it possible to reduce the impact of the second wave on the occurrence of these events, the role of communication seems essential. The overall patient satisfaction score as well as those for medical and paramedical care has increased, which may reflect patient solidarity with caregivers. The attitude of active resilience on the part of all actors has been a major element in risk management during this crisis and it is essential to capitalize on these collaborative processes for the future.


Subject(s)
COVID-19 , Patient Satisfaction , Aged , COVID-19/epidemiology , COVID-19/psychology , COVID-19/therapy , Emergency Service, Hospital/standards , France/epidemiology , Humans , Male , Middle Aged , Operating Rooms , Pandemics , Retrospective Studies , Risk Management
19.
Can J Surg ; 65(3): E382-E387, 2022.
Article in English | MEDLINE | ID: covidwho-1902661

ABSTRACT

BACKGROUND: Day-of surgery cancellation (DOSC) is considered to be a very inefficient use of hospital resources and results in emotional stress for the patient. To examine opportunities to minimize the incidence of preventable cancellations - an indicator of quality of care - we assessed the incidence of and reasons for DOSCs over 3 months among inpatients and outpatients at a trauma orthopedic service. METHODS: This was a prospective study of 2 cohorts of patients, inpatients and outpatients, scheduled for emergent orthopedic surgery at a Canadian tertiary level 1 trauma centre from Jan. 1 to Mar. 31, 2020. Patient demographic characteristics, injury characteristics, delays until surgery and reasons for DOSCs were recorded. RESULTS: A total of 185 patients (100 males and 85 females with a mean age of 54 yr) were included in the study. There were 98 outpatients and 87 inpatients. Seventy-five (40%) of the scheduled procedures in the outpatient group and 34 (30%) of those in the inpatient group were cancelled. In both groups, more than 85% of the cancellations were because of prioritization of a more urgent orthopedic or nonorthopedic surgical case. The average operative delay for the outpatient group was 11.4 days, compared to 3.8 days for the inpatient group (p < 0.001). CONCLUSION: High DOSC rates were observed among both outpatients and inpatients. The main reason for delaying surgery was prioritization of a more urgent surgical case. Providing the orthopedic trauma service with a dedicated OR opened 6 days per week, along with extended hours of OR services to 1700 daily, might be effective at minimizing DOSCs.


Subject(s)
Appointments and Schedules , Orthopedic Procedures , Canada , Female , Humans , Male , Middle Aged , Operating Rooms , Prospective Studies , Trauma Centers
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