Women in healthcare in Imperial Russia: The contribution of the surgeon Nikolay I Pirogov.

Nikolay Ivanovich Pirogov, one of the greatest Russian surgeons of the 19th Century, was convinced of the importance of deploying nurses to care for the casualties of war. With the support of Grand Duchess Elena Pavlovna, sister-in-law of Tsar Nikolas I, Pirogov realised the idea during the Crimean war when Russia became the first country to send female nurses to the battle front. Later in the 19th century, large numbers of Russian women trained as nurses under the auspices of the Russian Red Cross, founded in 1867. In peacetime, their expertise was extremely valuable.

Influence of latent risk factors on job satisfaction, job stress and intention to leave in anaesthesia teams: a cross-sectional survey.

CONTEXT: Current thinking about patient safety emphasises the causal relationship between working conditions, referred to as latent risk factors (LRFs), and the quality of clinical care. OBJECTIVE: To investigate the extent to which LRFs are related to job satisfaction, job stress and intention to leave for specialist anaesthetists, trainee anaesthetists and nurse anaesthetists. We expected the different members of the anaesthesia team to show differing perceptions of LRFs, and differences in predictive LRFs for well-being. DESIGN: Cross-sectional survey. SETTING: Three university hospitals in the Netherlands. PARTICIPANTS: One hundred and nine specialist anaesthetists, 46 trainee anaesthetists and 115 nurse anaesthetists. OUTCOME MEASURES: LRFs were measured as independent variables. Job satisfaction, job stress and intention to leave were measured as dependent variables. The differences between groups on LRFs, job satisfaction, job stress and intention to leave were analysed using one-way analysis of variance. The contribution of outcomes and LRFs were tested by regression analyses. RESULTS: The overall response rate was 62%. More than 60% of the professionals reported unfavourably on access to information and quality of procedures. Nurse anaesthetists reported more problems for every LRF than specialist anaesthetists and trainee anaesthetists. LRFs accounted for a significant proportion of variance in job satisfaction: 63% in specialist anaesthetists, 55% in trainee anaesthetists and 42% in nurse anaesthetists. LRFs also explained important parts of the variance in intention to leave in specialist anaesthetists (41%) and nurse anaesthetists (21%). LRFs accounted for a significant proportion of variance in stress: 25% in specialist anaesthetists and 22% in nurse anaesthetists. Only working hours was a predictor of stress in trainee anaesthetists (22%). CONCLUSION: LRFs are important correlates of the well-being of anaesthesia staff. Important differences between the different members of the anaesthesia team emerged in the set of LRFs that affect their well-being. These differences should be taken into account both in research and intervention projects.

Patient safety in the operating room: an intervention study on latent risk factors.

BACKGROUND: Patient safety is one of the greatest challenges in healthcare. In the operating room errors are frequent and often consequential. This article describes an approach to a successful implementation of a patient safety program in the operating room, focussing on latent risk factors that influence patient safety. We performed an intervention to improve these latent risk factors (LRFs) and increase awareness of patient safety issues amongst OR staff. METHODS: Latent risk factors were studied using a validated questionnaire applied to the OR staff before and after an intervention. A pre-test/post-test control group design with repeated measures was used to evaluate the effects of the interventions. The staff from one operating room of an university hospital acted as the intervention group. Controls consisted of the staff of the operating room in another university hospital. The outcomes were the changes in LRF scores, perceived incident rate, and changes in incident reports between pre- and post-intervention. RESULTS: Based on pre-test scores and participants' key concerns about organizational factors affecting patient safety in their department the intervention focused on the following LRFs: Material Resources, Training and Staffing Recourses. After the intervention, the intervention operating room - compared to the control operating room - reported significantly fewer problems on Material Resources and Staffing Resources and a significantly lower score on perceived incident rate. The contribution of technical factors to incident causation decreased significantly in the intervention group after the intervention. CONCLUSION: The change of state of latent risk factors can be measured using a patient safety questionnaire aimed at these factors. The change of the relevant risk factors (Material and Staffing resources) concurred with a decrease in perceived and reported incident rates in the relevant categories. We conclude that interventions aimed at unfavourable latent risk factors detected by a questionnaire focussed at these factors may contribute to the improvement of patient safety in the OR.

Redesign of a university hospital preanesthesia evaluation clinic using a queuing theory approach.

BACKGROUND: Changes in patient length of stay (the duration of 1 clinic visit) as a result of the introduction of an electronic patient file system forced an anesthesia department to change its outpatient clinic organization. In this study, we sought to demonstrate how the involvement of essential employees combined with mathematical techniques to support the decision-making process resulted in a successful intervention. METHODS: The setting is the preanesthesia evaluation clinic (PAC) of a university hospital, where patients consult several medical professionals, either by walk-in or appointment. Queuing theory was used to model the initial set-up of the clinic, and later to model possible alternative designs. With the queuing model, possible improvements in efficiency could be investigated. Inputs to the model were patient arrival rates and expected service times with clinic employees, collected from the clinic's logging system and by observation. The performance measures calculated with the model were patient length of stay and employee utilization rate. Supported by the model outcomes, a working group consisting of representatives of all clinic employees decided whether the initial design should be maintained or an intervention was needed. RESULTS: The queuing model predicted that 3 of the proposed alternatives would result in better performance. Key points in the intervention were the rescheduling of appointments and the reallocation of tasks. The intervention resulted in a shortening of the time the anesthesiologist needed to decide upon approving the patient for surgery. Patient arrivals increased sharply over 1 yr by more than 16%; however, patient length of stay at the clinic remained essentially unchanged. If the initial set-up of the clinic would have been maintained, the patient length of stay would have increased dramatically. CONCLUSIONS: Queuing theory provides robust methods to evaluate alternative designs for the organization of PACs. In this article, we show that queuing modeling is an adequate approach for redesigning processes in PACs.

A comparison of US, UK, and Dutch perioperative staffing practices.

American nurses developed the profession of the perioperative RN. Lasting personnel shortages led to the creation of the position of surgical technologist, however, and the necessity of having an RN in the OR has been under scrutiny in the United States and United Kingdom. The Netherlands had a different historical development of perioperative professions, resulting in ORs largely staffed by technicians. The differences in staffing practices have consequences not only for functionality but also for perioperative staff members job satisfaction. An examination of the historical differences in staffing may support the hypothesis that both disciplines may be needed for the OR to function most effectively.