MP48-10 SURGICAL INTRAOPERATIVE HANDOFF INITIATIVE: STANDARDIZING OPERATING ROOM COMMUNICATION USING A VISUAL COGNITIVE AID

BackgroundLow Back Pain (LBP) is the commonest musculoskeletal disorder and an important occupational hazard among healthcare workers (HCWs) that peaks among Operating Room (OR) staff. This cross-sectional study aimed to assess the prevalence, characteristics, and risk factors of low back pain among operating room (OR) staff in a tertiary healthcare center in Makkah, Saudi Arabia.MethodsA 39-item self-administered questionnaire was distributed to all available OR staff. Data about personal, sociodemographic, general risk factors OR specific risky activities, and LBP characteristics were obtained. Descriptive, crosstabs, and univariate and multivariate logistic regression tests were employed.ResultsOut of the 143 distributed questionnaires, 84 % were received. LBP prevalence was 74.2 %. No statistically significant associations were detected between LBP and any of the general risk factors (p >0.05). However, most of the OR risky activities were significantly associated with the occurrence of LBP (p <0.05) e.g. lifting objects above the waist, rotating torso while bearing weight, transferring patients onto bed or chair, pulling a patient up the bed, and repositioning a patient in bed. These significant associations were preserved after adjustment for gender, perceived stress at work, educational level, and receiving education about LBP. Rest and analgesics were reported to be the most common relievers.ConclusionsLBP is a common health issue among KAMC OR staff. OR risky activities were found to contribute to this problem. We suggest designing educational interventional programs to teach OR staff the best way to prevent this problem.

MP02-11 A SURVEY OF SURGICAL STAFF’S KNOWLEDGE, ATTITUDES, AND BARRIERS TO REDUCING OPERATING ROOM WASTE

Operating Room (OR) scheduling is crucial to allow efficient use of ORs. Currently, the predicted durations of surgical procedures are unreliable and the OR schedulers have to follow the progress of the procedures in order to update the daily planning accordingly. The OR schedulers often acquire the needed information through verbal communication with the OR staff, which causes undesired interruptions of the surgical process. The aim of this study was to develop a system that predicts in real-time the remaining procedure duration and to test this prediction system for reliability and usability in an OR. The prediction system was based on the activation pattern of one single piece of equipment, the electrosurgical device. The prediction system was tested during 21 laparoscopic cholecystectomies, in which the activation of the electrosurgical device was recorded and processed in real-time using pattern recognition methods. The remaining surgical procedure duration was estimated and the optimal timing to prepare the next patient for surgery was communicated to the OR staff. The mean absolute error was smaller for the prediction system (14 min) than for the OR staff (19 min). The OR staff doubted whether the prediction system could take all relevant factors into account but were positive about its potential to shorten waiting times for patients. The prediction system is a promising tool to automatically and objectively predict the remaining procedure duration, and thereby achieve optimal OR scheduling and streamline the patient flow from the nursing department to the OR.

MP68-19 USE OF THE OR BLACK BOX® TO EVALUATE OPERATING ROOM ECONOMIC EFFICIENCY

Operating room (OR) efficiency requires coordinated teamwork between the staff surgeon, anesthesia team, circulating nurse, surgical technician, and surgical trainee or assistant. Bariatric cases present unique challenges including difficult airways, challenging intravenous access, use of specialized surgical equipment, and synchronized exchange of orogastric tubes. The high contribution margin of these complex bariatric procedures rests on OR efficiency. To compare the efficiency of bariatric surgeries performed by a single surgeon at a tertiary academic medical center with its inherent variability of OR staff to that of a private hospital with a standardized surgical team. All laparoscopic Roux-en-Y gastric bypasses (LRYGB) performed by a single surgeon at University Hospitals Cleveland Medical Center (UHCMC) and a Community Affiliate (CA) from 2013 to 2015 were retrospectively reviewed.Patient demographics and preoperative comorbidities were compared. The variability of OR staff at each site was described. Four primary endpoints of the different OR phases were measured at the 2 locations and analyzed using standard statistical methods. The OR data of 74 cases of LRYGB at UHCMC and 106 cases at the CA were analyzed. Patient cohorts were comparable by age (45 ± 12 vs. 45 ± 10; p = 0.88), sex (82% vs. 79% female; p = 0.62), BMI (47.16 ± 7.33 vs. 45.91 ± 6.85; p = 0.25), and comorbidities.At CA, the teams who participated in LRYGB cases were fairly constant (8 circulating and scrub nurses, 4 anesthetists, 3 anesthesiologists), whereas at UHCMC there was great variability in the number of staff with 108 staff (39 circulating nurses, 57 scrub nurses/technicians, 59 anesthetists or anesthesia residents, 24 anesthesiologists) participated in LRYGB cases. There was no statistical difference between the total mean OR time and surgical time of the cases performed at the 2 sites (203 ± 59min vs. 188 ± 39min; p = 0.06; 152 ± 56min; 145 ± 37min; p = 0.36). However, the pre- and post-case times were longer at UHCMC compared to the CA (38 ± 9min vs. 33 ± 6min; p < 0.0001; 13 ± 6min vs. 10 ± 3min; p = 0.01). The academic center has much greater variability in staff for these complex bariatric procedures. There was a trend toward longer OR times at the tertiary center as demonstrated by the difference in pre- and post-case times, but the consistent surgeon and assistant allowed for consistent surgical case time regardless of the setting. The implication of variability in OR staff can be overcome by the surgeon directing the procedure itself. The opportunity for improving the efficiency of bariatric surgery should focus on the perioperative care of the patient in OR that requires everyone to be familiar with the procedure.

IntroductionInappropriate staff behaviours can lead to environmental contamination in the operating room (OR) and subsequent surgical site infection (SSI). This study will focus on the continued assessment of OR staff...

Surgeon and operating room (OR) staff radiation exposure during spinal surgery is a concern, especially with the increasing use of multiplanar fluoroscopy in minimally invasive spinal surgery procedures. Cone beam computed tomography (cbCT)-based, 3D image guidance does not involve the use of active fluoroscopy during instrumentation placement and therefore decreases radiation exposure for the surgeon and OR staff during spinal fusion procedures. However, the radiation scatter of a cbCT device can be similar to that of a standard 64-slice CT scanner and thus could expose the surgeon and OR staff to radiation during image acquisition. The purpose of the present study was to measure radiation exposure at several unshielded locations in the OR when using cbCT in conjunction with 3D image-guided spinal surgery in 25 spinal surgery cases. Five unshielded badge dosimeters were placed at set locations in the OR during 25 spinal surgery cases in which cbCT-based, 3D image guidance was used. The cbCT device (O-ARM) was used in conjunction with the Stealth S7 image-guided platform. The radiology department analyzed the badge dosimeters after completion of the last case. Fifty high-definition O-ARM spins were performed in 25 patients for spinal registration and to check instrumentation placement. Image-guided placement of 124 screws from C-2 to the ileum was accomplished without complication. Badge dosimetry analysis revealed minimal radiation exposure for the badges 6 feet from the gantry in the area of the anesthesiology equipment, as well as for the badges located 10-13 feet from the gantry on each side of the room (mean 0.7-3.6 mrem/spin). The greatest radiation exposure occurred on the badge attached to the OR table within the gantry (mean 176.9 mrem/spin), as well as on the control panel adjacent to the gantry (mean 128.0 mrem/spin). Radiation scatter from the O-ARM was minimal at various distances outside of and not adjacent to the gantry. Although the average radiation exposure at these locations was low, an earlier study, undertaken in a similar fashion, revealed no radiation exposure when the surgeon stood behind a lead shield. This simple precaution can eliminate the small amount of radiation exposure to OR staff in cases in which the O-ARM is used.

BackgroundClinical work in the operating room (OR) is considered challenging as it is complex, dynamic, and often time- and resource-constrained. Important characteristics for successful management of complexity include adaptations and adaptive coordination when managing expected and unexpected events. However, there is a lack of explorative research addressing what makes things go well and how OR staff describe they do when responding to challenges and compensating for constraints. The aim of this study was therefore to explore how complexity is managed as expressed by operating room nurses, registered nurse anesthetists, and surgeons, and how these professionals adapt to create safe care in the OR.MethodData for this qualitative explorative study were collected via group interviews with three professional groups of the OR-team, including operating room nurses, registered nurse anesthetists and operating and assisting surgeons in four group interview sessions, one for each profession except for ORNs for which two separate interviews were performed. The audio-taped transcripts were transcribed verbatim and analyzed by inductive qualitative content analysis.ResultsThe findings revealed three generic categories covering ways of creating safe care in the OR: preconditions and resources, planning and preparing for the expected and unexpected, and adapting to the unexpected. In each generic category, one sub-category emerged that was common to all three professions: coordinating and reaffirming information, creating a plan for the patient and undergoing mental preparation, and prioritizing and solving upcoming problems, respectively.ConclusionCreating safe care in the OR should be understood as a process of planning and preparing in order to manage challenging and complex work processes. OR staff need preconditions and resources such as having experience and coordinating and reaffirming information, to make sense of different situations. This requires a mental model, which is created through planning and preparing in different ways. Some situations are repetitive and easier to plan for but planning for the unexpected requires anticipation from experience. The main results strengthen that abilities described in the theory of resilience are used by OR staff as a strategy to manage complexity in the OR.

Fire in Labor and Delivery: Simulation Case Scenario

Objective:To model the volume of water used and wasted during wet scrubs at operating room (OR) scrub sinks and identify factors for reducing water waste.Background:Wasteful consumption of water by US health care systems has not been well characterized.Methods:This is a 2-component observational study. The first was an observational study of handwashing practices and water usage at scrub sinks in the OR at a single medical center. The second component was a series of 2 anonymous surveys of surgeons and OR staff to assess hand scrub practices and perspectives. Data from both components were used to estimate the volume of water used and wasted annually at OR scrub sinks.Results:The median total volume of water wasted at OR scrub sinks for 34,554 cases over 1 year is 337,595.6 L (interquartile range 139,010.0;911,210.5). This represents 34.2% of the total volume of water associated with wet scrubs (ie, water used during scrubbing and wasted after the conclusion of the scrub). Other pertinent findings are that attending surgeons and OR staff perform wet scrubs in 25.9% of cases; there are significant differences in scrub type preferences among OR users; the median volume of water wasted in a single wet scrub at timer-controlled sinks is 10 L; and significantly more water is wasted at timer-controlled sinks than knee-operated sinks.Conclusions:OR wet scrubs are a source of enormous water waste. We identified scrub sink characteristics and OR user beliefs and behaviors as modifiable factors for water waste reduction. We encourage all institutions and OR users to carefully examine their facility characteristics and practices to implement plans that will conserve water without compromising patient safety.

<h3>Introduction</h3> Operating room (OR) staff are exposed to surgical smoke on a daily basis. With the increased use of intraoperative smoke-generating devices, this is a significant occupational health hazard. <h3>Methods</h3> A database search was performed for literature on surgical smoke from 1980–2017. <h3>Results</h3> Electro-, laser and ultrasonic surgical techniques produce surgical smoke. 95% of surgical smoke is water and 5% is a combination of chemicals and cellular debris. Up to eighty chemicals, including the carcinogen Benzene, have been identified. The chemical load from cautery of one gram of tissue is comparable to that derived from six cigarettes. HIV and HPV viral DNA have been isolated, and both Staphylococcus and Neisseria cultured from surgical smoke. At less than ten micrometres in diameter, surgical smoke particles can remain airborne and are inhalable; the smallest fractions entering the alveoli. Smoke particles diffuse along concentration gradients within the OR atmosphere exposing all staff, and not just the operator or those scrubbed. Animal studies have demonstrated pulmonary congestion, interstitial pneumonia and emphysema secondary to surgical smoke exposure. Associated symptoms reported by staff include headache, problematic lacrimation and cough – affecting 58%, 42% and 20% of doctors respectively in one survey. An association with cancer has been made through case series. Standard surgical facemasks offer no protection; whilst portable evacuation devices are the best risk reduction measure. No legislation currently exists in the United Kingdom, but many international organisations offer guidance on minimising surgical smoke exposure in the workplace. <h3>Conclusion</h3> OR staff training ad policies should align with the latest guidance so that appropriate risk reduction measures can be put in place to protect health.

Microlaryngoscopy and bronchoscopy procedures (MLBs) are short-duration, high-acuity procedures that carry risk. Poor case flow and communication exacerbate such potential risk. Efficient operative flow is critical for patient safety and resource expenditure. To identify areas for improvement and evaluate the effectiveness of a multidisciplinary quality-improvement (QI) initiative. A QI project using the "Plan-Do-Study-Act" (PDSA) cycle was implemented to assess MLBs performed on pediatric patients in a tertiary academic children's hospital. Forty MLBs were audited using a QI evaluation tool containing 144 fields. Each MLB was evaluated for flow, communication, and timing. Opportunities for improvement were identified. Subsequently, QI interventions were implemented in an iterative cycle, and 66 MLBs were audited after the intervention. Specific QI interventions addressed issues of personnel frequently exiting the operating room (OR) and poor preoperative preparation, identified during QI audit as areas for improvement. Interventions included (1) conducting "huddles" between surgeon and OR staff to discuss needed equipment; (2) implementing improvements to surgeon case ordering and preference cards review; (3) posting an OR door sign to limit traffic during airway procedures; and (4) discouraging personnel breaks during airway procedures. Operating room exiting behavior of OR personnel, preoperative preparation, and case timing were assessed and compared before and after the QI intervention. Personnel exiting the OR during the MLB was identified as a preintervention issue, with the surgical technologist, circulator, or surgeon exiting the room in 55% of cases (n = 22). The surgical technologist and circulator left the room to retrieve equipment in 40% of cases (n = 16), which indicated the need for increased preoperative preparation to improve case timing and operative flow. The QI interventions implemented to address these concerns included education regarding break timing, improvements in communication, and improvements in ordering and preparation of equipment. After the QI intervention, the surgical technologist exiting rate decreased from 20% (n = 8) to 8% (n = 5), and the circulator exiting rate decreased from 38% (n = 15) to 27% (n = 17). In addition, the rate of surgeon exiting decreased significantly (from 25% [n = 10 of 40] to 9% [n = 6 of 66]) (P = .03). The surgical technologist and circulating nurse remaining in the room were significantly associated with decreased operating time (1.84-minute decrease for surgical technologist [P = .04] and 1.95-minute decrease for circulating nurse [P = .001]). Gains were made in personnel exiting behavior and case timing after implementation of the QI interventions, potentially leading to decreased risk. This process is easily reproduced and is widely accepted by stakeholders.

BackgroundEnvironmental noise pollution is regarded as a general stressor. Noise levels frequently exceed recommended noise levels by the World Health Organization in hospitals, especially in the operation room. The aim of this systematic review was to assess the effects of noise pollution on patient outcome and performance by operation room staff. In addition, the perception and attitude toward playing music in the operation room, which can increase noise levels, were assessed as well. Materials and methodsA systematic literature search of the databases Embase, Medline Ovid, and Cochrane from date of database inception until October 16th, 2020 using the exhaustive literature search method was performed. Prospective studies evaluating the effect of noise on the patient, surgeons, anesthesiologists, nurses, and other operation room staff, or perception and attitude toward playing music in the operation room, were included. This systematic review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines and was registered with PROSPERO (ID: 208282). ResultsThe literature search generated 4758 articles, and 22 prospective studies (3507 participants) were included. Three of the four studies that investigated the effect of noise on patient outcome reported a significant reduction of complication rate in surgical patients, when noise levels were lower. Six studies assessed the effect of noise in the operation room on the staff (1383 participants). Over half of the surveyed staff found noise levels to be a disturbing stressor and negatively impact performance. Although music increased decibel levels in the operation room, most surveyed staff was positively predisposed toward playing music during surgery, believing it to improve both individual and team performance. In general, music was not considered to be distracting or impairing communication. ConclusionsHigher noise levels seem to have a negative effect on patient outcome and adversely affect performance by members in the operation room. Further research is needed to assess whether this knowledge can benefit patient outcome and surgical performance. Notably, attitude of surgical team members toward music during surgery is generally regarded favorable.

Operating rooms (ORs) are an important source of hospital revenue, and utilization rate is a key determinant of OR efficiency. Multiple factors contribute to OR underutilization, and OR managers may have biased views about which factors contribute most to OR underutilization. We examined various factors leading to OR underutilization at one academic tertriary care center.Data were collected retrospectively from over a 12-month period. Contribution to OR underutilization was measured in terms of hours of OR underutilization. Statistical significance between categories and days was calculated using an unpaired t test.By comparing means of the various contributors to OR underutilization (patient in the room, turnover time, scheduling gaps, OR holds, closed rooms), we determined that mid/end-of-day gaps and closed rooms contributed the most hours (9.7% and 4.6%, respectively; P < .0001) to OR underutilization, whereas turnover time and "patient in the room" contributed the least (2.0% and 0.8%, respectively; P < .0001).The contributors to OR underutilization are complex, and many OR staff from physicians to nurses and OR administrators may have biased views about which factors contribute most predominantly to inefficiency. Awareness of how various factors contribute to OR underutilization can pave the way for goal-directed changes on a systems-based level to improve efficiency in the OR by decreasing underutilization.

Background &amp; Objectives: Healthcare workers (HCWs) are prone to occupational hazards, which may have a significant impact on their health and safety. Inadequate worker training, a lack of appropriate protection measures, and a high workload could worsen the situation, resulting in increased morbidity and mortality among exposed workers. The purpose of this study was to assess the knowledge and safety practices on occupational hazards among operating room (OR) staff of Mardan Medical Complex.&#x0D; Methodology: From April to September 2021, 109 OR staff participated in this cross-sectional study including the surgeons, the anesthetists, the technologists and the OR nurses. Data regarding the level of knowledge and safety practices among OR staff were recorded on a validated questionnaire. Data were analyzed on SPSS version 19 and presented in the form of tables and graphs. Chi-square test was used to find an association between categorical variables and P &lt; 0.05 were considered statistically significant.&#x0D; Results: Among all participants, 95% of surgeons were aware of the work-related hazards and their types, followed by OR nurses, technologists, and the anesthetists. The majority of OR personnel with less experience were least aware of the occupational hazards. The association with the participants job experience, degree of knowledge, and the safety practices was not statistically significant (P &gt; 0.05).&#x0D; Conclusion: The knowledge of the surgeons regarding occupational hazards and the safety practices was the highest, followed by the anesthetists, technicians/technologists, and the OR nurses in that order. Measures are required to promote safety practices and reinforcement of strategies aimed to minimize exposure to hazards. Routine training of staff on safety practices need to be initiated and made mandatory.&#x0D; Key words: Healthcare workers; Occupational Hazard; Occupational Health Risk&#x0D; Citation: Amin B, Ali N, Shahzeb M, Ahmad S, Shah A, Ahmad N. Knowledge and safety practices on occupational hazards among operating room staff in Mardan Medical Complex, Mardan, Pakistan. Anaesth. pain intensive care 2022;27(1):59−64. DOI: 10.35975/apic.v27i1.2119&#x0D; Received: Jul 28, 2022; Reviewed: Dec 15, 2022; Accepted: Dec 18, 2022