Operating room black box:Scrutinizer of theatre practices

Objective:Adverse surgical events are a major cause of morbidity,mortality,and disability worldw ide.The cause of many such events can be attributed to interruptions in the operating room(OR),muli-tasking by surgeons,etc.The objective of this study was to observe the types and frequency of intra-operative wor kflow interruptions in our ORs.Method:This ccoss-sectional study was conducted from March Do April of 2023.An observational approach using an audio-video recording device was employed to record OR flow disr uptions.One elective OR and one emergency OR under the Department of General Surgery were selected for the study.All open and laparoscopic surger ies conducted in the selected ORs were included.An Internet Protocol camera'was installed in the selec ted ORS with a view of the entire room,including the anesthesia station.Audio-video recording was started after the first indsion and stopped after closure of the surgical site.Result:Of the 51 cases that were studied,45(88.2%)were elective,and 18(35.3%)were laparoscopic cases.They could be classified into 8 types of open procedures and 4 types of lapar oscopic procedures.The mean maximum headcount inside the OR was 15.5土3.6 and doors opened on average of 15.8土6.0 times during a procedure.Other interruptions were surgeons attending phone calls(24,47.1%),leaving the sterile area(21,41.2%),technical disturbances(32,62.7%),anesthetic interruptions(18,35.3%),and faulty instruments(29,56.9%)Elective procedures had a signifcandy higher average number of in-terruptions per operating hour than emergency procedures(175±8.6vs.7.1±2.9,p<0.01).Condusion:Preventable factors such as faulty instruments,anesthetic interruption,and attending phone calls by the surgeon are commonly observed in ORs.They need to be addressed by timely surgical audits or the adoption of continued sureillance methods that can help take measures to minimize their occurrence.

Novel operating theatre scheduling method based on estimation of distribution algorithm

In order to improve the efficiency of operating rooms,reduce the costs for hospitals and improve the level of service qualities, a scheduling method was developed based on an estimation of distribution algorithm（ EDA）. First, a scheduling problem domain is described. Based on assignment constraints and resource capacity constraints, the mathematical programming models are set up with an objective function to minimize the system makespan. On the basis of the descriptions mentioned above, a solution policy of generating feasible scheduling solutions is established. Combined with the specific constraints of operating theatres, the EDA-based algorithm is put forward to solve scheduling problems. Finally, simulation experiments are designed to evaluate the scheduling method. The orthogonal table is chosen to determine the parameters in the proposed method. Then the genetic algorithm and the particle swarm optimization algorithm are chosen for comparison with the EDA-based algorithm, and the results indicate that the proposed method can decrease the makespan of the surgical system regardless of the size of operations. Moreover, the computation time of the EDA-based algorithm is only approximately 5 s when solving the large scale problems, which means that the proposed algorithm is suitable for carrying out an on-line scheduling optimization of the patients.

Operating Parameters of the District Heating Substation Cooperating With the Installation of Technological Air Conditioning With High Efficiency of Heat Recovery

The article analyses the problem of determining the operating parameters of the district heating substation cooperating with the air heating system in technological air conditioning systems equipped with heat exchangers with high efficiency of heat recovery.Attention was paid to the correct selection of heat exchangers for the heat output balance depending on the heat recovery protection algorithms against a drop in the temperature of the heat transfer surface below 0℃.Critical parameters were determined in Polish climatic conditions,at which the operation of the heat recovery exchanger in the air conditioning system is switched off or limited.It has been proven that the proper functioning of the district heating substation cooperating with the installation of air conditioning with high heat recovery efficiency requires the use of two heat exchangers with different characteristics,equipped with properly selected temperature control systems.The optimal model of cooperation between the technological air conditioning system and the heating substation was also indicated.

Filtered-beam-search-based approach for operating theatre scheduling

To improve the efficiency of operating rooms, reduce the hospital＇ s costs and improve the level of service qualities, a scheduling method is presented based on a filtered-beam-search-based algo- rithm. Firstly, a scheduling problem domain is described. Mathematical programming models are al- so set up with an objective function of minimizing related costs of the system. On the basis of the de= scriptions mentioned above, a solving policy of generating feasible scheduling solutions is estab- lished. Combining with the speeific constraints of operation theatres, a filtered-beam-search-based algorithm is put forward to solve scheduling problems. Finally, simulation experiments are designed. The performance of the proposed algorithm is evaluated and compared with that of other approaches through simulations. Results indicate that the proposed algorithm can reduce costs, and are of prac- ticality and effectiveness.

Headaches Associated with N95 Mask Usage amongst Healthcare Workers in Operating Theatres during COVID-19 Pandemic: A Cross-Sectional Study

Introduction: N95 respirator masks are a cornerstone in the fight against the ongoing COVID-19 pandemic. However, its use has side effects such as headaches. The primary aim of this study is to identify factors that may contribute to higher occurrences of headaches with wearing N95 masks. Methods: A cross-sectional study was conducted across healthcare providers in operating theatres of a tertiary hospital based in Singapore involved in the care of COVID-19 patients. The study involved a self-administered online questionnaire completed by all participants. Results: 176 participants were included into the study, of which 65 (36.9%) reported headaches associated with wearing N95 masks. Out of the 65 participants who experienced headaches, 28 (43.1%) reported experiencing “mild” headache, 30 (46.2%) reported experiencing “moderate” headache, and 7 (10.7%) reported experiencing “severe” headache. 44 participants (67.7%) reported that the headache has affected their work, and 20 participants (30.8%) required analgesia to relieve the headaches. Other symptoms associated with N95 mask usage include skin damage (12.3%), breathlessness (15.4%), giddiness (6.2%), nausea (6.2%) and ear pain (3.1%). Multivariate logistic regression analysis showed that participants younger than 32 years old (p = 0.001) and history of pre-existing headache disorders (p = 0.001) were associated with higher occurrences of headaches with wearing N95 masks. Conclusion: Our study showed that younger age and history of pre-existing headache disorders contribute to higher occurrences of headaches with N95 mask usage. These associations could be useful in identifying at-risk individuals so that precautions may be taken to reduce the occurrence of headaches when wearing N95 masks.

Intraoperative Care of the Conscious Patient from the Perspective of the Operating Theatre Nurse:A Grounded Theory

Introduction: Intraoperative care includes a unique knowledge of how to perform a safe and effective surgery procedure. Surgery performed under regional or local anaesthesia allows the patient to remain conscious during the procedure and is rather common in Swedish healthcare today. Aim: The aim was to obtain a deeper understanding of the main concerns of operating theatre nurses (OTN) when caring for conscious patients during the intraoperative phase. Methods: Interviews were conducted with 23 OTNs from five different hospitals in Sweden and analysed according to grounded theory. Findings: The main concern among the OTNs was to take the patient in consideration. The core category “achieve and maintain ethical treatment of patients” in the operating theatre (OT) was a strategy used throughout the intraoperative process. Ethical treatment was described as moral behaviour at different levels and included the team’s behaviour, respectful and individualised patientcare, and the working-morale of the professionals. Being vigilant and being flexible were the categories related to the core category. The OTNs constantly assessed where to pay most attention as they balanced between the needs of the patient, the team, and the surgery procedure. Conclusion: It is important that every patient is taken into consideration and that ethical principles are held to the highest standards in the OT. A familiar team can facilitate that. The complex skills that operating theatre nurses develop can be added to explain important competencies within the profession.

Instituting Pandemic Plans in a Singapore Anaesthesia Unit: The Challenges and Learning Points

The World Health Organization declared COVID-19 as a pandemic on 11 March 2020. Its rapid spread has put a strain on healthcare systems globally. Singapore ranked the highest in terms of reported cases outside of China in the first few weeks of this outbreak. The management of a patient with COVID-19 in the Operating Theatre (OT) presents a unique set of challenges to the Anaesthetist. Delivery of timely and quality care must be upheld while reducing the risk of transmission to healthcare staff and other patients. This article describes our Anaesthesia Unit’s experiences and challenges in instituting our pandemic plans. The authors hope that the sharing of our experience and practical approach would be useful to other Anaesthesia Units worldwide.

What Is the Evidence Supporting the Use of Surgical Face Masks in the Operating Room in Preventing Surgical Site Infection after Clean Surgery? A Systematic Review

Background: Facemask is an essential component of the surgical outfit adorned by operating room staff to filter microorganisms by droplets from the oral and nasopharynx of the personnel, thereby reducing contamination, protecting the patient’s wound and minimising the risk of Surgical Site Infections (SSI). Objective: The objective of this review was to explore the available evidence and provide a better understanding of the effect of a surgical facemask in preventing SSI in clean surgery performed in the operating room. Data sources: Key electronic databases related to nursing, allied health, life science, biomedicine and research were searched for published literature on the use of facemask in the operating room. Methodology: A systematic review of quantitative research studies of randomised controlled trials was conducted with a meta-analysis of the results. Results: No variation in the rate of infection between the two (masked and unmasked) groups. Conclusion: The effect of facemask in minimising SSI after clean surgery remains questionable due to the limited results. More comprehensive research is needed.

COMPARISON OF TWO METHODS OF OPERATING THEATRE PLANNING:APPLICATION IN BELGIAN HOSPITAL

Operating Theatre is the centre of the hospital management＇s efforts. It constitutes the most expensive sector with more than 10% of the intended operating budget of the hospital. To reduce the costs while maintaining a good quality of care, one of the solutions is to improve the existent planning and scheduling methods by improving the services and surgical specialty coordination or finding the best estimation of surgical case durations. The other solution is to construct an effective surgical case plan and schedule. The operating theatre planning and scheduling is the two important steps, which aim to make a surgical case programming with an objective of obtaining a realizable and efficient surgical case schedule. This paper focuses on the first step, the operating theatre planning problem. Two planning methods are introduced and compared. Real data of a Belgian university hospital ＂Tivoli＂ are used for the experiments.