Surgery scheduling problem considering the affinity and preferences in the surgical team.

Scheduling operating theatres: Mixed integer programming vs. constraint programming

A short-term operating room surgery scheduling problem integrating multiple nurses roster constraints

Exposure to certain bloodborne pathogens can prematurely end a person’s life. Healthcare workers (HCWs), especially those who are members of surgical teams, are at increased risk of exposure to these pathogens. The proper use of personal protective equipment (PPE) during operative/invasive procedures reduces that risk. Despite this, some HCWs fail to consistently use PPE as required by federal regulation, accrediting agencies, hospital policy, and professional association standards. The purpose of this mixed methods survey study was to (a) examine factors surgical team members perceive influence choices of wearing or not wearing PPE during operative/invasive procedures and (b) determine what would influence consistent use of PPE by surgical team members. Using an ex post facto, non-experimental design, the memberships of five professional associations whose members comprise surgical teams were invited to complete a mixed methods survey study. The primary research question for the study was: What differences (perceptual and demographic) exist between surgical team members that influence their choices of wearing or not wearing PPE during operative/invasive procedures? Four principal differences were found between surgical team members. Functional (i.e., profession or role based) differences exist between the groups. Age and experience (i.e., time in profession) differences exist among members of the groups. Finally, being a nurse anesthetist influences the use of risk assessment to determine the level of PPE to use. Four common themes emerged across all groups informing the two study purposes. Those themes were: availability, education, leadership, and performance. Subsidiary research questions examined the influence of previous accidental exposure to blood or body fluids, federal regulations, hospital policy and procedure, leaders’ attitudes, and patients’ needs on the use of PPE. Each of these was found to strongly influence surgical team members and their use of PPE during operative/invasive procedures. Implications based on the findings affect organizational policy, purchasing and distribution decisions, curriculum design and instruction, leader behavior, and finally partnership with PPE manufacturers. Surgical team members must balance their innate need to care for patients with their need to protect themselves. Results of this study will help team members, leaders, and educators achieve this balance.

BackgroundIn spite of the global implementation of surgical safety checklists to improve patient safety, patients undergoing surgical procedures remain vulnerable to a high risk of potentially preventable complications and adverse outcomes. The present study was designed to explore the surgical teams’ perceptions of patient safety culture, capture their perceptions of the risk for adverse events, and identify themes of interest for quality improvement within the surgical department.MethodsThis qualitative study had an explorative design with an abductive approach. Individual semi-structured in-depth interviews were conducted between 10/01/23 and 11/05/23. The participants were members of surgical teams (n = 17), general and orthopedic surgeons (n = 5), anesthesiologists (n = 4), nurse anesthetists (n = 4) and operating room nurses (n = 4). Middle managers recruited purposively from general and orthopedic surgical teams in two tertiary hospitals in Norway, aiming for a maximum variation due to gender, age, and years within the specialty. The data material was analyzed following Braun and Clarke’s method for reflexive thematic analysis to generate patterns of meaning and develop themes and subthemes.ResultsThe analysis process resulted in three themes describing the participants’ perceptions of patient safety culture in the surgical context: (1) individual accountability as a safety net, (2) psychological safety as a catalyst for well-being and safe performance in the operating room, and (3) the importance of proactive structures and participation in organizational learning.ConclusionsThis study provided an empirical insight into the culture of patient safety in the surgical context. The study highlighted the importance of supporting the individuals’ competence, building psychological safety in the surgical team, and creating structures and culture promoting a learning organization. Quality improvement projects, including interventions based on these results, may increase patient safety culture and reduce the frequency of adverse events in the surgical context.

Minimally Invasive Surgery Survey: A Survey of Surgical Team Members' Perceptions for Successful Minimally Invasive Surgery

<scp>AORN</scp> Position Statement on Managing Distractions and Noise During Perioperative Patient Care

Differences in perceptions of capability, autonomy, and expectations between residents and surgical team members in executing EPAs in Ethiopian medical education

Background: Communication errors in operating room (OR) settings are a common and avoidable source of patient harm. Communication in OR settings is enhanced when all members of the surgical team have knowledge of the skills and proficiency of their fellow team members. Student registered nurse anesthetists (SRNAs) provide anesthesia under the supervision of a certified registered nurse anesthetist (CRNA) or physician anesthesiologist. SRNAs’ proficiency in delivering anesthesia can vary significantly depending on their level of training, which varies based on the progression of the student in their multi-year nurse anesthesia program. Methods: This quality improvement project implemented a standardized non-verbal communication tool involving a color-coded visual cue system to aid surgical team members in quickly identifying the level of training of SRNAs in the operating room setting. Introduction of the intervention into the clinical setting was preceded by release of materials via email and posters to educate staff regarding the intervention. Pre-intervention and post-intervention surveys of surgical team members were conducted to gauge the effectiveness of the intervention. Results: A statistical analysis of these results did not demonstrate a significant improvement in surgical team members’ ability to quickly identify the level of training of SRNAs. Discussion: Poor statistical resolution secondary to small sample sizes and the limited means to educate a large pool of staff make interpretation of this result difficult. Conclusion: Further research using more robust methods of staff education and data collection would be necessary to firmly establish or discount the intervention’s validity.

Barriers to High-quality Postoperative Glycemic Management by Surgical Teams: A Theory-informed Qualitative Analysis

Selecting a winning team: Management of surgical team composition in robotic surgery

Background: Sterile surgical gloves protect patients from the surgical team members’ microbial flora of the hands, and mutually, the members of the surgical team from pathogens of the patient’s body. Damage of surgical gloves during each surgical procedure is one of the major concerns. There are a lot of risk factors and related issues associated with the damage of gloves that the results of other studies about them in some cases are consistent and in some cases inconsistent with each other. The aim of this study was to investigate the rate of surgical glove damages based on various factors in orthopedic surgery. Materials and Methods: In this descriptive-analytic study, 384 surgical gloves (192 pairs) were the study samples. The gloves were all made of the same material, and they were consisted of two layers. The gloves were selected based on a simple sampling study method. The study environment was the orthopedic and nerve operating room in Kashani Hospital associated with Isfahan’s Medical Sciences University. The study population included the gloves wore by the scrubbed individuals during foot and hand orthopedic plating operations. Data collection tools were comprised of questionnaires and checklists all constructed by the researcher. Questionnaire contained demographic information, surgery type, and the operation team members, and the checklists covered items pertaining to the surgical glove damages. The present study made use of Water Leak Test to evaluate whether the gloves have been damaged or not. To analyze the data, descriptive statistics tests and analytical statistical tests were applied, and the data were further inspected in the SPSS software, ver. 22. Results: The results of this study showed that there was a significant relationship between the type of surgery, the role of people in procedure, the gender of the surgical team, the location of damage on the gloves, the glove layer, the dominant hand of people, and the rate of damage of the surgical gloves, among different issues (*P 0.05). Discuss and Conclusion: Considering to risk factors that damage to surgical gloves by the surgical team, can reduce the number of needle sticks or transmission of infection between patients and them. According to the results, it is suggested that the surgical team during surgery should seek more attention to their dominant hands and in the areas contacting with the surgical instruments and the patient’s body, including the thumb and index finger. Furthermore, due to the higher rate of surgical gloves damages in implanting plates into the femur, it is recommended to put on two layers gloves or routine changing of them during these surgical procedures.

The aim of the present study was to observe surgical team members’ compliance with basic hand hygiene and intraoperative hygiene guidelines during the anaesthetic and surgical procedure. A secondary aim was to investigate the team members’ knowledge and attitudes toward these guidelines. A structured observation schedule was designed to capture observational data on compliance with hygiene guidelines. A questionnaire was also designed to elicit written responses on attitudes, beliefs and knowledge about hygiene routines. The results showed that the clinical procedures for basic hand hygiene and intraoperative hygiene were flawed in three areas. Hand disinfection before and after direct patient contact was incomplete. Secondly, the team members used gloves in an incorrect way. Thirdly, the scrub nurse did not always change sterile gloves after intraoperative skin disinfection before handling sterile instruments. The quantity of 0.5% chlorhexidine with 70% ethanol used varied and the mechanical performance of skin disinfection varied. Knowledge of hand hygiene routines and intraoperative hygiene routines among surgical team members is incomplete and adherence needs to improve. Regular routine observations and continuous feedback to all staff may be necessary to improve compliance and avoid deterioration of practice.

ObjectiveTo assess surgical team members’ differences in perception of non-technical skills.DesignQuestionnaire design.SettingOperating theatres (OTs) at one university hospital, three teaching hospitals and one general hospital in the Netherlands.ParticipantsSixty-six surgeons, 97 OT nurses, 18 anaesthetists and 40 nurse anaesthetists.MethodsAll surgical team members, of five hospitals, were asked to complete a questionnaire and state their opinion on the current state of communication, teamwork and situation awareness at the OT.ResultsRatings for ‘communication’ were significantly different, particularly between surgeons and all other team members (P ≤ 0.001). The ratings for ‘teamwork’ differed significantly between all team members (P ≤ 0.005). Within ‘situation awareness’ significant differences were mainly observed for ‘gathering information’ between surgeons and other team members (P < 0.001). Finally, 72–90% of anaesthetists, OT nurses and nurse anaesthetists rated routine team briefings and debriefings as inadequate.ConclusionsThis study shows discrepancies on many aspects in perception between surgeons and other surgical team members concerning communication, teamwork and situation awareness. Future research needs to ascertain whether these discrepancies are linked to greater risk of adverse events or to process as well as systems failures. Establishing this link would support implementation and use of complex team interventions that intervene at multiple levels of the healthcare system.

Background: The surgical environment demands meticulous attention to ensure patient safety, and the World Health Organization (WHO) recommends the Surgical Safety Checklist (SSC) as a critical component of risk mitigation and communication among surgical teams. Despite its importance, adherence to the SSC in Vietnam remains inconsistent, highlighting the need for further investigation into the factors influencing compliance and their impact on surgical outcomes. Objectives: This study aimed to (1) evaluate the adherence rates to the SSC, (2) examine causal relationships among workload burden, team attitudes and adherence to the SSC of surgical team members at My Thien hospital in Ho Chi Minh City, Vietnam. Methods: A cross-sectional descriptive study was conducted on 241 surgical team members, Data were collected using a structured questionnaire that included demographic information, the SSC, and the Maslach Burnout Inventory. Adherence rates were calculated, and statistical analyses were performed using Jamovi software to explore correlations and potential predictors of adherence. Results: The overall adherence rates to the SSC was 92.1%, with significant variations observed across different surgical phases. Emotional exhaustion (2.42 ± 0.39)) and depersonalization (2.36 ± 0.38)) scores were low, while personal accomplishment (3.59 ± 0.74)) was high, indicating a manageable workload for the surgical team. The attitudes of the surgical team towards the SSC are largely positive, with high mean scores for its usefulness (4.11 ± 0.52) and effectiveness in preventing mistakes (4.40 ± 0.52). However, concerns about its functionality and potential to cause delays were noted, with lower scores of 2.14 ± 0.45 and 2.59 ± 0.48, respectively. The study found that higher adherence was associated with lower workload burden, while the correlation between attitudes and workload dimensions was negligible. Notably, a significant direct relationship exists between positive attitudes towards the SSC and lower work burnout (estimate of 0.25, p = 0.019), suggesting that fostering positive attitudes may help reduce burnout among surgical team members. Conclusion: The findings underscore the importance of fostering positive attitudes towards the SSC among surgical team members to enhance adherence and improve patient safety. Regular interdisciplinary training and monitoring of workload and burnout levels are recommended to support the surgical team’s well-being and performance. Future research should explore the barriers to effective SSC implementation and the impact of team dynamics on adherence and burnout.

Using an Educational Intervention to Map our Surgical Teams’ Function, Emotional Intelligence, Communication and Conflict Styles