Intraoperative Communication Research Articles

Percutaneous endoscopic interlaminar discectomy with patients’ participation : better postoperative rehabilitation and satisfaction

ObjectEvaluation of the impact of patients’ participation on postoperative recovery and satisfaction who underwent the Percutaneous Endoscopic Interlaminar Discectomy(PEID).MethodsWe collected data from sixty-nine patients who underwent PEID surgery at Chuzhou Chinese and Western Medicine Hospital between January 2020 and December 2022. All patients had L5/S1 lumbar disc herniation and met the inclusion and exclusion criteria. The patients were divided into two groups: non-communication group (n = 33) and communication group (n = 36). The division was made based on whether the patients had preoperative surgical video viewing and intraoperative communication. We compared the baseline data, surgical time, VAS score, lumbar JOA score, surgical complications, and patient satisfaction between the two groups.ResultThe communication group showed better pain control and functional recovery in the early postoperative period. The communication group had better VAS scores on the first day and month after surgery, as well as JOA scores on the first week and month after surgery, with statistically significant differences (P < 0.05). There was no significant difference in hospital stay, VAS score, JOA score, and postoperative complications between the two groups of patients at 3 and 6 months after surgery. The communication group had higher patient satisfaction (P < 0.05).ConclusionPreoperative surgical video viewing and intraoperative communication by PEID patients can alleviate pain, accelerate functional recovery, improve symptoms, and increase patients’ satisfaction. We need to do more work to develop this new model.

Effect of standardized EHR-integrated handoff report on intraoperative communication outcomes.

We evaluated the effectiveness and implementability of a standardized EHR-integrated handoff report to support intraoperative handoffs. A pre-post intervention study was used to compare the quality of intraoperative handoffs supported by unstructured notes (pre) to structured, standardized EHR-integrated handoff reports (post). Participants included anesthesia clinicians involved in intraoperative handoffs. A mixed-method approach was followed, supported by general observations, shadowing, surveys, and interviews. One hundred and fifty-one intraoperative permanent handoffs (78 pre, 73 post) were included. One hundred percent of participants in the post-intervention cohort utilized the report. Compared to unstructured, structured handoffs using the EHR-integrated handoff report led to: (1) significant increase in the transfer of information about airway management (55%-78%, P < .001), intraoperative course (63%-86%, P < .001), and potential concerns (64%-88%, P < .001); (2) significant improvement in clinician satisfaction scores, with regards to information clarity and succinctness (4.5-4.7, P = .002), information transfer (3.8-4.2, P = .011), and opportunities for fewer errors reported by senders (3.3-2.5, P < .001) and receivers (3.2-2.4, P < .001); and (3) significant decrease in handoff duration (326.2-262.3 s, P = .016). Clinicians found the report implementation highly acceptable, appropriate, and feasible but noted a few areas for improvement to enhance its usability and integration within the intraoperative workflow. A standardized EHR-integrated handoff report ensures the effectiveness and efficiency of intraoperative handoffs with its structured, consistent format that-promotes up-to-date and pertinent intraoperative information transfer; reduces opportunities for errors; and streamlines verbal communication. Handoff standardization can promote safe and high-quality intraoperative care.

Abstract 953: Integration of functional precision medicine assay for high grade glioma management: A single institution experience

Abstract Despite the advances in precision oncology, genomic approaches have not significantly improved outcomes for high grade gliomas (HGGs) as once was anticipated. Recurrent HGG pose even greater therapeutic challenge. The integration of functional precision medicine (FPM), in which drugs screens are performed on live tissue, into clinical routine practice presents a promising alternative by offering personalized treatments based on the unique characteristics of the patient’s tumor. Here, we present our institutional experience of integrating a spheroid-based drug screening assay (3D PredictTM Glioma) in the treatment management of HGG patients to evaluate its feasibility and efficacy as a therapeutic tool in a clinical setting. We also sought to determine factors that related to assay success. Tissue from intracranial lesions of patients with presumed HGG and planned surgical resection at our institution were collected for ex vivo 3D cell culture and challenged with 12 drug agents to determine patient-specific response parameters. The impact of potential variables, such as ki67, tumor pathology, and shipment timing, on the assay’s success was evaluated. Clinical correlation was established between ex vivo response and clinical response in HGG patients. 57 samples, including 24 upfront HGGs, 32 recurrent HGGs, and one medulloblastoma, were sent for spheroid formation and drug testing. In total, 57.9% (33/57) or 23% (13/57) of the assays were successful and resulted in complete or partial functional profiling data, respectively. We conducted a multivariable analysis of our cohort to determine which variables (i.e. tumor volume sent, ki-67 proliferation index, tumor percentage determined by DNA sequencing by Tempus Lab, recurrent status, sample shipment time) were predictive of assay success. The only variable significantly associated with assay success was tumor percentage with samples comprised of &amp;gt;70% tumor leading to assay success, 40%-70% leading to 60% chance of success, and &amp;lt;40% having 0% success. Among 46 patients with partial or complete assay success, 26 patients (56.5%) had a targetable mutation and 17/26 yielded a moderate or full response to one or more of their corresponding targeted drugs in the assay. Treatments were newly administered or altered from prior treatments in 40/57 patients (70%) based on FPM results. Our study demonstrates the technical feasibility of incorporating FPM approaches in the development of treatment regimens for patients with HGG. Success was correlated to tumor percentage present in the sample which indicates intraoperative communication between surgeon and pathologist can lead to improved assay results. Our institutional protocol demonstrates that Integrating FPM into routine clinical practice is possible and can serve as a valuable guide in the refinement of therapeutic recommendations for HGG patients. Citation Format: Grace Guzman, Sahana Bettadapura, William Jeremy Shelton-Correa, Taylor Brooks, Melissa Rayner, Christopher Wardell, Analiz Rodriguez. Integration of functional precision medicine assay for high grade glioma management: A single institution experience [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 953.

The application of extended reality technology-assisted intraoperative navigation in orthopedic surgery.

Extended reality (XR) technology refers to any situation where real-world objects are enhanced with computer technology, including virtual reality, augmented reality, and mixed reality. Augmented reality and mixed reality technologies have been widely applied in orthopedic clinical practice, including in teaching, preoperative planning, intraoperative navigation, and surgical outcome evaluation. The primary goal of this narrative review is to summarize the effectiveness and superiority of XR-technology-assisted intraoperative navigation in the fields of trauma, joint, spine, and bone tumor surgery, as well as to discuss the current shortcomings in intraoperative navigation applications. We reviewed titles of more than 200 studies obtained from PubMed with the following search terms: extended reality, mixed reality, augmented reality, virtual reality, intraoperative navigation, and orthopedic surgery; of those 200 studies, 69 related papers were selected for abstract review. Finally, the full text of 55 studies was analyzed and reviewed. They were classified into four groups-trauma, joint, spine, and bone tumor surgery-according to their content. Most of studies that we reviewed showed that XR-technology-assisted intraoperative navigation can effectively improve the accuracy of implant placement, such as that of screws and prostheses, reduce postoperative complications caused by inaccurate implantation, facilitate the achievement of tumor-free surgical margins, shorten the surgical duration, reduce radiation exposure for patients and surgeons, minimize further damage caused by the need for visual exposure during surgery, and provide richer and more efficient intraoperative communication, thereby facilitating academic exchange, medical assistance, and the implementation of remote healthcare.

Patient perception and satisfaction in awake burr hole trepanation under local anesthesia for evacuation of chronic subdural hematoma

Evacuation of chronic subdural hematoma (CSDH) will be one of the most common neurosurgical procedures in the future in the increasingly aging societies. Performing cranial surgery on awake patients may place a psychological burden on them. Aim of this study was to evaluate the psychological distress of patients during awake CSDH relief. Patients with awake evacuation of CSDH via burr hole trepanation were included in our monocentric prospective study. Patient perception and satisfaction were measured using standardized surveys 3–5 days and 6 months after surgery. Among other questionnaires, the Hospital Anxiety and Depression and the Impact of Event Scale, were used to quantify patients' stress. A total of 50 patients (mean age 72.9 years (range 51 – 92)) were included. During surgery, 28 patients reported pain (mean 4.1 (SD 3.3)). Postoperatively, 26 patients experienced pain (mean 2.7 (SD 2.6)). Patients’ satisfaction with intraoperative communication was reported with a mean of 8.3 (SD 2.1). There was a significant negative correlation between intraoperatively perceived pain and satisfaction with intraoperative communication (p = 0.023). Good intraoperative communication during evacuation of CSDH in awake patients is associated with positive patient perception and correlates with pain reduction.

Implementation of a Specific Set of Intraoperative C-Arm Fluoroscopy Terminologies in Percutaneous Vertebroplasty.

Percutaneous vertebroplasty (PVP) is currently the primary minimally invasive surgical approach for treating vertebral compression fractures caused by senile osteoporosis. The current existing problem is the lack of research on the application of a specific set of intraoperative C-arm fluoroscopy terminologies in PVP. Therefore, the purpose of this study is to explore the use of a specific set of intraoperative C-arm fluoroscopic terminologies in PVP in order to increase fluoroscopy accuracy, decrease fluoroscopy frequencies and ray protection, and minimize operation times through rapid preoperative training of surgeons and radiographers. Spine surgeons and radiographers with at least 5 years of experience from nine different hospitals were randomly selected for a series of specialized intraoperative C-arm fluoroscopy terminology training between October 2018 and December 2021. Before and after the training, they were surveyed using a five-point Likert scale to statistically compare their knowledge of the terminology. Simultaneously, 190 PVP cases completed by these surgeons and radiographers before and after the training were chosen for comparison and analysis of fluoroscopy times, effective fluoroscopy rate, fluoroscopy time, repeated puncture rate, and other indicators before and after receiving specialized terminology training. Two-sample tests were mainly used to investigate differences in answers between surgeons and radiographers. After the training, there was a notable improvement in the fluency of intraoperative communication between professional spine surgeons and radiographers. By comparing the indicators of pre-training with post-training, the effective anteroposterior fluoroscopy rate increased from 46.5% to 75.7%; the effective lateral fluoroscopy rate increased from 59.8% to 76.9%. Moreover, a notable decrease in communication barriers, fluoroscopy frequencies, fluoroscopy time, and the rate of repeated punctures, and a notable increase in the effective fluoroscopy rate was observed. Smooth intraoperative communication between professional spine surgeons and radiographers can significantly lower the communication barrier, reduce the fluoroscopy frequencies and time, the rate of repeated puncture, and increase the effective fluoroscopy rate, all of which are important in improving the fluoroscopy in PVP.

Frozen Section Timeout: Pilot Study to Reconcile Margins Using 3D Resected Specimen and Defect Scans.

Opportunities exist to improve intraoperative communication and documentation of resection margin details. We instituted a "frozen section timeout" that centers around visualization of the paired resection specimen and surgical defect-facilitating effective, bidirectional exchange of information. We designed an interactive form for use during the "frozen section timeout" including annotated 3D virtual models of the resected specimen and surgical defect, plus a "line-item" table for primary and supplemental margin results. The "timeout" was conducted over a Zoom call between the operating room and frozen section laboratory. The form was simultaneously projected and discussed while all members of the surgical care team stopped activities. Nurses, co-surgeons, and all other members of the surgical team were encouraged to take part in this process. Twenty-six frozen section timeouts were conducted during head and neck surgeries in the Department of Otolaryngology at Mount Sinai West Hospital. These timeouts were facilitated by the lead surgeon, and all other activities were halted to ensure that critical information was shared, documented, and agreed upon. During the timeout, the annotated specimen and defect scans were displayed, clearly demonstrating the at-risk margins and the corresponding location and breadth of supplemental margins harvested. Incorporating a frozen section timeout can improve intraoperative communication, increase transparency, and potentially eliminate uncertainty regarding margin status and tumor clearance. Visualization of at-risk margins and the corresponding location and breadth of supplemental margins promises an unprecedented level of documentation and understanding. This novel technique can establish a new and improved standard of care. NA Laryngoscope, 134:725-731, 2024.

Education Team Time Out in Oncologic Visceral Surgery Optimizes Surgical Resident Training and Team Communication–Results of a Prospective Trial

Surgical education is highly dependent on intraoperative communication. Trainers must know the trainee's training level to ensure high-quality surgical training. A systematic preoperative dialogue (Educational Team Time Out, ETO) was established to discuss the steps of each surgical procedure. Over 6 months, ETO was performed within a time limit of 3 minutes. Digital surveys on the utility of ETO and its impact on performance were conducted immediately after surgery and at the end of the study period among the staff of the participating disciplines (trainer, trainee, surgical nursing staff, anaesthesiologists, and medical students). The number of surgical substeps performed was recorded and compared with the equivalent period one year earlier. ETO was performed in 64 of the 103 eligible operations (62%). Liver resection (n = 37) was the most frequent procedure, followed by left-sided colorectal surgery (n = 12), partial pancreaticoduodenectomy (n = 6), right-sided hemicolectomies (n = 5), and thyroidectomies (n = 4). Anaesthesiologists most frequently reported that ETO had a direct impact on their work during surgery (90.9%). The influence scores were 46.8% for trainees, 8.8% for trainers, 53.3% for surgical nursing staff and 66.6% for medical students. During the implementation of ETO, a trend towards more assisted substeps in oncologic visceral surgery was seen compared to the corresponding period one year earlier (51% vs.40%; p = 0.11). ETO leads to improved intraoperative communication and more performed substeps during complex procedures, which increases motivation and practical training. This concept can easily be implemented in all surgical specialties to improve surgical education.

When Patient Expectations Are Not Met: A Case Report.

Successful anesthetics occur when safe, effective perioperative care is coupled with patient satisfaction. We present the case of a 63-year-old woman with advanced Parkinson's disease who presented for a deep brain stimulation (DBS) device battery change under monitored anesthesia care (MAC). While MAC is commonly utilized for a DBS battery change, our patient reported previously experiencing intraoperative pain, anxiety, and the inability to communicate discomfort under MAC, leading to posttraumatic stress disorder. This case report highlights the importance of preoperative informed consent, discussion of patient expectations, and proactive planning for intraoperative communication strategies when MAC is the chosen method.

Role Reversal Between Trainees and Surgeons: Improving Autonomy and Confidence in Surgical Residents

IntroductionThere are increasing concerns regarding resident autonomy in the context of efficiency, legal ramifications, patient expectations and patient safety. However, autonomy is necessary to develop competent, independent surgeons. Therefore, educational paradigms that maximize opportunities for entrustability without sacrificing patient safety are necessary to ensure adequate training for surgeons. MethodsThis is a prospective, qualitative study of intraoperative role reversal between surgeons and residents. Using Likert scales and binary questions, preintervention and postintervention surveys were collected, evaluating variables including intraoperative learning, decision making, communication, confidence, autonomy and opportunity for safe struggle. The Mann-Whitney U test was used to analyze results and compare responses between training years. ResultsThirty-six general surgery residents comprising post-graduate year 1, 2, 4, and 5 acted as primary surgeon in a total of 36 cases. Preoperative knowledge scores were significantly higher in more senior residents (P < 0.001), but all residents had significant improvement in knowledge scores postoperatively (P < 0.001). The knowledge improvement was quantitatively larger for junior versus senior residents. Intraoperative decision making significantly improved after the intervention for all training levels (P < 0.001). 25 intraoperative “rescues” were performed by faculty for failure to progress or unsafe conditions (23 for junior residents, 2 for senior residents). Residents indicated that this intraoperative role reversal improved preparation, confidence, autonomy, and intraoperative communication. ConclusionsIntraoperative role reversal between residents and surgeons provides a safe opportunity for maximizing learning and increasing entrustability under direct supervision.

Augmented reality collaborative medical displays (ARC-MeDs) for multi-user surgical planning and intra-operative communication

ABSTRACT Digital Displays are integral to modern systems and serve as the primary visual human-computer interface. A physical monitor is a typical example for showing computer-generated information to a person – as long they are located directly in front of them. In an operating room, however, people may be unable to move freely or communicate only based on verbal communication due to noise pollution. Furthermore, mobile and connected editing and sharing of the same content on the go is currently not readily available. Therefore, we propose Augmented Reality Collaborative Medical Displays for duplicating any displayed content as a virtual monitor hovering in space in the real world. Our method replicates any user input on the virtual representation onto the original physical monitor. We put forward a use case in planning a surgical intervention of the abdomen with intra-operative CT imaging. Moreover, we demonstrate how a medical immersive teleconsultation system utilises our method for meaningful interactions. Finally, we evaluate our method with multiple display resolutions. Based on our observations from the use cases and quantitative evaluation, we believe our proposed concept facilitates the integration of future collaborative medical applications.

StOP? II trial: cluster randomized clinical trial to test the implementation of a toolbox for structured communication in the operating room—study protocol

BackgroundSurgical care, which is performed by intensely interacting multidisciplinary teams of surgeons, anesthetists, and nurses, remains associated with significant morbidity and mortality. Intraoperative communication has been shown to be associated with surgical outcomes, but tools ensuring efficient intraoperative communication are lacking. In a previous study, we developed the StOP?-protocol that fosters structured intraoperative communication. Before the critical phases of the operation, the responsible surgeon initiates and leads one or several StOP?s. During a StOP?, the surgeon informs about the progress of the operation (status), next steps and proximal goals (objectives), and possible problems (problems) and encourages all team members to voice their observations and ask questions (?). In a before-after study performed mainly in visceral surgery, we found effects of the StOP?-protocol on mortality, length of hospital stay, and reoperation. We intend to assess the impact of the StOP?-protocol in a cluster randomized trial, in a wider variety of surgical specialties (i.e., general, visceral, thoracic, vascular surgery, surgical urology, and gynecology). The primary hypothesis is that the consistent use of the StOP?-protocol by the main surgeon reduces patient mortality within 30 days after the operation. The secondary hypothesis is that the consistent use of the StOP?-protocol by the main surgeon reduces unplanned reoperations, length of hospital stay, and unplanned hospital readmissions.MethodsThis study is designed as a multicenter, cluster-randomized parallel-group trial. Board-certified surgeons of participating clinical departments will be randomized 1:1 to the StOP? intervention group or to the standard of care (control) group. The intervention group will undergo a training to use the StOP?-protocol and receive regular feedback on their compliance with the protocol. The surgeons in the control group will communicate as usual during their operations. The unit of observation will be operations performed by cluster surgeons. Consecutive patients will be enrolled over 4 months per cluster. A total of 400 surgeons will be recruited, and we expect to collect patient outcome data for 14,000 surgical procedures.DiscussionThe StOP?-protocol was designed as a tool to structure communication during surgical procedures. Testing its effects on patient outcomes will contribute to implementing evidenced-based interventions to reduce surgical complications.Trial registrationClinicalTrials.gov NCT05356962. Registered on May 2, 2022

Safe Technical Innovation: Development and Implementation of a Robotic Breast Operation Program.

Safe Technical Innovation: Development and Implementation of a Robotic Breast Operation Program.

Beyond the observation of all or nothing: The clinical significance of the pre-decompression instability of abnormal muscle response in Microvascular decompression for Hemifacial spasm

BackgroundIn microvascular decompression (MVD) surgery, abnormal muscle response (AMR) monitoring was utilized to confirm sufficient decompression. However, the AMR seems to contain more information that could improve surgical results. MethodPatients’ records of HFS treated with MVD under AMR monitoring, from January 2018 to December 2019 in our centre, were retrospectively reviewed. MVD procedures were performed via a suboccipital retrosigmoid approach, and AMR monitoring was performed. Pre-Decompression Instability (PDI) of AMR before the final decompression, including amplitude inconsistency and waveform chaos, was inspected and notified to the surgeon. Result165 cases were found with full follow-up data. In these cases, PDI was recognized in 144 cases. And in the remaining 21 cases, the AMR disappeared abruptly or continued to exist to the end of the MVD surgery. When PDI appeared, the rate of electrophysiological relief was significantly higher (91.7 % vs 66.7 %, P = 0.001). In cases with PDI appearance during MVD procedure, the rate of neurological dysfunction was lower (13.2 % vs 38.1 %, P = 0.004). The relief rate the PDI group tended to be higher without statistical significance. ConclusionThe appearance and observation of pre-decompression instability of AMR monitoring made a positive impact on the surgical outcomes of MVD surgeries. The advent of PDI indicates that the key step of the procedure has arrived. The timely notification of the PDI advent improved the surgical outcomes of MVD surgery by increasing the electrophysiological relief rate, reducing the incidence of neurological dysfunction, and possible elevation of the relief rate. Therefore, continuous intra-operative communication between the surgeon and electrophysiological monitoring staff should be encouraged.

Introduction of In Vivo Confocal Laser Endomicroscopy and Real-Time Telepathology for Remote Intraoperative Neurosurgery-Pathology Consultation.

Precise communication between neurosurgeons and pathologists is crucial for optimizing patient care, especially for intraoperative diagnoses. Confocal laser endomicroscopy (CLE) combined with a telepathology software platform (TSP) provides a novel venue for neurosurgeons and pathologists to review CLE images and converse intraoperatively in real-time. To describe the feasibility of integrating CLE and a TSP in the surgical workflow for real-time review of in vivo digital fluorescence tissue imaging in 3 patients with intracranial tumors. Although the neurosurgeon used the CLE probe to generate fluorescence images of histoarchitecture within the operative field that were displayed on monitors in the operating room, the pathologist simultaneously remotely viewed the CLE images. The neurosurgeon and pathologist discussed in real-time the histological structures of intraoperative imaging locations. The neurosurgeon placed the CLE probe at various locations on and around the tumor, in the surgical resection bed, and on surrounding brain tissue with communication through the TSP. The neurosurgeon oriented the pathologist to the location of the CLE, and the pathologist and neurosurgeon discussed the CLE images in real-time. The TSP and CLE were integrated successfully and rapidly in the operating room in all 3 cases. No patient had perioperative complications. Two novel digital neurosurgical cellular imaging technologies were combined with intraoperative neurosurgeon-pathologist communication to guide the identification of abnormal histoarchitectural tissue features in real-time. CLE with the TSP may allow rapid decision-making during tumor resection that may hold significant advantages over the frozen section process and surgical workflow in general.

A simulation study on the association of HRO communication patterns and surgical team performance.

The hallmarks of high-reliability organizations (HROs) have been broadly embraced by health-care organizations as a path to achieve greater reliability in patient care. A simulation study was conducted to investigate the hypothesis that surgical teams whose intraoperative communication displayed the HRO hallmarks had a greater capacity to detect and resolve surgical complications in less time. The study consisted of presenting four simulations to five surgical teams using a within-subject experimental design. In each simulation, the patient would manifest a complication in which the detection and/or resolution was either obscure or obvious. Communication patterns related to the frequency and sustained duration of HRO content were extracted from coded transcripts using recurrence quantification analysis (RQA), which were paired with the teams' elapsed time to detect or resolve a surgical complication. Spearman's rank-order statistics was then used to test for a monotonically decreasing association between these variables. Data consisting of the RQA metrics and elapsed times are reported for each surgical team in each simulation in addition to statistical tests for association between these variables and inter-rater reliability statistics of the coded communication. The study suggests that surgical teams whose communication espouses the HRO hallmarks of commitment to resilience and deference to expertise in both frequency and duration are able to resolve surgical complications with an obscure corrective action in less time. The study did not provide confirming evidence that these are associated with their ability to resolve a complication with an obvious corrective action in less time or that patterns of sensitivity to operations are associated with their ability to detect an obscure surgical complication in less time.

The impact of watching real-time videos of flexible ureteroscopic lithotripsy on anxiety and depression in patients.

This study examines the effect of intraoperative doctor-patient communication with real-time videos in flexible ureteroscopic lithotripsy on patients' anxiety and depression. Patients with upper urinary tract calculi were randomised into four groups. Group A (n = 29) watched the real-time operation video, but did not accept the relevant explanation during the operation; Group B (n = 31) received an explanation about the operation process during the operation alone. Patients in Group C (n = 33) watched the real-time operation video and received an explanation about the operation process during the operation. Group D (n = 31) neither watched the operation video nor received an explanation about the operation process. The self-rated anxiety and depression scores of the patients were evaluated using the self-rating anxiety scale (SAS) and the self-rating depression scale (SDS) before and after the operation. The clinical and demographic profiles (average age, gender distribution, educational level, body mass index, stone size, the position of stones in each groups, the length of stayand the numbers of severe postoperative complications) of the for groups showed no preoperation difference (P > 0.05). The preoperative anxiety scores and the preoperative depression scores showed no significant difference in the four groups (P > 0.05). The scores of postoperative anxiety and depression in groups A (n = 29), B (n = 31), and C (n = 33) were significantly lower than those in Group D (n = 31), (P < 0. 05). Compared to groups A and B, the scores of anxiety and depression in Group C were significantly decreased (P < 0.05). During flexible ureteroscopic lithotripsy, doctor-patient communication combined with real-time video can significantly reduce patients' postoperative anxiety and depression, and contribute to their physical and mental health recovery.

Learning NOTSS While Tying Knots: Integrating the Nontechnical Skills for Surgeons Course With Technical Surgical Skills Training, A Mixed Methods Study.

The aims of this study were to describe the process of integrating 2 established training programs, Nontechnical skills for surgeons, and a traditional essential surgical skills course and to measure the impact of this integrated course on the behaviors of interprofessional surgical teams in Rwandan district hospitals. Surgical errors and resulting adverse events are due to variability in both technical and nontechnical surgical skills. Providing technical and nontechnical skills training to the perioperative team may enhance the learning of both of these skills and promote safe intraoperative patient care. A quality improvement framework guided the process of integrating essential surgical skills and nontechnical skills into a single training program for surgical teams. The resulting 2-day training program was delivered to 68-person teams from 17 hospitals. Nontechnical skills for surgeons was taught through didactics and in the operating room, where preoperative briefing, intraoperative interactions, and postoperative debriefing were used as essential and nontechnical skills teaching moments. Postcourse surveys, follow-up interviews, focus groups, and direct observation of participants in the operating room were conducted to assess how participants implemented the knowledge and skills from the training into practice. Ninety-seven percent of the participants reported that they were satisfied with the course. Follow-up participant interviews and focus groups reported that the course helped them to improve their preoperative planning, intraoperative communication, decision-making, and postoperative debriefing. It is possible to implement an integrated essential surgical skills and nontechnical skills training course. Integrating nontechnical skills into essential surgical skills courses may enhance learning of these skills.

Operating Room Noise and Team Communication during Facial Plastic and Reconstructive Surgery: A Multicenter Study.

Operating room (OR) noise contributes to team miscommunication. In facial plastic and reconstructive surgery (FPRS), many cases are completed under sedation. This creates a unique environment wherein patients are aware of OR noise. The objectives of this study were to quantify noise and evaluate team members' perspectives on communication inside of FPRS ORs. This study was completed across three surgical institutions. Objective noise measurements were recorded with SoundMeter X. A communication questionnaire was delivered to OR team members following each case. Four hundred and twenty-three noise measurements were recorded during facelift/neck, eye/brow, rhinoplasty, and fat transfer/lip surgeries. The mean and maximum noise levels were 66.1 dB (dB) and 87.6 dB, respectively. Measurements during cases with general anesthetic (221/423, 52.2%) had higher noise measurements (70.3 dB) compared with those with sedation (202/423, 47.8%) (69.7 dB) (p = 0.04). The OR was louder with suction on (72.3 dB) versus off (69.3 dB) (p <0.00). Suction (34.5%) and music (22.4%) were the largest noise contributors according to questionnaire replies. Intraoperative noise, awake patients, and suctions/music may negatively impact FPRS OR communication. Innovation to improve FPRS intraoperative communication should be considered for effective patient care.

Guidelines in Practice: Specimen Management.

Specimen management is a complex process that involves multiple steps and numerous health care personnel. Preventable specimen-related errors are common and can occur during any phase of the specimen management process. Perioperative nurses manage specimens during the preanalytical phase before specimens are delivered to the laboratory for analysis. Errors in the preanalytical phase may include mislabeling, miscommunication, loss of a specimen, improper fixation of the specimen, and transport failures. The AORN "Guideline for specimen management" provides guidance for managing specimens collected during surgical and other invasive procedures, including recommendations for handling specific types of specimens. This article discusses the guideline recommendations for intraoperative team communication, transfer from the sterile field, containment, transport, and quality. A scenario describes a facility team's use of a root cause analysis and a failure modes and effects analysis tool to assess the risk and effects of specimen errors and create a process improvement plan.