Operating Room Team Research Articles

Implementation and adherence to a speciality-specific checklist for neurosurgery and its influence on patient safety.

Background and Aims:Neurosurgery involves a high level of expertise coupled with enduring and long duration of working hours. There is a paucity of published literature about the experience with a speciality-specific checklist in neurosurgery. We conducted a cross-sectional observational study to identify the adherence to various elements of the Modified World Health Organization Surgical Safety Checklist (WHO SSC) for neurosurgery by the operating room (OR) team.Methods:We implemented an intra-operative Modified WHO SSC consisting of 40 tools for neurosurgery, in 200 consecutive elective cases. Trained anaesthesiologists assumed the role of checklist co-ordinator. The checklist divided the surgery into 5 phases, each corresponding to a specific time-period. The adherence rates to various tools were evaluated and areas where the checklist prompted a corrective measure were analysed.Results:A total of 131 cases undergoing craniotomy and 69 cases undergoing spine surgery were studied. With the 40-point modified SSC applied in 200 cases, we analysed a total of 8000 observations. The modified checklist prompted the OR team to adhere to speciality-specific safety practices about application of compression stockings (9.5%); airway precautions in unstable cervical spine (2.5%); precautions for treatment of raised intracranial pressure (10.5%); and intraoperative neuro-monitoring (5%).Conclusion:The implementation of Modified WHO SSC for Neurosurgery, by a designated checklist co-ordinator, can rectify anaesthetic and surgical facets promptly, without increasing the OR time. The anaesthesiologist as SSC coordinator can effectively implement an intraoperative checklist ensuring excellent participation of operating room team members.

OR and ICU teams ‘running in parallel’ at the end of cardiothoracic surgery improves perceptions of handoff safety

The transfer of a cardiac surgery patient from the operating room (OR) to the intensive care unit (ICU) is both a challenging process and a critical period for outcomes. Information...

The precaution strategy toward the COVID-19 pandemic in the operating room of a tertiary hospital in Taiwan.

The pandemic of SARS-CoV-2 (COVID-19), which began in December 2019, spread mostly from person to person through respiratory droplets. A recommendation was issued to postpone all elective surgical practices. However, some confirmed or suspected COVID-19 patients required life-saving emergent surgeries. To facilitate emergent surgical interventions for these patients, we have reviewed the current literature and established an algorithm of precautions to be taken by operating room team members during the COVID-19 pandemic. The initial algorithm of preparation for surgical intervention during the COVID-19 pandemic was relatively simple. However, the abrupt increase of confirmed COVID-19 cases due to returned overseas travelers since mid-March 2020 disrupted the routine hospital clinical service. Due to the large number of febrile patients, the algorithm was therefore revised according to travel history, occupation, contact and cluster history (TOCC), unexplained fever/symptoms, and emergent/nonemergent surgery. TOCC (+) patients presenting with otherwise unexplained fever/symptoms would be regarded as belonging to the fifth category of "severe special infectious pneumonia." If the patient requires emergent surgery to relieve the non-life-threatening disorders, two times of negative COVID-19 tests are necessary before the operation is approved. For life-threatening situations without two negative results of COVID-19 tests, the operation schedule should be approved by the Chairman of Surgery Management Committee. The application of a clear and integrated algorithm for operating room team members aids in effective personal protective equipment facilitation to keep both healthcare providers and patients safe as well as to prevent hospital-based transmission of COVID-19.

Surgeon stress negatively affects their non-technical skills in the operating room

BackgroundPoor surgeons’ non-technical skills (NTS) and excessive stress and workload are known contributors to surgical errors. Our aim was to examine the relationship between surgeons’ stress and workload, and their observed NTS intraoperatively. MethodsSurgeon’s NTS were rated in the operating room (OR) by trained observers. Surgeon stress, workload, familiarity with the OR team, prior experience, and case difficulty were captured. Relationships between variables were assessed. ResultsFifteen surgeons participated in our study. Agreement among raters was high for NTS observations (ICC range = 0.56–0.96). Stress was negatively correlated with situation awareness, and workload was negatively correlated with decision making. Less familiarity among the team was correlated with higher stress. ConclusionsSurgeons’ stress and workload negatively affected their NTS in the OR. Further, unfamiliarity with the surgical team contributed to surgeon’s stress. Methods to reduce surgeons’ stress and workload such as mental skills training should be considered.

Perioperative Medical and Surgical Coronavirus Disease 2019 Issues: Keeping Surgeons, Operating Room Teams, and Patients Safe

BackgroundCoronavirus disease 2019 (COVID-19) has infected over 22 million people in the United States (US) and has had a devastating impact on the US economy and healthcare system. In order to help slow the spread of the virus and save hospital resources, nonessential businesses were forced to close and elective surgeries have been postponed. MethodsAs we reach the peak of the pandemic and the COVID-19 vaccine gets distributed, healthcare systems must develop plans to safely resume elective surgeries. This article outlines a single center academic medical center’s perioperative COVID-19 protocol to help keep surgeons, operating room teams, and patients safe. ResultsWhile testing protocols can help minimize the transmission of the virus, there is still the potential for COVID+ patients to undergo surgery undetected, due to potential false negative tests and the long incubation period before seroconversion and symptom development. ConclusionsAn effective institutional strategy not only includes clear perioperative testing protocols, but also education regarding clinical manifestations and exposure control.

Novel Assessments of Technical and Nontechnical Cardiac Surgery Quality: Protocol for a Mixed Methods Study.

BackgroundOf the 150,000 patients annually undergoing coronary artery bypass grafting, 35% develop complications that increase mortality 5 fold and expenditure by 50%. Differences in patient risk and operative approach explain only 2% of hospital variations in some complications. The intraoperative phase remains understudied as a source of variation, despite its complexity and amenability to improvement.ObjectiveThe objectives of this study are to (1) investigate the relationship between peer assessments of intraoperative technical skills and nontechnical practices with risk-adjusted complication rates and (2) evaluate the feasibility of using computer-based metrics to automate the assessment of important intraoperative technical skills and nontechnical practices.MethodsThis multicenter study will use video recording, established peer assessment tools, electronic health record data, registry data, and a high-dimensional computer vision approach to (1) investigate the relationship between peer assessments of surgeon technical skills and variability in risk-adjusted patient adverse events; (2) investigate the relationship between peer assessments of intraoperative team-based nontechnical practices and variability in risk-adjusted patient adverse events; and (3) use quantitative and qualitative methods to explore the feasibility of using objective, data-driven, computer-based assessments to automate the measurement of important intraoperative determinants of risk-adjusted patient adverse events.ResultsThe project has been funded by the National Heart, Lung and Blood Institute in 2019 (R01HL146619). Preliminary Institutional Review Board review has been completed at the University of Michigan by the Institutional Review Boards of the University of Michigan Medical School.ConclusionsWe anticipate that this project will substantially increase our ability to assess determinants of variation in complication rates by specifically studying a surgeon’s technical skills and operating room team member nontechnical practices. These findings may provide effective targets for future trials or quality improvement initiatives to enhance the quality and safety of cardiac surgical patient care.International Registered Report Identifier (IRRID)PRR1-10.2196/22536

Applicability of the Disruptions in Surgery Index in the Cardiovascular Management Scenarios - A Marker for Developing Functionally Efficient Teams.

Introduction To support the development of practices and guidelines that might help to reduce adverse events related to human factors, we aimed to study the response and perception by members of a cardiovascular surgery team of various error-driven or adverse features that might arise in the operating room (OR).Methods A previously validated Disruptions in Surgery Index (DiSI) questionnaire was completed by individuals working together in a cardiovascular surgical unit. Results were submitted to reliability analysis by calculating the Cronbach’s alpha coefficient. Non-parametric Kruskal-Wallis test and Dunn’s post-test were performed to estimate differences in perceptions of adverse events or outcomes between the groups (surgeons, nurses, anesthesiologists, and technicians). P<0.05 was considered statistically significant.Results Cronbach’s alpha reliability coefficients showed consistency within the recommended range for all disruption types assessed in DiSI: an individual’s skill (0.85), OR environment (0.88), communication (0.81), situational awareness (0.92), patient-related disruption (0.89), team cohesion (0.83), and organizational disruption (0.83). Nurses (27.4%) demonstrated significantly higher perception of disruptions than surgeons (25.4%), anesthetists (23.3%), and technicians (23.0%) (P=0.005). Study participants were more observant of their colleagues’ disruptive behaviors than their own (P=0.0001).Conclusion Our results revealed that there is a tendency among participants to hold a positive self-perception position. DiSI appears to be a reliable and useful tool to assess surgical disruptions in cardiovascular OR teams, identifying negative features that might imperil teamwork and safety in the OR. And human factors training interventions are available to develop team skills and improve safety and efficiency in the cardiovascular OR.

Ascertaining Design Requirements for Postoperative Care Transition Interventions.

Handoffs or care transitions from the operating room (OR) to intensive care unit (ICU) are fragmented and vulnerable to communication errors. Although protocols and checklists for standardization help reduce errors, such interventions suffer from limited sustainability. An unexplored aspect is the potential role of developing personalized postoperative transition interventions using artificial intelligence (AI)-generated risks. This study was aimed to (1) identify factors affecting sustainability of handoff standardization, (2) utilize a human-centered approach to develop design ideas and prototyping requirements for a sustainable handoff intervention, and (3) explore the potential role for AI risk assessment during handoffs. We conducted four design workshops with 24 participants representing OR and ICU teams at a large medical academic center. Data collection phases were (1) open-ended questions, (2) closed card sorting of handoff information elements, and (3) scenario-based design ideation and prototyping for a handoff intervention. Data were analyzed using thematic analysis. Card sorts were further tallied to characterize handoff information elements as core, flexible, or unnecessary. Limited protocol awareness among clinicians and lack of an interdisciplinary electronic health record (EHR)-integrated handoff intervention prevented long-term sustainability of handoff standardization. Clinicians argued for a handoff intervention comprised of core elements (included for all patients) and flexible elements (tailored by patient condition and risks). They also identified unnecessary elements that could be omitted during handoffs. Similarities and differences in handoff intervention requirements among physicians and nurses were noted; in particular, clinicians expressed divergent views on the role of AI-generated postoperative risks. Current postoperative handoff interventions focus largely on standardization of information transfer and handoff processes. Our design approach allowed us to visualize accurate models of user expectations for effective interdisciplinary communication. Insights from this study point toward EHR-integrated, "flexibly standardized" care transition interventions that can automatically generate a patient-centered summary and risk-based report.

Starting the first robotic lobectomy program in the Eastern Europe during Coronavirus disease-2019 pandemic.

We report our experience in starting RATS (robotic-assisted thoracic surgery) lobectomy program during COVID-19 pandemic. Data from 20 consecutive cases undergoing RATS lobectomy between August 2020 and April 2021 were prospectively accumulated into our database. The mean operational time was 235±69 minutes (median 210, range 175 to 370). Conversion-to-open rate was 5 %. One patient was converted to an open procedure during surgery due to surgical bleeding. One patient (5 %), with sever chronic obstructive pulmonary disease (COPD), had prolonged air leak with chest drainage 11 days and conservative treatment. Morbidity rate was 10 % (2 patients). Estimated costs of RATS lobectomy in our department were $9,590 (range $8,250-$12,730). 30-days mortality was 0%. Safe robotic surgery is based not only on improved robotic equipment, but also on good technical skills and medical knowledge. It requires training of the entire operating room team. The learning curve is steep, involving port placement, use of the correct robotic arms, availability of the proper instrumentation, and proper patient positioning (Tab. 2, Ref. 28).

Simulating the effects of operating room staff movement and door opening policies on microbial load.

To identify factors that increase the microbial load in the operating room (OR) and recommend solutions to minimize the effect of these factors. Observation and sampling study. Academic health center, public hospitals. We analyzed 4 videotaped orthopedic surgeries (15 hours in total) for door openings and staff movement. The data were translated into a script denoting a representative frequency and location of movements for each OR team member. These activities were then simulated for 30 minutes per trial in a functional operating room by the researchers re-enacting OR staff-member roles, while collecting bacteria and fungi using settle plates. To test the hypotheses on the influence of activity on microbial load, an experimental design was created in which each factor was tested at higher (and lower) than normal activity settings for a 30-minute period. These trials were conducted in 2 phases. The frequency of door opening did not independently affect the microbial load in the OR. However, a longer duration and greater width of door opening led to increased microbial load in the OR. Increased staff movement also increased the microbial load. There was a significantly higher microbial load on the floor than at waist level. Movement of staff and the duration and width of door opening definitely affects the OR microbial load. However, further investigation is needed to determine how the number of staff affects the microbial load and how to reduce the microbial load at the surgical table.

Ergonomic Process Improvement for Mapping Risk and Identifying Key Interventions for Eliminating Injuries from Needles and Sharps in the OR

The risk of a needle stick or sharps injury in the operating room (OR) is high due to conditions such as minimal physical protective measures, frequent transfer of sharps, and reliance on human attention and skill for injury avoidance. An ergonomic process improvement project was initiated at a large metro teaching hospital to identify ergonomic risk factors for these OR injuries. To maximize the engagement of the front- end users, an ergonomic process improvement (EPI) team was developed, consisting of representatives from participating OR teams, an employee health nurse and two ergonomists. Surveys, observations, and interviews were conducted to quantify injury risk for the OR teams, evaluate barriers to best practice adherence, and identify opportunities for targeted interventions. Risk mapping was completed for the surgeons, surgical techs and OR nurses identifying double gloving and safe passing zone as areas in need of improvement. Through observation and interviews, researchers identified physical factors relating to musculoskeletal pain and cognitive factors leading to distractions as safety risk concerns. The overall success of the EPI was the engagement of the OR teams and surgeons in the process of identifying risk factors and potential opportunities for ergonomic solutions related to cognitive workload, physical workload, teamwork, and work design for injury prevention. The risk factors identified will provide the basis for developing targeted, effective interventions for eliminating injuries from needles and sharps within the OR.

Episodes of strain experienced in the operating room: impact of the type of surgery, the profession and the phase of the operation

BackgroundStrain episodes, defined as phases of higher workload, stress or negative emotions, occur everyday in the operating room (OR). Accurate knowledge of when strain is most intense for the different OR team members is imperative for developing appropriate interventions. The primary goal of the study was to investigate temporal patterns of strain across surgical phases for different professionals working in the OR, for different types of operations.MethodsWe developed a guided recall method to assess the experience of strain from the perspective of operating room (OR) team members. The guided recall was completed by surgeons, residents, anesthesiologists, circulating nurses and scrub technicians immediately after 113 operations, performed in 5 departments of one hospital in North America. We also conducted interviews with 16 surgeons on strain moments during their specific operation types. Strain experiences were related to surgical phases and compared across different operation types separately for each profession in the OR.ResultsWe analyzed 693 guided recalls. General linear modeling (GLM) showed that strain varied across the phases of the operations (defined as before incision, first third, middle third and last third) [quadratic (F = 47.85, p < 0.001) and cubic (F = 8.94, p = 0.003) effects]. Phases of operations varied across professional groups [linear (F = 4.14, p = 0.001) and quadratic (F = 14.28, p < 0.001) effects] and surgery types [only cubic effects (F = 4.92, p = 0.001)]. Overall strain was similar across surgery types (F = 1.27, p = 0.28). Surgeons reported generally more strain episodes during the first and second third of the operations; except in vascular operations, where no phase was associated with significantly higher strain levels, and emergency/trauma surgery, where strain episodes occurred primarily during the first third of the operation. Other professional groups showed different strain time patterns.ConclusionsMembers of the OR teams experience strain differently across the phases of an operation. Thus, phases with high concentration requirements may highly vary across OR team members and no single phase of an operation can be defined as a “sterile cockpit” phase for all team members.

Robotic Assisted Surgery: The Gap Between Challenges And Solutions

A roboticist by the name of Rodney Brooks once said, “the benefits of having robots could vastly outweigh the problems.” While this may be true, it is important to assess these problems and understand how they may be mitigated. The use of robots is growing in many industries and can be found in areas such as manufacturing, healthcare, agriculture, food preparation and national defense. Within healthcare, robots are commonly used in surgery to perform procedures such as sacrocolpopexies, prostatectomies, hysterectomies, hernia repairs and nephrectomies. The benefits of robotic-assisted surgery (RAS) are similar to laparoscopy and include decreased blood loss, faster recovery time, and shorter lengths of stay at the hospital. Unlike purely laparoscopic surgery, the robot provides wrist dexterity, allowing for more complex surgeries to be performed in a minimally invasive fashion by surgeons who may not have expertise in laparoscopy. However, recent reports have heightened challenges facing RAS operating room (OR) teams. Effects of the OR layout, team communication, team coordination, disruptions to workflow, and equipment malfunctions were among the issues observed in a variety of RAS procedures. Issues such as disruptions to the workflow trigger delays and inefficiencies, which in turn could affect patient safety and quality of care. As part of a wider study to implement and evaluate multiple interventions associated with improving efficiency and safety of RAS, a literature search was conducted to investigate issues experienced by the OR team in RAS and the interventions developed and tested to resolve these issues. The literature search excluded studies concerned with laparoscopic and open surgery; proficiency training; and articles that were not written in English. Commentaries, editorials, and abstracts were further excluded. At the conclusion of the literature search, 17 articles involving the implementation or evaluation of interventions surrounding RAS were evaluated and categorized based on the issues that were addressed. Seven articles discussed disruptions to the OR team’s workflow; five articles discussed issues with patient safety, surgical complications, or risk assessment; three papers discussed issues with teamwork; and the remaining articles discussed issues with communication, efficiency, cognitive load, and surgical performance. Despite the number of articles that were found to discuss issues in RAS, only four of the 17 articles implemented interventions. The interventions primarily included the use of checklists and nontechnical skills training. The scarce number of articles focusing on interventions aimed at improving the safety, quality, and efficiency of RAS demonstrates the wide gap that exists between known problems and potential solutions. As the number of robotic-assisted procedures continue to grow, it is important to improve OR team efficiency and patient care. The current study is part of a five-year, four-site study investigating the nature of issues that exist in RAS. The larger study will also design and implement interventions based on RAS observations conducted by the researchers in an effort to ensure that the benefits of robotic surgery truly do outweigh the existing problems.

Learning experience on sentinel cases of COVID-19 at a public healthcare institution: sharing on operating room processes.

Learning experience on sentinel cases of COVID-19 at a public healthcare institution: sharing on operating room processes.

Operating room efficiency and cost reduction in shoulder arthroplasty: is there an advantage of a dedicated operating room team?

Operating room (OR) efficiency is a crucial component in the delivery of high quality, cost-efficient healthcare in orthopedic shoulder arthroplasty, and generally in surgery. Utilizing a dedicated OR team may lead to higher clinical efficiency by potentially reducing total OR time and cost while avoiding operational redundancies or errors. The purpose of this study is to identify specific parameters influencing OR efficiency with a 2-roomed system with dedicated OR staff and evaluate its influence on operational cost of the OR per min. From 2017 to 2018, 348 patients underwent primary shoulder arthroplasty at one institution, that had 2 established OR systems: A traditional “1-room” system (TS) with general OR staff, and a “2-room” shoulder service (SS) with a dedicated OR team. Medical health records were accessed to obtain pertinent study data, which included demographics, surgical indication, and time-points per surgical case. Anesthesia preparatory time (APT) was time from patient OR entry to skin incision; surgery time (ST) – from skin incision to skin closure; conclusion time (CT) – from skin closure to patient exiting OR; and turnover time (TT) – time from 1 patient's exiting to the next patient's admittance into the OR. Nonoperative time was a summation of APT, CT, and TT, while Total OR time comprised of nonoperative time and ST. Cost equivalent per minute OR operation was then used to calculate differences between the 2 interest groups. The SS treated 270 patients (77.6%) and TS treated 78 patients (22.4%). The SS demonstrated a 74 minutes decrease in total OR time (116 vs. 190 minutes) when compared to the TS ( P < .0001). When surgeon factor (“surgery time”) was removed, the SS consistently demonstrated a 23-minute decrease in nonoperative time (76 vs. 99 minutes, P < .0001) and a 26-minute decrease in turnover time (14 vs. 40 minutes, P < .0001) – about a 3-fold reduction. When analyzing cost, the SS demonstrated a $291 decrease in nonoperative cost per case ($1090 vs. $1381, P < .0001) despite the staffing cost of 3 floating staff members. The TT reduction translated to $360 savings in OR cost per case ($198 vs. $558, P < .0001). A dedicated OR team using 2 ORs improves both clinical efficiency (decreases total OR time) and reduces cost (decreases total OR cost) - despite having more staff members and associated staffing costs - compared to a traditional 1-room system. When surgeon-specific factors were removed, the largest reduction in OR cost was associated with decrease in turnover time. Level III.

Noise in Endoscopic Sinus and Skull Base Surgery Operating Rooms.

Noise in the operating room (OR) contributes to miscommunication among team members and may negatively impact patient outcomes. This study aimed to quantify noise levels during endoscopic sinus and skull base surgery. The secondary aim was to understand how OR team members perceive noise during endoscopic sinus and skull base surgery. Noise levels were measured using the validated phone application SoundMeter X 10.0.4 (r1865) (Faber Acoustical, Utah, USA) at the ear-level of the surgeon, scrub nurse, circulating nurse, and anesthesiologist. At the end of each surgery, OR team members were asked to complete a six-question questionnaire about noise during that surgery. One thousand four hundred and two noise measurements were recorded across 353 trials. The loudest mean noise measurement was 84.51 dB and maximum noise measurement was 96.21 dB at the ear-level of the surgeon. Noise was significantly higher at the ear-level of the surgeon and scrub nurse in comparison to the circulating nurse (p = .000) and anesthesiologist (p = .000). Forty percent of questionnaire respondents believed noise was a problem and 38% stated that noise caused communication issues during surgery. Surgeons and scrub nurses have significantly higher noise exposure in comparison to circulating nurses and anesthesiologists during endoscopic sinus and skull base surgery. For these members of the OR team, noise is also identified as problematic and causing issues with communication. Mechanisms to reduce potential noise may be implemented to improve communication and patient outcomes in endoscopic sinus and skull base surgery.

Comprehensive Literature Search to Identify Assessment Tools for Operating Room Nontechnical Skills to Determine Common Critical Components.

Effective use of nontechnical skills (NTS) contributes to the provision of safe, quality care in the fast-paced, dynamic setting of the operating room (OR). Inter-professional education of NTS to OR team members can improve performance. Such training requires the accurate measurement of NTS in order to identify gaps in their utilization by OR teams. Although several instruments for measuring OR NTS exist in the literature, each tool tends to define specific NTS differently. We aimed to determine commonalities in defined measurements among existing OR NTS tools. We undertook a comprehensive literature review of assessment tools for OR NTS to determine the critical components common to these instruments. A PubMed search of the literature from May 2009 to May 2019 combined various combinations of keywords and Medical Subject Headings (MeSH) related to the following subjects: teamwork, teams, assessment, debriefing, surgery, operating room, nontechnical, communication. From this start, articles were selected describing specific instruments. Three reviewers then identified the common components measured among these assessment tools. Reviewers collated kin constructs within each instrument using frequency counts of similarly termed and conceptualized components. The initial PubMed search produced 119 articles of which 24 articles satisfied the inclusion criteria. Within these articles, 10 assessment tools evaluated OR NTS. Kin constructs were grouped into six NTS categories in the following decreasing frequency order: communication, situation awareness, teamwork, leadership, decision making, andtask management/decision making (equal). NTS OR assessment tools in the literature have a variety of kin constructs related to the specific measured components within the instruments. Such kin constructs contain thematic cohesion across six primary NTS groupings with some variation in scale and scope. Future plans include using this information to develop an easy-to-use assessment tool to assist with debriefing in the clinical environment.

Qualitative Analysis of Effective Teamwork in the Operating Room (OR)

To conduct focus group interviews with operating room (OR) personnel to determine components of effective teamwork to inform a revision of a teamwork assessment instrument. Qualitative research study targeting OR personnel using semi-structured focus group interviews of interprofessional OR personnel. Responses were digitally recorded and transcribed. Qualitative analysis was undertaken by 2 reviewers who identified major themes related to effective teamwork. Inter-coder agreement was employed to confirm findings and themes. Major academic medical center and Level 1 Trauma Center in Southeastern United States. Fifteen OR staff members including surgeons, an anesthesiologist, nurse anesthetists, circulating nurses, and scrub technicians. Three focus groups involving 15 individuals (2 surgeons, 1 anesthesiologist, 8 nurse anesthetists, 2 circulating nurses, and 2 surgical technologists) were conducted over a 1-month period in 2017. Four major themes related to effective teamwork emerged from analysis: (1) Smooth flow, (2) United effort, (3) Communication, and (4) Positive attitude. Among the OR team members, agreement regarding effective teamwork centers around the concepts of smooth procedural flow, unified effort, clear communication, and positive attitude of the team. These findings have helped refine a teamwork instrument to increase its utility for formative use in the clinical environment.

Videoscope-Assisted Cleft Palate Surgery: Rationale, Experience, and Technical Implementation.

Limited visibility characteristic of cleft palate repair presents both ergonomic and educational challenges to cleft surgeons. Despite widespread recognition and reporting, posture-related spine disorders continue to represent a significant and potentially career-limiting problem for cleft/craniofacial surgeons. In addition, education and participation during palate repairs is difficult because of visual field constraints. At the authors' institution, a novel videoscope system was designed and implemented to (1) provide visualization for all surgical team members during palate operations, (2) facilitate active resident education, and (3) improve surgeon ergonomics. The authors' prior report demonstrated proof of concept for this method, which is now used in all cleft palate operations at their center. The purpose of this report is to share the detailed methodology to facilitate implementation by others and a retrospective review of the authors' experience before and after implementation. Video demonstration of the videoscope setup and a representative, recorded case are provided. The use of the videoscope was feasible in palatoplasties regardless of palatal phenotype and repair technique and did not have an effect on operative time. Subjectively, the authors report reduced procedure time in cervical flexion and subjectively improved musculoskeletal strain associated with videoscope use. Importantly, use of this system also provided complete visualization for all operating room team members and enabled enhanced resident autonomy during palate operations. Finally, it has facilitated the creation and archive of high-definition educational videos with unparalleled perspective. The equipment required to implement the system is likely already available in many medical centers. Adoption of this system may provide an opportunity to improve posture and teaching capabilities for cleft surgeons. CLINICAL QUESTION/LEVEL OF EVIDENCE:: Therapeutic, III.

The Effect of Noise Levels in the Operating Room on the Stress Levels and Workload of the Operating Room Team

PurposeThe research was conducted to evaluate the noise levels and the effect of noise on the workload and stress levels of the operating room (OR) staff of a public hospital. DesignDescriptive and cross-sectional study. MethodsThe data were obtained by measuring ambient noise during 403 orthopaedic, urological, and general surgeries on weekdays between July and October 2019. We measured the noise by dividing the surgery into three phases. These phases are as follows: from the entry of the patient, induction of anesthesia, and preparation of the surgical area until the start of the procedure (Phase I), from the incision until the completion of closure and dressing application (Phase II), from the completion of closure and dressing application until the exit of the patient (Phase III). Furthermore, the workload and stress levels of 45 OR staff who work in the general surgery, orthopaedics, and urology ORs were measured. Data were collected using a CA 834 noise measurement device, State-Trait Anxiety Inventory (STAI Form TX-I), the National Aeronautics and Space Administration (NASA) Task Load Index Workload Scale, and Information form related to surgery and ORs. FindingsThe noise in the OR was higher than 35 dB, A-weighted [dB(A)], the limit proposed by the World Health Organization for hospitals. Phase I average noise level was 63.00 ± 3.50, Phase II average noise level was 62.94 ± 3.75, and Phase III average noise level was 63.67 ± 2.81. The mean anxiety score was 34.50 ± 6.09. The total workload level was found to be 56.91 ± 15.67. Anxiety scores and workload scores had positive weak and moderate correlations with noise levels (P < .01). ConclusionsThe noise in the OR was high, and anxiety scores and workload scores correlated positively with noise levels.