Operating Theatre Staff Research Articles

Effects of music therapy on occupational stress and burn-out risk of operating room staff

ABSTRACT The operating theatre staff is exposed to various constraints such as excessive working hours, severe medical conditions and dreadful consequences in case of malpractice. These working conditions may lead to high and chronic levels of stress, which can interfere with medical staff well-being and patients quality of care. The aim of this study is toassess the impact of music therapy on stress levels and burnout risk on the operating room staff. This is a pre-experimental study including the operating rooms staff of urology and maxillofacial surgery in the academic hospital of Sahloul Sousse (Tunisia) over a period of six weeks. The study consisted of three phases. The first was an initial assessment of stress level with a predefined survey. The second included three music therapy sessions per day over one month. The third was an immediate stress level reassessment following the intervention. Stress levels were evaluated using the Perceived Stress Scale version PSS-10 and the Maslach Burnout Inventory. The overall response rate was 73.9%.The average age of the study population was 37.8 ± 7.7 years with a female predominance (64.7%). After the music therapy program, Perceived Stress Scale average score decreased from 22 ± 8.9 to 16 ± 7.9 (p = 0.006). Concerning the burnout, only the average score of emotional exhaustion decreased significantly from 27 ± 10.8 to 19.2 ± 9.5 (p = 0.004). Music therapy is an innovative approach that seems to reduce operating theatre staff stress. It must be considered as a non pharmacological, simple, economic and non invasive preventive tool.

Intrathecal tranexamic acid during spinal anaesthesia for caesarean delivery: A lethal drug error

The National Committee on Confidential Enquiries into Maternal Deaths recently received notification of a death in South Africa caused by inadvertent intrathecal administration of tranexamic acid (TXA). TXA is increasingly used during caesarean delivery following updated recommendations from the World Health Organization in 2017. However, its greater availability has led to an international rise in drug errors during obstetric spinal anaesthesia. This case highlights a growing clinical risk, of which all operating theatre staff should be aware. Review of existing operating theatre drug handling practices is required in order to decrease this risk. Recommendations are made that aim to minimise drug errors associated with the use of this potentially life-saving intervention.

Implant wastage in orthopaedic trauma: a UK experience.

Implant wastage is an under-reported issue in orthopaedics, yet it has been shown to have a significant cost burden on healthcare budgets. In a background of a perilous financial climate in the UK health service, our aim was to define the frequency and costs of implant wastage in orthopaedic trauma. The trauma theatre's implant logbook was retrospectively analysed between April 2017 and April 2018. Wasted implants were identified by the study authors independently. Patient demographics, implant details and costs were among the data collected. Product codes of wasted implants were used to identify implant costs through the manufacturer. Implant wastage occurred in 25.1% of trauma procedures during the study period. Most wasted implants (91%) were screws. The total cost of implant wastage was £8,377.25 during the 12-month period, accounting for 2% of the total implant budget. Wasted intramedullary nails accounted for almost 50% of the total cost. More than 51% of affected procedures involved a trainee as the primary operator. We report the first study of implant wastage in orthopaedics from the UK. Total implant wastage was higher than reported in most of the published literature, although it represented a small portion of the budget. Implant wastage is attributable to surgeons or operating theatre staff in most cases and is compounded by surgeons' limited understanding of implant costs. Initiatives to reduce implant wastage should include raising awareness of costs and departmental wastage to surgeons and operating theatre staff as well as employing preoperative planning techniques.

Evaluation of Bacterial Flora Among Operation Theatre Staff at a Tertiary Care Hospital

Evaluation of Bacterial Flora Among Operation Theatre Staff at a Tertiary Care Hospital

Initial experience with the subcutaneous implantable cardioverter-defibrillator with the real costs of hospitalization analysis in a single Polish center.

The recent introduction of an entirely subcutaneous implantable cardioverter-defibril-lator (S-ICD) represents an important progress in the defibrillation technology towards a less invasive approach. This is a single-center observational study of S-ICD implantations in Poland. The S-ICD was implanted in 11 patients with standard indications for an ICD. Patients in whom the device was implanted were evaluated for adverse events and device function at hospital discharge. All hospitalization costs were calculated and summed up for all patients. Costs were divided into following categories: medical materials, pharmaceuticals, operating theatre staff, cardiology depart-ment staff, laboratory tests, non-laboratory tests and additional non-medical costs. The mean age of patients was 51.6 ± 16.4 years, 9 were men and 2 were women. Four pa-tients had atrial fibrillation as the basal rhythm, 1 patient had atrial flutter and 6 patients had sinus rhythm. All patients had at least one condition that precluded the use of a traditional ICD system or the S-ICD was preferred due to other conditions, i.e. a history complicated transvenous ICD therapy (18%), anticipated higher risk of infection (27%), lack or difficult vascular access (18%), young age and anticipated high cumulated risk of lifetime device therapy (36%). The mean duration of the im-plantation procedure was 2 h. One patient developed a postoperative pocket hematoma. Mean total time of hospitalization was 28 (6-92) days. Average cost of hospitalization per patient was 21,014.29 EUR (minimal = 19,332.71 EUR and maximal = 24,824.14 EUR). S-ICD implantation appears to provide a viable alternative to transvenous ICD, espe-cially for patients without pacing requirements.

Knowledge and attitudes of theatre staff prior to the implementation of robotic-assisted surgery in the public sector.

BackgroundThe use of robotic-assisted surgery (RAS) is becoming increasingly prevalent across a range of surgical specialties within public hospitals around Australia. As a result, it is critical that organisations consider workplace factors such as staff knowledge, attitudes and behaviours prior to the implementation of such new technology. This study aimed to describe the knowledge and attitudes of operating theatre staff from a large public tertiary referral hospital prior to the commencement of an RAS program.MethodsA cross-sectional survey of nursing, medical and support staff working in the operating theatre complex of a large public tertiary referral hospital was completed over a one-week period in June 2016. A 23-item questionnaire was utilised for data collection.Results164 (66%) theatre staff returned the surveys and were included in this study. The majority of medical staff reported being knowledgeable about RAS, whilst the majority of nursing and support staff did not. Overall the theatre staff were neutral about the potential benefits of RAS to patients. The majority of medical staff believed the implementation of RAS will increase the value of staff roles and job satisfaction, while nursing and support staff were uncertain about these benefits. All three staff groups were concerned about the impact of an RAS program on Workplace Health and Safety, and care and handling.ConclusionOperating theatre staff presented different knowledge and attitudes prior to the introduction of RAS. Whilst theatre staff were more favourable towards RAS than negative, they largely reserved their judgement about the new system prior to their own experiences. Collectively, these findings should be taken into consideration for training and support strategies prior to the implementation of a RAS program.

Do theatre staff use face masks in accordance with the manufacturers' guidelines of use?

Surgical face masks are worn by theatre staff to protect the surgical site from airborne contamination and the wearer from bodily fluid splash. This observational/audit aimed to assess whether theatre staff wear masks in accordance with manufacturers'/Centers for Disease Control and Prevention (CDC) guidelines of use. A total of 1034 surgically scrubbed staff were assessed on their technique of applying surgical face masks, compared to the CDC guidelines as manufacturers' guidelines were not available as per Health and Safety Executive guidelines. Only 18% of surgically scrubbed staff fully complied with the CDC guidelines on the application of a face mask. Compliance was worst in urology, ophthalmology and vascular surgeons, whereas orthopaedic and plastic surgeons were the most compliant. Compliance with CDC face mask guidelines may have an impact on surgical site infections (SSI) and protection of staff from body fluid splash, but most staff do not comply with these guidelines. Most operating theatre staff do not apply a face mask using correct technique, outlined in CDC guidance, which may increase SSI rates. Staff are not aware of existing guidelines for donning a mask.

Near Misses" Regarding Cataract Operation In Small Incision Cataract Surgery: How Do We Rectify Understanding And Documentation?

Background: Aim: Near misses are widely reported to the precursors of adverse events that highlight vulnerabilities and potentially unsafe areas of practice .The aim of this study was to see if a descriptive method of recording near misses was an appropriate method for use in an ophthalmic operating theatre and to quantify how many untoward events were recorded using this system related to the cataract surgery. Subjects and Methods: The study was wholly conducted in a operation theatre in the HIMS, Varanasi. The operation theatre staff assigned to the patient in their journey through the operating theatre was asked to note any untoward events. As, at present, there is no consensus definition of near misses in ophthalmology the staff recorded, in free text, any events that they considered to be a deviation from the normal in that theatre. Results: 250 cataract cases were randomly enrolled, 48 deviations from normal routine were described in 46 patients - that is, 19% of cases. All forms distributed to the staff were returned (100% response rate). The commonest abnormal events were intraoperative (35), with a lesser number being recorded preoperatively (13). When these events were further classified, it was thought that 13 could be classified as near misses. Once true adverse event was recorded during the study. Conclusion: The result suggest that experienced staff in an ophthalmic theatre are a reliable source for collecting data regarding near misses. A consensus is now required to define near misses in ophthalmology and to devise a user friendly input system that can use these definitions to consistently record these potentially vital events.

The Influence of Operation Theater Environment on Patients' Perceptions During Awake Procedures: A Cross-sectional study

To determine the perceptions of patients regarding operation theatre conversation and environment during an awake procedure. The descriptive, cross-sectional study was conducted from February to August 2017 in postoperative wards of Military Hospital, Rawalpindi, Pakistan, and comprised women undergoing gynaecological or obstetric procedures under regional anaesthesia. Closedended questionnaires were distributed via nonprobability convenient sampling. Operation theatre data was collected from the anaesthesia notes, and data was analysed using SPSS 22. There were 93 female subjects with a mean age of 28.23}5.42 years (range: 19-48 years). Overall, 90(96.8%) subjects regarded the conduct of operation theatre staff as cooperative and friendly with 64(68.8%) viewing the conversation among the staff as helpful in relieving anxiety. The thought of anaesthesia waning caused anxiety in 40(43%) subjects, but there was no difference in perceived anxiety between those counselled 61(65%) and not counselled by the anaesthetist. With regards to the environment, 41(44%) subjects said more measures were required to prevent patients from seeing the operating field. Besides, 30(32.2%) and 20(21%)subjects had reservations regarding the presence of male staff and medical students respectively. The opinion regarding medical professionals did not change for 60(64%) subjects after the procedure, and 37(39.8%) recommended that communication skills of medical professional needed improvement. The environment in the theatre can have an influence on the patient's anxiety levels. Counselling by surgeons, casual conversations in the theatre can help alleviate apprehensions of the patients.

Effect of an exfoliating skincare regimen on the numbers of epithelial squames on the skin of operating theatre staff, studied by surface microscopy

The shedding of epithelial squames (skin scales) by staff in operating theatre air is an important source of deep infection following joint replacement surgery. This is a serious complication, resulting in significant morbidity for the patient and substantial cost implications for healthcare systems. Much effort has been put into providing clean air in operating theatres, yet little attention has been given to reducing the shedding of surface skin scales at source. To develop a novel method for calculating surface skin scale density using surface microscopy, and to use it to evaluate the effect of a skincare regimen on operating theatre staff. Surface microscopy with Z-stacked imaging was used to visualize the effect of a skincare regimen involving three stages: washing with soap; exfoliation; and application of emollient. A USB microscope was then used in a field study to take images of the skin of operating theatre staff who applied the regimen to one lower limb the night before testing. The other limb was used as a control. Two blinded assessors analysed scale density. Z-stack images from the surface microscope enabled observations of the skincare regimen. The USB microscope also provided adequate images that enabled assessment of skin scale density. In the operating theatre staff, a 72.1% reduction in visible skin scales was observed following application of the skincare regimen. Further work is required to demonstrate how this effect correlates with dispersion of skin particles in a cleanroom, and subsequently in live operating theatre studies.

Developing Process Maps as a Tool for a Surgical Infection Prevention Quality Improvement Initiative in Resource-Constrained Settings

Surgical infections cause substantial morbidity and mortality in low-and middle-income countries (LMICs). To improve adherence to critical perioperative infection prevention standards, we developed Clean Cut, a checklist-based quality improvement program to improve compliance with best practices. We hypothesized that process mapping infection prevention activities can help clinicians identify strategies for improving surgical safety. We introduced Clean Cut at a tertiary hospital in Ethiopia. Infection prevention standards included skin antisepsis, ensuring a sterile field, instrument decontamination/sterilization, prophylactic antibiotic administration, routine swab/gauze counting, and use of a surgical safety checklist. Processes were mapped by a visiting surgical fellow and local operating theater staff to facilitate the development of contextually relevant solutions; processes were reassessed for improvements. Process mapping helped identify barriers to using alcohol-based hand solution due to skin irritation, inconsistent administration of prophylactic antibiotics due to variable delivery outside of the operating theater, inefficiencies in assuring sterility of surgical instruments through lack of confirmatory measures, and occurrences of retained surgical items through inappropriate guidelines, staffing, and training in proper routine gauze counting. Compliance with most processes improved significantly following organizational changes to align tasks with specific process goals. Enumerating the steps involved in surgical infection prevention using a process mapping technique helped identify opportunities for improving adherence and plotting contextually relevant solutions, resulting in superior compliance with antiseptic standards. Simplifying these process maps into an adaptable tool could be a powerful strategy for improving safe surgery delivery in LMICs.

Incidence of clinical isolates and its antimicrobial resistance pattern among the nasal and hand swabs of operation theatre staff in tertiary and secondary care hospitals

The aim of this study is to identify antimicrobial resistance patterns among bacterial isolates causing nosocomial infection among staff of the surgical units of two hospitals in the north Indian setting. This was a cross sectional study design. Samples were obtained from health care givers with the selection criteria of: No previous history of hospitalization, no history of likely contact with patients of Staphylococcus aureus, and the health personnel available in the operation theatre at the time of sample collection. All the specimens were inoculated on sheep blood agar and MacConkey agar media and thereafter incubated at 37°C for 24 h for the bacterial identification. The MRSA was lower among nasal (8.1%) and hand swabs (6.7%) than MSSA (nasal=33.9%, hand=28.3) among surgeons. However, MSSA was 30% among nasal swabs and 24.1% among hand swabs in tertiary care hospital. Gram positive bacterial isolates were highly resistant to ampicillin (98.3%), amoxy/clav (95.4%), active ingredient (82.3%) and tetracycline (77.1%) in nasal swab of surgeons and OT health staffs in tertiary care hospital while these were ampicillin (84.3%), amoxy/clav (79.9%), active ingredient (68.7%) and tetracycline (65.7%) resistant in secondary care hospital. Gram negative bacterial isolates were highly resistant to ampicillin (88.0%), amoxy/clav, ceftazidime and cefepime (80.0%) each in nasal swab of surgeons and OT health staffs in tertiary care hospital while these were ampicillin (83.0%), amoxy/clav (68.8%), active ingredient (61.1%), ceftazidime and tobramycin (60.0%) each resistant in secondary care hospital. The data of the present study demonstrate the widespread problem of antibiotic resistance among staff of surgical units in the two hospitals. Continued surveillance is necessary to guide appropriate empirical therapy for these infections. It is imperative that all professionals take an active role in infection control within their establishments. More resources should be provided to encourage good antibiotic practice and good hygiene in hospitals.

Intraoperative magnesium sulphate decreases agitation and pain in patients undergoing functional endoscopic surgery: A randomised double-blind study.

Postoperative agitation is harmful for the patient as it may be associated with removal of catheters, nasal packs, oxygen masks and self-injury, and pose a danger to operating theatre staff. The current study investigated the potential role of magnesium sulphate in treatment of postoperative agitation following functional endoscopic sinus surgery. A randomised, double-blinded, placebo-controlled trial. ENT operating room, Menofia University Hospitals, Egypt. A total of 312 adult patients (171 men and 141 women) were enrolled in the study. Eighteen patients (10 men and eight women) were excluded; data from 294 patients were analysed. Inclusion criteria were age between 20 and 60 years, American Society of Anesthesiologists' physical status 1 or 2 scheduled for functional endoscopic sinus surgery. Exclusion criteria were hypertension, cardiac ischaemia, cerebrovascular insufficiency, neuromuscular diseases, pregnancy, prolonged treatment with calcium-channel blockers, diabetic neuropathy or a known allergy to magnesium compounds. Patients were allocated randomly to either the magnesium group (a magnesium infusion of 30 mg kg in the first hour followed by 9 mg kg h until the end of the surgical procedure) or the control group (0.9% saline at the same volume and rate). Hypotensive anaesthesia was induced by nitroglycerine 5 to 20 μg kg min. In the postanaesthetic care unit (PACU), patients were assessed for agitation and pain using the Richmond agitation-sedation scale and numerical rating scale, respectively. The incidence and severity of agitation measured 5 min after admission to the PACU. Magnesium reduced postoperative agitation at time 0 (P = 0.009) and 5, 10, 15 and 30 min after PACU admission (P < 0.0001) as well as total agitation score [3 (0 to 6) versus 9 (0 to 12), P < 0.0001]. Magnesium also reduced pain [4.5 (4 to 5) versus 6 (5 to 6.25), P < 0.0001] and length of PACU stay (88 ± 23 versus 111 ± 31 min, P < 0.0001). The magnesium group consumed less pethidine in PACU compared with the control group (43 ± 15 and 59 ± 19 mg, respectively, P < 0.0001). The intraoperative end-tidal CO2 tension was comparable between groups (4.7 ± 0.7 versus 4.8 ± 1.2 kPa). Intraoperative infusion of magnesium in patients undergoing endoscopic sinus surgery reduced postoperative agitation, pethidine consumption and pain assessed in the PACU. It also decreased the length of stay in PACU compared with the control group. The current study was registered according to WHO and ICMJE standards on 7 January 2014, under registration number PACTR 201402000737691.

Enhancing patient safety in the operating theatre: from the perspective of experienced operating theatre nurses.

Surgical care is an extensive component of modern health care, but patient safety issues and complications of surgery have been identified as a major cause of death and disability. The aim of this study was to identify, from the perspective of experienced operating theatre nurses (OTNs), how patient safety in the operating theatre (OT) can be enhanced. In this phenomenological study, 14 individual interviews were conducted with a purposive sample of 11 participants: ten women and one man. Work experience as an OTN spanned 10-40years. Mean experience was 16years. The enhancement of patient safety in the OT from the perspective of the experienced OTNs is a constant endeavour of managing risks and preventing patient harm it involves respecting the vulnerability of the patient in the OT by being attentive to the patient at each moment, making contact with the patient and recognising how the patient loses all control by being anaesthetised or sedated and is, therefore totally dependent on OT staff. It also involves the OTN navigating the patient as safely as possible through the perioperative process by careful preparation, the use of protocols and checklists and taking measures to prevent complications and harm. Moreover, it involves contributing to a culture of safety by improving work conditions in the OT. Certain competencies of the OTN are essential for the enhancement of patient safety in the OT. These involve both nontechnical and technical competencies. Constantly managing risk and preventing the OT patient from harm is essential according to the experienced OTNs, who are in a key position to identify threats to patient safety and should be empowered to enhance patient safety as a constant endeavour.

Mixed methods study on the use of and attitudes towards safety checklists in interventional radiology.

The use of safety checklists in interventional radiology is an intervention aimed at reducing mortality and morbidity. Currently there is little known about their practical use in Australian radiology departments. The primary aim of this mixed methods study was to evaluate how safety checklists (SC) are used and completed in radiology departments within Australian hospitals, and attitudes towards their use as described by Australian radiologists. A mixed methods approach employing both quantitative and qualitative techniques was used for this study. Direct observations of checklist use during radiological procedures were performed to determine compliance. Medical records were also audited to investigate whether there was any discrepancy between practice (actual care measured by direct observation) and documentation (documented care measured by an audit of records). A focus group with Australian radiologists was conducted to determine attitudes towards the use of checklists. Among the four participating radiology departments, overall observed mean completion of the components of the checklist was 38%. The checklist items most commonly observed to be addressed by the operating theatre staff as noted during observations were correct patient (80%) and procedure (60%). Findings from the direct observations conflicted with the medical record audit, where there was a higher percentage of completion (64% completion) in comparison to the 38% observed. The focus group participants spoke of barriers to the use of checklists, including the culture of radiology departments. This is the first study of safety checklist use in radiology within Australia. Overall completion was low across the sites included in this study. Compliance data collected from observations differed markedly from reported compliance in medical records. There remain significant barriers to the proper use of safety checklists in Australian radiology departments.

Patient satisfaction with the perioperative surgical services and associated factors at a University Referral and Teaching Hospital, 2014: a cross-sectional study.

IntroductionGlobally, increasing consideration has been given to the assessment of patient satisfaction as a method of monitor of the quality of health care provision in the health institutions. Perioperative patient satisfaction has been contemplated to be related with the level of postoperative pain intensity, patients’ expectation of the outcome, patient health provider relationship, inpatient services, hospital facilities, access to care, waiting time, cost and helpfulness of treatments received. The study aimed to assess the level of patient satisfaction with perioperative surgical services and associated factors.MethodsHospital based quantitative cross-sectional study was conducted in University of Gondar teaching hospital from April1-30, 2014. Structured Amharic version questionnaire and checklist used for data collection. All patients who operated upon during the study period were included. Both bivariate and multivariate logistic regression model used to identify the variables which had association with the dependent variable. P-values < 0.05 were considered statistically significant.ResultsTwo hundred and seventy eight patients underwent surgery during the study period. Nine patients were excluded due to refusal to participate in the study. A total of 269 out of 278 patients were included in the study with a response rate of 96.8%. The overall level of patient satisfaction with perioperative surgical services was 98.1%. The variables that had association with the outcome variable from the multivariate analysis were patient admission status (AOR=0.073, CI=0.007-0.765, P=0.029), information about the disease and operation (AOR=0.010, CI=0.001-0.140, P=0.001) and operation theatre staff attention to the patients complains (AOR=0.028, CI=0.002-0.390, P=0.008) respectively.ConclusionThe level of patient satisfaction with perioperative surgical services was high compared with previous studies conducted in the country and other countries in the world. Health professionals need to give emphasis for information on care provision processes, patients' health progress and patients' complaints.

When near enough is not good enough – The sequel reducing sharps injuries in the operating theatre

Intro.: This session will cover a case study of collaboration between the infection control nurses of St. Vincent’s Private Hospital Melbourne and PDMedical with the aim of Reducing Sharps Injuries in the Operating Theatre. This will highlight what can be achieved when industry and the medical sector collaborate. Methods: This collaboration by St Vincent’s Private Infection Control nurses and PDMedical resulted in the development of the Sharps Caddy used in hospital wards. By observing the procedural setup, operation and clean-up process through the eye of the engineer, as well as through discussions with surgeons, nurses, NUM’s and infection control staff, key practices needing consideration were identified. From this, simple changes were identified to improve the safety to staff of sharps injury. Results: This session will present the key findings best able to protect nurses, surgeons and operating theatre staff from sharps injury. The recommendations for and best ways to transition include changes to setup and layout, scrub nurse to surgeon positioning, transfer trays use and valuable incidence recording and safety performance monitoring. Conc.:The solution worthy of consideration is one requiring a few simple changes to help the scrub nurse become more efficient, maintain order through the procedure and improve their own safety as well as the safety of others from sharps injury. If improving safety in theatre and reducing sharps injures is of interest, an outsiders view of what you take for granted may help you see things in a slightly different light and help you achieve your goals

Percutaneous nephrolithotomy in complete supine flank-free position in comparison to prone position: A single-centre experience

ObjectivesTo assess the outcomes of performing percutaneous nephrolithotomy (PCNL) in a modified supine position, more feasible for surgeons, anaesthetists, and operating theatre staff, as well as for the patient himself, and evaluating it in comparison to the standard prone position. Patient and methodsA retrospective, case-control study was conducted between January 2011 and December 2015. In all, 197 patient’s records were reviewed. The initial 101 patients were operated upon in prone position. From mid-2013, 96 patients were operated upon in a complete supine, flank-free position. The groups were compared in terms of operation time, calculated from positioning the patient after anaesthesia induction, insertion of ureteric catheter, puncture of renal system, until the end of procedure; stone-free rate; hospital stay; and postoperative complications, such as transfusion rate, fever, and urinary leakage. ResultsThere were two significant differences between the groups. Firstly, the operation time was a mean (SD) 32.3 (6.6) min shorter for the supine versus the prone position (P<0.001). Secondly, hospital stay was a mean (SD) 1.2 (0.75) days shorter for the supine vs the prone position (P<0.001). The complete stone clearance rate (85.4% for supine vs 79.2% for prone; P=0.2) and postoperative complications (7.3% for supine vs 17.8% for prone; P=0.02) were comparable in both groups. ConclusionSupine PCNL is a feasible procedure with similar outcomes in terms of stone-free rate as well as postoperative complications, to the standard prone PCNL. It reduces unnecessary delay that occurs during change of position resulting in significant shortening of the total operation time and surgeons can perform supine PCNL whilst sitting.

Left-handed surgical instruments - a guide for cardiac surgeons.

For ease of use and to aid precision, left-handed instruments are invaluable to the left-handed surgeon. Although they exist, they are not available in many surgical centres. As a result, most operating theatre staff (including many left-handers) have little knowledge of their value or even application. With specific reference to cardiac surgery, this article addresses the ways in which they differ, why they are needed and what is required - with tips on use.Electronic supplementary materialThe online version of this article (doi:10.1186/s13019-016-0497-9) contains supplementary material, which is available to authorized users.

Use of surgical safety checklists in Australian operating theatres: an observational study.

The use of surgical safety checklists (SSC) is an intervention aimed at reducing mortality and morbidity. Although the effectiveness of their use in surgery has been studied extensively, little is known about their practical use in Australian hospitals. The aim of this study was to observe and document the use of SSC in Australia. This study employed direct observations of checklist use for surgical procedures by trained observers. Medical records were also audited to determine compliance with checklist use and to investigate whether there was any discrepancy between practice (actual care measured by direct observation) and documentation (documented care measured by an audit of records). Among the 11 participating hospitals, overall observed mean completion of the components of the checklist was 27%. Only one hospital used the original World Health Organization checklist. The checklist items most commonly observed to be addressed by the operating theatre staff as noted during observations were: correct patient (99%) and procedure (97%), whether the patient had any allergies (80%), and whether the instrument counts were performed correctly (56%). Findings from the direct observations conflicted with the medical record audit, where there was a higher percentage of completion (86% completion) in comparison to the 27% observed. This is the first study of surgical checklist use within Australia. Overall completion was low across the sites included in this study. Compliance data collected from observations differed markedly from reported compliance in medical records.