10 Important Findings for Hospital ORs

1. Most cases of appendicitis do not need to be rushed to the operating room. While providers commonly believe appendicitis cases need to be dealt with swiftly, studies have shown appendicitis patients who waited more than 10 hours to undergo surgery did not demonstrate worse outcomes than those who received immediate care.

2. Many residency programs do not provide basic surgical skills evaluations. In a study, interviews were conducted with 23 invited residency program directors. Results showed only four programs perform formal basic surgical skills evaluation with mandatory remediation. Also, no program director had prevented residents with demonstrable poor basic surgical skills from going to the operating room or used poor basic surgical skills as a reason to deny promotion.

3. A latex-free environment can significantly reduce latex-related allergies among OR staff workers. Approximately 5-15 percent of healthcare workers suffer from latex allergies, and study findings suggested that revamping ORs to be latex-free reduced latex sensitization from 14.1 percent in 1998 to 3.9 percent in 2009.

4. Surgeons' stress levels are linked to length of surgery and blood loss. Researchers assessed stress levels of 66 surgeons and used the NASA Task Load Index and Stress Arousal Checklist and urine biopyrin levels to measure outcomes. Their findings suggest as the length of surgery and the amount of surgical blood loss increased, surgeons' stress levels increased as well.

5. Heart transplants at low-volume transplant centers have higher mortality rates. Johns Hopkins researchers found that high-risk patients transplanted at low-volume centers had a 67 percent increased risk of death one year post-surgery. For both 30-day and one-year survival, there was a significant positive interaction between a center's volume and recipient risk score, indicating the effect of risk on mortality is greater at low-volume centers than would be expected by either variable individually. Overall, center volume mattered less for low-risk patients.

6. The success of surgical safety checklists depends on leaders' ability to persuasively explain why and show how to implement the checklist. A study found that surgical staff members who used the checklist most thoroughly were those who had received explanations and demonstrations as to why and how it should be used. When implementation leaders failed to explain this, staff members became frustrated, uninterested and eventually abandoned the checklist despite a hospital-wide mandate.

7. Surgical staff members who are reminded of the costs of daily bloodwork appear to reduce the amount of routine tests ordered and lower costs for the hospital. At a Rhode Island Hospital, study leaders made a weekly announcement for 11 weeks to surgical house staff. The announcement shared the amount spent on blood draws and laboratory tests per non-ICU patient and as a whole.  At the end of the 11-week study period, the researchers calculated that $54,967 had been saved through reduced bloodwork orders.

8. The time of day may not affect patient survival for heart and lung transplants. Johns Hopkins research covered heart and lung transplants at medical centers across the country from 2000-2010. After one year, the survival rate for heart transplants was 88 percent for daytime recipients and 87.7 percent for those who received a transplant at night. For lung transplants, 83.8 percent of patients who received the organ during the day survived compared to 82.6 percent who underwent surgery at night.

9. Noisy operating rooms may put patients at greater risk for surgical site infections. Researchers measured the sound level during 35 elective open abdominal procedures, and the primary outcome parameter was the SSI rate within 30 days of surgery. The overall SSI rate was 17 percent and the median sound level was significantly higher for those patients who developed an SSI. Sources of noise mentioned in the study include surgical instruments, monitors, alarms, conversation, suction machines and background noise.

10. The addition of an intraoperative monitoring technician may improve OR efficiency and patient outcomes. A study suggested the intraoperative monitoring technician’s sole responsibility would be to supervise intraoperative monitoring during procedures that pose a greater risk of central and peripheral nerve injury. This staff member’s monitoring functions could potentially promote the smoothing of surgical procedures in hospital operating rooms.

Related Articles on OR Efficiency:
4 Steps to Make Hospital ORs More Change-Friendly
6 Steps to Build of a "Culture of Safety" in the Hospital Operating Room
6 Ways to Curb Sharps Injuries and Needle Sticks in the Hospital OR

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