Is ECG monitoring in the operating room cost effective?

ECG monitoring during anesthesia detects many arrhythmias, even in healthy patients. The clinical significance of these arrhythmias is uncertain. However, a conservative analysis of the cost of ECG monitoring in the USA reveals that the prevention of cardiac arrests occurring in 1 of 3,500 cases is quite cost effective. Routine ECG monitoring for all anesthetics in the USA is recommended.     

关于医院洁净手术室应用标准与运行成本的思考

1 目前状况近十年来,我国逐渐出现了大规模的医院建设及改造的高潮,同时也对医院的核心部分一手术室加大了投入,改变了过去那种手术室里空气质量低劣、新风不足、有害挥发性气体浓度过高、室内空气洁净度差而手术感染严重的状况。以控制微生物浓度减少病人感染,提高治疗成功率为目标的空气洁净技     

Sharps injuries in the operating room

Objectives

We aimed to identify who sustains needlestick and sharps injuries, under what circumstances and what actions are taken to minimize the risk and in response to intraoperative NSSIs.

Methods

The cross-sectional study was conducted in 2013 on 215 operation room personnel in 14 hospitals of the Hormozgan province, Iran.

Results

Two hundred and fifty appropriate responders completed the questionnaire (86 %). Anaesthesia 59 (27.4 %) and operation room technicians 55 (25.6 %) sustained the greatest numbers of NSSIs over the past year. Awareness of local protocols was significantly worse in the residents group. The commonest reasons for noncompliance with NSSIs local protocols were not sure of the local protocols 44 (20.4 %) and prolonged operation so unable to leave operation table 37 (17.3 %).

Conclusions

A revision of the local protocol to reduce the time it takes to complete may improve compliance. Education is of paramount importance in making health care workers aware of this issue. The application of safety devices led to a reduction in NSSIs and reduces the risk of blood borne infection as well.     

Patient safety in the operating room

This month's foldout helps hospitals assess their OR culture and pinpoints where breakdowns in communication occur and why they can be deadly. Five risk managers describe their priorities and what their executives ought to know.     

医院手术室人力资源管理

目的：探讨适合基层医院手术室人力资源的最佳管理方法，提高医患满意度。方法：2006年3-7月在手术室采取对手术护士专科配备，并引入配置护工的管理方法。观察比较实施前（2005年10月-2006年2月）和实施后的手术完成情况及医生、患者的满意率。结果：实施后医生和患者的满意率明显高于实施前（均P〈0．05）。结论：手术室护士专科相对固定及护工的引入可有效提高医惠满意度及手术室整体工作效率、质量，降低了用人成本。     

手术室人力资源的有效利用

作者提出在市场经济条件下，要开发人力资源，加强内涵建设，必须树立资源＝交通管理的理念。介绍了通过培养优秀的手术专科护士，护高护理专业的高科技含量，建立知识化的管理人才梯队，制定责任制手术间、弹性排班，弹性排班，合理使用合同护士的一系列管理措施，在手术量大幅上升，而人员、台次比例未有明显增加的情况下，进行了人力资源的合理利用。     

Improving operating room schedules

Operating rooms (ORs) in US hospitals are costly to staff, generate about 70 % of a hospital’s revenues, and operate at a staffed-capacity utilization of 60-70 %. Many hospitals allocate blocks of OR time to individual or groups of surgeons as guaranteed allocation, who book surgeries one at a time in their blocks. The booking procedure frequently results in unused time between surgeries. Realizing that this presents an opportunity to improve OR utilization, hospitals manually reschedule surgery start times one or two days before each day of surgical operations. The purpose of rescheduling is to decrease OR staffing costs, which are determined by the number of concurrently staffed ORs. We formulate the rescheduling problem as a variant of the bin-packing problem with interrelated items, which are the surgeries performed by the same surgeon. We develop a lower bound (LB) construction algorithm and prove that the LB is at least (2/3) of the optimal staffing cost. A key feature of our approach is that we allow hospitals to have two shift lengths. Our analytical results form the basis of a branch-and-bound algorithm, which we test on data obtained from three hospitals. Experiments show that rescheduling saves significant staffing costs.     

High-tech tools transform the operating room

This installment of our quarterly Clinical Management series examines how the hospital operating room is becoming a safer place for patients. Thanks to such technological breakthroughs as 3-D images, virtual patients and robots, surgeons can operate with more accuracy and efficiency.