手术室供应室一体化运作中器械的管理

目的探讨手术室供应室一体化运作中有效的器械管理方法。方法收集该院2012年6月—2013年1月实施手术所用的组织钳、止血钳共2000件,将所有器械随机分为试验组和对照组。试验组器械由供应室专门负责全部工作流程,对照组器械由手术室护理人员负责清洗、消毒、包装、灭菌。结果试验组手术器械的清洗合格率为97.5%,灭菌合格率为98.5%;对照组手术机械的清洗合格率为85.5%,灭菌合格率为88%。结论实行手术室与供应室一体化运作管理手术器械可以有效地提高手术器械护理的合格率。     

Anesthesia Residents Preferentially Request Operating Room Case Assignments with Complex Cases

Self-directed learning is associated with knowledge and performance improvements, increased identification and amelioration of knowledge gaps, and heightened critical appraisal of available evidence. We developed and implemented a decision support system that could support self-directed learning for anesthesia residents by soliciting resident input in case selection. We hypothesized that residents would utilize this system to request complex cases, and that more advanced residents would request more complex cases. Prospective, observational study involving 101 anesthesiology residents. We used a web-based interface, RHINOS [Residents Helping in Navigating Operating Room (OR) Scheduling], which allowed residents to share their rank-ordered preferences for OR assignment. Number of cases per OR, anesthesia base units, time units, and proportion of inpatient cases were used as proxies for case complexity. Data were analyzed using a mixed linear model. Residents requested rooms with fewer cases [F(3,22,350) = 194.0; p < 0.001], more base units [F(3,19,158) = 291.4; p < 0.001], more time units [F(3,19,744) = 186.4; p < 0.001], and a greater proportion of cases requiring inpatient preoperative evaluation [F(3,51,929) = 11.3; p < 0.001]. In most cases, these differences were greater for more advanced residents. As hypothesized, residents requested ORs with higher case complexity, and these cases more often required inpatient preoperative evaluation. More advanced residents exhibited a stronger preference for more educational cases than junior residents.     

Analysis to Establish Differences in Efficiency Metrics Between Operating Room and Non-Operating Room Anesthesia Cases

While a number of studies have examined efficiency metrics in the operating rooms (ORs), there are few studies addressing non-operating room anesthesia (NORA) metrics. The standards established in the realm of OR studies may not apply to ongoing investigations of NORA efficiency. We hypothesize that there are significant differences in these commonly used metrics?. Using retrospective data from a single tertiary care hospital in the 2015 calendar year, we measured turnover times, cancellation rates, first case start delays, and scheduling error (actual time minus scheduled time) for the OR and NORA settings. On average, TOTs for NORA cases were approximately 50% shorter than OR cases (16.21 min vs. 37.18 min), but had a larger variation (11.02 min vs. 8.12 min). NORA cases were 64% as likely to be cancelled compared to OR cases. In contrast, NORA cases had an average first case start delay that was two times greater than that of OR cases (24.45 min vs. 10.58 min), along with over double the standard deviation (11.97 min vs. 5.90 min). Case times for NORA settings tended to be overestimated (?4.07 min versus ?2.12 min), but showed less variation (8.61 min vs. 17.92 min). In short, there are significant differences in common efficiency metrics between OR and NORA cases. Future studies should elucidate and validate appropriate efficiency benchmarks for the NORA setting.     

手术室环境护理在椎管内麻醉手术中的应用价值研究

目的探讨研究手术室环境护理在椎管内麻醉手术中的应用价值。方法将在该院接受椎管内麻醉手术的患者纳入研究,随机分为给予手术室环境护理的观察组和常规护理的对照组,观察麻醉诱导前的负面情绪及做手术切口时的血流动力学指标。结果观察组患者的HAMA评分、HAMD评分以及收缩压、舒张压、心率低于对照组。结论手术室环境护理有助于缓解负面情绪、稳定生命体征,具有积极的临床价值。     

数字化手术室设备的质量控制

目的 探讨现代化手术室开展医疗设备质量控制的思路、内容和实践措施,从而确保手术室医疗设备和附属设施的安全使用和顺利运转.方法 基于手术室各种医疗仪器设备的维修和维护历史数据,提出以设备维修为切入点开展手术室医疗设备质量控制的实践措施.结果 手术室医疗设备实施质量控制后,故障率明显下降,确保了手术的顺利进行和开展.结论 手术室专职医学工程师改变了传统工作模式,将应急维修和预防性维修相结合,积极开展质量控制,对做好手术室医学工程技术保障具有十分重要的现实意义.     

医疗设备信息集成技术在数字化手术室中的应用

手术室与监护病房中应用了大量贵重的医疗设备,在临床应用中,设备产生了大量有意义的临床诊疗数据,这些数据对于临床医疗工作具有重要价值。由于医疗设备普遍存在硬件接口多样化、软件通讯协议没遵循统一标准或不存在统一标准等现象,使得采集此类设备数据、实现设备的信息集成存在相当大的困难。如何实现设备的信息集成是建设数宇化手术室与数字化监护病房建设的门槛。从综合角度对手术室与监护病房常用设备进行了分类,并从通用到个别对各类设备的接口技术与信息集成方法进行了探讨。最后提出了数字化手术室与数字化监护病房建设的建议方案。     

手术室硬式内镜器械清洗管理模式探讨

目的探讨手术室硬式内镜器械清洗管理模式,防止清洗不到位引发消毒失效。方法通过多种清洗模式的对比,分析利弊,寻求符合本院特点的最佳模式。结果供应室人员的专业知识使硬式内镜器械的清洗得到保证。结论内镜的规范清洗管理是内镜消毒灭菌的保证。     

入手术室后心理护理对非全麻手术患者的情绪影响

分析入手术室后心理护理对非全麻手术患者的情绪影响.方法:将180例非全麻手术患者分为实验组和对照组.实验组行常规术前访视及入手术室后心理护理,对照组只进行常规术前访视,比较两组患者的手术配合程度及生理指标.结果:实验组的手术配合程度比对照组的配合程度高,生理指标变化低于对照组,差异有统计学意义(P＜0.05).结论:入手术室后心理护理可改善非全麻手术患者的情绪,使患者尽快地更好地适应手术环境,保持相对稳定的情绪配合手术,为手术的成功奠定了基础.     

消毒供应中心与手术室合作管理的效果探讨

目的研究消毒供应中心与手术室联合管理模式的方法及效果。方法该院自2011年5月起采用消毒供应中心与手术室联合管理模式。完善相关设备配置、培训工作人员、制定标准操作流程。在施行联合管理模式一年后,较联合管理前的手术器械清洗及包装质量、无菌抽查结果等进行比较分析。结果施行联合管理模式后手术器械清洗及包装质量、手无菌抽查结果等与施行前相比有了显著提升,差异有统计学意义（P〈0．05）。结论消毒供应中心与手术室联合管理模式能显著提高手术器械清洗及包装、消毒灭菌的质量,降低院内感染发病率,值得在临床工作中加以推广。     

物流机器人在手术室器械耗材配送中的作用及可行性探讨

目的:探讨运用物流机器人在手术室器械耗材配送中的作用及可行性。方法:选取:烟台毓璜顶医院2019年08月至2019年09月之间的手术,将手术器械耗材配送分为机器人组和人工组。对比两组手术器械耗材的平均配送时间、运送物品遗漏率、运送物品核查正确率、运送物品完好率、避开人和障碍物的智能性等评价指标之间的差异。结果:手术器械耗材的平均配送时间2.1 min,每台手术器械耗材配送可代替2~3人工作量、运送物品遗漏率<1.133%、运送物品核查正确率≥98.954%、运送物品完好率100%、避开人和障碍物的智能性≥89.969%;与人工组对比各项评价指标,各项差异均具有统计学意义(P<0.05)。结论:运用物流机器人配送手术室器械耗材有效缩短物品准备时间,物品准确完备,节省手术护士时间,具有可行性。     

A System-Wide Approach to Physician Efficiency and Utilization Rates for Non-Operating Room Anesthesia Sites

There has been little in the development or application of operating room (OR) management metrics to non-operating room anesthesia (NORA) sites. This is in contrast to the well-developed management framework for the OR management. We hypothesized that by adopting the concept of physician efficiency, we could determine the applicability of this clinical productivity benchmark for physicians providing services for NORA cases at a tertiary care center. We conducted a retrospective data analysis of NORA sites at an academic, rural hospital, including both adult and pediatric patients. Using the time stamps from WiseOR® (Palo Alto, CA), we calculated site utilization and physician efficiency for each day. We defined scheduling efficiency (SE) as the number of staffed anesthesiologists divided by the number of staffed sites and stratified the data into three categories (SE < 1, SE = 1, and SE >1). The mean physician efficiency was 0.293 (95% CI, [0.281, 0.305]), and the mean site utilization was 0.328 (95% CI, [0.314, 0.343]). When days were stratified by scheduling efficiency (SE < 1, =1, or >1), we found differences between physician efficiency and site utilization. On days where scheduling efficiency was less than 1, that is, there are more sites than physicians, mean physician efficiency (95% CI, [0.326, 0.402]) was higher than mean site utilization (95% CI, [0.250, 0.296]). We demonstrate that scheduling efficiency vis-à-vis physician efficiency as an OR management metric diverge when anesthesiologists travel between NORA sites. When the opportunity to scale operational efficiencies is limited, increasing scheduling efficiency by incorporating different NORA sites into a “block” allocation on any given day may be the only suitable tactical alternative.     

传染病手术室护士职业防护依从性的质性研究

目的 了解和探讨传染病手术室护士职业防护依从性的影响因素,提高护士的职业防护意识.方法 以质性研究中的现象学为指导,采用个人访谈法,深度访问某“三甲”传染病手术室工作的10名护士.结果 运用现象学分析法对资料进行分析,得出影响传染病手术室护士职业防护依从性的因素,主要有:防护知识缺乏;防护意识淡漠;超负荷高强度劳动.结论 医院应增强传染病手术室护士职业防护依从性,尽量减少护士的职业伤害,加强各种职业防护教育,增强职业防护意识,合理安排人力资源与工作饱和度,运用和谐伦理观指导临床实践,从而使传染病手术室护士更加积极有效地工作.     

三甲医院IDC机房整体迁移的研究与实践

以容灾思路构建一个新的IDC机房,新建核心网和核心业务系统,以容灾切换的方式从旧机房平滑切换到新机房,完善医院信息系统的架构,有效优化核心业务系统,解决架构缺陷,消除性能瓶颈。同时利用机房整体搬迁的机会,部署和构建AD域控制器、远程管理、虚拟化系统和测试平台等系统,为医院信息系统未来的容灾、备份、信息安全、身份管理、远程维护和瘦客户端的建设奠定坚实基础,从而更有力地支持医院医疗业务的进一步发展。     

探索急救与危重症医学装备保障新模式

急救与危重症医学装备是非常重要的医疗装备,因此此类医学装备的质控与管理也就非常重要.本文根据我院实际工作,对如何做好超大规模急救与危重医学装备的质控与管理进行了讨论,并提出了个人的一些看法.     

某综合医院2010--2011年手术室医护人员职业暴露情况分析

目的了解手术室医护人员职业暴露情况,探讨有效的防护对策。方法使用“医务人员职业暴露个案登记表”记录2010、2011两年手术室医护人员职业暴露相关情况。结果共发生职业暴露46例,其中医生14例,护士30例,护生2例。HBV31例为主要暴露源,锐器损伤38例为主要暴露方式,器械分类和手术缝合各10例为主要环节。暴露后均能正确处理伤口,46例职业暴露无1例感染。结论手术室医护人员易发生职业暴露,应加强医护人员职业安全教育,强化标准预防,做好医院感染环节质量控制。     

一次平滑的升级一次精彩的迁移——厦门中山医院应用戴尔设备及全面解决方案进行系统升级和机房迁移

厦门大学附属中山医院(以下简称"厦门中山医院")是一所有着悠久历史传统的百年医院,经过将近一个世纪的沿革,如今该院已发展成为拥有价值3亿元各类先进医疗设备、1 600张床位,集医疗、教学、科研、预防保健于一体的现代化综合性三级甲等医院,其170余万人次的年门诊量位居全省前列.