A Second Time-Study of the Anaesthetist’s Intraoperative Period

Abstract

This second time-study of the anaesthetist's intraoperative period was conducted at The Ohio State University Hospitals. The study involved a total of 30 anaesthetic procedures. The activities of the anaesthetists were videotaped and analysed independently by three reviewers. Unlike our previous study, the present study was performed at a time when automatic noninvasive arterial pressure monitors, automatic ventilators and patient breathing circuit disconnect alarms were in use. The greatest amount of intraoperative time of the anaesthetist (59.1%) was spent monitoring the patient directly (44.8%) or indirectly (14.3%) via patient monitors. This represented an increase from our previous study attributable to the increased use of technology in the operating room. The anaesthetist still spent about 10-12% of his/her time completing patient records.

Best Practices in OR Suite Layout and Equipment Choices to Reduce Slips, Trips, and Falls

“… Door placement in relation to the OR bed should be such that aseptic and sterile work zones are maintained for surgeons and OR staff members. A modular, structural, ceiling system should be constructed that has multiple mounting locations, each able to hold various support arms, and a center mounting location reserved for a ceiling‐mounted robotic arm. The equipment boom should be placed on the sterile core side of the room away from the OR door. A seated workstation should be placed facing the OR bed and adjacent to the door between the OR and the sterile core. Adequate expansion space should be provided for future robotic systems. A vertical, downdraft, high‐efficiency, particulate air filtered‐curtain system should be installed to reduce airborne impurities.The key priorities for reducing STFs are the same as those for good OR design. Unobstructed access to the patient—this relates to the area primarily around the OR bed so that physicians and perioperative staff members can provide hands‐on care during the procedure with unobstructed floor paths. Clear pathways for the circulating nurse—the pathways for the circulating nurse extend beyond the OR bed to points of access, such as storage shelves, wall‐mounted equipment, and communication devices. Although the practice of ergonomics had some of its early roots in the perioperative area, 13 few recent studies have been conducted using ergonomic analysis techniques in the OR, and many of the studies that do use such techniques (eg, link or flow analysis) focus on the tasks of the anesthesia care provider and not the overall OR layout; none have focused on STF risk 14–21 . In the absence of formal analyses that specify appropriate guidelines, providing OR workers with a formal step in their procedures to clear pathways is critical. Appropriate square footage—if the OR square footage is too small, cramped spaces, restricted walking paths, and increased tripping hazards can contribute to STF risk.…”

“…Clear pathways for the circulating nurse—the pathways for the circulating nurse extend beyond the OR bed to points of access, such as storage shelves, wall‐mounted equipment, and communication devices. Although the practice of ergonomics had some of its early roots in the perioperative area, 13 few recent studies have been conducted using ergonomic analysis techniques in the OR, and many of the studies that do use such techniques (eg, link or flow analysis) focus on the tasks of the anesthesia care provider and not the overall OR layout; none have focused on STF risk 14–21 . In the absence of formal analyses that specify appropriate guidelines, providing OR workers with a formal step in their procedures to clear pathways is critical.…”

Patient data management systems in anaesthesia: an emerging technology

“…28 The PDMS, by automating data acquisition, and improving data presentation, will enable the physician to spend more lime on clinical monitoring and management of the patient, although this has never been proved. Furthermore, these systems may optimize clinical decision-making and improve quality assurance evaluation and risk management programmes.…”

A randomized comparison between records made with an anesthesia information management system and by hand, and evaluation of the Hawthorne effect

“…Fifteen percent of anesthesiologists intraoperative time is dedicated to compiling handwritten records. [1][2][3] Automation of this task can reduce the time devoted to completing anesthetic records [4][5][6] while increasing the quality of data contained in them. [7][8][9][10] Anesthesia information management system (AIMS) technology was once the domain of an enthusiastic minority, but use is increasing.…”