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This study aimed to assess the levels of psychological capital, job crafting, and innovative behavior among operating room nurses and to examine the mediating mechanism of job crafting in the relationship between psychological capital and innovative behavior. A multicenter cross-sectional study was conducted. In June 2025, a total of 361 operating room nurses from six tertiary hospitals in Nanjing, China, were recruited via convenience sampling. Data were collected electronically using validated scales: Demographic Questionnaire, the Psychological Capital Questionnaire, the Job Crafting Scale, and the Nurse Innovative Behavior Scale. Data were analyzed using SPSS 26.0 and AMOS 28.0. Structural equation modeling with bootstrapping tested the mediation model, controlling for educational level and specialist nurse status. Participants reported moderate-to-high levels of psychological capital, job crafting, and innovative behavior. Correlation analysis revealed that innovative behavior was significantly and positively correlated with both psychological capital and job crafting. Hierarchical regression analysis, controlling for significant covariates, showed that both psychological capital and job crafting contributed significantly to the variance in innovative behavior. Mediation analysis demonstrated that job crafting partially mediated the relationship between psychological capital and innovative behavior. Operating room nurses reported moderately high levels of psychological capital, job crafting, and innovative behavior. Furthermore, job crafting was identified as a significant partial mediator in the relationship between psychological capital and innovative behavior. Nursing management can foster innovation in operating room nurses by developing psychological capital and job crafting skills through targeted training and academic support.

In this study, the authors designed checklists to guide care during operating-room crises and evaluated them in a simulated operating room. The availability of checklists improved adherence to best practices by operating-room teams during simulations of surgical crises. Operating-room crises (e.g., massive hemorrhage and cardiac arrest) are high-risk, stressful events that require rapid and coordinated care in a time-critical setting. The reported incidence may be rare for an individual practitioner, 1 but the aggregate incidence for a hospital with 10,000 operations a year is estimated to be approximately 145 such events annually. 2 These are situations in which the way the team cares for a patient will make the difference between life and death. Failure to effectively manage life-threatening complications in surgical patients has been recognized as the largest source of variation in surgical mortality among hospitals. 3 – 7 Small-scale studies . . .

Background The operating room is a high-risk environment where proper patient positioning is crucial for minimizing injury and ensuring optimal access to surgical sites. This process requires effective collaboration among surgical team members, particularly operating room nurses who play a vital role in patient safety. Despite advancements in technology, challenges such as pressure injuries persist, with a significant incidence rate. Video-based training (VBT) emerges as a promising educational tool, enhancing knowledge retention and fostering a learner-centered approach. This study aims to evaluate the impact of VBT on adherence to surgical positioning standards, highlighting its potential to improve safety protocols in the operating room. Methods In this clinical trial, 62 qualified operating room nurses (50 women, 12 men, average age: 28.90 ± 3.75 years) were randomly divided into control and intervention group ( n  = 31 in each group). The control group only received positioning recommendations, but in the intervention group, in addition to the recommendations, video-based surgical positioning training was performed for 1 month, at least 3 times a week. The performance of nurses in both groups was evaluated through a researcher-made checklist at baseline and post-intervention. Results Based on findings, there was no significant difference between the two groups in compliance with surgical positioning standards at baseline ( p  = 0.07). However, after the intervention, compliance scores significantly improved in the VBT group compared to the control group ( p  < 0.001). The VBT group showed a mean improvement of 62.12 points, while the control group improved by 10.77 points ( p  < 0.001). Conclusions This preliminary study demonstrated a notable improvement in compliance with surgical positioning standards among operating room nurses following VBT intervention. Despite the promising results, the small sample size and preliminary nature of the research necessitate further studies to confirm these findings and assess long-term outcomes. These initial insights highlight the potential of innovative training methods in enhancing surgical practices.

Purpose of ReviewOperating rooms are critical financial centers for hospital systems, with surgical care representing about a third of all health care spending. However, not all of the costs are appropriate or necessary, as there are sometimes significant inefficiencies in how operating rooms are utilized.Recent FindingsRecent innovations utilizing patient-centered data, systems principles from manufacturing industries, and enhanced communication processes have made significant improvements in improving operating room efficiency.SummaryBy focusing on improving communication, standardizing processes, and embracing a learning health system with innovations, significant improvements in operating room efficiency can be seen to improve outcomes and costs for the health system and patient.

Perception of a surgeon based on physical attributes in the operating room (OR) environment has not been assessed, which was our primary goal. A common OR scenario was simulated using 8 different actors as a lead surgeon with combinations of age (<40 vs. >55), race (white vs. black), and gender (male vs. female). One video scenario with a survey was electronically distributed to surgeons, residents, and OR nurses/staff. The overall rating, assessment, and perception of the lead surgeon were assessed. Of 974 respondents, 64.5% were females. There were significant differences in the rating and assessment based upon surgeon's age (p = .01) favoring older surgeons. There were significant differences in the assessments of surgeons by the study group (p = .03). The positive assessments as well as perceptions trended highest towards male, older, and white surgeons, especially in the stressful situation. While perception of gender bias may be widespread, age and race biases may also play a role in the OR. Inter-professional education training for OR teams could be developed to help alleviate such biases. •In addition to widespread phenomenon of gender bias, age bias may also play a role in the operative environment.•Perception towards the lead surgeon changes in operating room especially when situation gets stressful.•Assessment and perception of the surgeon from fellow surgeons vs. OR staff varies significantly; staff being more negative.

Intraoperative radiography imaging is essential for accurate spinal implant placement. Hazards caused by ionizing radiation raised concern on personnel’s work life long exposure in the operating room (OR). To particularize a cumulative risk estimation of radiation of personnel and patient, depending on used methods (C-arm fluoroscopy, O-arm navigation) and patient characteristics during spinal surgery, detailed investigation of radiation exposure in a clinical setting is required. Lumbosacral dorsal spinal fusion was performed in 37 patients (19 navigated, 18 fluoroscopy) during this prospective study. Radiation exposure was measured on several body regions with thermoluminescent dosimeters on patient and OR personnel (surgeon, assistant, sterile nurse, radiology technologist). Comparison between patient characteristics and radiation exposure was included. The highest patients values were measured in the surgery field and gonads area during navigation (43.2 ± 19.4 mSv; fluoroscopy: 27.7 ± 31.3 mSv; p = 0.02), followed by the thoracic region during fluoroscopy (7.7 ± 14.8 mSv; navigation: 1.1 ± 1.0 mSv; p = 0.06), other measured regions can be considered marginal in comparison. Amongst OR personnel exposure of the surgeon was significant higher during fluoroscopy (right hand: 566 ± 560 µSv and thoracic region: 275 ± 147 µSv; followed by thyroid and forehead) compared to navigation (right finger: 49 ± 19 µSv; similar levels for all regions; p < 0.001 in all regions). When compared to the surgeon, other OR personnel had significantly lower radiation doses on all body regions using fluoroscopy, and similar dose during navigation. The highest eye’s lens region value was measured during fluoroscopy for the patient (185 ± 165 µSv; navigation: 205 ± 60 µSv; p = 0.57) and the surgeon (164 ± 74 µSv; navigation: 92 ± 41 µSv; p < 0.001). There was a significant correlation between patient BMI and radiation exposure to the surgery field during fluoroscopy. To our knowledge, these data present the first real life, detailed comparison of radiation exposure on OR personnel and patients between clinical use of navigation and fluoroscopy. Although patient’s radiation dose is approximately 3-fold during navigation compared to the fluoroscopy, we found that a spinal surgeon could perform up to 10-fold number of surgeries (10.000 versus 883) until maximum permissible annual effective radiation dose would be reached. Especially for a spinal surgeon, who is mainly exposed amongst OR personnel, radiation prevention and protection must remain a main issue.

Canada's health care systems contribute about 4.6% of Canada's greenhouse gas emissions and 200 000 tonnes of other pollutants, with operating rooms (ORs) having a substantial environmental impact. In this guideline, we provide actionable recommendations to increase the environmental sustainability of ORs. This guideline was developed by the Best Practice in Surgery Group from the University of Toronto, with national representation. We followed the Appraisal of Guidelines for Research and Evaluation (AGREE) Health Services tool, ADAPTE, and Guidelines International Network principles. Given the nature of the evidence, we created a unique grading matrix based on the triple bottom line (people, profit, planet) and did not assess quality of studies. Twenty-four rapid reviews informed the guideline, and we used a modified Delphi approach to reach consensus. We conducted external reviews with various hospitals across Canada. We outline 21 recommendations to improve the environmental sustainability of ORs, grouped into 4 categories: reduce, reuse, recycle, and rethink. The \"reduce\" category focuses on decreasing unnecessary waste by way of appropriate waste segregation, decreasing pharmaceutical waste, reducing instruments in surgical trays and custom packs, and lowering unnecessary energy use. We also provide recommendations for reducing emissions from inhalational anesthesia. \"Reuse\" emphasizes replacing disposable items - such as medical devices, textiles, and sharps containers - with reusable alternatives. \"Recycle\" includes recommendations for traditional and specialized recycling programs. \"Rethink\" includes strategies with limited direct evidence but considered essential to long-term sustainability, such as donations, alcohol hand rub, and environmentally preferrable purchasing policies. Operating rooms greatly contribute to the environmental burden of the Canadian health care system and these recommendations can help to reduce this impact.

As much as 85% of hospital waste is nonhazardous solid waste.2,24 Unfortunately, 50%-85% of waste that should be disposed of as solid waste is actually disposed of as biohazard waste.25 The same improper disposal of waste can be seen in the operating room, where one case study reported that up to 92% of discarded biohazard waste may be nonhazardous.3 Expert opinion suggests that biohazard waste should constitute no more than 15% of an institution's total waste stream.26 Inappropriate disposal is largely due to a lack of awareness among health care workers on what constitutes biohazard waste.2,25 A single surgery may produce up to 12 L of fluid waste, and a typical operating room generates up to 2 tons of fluid waste each month.27 Fluid disposal in the operating room traditionally occurs by pouring fluids into wastewater streams, collecting fluids in surgical suction canisters and disposing of them as biohazard waste, or mixing the fluids with solidifiers with subsequent disposal in the regular waste stream. Surgical suction canisters are estimated to include up to 25% of biohazard waste from operating rooms.27,28

The operating room is a major cost and revenue center for most hospitals. Thus, more effective operating room management and scheduling can provide significant benefits. In many hospitals, the post-anesthesia care unit (PACU), where patients recover after their surgical procedures, is a bottleneck. If the PACU reaches capacity, patients must wait in the operating room until the PACU has available space, leading to delays and possible cancellations for subsequent operating room procedures. We develop a generalizable optimization and machine learning approach to sequence operating room procedures to minimize delays caused by PACU unavailability. Specifically, we use machine learning to estimate the required PACU time for each type of surgical procedure, we develop and solve two integer programming models to schedule procedures in the operating rooms to minimize maximum PACU occupancy, and we use discrete event simulation to compare our optimized schedule to the existing schedule. Using data from Lucile Packard Children’s Hospital Stanford, we show that the scheduling system can significantly reduce operating room delays caused by PACU congestion while still keeping operating room utilization high: simulation of the second half of 2016 shows that our model could have reduced total PACU holds by 76% without decreasing operating room utilization. We are currently working on implementing the scheduling system at the hospital.

Background Approximately half of all adverse events occur in the operating room, highlighting the critical role of non-technical skills in operating rooms. Effective non-technical skills among operating room nurses can significantly reduce the occurrence of such events. Moreover, self-efficacy in non-technical skills may directly impact professional performance and patient safety. Therefore, this study aimed to investigate the impact of intraoperative non-technical skills training on scrub practitioners' self-efficacy. Methods In a randomized controlled trial, 30 scrub practitioners were assigned to the intervention group and 30 to the control group through random allocation. The intervention group underwent training in non-technical skills using a combined technique of lectures and simulated video scenarios delivered in two two-hour training sessions. Meanwhile, the control group received no training. The data collection tool was a two-part questionnaire. The first part collected demographic data (age, gender, work experience, and educational level), while the second part assessed scrub practitioners' self-efficacy in intraoperative non-technical skills. The questionnaire was administered online in two phases, with a one-month interval between them, through the Telegram application to the participants in both groups. The data were analyzed using descriptive statistics, independent t-tests, and paired t-tests. Results The demographic variables of the intervention group did not show significant differences compared to the control group. The independent t-test revealed no significant difference in overall self-efficacy between the intervention and control groups before the training ( P  = 0.513). However, after the training, a statistically significant difference was observed ( P  = 0.025). There were no significant differences among the self-efficacy components between the intervention and control groups before the training ( P  > 0.05). However, after the training, self-efficacy in the two skills of situation awareness and communication and teamwork showed statistically significant differences ( P  < 0.05). Conclusion Non-technical skills are crucial for scrub practitioners to perform their tasks safely and efficiently. Training can enhance the self-efficacy of scrub practitioners in their non-technical skills. Therefore, it is necessary to incorporate non-technical skills training into the educational curriculum and continuing education programs for scrub practitioners. Trial registration The IRCT code (IRCT20150715023216N15) was obtained from the Iranian Clinical Trials Registry website on 2023/08/05 before sampling.