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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.

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.

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

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 . . .

BackgroundWith the introduction of robot-assisted surgery, the role and responsibility of the operating room nurses have been expanded. The surgical team for robotic-assisted surgery depends on the ability of the operating room nurses to operate and handle the robotic system before, during, and after procedures. However, operating room nurses must acquire the necessary competencies for robotic-assisted surgery.MethodWe performed a systematic review using the databases MEDLINE and EMBASE to review the evidence on educating and training operating room nurses in robot-assisted surgery. Studies describing operating room nurses’ training and team-training with operating room nurses for robot-assisted surgery were included. The Medical Education Research Study Quality Instrument (MERSQI) and the Newcastle–Ottawa Scale-Education (NOS-E) were used to evaluate the quality of the included studies.ResultsWe identified 3351 potential studies and included 16 in the final synthesis. Nine studies focused on team-training in robot-assisted surgery: four focused solely on training for operating room nurses, and only three on operating room nurses as first assistants in robot-assisted surgery. Most studies examined team-training in RAS, including OR nurses, focused on emergency situations and conversion to an open procedure. Only a few studies addressed other competencies relevant to OR nurses in RAS. No randomized controlled trials were identified. Only a few studies used pre- and post-testing, and only one examined clinical outcomes. The quality assessment of the included studies was moderate to low, with a median MERSQI score of 10.3 and a median NOS-E score of 2.ConclusionThere is sparse research on the education of operating room nurses in robot-assisted surgery, and the literature emphasizes the training of surgeons. More research is needed to develop evidence-based training for operating room nurses in robot-assisted surgery.

Background. Missed nursing care, which has been explored in various acute care settings, results in adverse patient outcomes and job dissatisfaction in nurses. However, little is known about missed care in the operating room. Objective. This study tested a hypothesised model to identify relationships between nurses’ age, years of experience in the operating room, job satisfaction, and intention to leave which have direct and indirect effects on the frequency of missed care. The frequency of missed care was hypothesised to be mediated by nurses reported perioperative competence and the reasons for missed care. Design. A cross-sectional design using an online survey of Australian perioperative nurses was undertaken in 2022. Methods. All Australian College of Perioperative Nurses members were invited to participate. Missed nursing care was measured using the MISSCARE Survey-OR. Age, years of experience, and intention to leave were single-item measures. Satisfaction was a three-item scale. Competence was measured by the 18-item Perceived Perioperative Competence Scale-Short Form. Structural equation modelling was used to test our hypothesised model. Results. Of the 5,500 nurses invited, 853 (15.5%) responded, but only 602 (10.9%) participant responses were usable for inclusion in the model. The model demonstrates that participants’ age directly predicted the frequency of missed care, nurse role satisfaction, perceived perioperative competence, and reasons for missed care. The reasons for missed care and perceived perioperative competence were mediators that were negatively associated with the frequency of missed care. Conclusions. While the final model explained 22.6% of the frequency of missed care, other variables not identified in this study may influence this outcome.

Background and Objectives: A medication error can occur at any stage of medication administration at the ward, from the moment the medication is prescribed through the preparation to the administration to the patient. The statistics indicate that the scale of the problem, which has a significant impact on the safety and health of patients, is still poorly known. The purpose of the systematic review was to synthesise the published research about the number of medication errors in operating room theatres and intensive care units. Materials and Methods: The literature review was conducted in the third quarter of 2023. The overview included papers found in Science Direct, EBSCO, PubMed, Ovid, Scopus, and original research papers published in English meeting the PICOS criteria. Original articles published between 2017 and 2023 that meet the inclusion criteria were included for further analysis. Results: The review included 13 articles and original studies, which met the PICOS-based criteria. The analyses confirmed that the operating theatre’s medication error rate was 7.3% to 12%. In the case of intensive care units, the medication error rate was from 1.32 to 31.7%. Conclusions: Medication errors in the operating room and intensive care are high. However, the values presented herein do not differ from the general Medication Error Index for medical centres, as calculated by the World Health Organization.

Perioperative inefficiency can increase cost. We describe a process improvement initiative that addressed preoperative delays on an academic vascular surgery service. First case vascular surgeries from July 2019–January 2020 were retrospectively reviewed for delays, defined as late arrival to the operating room (OR). A stakeholder group spearheaded by a surgeon-informaticist analyzed this process and implemented a novel electronic medical records (EMR) preoperative tool with improved preoperative workflow and role delegation; results were reviewed for 3 months after implementation. 57% of cases had first case on-time starts with average delay of 19 min. Inappropriate preoperative orders were identified as a dominant delay source (average delay = 38 min). Three months post-implementation, 53% of first cases had on-time starts with average delay of 11 min (P < 0.05). No delays were due to missing orders. Inconsistent preoperative workflows led to inappropriate orders and delays, increasing cost and decreasing quality. A novel EMR tool subsequently reduced delays with projected savings of $1,200/case. Workflow standardization utilizing informatics can increase efficiency, raising the value of surgical care. •Standardization of workflows is a critical quality improvement tool.•Inconsistent results can decrease the quality and value of patient care.•Informatics can be utilized to study issues and implement change in healthcare.•Perioperative inefficiency is a major source of waste in healthcare.

Among hospital staff, little is known concerning barriers to recycling and perception of waste in the operating room (OR), despite continued improvement in recycling programs. This study sought to identify barriers to OR recycling and implement a recycling improvement educational program. A survey was administered within Mayo Clinic at four campuses. Based on survey results, a recycling improvement program was devised and implemented at a surgery center in Paradise Valley, Arizona. A cost-savings analysis was performed thereafter. Of 524 participants, 56.7% reported being unclear which OR items are recyclable, and 47.7% thought the greatest barrier to recycling was lack of knowledge. After implementation of the recycling educational program, cost savings of 10.3% (p = 0.004) were achieved in sharps waste disposal when compared to the previous year at the surgery center. Addressing barriers to recycling in the OR can significantly reduce waste and save valuable healthcare dollars. •57% reported being unclear which OR items are recyclable.•39% reported they ‘only sometimes’ or ‘never’ recycle in the OR.•48% reported greatest barrier was lack of knowledge of recyclable items.•17% reported greatest barrier was having to handle contaminated materials.•Cost savings of 10% were achieved in sharps waste disposal after education program.

This study examines the factors influencing the quality of operating theatres in Indian multispeciality hospitals, focusing on key managerial and infrastructural components. The study investigates the influence of automated doors and scrub stations, HEPA filters, medical waste management, operating theatre management, pathology services in the operating theatre, and unidirectional workflow on the quality of the operating theatre, as well as the moderating role of operating theatre management between medical waste management and the quality of the operating theatre. This study employed the Donabedian quality of care framework, combined with partial least squares structural equation modeling (PLS-SEM), to analyze data from 483 respondents, including theatre staff, nurses, and surgeons. The findings reveal that all factors significantly influence the quality of operating theatres, with operating theatre management having the strongest effect. This study offers critical insights for healthcare policymakers and hospital administrators seeking to optimize workflow and surgical infrastructure. Therefore, this study contributes to the growing literature on the quality of surgical environments in emerging economies.