Abstract:
BACKGROUND:Work disruption in operating rooms hinders flow of patients and increases chances of error. Previous studies have largely considered the types of disruption occurring in operating rooms, but have not analysed systematically the objective impact of disruption. OBJECTIVE:The objective was to evaluate the impact of disruption on time efficiency in preoperative anaesthetic work in the operating room and to link disruption to failures in co-ordination of care. DESIGN:Prospective, cross-sectional and observational study. SETTING:Disruptions were evaluated in operating rooms of five hospitals across three countries: Australia (one community hospital, one teaching hospital); Thailand (two community hospitals); China (one teaching hospital). PARTICIPANTS:The preoperative phase of anaesthesia induction/patient positioning of 64 surgical patients across specialities was prospectively evaluated (Australia = 33; Thailand = 12; China = 10). Further, interviews were carried out with 16 consultant anaesthetists and surgeons and 13 senior operating room nurses involved in the care of these patients. MAIN OUTCOME MEASURES:Disruptions were identified by trained observers in real time during the preoperative phase; four types of care co-ordination problems were identified from the interviews with senior anaesthetists, surgeons and nurses, and linked to the disruptions. Descriptive analyses of time efficiency were performed. RESULTS:Complete data were available from 55 cases. Good inter-observer agreement was obtained across measurements (range 74 to 92%). An average of three disruptions per case during the preoperative phase, were observed (range 2 to 9). 'Disruption types': disruptive staff activities were associated with most timewasting (median = 1 min per case, range 0 min 0 s to 4 min 45 s per case). 'Care co-ordination problems': co-ordination lapses within the operating room team, and between them and the preoperative team were associated with most timewasting (median = 1 min per case, range 0 min 0 s to 5 min 0 s per case). CONCLUSION:The study quantifies time inefficiencies affecting anaesthetic work during the preoperative phase. Work disruption wastes time and is preventable.
journal_name
Eur J Anaesthesioljournal_title
European journal of anaesthesiologyauthors
Al-Hakim L,Arora S,Sevdalis Ndoi
10.1097/EJA.0000000000000484subject
Has Abstractpub_date
2016-08-01 00:00:00pages
581-7issue
8eissn
0265-0215issn
1365-2346journal_volume
33pub_type
杂志文章,多中心研究abstract:BACKGROUND:In patients undergoing general anaesthesia, intraoperative hypotension occurs frequently and is associated with adverse outcomes such as postoperative acute kidney failure, myocardial infarction or stroke. A history of chronic hypertension renders patients more susceptible to a decrease in blood pressure (BP...
journal_title:European journal of anaesthesiology
pub_type: 杂志文章,随机对照试验
doi:10.1097/EJA.0000000000000690
更新日期:2017-11-01 00:00:00
abstract::Patients about to undergo a suspension laryngoscopy were randomly assigned to one of two groups (n = 10). They were given either etomidate 1 mg kg-1 followed by 1 mg kg-1 h-1, or propofol 2.5 mg kg-1 followed by 9 mg kg-1 h-1. Alfentanil 10 micrograms kg-1 was given to provide analgesia with a further half dose if nec...
journal_title:European journal of anaesthesiology
pub_type: 临床试验,杂志文章,随机对照试验
doi:
更新日期:1991-03-01 00:00:00
abstract:BACKGROUND:The isolated heart model is widely used for the assessment of coronary vascular response under various experimental conditions. As medium perfusate influences oxygenation conditions, coronary vascular response and myocardial consumption performance may differ between isolated hearts perfused with from with K...
journal_title:European journal of anaesthesiology
pub_type: 杂志文章
doi:10.1097/EJA.0b013e328337cc0d
更新日期:2010-09-01 00:00:00
abstract:BACKGROUND:Transoesophageal echocardiography (TOE) probe insertion in anaesthetised patients can cause pharyngeal and oesophageal injuries. Kim et al. have shown that insertion assisted by a Macintosh laryngoscope can reduce such complications but it may sometimes be difficult to observe the passage of a TOE probe. The...
journal_title:European journal of anaesthesiology
pub_type: 杂志文章,随机对照试验
doi:10.1097/EJA.0000000000000367
更新日期:2016-04-01 00:00:00
abstract::A 36-year-old female presented with seizures and transient dysphasia in her 31 week of pregnancy. Neuroradiological investigations revealed a large falx meningioma. A decision was taken to deliver the infant and excise the tumor before term because of the risk of an increase in the size of the tumour and the risk of s...
journal_title:European journal of anaesthesiology
pub_type: 杂志文章
doi:10.1046/j.1365-2346.1998.00225.x
更新日期:1998-01-01 00:00:00
abstract:BACKGROUND AND OBJECTIVE:To evaluate the efficacy of 0.1% ropivacaine with fentanyl 2 microg mL(-1) via epidural for analgesia in labour. METHODS:In a randomized study, 80 nulliparous parturients in labour had epidural analgesia initiated with 0.2% ropivacaine and fentanyl and were then randomized to receive either 0....
journal_title:European journal of anaesthesiology
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1017/s0265021504000031
更新日期:2004-10-01 00:00:00
abstract:BACKGROUND:When airway management is difficult, various measures can be taken to facilitate tracheal intubation. The Bullard and Airtraq laryngoscopes were developed for this purpose. We hypothesised that the Bullard and Airtraq laryngoscopes would perform better than a conventional laryngoscope in the management of a ...
journal_title:European journal of anaesthesiology
pub_type: 杂志文章,随机对照试验
doi:10.1097/EJA.0b013e328354b22c
更新日期:2012-07-01 00:00:00
abstract:CONTEXT:Previous research has shown that most patients are satisfied with their anaesthetic care. For those who are not the causes may be multifactorial including dissatisfaction with surgical outcomes. OBJECTIVES:We aimed to identify whether quality of recovery after anaesthesia and surgery measured in multiple domai...
journal_title:European journal of anaesthesiology
pub_type: 杂志文章,多中心研究
doi:10.1097/EJA.0b013e328357e584
更新日期:2013-03-01 00:00:00
abstract::Anaesthesia and surgical stress can affect renal function and body fluid regulation indirectly as well as directly. The indirect effects, through influences on haemodynamics, sympathetic activity and humoral regulation, are more pronounced than the direct ones. Inhalational anaesthetics generally reduce glomerular fil...
journal_title:European journal of anaesthesiology
pub_type: 杂志文章,评审
doi:
更新日期:1994-05-01 00:00:00
abstract:BACKGROUND:Continuous positive airway pressure (CPAP) prevents peri-operative atelectasis in adults, but its effect in children has not been quantified. OBJECTIVE:The aim of this study was to evaluate the role of CPAP in preventing postinduction and postoperative atelectasis in children under general anaesthesia. DES...
journal_title:European journal of anaesthesiology
pub_type: 杂志文章
doi:10.1097/EJA.0000000000001351
更新日期:2021-01-01 00:00:00
abstract::The hypothesis that calcium channel blockers can potentiate and prolong the anti-nociceptive effects of opioids was tested. Forty-five men scheduled for aorto-coronary bypass operation received fentanyl according to their individual demands (haemodynamics, clinical parameters). The patients were allocated at random in...
journal_title:European journal of anaesthesiology
pub_type: 临床试验,杂志文章,随机对照试验
doi:
更新日期:1987-11-01 00:00:00
abstract:BACKGROUND AND OBJECTIVE:To examine whether prophylactic use of haloperidol in addition to dexamethasone decreased the incidence of postoperative nausea and vomiting in high-risk patients undergoing ambulatory surgery. METHODS:One hundred and sixty nonsmoking women aged between 18 and 50 years receiving a standardized...
journal_title:European journal of anaesthesiology
pub_type: 杂志文章,随机对照试验
doi:10.1097/EJA.0b013e32832fce15
更新日期:2010-02-01 00:00:00
abstract:BACKGROUND AND OBJECTIVE:Bleeding after cardiac surgery correlates with morbidity and mortality. The aim of this study was to determine the influence of antiplatelet therapy on bleeding and transfusion rates in coronary artery bypass grafting. METHODS:Forty patients receiving aspirin and/or clopidogrel/ticlopidine wit...
journal_title:European journal of anaesthesiology
pub_type: 杂志文章
doi:10.1017/S0265021506002262
更新日期:2007-04-01 00:00:00
abstract:BACKGROUND:The base excess gap (BE(gap)) method is commonly used for the quantification of unmeasured ions in critically ill patients. However, it has never been validated against the standard quantitative acid-base approach. OBJECTIVE:To compare the BE(gap) as a tool for the prediction of the excess of unmeasured ion...
journal_title:European journal of anaesthesiology
pub_type: 杂志文章
doi:10.1097/EJA.0b013e32836412db
更新日期:2013-11-01 00:00:00
abstract::Haemodynamic alterations elicited by iced injectate during thermodilution cardiac output measurements were evaluated in the presence of metabolic acidosis or hypoxic hypoxia in 14 instrumented anaesthetized dogs. The alterations in some haemodynamic variables during slowing of the heart rate following injection of 3 m...
journal_title:European journal of anaesthesiology
pub_type: 杂志文章
doi:
更新日期:1993-09-01 00:00:00
abstract::Etomidate is an imidazole-derived hypnotic agent preferentially used for rapid sequence induction of anaesthesia because of its favourable haemodynamic profile. However, 11β-hydroxylase inhibition causes adrenal insufficiency with potentially fatal consequences in specific populations. We review the arguments against ...
journal_title:European journal of anaesthesiology
pub_type: 评论,杂志文章
doi:10.1097/EJA.0b013e32835819ca
更新日期:2012-11-01 00:00:00
abstract:BACKGROUND AND OBJECTIVE:To evaluate the noninvasive electrical velocimetry (Aesculon) monitor for cardiac output (CO) by subxiphoidal Doppler flow measurement in children. METHODS:CO was determined at the end of diagnostic or interventional cardiac catheterization for congenital heart defects. Standard ECG surface el...
journal_title:European journal of anaesthesiology
pub_type: 杂志文章
doi:10.1097/EJA.0b013e3283240438
更新日期:2009-05-01 00:00:00
abstract::The rate of failed spinal anaesthesia, defined as the need for unplanned general anaesthesia, was evaluated in a prospective study involving 137 patients undergoing transurethral resection of the prostate (TURP). The incidence of sensations at the operative site which did not require general anaesthesia was also evalu...
journal_title:European journal of anaesthesiology
pub_type: 临床试验,杂志文章,随机对照试验
doi:
更新日期:1992-01-01 00:00:00
abstract:BACKGROUND AND OBJECTIVE:Acute renal failure is a serious complication of cardiac surgery. We studied the long-term survival and quality of life of patients requiring renal replacement therapy after cardiac surgery, since they represent a heavy burden on hospital resources and their outcome has never been adequately ev...
journal_title:European journal of anaesthesiology
pub_type: 临床试验,杂志文章
doi:10.1017/S0265021505001705
更新日期:2006-01-01 00:00:00
abstract:BACKGROUND:Communication errors cause clinical incidents and adverse events in relation to surgery. To ensure proper postoperative patient care, it is essential that personnel remember and recall information given during the handover from the operating theatre to the postanaesthesia care unit. Formalizing the handover ...
journal_title:European journal of anaesthesiology
pub_type: 杂志文章,多中心研究
doi:10.1097/EJA.0000000000000335
更新日期:2016-03-01 00:00:00
abstract:BACKGROUND:Flexible fibreoptic endoscopic (FFE) intubation is considered the 'gold-standard' when difficult airway management is anticipated. Several videolaryngoscopes have been developed to facilitate intubation by laryngoscopy. OBJECTIVE:The aim of the study was to compare the performance of the McGrath series 5 vi...
journal_title:European journal of anaesthesiology
pub_type: 杂志文章,随机对照试验
doi:10.1097/EJA.0b013e32836590a7
更新日期:2014-03-01 00:00:00
abstract:BACKGROUND AND OBJECTIVES:Infraclavicular plexus block has many advantages of particular interest in the emergency setting. However, the number of nerve stimulations needed to optimize the technique remains unclear. We evaluated both the local anaesthetic requirement and the success rate of Sim's derived infraclavicula...
journal_title:European journal of anaesthesiology
pub_type: 杂志文章,随机对照试验
doi:10.1017/S0265021506000329
更新日期:2006-04-01 00:00:00
abstract:BACKGROUND AND OBJECTIVES:In isolated-perfused lungs of lipopolysaccharide (LPS)-challenged rats, vasodilatation to inhaled nitric oxide (NO) is impaired. Inhibition of nitric oxide synthase 2 (NOS2) by aminoguanidine (AG) prevented hyporesponsiveness to inhaled NO. Here, we investigated whether NOS2-mediated nitrite/n...
journal_title:European journal of anaesthesiology
pub_type: 杂志文章
doi:10.1017/S0265021506001463
更新日期:2007-04-01 00:00:00
abstract::Intra-operative segmental wall motion abnormalities (SWMA) detected by transoesophageal echocardiography (TOE) have been shown to be a sensitive indicator of myocardial ischaemia. To determine the incidence and characteristics of segmental wall motion abnormalities and to relate these changes to perioperative myocardi...
journal_title:European journal of anaesthesiology
pub_type: 临床试验,杂志文章
doi:10.1046/j.1365-2346.1997.00166.x
更新日期:1997-07-01 00:00:00
abstract:BACKGROUND AND OBJECTIVE:Combined spinal-epidural is an alternative technique to epidural analgesia for labour, but its benefits are not clearly identified. METHODS:A prospective, blinded, randomized study was undertaken involving 113 women attending a university hospital obstetric department. Analgesia was initiated ...
journal_title:European journal of anaesthesiology
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1017/s0265021504003047
更新日期:2004-03-01 00:00:00
abstract:BACKGROUND AND OBJECTIVE:Proinflammatory cytokines as well as nitric oxide (NO) play a major role in mediating the response to lipopolysaccharide (LPS). The present study tested the hypothesis that LPS induces proinflammatory cytokines in the lung via the Toll-like receptor 4 (TLR4)/CD14 signalling cascade. METHODS:Co...
journal_title:European journal of anaesthesiology
pub_type: 杂志文章
doi:10.1017/S0265021506001098
更新日期:2006-12-01 00:00:00
abstract:BACKGROUND AND OBJECTIVE:Postoperative nausea and vomiting causes discomfort in many patients despite both antiemetic prophylactics and improved anaesthetic techniques. Stimulation of acupoint P6 is described as an alternative method for prophylaxis of postoperative nausea and vomiting.In a randomised, double-blinded s...
journal_title:European journal of anaesthesiology
pub_type: 杂志文章,随机对照试验
doi:10.1097/EJA.0b013e32833f6f42
更新日期:2011-06-01 00:00:00
abstract:BACKGROUND AND OBJECTIVE:To investigate whether the administration of ketamine before induction with propofol produces a smaller decrease in arterial pressure. METHODS:Twenty-two patients were assigned to one of two groups to receive either propofol with ketamine (n = 11) or propofol alone (n = 11, control). Anaesthes...
journal_title:European journal of anaesthesiology
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1046/j.0265-0215.2000.00784.x
更新日期:2001-02-01 00:00:00
abstract::The effects of protamine (6 mg kg-1) injected after heparin (5 mg kg-1) have been studied in five groups of five New Zealand white rabbits. Group I was treated with the sequence heparin-protamine and group II with protamine alone. The animals of groups III and IV received respectively intravenous indomethacin (3 mg kg...
journal_title:European journal of anaesthesiology
pub_type: 杂志文章
doi:
更新日期:1992-07-01 00:00:00
abstract:PURPOSE OF REVIEW:To evaluate the efficacy of a single preoperative dose of 600 mg of gabapentin for reducing postoperative pain and tramadol consumption after minilap open cholecystectomy. METHOD:A total of 120 adult patients of either sex were randomly assigned to receive 600 mg of gabapentin or a matched placebo or...
journal_title:European journal of anaesthesiology
pub_type: 杂志文章,随机对照试验
doi:10.1097/EJA.0b013e328334de85
更新日期:2010-04-01 00:00:00