Search

Objective: To systematically review the literature surrounding operating room-based in situ training in surgery., Methods: A systematic review was conducted of MEDLINE. The review was conducted based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology, and employed the Population, Intervention, Comparator, Outcome (PICO) structure to define inclusion/exclusion criteria. The Kirkpatrick model was used to further classify the outcome of in situ training when possible., Results: The search returned 308 database hits, and ultimately 19 articles were identified that met the stated PICO inclusion criteria. Operating room-based in situ simulation is used for a variety of purposes and in a variety of settings, and it has the potential to offer unique advantages over other types of simulation. Only one randomized controlled trial was conducted comparing in situ simulation to off-site simulation, which found few significant differences. One large-scale outcome study showed improved perinatal outcomes in obstetrics., Conclusions: Although in situ simulation theoretically offers certain advantages over other types of simulation, especially in addressing system-wide or environmental threats, its efficacy has yet to be clearly demonstrated., (Copyright © 2017 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.)

Background: Accurate monitoring of respiratory rate may be useful for the early detection of patient deterioration. Monitoring of respiratory rate in the operating room under general anesthesia by spirometry is technically straightforward and demonstrates high fidelity. Accurate measurement of the respiratory rate of an unattended patient outside the operating room is fraught with challenges. Monitors such as capnometry and thoracic impedance pneumography have significant drawbacks. Respiratory acoustic monitoring (RRa™) is a new technology for respiratory rate monitoring, which has been demonstrated to provide accurate respiratory rates in patients recovering from anesthesia, but the performance of this RRa-enabled monitor under conditions of major respiratory rate variation has not been evaluated., Methods: We enrolled 53 patients undergoing urologic procedures in the operating room under general anesthesia with a laryngeal mask airway, spontaneous ventilation, and no muscle relaxation in an observational study. Respiratory signals (RRa and in-circuit pneumotachograph) were stored for later analysis. Artifacts were excluded based on visual inspection of the raw respiratory waveforms. Instantaneous respiratory rates were obtained from the pneumotachograph signal using the Hilbert-Huang Transform. Instantaneous rate estimates (IREs) were compared with RRa by 3 methods. First, the mean delay between IREs and RRa was determined. Second, precision was obtained by Bland-Altman analysis for repeated measures. Third, for all disparities in rates exceeding 4 breaths per minute (bpm), the probability of persistent error was determined as a function of time, with 95% confidence intervals estimated by bootstrap analysis., Results: Data were collected from 53 patients. Three patients were excluded due to missing data. There were no adverse events related to RRa monitoring. RRa demonstrated a median delay of 45 seconds (interquartile range 20 seconds) to detect a 1- bpm change in IREs. Bland-Altman revealed 95% limits of agreement of -2.1 to 2.2 bpm across the range of 7 to 48 bpm. Disparities in respiratory rate >4 bpm between the 2 methods did not persist beyond 160 seconds, and 90% of these differences resolved within 33 seconds (95% confidence interval 23-48 seconds)., Conclusions: The data demonstrate that, under conditions of general anesthesia with a laryngeal mask airway and spontaneous ventilation, the RRa rapidly detects changes in respiratory rate, demonstrates minimal bias, and when errors in rate occur, these do not persist. The utility of this monitoring technology in detecting rate changes in unattended patients will require further study.

Communication failure is a common root cause of adverse clinical events. Problematic communication domains are difficult to decipher, and communication improvement strategies are scarce. This study compared perioperative incident reports (IR) identifying potential communication failures with the results of a contemporaneous peri-operative Relational Coordination (RC) survey. We hypothesised that IR-prevalent themes would map to areas-of-weakness identified in the RC survey. Perioperative IRs filed between 2018 and 2020 (n = 6,236) were manually reviewed to identify communication failures (n = 1049). The IRs were disaggregated into seven RC theory domains and compared with the RC survey. Report disaggregation ratings demonstrated a three-way inter-rater agreement of 91.2%. Of the 1,049 communication failure-related IRs, shared knowledge deficits (n = 479, 46%) or accurate communication (n = 465, 44%) were most frequently identified. Communication frequency failures (n = 3, 0.3%) were rarely coded. Comparatively, shared knowledge was the weakest domain in the RC survey, while communication frequency was the strongest, correlating well with our IR data. Linking IR with RC domains offers a novel approach to assessing the specific elements of communication failures with an acute care facility. This approach provides a deployable mechanism to trend intra- and inter-domain progress in communication success, and develop targeted interventions to mitigate against communication failure-related adverse events. [ABSTRACT FROM AUTHOR]