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Operating Room Inefficiencies May Cost Lives If Left Unattended

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In a surgical room, decent air quality, volume changes, and air flow direction are critical to the patient’s health from the angle of keeping away elements of contamination.

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However, a recent study has unveiled many operating room inefficiencies revolving around the air adequacy in the surgery room.

The Study and Results

The study which was published in the Orthopedics journal reveals that too frequent opening of doors in an OR can lead to pressure differences in the room and affect its sterility, thus indicating personnel and logistical inefficiencies.

Stephen Belkoff(PhD, MD), Renee Blanding(MD), and Simon Mears(PhD, MPH) conducted their study on 190 surgeries of about 90-180 minutes’ duration. They discovered that the OR doors were opened every 2.5 minutes. They also noticed how the doors stayed ajar for 9.6 minutes on average.

The authors noted that the doors were open for long enough to defeat the positive room pressure, cause a difference in potential, and cause the air to flow towards the OR. This discovery stood true for 77 out of the 191 cases.

OR Traffic Could Be Dangerous for the Patient

The total time of which the door stood open affected the pressure of the room as recorded in the investigation. However, the change in positive pressure was found to be transient and easily reversible.

The study opens doors for discussion. If the operating room’s doors are left open for longer, the effect will be greater as well. Since the ultimate toll of changing the positive pressure in an OR is paid by the level of sterility of the room, such inefficiencies could cause infections ranging from mild to severe.

The door openings are also considered predictors of a high bacterial count. However, the study was performed on knee and hip arthroplasty surgeries which aren’t known for high infection rates. Out of the sample operations, the authors found a single case of infection only. Any conclusive inference in this particular scenario would require a much wider sample size.

Why Is There So Much Traffic in the OR?

The authors didn’t record any data on the reasons for multiple and frequent door openings as they didn’t want to tip off the staff about being watched. However, in the study Operating room traffic: is there any role of monitoring it? Parikh and others have clarified that operating room staff aren’t much perturbed by the awareness of being observed. Anyhow, the case requires follow-up investigations to explain the cause of frequent door openings.

CEO of ThedaCare Center for Healthcare Value, Dr John Toussaint, suggests that OR inefficiencies are quite common. His group also found that most of the movements in and out of the OR are because the staff needs stuff and can’t find it in the right place.

Dr Toussaint mentions the need to track the inefficiency to understand the severity of the issue. He along with his team works with healthcare leaders to educate them on Lean quality improvement i.e. reduce waste and create more value with fewer resources.

A proper study involving a large sample size, appropriate tracking techniques, and a list of the harms of increased OR traffic is essential to prevent an adverse impact on quality and understand the cause of said traffic.

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