5 (Completely Avoidable) Issues in Operating Theatres (2019)

No matter the hospital or practice, operating room issues are bound to arise.

In some cases, those issues can become huge detriments to the safety of both patients and surgical teams. They might even result in higher costs due to inefficient practices.

But don’t fret. Not all operating room issues require complicated fixes.

Below, we explore five completely avoidable issues that you may be experiencing in your operating rooms, and how hospitals across the world have chosen to address them.

1. Playing Music in the Operating Room

Playing music in the operating room has been a common practice for nearly 100 years.

What started as a practice designed to help aid patient anxiety, has morphed into background noise that helps surgeons and nurses concentrate. MP3 players and docking stations are commonplace in today’s OR.

However, the practice of music in the OR has developed its own set of challenges around patient safety.

In a new research study, the Imperial College of London discovered that while about 70% of surgeons use music, nurses were five times more likely to have to ask for instructions to be repeated if music was playing. In emergency situations, repeated or misunderstood instructions can be a huge risk.

doctors-music(Source: Straight Talk MD)

Is This a Problem in Your OR?

Conduct a survey among your team members that asks two simple questions:

⦁ Is the background music in the OR too loud? Yes___ No___

⦁ What genre of background music do you prefer?_____

Note: This must be a confidential survey.

What the Imperial College of London Suggests:

Don’t worry – no one is suggesting that music be completely removed from the operating room.

The Imperial College of London’s study suggests just the opposite.

Instead, surgical teams can adopt a standardized practice around music. There needs to be a well-defined policy surrounding the use of music in your OR, including:

⦁ Decibel levels
⦁ Genres
⦁ Acceptability of vocals
⦁ Situations where music needs to be turned off

This involves stopping the practice of letting a senior medic make all background music decisions and receiving input from your entire OR team.

Alternatively, you can outfit your surgeons with bone-conducting headphones that sync via blue-tooth to their phone, which will allow them to listen to music while still being able to hear what’s going on around them.

2. High Rate Of Surgical Errors

Errors are inevitable in any surgical procedure. After all, surgeons and nurses are just human.

Nevertheless, despite multiple American and global patient safety initiatives, adverse event rates remain unacceptably high.

While it is important to recognize that people make errors, these failures can be minimized by having a system in place that is designed to remedy errors as quickly as possible.

Is This a Problem in Your OR?

To identify this issue in your OR, you can analyze how the surgical errors occur.

First, outline the entire system you have set up in your operating theatres and the role of any surgeon and nurse involved.

Second, identify what errors are occurring in this system and at what stage of the process they are most often occuring.

Third, do you have systems in place to catch errors? For instance, if a patient signs the wrong surgical site consent form it could lead to the patient receiving surgery on the wrong surgical site. How do you catch an error before it happens?

What AHRQ’s Patient Primer Suggests:

A popular method to minimizing errors in the OR is the Swiss Cheese Method, founded by Dante Orlandella and James T. Reason at the University of Manchester.

The reality is that every step taken in and around the OR can potentially result in failure to a varying degree.

Imagine each process as a slice of Swiss cheese, and the holes are the opportunities for a process to fail.

In a failing system the cheese slices all have holes in the same location; if a process fails and falls through a hole, it would keep falling and falling without getting caught.

swiss-cheese-method-productivity(Source: NCBI)

In the ideal system, the holes in each slice are in a different position. So, in the case of an error, it would be caught by the next layer. Therefore, the more layers of defense in your system, the higher chance errors will be caught as soon as possible.

3. Time Spent Repositioning Overhead Lights

Surgeons and OR nurses all know the frustrating feeling of having to constantly reposition overhead lights.

According to recent research, every 7.5 minutes of overhead illumination required a luminaire action (LA) of adjusting an overhead light. Of these LAs, about 75% were performed by surgeons and residents, and during 64% of these adjustments, the OR staff was interrupted.

For example, during a four-hour operation, if an OR staff has to reposition overhead lights every 7.5 minutes, they are repositioning those lights 32 times.

Consider the cost of a single operation.

The longer the operation, the more it costs. And going by this research, more than half of those 32 adjustments will result in an interruption to the procedure.

How much time could be saved by minimizing these actions?

Is This a Problem in Your OR?

Chances are you’ve heard your staff complain about adjusting lighting during an operation.

But even if none of your staff have brought this issue to your attention, there is an easy way to benchmark adjustment times in your OR.

For the next 30 days, keep track of adjustment time during every single procedure in your operating room. You’ll want to keep track of a few different stats:

⦁ How many times were lights adjusted?
⦁ How much time does each adjustment take?
⦁ Who on the surgical team adjusted the light?
⦁ And, how many times was the procedure interrupted due to the adjustment period?


How Other Healthcare Institutions Are Addressing this:

By analyzing your OR’s lighting habits, you’ve already taken the first step in addressing this issue. Getting a complete picture of your unique overhead light repositioning habits allows you to tackle any glaring problems.

As suggested by the research study above, you could already cut down those 32 LAs to 25 by removing unnecessary adjustments.

Another option is adding surgical headlights to your ORs.

This type of lighting is growing in popularity as the surgical lights market continues to expand. Hospitals are expanding surgical headlights as a way to offer more diverse lighting in their operating rooms.

Surgical headlights can offer consistent illumination and brightness across the entire procedure field of view. Instead of investing in new or additional overhead lights, you can adopt a surgical headlight to enhance your current illumination and eliminate LA interruptions.

4. Clutter/Lack of Space and Inefficient Organization

Safety issues are another important problem to tackle in your operating theatre. A high amount of clutter, lack of space, and overall inefficient organization can leave your surgical team and patients at high risk.

Modern operating theatres are quite small, averaging from 300 to 550 square feet, and were not designed with the size of the high-tech medical equipment in use today. Because of this lack of space, clutter and inefficiencies can cause problems in your OR.

This is also a cause for heavy time consumption as inefficient practices around re-stocking can increase OR turnover time, which then may result in cost overruns and overtime expenses.

In fact, an average of 12.5 minutes is currently being spent looking for missing equipment.

Is This a Problem in Your OR?


(Source: UC Davis)                                                                                                                                                            (Source: Optimus)

For now, the minimalist operating room of the future is still a ways off.

Operating room issues — be it due to lack of space, clutter, and inefficient organization — are abundant. Study the errors that are being made in your ORs and see how many of them could have been avoided with just proper organization alone.

Take a look at the two pictures above. Which one most resembles your OR?

What Other Hospitals Are Doing:

This is another instance where tracking time can pay huge dividends. It allows you to identify where your biggest inefficiencies are.

For instance, due to cabinet space, your current practice may rely on circulating nurses who have to leave the room to obtain supplies. This type of practice is not only a hazard to staff but incredibly dangerous to a patient.

After all, it’s unrealistic to expect your OR to magically grow in size. But by taking stock in your inefficiencies and clutter, you can maximize the use of that limited space.

5. Third Parties in the OR

The practice of allowing third parties into an operating room during surgery has become commonplace, especially in the case of sales reps.

For instance, depending on the medical equipment and procedure, it may be beneficial to have a sales rep in the OR to improve patient safety. This representative, however, is NOT part of the surgical team.

While for medical teams this would come to no surprise, it is a different story for patients.

Is This a Problem in Your OR?

This will become a big problem for your hospital if there are no steps taken to gather consent from the patient and create strict approval policies.

Without consent, this opens up your surgical team and hospital to potential legal risks. A complaint could put a physician in front of their provincial/territorial regulatory authority or a privacy commissioner.

What the Canadian Medical Protective Association Suggests:

Hospitals that avoid this issue are establishing a best practice where consent is collected before any third-party individuals enter an OR during surgery.

The Canadian Medical Protective Association, for one, recommends these primary best practices:

⦁ Establish a procedure for approval by a surgeon prior to any attendance;
⦁ Third party individuals must have proper identification;
⦁ And, limit their involvement – i.e. no “scrubbing in”, touching the patients, etc.

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