Health Sciences Centre (HSC) in Winnipeg is the major healthcare facility serving Manitoba, Northwestern Ontario, and Nunavut. An evaluation of HSC’s adult surgical patient flow revealed that one major barrier to smooth flow was their Operating Room (OR) scheduling system. This thesis presents a new two-stage elective OR scheduling system for HSC, which generates weekly OR schedules that reduce artificial variability in order to facilitate smooth patient flow. The first stage reduces day-to-day variability while the second stage reduces variability occurring within a day. The scheduling processes in both stages are mathematically modelled as multi-objective optimization problems. An attempt was made to solve both models using lexicographic goal programming. However, this proved to be an unacceptable method for the second stage, so a new multi-objective genetic algorithm, Nondominated Sorting Genetic Algorithm II – Operating Room (NSGAII-OR), was developed. Results indicate that if the system is implemented at HSC, their surgical patient flow will likely improve.

Thesis, PlanB (M.S.)--University of Wisconsin--Stout, 1999. / Includes bibliographical references.

Operating room nurses form the corner-stone of the operating room because perioperative care of the patient rests mainly in the hands of the nursing personnel. Unique challenges face nurses functioning in the stressful surgical environment where anticipation to prevent or cope with life-threatening situations is the order of the day. The operating room nurse must be knowledgeable, skilled and alert, as he/she is held accountable for all acts of commission and omission. To ensure that nurses are appropriately educated and trained and able to keep trend with the changing technology in the operating room, it is essential that learning programmes meet the minimum standards for registration as prescribed by the South African Nursing Council. Reviewing and evaluating learning programmes on a regular basis by specialist nursing educationists, are therefore essential to ensure that the standards of education and training are maintained and upgraded if required. The aim of this study is to explore and describe the various Operating Room Nursing Science Learning Programmes offered at accredited Higher Education Institutions, utilized for the education and training of the operating room nursing students in South Africa. The proposed research is based on a qualitative paradigm and the theoretical grounding is found in Bergman’s model for professional accountability (Bergman, 1982:8). A document analysis of five approved comprehensive Operating Room Nursing Science Learning Programmes from higher education institutions in South Africa (nursing colleges and universities) was carried out, together with a sixth programme, the Operating Theatre Learning Programme, as suggested by the Standard Generating Body. Requests for permission were forwarded to the management of the selected colleges or universities for inclusion of the respective programmes in the study. The researcher formulated and utilized thirty-four essential criteria derived from three documents, the first being a document entitled “Proposed Standards for Nursing and Midwifery Qualifications” submitted to the SANC and SAQA by the SGB for Nursing and Midwifery (2001-2004). The second document entitled the Public and Private Higher Education Institutions format template for criteria for the Generation and Evaluation of Qualifications and Standards within the National Qualifications Framework was also utilized (SAQA, 1430/00) and thirdly the researcher included the most relevant criteria from the list of criteria for curriculum development as indicated by the South African Nursing Council. Various tables were compiled, to reflect the findings of the document analysis according to the thirty-three criteria indicated above, to provide a clear and broad overview of the specific data in the respective six Operating Room Nursing Science Learning Programmes utilized in the study. In conclusion recommendations for a broad macro-curriculum were made to facilitate formulation of programmes in Operating Room Nursing Science relevant to the South African context.

M.Cur. (Nursing Science) / The need for improved nursing leadership. especially in the nursing service situation, within an ethnicheterogenous nursing society demands appropriate leadership development to meet the needs of dynamic health care delivery. Nursing leadership from an ethnographic perspective has not been researched in this country. Hence, the views of senior black professional nurses, within a particular research context (operating theater department), have been explored in relation to the influence of their occupational life histories on their particular views. The results have been controlled with an extensive literature review...

Abstract not available

Bakgrund Yrket som operationssjuksköterska är idag den äldsta sjuksköterskespecialiteten men förblir främst en dold yrkesroll på grund av att det utövas bakom stängda dörrar. Yrkesrollen skildrades som komplex och kretsade omkring patienten, samarbetet och den tekniska utrustningen Patricia Benners teorier om sjuksköterskans yrkesutveckling användes som teoretisk förankring i studien. Syfte Studiens syfte var att belysa hur operationssjuksköterskan upplever sin yrkesroll. Metod Studien genomfördes med en kvalitativ ansats och tio semistrukturerade intervjuer utfördes med operationssjuksköterskor från två sjukhus i Sverige under våren 2011. Alla intervjuer spelades in och transkriberades ordagrant. Insamlat data analyserades med kvalitativ innehållsanalys. Resultat I textanalysen identifierades tolv subkategorier och fyra kategorier; rollen som omvårdnadsansvarig, upplevelsen av vad som gör operationssjuksköterskan trygg i sin yrkesroll, betydelsen av att vara medarbetare i arbetet på operationssalen och synen på den egna professionen. Operationssjuksköterskorna beskrev sitt arbete som patientfokuserat och möjligheten att hjälpa medförde känslan av att göra skillnad. Erfarenhet och uppskattning gav ett självförtroende som resulterade i att operationssjuksköterskorna blev trygga i sin yrkesroll. Operationssjuksköterskorna beskrev kommunikation på salen som essentiellt för ett fungerande samarbete och menade att de anpassade sig efter sina medarbetare. Operationssjuksköterskorna upplevde sin yrkesroll både som osynlig och utvecklande. Citat från informanterna presenterades i texten för att tydliggöra resultatet.  Slutsats Studien visade att operationssjuksköterskorna har en central roll för omvårdnaden på operationsavdelningen och för patienten. Operationssjuksköterskans närvaro och kompetens vid operationer var oersättlig men ständigt beroende av teamet omkring sig. / Background The profession of operating room nurse is now the oldest nursing specialty, but remains primarily a hidden profession because it is exercised behind closed doors. The professional role were described as complex and revolved around the patient, cooperation and the technical equipment. Patricia Benners theories on the nurses’ professional development were used as a theoretical basis in the study. Aim The study aimed to elucidate how the operating room nurse perceives the professional role. Method The study was conducted with a qualitative approach and ten semi-structured interviews were carried out with operating room nurses from two hospitals in Sweden in spring 2011. All interviews were recorded and transcribed verbatim. To analyze the collected data content analysis with an inductive approach was used. Result In the text analysis twelve subcategories and four categories were identified: the role as being responsible of nursing, the experience of what makes the operating room nurse safe in the professional role, the meaning of being a co-worker during the work on the operating room and the view on the own profession Quotes from the informants were presented in the text to clarify the result. Conclusion The study showed that the operating room nurse has a central role for nursing in the surgical ward and the patient. The operating room nurse presence and expertise in operations was irreplaceable, but always dependent of the team around him/her.

Unintentional harm due to healthcare is common, especially in the operating theatre. Previous research, aiming to reduce harm to patients in the operating theatre, has not examined the non-technical skills of anaesthetic assistants. The aim of this project was to identify the essential non-technical skills required by anaesthetic assistants for safe and effective practice, and to develop a behavioural marking system to assess these skills. A literature review identified three articles which described anaesthetic assistants' non-technical skills. An interview study with anaesthetic assistants (n=22) and anaesthetists (n=23) described the use of situation awareness, teamwork and task management more commonly than leadership or decision making. This was corroborated by a critical incident database review of the Australian Incident Monitoring System from 2002 to 2008. The material identified in the interview study was considered by focus groups of anaesthetic assistants (n=6,7,3,4) to generate headings. These themes were considered by anaesthetic assistant lecturers (n=6) in a Delphi questionnaire, and positive and negative behavioural markers proposed. The Anaesthetic Non-Technical Skills for Anaesthetic Practitioners (ANTS-AP) behavioural marker system was completed by a research panel. The prototype ANTS-AP system had three categories: 'situation awareness', 'communication and teamwork', and 'task management', each with three elements. The reliability, validity and usability of the ANTS-AP system were evaluated by anaesthetic assistants (n=48) observing videos of simulated theatre work at a 3.5 hour workshop. The system had good internal consistency, and was able to discriminate good, average and poor behaviours. The element 'coping with pressure' was removed due to its poor inter-rater reliability. Future work will assess the inter-rater reliability of the ANTS-AP system, when observers have the opportunity for calibration. This project has provided anaesthetic assistants a means of structuring observation and feedback for training and reflection with the goal of improving patient care.

M.Cur. / Please refer to full text to view abstract

Until recently, the model for training new orthopaedic surgeons was referred to as “see one, do one, teach one”. Resident surgeons acquired their surgical skills by observing attending surgeons in the operating room and then attempted to replicate what they had observed on new patients, under the supervision of more experienced surgeons. Learning in the operating is an unideal environment to learn because it adds more time to surgical procedures and puts patients at an increased risk of having surgical errors occur during the procedure. Programs are slowly beginning to switch to a model that involves simulation-based training outside of the operating room. Wire navigation is one key skill in orthopaedics that has traditionally been difficult for programs to train on in a simulated environment. Our group has developed a radiation free wire navigation simulator to help train residents on this key skill. For simulation training to be fully adopted by the orthopaedic community, strong evidence that it is beneficial to a surgeon’s performance must first be established. The aim of this work is to examine how simulation training with the wire navigation simulator can be used to improve a resident’s wire navigation performance. The work also examines the metrics used to evaluate a resident’s performance in a simulated environment and in the operating room to understand which metrics best capture wire navigation performance. In the first study presented, simulation training is used to improve first year resident wire navigation performance in a mock operating room. The results of this study show that depending on how the training was implemented, residents were able to significantly reduce their tip-apex distance in comparison with a group that had received a simple didactic training. The study also showed that performance on the simulator was correlated with performance in this operating room. This study helps establish the transfer validity of the simulator, a key component in validating a simulation model. The second study presents a model for using the simulator as a platform on which a variety of wire navigation procedures could be developed. In this study, the simulator platform, originally intended for hip wire navigation, was extended and modified to train residents in placing a wire across the iliosacral joint. A pilot study was performed with six residents from the University of Iowa to show that this platform could be used for training the other applications and that it was accepted by the residents. The third study examined wire navigation performance in the operating room. In this study, a new metric of performance was developed that measures decision making errors made during a wire navigation procedure. This new metric was combined with the other metrics of wire navigation performance (tip-apex distance) into a composite score. The composite score was found to have a strong correlation (R squared = 0.79) with surgical experience. In the final study, the wire navigation simulator was taken to a national fracture course to collect data on a large sample of resident performance. Three groups were created in this study, a baseline group, a group that received training on the simulator, and a third group that observed the simulator training. The results of this study showed that the training could improve the overall score of the residents compared to the baseline group. The overall distribution from resident performance between groups also shows that a large portion of residents that did not receive training came in below what might be considered as competent performance. Further studies will evaluate how this training impacts performance in the operating room.

The implementation of the mandatory alternative payment model (APM) guarantees savings for Medicare regardless of participant hospitals ability for reducing spending that shifts the cost minimization burden from insurers onto the hospital administrators. Surgical interventions account for more than 30% and 40% of hospitals total cost and total revenue, respectively, with a cost structure consisting of nearly 56% direct cost, thus, large cost reduction is possible through efficient operation management. However, optimizing operating rooms (ORs) schedules is extraordinarily challenging due to the complexities involved in the process. We present new algorithms and managerial guidelines to address the problem of OR planning and scheduling with disturbances in demand and case times, and inconsistencies among the performance measures. We also present an extension of these algorithms that addresses production scheduling for sustainability. We demonstrate the effectiveness and efficiency of these algorithms via simulation and statistical analyses.