Bakgrund: Operationssjuksköterskan har ett avgörande ansvar gällande patientsäkerheten eftersom arbetet fokuserar på aseptik, samt att förebygga postoperativa infektioner och tryckskador. Den omvårdande yrkesrollen upplevs åsidosatt på grund av mer avancerad teknik. Hinder som tidsbrist, bristande respekt och kommunikation kan försvåra samarbetet på operationssalen. Syfte: Syftet med studien var att beskriva hur specialistsjuksköterskor inom operationssjukvård uppfattar sin omvårdande yrkesroll vid omhändertagandet av patienter perioperativt.  Metod: En kvalitativ studie bestående av semistrukturerade intervjuer utfördes med 11 operationssjuksköterskor på ett sjukhus i Mellansverige. Dataanalysen genomfördes med en fenomenografisk forskningsansats. Resultat: Genom den fenomenografiska textanalysen framkom fem uppfattningar om operationssjuksköterskans omvårdande yrkesroll. Uppfattningarna var: skydda patienten från vårdskador, övervaka andra personers agerande, ett fungerande interprofessionellt samarbete, en kritisk granskning av utförda omvårdnadsåtgärder, samt hinder som skapar en otillräcklig omvårdnad. De fyra första uppfattningarna var påbyggande kategorier utifrån kompetens och erfarenhetsbaserad kunskap, medan den femte kategorin innefattar olika faktorer som hindrar utförandet av en god perioperativ omvårdnad.  Slutsats: Studien visade att operationssjuksköterskorna främst uppfattade sin omvårdande yrkesroll som patientens beskyddare. Ansvaret kring att upprätthålla steriliteten och övervaka operationssalen var en väsentlig funktion. Även det interprofessionella samarbetet var betydelsefullt för patientens omvårdnad. Yrkeskunnandet utvecklades genom en utvärdering av omvårdnadsåtgärderna. Olika hinder kunde dock orsaka att kvaliteten på omvårdnaden varierade. / Background: The operating theatre nurse (OTN) has a crucial responsibility regarding patient safety, since the work centers around aseptics, and to prevent postoperative infections and pressure injuries. The OTN might experience that nursing care has to be put aside in order to prioritise operating technical equipment. Other hindrances to an optimal collaboration include time pressure, intercollegial disrespectfulness and a lack of communication. Aim: The aim of the study was to describe OTNs’ perceptions of perioperative caring as part of their profession. Method: The study had a qualitative approach consisting of semi-structured interviews with 11 OTNs at a hospital in central Sweden. The data analysis was carried out using a phenomenographic approach. Results: The phenomenographic text analysis resulted in five perceptions. These perceptions were: to prevent adverse events, to oversee the actions of other people, a working interprofessional collaboration, a critical examination of carried out nursing care and obstacles which create an inadequate care. The first four perceptions were expanding categories building on competence and experience-based knowledge, whilst the fifth category included factors which are a hindrance in the carrying out of good perioperative care.  Conclusion: OTNs perceived their caring role as protecting the patient undergoing surgery. In addition, responsibility for maintaining a sterile environment and monitoring of the operating theatre were seen as important. The interprofessional teamwork was significant for patient care. Part of the caring role was to evaluate nursing care and develop professionally. Several hindrances could result in reduced quality of care.

Dagens komplexa vårdmiljö kan förenklas genom att utrusta sjukhusensoperationssalar med en integrerad systemlösning. Syftet är att möjliggöramanövrering av all utrustning från en gemensam enhet, och på så sätt effektiviseraarbetsflödet. Idag saknas data som stödjer påståendet att systemetsförprogrammerade scenarion innebär en förbättring. Det här arbetet går ut på att undersöka den nytta som integrationslösningenmedför i operationssalar. Detta görs genom att undersöka arbetsflödet utifrån treolika styrningsfall (med förprogrammerade scenarion, manuellt via applikationeroch exludering av systemet), samt utifrån tre olika mätparametrar (klick, steg ochtid). Syftet med jämförelsen är att se vilket av dessa fall som är optimalt utifrån ettanvändarperspektiv. Resultatet visar på en tydlig fördel för styrning av systemet med förprogrammeradescenarion utifrån samtliga mätparametrar. De antaganden som har formatundersökningen, samt de kvantitativa begränsningarna i studiens data, tas hänsyntill i analysen. Under analys stärks det framtagna resultatet. I kombination med en fördeladstyrning mellan användarna utgör styrning med förprogrammerade scenarion detbästa alternativet för ett optimerat arbetsflöde. / Healthcare system complexity can be simplified by equipping hospital operatingtheatres with an integrated system solution. The goal is to improve the hospitalworkflow by enabling maneuvering of all the equipment from a common unit.Today there is no data to support the claim that the system offered feature of usingpreset scenes provides any improvements. The aim of this study is to demonstrate the benefits of the integrated operatingsystem. This is done by performing a workflow analysis based on three differentcases (with preset scenes, maneuvered through the applications and without use ofthe integrated system) and three different parameters (clicks, steps, and time). Thepurpose is to clarify the, from a user perspective, most beneficial case. The measured result shows an advantage when using the system with presetscenes. All of the assumptions in the survey, including the limitations ofquantitative data, are considered in the study. The result is validated by the analysis. A combination of the case with preset scenesand a distributed control between the users are therefore the best alternative for anoptimized workflow.

Världshälsoorganisationen (WHO) introducerade 2008 checklistan för säker kirurgi, som ett led i att minska vårdskador i samband med kirurgiska ingrepp och stärka kommunikationen mellan de olika professionerna på operationssalen. Denna checklista är uppdelad i tre delar; kontroll inför anestesistart, kontroll inför operationsstart (time-out), samt avslutning. Eftersom vår profession är operationssjuksköterskor, valde vi att fokusera på time-out, för att beskriva operationssjuksköterskors upplevelser av kommunikationen och följsamheten i samband med time-out. Uppsatsen är en litteraturstudie baserad på tio kvalitativa vetenskapliga artiklar, vilka granskades och analyserades. I artiklarna sökte vi efter gemensamma nämnare, de kategoriserades till huvudteman och underteman. Under huvudtemat kommunikation återfinns hierarki, som var en starkt bidragande faktor till bristfällig kommunikation inom det interprofessionella operationsteamet och till en låg följsamhet till WHO´s checklista för säker kirurgi. I huvudtemat utbildning framkom problem i samband med implementeringen av WHO´s checklista för säker kirurgi, där det saknas adekvat utbildning och handledning för hela teamet. Resultatet för uppsatsen kan ligga till grund för vidare forskning inom ämnet och bidraga till utbildning i interprofessionell kommunikation och utveckling, samt hantering av de olika hierarkierna på en operationsavdelning. / In 2008, the World Health Organization (WHO) introduced the Surgical Safety Checklist as a means to reduce surgical complications and improve communication among healthcare professionals in the operating room. The checklist is divided into three parts: pre-anesthesia check, time-out before incision, and closing check. As operating room nurses, we chose to focus on the time-out component to describe operating room nurses' experiences with communication and compliance during time-out.   This literature review is based on ten qualitative scientific articles, which were reviewed and analyzed. We searched for common themes in the articles, which were categorized into main themes and sub-themes. Under the main theme of communication, we found that hierarchy was a strong contributing factor to poor communication within the interprofessional operating team and low compliance with the WHO's Surgical Safety Checklist.   Under the main theme of education, we found problems with the implementation of the WHO's Surgical Safety Checklist, including inadequate education and training for the entire team. The results of this study can form the basis for further research on interprofessional communication and development, as well as the management of different hierarchies in the operating room.

Au sein d’un établissement hospitalier, le bloc opératoire représente un des secteurs les plus emblématiques et les plus coûteux. Le fonctionnement du bloc opératoire est orchestré par un programme opératoire qui consiste à construire un planning prévisionnel des interventions chirurgicales à réaliser pendant un horizon donné. La littérature abondante sur le sujet est unanime sur le fait que la construction du programme opératoire est une tâche complexe, car il s’agit non seulement de planifier et d’ordonnancer les interventions, mais aussi de satisfaire des exigences souvent antagonistes. Ce projet est le fruit d’une collaboration entre la Communauté d’Agglomération de Sarreguemines Confluences et la Région Lorraine, des membres du secteur hospitalier (Hôpital Robert Pax de Sarreguemines) et l’équipe Gestion Industrielle et Logistique (GIL) du Laboratoire de Génie Industriel, de Production et de Maintenance (LGIPM). L’objectif de cette recherche est d’apporter une aide aux gestionnaires du bloc opératoire, qui ont besoin de plus en plus des méthodes et des outils d’aide à la décision en vue d’optimiser leur fonctionnement. Pour répondre à ce besoin nous nous intéressons dans la première partie de cette thèse à la gestion des opérations électives en prenant en compte différentes contraintes et en particulier la disponibilité des chirurgiens. Nous nous plaçons dans le contexte d’une stratégie « open scheduling » et nous proposons deux modèles mathématiques permettant d’élaborer le programme opératoire. La complexité des modèles mathématiques et leur explosion combinatoire rendent difficile la recherche de l’optimum pour des tailles réalistes. Ceci nous a donc amené à proposer une heuristique constructive utilisant le modèle proposé et permettant d’obtenir des solutions là où la méthode exacte ne nous le permettait pas. Dans la seconde partie de cette thèse, nous considérons l’intégralité du processus opératoire (brancardage vers le bloc opératoire, préparation et anesthésie, acte chirurgicale et réveil). Nous modélisons ce processus comme un flow shop hybride à 4 étages avec contrainte de blocage de type RSb, et nous le résolvons à l’aide d’un algorithme génétique dont l’objectif est de synchroniser toutes les ressources nécessaires, en respectant au mieux le programme opératoire prévisionnel. Outre les opérations électives, nous nous intéressons dans la dernière partie aux opérations urgentes. Nous proposons un outil d’aide à la décision pour la gestion des opérations urgentes. En prenant en considération la pathologie et la gravité de l’état du patient, nous distinguons principalement 3 degrés d’urgences et proposons pour chacune un algorithme permettant d’intégrer en temps réel ces opérations dans le programme prévisionnel, tout en minimisant différents critères (temps d’attente avant affectation, heures supplémentaires, décalage par rapport aux anciennes dates de débuts) / The operating theater is one of the most critical and expensive hospital resources. Indeed, a high percentage of hospital admissions are due to surgical interventions. Rising expenditures spur health care organizations to organize their processes more efficiently and effectively. This thesis is supported by the urban community of Sarreguemines-France and the region of Lorraine-France, and is carried out in collaboration with the Centre Hospitalier de Sarreguemines - Hôpital Robert Pax. In the first part of this work, we propose two mathematical programming models to help operating theater managers in developing an optimal operating rooms scheduling. We also propose a constructive heuristic to obtain near optimal results for realistic sizes of the problem. In the second part of our work, the whole scheduling process is modeled as a hybrid four-stage flow shop problem with RSb blocking constraint, and is solved by a genetic algorithm. The objective is to synchronize all the needed resources around the optimal daily schedule obtained with the proposed mathematical model. The last part of our work is dedicated to non-elective surgeries. We propose a decision support tool, guiding the operating room manager, to handle this unpredictable flow of patients. Non-elective patients are classified according to their medical priority. The main contribution of the proposed decision support tool is to provide online assignment strategies to treat each non elective patient category. Proposed assignments are riskless on patient’s health. According to non-elective surgery classes, the proposed adjusted schedule minimizes different criteria such as patient’s waiting time, deviation from the firstly scheduled starting time of a surgery and the amount of resulting overtime

Thesis (PhD)--Macquarie University, Macquarie Graduate School of Management, 2001. / Bibliography: leaves 288-310. / Introduction -- Introduction to research problem and methodology -- Study context -- Theoretical framework - Review of the literature -- Study design and methods -- Study sites, surgical procedures, and labour input to surgical production -- New intra-operative artefacts: goals, choices and consequences -- Conclusion. / Surgical technologies since the late 1980s have undergone substantial innovations that have involved ...the adoption of new machines, instruments, and related surgical materials... referred to throughtout this thesis as intra-operative artefacts... typically represents a commitment of substantial financial resources by the hospitals concerned. However, little is documented about the process whereby the decisions are made to adopt new intra-operative artefacts, and no previous research appears to have explored the work-related consequences of new intra-operative artefact adoption within operating theatre services. This thesis explores the reasons why new intra-operative artefacts are adopted, how the decisions are made, who are the participants in the decsion process and what are the expected and actual organisational consequences of new intra-operative artefact adoption. / Electronic reproduction. / xii, 347 leaves, bound : / Mode of access: World Wide Web. / Also available in print form

This diploma thesis deals with the design and elaboration process of a project documentation of medical center in city Hlinsko. New building is situated in the northern part of the city in the area determined for constructions of public infrastructure. It´s a four-floor object with partial basement and slant mansard and flat vegetative roof.Object is based on foundation strips and footings made from reinforced concrete.The bearing and internal walls are designed from KALKSANDSTEIN lime sand blocks.The beams and collums are used in the placed designed with open disposition.The ceiling in 1.PP is designed as reinforced concrete for securing fire safety.The rest od ceiling constructions is designed from prestressed concrete panels SPIROLL,with exception in 4.NP,where the ceiling constructions are made from solid roof system YTONG KOMFORT,which is layed on frame system made of steel and reinforced concrete.The peripheral walls of 1.PP are made from lost formwork, which is insulated with extruded polystyrene.The walls in floors above ground are insulated with combination of external thermal insulation system (ETICS) and ventilated facade with CEMBRIT SOLID and PATINA facade cladding panels. The building is functionally divided into several part.Cafe, pharmacy, ambulance and medical center, each with it´s own entrance.Pharmacy is equipped with shop, medicine mixer and storage.Ambulance is equipped with garage slots, background for employees, room of crisis preparedness and operating center.Medical centrum is equipped with emergency, RTG, operating theater, rehabilitations and other types of examination rooms.Each examination room is equipped with waiting room.For more comfort the center has a background for employees.The whole object is designed with forced air exchange. Designed object is barrier-free.In front of the building is situated parking slots for cars, motorbikes and ambulances.Total number of slots is 74 places, which 5 is designed for disabled people.