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PubMed2005

The doctor-nurse relationship in the operating theatre.

This article examines the organisational culture in theatres, specifically the doctor-nurse relationship, based on the literature and the experience of one author (Anika Reynolds) on placement in theatres. The initial motivation for the study was noticing how well these doctors and nurses got on in a friendly, informal and efficient atmosphere. This relationship between the multidisciplinary team was especially surprising when compared with the experience of hospital wards. Why did such a difference exist?

Clinical Competence↗
PubMed1992

Keeping an OR supply system with '90s reimbursement.

1. Operating rooms need to be run as efficient businesses. The supply costs are major expenses; OR directors must have systems that provide information on usage, costs, and inventory of all supplies. 2. The following goals were developed: decrease outages; increase revenue; identify appropriate ordering personnel; provide information for decision-making; control supplies; maintain supplies in good condition; control the budget; develop an overall supply system; and reduce inventory. 3. The inventory control technicians are responsible for the dollars in their accounts, ordering, maintaining pars, receiving, and planning for ways to cut costs. They work closely with OR teams, giving nurses more time to assess, plan, implement, and evaluate the OR cases in their rooms.

Documentation↗
PubMed1996

The first assistant role in PEG tube insertion.

Nurses are under pressure to take on junior doctors' tasks. Expansion of the nurse's role should be of benefit to patients and professionally appropriate. The development of the first assistant role in PEG may be an avenue for expanding nursing.

Clinical Competence↗
PubMed2006

Governing the surgical count through communication interactions: implications for patient safety.

BACKGROUND: Intermittently, the incidence of retained surgical items after surgery is reported in the healthcare literature, usually in the form of case studies. It is commonly recognised that poor communication practices influence surgical outcomes. AIM: To explore the power relationships in the communication between nurses and surgeons that affect the conduct of the surgical count. METHODS: A qualitative, ethnographic study was undertaken. Data were collected in three operating room departments in metropolitan Melbourne, Australia. 11 operating room nurses who worked as anaesthetic, instrument and circulating nurses were individually observed during their interactions with surgeons, anaesthetists, other nurses and patients. Data were generated through 230 h of participant observation, 11 individual and 4 group interviews, and the keeping of a diary by the first author. A deconstructive analysis was undertaken. RESULTS: Results are discussed in terms of the discursive practices in which clinicians engaged to govern and control the surgical count. The three major issues presented in this paper are judging, coping with normalisation and establishing priorities. CONCLUSIONS: The findings highlight the power relationships between members of the surgical team and the complexity of striking a balance between organisational policy and professional judgement. Increasing professional accountability may help to deal with the issues of normalisation, whereas greater attention needs to be paid to issues of time management. More sophisticated technological solutions need to be considered to support manual counting techniques.

Adult↗
PubMed1997

Opportunities for control of hospital cost for total knee arthroplasty.

The hospital financial records of 120 consecutive patients who underwent unilateral knee replacement surgery at one hospital during 1995 were reviewed to determine opportunities for control of hospital cost for total knee arthroplasty. The average hospital length of stay for these patients was 4.27 days (range, 3-10 days). The average hospital cost was $10,231. All 120 patients were classified under Diagnosis Related Group 209, principle procedure 81.54 primary total knee arthroplasty. Medicare paid for 70% of the patients. All payers were profitable except Medicaid and one managed care organization. When hospital cost for total knee arthroplasty was allocated to hospital service centers, 78% of the cost was attributed to the operating room, nursing units, recovery room, and pharmacy. When hospital cost for total knee arthroplasty was allocated to hospital days, 80% of the hospital cost occurred during the first 48 hours of hospitalization. Hospital reimbursement for total knee arthroplasty is primarily a prospective case price payment system. After initial cost containment efforts reduce the hospital length of stay for total knee arthroplasty to 4 to 6 days, additional control of hospital cost should focus on these areas of opportunity.

Aged↗
PubMed1988

Total temporal bone resection. A radical but life-saving procedure.

Traditional therapeutic approaches for malignancies of the temporal bone have produced unacceptably low survival figures. The morbidity and mortality associated with temporal bone cancer justify extensive surgery. Total temporal bone resection can be performed successfully in the hands of an experienced skull-base surgical team. By circumscribing the tumor rather than transgressing it, this procedure follows generally accepted principles of oncologic surgery. This procedure also shows promise in resection of extensive, carefully selected, recurrent benign tumors. We believe this approach offers hope for improved survival in patients with malignancy of the temporal bone. Further refinements in technique are suggested by each new case. Additional experience and long-term follow-up are needed to assess the efficacy of this procedure. The interest, expertise, and active participation of the operating room nursing team are critical to the success of this surgery. Ideally, not only intraoperative participation but also preoperative assessment and postoperative support should be routine. Close cooperation and extensive communication among the surgeons and nurses are essential.

Adult↗