OR Staffing and Patient Outcomes

Aside from the Intensive Care Unit (ICU) of every hospital, the Operating Room (OR) warrants not just skilled staff, including nurses, but also a correct or sufficient staff mix and ratio. A study conducted in 2013 by Talsma, Anderson, Geun, Guo, and Campbell entitled “Evaluation of OR Staffing and Postoperative Patient Outcomes”, addressed the knowledge gap between staffing at the Operating Room and patient outcomes. Moreover, the study aimed at providing OR staffing measures with the use of data from electronic medical records (EMRs) which reflects a personnel’s time spent in a specific procedure. It also aimed to evaluate the association of such measures with the probability of patients to develop postoperative complications.

Total OR personnel, total OR nursing personnel, and postoperative outcomes were the main variables used in the study. There were also control variables which include patient demographics, comorbidities, and OR context. Using the American College of Surgeons National Surgical Quality Improvement Project, the researchers obtained data from a sample of general surgery patients. The total OR staffing and nurse staffing were obtained from the data from electronic medical records. Both OR and nurse staffing data were derived from the different personnel involved in specific surgeries.

The end point of the study reached at two important associations which are both statistically significant. One of which is the fact that there is an association between OR nursing personnel and the occurrence of postoperative complications. It was revealed that “a higher number of total nursing personnel involved
in a surgical procedure was associated with any postoperative complication at the P=.095 level.” Further, the study revealed that there is an association between a higher number of total OR personnel with surgical site infections. Other comparisons were not statistically different for patients with or without complications.

Even though most of the relationships were considered to be statistically insignificant, the researchers still argue that their research showed the usefulness of the OR staffing measures for such relationship. This study suggests that in the OR setting, the opposite may be true for staffing in contrast with existing unit-level staffing where higher number of staff or personnel is associated with fewer patient complications r adverse outcomes.

There are very few studies done in the perioperative setting as compared with unit-based staffing especially on the relationship between staffing and OR outcomes. With more research centered in the discovery of such relationship, there will be an increased understanding on the effect of staffing on complications. It is highly suggested that further studies be done to develop further these OR staffing measures and thereby expand the evidence base which employees with administrative roles may use when coming up with decisions and choices about requirements for staffing.

I am convinced that all health institutions, especially hospitals catering both minor and major operations, need to consistently evaluate their mechanisms or systems for staffing. Such systems derived from different models and influenced by many internal and external factors were proven to influence nurse and patient outcomes.

The highlight of the journal article was the association of the different variables to some postoperative complications which may be prevented. This is exactly what I want to look on further. This journal article encouraged me to look on articles regarding the OR staffing in the Philippines. I think it is high time, again, for us to review, reflect, evaluate, and improve our staffing if necessary.

These changes may contribute to improved nurse outcomes especially when job dissatisfaction and burnout felt by most nurses are eradicated in the system. This leads us to better-quality patient care which translates into better patient care and outcomes thereby lessening the occurrence of not only postoperative, but also pre- and intra-operative complications brought about by errors.

After reading the article, a few thoughts came into my mind. It is none other done engaging in research ventures in the Philippine setting and doing such both for the welfare of the patient and the nurses. I believe such research will be vital for all health institutions in the country even though each adopts its own system for staffing. OR staffing measures are different, in my opinion, from that of usual ward staffing measures. It is because the OR itself is a separate and unique setting which primarily requires a unique set of measures.

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