Long Shifts Burn Out Nurses, Hurt Patient Care

Nurses working longer shifts are more likely to experience burnout and increase patients' dissatisfaction with their care, says a new study.

Nearly 23,000 registered nurses took part over 3 years in the study at the University of Pennsylvania's School of Nursing, which examined the relationship between the length of nurses' shifts and patients' assessment of care quality. The researchers found that nurses working shifts of 10 hours or longer were up to 2.5 times more likely than those working shorter shifts to experience burnout and job dissatisfaction.

What's more, 7 in 10 patient outcomes were significantly and adversely affected by the longest shifts. In hospitals with higher proportions of nurses working longer shifts, higher percentages of patients reported that nurses sometimes or never communicated well, pain was sometimes or never well controlled, and they sometimes or never received help as soon as they wanted.

The authors' recommendations include restricting consecutive hours worked, monitoring of hours worked (including on second jobs), and respecting nurses' days off and vacation time.

Stephanie Wasek

Is SpongeBob on Your Pre-Op Team?

Anesthetic induction is a big, anxiety-laden step for most pediatric patients. But children who get to choose a cartoon to watch until they're under seem to take the pre-op process in stride, say a group of South Korean researchers.

For a study appearing in the November issue of the journal Anesthesia & Analgesia, 130 children, aged 3 to 7 years, who were undergoing tonsillectomies and other routine surgeries were divided into 3 groups. One group of children watched an animated film on a tablet or laptop computer, the children of the second group were asked to bring a favorite toy to play with and a control group received no special treatment. The children's anxiety levels were rated by way of parents' and clinicians' observations of their behavior.

In the waiting room, the toy group children appeared to be the least anxious. But upon arrival in the OR, it was the children distracted by the cartoon who were calmest, much more so than the toy or control groups. The entertainment, says study co-author Jeong-Woo Lee, MD, of Chonbuk National University Hospital, is an "inexpensive, easy to administer and comprehensive method for anxiety reduction."

An accompanying editorial concurs, explaining children's absorbed attentions through a common household example. "Trying to interact with our children when Cars or SpongeBob is on television is futile," it says.

David Bernard

Aspirin Prevents Dangerous Surgical Complication

Aspirin is just as effective as the commonly administered blood thinner warfarin in preventing pulmonary embolism following knee and hip replacement surgeries, according to researchers at the Rothman Institute in Philadelphia, Pa.

In a study presented at the annual meeting of the American Association of Hip and Knee Surgeons in Dallas last month, a research team led by orthopedic surgeon Jarvad Parvizi, MD, reviewed nearly 26,500 total joint cases performed from 2000 to 2011 at Thomas Jefferson University Hospitals in Philadelphia.

Close to 2,000 of the patients received aspirin alone before surgery, while approximately 9,000 patients were given warfarin, which can increase the risk of bleeding, infections and hospital readmissions, say the study's authors.

Patients who received aspirin had fewer pulmonary emboli (0.2%) compared to the warfarin group (1%). Additionally, patients who took aspirin had fewer hematomas, wound issues and acute infections.

Dr. Parvizi says aspirin was shown to prevent clots after joint replacement in healthy patients. As a result, orthopedic surgeons at Jefferson have begun using aspirin instead of warfarin for prophylactic use before such surgeries.

Daniel Cook

InstaPoll: What Do You Call This Thing We Do?

Same day surgery goes by many names. Tell us in Outpatient Surgery Magazine's weekly InstaPoll which term most appeals to you.

Last week we asked if you've ever revoked a surgeon's block time. Nearly 6 out of 10 of our 61 poll respondents did — 38% because the block was less than 60% filled and 21% because the block was less than 80% filled. Another 13% indicated they'd like to revoke a surgeon's block time, but couldn't because the surgeon in question is an owner. Twenty-eight percent say they've never touched a surgeon's block.

Dan O'Connor

News & Notes
  • 2013's top medical innovation? The Cleveland Clinic has named bariatric surgery for the control of diabetes the top medical innovation for 2013. Medications to control diabetes are largely effective, notes the Clinic, but about half of the people who take them are unable to control their disease. On the other hand, it says, patients who undergo bariatric surgery are more likely to be diabetes-free or have reduced dependence on medications for at least 2 years. Femtosecond laser cataract surgery earned the sixth spot on the list, the only other surgical procedure to crack the top 10.
  • Nasal prep cuts SSIs A quick pre-op nasal application of povidone-iodine may be more efficacious than nasal mupirocin for preventing deep SSIs caused by Staphylococcus aureus, according to a study from New York University's Langone Medical Center. The randomized trial assigned 1,697 patients undergoing arthroplasty or spine fusion surgery evenly to the two treatments. All patients underwent chlorhexidine cleansing of the skin and received standard antimicrobial prophylaxis. The povidone-iodine group's SSI rate was one-sixth that of the mupirocin group. Povidone-iodine patients also had a lower rate of adverse events and less often rated their treatment as unpleasant.
  • Hazards in health technology The ECRI Institute has issued its annual list of the top 10 health technology hazards. The 2013 lineup, available free of charge through the non-profit healthcare research organization's website, includes ignored alarms, pain pump drug delivery errors and electronic record mismatches.