Background: In production environments, a countdown timer is used to report the status of the planned start time and to provide both a communication mechanism and an accountability aid.¹ It has been used in the airline industry to remind all personnel of the remaining time until when the aircraft door should be closed. This study explored the effectiveness of a countdown timer in the operating room (OR).

Aims: This study was designed to assess the effectiveness of a countdown timer in the OR setting and to determine the factors that contribute to prolonged OR turnover time (TOT) (defined to be from the “procedure finish” time of the preceding case to the “procedure start” time of the following case), as well as the impact each of the significant factors has on TOT. In this study, the term case denotes a surgical procedure.

Method: An Android app named ORTimer was developed for the study. The app was installed on Android tablets that were placed at the Certified Registered Nurse Anesthetist (CRNA) workstations in the OR at Greenville Memorial Hospital (GMH) in South Carolina. The CRNAs helped collect the event milestones and record the delay reasons (if applicable). Additional OR case information was extracted from GMH’s electronic medical record. Regression analysis was used to identify significant factors that contribute to prolonged OR TOT and to estimate their impacts. A t-test was conducted to test the hypothesis that the use of a countdown timer is effective in an OR environment.

Results: The data from a total of 232 cases where the ORTimer app was used were examined. Among the factors (i.e., delay reasons and case information) considered, an outpatient from a following case had the highest correlation with excessive room idle time, which is the difference between the actual TOT and the allotted TOT. Delays due to patient-related issues added about 12.7 minutes to the turnover time (90% CI: 7.2, 18.3) when other factors were fixed. Delays due to preoperative-related issues added about 27.4 minutes to the turnover time (90% CI: 20.0, 34.7) when other factors were fixed.

Conclusions: As is the case with most production environments,¹ the use of a visual management tool such as the countdown timer in the OR is found to be effective. Additional research is needed to determine whether this finding is applicable to other hospitals.

Keywords: Information Technology (IT) intervention, operating room efficiency, operating room process improvement.

Background: The ability to obtain high quality ocular images utilizing smartphone technology is of special interest in under-resourced parts of the world where traditional ocular imaging devices are cost-prohibitive, difficult to transport, and require a trained technician for operation.

Purpose: The purpose of this study was to explore potential anterior and posterior segment ocular imaging use cases for a smartphone-based ophthalmic camera adapter (Paxos Scope, Digisight Technologies, San Francisco, CA, USA) in under-resourced settings in Nepal.

Methods: From September to November of 2015 we utilized the Paxos Scope smartphone camera adapter coupled with an iPhone 5 to explore anterior and posterior segment clinical applications for this mobile technology. We used the device at a tertiary eye care facility, a rural eye hospital and a rural cataract outreach camp. We tested the device’s capability for high quality photo-documentation in clinic, in the operating room, and in the outreach camp setting. Images were automatically uploaded to a secure, cloud-based electronic medical record system that facilitated sharing of images with other providers for telemedicine purposes.

Results: Herein we present 17 ocular images documenting a wide variety of anterior and posterior segment pathology using the Paxos Scope from clinical cases seen in a variety of settings in Nepal.

Conclusions: We found the quality of both the anterior and posterior segment images to be excellent in the clinic, the operating room, and the outreach camp settings. We found the device to be versatile and user-friendly, with a short learning curve. The Paxos Scope smartphone camera adapter may provide an affordable, high-quality, mobile ocular imaging option for under-resourced parts of the world.

Keywords: Paxos Scope, mobile health, smartphone ophthalmic imaging, teleophthalmology, triage

Background: Student attendance at teaching-learning sessions is traditionally registered using pen-and-paper. This method has many weaknesses: lost, hard to verify, attendance-by-proxy, late submission. The Quick-Response Code is a two-dimensional barcode that can be read with a QR reader on a smartphone that captures and instantly transmits information to a cloud storage. We describe the use of a QRC method to register medical students’ attendance and assessed their perception of this method compared to PAP.

Method: The attendance of 112 medical students in all teaching and learning sessions in internal medicine posting was registered either with QRC or PAP. A static QR code was generated using open source software online and linked to Google Document for storage of data registered. At the end of the posting, the students’ perception was assessed using a 4-point Likert scale satisfaction survey.

Results: 83 students participated in the survey (74% response rate). 100% owned a smart device and 91.6% had data connectivity. Compared to PAP, the QRC method was perceived to be more convenient, more accurate, more secure and more environment-friendly and preferred (all p < 0.05). The QRC method was not significantly faster than the PAP (p = 0.361).

Conclusion: The QRC method was the preferred attendance record tool compared to the traditional PAP method. Its adoption in the closed and secure environment of a medical campus and hospital is feasible and should be explored.

Keywords: QR code, attendance record tool, medical school