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Karmarkar T, Mahadev A, Bachar A, McKenzie A, Sutkin G. "Right Into the Center": A Semantic Analysis of Direction in Operating Room Instruction. JOURNAL OF SURGICAL EDUCATION 2024; 81:688-695. [PMID: 38548558 DOI: 10.1016/j.jsurg.2024.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 02/11/2024] [Accepted: 02/19/2024] [Indexed: 04/26/2024]
Abstract
OBJECTIVE In our previous work, teaching surgeons used potentially ambiguous language in the OR 12.3 times per minute. Our objectives were to examine ambiguous examples featuring Directional Frame of Reference (DFoR), which involves instructions containing directional terms like "up" or "left," and to uncover what contributes to understanding or misunderstanding of such instruction. DESIGN We videorecorded the critical moments of 6 surgeries, as chosen by the surgeons. With a semanticist, we applied constructs from formal semantics to choose potentially ambiguous DFoR terms commonly flagged in our previous work. We separately interviewed attending and resident surgeons, asking each to describe the meaning of those DFoR terms while they viewed case recordings alongside transcripts. We compared their responses, analyzing them for agreement in direction. We performed thematic analysis on case and interview transcripts for themes related to DFoR. SETTING Midwestern academic university teaching hospital. PARTICIPANTS Six attending and 6 resident surgeons. RESULTS Attending and resident surgeons disagreed on direction in 9 of the 26 (34.6%) DFoR examples. Misunderstanding arose from using linear direction to describe three-dimensional space, e.g., "up" for anterior/cephalad/right. It also arose when combining degree modifiers with DfoR, e.g., "we're far enough back" combines the ambiguities of "back" (DfoR) and "far enough" (degree modifier). Use of axial parts (noun-like directional terms), e.g., "bottom," and confusing "left" for "right" also provoked misunderstanding. Misunderstanding was associated with lack of experience and mitigated by pointing with a finger or instrument, concurrent with speech. CONCLUSIONS Use of ambiguous language with DFoR incurs a high potential for misunderstanding, especially with novice surgeons. We recommend avoiding linear directions and axial parts, and instead physically pointing to represent complex 3D directions. Degree modifiers can be replaced with exact distances e.g., replace "little more anterior" with "1 centimeter anterior," and semaphores can be used to clarify direction.
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Affiliation(s)
- Tanvi Karmarkar
- Female Pelvic Medicine and Reconstructive Surgery, University of Missouri Kansas City School of Medicine, 2411 Holmes Street, Kansas City, MO 64108
| | - Ashna Mahadev
- Female Pelvic Medicine and Reconstructive Surgery, University of Missouri Kansas City School of Medicine, 2411 Holmes Street, Kansas City, MO 64108
| | - Austin Bachar
- Female Pelvic Medicine and Reconstructive Surgery, University of Missouri Kansas City School of Medicine, 2411 Holmes Street, Kansas City, MO 64108
| | - Andrew McKenzie
- Department of Linguistics, University of Kansas, 1541 Lilac Lane, Lawrence, KS 66045
| | - Gary Sutkin
- Female Pelvic Medicine and Reconstructive Surgery, University of Missouri Kansas City School of Medicine, 2411 Holmes Street, Kansas City, MO 64108.
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Bachar A, Brommelsiek M, Simonson RJ, Raymond Chan YY, Davies A, Catchpole K, Sutkin G. Speech Communication Interference in the Operating Room. J Surg Res 2024; 295:723-731. [PMID: 38142575 DOI: 10.1016/j.jss.2023.11.064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 10/24/2023] [Accepted: 11/12/2023] [Indexed: 12/26/2023]
Abstract
INTRODUCTION Operating room communication is frequently disrupted, raising safety concerns. We used a Speech Interference Instrument to measure the frequency, impact, and causes of speech communication interference (SCI) events. METHODS In this prospective study, we observed 40 surgeries, primarily general surgery, to measure the frequency of SCI, defined as "group discourse disrupted according to the participants, the goals, or the physical and situational context of the exchange." We performed supplemental observations, focused on conducting postsurgery interviews with SCI event participants to identify contextual factors. We thematically analyzed notes and interviews. RESULTS The observed 103 SCI events in 40 surgeries (mean 2.58) mostly involved the attending (50.5%), circulating nurse (44.6%), resident (44.6%), or scrub tech (42.7%). The majority (82.1%) of SCI events occurred during another patient-related task. 17.5% occurred at a critical moment. 27.2% of SCI events were not acknowledged or repeated and the message was lost. Including the supplemental observations, 97.0% of SCI events caused a delay (mean 5 s). Inter-rater reliability, calculated by Gwet's AC1 was 0.87-0.98. Postsurgery interviews confirmed miscommunication and distractions. Attention was most commonly diverted by loud noises (e.g., suction), conversations, or multitasking (e.g., using the electronic health record). Successful strategies included repetition or deferment of the request until competing tasks were complete. CONCLUSIONS Communication interference may have patient safety implications that arise from conflicts with other case-related tasks, machine noises, and other conversations. Reorganization of workflow, tasks, and communication behaviors could reduce miscommunication and improve surgical safety and efficiency.
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Affiliation(s)
- Austin Bachar
- Urogynecology and Reconstructive Pelvic Surgery, University of Missouri Kansas City School of Medicine, Kansas City, Missouri
| | - Margaret Brommelsiek
- Interprofessional Education Health Sciences Schools, University of Missouri Kansas City School of Nursing, Kansas City, Missouri
| | - Richard John Simonson
- Childrens Mercy Hospital, University of Missouri Kansas City School of Medicine Department of Pediatrics, Kansas City, Missouri
| | - Yui-Yee Raymond Chan
- Childrens Mercy Hospital, University of Missouri Kansas City School of Medicine Department of Pediatrics, Kansas City, Missouri
| | - Amber Davies
- Department of Anesthesia, University Health Hospital System, Kansas City, Missouri
| | - Ken Catchpole
- Embedded Human Factors and Clinical Safety Science Unit, Medical University of South Carolina, Charleston, South Carolina
| | - Gary Sutkin
- Urogynecology and Reconstructive Pelvic Surgery, University of Missouri Kansas City School of Medicine, Kansas City, Missouri.
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Williams SC, Ahmed R, Davids JD, Funnell JP, Hanrahan JG, Layard Horsfall H, Muirhead W, Nicolosi F, Thorne L, Marcus HJ, Grover P. Benchtop simulation of the retrosigmoid approach: Validation of a surgical simulator and development of a task-specific outcome measure score. World Neurosurg X 2023; 20:100230. [PMID: 37456690 PMCID: PMC10344945 DOI: 10.1016/j.wnsx.2023.100230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 05/11/2023] [Accepted: 06/12/2023] [Indexed: 07/18/2023] Open
Abstract
Background Neurosurgical training is changing globally. Reduced working hours and training opportunities, increased patient safety expectations, and the impact of COVID-19 have reduced operative exposure. Benchtop simulators enable trainees to develop surgical skills in a controlled environment. We aim to validate a high-fidelity simulator model (RetrosigmoidBox, UpSurgeOn) for the retrosigmoid approach to the cerebellopontine angle (CPA). Methods Novice and expert Neurosurgeons and Ear, Nose, and Throat surgeons performed a surgical task using the model - identification of the trigeminal nerve. Experts completed a post-task questionnaire examining face and content validity. Construct validity was assessed through scoring of operative videos employing Objective Structured Assessment of Technical Skills (OSATS) and a novel Task-Specific Outcome Measure score. Results Fifteen novice and five expert participants were recruited. Forty percent of experts agreed or strongly agreed that the brain tissue looked real. Experts unanimously agreed that the RetrosigmoidBox was appropriate for teaching. Statistically significant differences were noted in task performance between novices and experts, demonstrating construct validity. Median total OSATS score was 14/25 (IQR 10-19) for novices and 22/25 (IQR 20-22) for experts (p < 0.05). Median Task-Specific Outcome Measure score was 10/20 (IQR 7-17) for novices compared to 19/20 (IQR 18.5-19.5) for experts (p < 0.05). Conclusion The RetrosigmoidBox benchtop simulator has a high degree of content and construct validity and moderate face validity. The changing landscape of neurosurgical training mean that simulators are likely to become increasingly important in the delivery of high-quality education. We demonstrate the validity of a Task-Specific Outcome Measure score for performance assessment of a simulated approach to the CPA.
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Affiliation(s)
- Simon C. Williams
- Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences (WEISS), London, UK
| | - Razna Ahmed
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences (WEISS), London, UK
- Queen Square Institute of Neurology, University College London, London, UK
| | - Joseph Darlington Davids
- Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
- Institute of Global Health Innovation and Hamlyn Centre for Robotics Surgery, Imperial College London, London, UK
| | - Jonathan P. Funnell
- Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences (WEISS), London, UK
| | - John Gerrard Hanrahan
- Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences (WEISS), London, UK
| | - Hugo Layard Horsfall
- Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences (WEISS), London, UK
| | - William Muirhead
- Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences (WEISS), London, UK
| | - Federico Nicolosi
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Lewis Thorne
- Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
| | - Hani J. Marcus
- Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences (WEISS), London, UK
| | - Patrick Grover
- Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
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Fehervari M, Fadel MG, Reddy M, Khan OA. Medicolegal Cases in Bariatric Surgery in the United Kingdom. Curr Obes Rep 2023; 12:355-364. [PMID: 37266862 PMCID: PMC10236394 DOI: 10.1007/s13679-023-00508-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/05/2023] [Indexed: 06/03/2023]
Abstract
PURPOSE OF REVIEW To evaluate the current state of bariatric medicolegal activity and explore the reasons of litigation in bariatric surgery. The underlying legal principles in bariatric medicolegal cases and most frequent pitfalls will also be discussed. RECENT FINDINGS There is a growing number of litigations in bariatric surgery, particularly relating to complications and long waiting lists for bariatric surgery within the public-funded health systems. The main issues are related to consent, lack of follow-up, delayed identification of complications and lack of appropriate emergency management of complications, involving bariatric surgeons, clinicians, general practitioners and multidisciplinary team members. Appropriate multidisciplinary involvement pre- and postoperatively and robust follow-up protocols can help to mitigate the risks. Bariatric surgery requires a unique paradigm with a multidisciplinary approach both pre- and postoperatively to improve the long-term functional outcomes of patients. There is a rising incidence of medicolegal claims following bariatric surgery. The underlying reasons for this are multifactorial including an increase in the volume of surgery, high patient expectations, the incidence of long-term postoperative complications and the requirement of long-term follow-up.
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Affiliation(s)
- Matyas Fehervari
- Department of Bariatric Surgery, St George's Hospital, London, UK.
- Department of Surgery and Cancer, Imperial College London, London, UK.
| | - Michael G Fadel
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Marcus Reddy
- Department of Bariatric Surgery, St George's Hospital, London, UK
| | - Omar A Khan
- Department of Bariatric Surgery, St George's Hospital, London, UK
- Population Sciences Department, St George's University of London, London, UK
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Kauffmann EF, Napoli N, Ginesini M, Gianfaldoni C, Asta F, Salamone A, Amorese G, Vistoli F, Boggi U. Feasibility of "cold" triangle robotic pancreatoduodenectomy. Surg Endosc 2022; 36:9424-9434. [PMID: 35881243 PMCID: PMC9652209 DOI: 10.1007/s00464-022-09411-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 06/19/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND Triangle pancreatoduodenectomy adds to the conventional procedure the en bloc removal of the retroperitoneal lympho-neural tissue included in the triangular area bounded by the common hepatic artery (CHA), the superior mesenteric artery (SMA), and the superior mesenteric vein/portal vein. We herein aim to show the feasibility of "cold" triangle robotic pancreaticoduodenectomy (C-Tr-RPD) for pancreatic cancer (PDAC). METHODS Cold dissection corresponds to sharp arterial divestment performed using only the tips of robotic scissors. After division of the gastroduodenal artery, triangle dissection begins by lateral-to-medial divestment of the CHA and anterior-to-posterior clearance of the right side of the celiac trunk. Next, after a wide Kocher maneuver, the origin of the SMA, and the celiac trunk are identified. After mobilization of the first jejunal loop and attached mesentery, the SMA is identified at the level of the first jejunal vein and is divested along the right margin working in a distal-to-proximal direction. Vein resection and reconstruction can be performed as required. C-Tr-RPD was considered feasible if triangle dissection was successfully completed without conversion to open surgery or need to use energy devices. Postoperative complications and pathology results are presented in detail. RESULTS One hundred twenty-seven consecutive C-Tr-RPDs were successfully performed. There were three conversions to open surgery (2.3%), because of pneumoperitoneum intolerance (n = 2) and difficult digestive reconstruction. Thirty-four patients (26.7%) required associated vascular procedures. No pseudoaneurysm of the gastroduodenal artery was observed. Twenty-eight patients (22.0%) developed severe postoperative complications (≥ grade III). Overall 90-day mortality was 7.1%, declining to 2.3% after completion of the learning curve. The median number of examined lymph nodes was 42 (33-51). The rate of R1 resection (7 margins < 1 mm) was 44.1%. CONCLUSION C-Tr-RPD is feasible, carries a risk of surgical complications commensurate to the magnitude of the procedure, and improves staging of PDAC.
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Affiliation(s)
- Emanuele F. Kauffmann
- Division of General and Transplant Surgery, University of Pisa, Via Paradisa 2, 56124 Pisa, Italy
| | - Niccolò Napoli
- Division of General and Transplant Surgery, University of Pisa, Via Paradisa 2, 56124 Pisa, Italy
| | - Michael Ginesini
- Division of General and Transplant Surgery, University of Pisa, Via Paradisa 2, 56124 Pisa, Italy
| | - Cesare Gianfaldoni
- Division of General and Transplant Surgery, University of Pisa, Via Paradisa 2, 56124 Pisa, Italy
| | - Fabio Asta
- Division of General and Transplant Surgery, University of Pisa, Via Paradisa 2, 56124 Pisa, Italy
| | - Alice Salamone
- Division of General and Transplant Surgery, University of Pisa, Via Paradisa 2, 56124 Pisa, Italy
| | - Gabriella Amorese
- Division of Anesthesia and Intensive Care, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Fabio Vistoli
- Division of General and Transplant Surgery, University of Pisa, Via Paradisa 2, 56124 Pisa, Italy
| | - Ugo Boggi
- Division of General and Transplant Surgery, University of Pisa, Via Paradisa 2, 56124 Pisa, Italy
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Boggi U. Laparoscopic duodenum-preserving total pancreatic head resection for pancreatic tumors: the difficult balance among overtreatment, ideal treatment, and undertreatment. Langenbecks Arch Surg 2022; 407:3859-3861. [DOI: 10.1007/s00423-022-02512-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 04/08/2022] [Indexed: 12/07/2022]
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7
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Yan M, Wang M, Al-Hakim L. Barriers to reporting near misses and adverse events among professionals performing laparoscopic surgeries: a mixed methodology approach. Surg Endosc 2021; 35:7015-7026. [PMID: 33398582 DOI: 10.1007/s00464-020-08215-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 12/03/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND The literature has investigated barriers to reporting adverse events in surgery, but with less emphasis on near misses. No attempt was made to categorise near misses by type and reportability. This paper attempts to fill these two gaps in the literature. METHODS A mixed methodology approach was adopted. A sample of 16 laparoscopic surgeries were observed followed by a questionnaire distributed among professionals dealing with laparoscopies. Non-parametric tests and mediation-moderation analysis were used to compare responses and identify causal factors. RESULTS A total of 469 near misses were observed, and classified into two categories: reportable events and common events. Among 23 observed reportable events, only 9 events were reported. Out of 300 distributed questionnaires, we received 178 valid responses (response rate 59%). The professionals strongly disagreed that reporting near misses (Mean 4.09, STD 0.95) and adverse events (4.17, 1.02) makes little contribution to the quality of surgery. However, the results show that professionals were more willing to disclose adverse events than near misses, Heavy workload, privacy, lack of support, and fear from disciplinary actions negatively affected professionals' willingness to report near misses. DISCUSSION Error reporting should aim to promote safety, knowledge sharing and education. It is important to differentiate near misses that should be reported from voluntary reported events. Hospital's management might award professionals who frequently report errors and provide solutions, Quality rather than quantity of reports should be emphasised with flexibility in the way near misses are reported. CONCLUSION The outcome of this study has benefits of understanding the attitudes of surgical professionals towards error reporting. It provides healthcare management with tool for enhancing safety and providing suitable training for their professionals.
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Affiliation(s)
- Min Yan
- Department of Anesthesiology, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Ming Wang
- Department of Urology, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Latif Al-Hakim
- School of Management and Enterprise, University of Southern Queensland, Toowoomba, QLD, Australia.
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Kanjilal D, Mahmud F, Sutkin G. Constructivist Grounded Theory to Establish the Relationship Between Technical Error and Adverse Patient Outcome: Modeling Technical Error and Adverse Outcomes. Am Surg 2020; 87:753-759. [PMID: 33170022 DOI: 10.1177/0003134820952837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Preventable intraoperative errors have the potential to lead to adverse events. Our objective was to build a conceptual model of the relationship between minute technical errors performed by the surgeon and adverse patient outcomes. MATERIALS AND METHODS We used constructivist grounded theory methodology to build a model for the avoidance of technical errors. We used the Observational Clinical Human Reliability Assessment system, which categorizes granular, technical intraoperative errors, as our conceptual framework. We iteratively interviewed surgeons from multiple adult and pediatric surgical specialties, refined our semi-structured interview, and developed a conceptual model. Our model remained stable after interviewing 11 surgeons, and we reviewed it with earlier interviewed surgeons. RESULTS Our conceptual model helps us understand how technical errors can be associated with adverse outcomes and is applicable to a broad range of surgical steps. Each technical error is defined by a unique improper technical motion that without a compensatory response, it may lead to 1 or more discreet adverse outcomes. Our model includes 5 primary defenses against an adverse outcome, including perfect technique, recognizing imperfect technique, adequately correcting imperfect technique, recognizing an adverse event, and adequately compensating for an adverse event. It includes multiple examples of compensating for a technical error, resulting in a near miss. DISCUSSION Our conceptual model suggests that adverse patient outcomes can be related to minute technical deviations in surgical technique and provides a basis to study these preventable errors. Our model can also be used to develop intraoperative strategies to prevent these technical surgical errors.
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Affiliation(s)
- Debolina Kanjilal
- University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
| | - Fizza Mahmud
- University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
| | - Gary Sutkin
- University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
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Preventing Error in the Operating Room: Five Teaching Strategies for High-Stakes Learning. J Surg Res 2019; 236:12-21. [DOI: 10.1016/j.jss.2018.10.050] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Revised: 10/14/2018] [Accepted: 10/26/2018] [Indexed: 01/27/2023]
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"To Err Is Human…"-Managing Human Error in Reconstructive Microsurgery Training with Defense Barriers. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2018; 6:e1753. [PMID: 29876187 PMCID: PMC5977954 DOI: 10.1097/gox.0000000000001753] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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11
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Towards standardized robotic surgery in gastrointestinal oncology. Langenbecks Arch Surg 2017; 402:1003-1014. [DOI: 10.1007/s00423-017-1623-4] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Accepted: 09/10/2017] [Indexed: 02/07/2023]
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Hogg ME, Besselink MG, Clavien PA, Fingerhut A, Jeyarajah DR, Kooby DA, Moser AJ, Pitt HA, Varban OA, Vollmer CM, Zeh HJ, Hansen P, Barkun J, Kendrick ML, Kooby DA, Hansen PD, Vollmer CM, Zeh H, Montagnini AL, Besselink MG, Boggi U, Conlon KC, Røsok BI, Han HS, Palanivelu C, Shrikhande SV, Wakabayashi G. Training in Minimally Invasive Pancreatic Resections: a paradigm shift away from "See one, Do one, Teach one". HPB (Oxford) 2017; 19:234-245. [PMID: 28190709 DOI: 10.1016/j.hpb.2017.01.016] [Citation(s) in RCA: 82] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Accepted: 01/06/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND Increased incorporation of minimally invasive pancreatic resections (MIPR) has emerged into hepato-pancreato-biliary practice, however, no standardization exists for its safe adoption. Novel strategies are presented for dissemination of safe MIPR. METHODS An international State-of-the-Art conference evaluating multiple aspects of MIPR was conducted by a panel of pancreas experts in Sao Paulo, Brazil on April 20, 2016. Training and education issues were discussed regarding the introduction of novel strategies for safe dissemination of MIPR. RESULTS The low volume of pancreatic resections per institution poses a challenge for surgeons to overcome their MIPR learning curve without deliberate training. A mastery-based simulation and biotissue curriculum can improve technical proficiency and allow for training of surgeons before the operating room. Video-based platforms allow for performance reporting and feedback necessary for coaching and surgical quality improvement. Centers of excellence with training involving a standardized approach and proctorship are important concepts that can be utilized in various formats internationally. DISCUSSION Surgical volume is not sufficient to ensure quality and patient safety in MIPR. Safe adoption of these complex procedures should consider innovative mastery-based training outside of the operating room, novel video based coaching techniques and prospective reporting of patient data and outcomes using standardized definitions.
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Affiliation(s)
- Melissa E Hogg
- University of Pittsburgh Medical Center, Division of Surgical Oncology, Pittsburgh, PA, USA.
| | | | - Pierre-Alain Clavien
- Department of Surgery and Transplantation, University Hospital Zurich, Zurich, Switzerland
| | | | | | - David A Kooby
- Emory University, Department of Surgery, Atlanta, GA, USA
| | - A James Moser
- Beth Israel Deaconess Medical Center, Pancreas and Liver Institute, Boston, MA, USA
| | - Henry A Pitt
- Lewis Katz School of Medicine at Temple University, Department of Surgery, Philadelphia, PA, USA
| | - Oliver A Varban
- University of Michigan, Division of Minimally Invasive Surgery, Ann Arbor, MI, USA
| | | | - Herbert J Zeh
- University of Pittsburgh Medical Center, Division of Surgical Oncology, Pittsburgh, PA, USA
| | - Paul Hansen
- Portland Providence Cancer Institute, Liver and Pancreas Surgery, Portland, OR, USA
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Zevin B, Dedy NJ, Bonrath EM, Grantcharov TP. Comprehensive simulation-enhanced training curriculum for an advanced minimally invasive procedure: a randomized controlled trial. Surg Obes Relat Dis 2016; 13:815-824. [PMID: 28392018 DOI: 10.1016/j.soard.2016.11.019] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Revised: 11/10/2016] [Accepted: 11/24/2016] [Indexed: 12/26/2022]
Abstract
BACKGROUND There is no comprehensive simulation-enhanced training curriculum to address cognitive, psychomotor, and nontechnical skills for an advanced minimally invasive procedure. OBJECTIVES 1) To develop and provide evidence of validity for a comprehensive simulation-enhanced training (SET) curriculum for an advanced minimally invasive procedure; (2) to demonstrate transfer of acquired psychomotor skills from a simulation laboratory to live porcine model; and (3) to compare training outcomes of SET curriculum group and chief resident group. SETTING University. METHODS This prospective single-blinded, randomized, controlled trial allocated 20 intermediate-level surgery residents to receive either conventional training (control) or SET curriculum training (intervention). The SET curriculum consisted of cognitive, psychomotor, and nontechnical training modules. Psychomotor skills in a live anesthetized porcine model in the OR was the primary outcome. Knowledge of advanced minimally invasive and bariatric surgery and nontechnical skills in a simulated OR crisis scenario were the secondary outcomes. Residents in the SET curriculum group went on to perform a laparoscopic jejunojejunostomy in the OR. Cognitive, psychomotor, and nontechnical skills of SET curriculum group were also compared to a group of 12 chief surgery residents. RESULTS SET curriculum group demonstrated superior psychomotor skills in a live porcine model (56 [47-62] versus 44 [38-53], P<.05) and superior nontechnical skills (41 [38-45] versus 31 [24-40], P<.01) compared with conventional training group. SET curriculum group and conventional training group demonstrated equivalent knowledge (14 [12-15] versus 13 [11-15], P = 0.47). SET curriculum group demonstrated equivalent psychomotor skills in the live porcine model and in the OR in a human patient (56 [47-62] versus 63 [61-68]; P = .21). SET curriculum group demonstrated inferior knowledge (13 [11-15] versus 16 [14-16]; P<.05), equivalent psychomotor skill (63 [61-68] versus 68 [62-74]; P = .50), and superior nontechnical skills (41 [38-45] versus 34 [27-35], P<.01) compared with chief resident group. CONCLUSION Completion of the SET curriculum resulted in superior training outcomes, compared with conventional surgery training. Implementation of the SET curriculum can standardize training for an advanced minimally invasive procedure and can ensure that comprehensive proficiency milestones are met before exposure to patient care.
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Affiliation(s)
- Boris Zevin
- Department of Surgery, University of Toronto, Toronto, Canada.
| | - Nicolas J Dedy
- Institute of Medical Science, University of Toronto, Toronto, Canada
| | - Esther M Bonrath
- Institute of Medical Science, University of Toronto, Toronto, Canada
| | - Teodor P Grantcharov
- Department of Surgery, University of Toronto, Toronto, Canada; Division of General Surgery, St. Michael׳s Hospital, Toronto, Canada
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Nagy P, George I, Bernstein W, Caban J, Klein R, Mezrich R, Park A. Radio Frequency Identification Systems Technology in the Surgical Setting. Surg Innov 2016; 13:61-7. [PMID: 16708157 DOI: 10.1177/155335060601300110] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Radio frequency identification (RFID) is a technology that will have a profound impact on medicine and the operating room of the future. The purpose of this article is to provide an introduction to this exciting technology and a description of the problems in the perioperative environment that RFID might address to improve safety and increase productivity. Although RFID is still a nascent technology, applications are likely to become much more visible in patient care and treatment areas and will raise questions for practitioners. We also address both the current limitations and what appear to be reasonable near-future possibilities.
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Affiliation(s)
- Paul Nagy
- University of Maryland School of Medicine, Baltimore, MD 21201, USA.
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15
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van Rutte P, Nienhuijs SW, Jakimowicz JJ, van Montfort G. Identification of technical errors and hazard zones in sleeve gastrectomy using OCHRA : "OCHRA for sleeve gastrectomy". Surg Endosc 2016; 31:561-566. [PMID: 27287912 DOI: 10.1007/s00464-016-4997-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Accepted: 05/19/2016] [Indexed: 12/19/2022]
Abstract
BACKGROUND The sleeve gastrectomy is an example of minimally invasive surgery. It is important to determine the critical steps of the procedure in order to reduce complications and increase safety and efficiency. OBJECTIVE The aim of this study was to detect the key elements of the sleeve gastrectomy and find the potential hazard zones of the procedure. SETTING Bariatric department of a large teaching hospital in the Netherlands. METHODS A prospective clinical observation study was performed including 60 sleeve gastrectomy procedures. An expert panel determined the key steps, and two experts assessed the procedures systematically for technical errors according to the principles of Observational Clinical Human Reliability Assessment (OCHRA). RESULTS A total of 213 technical errors have been made, and the majority were made during mobilization of the greater curvature and during stapling of the stomach. In 44.6 %, errors had consequences and 96 additional actions were performed. There was a significant correlation between errors during opening of the lesser sac and postoperative complications, and between repositioning of the stapler and postoperative complications. CONCLUSIONS In this study, the 13 key steps of the SG were defined, and OCHRA was considered a valuable assessment tool for surgical performance and potential hazard zones. Most consequential errors are made during dissection of the greater curvature and during stapling of the stomach. Errors during the start of mobilization of the greater curvature and repositioning of the stapler lead to longer duration of the procedure and are associated with a higher risk of postoperative complications.
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Affiliation(s)
- Pwj van Rutte
- Department of Surgery, Catharina Hospital Eindhoven, Michelangelolaan 2, 5623 EJ, Eindhoven, The Netherlands.
| | - S W Nienhuijs
- Department of Surgery, Catharina Hospital Eindhoven, Michelangelolaan 2, 5623 EJ, Eindhoven, The Netherlands
| | - J J Jakimowicz
- Department of Surgery, Catharina Hospital Eindhoven, Michelangelolaan 2, 5623 EJ, Eindhoven, The Netherlands.,Technical University of Delft, Delft, The Netherlands
| | - G van Montfort
- Department of Surgery, Catharina Hospital Eindhoven, Michelangelolaan 2, 5623 EJ, Eindhoven, The Netherlands
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Foster JD, Miskovic D, Allison AS, Conti JA, Ockrim J, Cooper EJ, Hanna GB, Francis NK. Application of objective clinical human reliability analysis (OCHRA) in assessment of technical performance in laparoscopic rectal cancer surgery. Tech Coloproctol 2016; 20:361-367. [PMID: 27154295 DOI: 10.1007/s10151-016-1444-4] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Accepted: 01/30/2016] [Indexed: 02/06/2023]
Abstract
BACKGROUND Laparoscopic rectal resection is technically challenging, with outcomes dependent upon technical performance. No robust objective assessment tool exists for laparoscopic rectal resection surgery. This study aimed to investigate the application of the objective clinical human reliability analysis (OCHRA) technique for assessing technical performance of laparoscopic rectal surgery and explore the validity and reliability of this technique. METHODS Laparoscopic rectal cancer resection operations were described in the format of a hierarchical task analysis. Potential technical errors were defined. The OCHRA technique was used to identify technical errors enacted in videos of twenty consecutive laparoscopic rectal cancer resection operations from a single site. The procedural task, spatial location, and circumstances of all identified errors were logged. Clinical validity was assessed through correlation with clinical outcomes; reliability was assessed by test-retest. RESULTS A total of 335 execution errors identified, with a median 15 per operation. More errors were observed during pelvic tasks compared with abdominal tasks (p < 0.001). Within the pelvis, more errors were observed during dissection on the right side than the left (p = 0.03). Test-retest confirmed reliability (r = 0.97, p < 0.001). A significant correlation was observed between error frequency and mesorectal specimen quality (r s = 0.52, p = 0.02) and with blood loss (r s = 0.609, p = 0.004). CONCLUSIONS OCHRA offers a valid and reliable method for evaluating technical performance of laparoscopic rectal surgery.
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Affiliation(s)
- J D Foster
- Yeovil District Hospital NHS Foundation Trust, Higher Kingston, Yeovil, Somerset, BA21 2RH, UK.,Imperial College, London, UK
| | - D Miskovic
- John Goligher Department of Colorectal Surgery, St. James University Hospital, Leeds, UK
| | - A S Allison
- Yeovil District Hospital NHS Foundation Trust, Higher Kingston, Yeovil, Somerset, BA21 2RH, UK
| | - J A Conti
- Queen Alexandra Hospital, Portsmouth, UK
| | - J Ockrim
- Yeovil District Hospital NHS Foundation Trust, Higher Kingston, Yeovil, Somerset, BA21 2RH, UK
| | - E J Cooper
- Yeovil District Hospital NHS Foundation Trust, Higher Kingston, Yeovil, Somerset, BA21 2RH, UK
| | | | - N K Francis
- Yeovil District Hospital NHS Foundation Trust, Higher Kingston, Yeovil, Somerset, BA21 2RH, UK.
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Tapia-Araya AE, Usón-Gargallo J, Enciso S, Pérez-Duarte FJ, Díaz-Güemes Martin-Portugués I, Fresno-Bermejo L, Sánchez-Margallo FM. Assessment of Laparoscopic Skills in Veterinarians Using a Canine Laparoscopic Simulator. JOURNAL OF VETERINARY MEDICAL EDUCATION 2015; 43:71-79. [PMID: 26653288 DOI: 10.3138/jvme.0315-034r1] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The aim of the present study was to assess the content and construct validity of the Canine Laparoscopic Simulator (CLS). Forty-two veterinarians were assigned to experienced (n=12), control (n=15), and training (n=15) groups, which were assessed while performing four laparoscopic tasks on the CLS. The initial and final assessments of all tasks were performed blindly by two experienced surgeons using the Global Operative Assessment of Laparoscopic Skills (GOALS) and a task-specific checklist. At the end of the study, the subjects completed an anonymous survey. The experienced group performed all of the tasks faster, with higher GOALS and checklist scores than the training and control groups (p≤.001). In the second assessment, the training group reduced the time needed to complete all of the tasks and obtained significantly higher GOALS and checklist scores than the control group. The participants perceived the CLS and its training program to be positive or very positive. The CLS and its training program demonstrated content and construct validity, supporting the suitability of the simulator for training and teaching and its ability to distinguish the degree of experience in laparoscopic surgery among veterinarians. In addition, face validity showed that the veterinarians fully accepted the CLS's usefulness for learning basic laparoscopic skills.
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18
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White AD, Skelton M, Mushtaq F, Pike TW, Mon-Williams M, Lodge JPA, Wilkie RM. Inconsistent reporting of minimally invasive surgery errors. Ann R Coll Surg Engl 2015; 97:608-12. [PMID: 26492908 PMCID: PMC5096613 DOI: 10.1308/rcsann.2015.0038] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/28/2015] [Indexed: 12/30/2022] Open
Abstract
INTRODUCTION Minimally invasive surgery (MIS) is a complex task requiring dexterity and high level cognitive function. Unlike surgical 'never events', potentially important (and frequent) manual or cognitive slips ('technical errors') are underresearched. Little is known about the occurrence of routine errors in MIS, their relationship to patient outcome, and whether they are reported accurately and/or consistently. METHODS An electronic survey was sent to all members of the Association of Surgeons of Great Britain and Ireland, gathering demographic information, experience and reporting of MIS errors, and a rating of factors affecting error prevalence. RESULTS Of 249 responses, 203 completed more than 80% of the questions regarding the surgery they had performed in the preceding 12 months. Of these, 47% reported a significant error in their own performance and 75% were aware of a colleague experiencing error. Technical skill, knowledge, situational awareness and decision making were all identified as particularly important for avoiding errors in MIS. Reporting of errors was variable: 15% did not necessarily report an intraoperative error to a patient while 50% did not consistently report at an institutional level. Critically, 12% of surgeons were unaware of the procedure for reporting a technical error and 59% felt guidance is needed. Overall, 40% believed a confidential reporting system would increase their likelihood of reporting an error. CONCLUSION These data indicate inconsistent reporting of operative errors, and highlight the need to better understand how and why technical errors occur in MIS. A confidential 'no blame' reporting system might help improve patient outcomes and avoid a closed culture that can undermine public confidence.
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Affiliation(s)
- A D White
- Leeds Teaching Hospitals NHS Trust , UK
- University of Leeds , UK
| | | | | | - T W Pike
- Leeds Teaching Hospitals NHS Trust , UK
- University of Leeds , UK
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19
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Abstract
Background. Surgical training is changing and evolving as time, pressure, and legislative demands continue to mount on trainee surgeons. A paradigm change in the focus of training has resulted in experts examining the cognitive steps needed to perform complex and often highly pressurized surgical procedures. Objective. To provide an overview of the collective evidence on cognitive task analysis (CTA) as a surgical training method, and determine if CTA improves a surgeon’s performance as measured by technical and nontechnical skills assessment, including precision, accuracy, and operative errors. Methods. A systematic literature review was performed. PubMed, Cochrane, and reference lists were analyzed for appropriate inclusion. Results. A total of 595 surgical participants were identified through the literature review and a total of 13 articles were included. Of these articles, 6 studies focused on general surgery, 2 focused on practical procedures relevant to surgery (central venous catheterization placement), 2 studies focused on head and neck surgical procedures (cricothyroidotomy and percutaneous tracheostomy placement), 2 studies highlighted vascular procedures (endovascular aortic aneurysm repair and carotid artery stenting), and 1 detailed endovascular repair (abdominal aorta and thoracic aorta). Overall, 92.3% of studies showed that CTA improves surgical outcome parameters, including time, precision, accuracy, and error reduction in both simulated and real-world environments. Conclusion. CTA has been shown to be a more effective training tool when compared with traditional methods of surgical training. There is a need for the introduction of CTA into surgical curriculums as this can improve surgical skill and ultimately create better patient outcomes.
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Graafland M, Schraagen JMC, Boermeester MA, Bemelman WA, Schijven MP. Training situational awareness to reduce surgical errors in the operating room. Br J Surg 2014; 102:16-23. [DOI: 10.1002/bjs.9643] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2014] [Revised: 06/20/2014] [Accepted: 08/06/2014] [Indexed: 12/21/2022]
Abstract
Abstract
Background
Surgical errors result from faulty decision-making, misperceptions and the application of suboptimal problem-solving strategies, just as often as they result from technical failure. To date, surgical training curricula have focused mainly on the acquisition of technical skills. The aim of this review was to assess the validity of methods for improving situational awareness in the surgical theatre.
Methods
A search was conducted in PubMed, Embase, the Cochrane Library and PsycINFO® using predefined inclusion criteria, up to June 2014. All study types were considered eligible. The primary endpoint was validity for improving situational awareness in the surgical theatre at individual or team level.
Results
Nine articles were considered eligible. These evaluated surgical team crisis training in simulated environments for minimally invasive surgery (4) and open surgery (3), and training courses focused at training non-technical skills (2). Two studies showed that simulation-based surgical team crisis training has construct validity for assessing situational awareness in surgical trainees in minimally invasive surgery. None of the studies showed effectiveness of surgical crisis training on situational awareness in open surgery, whereas one showed face validity of a 2-day non-technical skills training course.
Conclusion
To improve safety in the operating theatre, more attention to situational awareness is needed in surgical training. Few structured curricula have been developed and validation research remains limited. Strategies to improve situational awareness can be adopted from other industries.
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Affiliation(s)
- M Graafland
- Department of Surgery, Academic Medical Centre, Amsterdam, The Netherlands
| | - J M C Schraagen
- Netherlands Organization for Applied Scientific Research (TNO), Soesterberg, The Netherlands
- Faculty of Behavioural, Management and Social Sciences, University of Twente, Twente, The Netherlands
| | - M A Boermeester
- Department of Surgery, Academic Medical Centre, Amsterdam, The Netherlands
| | - W A Bemelman
- Department of Surgery, Academic Medical Centre, Amsterdam, The Netherlands
| | - M P Schijven
- Department of Surgery, Academic Medical Centre, Amsterdam, The Netherlands
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McCrory B, LaGrange CA, Hallbeck M. Quality and safety of minimally invasive surgery: past, present, and future. Biomed Eng Comput Biol 2014; 6:1-11. [PMID: 25288906 PMCID: PMC4147776 DOI: 10.4137/becb.s10967] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2014] [Revised: 03/17/2014] [Accepted: 03/18/2014] [Indexed: 12/14/2022] Open
Abstract
Adverse events because of medical errors are a leading cause of death in the United States (US) exceeding the mortality rates of motor vehicle accidents, breast cancer, and AIDS. Improvements can and should be made to reduce the rates of preventable surgical errors because they account for nearly half of all adverse events within hospitals. Although minimally invasive surgery (MIS) has proven patient benefits such as reduced postoperative pain and hospital stay, its operative environment imposes substantial physical and cognitive strain on the surgeon increasing the risk of error. To mitigate errors and protect patients, a multidisciplinary approach is needed to improve MIS. Clinical human factors, and biomedical engineering principles and methodologies can be used to develop and assess laparoscopic surgery instrumentation, practices, and procedures. First, the foundational understanding and the imperative to transform health care into a high-quality and safe system is discussed. Next, a generalized perspective is presented on the impact of the design and redesign of surgical technologies and processes on human performance. Finally, the future of this field and the research needed to further improve the quality and safety of MIS is discussed.
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Affiliation(s)
- Bernadette McCrory
- Mechanical and Materials Engineering Department, University of Nebraska, Lincoln, NE, USA
| | - Chad A LaGrange
- Division of Urologic Surgery, Department of Surgery, University of Nebraska Medical Center, Omaha, NE, USA
| | - Ms Hallbeck
- Mechanical and Materials Engineering Department, University of Nebraska, Lincoln, NE, USA. ; Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Health Care Policy and Research Department, Mayo Clinic, Rochester, MN, USA
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Dedhia RC, Shwaish K, Snyderman CH, Monte R, Eibling DE. Perioperative process errors and delays in otolaryngology at a Veterans Hospital: prospective study. Laryngoscope 2013; 123:3010-5. [PMID: 23649943 DOI: 10.1002/lary.24191] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2013] [Revised: 04/08/2013] [Accepted: 04/16/2013] [Indexed: 12/12/2022]
Abstract
OBJECTIVES/HYPOTHESIS To understand the leading causes for process errors and delays in the otolaryngology operating room and recognize the impact of process errors and delays on patient safety, operating room resources and hospital costs. STUDY DESIGN Prospective, observational study. METHODS A 4-week study was conducted during 1 calendar month in 2012, evaluating 23 elective otolaryngology cases. A standardized data collection tool was developed and refined based on prestudy pilot observations. Two trained observers recorded relevant times and actions from patient check-in time in the preoperative holding area to the "wheels out" time. RESULTS The mean case observation time was 220.0 ± 167.8 minutes, with mean duration of operation length being 107.0 ± 146.2 minutes. The perioperative period was divided into six stages: patient holding, room preparation, preintubation, postintubation, intraoperative, and postextubation. One hundred process errors were recorded (average of 4.3 per case), 34% of which were due to communication failures. Forty delays were observed, resulting in 336 minutes of standstill delay. Again, communication failures represented the most common etiology, with 17 communication failures resulting in 146 minutes of standstill delay. The preintubation stage was most affected by delay, with 1 in 6 minutes comprising standstill delay. CONCLUSION Process errors and significant delays were common in cases performed at our institution; communication errors were the most common etiology. There is opportunity for preoperative team discussion and the use of technology to minimize communication-related process errors and standstill delays. Further work is currently being undertaken to study this critical issue across specialties.
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Affiliation(s)
- Raj C Dedhia
- Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, U.S.A
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Marcus H, Vakharia V, Kirkman MA, Murphy M, Nandi D. Practice makes perfect? The role of simulation-based deliberate practice and script-based mental rehearsal in the acquisition and maintenance of operative neurosurgical skills. Neurosurgery 2013; 72 Suppl 1:124-30. [PMID: 23254801 DOI: 10.1227/neu.0b013e318270d010] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Despite significant advances in technology and intraoperative techniques over the last century, operations on the brain and spinal cord continue to carry a significant risk of serious morbidity or mortality. Potentially avoidable technical errors are well recognized as contributing to poor surgical outcome. Surgical education is undergoing overwhelming change, in part as a result of changes in the economic, political, social, cultural, and technological climates in which it operates. Shortened training, reductions in the working week, economic difficulties, and increasing emphasis on patient safety have required educators to radically rethink the way in which surgical education is delivered. This has resulted in the development of simulation technology, mental script-based rehearsal, and simulation-based deliberate practice. Although these tools and techniques are garnering increasing evidence for their efficacy, the evidence for their use in neurosurgery is somewhat more limited. Here, we review the theory behind these tools and techniques and their application to neurosurgery. We conclude that further research into the utility of these tools and techniques is essential for determining their widespread adoption. If they ultimately prove to be successful, they may have a central role in neurosurgical training in the 21st century, improving the acquisition of technical skills in a specialty in which a technical error can result in grave consequences.
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Affiliation(s)
- Hani Marcus
- Department of Neurosurgery, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
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Nugent E, Hseino H, Ryan K, Traynor O, Neary P, Keane FBV. The surgical safety checklist survey: a national perspective on patient safety. Ir J Med Sci 2012; 182:171-6. [PMID: 22968898 DOI: 10.1007/s11845-012-0851-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2012] [Accepted: 08/29/2012] [Indexed: 12/29/2022]
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Disorganized care: the findings of an iterative, in-depth analysis of surgical morbidity and mortality. J Surg Res 2012; 177:43-8. [DOI: 10.1016/j.jss.2012.05.007] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2012] [Revised: 04/26/2012] [Accepted: 05/02/2012] [Indexed: 01/24/2023]
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CUTTER JAYNE, JORDAN SUE. The systems approach to error reduction: factors influencing inoculation injury reporting in the operating theatre. J Nurs Manag 2012; 21:989-1000. [DOI: 10.1111/j.1365-2834.2012.01435.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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Rassweiler MC, Mamoulakis C, Kenngott HG, Rassweiler J, de la Rosette J, Laguna MP. Classification and Detection of Errors in Minimally Invasive Surgery. J Endourol 2011; 25:1713-21. [DOI: 10.1089/end.2011.0068] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Affiliation(s)
| | | | | | | | - Jean de la Rosette
- Department of Urology, AMC University of Amsterdam, Amsterdam, The Netherlands
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Brown-Clerk B, Rousek JB, Lowndes BR, Eikhout SM, Balogh BJ, Hallbeck MS. Assessment of electrosurgical hand controls integrated into a laparoscopic grasper. MINIM INVASIV THER 2011; 20:321-8. [DOI: 10.3109/13645706.2011.556646] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Cuschieri A, Tang B. Human reliability analysis (HRA) techniques and observational clinical HRA. MINIM INVASIV THER 2010; 19:12-7. [PMID: 20095892 DOI: 10.3109/13645700903492944] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
This review explains the nature of human reliability analysis (HRA) methods developed and used for predicting safety in high-risk human activities. HRA techniques have evolved over the years and have become less subjective as a result of inclusion of (i) cognitive factors in the man-machine interface and (ii) high and low dependency levels between human failure events (HFEs). All however remain probabilistic in the assessment of safety. In the translation of these techniques, developed for assessment of safety of high-risk industries (nuclear, aerospace etc.) where catastrophic failures from the man-machine complex interface are fortunately rare, to the clinical operative surgery (with its high incidence of human errors), the system loses subjectivity since the documentation of HFEs can be assessed and studied prospectively on the basis of an objective data capture of errors enacted during a defined clinical activity. The observational clinical-HRA (OC-HRA) was developed specifically for this purpose, initially for laparoscopic general surgery. It has however been used by other surgical specialties. OC-HRA has the additional merit of objective determination of the proficiency of a surgeon in executing specific interventions and is adaptable to the evaluation of safety and proficiency in clinical activities within the preoperative and postoperative periods.
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Affiliation(s)
- Alfred Cuschieri
- Institute for Medical Science and Technology, University of Dundee and Scuola Superiore Sant'Anna di Studi Universitari Pisa, Pisa, Italy.
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Chua WC, D'Amours SK, Sugrue M, Caldwell E, Brown K. Performance and consistency of care in admitted trauma patients: our next great opportunity in trauma care? ANZ J Surg 2009; 79:443-8. [DOI: 10.1111/j.1445-2197.2009.04946.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Informed consent-'da Vinci code' for our safety in empowered patient's safety. Surg Endosc 2009; 23:1158-60. [PMID: 19301073 DOI: 10.1007/s00464-009-0409-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2008] [Accepted: 02/11/2009] [Indexed: 12/16/2022]
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Champion HR, Meglan DA, Shair EK. Minimizing Surgical Error by Incorporating Objective Assessment into Surgical Education. J Am Coll Surg 2008; 207:284-91. [DOI: 10.1016/j.jamcollsurg.2008.02.038] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2007] [Revised: 02/13/2008] [Accepted: 02/27/2008] [Indexed: 12/31/2022]
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Abstract
BACKGROUND As the attitude to adverse events has changed from the defensive "blame and shame culture" to an open and transparent healthcare delivery system, it is timely to examine the nature of human errors and their impact on the quality of surgical health care. METHODS The approach of the review is generic rather than specific, and the account is based on the published psychologic and medical literature on the subject. CONCLUSIONS Rather than detailing the various "surgical errors," the concept of error categories within the surgical setting committed by surgeons as front-line operators is discussed. The important components of safe surgical practice identified include organizational structure with strategic control of healthcare delivery, teamwork and leadership, evidence-based practice, proficiency, continued professional development of all staff, availability of wireless health information technology, and well-embedded incident reporting and adverse events disclosure systems. In our quest for the safest possible surgical health care, there is a need for prospective observational multidisciplinary (surgeons and human factors specialists) studies as distinct for retrospective reports of adverse events. There is also need for research to establish the ideal system architecture for anonymous reporting of near miss and no harm events in surgical practice.
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Affiliation(s)
- Alfred Cuschieri
- Department of Surgery, Division of Medical Sciences, Scuola Superiore S'Anna di Studi Universitari, Pisa, Italy.
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