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Incze T, Pinkney SJ, Li C, Hameed U, Hallbeck MS, Grantcharov TP, Trbovich PL. Using the Operating Room Black Box to Assess Surgical Team Member Adaptation Under Uncertainty: An Observational Study. Ann Surg 2024; 280:75-81. [PMID: 38193296 PMCID: PMC11161221 DOI: 10.1097/sla.0000000000006191] [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] [Indexed: 01/10/2024]
Abstract
OBJECTIVE Identify how surgical team members uniquely contribute to teamwork and adapt their teamwork skills during instances of uncertainty. BACKGROUND The importance of surgical teamwork in preventing patient harm is well documented. Yet, little is known about how key roles (nurse, anesthesiologist, surgeon, and medical trainee) uniquely contribute to teamwork during instances of uncertainty, particularly when adapting to and rectifying an intraoperative adverse event (IAE). METHODS Audiovisual data of 23 laparoscopic cases from a large community teaching hospital were prospectively captured using OR Black Box. Human factors researchers retrospectively coded videos for teamwork skills (backup behavior, coordination, psychological safety, situation assessment, team decision-making, and leadership) by team role under 2 conditions of uncertainty: associated with an IAE versus no IAE. Surgeons identified IAEs. RESULTS In all, 1015 instances of teamwork skills were observed. Nurses adapted to IAEs by expressing more backup behavior skills (5.3× increase; 13.9 instances/hour during an IAE vs 2.2 instances/hour when no IAE) while surgeons and medical trainees expressed more psychological safety skills (surgeons: 3.6× increase; 30.0 instances/hour vs 6.6 instances/hour and trainees: 6.6× increase; 31.2 instances/hour vs 4.1 instances/hour). All roles expressed fewer situation assessment skills during an IAE versus no IAE. CONCLUSIONS OR Black Box enabled the assessment of critically important details about how team members uniquely contribute during instances of uncertainty. Some teamwork skills were amplified, while others dampened when dealing with IAEs. The knowledge of how each role contributes to teamwork and adapts to IAEs should be used to inform the design of tailored interventions to strengthen interprofessional teamwork.
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Affiliation(s)
- Taylor Incze
- Dalla Lana School of Public Health, Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Sonia J. Pinkney
- Dalla Lana School of Public Health, Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Cherryl Li
- Dalla Lana School of Public Health, Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Usmaan Hameed
- Department of Surgery, North York General Hospital, Toronto, ON, Canada
| | - M. Susan Hallbeck
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Division of Health Care Delivery Research, Mayo Clinic, Rochester, MN
- Department of Surgery, Mayo Clinic, Rochester, MN
| | - Teodor P. Grantcharov
- Department of Surgery, Clinical Excellence Research Centre, Stanford University, Stanford, CA
| | - Patricia L. Trbovich
- Dalla Lana School of Public Health, Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- HumanEra, Office of Research and Innovation, North York General Hospital, Toronto, ON, Canada
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Athanasiadis DI, Monfared S, Timsina L, Whiteside J, Banerjee A, Butler A, Stefanidis D. Evaluation of operating room inefficiencies and their impact on operating room duration using a surgical app. Am J Surg 2024:S0002-9610(24)00239-3. [PMID: 38679510 DOI: 10.1016/j.amjsurg.2024.04.022] [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: 02/10/2024] [Revised: 03/09/2024] [Accepted: 04/23/2024] [Indexed: 05/01/2024]
Abstract
BACKGROUND Efficient utilization of the operating room (OR) is essential. Inefficiencies are thought to cause preventable delays. Our goal was to identify OR incidents causing delays and estimate their impact on the duration of various general surgery procedures. MATERIALS Three trained observers prospectively collected intraoperative data using the ExplORer Surgical app, a tool that helped capture incidents causing delays. The impact of each incident on case duration was assessed using multivariable analysis. RESULTS 151 general surgery procedures were observed. The mean number of incidents was 2.7 per each case that averaged 109min. On average, each incident caused a 2.8 min delay (p < 0.001), however, some incidents were associated with longer delays. The procedural step of each procedure most susceptible to incidents was also defined. CONCLUSION The identification of the type of incidents and the procedural step during which they occur may allow targeted interventions to optimize OR efficiency and decrease operative time.
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Affiliation(s)
| | - Sara Monfared
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Lava Timsina
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Jake Whiteside
- Indiana University School of Medicine, Indianapolis, IN, USA
| | - Ambar Banerjee
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Annabelle Butler
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Dimitrios Stefanidis
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA.
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Nagy T, Fritúz G, Gál J, Székely A, Kovács E. Teaching nontechnical skills in the undergraduate education of health care professionals: a nationwide cross-sectional study in Hungary. BMC MEDICAL EDUCATION 2024; 24:174. [PMID: 38388925 PMCID: PMC10885394 DOI: 10.1186/s12909-024-05164-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 02/11/2024] [Indexed: 02/24/2024]
Abstract
BACKGROUND The aim of our cross-sectional study was to evaluate the current situation and curriculum of nontechnical skills (NTS) training in the undergraduate education of health care professionals in Hungary. METHODS All institutes with relevant NTS training in Hungarian faculties of medicine and faculties of health sciences were asked to fill out a 19-item questionnaire. Descriptive statistics were performed, and the characteristics of NTS teaching and non-NTS teaching institutes were compared. The independent predictors of teaching NTS in a particular institute were identified with multiple logistic regression. RESULTS Seventy-seven institutes responded (52% response rate), of which 66% trained NTS. The most frequent method of NTS training is talking about them during a practice or lecture, and less than half of NTS respondents use simulation. The most frequent cause of not teaching NTS is a lack of human or technical resources. The type of faculty (p = 0.025), academic year (p = 0.001), field of medicine (p = 0.025), and importance of teamwork (p = 0.021) differed between NTS and noNTS institutes. Teaching students in academic year two represented the only independent predictor of NTS education (p = 0.012). CONCLUSIONS Our findings show that the undergraduate curriculum of Hungarian universities includes some type of NTS education; however, this education requires further development.
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Affiliation(s)
- Tamás Nagy
- Subdepartment of Clinical Simulation, Semmelweis University, P.O.B. 2, Budapest, H-1428, Hungary
- Faculty of Health Sciences, Semmelweis University, P.O.B. 2, Budapest, H-1428, Hungary
| | - Gábor Fritúz
- Subdepartment of Clinical Simulation, Semmelweis University, P.O.B. 2, Budapest, H-1428, Hungary
- Department of Anaesthesiology and Intensive Therapy, Semmelweis University, P.O.B. 2, Budapest, 1428, Hungary
| | - János Gál
- Department of Anaesthesiology and Intensive Therapy, Semmelweis University, P.O.B. 2, Budapest, 1428, Hungary
| | - Andrea Székely
- Faculty of Health Sciences, Semmelweis University, P.O.B. 2, Budapest, H-1428, Hungary
- Department of Anaesthesiology and Intensive Therapy, Semmelweis University, P.O.B. 2, Budapest, 1428, Hungary
- Heart and Vascular Center, Semmelweis University, P.O.B. 2, Budapest, H-1428, Hungary
| | - Enikő Kovács
- Department of Anaesthesiology and Intensive Therapy, Semmelweis University, P.O.B. 2, Budapest, 1428, Hungary.
- Heart and Vascular Center, Semmelweis University, P.O.B. 2, Budapest, H-1428, Hungary.
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Kapustin DA, Yun J, Su V, Rubin SJ, Modica I, Chung D, Fan J, Khan MN, Chai RL, Karasick M, Doyle S, Brandwein-Weber M, Urken ML. Frozen Section Timeout: Pilot Study to Reconcile Margins Using 3D Resected Specimen and Defect Scans. Laryngoscope 2024; 134:725-731. [PMID: 37466312 DOI: 10.1002/lary.30892] [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: 04/17/2023] [Revised: 06/28/2023] [Accepted: 07/02/2023] [Indexed: 07/20/2023]
Abstract
OBJECTIVE Opportunities exist to improve intraoperative communication and documentation of resection margin details. We instituted a "frozen section timeout" that centers around visualization of the paired resection specimen and surgical defect-facilitating effective, bidirectional exchange of information. METHODS We designed an interactive form for use during the "frozen section timeout" including annotated 3D virtual models of the resected specimen and surgical defect, plus a "line-item" table for primary and supplemental margin results. The "timeout" was conducted over a Zoom call between the operating room and frozen section laboratory. The form was simultaneously projected and discussed while all members of the surgical care team stopped activities. Nurses, co-surgeons, and all other members of the surgical team were encouraged to take part in this process. RESULTS Twenty-six frozen section timeouts were conducted during head and neck surgeries in the Department of Otolaryngology at Mount Sinai West Hospital. These timeouts were facilitated by the lead surgeon, and all other activities were halted to ensure that critical information was shared, documented, and agreed upon. During the timeout, the annotated specimen and defect scans were displayed, clearly demonstrating the at-risk margins and the corresponding location and breadth of supplemental margins harvested. CONCLUSION Incorporating a frozen section timeout can improve intraoperative communication, increase transparency, and potentially eliminate uncertainty regarding margin status and tumor clearance. Visualization of at-risk margins and the corresponding location and breadth of supplemental margins promises an unprecedented level of documentation and understanding. This novel technique can establish a new and improved standard of care. LEVEL OF EVIDENCE NA Laryngoscope, 134:725-731, 2024.
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Affiliation(s)
- Danielle A Kapustin
- THANC (Thyroid, Head & Neck Cancer) Foundation, New York, New York, U.S.A
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, U.S.A
| | - Jun Yun
- THANC (Thyroid, Head & Neck Cancer) Foundation, New York, New York, U.S.A
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, U.S.A
| | - Vivian Su
- THANC (Thyroid, Head & Neck Cancer) Foundation, New York, New York, U.S.A
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, U.S.A
| | - Samuel J Rubin
- THANC (Thyroid, Head & Neck Cancer) Foundation, New York, New York, U.S.A
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, U.S.A
| | - Ippolito Modica
- Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, New York, U.S.A
| | - Daniel Chung
- Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, New York, U.S.A
| | - Jun Fan
- Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, New York, U.S.A
| | - Mohemmed N Khan
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, U.S.A
| | - Raymond L Chai
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, U.S.A
| | - Michael Karasick
- THANC (Thyroid, Head & Neck Cancer) Foundation, New York, New York, U.S.A
| | - Scott Doyle
- Department of Pathology and Anatomical Sciences, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, U.S.A
| | | | - Mark L Urken
- THANC (Thyroid, Head & Neck Cancer) Foundation, New York, New York, U.S.A
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, U.S.A
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Heinke TL, Joseph A, Carroll D. Safety in Health Care: The Impact of Operating Room Design. Anesthesiol Clin 2023; 41:789-801. [PMID: 37838384 DOI: 10.1016/j.anclin.2023.05.005] [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] [Indexed: 10/16/2023]
Abstract
The science of operating room design has grown over the past 20 years due to the realization that the physical environment influences health care provider performance and patient outcomes. Medical errors occur when the normal workflow in an operating room is disrupted as providers must overcome sub-optimal conditions. All aspects of the physical environment can impact operating room flow. Studying the layout, contents, ergonomics, and environmental parameters of the operating can lead improved work conditions resulting improved patient and provider safety. At the forefront of operating room design science is the use of simulation and the evaluation of new technologies.
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Affiliation(s)
- Timothy L Heinke
- Department of Anesthesia & Perioperative Medicine, Medical University of South Carolina, 25 Courtenay Drive, Suite 4200, MSC 240, Charleston, SC 29425, USA.
| | - Anjali Joseph
- Center for Health Facilities Design and Testing, School of Architecture, 2-141 Lee Hall, Clemson University, Clemson, SC 29631, USA
| | - David Carroll
- Department of Anesthesia & Perioperative Medicine, Medical University of South Carolina, 25 Courtenay Drive, Suite 4200, MSC 240, Charleston, SC 29425, USA
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Stucky CH, Kabo FW, De Jong MJ, House SL, Wymer JA. Surgical Team Structure: How Familiarity and Team Size Influence Communication Effectiveness in Military Surgical Teams. Mil Med 2023; 188:232-239. [PMID: 37948213 DOI: 10.1093/milmed/usad098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 03/13/2023] [Accepted: 03/16/2023] [Indexed: 11/12/2023] Open
Abstract
INTRODUCTION Preventable patient harm has persisted in health care despite recent advances to reduce errors. There is increasing recognition that non-technical skills, including communication and relationships, greatly impact interprofessional team performance and health care quality. Team familiarity and size are critical structural components that potentially influence information flow, communication, and efficiency. METHODS In this exploratory, prospective, cross-sectional study, we investigated the key structural components of surgical teams and identified how surgical team structure shapes communication effectiveness. Using total population sampling, we recruited surgical clinicians who provide direct patient care at a 138-bed military medical center. We used statistical modeling to characterize the relationship between communication effectiveness and five predictors: team familiarity, team size, surgical complexity, and the presence of surgical residents and student anesthesia professionals. RESULTS We surveyed 137 surgical teams composed of 149 multidisciplinary clinicians for an 82% response rate. The mean communication effectiveness score was 4.61 (SD = 0.30), the average team size was 4.53 (SD = 0.69) persons, and the average surgical complexity was 10.85 relative value units (SD = 6.86). The surgical teams exhibited high variability in familiarity, with teams co-performing 26% (SD = 0.16) of each other's surgeries. We found for every unit increase in team familiarity, communication effectiveness increased by 0.36 (P ≤ .05), whereas adding one additional member to the surgical team decreased communication effectiveness by 0.1 (P ≤ .05). Surgical complexity and the influence of residents and students were not associated with communication effectiveness. CONCLUSIONS For military surgical teams, greater familiarity and smaller team sizes were associated with small improvements in communication effectiveness. Military leaders can likely enhance team communication by engaging in a thoughtful and concerted program to foster cohesion by building familiarity and optimizing team size to meet task and cognitive demands. We suggest leaders develop bundled approaches to improve communication by integrating team familiarity and team size optimization into current evidence-based initiatives to enhance performance.
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Affiliation(s)
- Christopher H Stucky
- Center for Nursing Science and Clinical Inquiry (CNSCI), Landstuhl Regional Medical Center, Landstuhl Kirchberg, Rheinland-Pfalz 66849, Germany
| | - Felichism W Kabo
- Institute for Social Research (ISR), University of Michigan, Ann Arbor, MI 48106-1248, USA
| | - Marla J De Jong
- University of Utah College of Nursing, University of Utah, Salt Lake City, UT 84112-5880, USA
| | - Sherita L House
- Indiana University School of Nursing, Indiana University, Indianapolis, IN 46202, USA
| | - Joshua A Wymer
- Department of Nursing, Naval Medical Center San Diego, San Diego, CA 92134, USA
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Schwendner M, Liang R, Butenschöen VM, Krieg SM, Ille S, Meyer B. Spinal Navigation for Lateral Instrumentation of the Thoracolumbar Spine. Oper Neurosurg (Hagerstown) 2023; 25:303-310. [PMID: 37441800 DOI: 10.1227/ons.0000000000000803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 04/29/2023] [Indexed: 07/15/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Three-dimensional imaging-based navigation in spine surgery is mostly applied for pedicle screw placement. However, its potential reaches beyond. In this study, we analyzed the incorporation of spinal navigation for lateral instrumentation of the thoracolumbar spine in clinical routine at a high-volume spine center. METHODS Patients scheduled for lateral instrumentation were prospectively enrolled. A reference array was attached to the pelvis, and a computed tomography scan was acquired intraoperatively. A control computed tomography scan was routinely performed after final cage placement, replacing conventional 2-dimensional X-ray imaging. RESULTS 145 cases were enrolled from April to October 2021 with a median of 1 (1-4) level being instrumented. Indications for surgery were trauma (35.9%), spinal infection (31.7%), primary and secondary tumors of the spine (17.2%), and degenerative spine disease (15.2%). The duration of surgery after the first scan was 98 ± 41 (20-342) minutes. In total, 190 cages were implanted (94 expandable cages for vertebral body replacement (49.5%) and 96 cages for interbody fusion [50.5%]). Navigation was successfully performed in 139 cases (95.9%). The intraoperative mental load was rated on a scale from 0 to 150 (maximal effort) by the surgeons, showing a moderate effort (median 30 [10-120]). CONCLUSION Three-dimensional imaging-based spinal navigation can easily be incorporated in clinical routine and serves as a reliable tool to achieve precise implant placement in lateral instrumentation of the spine. It helps to minimize radiation exposure to the surgical staff.
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Affiliation(s)
- Maximilian Schwendner
- Department of Neurosurgery, Technical University of Munich, Germany, School of Medicine, Klinikum rechts der Isar, Munich, Germany
- TUM-Neuroimaging Center, Technical University of Munich, Munich, Germany
| | - Raimunde Liang
- Department of Neurosurgery, Technical University of Munich, Germany, School of Medicine, Klinikum rechts der Isar, Munich, Germany
| | - Vicki M Butenschöen
- Department of Neurosurgery, Technical University of Munich, Germany, School of Medicine, Klinikum rechts der Isar, Munich, Germany
| | - Sandro M Krieg
- Department of Neurosurgery, Technical University of Munich, Germany, School of Medicine, Klinikum rechts der Isar, Munich, Germany
- TUM-Neuroimaging Center, Technical University of Munich, Munich, Germany
| | - Sebastian Ille
- Department of Neurosurgery, Technical University of Munich, Germany, School of Medicine, Klinikum rechts der Isar, Munich, Germany
- TUM-Neuroimaging Center, Technical University of Munich, Munich, Germany
| | - Bernhard Meyer
- Department of Neurosurgery, Technical University of Munich, Germany, School of Medicine, Klinikum rechts der Isar, Munich, Germany
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Kabo FW, Stucky CH, De Jong MJ. Associations of Surgical Team Communication With the Layout of Physical Space: A Network Analysis of the Operating Room in a Military Medical Center. HERD-HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL 2023; 16:134-145. [PMID: 36866407 DOI: 10.1177/19375867231159130] [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] [Indexed: 03/04/2023]
Abstract
AIM To examine how the spatial topology of the operating room (OR) within the medical center impacts surgical team communication. BACKGROUND Understanding the complex association between surgical team communication and the OR's spatial network location is critical to patient safety. Effective surgical communication is associated with fewer adverse events and medical errors. METHODS We employed a cross-sectional, quantitative, case study, and network-centric study design. We studied the population of 204 clinicians in a large military medical center (36 perioperative nurses, 34 surgical technicians, 62 anesthesia providers, and 72 surgeons), focusing on surgical teams with cases completed within duty hours. Data were collected from December 2020 to June 2021 using an electronic survey. Spatial network analysis was done using electronic floor plans. Statistical analysis was done with descriptive statistics and linear regressions. The outcomes were general and task-specific communication, and team-level variables were aggregated from scores for all team members. Spatial effects were assessed with network centrality (degree, Laplacian, and betweenness). RESULTS The individual-level survey response rate was 77% (157 of 204). Data were collected on 137 surgical teams. On a 5-point scale, general and task-specific communication ranged from 3.4 to 5.0 and 3.5 to 5.0, respectively (for both, median = 4.7). Team size ranged from 4 to 6 individuals (median = 4). Surgical suites with higher network centralities were associated with significantly lower communication scores. CONCLUSIONS The OR's spatial network location has important impacts on surgical team communication. Our findings have design and workflow implications for ORs and even surgical care in combat zones.
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Affiliation(s)
- Felichism W Kabo
- Institute for Social Research, University of Michigan, Ann Arbor, MI, USA
| | - Christopher H Stucky
- Center for Nursing Science and Clinical Inquiry, Landstuhl Regional Medical Center, Landstuhl Kirchberg, Rheinland-Pfalz, Germany
| | - Marla J De Jong
- College of Nursing, University of Utah, Salt Lake City, UT, USA
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Dias RD, Kennedy-Metz LR, Srey R, Rance G, Ebnali M, Arney D, Gombolay M, Zenati MA. Using Digital Biomarkers for Objective Assessment of Perfusionists' Workload and Acute Stress During Cardiac Surgery. BIOINFORMATICS AND BIOMEDICAL ENGINEERING : 10TH INTERNATIONAL WORK-CONFERENCE, IWBBIO 2023, MELONERAS, GRAN CANARIA, SPAIN, JULY 12-14, 2023, PROCEEDINGS. PART I. IWBBIO (CONFERENCE) (10TH : 2023 : GRAN CANARIA, CANARY ISLANDS) 2023; 13919:443-454. [PMID: 37497240 PMCID: PMC10371197 DOI: 10.1007/978-3-031-34953-9_35] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/28/2023]
Abstract
The cardiac operating room (OR) is a high-risk, high-stakes environment inserted into a complex socio-technical healthcare system. During cardiopulmonary bypass (CPB), the most critical phase of cardiac surgery, the perfusionist has a crucial role within the interprofessional OR team, being responsible for optimizing patient perfusion while coordinating other tasks with the surgeon, anesthesiologist, and nurses. The aim of this study was to investigate objective digital biomarkers of perfusionists' workload and stress derived from heart rate variability (HRV) metrics captured via a wearable physiological sensor in a real cardiac OR. We explored the relationships between several HRV parameters and validated self-report measures of surgical task workload (SURG-TLX) and acute stress (STAI-SF), as well as surgical processes and outcome measures. We found that the frequency-domain HRV parameter HF relative power - FFT (%) presented the strongest association with task workload (correlation coefficient: -0.491, p-value: 0.003). We also found that the time-domain HRV parameter RMSSD (ms) presented the strongest correlation with perfusionists' acute stress (correlation coefficient: -0.489, p-value: 0.005). A few workload and stress biomarkers were also associated with bypass time and patient length of stay in the hospital. The findings from this study will inform future research regarding which HRV-based biomarkers are best suited for the development of cognitive support systems capable of monitoring surgical workload and stress in real time.
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Affiliation(s)
- Roger D Dias
- Harvard Medical School, Boston, MA, USA
- Department of Emergency Medicine, Mass General Brigham, Boston, MA, USA
| | | | - Rithy Srey
- Division of Cardiac Surgery, Veterans Affairs Boston Healthcare System, Boston, MA, USA
| | - Geoffrey Rance
- Department of Cardiac Surgery, Cape Cod Healthcare, Hyannis, MA, USA
| | - Mahdi Ebnali
- Harvard Medical School, Boston, MA, USA
- Department of Emergency Medicine, Mass General Brigham, Boston, MA, USA
| | - David Arney
- Harvard Medical School, Boston, MA, USA
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA, USA
| | | | - Marco A Zenati
- Harvard Medical School, Boston, MA, USA
- Division of Cardiac Surgery, Veterans Affairs Boston Healthcare System and Medical Robotics and Computer Assisted Surgery Lab, Boston, MA, USA
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Rosendal AA, Sloth SB, Rölfing JD, Bie M, Jensen RD. Technical, Non-Technical, or Both? A Scoping Review of Skills in Simulation-Based Surgical Training. JOURNAL OF SURGICAL EDUCATION 2023; 80:731-749. [PMID: 36906398 DOI: 10.1016/j.jsurg.2023.02.011] [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: 10/19/2022] [Revised: 01/10/2023] [Accepted: 02/15/2023] [Indexed: 05/09/2023]
Abstract
OBJECTIVE Technical and non-technical skills are traditionally investigated separately in simulation-based surgical training (SBST). Recent literature has indicated an interrelation of these skills, but a clear relationship is yet to be established. This scoping review aimed to identify published literature on the use of both technical and non-technical learning objectives in SBST and investigate how the entities are related. Additionally, this scoping study reviewed the literature with the aim of mapping how publications on technical and non-technical skills within SBST have changed over time. DESIGN We conducted a scoping review using the 5 step framework by Arksey and O'Malley and reported our results according to the PRISMA guidelines for scoping reviews. Four databases, PubMed, Web of Science, Embase and Cochrane Library, were systematically searched for empirical studies on SBST. Studies within surgical training addressing both technical and non-technical learning objectives and presenting primary data were included for further analysis. RESULTS Our scoping review identified 3144 articles on SBST published between 1981 and 2021. During our analysis, an emphasis on technical skills training in published literature was identified. However, recent years have seen an immense increase of publications within either technical or non-technical skills. A similar trend is seen in publications addressing both technical and non-technical. In total, 106 publications addressed both technical and non-technical learning objectives and were included for further analysis. Only 45 of the included articles addressed the relationship between technical and non-technical skills. These articles mainly focused on the effect of non-technical skills on technical skills. CONCLUSIONS Though literature on the relationship between technical and non-technical skills remains scarce, the included studies on technical skills and non-technical skills such as mental training suggest such a relationship exists. This implies that the separation of the skill sets is not necessarily beneficial for the outcome of SBST. A shift towards seeing technical and non-technical skills as intertwined may enhance learning outcomes from SBST.
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Affiliation(s)
- Amalie Asmind Rosendal
- Corporate HR MidtSim, Central Denmark Region, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
| | - Sigurd Beier Sloth
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark; Department of Obstetrics and Gynaecology, Randers Regional Hospital, Randers, Denmark
| | - Jan Duedal Rölfing
- Corporate HR MidtSim, Central Denmark Region, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark; Department of Orthopaedics, Aarhus University Hospital, Aarhus, Denmark
| | - Magnus Bie
- Corporate HR MidtSim, Central Denmark Region, Aarhus, Denmark
| | - Rune Dall Jensen
- Corporate HR MidtSim, Central Denmark Region, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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Cochran A, Rayo MF. Toward Joint Activity Design: Augmenting User-Centered Design with Heuristics for Supporting Joint Activity. PROCEEDINGS OF THE INTERNATIONAL SYMPOSIUM OF HUMAN FACTORS AND ERGONOMICS IN HEALTHCARE. INTERNATIONAL SYMPOSIUM OF HUMAN FACTORS AND ERGONOMICS IN HEALTHCARE 2023; 12:19-23. [PMID: 37325413 PMCID: PMC10263067 DOI: 10.1177/2327857923121006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
From their common roots in Human Factors Engineering, Human-Centered Design and Cognitive Systems Engineering have drifted into distinct fields over the past three decades, each developing beneficial heuristics, design patterns, and evaluation methods for designing for individuals and teams, respectively. GeoHAI, a clinical decision support application for preventing hospital-acquired infection, has yielded positive results in early usability testing and is expected to test positively in supporting joint activity, which will be measured through the novel implementation of Joint Activity Monitoring . The design and implementation of this application provide a demonstration of the possibilities and necessities to unify the work of Human-Centered Design and Cognitive Systems Engineering when designing technologies that are usable and useful to individuals engaged in joint activity with machine counterparts and other people. We are calling this unified process Joint Activity Design, which supports designing for machines to be good team players.
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12
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Takahashi K, Fukatsu T, Oki S, Iizuka Y, Otsuka Y, Sanui M, Lefor AK. Characteristics of retained foreign bodies and near-miss events in the operating room: a ten-year experience at one institution. J Anesth 2023; 37:49-55. [PMID: 36346477 DOI: 10.1007/s00540-022-03127-7] [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: 04/02/2022] [Accepted: 10/17/2022] [Indexed: 11/11/2022]
Abstract
PURPOSE Retained foreign bodies (RFBs) are a major complication of surgical procedures. However, the efficacy of preventive measures is not well defined. This study investigates the characteristics of potential (near miss) and actual RFBs, and the contributions of routine practice for the prevention of RFB events. METHODS We conducted a retrospective review of incident reports regarding near-miss and RFB events in patients who underwent surgery under general anesthesia in our institution between October 2008 and November 2018. RESULTS Among 49,831 operations under general anesthesia, there were 106 (2.13/1000) near-miss events and 24 (0.48/1000) RFB events. Counting surgical materials and intraoperative X-rays detected the remaining items before completion of surgery in 59 (56%) and 15 (14%) cases, respectively. The operator or staff noticed the surgical materials in the remaining 32 (30%) near-miss events. RFBs included 4 sponges (17%), 4 instruments (17%), 4 needles (17%), and 12 miscellaneous items (50%). Of these, 12 (50%) RFBs were discovered on postoperative X-rays and 16 (67%) patients required operative removal. Four incidents (17%) with RFBs were attributable to ignoring count discrepancies during surgery. CONCLUSION The actual incidence of RFB events is higher than previously reported. A standardized counting protocol, communication among staff, and intra- and postoperative X-rays may contribute to the prevention and detection of RFBs.
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Affiliation(s)
- Kyosuke Takahashi
- Department of Anesthesiology and Critical Care Medicine, Jichi Medical University Saitama Medical Center, Saitama, Japan.
| | - Takeshi Fukatsu
- Department of Anesthesia, Tokyo Bay Urayasu Ichikawa Medical Center, Chiba, Japan
| | - Sayaka Oki
- Department of Anesthesiology and Critical Care Medicine, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Yusuke Iizuka
- Department of Anesthesiology and Critical Care Medicine, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Yuji Otsuka
- Department of Anesthesiology and Critical Care Medicine, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Masamitsu Sanui
- Department of Anesthesiology and Critical Care Medicine, Jichi Medical University Saitama Medical Center, Saitama, Japan
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13
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D'Ambrosia C, Aronoff-Spencer E, Huang EY, Goldhaber NH, Christensen HI, Broderick RC, Appelbaum LG. The neurophysiology of intraoperative error: An EEG study of trainee surgeons during robotic-assisted surgery simulations. FRONTIERS IN NEUROERGONOMICS 2023; 3:1052411. [PMID: 38235463 PMCID: PMC10790934 DOI: 10.3389/fnrgo.2022.1052411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 12/19/2022] [Indexed: 01/19/2024]
Abstract
Surgeons operate in mentally and physically demanding workspaces where the impact of error is highly consequential. Accurately characterizing the neurophysiology of surgeons during intraoperative error will help guide more accurate performance assessment and precision training for surgeons and other teleoperators. To better understand the neurophysiology of intraoperative error, we build and deploy a system for intraoperative error detection and electroencephalography (EEG) signal synchronization during robot-assisted surgery (RAS). We then examine the association between EEG data and detected errors. Our results suggest that there are significant EEG changes during intraoperative error that are detectable irrespective of surgical experience level.
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Affiliation(s)
- Christopher D'Ambrosia
- College of Physicians and Surgeons, Columbia University, New York, NY, United States
- Cognitive Robotics Laboratory, Department of Computer Science and Engineering, Contextual Robotics Institute, University of California, San Diego, La Jolla, CA, United States
| | - Eliah Aronoff-Spencer
- Department of Medicine, University of California, San Diego, La Jolla, CA, United States
| | - Estella Y. Huang
- Division of Minimally Invasive Surgery, Department of Surgery, University of California, San Diego, La Jolla, CA, United States
| | - Nicole H. Goldhaber
- Division of Minimally Invasive Surgery, Department of Surgery, University of California, San Diego, La Jolla, CA, United States
| | - Henrik I. Christensen
- Cognitive Robotics Laboratory, Department of Computer Science and Engineering, Contextual Robotics Institute, University of California, San Diego, La Jolla, CA, United States
| | - Ryan C. Broderick
- Division of Minimally Invasive Surgery, Department of Surgery, University of California, San Diego, La Jolla, CA, United States
| | - Lawrence G. Appelbaum
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, United States
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14
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Adair White BA, Picchioni A, Gentry L, Malek AJ, Mrdutt MM, Fleshman JW, Bird ET, Arroliga AC, Papaconstantinou HT. Closing the educational gap in surgery: Teaching team communication and conflict management. Am J Surg 2022; 224:1488-1491. [PMID: 36123187 DOI: 10.1016/j.amjsurg.2022.08.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Revised: 08/05/2022] [Accepted: 08/22/2022] [Indexed: 12/14/2022]
Affiliation(s)
- Bobbie Ann Adair White
- Department of Surgery, Baylor Scott & White Medical Center, Baylor Scott & White Health, Brindley Circles 7th Floor, 2401 South 31st Street, Temple, TX, 76508, USA; MGH Institute of Health Professions, Department of Health Professions Education, 36 First Avenue, Charlestown Navy Yard, Boston, Massachusetts 02129-4557, USA
| | - Anthony Picchioni
- Department of Surgery, Baylor Scott & White Medical Center, Baylor Scott & White Health, Brindley Circles 7th Floor, 2401 South 31st Street, Temple, TX, 76508, USA; MGH Institute of Health Professions, Department of Health Professions Education, 36 First Avenue, Charlestown Navy Yard, Boston, Massachusetts 02129-4557, USA
| | - Lonnie Gentry
- Department of Surgery, Baylor Scott & White Medical Center, Baylor Scott & White Health, Brindley Circles 7th Floor, 2401 South 31st Street, Temple, TX, 76508, USA; MGH Institute of Health Professions, Department of Health Professions Education, 36 First Avenue, Charlestown Navy Yard, Boston, Massachusetts 02129-4557, USA
| | - Adil Justin Malek
- Department of Surgery, Baylor Scott & White Medical Center, Baylor Scott & White Health, Brindley Circles 7th Floor, 2401 South 31st Street, Temple, TX, 76508, USA; MGH Institute of Health Professions, Department of Health Professions Education, 36 First Avenue, Charlestown Navy Yard, Boston, Massachusetts 02129-4557, USA
| | - Mary M Mrdutt
- Department of Surgery, Baylor Scott & White Medical Center, Baylor Scott & White Health, Brindley Circles 7th Floor, 2401 South 31st Street, Temple, TX, 76508, USA; MGH Institute of Health Professions, Department of Health Professions Education, 36 First Avenue, Charlestown Navy Yard, Boston, Massachusetts 02129-4557, USA
| | - James W Fleshman
- Department of Surgery, Baylor University Medical Center, Baylor Scott & White Health, 3500 Gaston Ave. 2nd Floor Pickens, Dallas, TX, 75246, USA
| | - Erin T Bird
- Department of Surgery, Baylor Scott & White Medical Center, Baylor Scott & White Health, Brindley Circles 7th Floor, 2401 South 31st Street, Temple, TX, 76508, USA
| | - Alejandro C Arroliga
- Office of Chief Clinical Innovations Officer, Baylor Scot & White Health, 2401 South 31st Street, MS-14-170, Temple, TX, 76508, USA
| | - Harry T Papaconstantinou
- Department of Surgery, Baylor Scott & White Medical Center, Baylor Scott & White Health, Brindley Circles 7th Floor, 2401 South 31st Street, Temple, TX, 76508, USA.
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15
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Varallo JE, Ruto D, Patted A. Surgical Burden of Disease in Women. Obstet Gynecol Clin North Am 2022; 49:795-808. [DOI: 10.1016/j.ogc.2022.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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16
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Abraham J, Meng A, Montes de Oca A, Politi M, Wildes T, Gregory S, Henrichs B, Kannampallil T, Avidan MS. An ethnographic study on the impact of a novel telemedicine-based support system in the operating room. J Am Med Inform Assoc 2022; 29:1919-1930. [PMID: 35985294 PMCID: PMC10161534 DOI: 10.1093/jamia/ocac138] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 07/07/2022] [Accepted: 08/04/2022] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE The Anesthesiology Control Tower (ACT) for operating rooms (ORs) remotely assesses the progress of surgeries and provides real-time perioperative risk alerts, communicating risk mitigation recommendations to bedside clinicians. We aim to identify and map ACT-OR nonroutine events (NREs)-risk-inducing or risk-mitigating workflow deviations-and ascertain ACT's impact on clinical workflow and patient safety. MATERIALS AND METHODS We used ethnographic methods including shadowing ACT and OR clinicians during 83 surgeries, artifact collection, chart reviews for decision alerts sent to the OR, and 10 clinician interviews. We used hybrid thematic analysis informed by a human-factors systems-oriented approach to assess ACT's role and impact on safety, conducting content analysis to assess NREs. RESULTS Across 83 cases, 469 risk alerts were triggered, and the ACT sent 280 care recommendations to the OR. 135 NREs were observed. Critical factors facilitating ACT's role in supporting patient safety included providing backup support and offering a fresh-eye perspective on OR decisions. Factors impeding ACT included message timing and ACT and OR clinician cognitive lapses. Suggestions for improvement included tailoring ACT message content (structure, timing, presentation) and incorporating predictive analytics for advanced planning. DISCUSSION ACT served as a safety net with remote surveillance features and as a learning healthcare system with feedback/auditing features. Supporting strategies include adaptive coordination and harnessing clinician/patient support to improve ACT's sustainability. Study insights inform future intraoperative telemedicine design considerations to mitigate safety risks. CONCLUSION Incorporating similar remote technology enhancement into routine perioperative care could markedly improve safety and quality for millions of surgical patients.
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Affiliation(s)
- Joanna Abraham
- Department of Anesthesiology, School of Medicine, Washington University in St. Louis, St. Louis, Missouri, USA
- Institute for Informatics, School of Medicine, Washington University in St. Louis, St. Louis, Missouri, USA
- Division of Biology and Biomedical Sciences, School of Medicine, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Alicia Meng
- Department of Anesthesiology, School of Medicine, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Arianna Montes de Oca
- Department of Anesthesiology, School of Medicine, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Mary Politi
- Department of Surgery, School of Medicine, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Troy Wildes
- Department of Anesthesiology, School of Medicine, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Stephen Gregory
- Department of Anesthesiology, School of Medicine, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Bernadette Henrichs
- Department of Anesthesiology, School of Medicine, Washington University in St. Louis, St. Louis, Missouri, USA
- Goldfarb School of Nursing, Barnes-Jewish College, St. Louis, Missouri, USA
| | - Thomas Kannampallil
- Department of Anesthesiology, School of Medicine, Washington University in St. Louis, St. Louis, Missouri, USA
- Institute for Informatics, School of Medicine, Washington University in St. Louis, St. Louis, Missouri, USA
- Division of Biology and Biomedical Sciences, School of Medicine, Washington University in St. Louis, St. Louis, Missouri, USA
- Department of Computer Science & Engineering, McKelvey School of Engineering, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Michael S Avidan
- Department of Anesthesiology, School of Medicine, Washington University in St. Louis, St. Louis, Missouri, USA
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17
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Gu Y, Yu H, Wang Y, Zhou S. The moderating effect of cultural intelligence between nurses’ relationship conflict and teamwork. J Nurs Manag 2022; 30:3313-3321. [DOI: 10.1111/jonm.13772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Revised: 08/13/2022] [Accepted: 08/19/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Yanfen Gu
- Nursing Department, Shanghai East Hospital Tongji University School of Medicine Shanghai P.R. China
| | - Haiping Yu
- Nursing Department, Shanghai East Hospital Tongji University School of Medicine Shanghai P.R. China
| | - Yinyu Wang
- Nursing Department, Shanghai East Hospital Tongji University School of Medicine Shanghai P.R. China
| | - Shanshan Zhou
- Shanghai Xincheng United Family Hospital, Pdes‐in Department Shanghai China
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18
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Vaysburg DM, Delman AM, Turner KM, Salvator A, Frasier LL. Laparoscopic Appendectomy and Cholecystectomy Timing Predicts Hand-Offs but Not Miscounts. J Surg Res 2022; 280:55-62. [PMID: 35963015 DOI: 10.1016/j.jss.2022.06.016] [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: 12/30/2021] [Revised: 03/03/2022] [Accepted: 06/08/2022] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Intraoperative hand-offs are poorly coordinated and associated with risk of surgical miscount. We evaluated hand-off patterns for nursing staff during two common operations hypothesizing that hand-off patterns would be associated with increased surgical miscounts and vary during operations performed standard versus nonstandard operating hours. METHODS We retrospectively analyzed laparoscopic cholecystectomy (N = 3888) and appendectomy (N = 1768) from 2012 to 2021 at a single institution using electronic medical records. We evaluated intraoperative hand-off patterns and the presence of miscounts for operations performed during standard versus nonstandard hours. Standard operating hours were defined as M-F 7:30 am to 5:00 pm. RESULTS Across 5656 operations, 10 cases had surgical miscounts and were significantly longer than those without (156.5 versus 101 min P = 0.0178). More than half (51.3%) of cases had no identified hand-offs, and 42.9% of cases occurred during nonstandard hours. Cases during standard versus nonstandard hours were more likely to have hand-offs (56.0% versus 38.9%), P < 0.0001 and had shorter interval between hand-offs (64 versus 75 min), P < 0.0001. The period between patient entry to the room and intubation, which includes initial counts, had a disproportionately high percentage of hand-offs (P < 0.0001). CONCLUSIONS Variability in hand-off occurrence and frequency in operations performed during standard and nonstandard hours suggest that hand-offs are influenced by staffing patterns. Few surgical miscounts occurred but were associated with longer cases. Hand-offs disproportionately occurred between patient entry and intubation, with a potential for disruption of initial instrument counts. Future work optimizing hand-off coordination is an opportunity to mitigate risk to patients.
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Affiliation(s)
- Dennis M Vaysburg
- Department of Surgery, University of Cincinnati, Cincinnati Research on Education in Surgical Training (CREST), Cincinnati, Ohio
| | - Aaron M Delman
- Department of Surgery, University of Cincinnati, Cincinnati Research on Education in Surgical Training (CREST), Cincinnati, Ohio
| | - Kevin M Turner
- Department of Surgery, University of Cincinnati, Cincinnati Research on Education in Surgical Training (CREST), Cincinnati, Ohio
| | - Ann Salvator
- Department of Surgery, University of Cincinnati, Cincinnati Research on Education in Surgical Training (CREST), Cincinnati, Ohio
| | - Lane L Frasier
- Department of Surgery, University of Cincinnati, Cincinnati Research on Education in Surgical Training (CREST), Cincinnati, Ohio.
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19
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Kim DK. Installation of CCTVs in Operating Rooms, How Should We Prepare? J Korean Med Sci 2022; 37:e136. [PMID: 35470605 PMCID: PMC9039194 DOI: 10.3346/jkms.2022.37.e136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 04/07/2022] [Indexed: 11/29/2022] Open
Affiliation(s)
- Do-Kyong Kim
- Department of Medical Humanities, Dong-A University College of Medicine, Busan, Korea.
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20
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Doorey AJ, Turi ZG, Lazzara EH, Casey M, Kolm P, Garratt KN, Weintraub WS. Safety gaps in medical team communication: Closing the loop on quality improvement efforts in the cardiac catheterization lab. Catheter Cardiovasc Interv 2022; 99:1953-1962. [PMID: 35419927 DOI: 10.1002/ccd.30189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 03/08/2022] [Accepted: 03/14/2022] [Indexed: 11/06/2022]
Abstract
Closed-loop communication (CLC) is a fundamental aspect of effective communication, critical in the cardiac catheterization laboratory (cath lab) where physician orders are verbal. Complete CLC is typically a hospital and national mandate. Deficiencies in CLC have been shown to impair quality of care. Single center observational study, CLC for physician verbal orders in the cath lab were assessed by direct observation during a 5-year quality improvement effort. Performance feedback and educational efforts were used over this time frame to improve CLC, and the effects of each intervention assessed. Responses to verbal orders were characterized as complete (all important parameters of the order repeated, the mandated response), partial, acknowledgment only, or no response. During the first observational period of 101 cases, complete CLC occurred in 195 of 515 (38%) medication orders and 136 of 235 (50%) equipment orders. Complete CLC improved over time with various educational efforts, (p < 0.001) but in the final observation period of 117 cases, complete CLC occurred in just 259 of 328 (79%) medication orders and 439 of 581 (76%) equipment orders. Incomplete CLC was associated with medication and equipment errors. CLC of physician verbal orders was used suboptimally in this medical team setting. Baseline data indicate that physicians and staff have normalized weak, unreliable communication methods. Such lapses were associated with errors in order implementation. A subsequent 5-year quality improvement program resulted in improvement but a sizable minority of unacceptable responses. This represents an opportunity to improve patient safety in cath labs.
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Affiliation(s)
- Andrew J Doorey
- Center for Heart and Vascular Health, ChristianaCare, Newark, Delaware, USA.,Division of Cardiology, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Zoltan G Turi
- Hackensack University Medical Center, Hackensack, New Jersey, USA
| | - Elizabeth H Lazzara
- Department of Human Factors, Embry-Riddle Aeronautical University, Daytona Beach, Florida, USA
| | - Molly Casey
- Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania, USA
| | - Paul Kolm
- MedStar Washington Health Research Institute, Washington, District of Columbia, USA
| | - Kirk N Garratt
- Center for Heart and Vascular Health, ChristianaCare, Newark, Delaware, USA
| | - William S Weintraub
- Center for Heart and Vascular Health, ChristianaCare, Newark, Delaware, USA.,MedStar Washington Health Research Institute, Washington, District of Columbia, USA.,Division of Cardiology, Georgetown University, Washington, District of Columbia, USA
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Hendricks W, Mecca J, Rahimi M, Rojo MR, Von Ballmoos MCW, McFall RG, Haddad P, Berczeli MT, Sinha K, Barnes RG, Peden EK, Lumsden AB, MacGillivray TE, Corr SJ. Evaluation of a Novel System for RFID Intraoperative Cardiovascular Analytics. IEEE JOURNAL OF TRANSLATIONAL ENGINEERING IN HEALTH AND MEDICINE 2022; 10:1900309. [PMID: 35992372 PMCID: PMC9384959 DOI: 10.1109/jtehm.2022.3196832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 05/27/2022] [Accepted: 07/27/2022] [Indexed: 11/23/2022]
Abstract
Objective: To evaluate a novel technology for real time tracking of RF-Identified (RFID) surgical tools (Biotic System), providing intraoperative data analytics during simulated cardiovascular procedures. Ineffective asset management in the Operating Room (OR) leads to inefficient utilization of resources and contributes to prolonged operative times and increased costs. Analysis of captured data can assist in quantifying instrument utilization, procedure flow, performance and prevention of retained instruments. Methods & Results: Five surgeons performed thirteen simulated surgical cases on three human cadavers. Procedures included (i) two abdominal aortic aneurysm (AAA) repairs, (ii) three carotid endarterectomies (CE), (iii) two femoropopliteal (fem-pop) bypasses, (iv) thoracic aortic aneurysm repair, (v) coronary artery bypass graft, (vi) aortic valve replacement, (vii) ascending aortic aneurysm repair, (viii) heart transplants, and (ix) mitral valve replacement. For each case an average of 139 surgical instruments were RFID-tagged and tracked intraoperatively. Data was captured and analyzed retrospectively. Of the 139 instruments tracked across each of the 13 cases, 55 instruments (39.5%) were actually used, demonstrating a high level of redundancy. For repeat cases (i.e. CE/AAA/fem-pop): (i) average instrument usage was 41 ± 3.6 (8.8% variation) for CE (n=3); (ii) average instrument usage was 69 ± 4.0 (5.8% variation) for AAA (n=2); and (iii) average instrument usage was 48 ± 2.5 (5.3% variation) for fem- pop (n=2). Results also showed a reduction in end-of-procedure instrument counting times of 58-87%. Conclusions: We report on a method for collecting intraoperative data analytics regarding instrument usage via RFID technology. This system will help refine instrument selection, quantitate instrument utilization and prevent inadvertent retention in a patient. This should help increase efficiency in packaging and sterilization and let surgeons make objective decisions in the composition of surgical trays. Clinical and Translational Impact Statement—Intraoperative analytics of surgical tools and associated equipment may ultimately lead to safer more efficient surgeries that increase patient outcomes while decreasing the cost of care.
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Affiliation(s)
| | | | - Maham Rahimi
- Department of Cardiovascular Surgery, Houston Methodist Hospital, Houston, TX, USA
| | - Manuel R Rojo
- Department of Cardiovascular Surgery, Houston Methodist Hospital, Houston, TX, USA
| | | | - Ross G. McFall
- Department of Cardiovascular Surgery, Houston Methodist Hospital, Houston, TX, USA
| | - Paul Haddad
- Department of Cardiovascular Surgery, Houston Methodist Hospital, Houston, TX, USA
| | - Marton T. Berczeli
- Department of Cardiovascular Surgery, Houston Methodist Hospital, Houston, TX, USA
| | - Kavya Sinha
- Department of Cardiovascular Surgery, Houston Methodist Hospital, Houston, TX, USA
| | - Rebecca G. Barnes
- Department of Cardiovascular Surgery, Houston Methodist Hospital, Houston, TX, USA
| | - Eric K. Peden
- Department of Cardiovascular Surgery, Houston Methodist Hospital, Houston, TX, USA
| | - Alan B. Lumsden
- Department of Cardiovascular Surgery, Houston Methodist Hospital, Houston, TX, USA
| | | | - Stuart J. Corr
- Department of Cardiovascular Surgery, Houston Methodist Hospital, Houston, TX, USA
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22
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Tschan F, Keller S, Semmer NK, Timm-Holzer E, Zimmermann J, Huber SA, Wrann S, Hübner M, Banz V, Prevost GA, Marschall J, Candinas D, Demartines N, Weber M, Beldi G. Effects of structured intraoperative briefings on patient outcomes: multicentre before-and-after study. Br J Surg 2021; 109:136-144. [PMID: 34850862 PMCID: PMC10401893 DOI: 10.1093/bjs/znab384] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 09/29/2021] [Indexed: 11/12/2022]
Abstract
BACKGROUND Operations require collaboration between surgeons, anaesthetia professionals, and nurses. The aim of this study was to determine whether intraoperative briefings influence patient outcomes. METHODS In a before-and-after controlled trial (9 months baseline; 9 months intervention), intraoperative briefings were introduced in four general surgery centres between 2015 and 2018. During the operation, the responsible surgeon (most senior surgeon present) briefed the surgical team using the StOP? protocol about: progress of the operation (Status), next steps (Objectives), possible problems (Problems), and encouraged asking questions (?). Differences between baseline and intervention were analysed regarding surgical-site infections (primary outcome), mortality, unplanned reoperations, and duration of hospital stay (secondary outcomes), using inverse probability of treatment (IPT) weighting based on propensity scores. RESULTS In total, 8256 patients underwent surgery in the study. Endpoint data were available for 7745 patients (93.8 per cent). IPT-weighted and adjusted intention-to-treat analyses showed no differences in surgical-site infections between baseline and intervention (9.8 versus 9.6 per cent respectively; adjusted difference (AD) -0.15 (95 per cent c.i. -1.45 to 1.14) per cent; odds ratio (OR) 0.92, 95 per cent c.i. 0.83 to 1.15; P = 0.797), but there were reductions in mortality (1.6 versus 1.1 per cent; AD -0.54 (-1.04 to -0.03) per cent; OR 0.60, 0.39 to 0.92; P = 0.018), unplanned reoperations (6.4 versus 4.8 per cent; AD -1.66 (-2.69 to -0.62) per cent; OR 0.72, 0.59 to 0.89; P = 0.002), and fewer prolonged hospital stays (21.6 versus 19.8 per cent; AD -1.82 (-3.48 to -0.15) per cent; OR 0.87, 0.77 to 0.98; P = 0.024). CONCLUSION Short intraoperative briefings improve patient outcomes and should be performed routinely.
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Affiliation(s)
- Franziska Tschan
- Institute for Work and Organizational Psychology, University of Neuchâtel, Neuchâtel, Switzerland
| | - Sandra Keller
- Institute for Work and Organizational Psychology, University of Neuchâtel, Neuchâtel, Switzerland
| | - Norbert K Semmer
- Department of Psychology, University of Berne, Berne, Switzerland
| | - Eliane Timm-Holzer
- Institute for Work and Organizational Psychology, University of Neuchâtel, Neuchâtel, Switzerland
| | - Jasmin Zimmermann
- Institute for Work and Organizational Psychology, University of Neuchâtel, Neuchâtel, Switzerland
| | - Simon A Huber
- Institute for Work and Organizational Psychology, University of Neuchâtel, Neuchâtel, Switzerland
| | - Simon Wrann
- Department of Surgery, Triemli Hospital, Zurich, Switzerland
| | - Martin Hübner
- Department of Visceral Surgery, University Hospital Lausanne (CHUV), Lausanne, Switzerland
| | - Vanessa Banz
- Department of Visceral Surgery and Medicine, Berne University Hospital, University of Berne, Berne, Switzerland
| | - Gian Andrea Prevost
- Department of Visceral Surgery and Medicine, Berne University Hospital, University of Berne, Berne, Switzerland.,Department of Surgery, Kantonsspital Graubünden, Chur, Switzerland
| | - Jonas Marschall
- Department of Infectious Diseases, University Hospital Berne, Berne, Switzerland
| | - Daniel Candinas
- Department of Visceral Surgery and Medicine, Berne University Hospital, University of Berne, Berne, Switzerland
| | - Nicolas Demartines
- Department of Visceral Surgery, University Hospital Lausanne (CHUV), Lausanne, Switzerland
| | - Markus Weber
- Department of Surgery, Triemli Hospital, Zurich, Switzerland
| | - Guido Beldi
- Department of Visceral Surgery and Medicine, Berne University Hospital, University of Berne, Berne, Switzerland
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Picard J, Evain JN, Douron C, Maussion É, Stihle X, Manhes P, Romegoux P, Baron A, Chapuis C, Vermorel C, Garel B, Faucheron JL, Bouzat P, Bosson JL, Albaladejo P. Impact of a large interprofessional simulation-based training course on communication, teamwork, and safety culture in the operating theatre: a mixed-methods interventional study. Anaesth Crit Care Pain Med 2021; 41:100991. [PMID: 34863967 DOI: 10.1016/j.accpm.2021.100991] [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: 03/23/2021] [Revised: 10/26/2021] [Accepted: 11/01/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Communication and teamwork are critical non-technical skills in the operating theatre. However, prevention of events associated with communication failures by large simulation-based programs remains to be evaluated. The objective was to assess the impact of an interprofessional simulation-based training course on communication, teamwork, checklist adherence, and safety culture. METHODS We aimed to assess the impact of an interprofessional simulation-based training course on communication, teamwork, checklist adherence, and safety culture. We conducted a before-and-after interventional study based on a mixed-methods approach combining qualitative and quantitative evaluation criteria. The study was performed in a University Hospital with 39 operating theatres operated by 300 providers before (period 1) and after (period 2) an interprofessional simulation-based training course. Surgical procedures were observed, and the primary outcome measure was the rate of procedures with at least one communication failure associated with adverse event. Additional outcomes measured included the rate of or other communication failures, checklist adherence, while teamwork and safety culture as assessed by questionnaires. RESULTS In total, 46 970 communication episodes were analysed during 131 (period 1) and 122 (period 2) surgical procedures. One hundred sixty-four professionals attended 40 simulation-based sessions. The rate of procedures with at least one communication failure associated with adverse events was not significantly different between the 2 periods (38% in period 1 and 43% in period 2; P = 0.47). Nevertheless, the rate of communication failures reduced between period 1 and 2 (8117/28 303 (29%) vs. 3868/18 667 (21%), respectively; P < 0.01). Teamwork scores and checklist adherence increased significantly after the intervention (8.1 (7.2 to 8.7) in period 1 vs. 8.6 (8.0 to 9.2) in period 2; P < 0.01 and 17% (0-35%) in period 1 vs. 44% (26-57%) in period 2; P < 0.01). Safety culture ratings did not change significantly. CONCLUSION This study shows that although the rate of procedures with at least one communication failure associated with adverse event (primary endpoint) was not significantly different, a large interprofessional simulation-based training course has a positive effect on communication failures, teamwork, and checklist adherence.
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Affiliation(s)
- Julien Picard
- Department of Anaesthesiology and Critical Care Medicine and Simulation Centre, Grenoble-Alpes University Hospital, Grenoble, France; ThEMAS, TIMC, UMR, CNRS 5525, Grenoble-Alpes University, Grenoble, France.
| | - Jean-Noël Evain
- Department of Anaesthesiology and Critical Care Medicine and Simulation Centre, Grenoble-Alpes University Hospital, Grenoble, France; ThEMAS, TIMC, UMR, CNRS 5525, Grenoble-Alpes University, Grenoble, France
| | - Charlène Douron
- Department of Anaesthesiology and Critical Care Medicine and Simulation Centre, Grenoble-Alpes University Hospital, Grenoble, France
| | - Éloïse Maussion
- Department of Anaesthesiology and Critical Care Medicine and Simulation Centre, Grenoble-Alpes University Hospital, Grenoble, France
| | - Xavier Stihle
- Department of Anaesthesiology and Critical Care Medicine and Simulation Centre, Grenoble-Alpes University Hospital, Grenoble, France
| | - Pauline Manhes
- Department of Anaesthesiology and Critical Care Medicine and Simulation Centre, Grenoble-Alpes University Hospital, Grenoble, France
| | - Pauline Romegoux
- Department of Anaesthesiology and Critical Care Medicine and Simulation Centre, Grenoble-Alpes University Hospital, Grenoble, France
| | - Aline Baron
- Department of Anaesthesiology and Critical Care Medicine and Simulation Centre, Grenoble-Alpes University Hospital, Grenoble, France
| | - Claire Chapuis
- ThEMAS, TIMC, UMR, CNRS 5525, Grenoble-Alpes University, Grenoble, France; Department of Pharmacy, Grenoble-Alpes University Hospital, Grenoble, France
| | - Céline Vermorel
- ThEMAS, TIMC, UMR, CNRS 5525, Grenoble-Alpes University, Grenoble, France; Department of Biostatistics, Grenoble-Alpes University Hospital, Grenoble, France
| | - Benjamin Garel
- Hospital Administrator, Grenoble-Alpes University Hospital, Grenoble, France
| | - Jean-Luc Faucheron
- Department of Surgery, Grenoble-Alpes University Hospital, Grenoble, France
| | - Pierre Bouzat
- Department of Anaesthesiology and Critical Care Medicine and Simulation Centre, Grenoble-Alpes University Hospital, Grenoble, France
| | - Jean-Luc Bosson
- ThEMAS, TIMC, UMR, CNRS 5525, Grenoble-Alpes University, Grenoble, France; Department of Biostatistics, Grenoble-Alpes University Hospital, Grenoble, France
| | - Pierre Albaladejo
- Department of Anaesthesiology and Critical Care Medicine and Simulation Centre, Grenoble-Alpes University Hospital, Grenoble, France; ThEMAS, TIMC, UMR, CNRS 5525, Grenoble-Alpes University, Grenoble, France
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Sirihorachai R, Saylor KM, Manojlovich M. Interventions for the Prevention of Retained Surgical Items: A Systematic Review. World J Surg 2021; 46:370-381. [PMID: 34773133 PMCID: PMC10186264 DOI: 10.1007/s00268-021-06370-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/20/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Retained surgical items (RSI) are preventable error events. Interest in reducing RSI is increasing globally because of increasing demand for safe surgery. While research of interventions to prevent RSI have been reported, no rigorous analysis of the type and effectiveness of interventions exists. This systematic review examines (1) what types of intervention have been implemented to prevent RSI; and (2) what is the effectiveness of those interventions. METHODS We performed a systematic review of PubMed, Embase, CINAHL, Cochrane Library, Scopus, ClinicalTrials.gov, Mednar, and OpenGrey databases. Two reviewers independently screened a total of 1,792 titles and abstracts, and reviewed 87 full-text articles, resulting in 17 articles in the final analysis. Study characteristics included qualitative and quantitative studies that examined the effectiveness of RSI prevention interventions for adult patients who undergo open surgery. The primary outcome was RSI and related error events. RESULTS Four studies and 13 quality improvement projects described RSI interventions categorized into four groups: (1) technology-based, (2) communication-based, (3) practice- or guideline-based, (4) interventions that fell into more than one category. Following guidance in the Quality Improvement minimum quality criteria set, the quality of all studies ranged from poor to fair. Heterogeneity in the interventions used and variable study quality limit our confidence in the interventions' ability to reduce RSI. CONCLUSION Since technology-based interventions may not be financially feasible in low and middle-income countries (LMIC), in those settings interventions that target the social system may be more appropriate. Rigorous methods to investigate local contexts and build knowledge are needed so that interventions to prevent RSI have a greater likelihood of success.
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Affiliation(s)
- Rattima Sirihorachai
- Faculty of Nursing, Mahidol University, 2 Wang Lang Road, Siriraj, Bangkoknoi, Bangkok, 10700, Thailand.
| | - Kate M Saylor
- MSI, Taubman Health Sciences Library, University of Michigan, Ann Arbor, MI, USA
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Mansour D, Sayeed Z, Padela MT, McCarty S, Tonnos F, Silas D, Mostafa G, Yassir WK. Accountable Operating Room Teams. Orthopedics 2021; 44:e463-e470. [PMID: 34292838 DOI: 10.3928/01477447-20210618-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
With Medicare reimbursement diminishing and the aging population consuming more health care, hospitals continue to push for reforms to improve the efficiency of health care delivery, decrease consumption, and elevate the quality of care. Operating rooms command a large share of hospital resources but are also major revenue generators. Surgical care has evolved to become more efficient and accountable. Defining the characteristics of an accountable operating room team has been more elusive and inconsistent. This review defines the characteristics of accountable operating room teams and recommends measures by which to evaluate them. [Orthopedics. 2021;44(4):e463-e470.].
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Fahy AS, Mueller C, Fecteau A. Conflict resolution and negotiation in pediatric surgery. Semin Pediatr Surg 2021; 30:151100. [PMID: 34635278 DOI: 10.1016/j.sempedsurg.2021.151100] [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: 10/20/2022]
Abstract
Conflict is pervasive in pediatric surgery - it is experienced during patient care, in the operating room and between colleagues. The ethical principles of autonomy, beneficience, non-maleficience and justice are firmly anchored in any discourse regarding conflict in the setting of healthcare. The authors review key features of conflict in healthcare including the effect on patient outcomes as well as implications for the ability of the surgeon and the medical team to function appropriately and safely when conflicts arise. Although most pediatric surgery fellowship programs have no formal training in conflict management, much has been written about strategies to teach and utilize techniques of conflict mitigation and negotiation. In this article, the authors discuss common areas of conflict in the medical environment and suggest useful tools for the practicing pediatric surgeon to aid in the resolution of conflict.
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Affiliation(s)
- Aodhnait S Fahy
- Division of General and Thoracic Surgery, The Hospital for Sick Children, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Claudia Mueller
- Pediatric General Surgery, Lucile Packard Children's Hospital Stanford, San Francisco, CA, USA
| | - Annie Fecteau
- Division of General and Thoracic Surgery, The Hospital for Sick Children, Department of Surgery, University of Toronto, Toronto, ON, Canada.
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Lorenzi C, Duffy CC. Incorporating Human Factors in Perioperative Nursing to Reduce Errors. AORN J 2021; 114:380-386. [PMID: 34586659 DOI: 10.1002/aorn.13516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 04/07/2021] [Indexed: 11/10/2022]
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System Factors Affecting Patient Safety in the OR: An Analysis of Safety Threats and Resiliency. Ann Surg 2021; 274:114-119. [PMID: 31592890 DOI: 10.1097/sla.0000000000003616] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVE The objective of this study is to determine the characteristics and frequency of intraoperative safety threats and resilience supports using a human factors measurement tool. BACKGROUND Human factors analysis can provide insight into how system elements contribute to intraoperative adverse events. Empiric evidence on safety threats and resilience in surgical practice is lacking. METHODS A cross-sectional study of 24 patients undergoing elective laparoscopic general surgery at a single center in the Netherlands from May to November, 2017 was conducted. Video, audio, and patient physiologic data from all included procedures were obtained through a multichannel synchronized recording device. Trained analysts reviewed the recordings and coded safety threats and resilience supports. The codes were categorized into 1 of 6 categories (person, task, tools and technology, physical environment, organization, and external environment). RESULTS A median of 14 safety threats [interquartile range (IQR) 11-16] and 12 resilience supports (IQR 11-16) were identified per case. Most safety threat codes (median 9, IQR 7-12) and resilience support codes (median 10, IQR 7-12) were classified in the person category. The organization category contained a median of 2 (IQR 1-2) safety threat codes and 2 (IQR 2-3) resilience support codes per case. The tools and technology category contributed a small number of safety threats (median 1 per case, IQR 0-1), but rarely provided resilience support. CONCLUSIONS Through a detailed human factors analysis of elective laparoscopic general surgery cases, this study provided a quantitative analysis of the existing safety threats and resilience supports in a modern endoscopic operating room.
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Dias RD, Zenati MA, Conboy HM, Clarke LA, Osterweil LJ, Avrunin GS, Yule SJ. Dissecting Cardiac Surgery: A Video-based Recall Protocol to Elucidate Team Cognitive Processes in the Operating Room. Ann Surg 2021; 274:e181-e186. [PMID: 31348036 PMCID: PMC7241253 DOI: 10.1097/sla.0000000000003489] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVE The aim of this study was to elucidate the cognitive processes involved in surgical procedures from the perspective of different team roles (surgeon, anesthesiologist, and perfusionist) and provide a comprehensive compilation of intraoperative cognitive processes. SUMMARY BACKGROUND DATA Nontechnical skills play a crucial role in surgical team performance and understanding the cognitive processes underlying the intraoperative phase of surgery is essential to improve patient safety in the operating room (OR). METHODS A mixed-methods approach encompassing semistructured interviews with 9 subject-matter experts. A cognitive task analysis was built upon a hierarchical segmentation of coronary artery bypass grafting procedures and a cued-recall protocol using video vignettes was used. RESULTS A total of 137 unique surgical cognitive processes were identified, including 33 decision points, 23 critical communications, 43 pitfalls, and 38 strategies. Self-report cognitive workload varied substantially, depending on team role and surgical step. A web-based dashboard was developed, providing an integrated visualization of team cognitive processes in the OR that allows readers to intuitively interact with the study findings. CONCLUSIONS This study advances the current body of knowledge by making explicit relevant cognitive processes involved during the intraoperative phase of cardiac surgery from the perspective of multiple OR team members. By displaying the research findings in an interactive dashboard, we provide trainees with new knowledge in an innovative fashion that could be used to enhance learning outcomes. In addition, the approach used in the present study can be used to deeply understand the cognitive factors underlying surgical adverse events and errors in the OR.
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Affiliation(s)
- Roger D Dias
- STRATUS Center for Medical Simulation, Brigham and Women's Hospital, Boston, MA
- Department of Emergency Medicine, Harvard Medical School, Boston, MA
| | - Marco A Zenati
- Medical Robotics and Computer Assisted Surgery (MRCAS) Laboratory, Division of Cardiac Surgery, Veterans Affairs Boston Healthcare System, Boston, MA
- Department of Surgery, Harvard Medical School, Boston, MA
| | - Heather M Conboy
- College of Information and Computer Sciences, University of Massachusetts, Amherst, MA
| | - Lori A Clarke
- College of Information and Computer Sciences, University of Massachusetts, Amherst, MA
| | - Leon J Osterweil
- College of Information and Computer Sciences, University of Massachusetts, Amherst, MA
| | - George S Avrunin
- College of Information and Computer Sciences, University of Massachusetts, Amherst, MA
| | - Steven J Yule
- STRATUS Center for Medical Simulation, Brigham and Women's Hospital, Boston, MA
- Department of Surgery, Harvard Medical School, Boston, MA
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA
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Schnock KO, Biggs B, Fladger A, Bates DW, Rozenblum R. Evaluating the Impact of Radio Frequency Identification Retained Surgical Instruments Tracking on Patient Safety: Literature Review. J Patient Saf 2021; 17:e462-e468. [PMID: 28230583 DOI: 10.1097/pts.0000000000000365] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Retained surgical instruments (RSI) are one of the most serious preventable complications in operating room settings, potentially leading to profound adverse effects for patients, as well as costly legal and financial consequences for hospitals. Safety measures to eliminate RSIs have been widely adopted in the United States and abroad, but despite widespread efforts, medical errors with RSI have not been eliminated. OBJECTIVE Through a systematic review of recent studies, we aimed to identify the impact of radio frequency identification (RFID) technology on reducing RSI errors and improving patient safety. METHODS A literature search on the effects of RFID technology on RSI error reduction was conducted in PubMed and CINAHL (2000-2016). Relevant articles were selected and reviewed by 4 researchers. RESULTS After the literature search, 385 articles were identified and the full texts of the 88 articles were assessed for eligibility. Of these, 5 articles were included to evaluate the benefits and drawbacks of using RFID for preventing RSI-related errors. The use of RFID resulted in rapid detection of RSI through body tissue with high accuracy rates, reducing risk of counting errors and improving workflow. CONCLUSIONS Based on the existing literature, RFID technology seems to have the potential to substantially improve patient safety by reducing RSI errors, although the body of evidence is currently limited. Better designed research studies are needed to get a clear understanding of this domain and to find new opportunities to use this technology and improve patient safety.
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Affiliation(s)
| | - Bonnie Biggs
- Bouve' School of Health Sciences, School of Nursing, Northeastern University
| | - Anne Fladger
- Medical Library and Educational Services, Brigham and Women's Hospital, Boston, Massachusetts
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Tsuda S, Olasky J, Jones DB. Team training and surgical crisis management. J Surg Oncol 2021; 124:216-220. [PMID: 34245574 DOI: 10.1002/jso.26523] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 04/27/2021] [Accepted: 04/29/2021] [Indexed: 11/11/2022]
Abstract
Team training and crisis management derive their roots from fundamental learning theory and the culture of safety that burgeoned forth from the industrial revolution through the rise of nuclear energy and aviation. The integral nature of telemedicine to many simulation-based activities, whether to bridge distances out of convenience or necessity, continues to be a common theme moving into the next era of surgical safety as newer, more robust technologies become available.
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Affiliation(s)
- Shawn Tsuda
- Valley Health System General Surgery Residency, Las Vegas, Nevada, USA
| | - Jaisa Olasky
- Mount Auburn Hospital, Cambridge, Massachusetts, USA
| | - Daniel B Jones
- Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
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Nasiri E, Lotfi M, Mahdavinoor SMM, Rafiei MH. The impact of a structured handover checklist for intraoperative staff shift changes on effective communication, OR team satisfaction, and patient safety: a pilot study. Patient Saf Surg 2021; 15:25. [PMID: 34275484 PMCID: PMC8286430 DOI: 10.1186/s13037-021-00299-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 07/05/2021] [Indexed: 11/23/2022] Open
Abstract
Objective Handover without a structured format is prone to the omission of information and could be a potential risk to patient safety. We sought to determine the effect of a structured checklist on the quality of intraoperative change of shift handover between scrubs and circulars. Methods We conducted a control intervention study on operating room wards of two teaching hospitals from 20 Feb to 21 Nov 2020. This research was conducted in three stages as follows: assessing the current situation (as a group before the intervention), performing the intervention and evaluating the effect of using a checklist on handover quality after the intervention in two groups: with and without checklist. We examined the quality of handover between scrub and circular personnel in terms of handover duration and quality, omission of information and improvement in OR staff satisfaction. Results A total of 120 handovers were observed and evaluated. After intervention in the group using the checklist, the percentage of information omission in surgical report was decreased from 19.5 to 12.1% between scrubs (P < 0.00) and from 16.8 to 14.1% between circulars (P < 0.03). Also, in the role of scrub, the mean overall score of handover process quality was significantly higher after the intervention (x̄ = 7 ± 1.5) than before it (x̄ = 6.5 ± 0.9) (p < 0.02). In the role of circulating, despite the positive effect of overall score checklist, no significant difference was observed (p < 0.08). The use of checklist significantly increased the handover duration between scrubs (p < 0.03) and circulars (p < 0.00). The overall mean percentage of handover satisfaction increased from 67.5% before the intervention to 85.5% after the intervention (p < 0.00). Conclusion The implementation of a new structured handover checklist had a positive impact on improving the quality of communication between the surgical team, reducing the information omission rate and increasing the satisfaction.
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Affiliation(s)
- Ebrahim Nasiri
- Assistant Professor of Traditional Medicine, Department of Anesthesiology and Operating Room, Faculty of Allied Medical Sciences, Mazandaran University of Medical Sciences, Sari, Iran
| | - Mojgan Lotfi
- Associate Professor of Nursing Education, Department of Medical Surgical Nursing, Faculty of Nursing and Midwifery, Sina Hospital, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Seyyed Muhammad Mahdi Mahdavinoor
- Undergraduate Bachelor Student of Surgical Technology, Department of Anesthesiology, Operating Room and Emergencies, School of Allied Medical Sciences Mazandaran University of Medical Sciences, Sari, Iran
| | - Mohammad Hossein Rafiei
- MSc Student in Surgical Technology, School of Allied Medical Sciences, Student Research Committee, Mazandaran University of Medical Sciences, Sari, Iran.
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Surgical Tray Optimization: a Quality Improvement Initiative that Reduces Operating Room Costs. J Med Syst 2021; 45:78. [PMID: 34231049 DOI: 10.1007/s10916-021-01753-4] [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: 02/22/2020] [Accepted: 06/28/2021] [Indexed: 10/20/2022]
Abstract
Surgical trays contain unused instruments which generate wasted resources from unnecessary reprocessing/replacement costs. We implemented a quality improvement initiative to optimize surgical trays for common otolaryngology procedures, and examined the impact on costs, operating room (OR) efficiency, and patient safety.We studied five common otolaryngology procedures over a 10-month period at a single community hospital. We compared pre- and post-intervention outcome measures including instrument utilization, tray set up time, tray rebuilding time, and balancing measures (operative time, instrument recall, patient safety). We estimated cost-savings from an institutional perspective over 1- and 10-year time horizons. Costs were expressed in 2017 Canadian dollars and modeled as a function of surgical volume, labor costs, instrument depreciation, and indirect costs.A total of 238 procedures by six surgeons were observed. At baseline, only 35% of instruments were utilized. We achieved an average instrument reduction of 26%, yielding 1-year cost savings of $9,010 CDN and 10-year cost savings of $69,576 CDN. Tray optimization reduced average OR tray setup time by 2.5 ± 0.4 min (p = 0.03) and average tray rebuilding time by 1.4 ± 0.2 min (p = 0.06). There was minimal impact on balancing measures such as OR time, stakeholder perception of patient safety and trainee education, and only a single case of instrument recall.Surgical tray optimization is a simple, effective, and scalable strategy for reducing costs and improving OR efficiency without compromising patient safety.
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Wood BC, Konchan S, Gay S, Rath S, Deshpande V, Knowles M. Data Analysis of Plastic Surgery Instrument Trays Yields Significant Cost Savings and Efficiency Gains. Ann Plast Surg 2021; 86:S635-S639. [PMID: 34100825 DOI: 10.1097/sap.0000000000002913] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Inpatient surgery costs have risen 30% over the past 5 years, and the operating room accounts for up to 60% of total hospital operational expense. On average, only 13.0% to 21.9% of instruments opened for a case are used, contributing to significant avoidable reprocessing, repurchase, and labor expense. METHODS A comprehensive review of 40 major instrument trays at UNC Rex Hospital was conducted using a technology service (OpFlow; Operative Flow Technologies, Raleigh, NC). Among the full scope of the project, the general plastics tray and breast reconstruction tray were evaluated for the plastic surgery service line over a 3-month period. Intraoperative data collection was performed on the exact instruments used across a standard breadth of cases. Data analytics were conducted stratifying instrument usage concordance among surgeons by tray and procedure type. After a surgeon-led review of the proposed new tray configurations, the optimized versions were implemented via a methodical change management process. RESULTS A total of 183 plastic surgery cases were evaluated across 17 primary surgeons. On average, the instrument usage per tray was 15.8% for the general plastics tray and 23.5% for the breast reconstruction tray. After stakeholder review, 32 (45.1%) of 71 instruments were removed from the general plastics tray and 40 (36.7%) of 109 were removed from the breast reconstruction tray, resulting in a total reduction of 2652 instruments. This resulted in a decrease of 81,696 instrument sterilization cycles annually. The removal of the instruments yielded an estimated cost avoidance of US $163,800 for instrument repurchase and US $69,441 in annual resterilization savings. The instrument volume reduction is projected to save 383.5 hours of sterile processing personnel time in tray assembly annually. CONCLUSIONS An analytics-driven method applying empirical data on actual case-based instrument usage has implications for better efficiency, improved quality, and cost avoidance related to instrument repurchase and sterile processing. Given increasing cost constraints and the transition to value-based care models, leveraging a technology-based solution enables meaningful change in the sterile processing department as a source for cost reduction and quality of care improvement.
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Affiliation(s)
| | | | | | - Sandeep Rath
- Department of Operations, UNC Kenan-Flagler Business School
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Association between Functional Brain Network Metrics and Surgeon Performance and Distraction in the Operating Room. Brain Sci 2021; 11:brainsci11040468. [PMID: 33917719 PMCID: PMC8068138 DOI: 10.3390/brainsci11040468] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 04/02/2021] [Accepted: 04/06/2021] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE The aim of this work was to examine (electroencephalogram) EEG features that represent dynamic changes in the functional brain network of a surgical trainee and whether these features can be used to evaluate a robot assisted surgeon's (RAS) performance and distraction level in the operating room. MATERIALS AND METHODS Electroencephalogram (EEG) data were collected from three robotic surgeons in an operating room (OR) via a 128-channel EEG headset with a frequency of 500 samples/second. Signal processing and network neuroscience algorithms were applied to the data to extract EEG features. The SURG-TLX and NASA-TLX metrics were subjectively evaluated by a surgeon and mentor at the end of each task. The scores given to performance and distraction metrics were used in the analyses here. Statistical test data were utilized to select EEG features that have a significant relationship with surgeon performance and distraction while carrying out a RAS surgical task in the OR. RESULTS RAS surgeon performance and distraction had a relationship with the surgeon's functional brain network metrics as recorded throughout OR surgery. We also found a significant negative Pearson correlation between performance and the distraction level (-0.37, p-value < 0.0001). CONCLUSIONS The method proposed in this study has potential for evaluating RAS surgeon performance and the level of distraction. This has possible applications in improving patient safety, surgical mentorship, and training.
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Sahebi A, Golitaleb M, Jahangiri K. Survey of Critical Standards of Patient Safety in Hospitals of Iran: A Systematic Review and Meta-Analysis. Int J Prev Med 2021; 12:34. [PMID: 34249283 PMCID: PMC8218805 DOI: 10.4103/ijpvm.ijpvm_467_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Accepted: 10/14/2020] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Patient safety is an important and mandatory component of quality health services. Insecure health services, in addition to inflicting pain and suffering to patients, impose a high financial burden on the health system of every society. The present study was conducted to evaluate the critical standards of patient safety based on the Patient Safety Friendly Hospital Initiative (PSFHI) checklist in Iran. METHODS The present systematic review and meta-analysis were performed based on the PRISMA guideline. For this purpose, articles related to the critical standards of patient safety based on the PSFHI checklist were obtained by searching valid Persian and English keywords in SID, Magiran, PubMed, Scopus, Web of Science, and Google scholar data resource through the end of 2019. The studies were analyzed using the STATA (version 14) software. RESULTS In the initial search, 533 articles were extracted among which 7 were eligible and entered into the meta-analysis process. Overall, 55 hospitals were surveyed, and the results of the meta-analysis showed that the average critical standards of patient safety were 69.52% (95%, CI = 57.09-81.95, I2 = 69%, P = 0.004). CONCLUSIONS The results showed that a moderate level of critical standards of patient safety in hospitals in Iran. Since meta-regression analysis revealed a decreasing trend in compliance rate, hospital managers should implement principals designated by the World Health Organization to achieve the required standards that are the basis and pillar of a patient-friendly hospital. With proper management, hospitals should set goals and take steps based on a strategic plan toward achieving these goals.
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Affiliation(s)
- Ali Sahebi
- Department of Health in Disasters and Emergencies, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Non - Communicable Diseases Research Center, Ilam University of Medical Sciences, Ilam, Iran
| | - Mohamad Golitaleb
- Department of Nursing, School of Nursing and Midwifery, Arak University of Medical Sciences, Arak, Iran
| | - Katayoun Jahangiri
- Safety Promotion and Injury Prevention Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Health in Disasters and Emergencies, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Alexander HC, McLaughlin SJ, Thomas RH, Merry AF. Checklists for image-guided interventions: a systematic review. Br J Radiol 2021; 94:20200980. [PMID: 33684307 DOI: 10.1259/bjr.20200980] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES Safety checklists have improved safety in patients undergoing surgery. Checklists have been designed specifically for use in image-guided interventions. This systematic review aimed to identify checklists designed for use in radiological interventions and to evaluate their efficacy for improving patient safety. Secondary aims were to evaluate attitudes toward checklists and barriers to their use. METHODS OVID, MEDLINE, CENTRAL and CINAHL were searched using terms for "interventional radiology" and "checklist". Studies were included if they described pre-procedural checklist use in vascular/body interventional radiology (IR), paediatric IR or interventional neuro-radiology (INR). Data on checklist design, implementation and outcomes were extracted. RESULTS Sixteen studies were included. Most studies (n = 14, 87.5%) focused on body IR. Two studies (12.5%) measured perioperative outcome after checklist implementation, but both had important limitations. Checklist use varied between 54 and 100% and completion of items on the checklists varied between 28 and 100%. Several barriers to checklist use were identified, including a lack of leadership and education and cultural challenges unique to radiology. CONCLUSIONS We found few reports of the use of checklists in image-guided interventions. Approaches to checklist implementation varied, and several barriers to their use were identified. Evaluation has been limited. There seems to be considerable potential to improve the effective use of checklists in radiological procedures. ADVANCES IN KNOWLEDGE There are few reports of the use of checklists in radiological interventions, those identified reported significant barriers to the effective use of checklists.
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Affiliation(s)
- Harry C Alexander
- Department of Anaesthesiology, University of Auckland, Auckland, New Zealand
| | - Scott Jp McLaughlin
- Department of Anaesthesiology, University of Auckland, Auckland, New Zealand
| | - Robert H Thomas
- Department of Interventional Radiology, Saint Mary's Hospital, London, UK
| | - Alan F Merry
- Department of Anaesthesiology, University of Auckland, Auckland, New Zealand.,Department of Anaesthesia, Auckland City Hospital, Auckland, New Zealand
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McLeod M, Signal V, Gurney J, Sarfati D. Postoperative Mortality of Indigenous Populations Compared With Nonindigenous Populations: A Systematic Review. JAMA Surg 2021; 155:636-656. [PMID: 32374369 DOI: 10.1001/jamasurg.2020.0316] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Importance A range of factors have been identified as possible contributors to racial/ethnic differences in postoperative mortality that are also likely to hold true for indigenous populations. Yet despite its severity as an outcome, death in the period following a surgical procedure is underresearched for indigenous populations. Objective To describe postoperative mortality experiences for minority indigenous populations compared with numerically dominant nonindigenous populations and examine the factors that drive any differences observed. Evidence Review This review was conducted according to PRIMSA guidelines and registered on PROSPERO. Articles were identified through searches of the Embase, Ovid MEDLINE, Scopus, and Cumulative Index to Nursing and Allied Health Literature databases, with manual review of references and gray literature searches conducted. Eligible articles included those that reported associations between ethnicity/indigeneity and mortality up to 90 days following surgery and published in English between January 1, 1990, and March 26, 2019. Data on the study design, setting, participants (including indigeneity), and results were extracted. A modified Newcastle-Ottawa Quality Assessment Scale was used to determine study quality. Findings A total of 442 abstracts were screened, 92 articles were reviewed in full text, and 21 articles (from 20 studies) and 7 reports underwent data extraction. All included studies were cohort studies (3 prospective and the remainder retrospective) investigating a wide range of surgical procedures in the US, Australia, or New Zealand. Seven studies were from single facilities, while the remainder used data from national databases. Sample sizes ranged, with indigenous sample sizes ranging from 20 to 3052 patients and a number of studies reporting less than 10 indigenous deaths. The postoperative mortality experience for minority indigenous populations compared with the nonindigenous populations was mixed. There was evidence from several studies that indigenous populations may be more likely to die following cardiac procedures. However, the available evidence has overall poor study quality, with methods to identify the indigenous populations being a major limitation of most of the studies. Conclusions and Relevance Postoperative mortality experiences for indigenous populations should not be interpreted in isolation from the broader context of inequities across the health care pathway and must take into account the quality of data used for indigenous identification.
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Affiliation(s)
- Melissa McLeod
- Department of Public Health, University of Otago Wellington, Wellington, New Zealand
| | - Virginia Signal
- Department of Public Health, University of Otago Wellington, Wellington, New Zealand
| | - Jason Gurney
- Department of Public Health, University of Otago Wellington, Wellington, New Zealand
| | - Diana Sarfati
- Department of Public Health, University of Otago Wellington, Wellington, New Zealand
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System Factors Affecting Intraoperative Risk and Resilience: Applying a Novel Integrated Approach to Study Surgical Performance and Patient Safety. Ann Surg 2020; 272:1164-1170. [PMID: 30946083 DOI: 10.1097/sla.0000000000003280] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To identify and categorize system factors in complex laparoscopic surgery that have the potential to either threaten patient safety or support system resilience. BACKGROUND The operating room is a uniquely complex sociotechnical work system wherein surgical successes prevail despite pervasive safety threats. Holistically characterizing intraoperative factors that thus support system resilience in addition to those that threaten patient safety using contextual methodologies is critical for optimizing surgical safety overall. METHOD In this prospective descriptive interdisciplinary study, 19 audio/video recordings of complex laparoscopic general surgical procedures were directly observed and transcribed. Using a qualitative systems-based approach, intraoperative human factors with the potential to impact patient safety, either as a safety threat or as a support for resilience, were identified. Adverse events were further assessed for shared threats and supports. Data collection was guided by the Systems Engineering Initiative for Patient Safety 2.0 work system model. RESULTS A total of 1083 relevant observations were made over 39.8 hours of operative time, enabling the identification of 79 distinct safety threats and 67 resilience supports within the surgical system. Safety threats associated with the physical environment, tasks, organization, and equipment were prevalent and observed in equal measure, whereas supports for resilience were predominantly attributed to clinician behaviors, including proactive team management and skills coaching. Two subclinical adverse events were identified; shared safety threats included suboptimal technology design, whereas shared resilience supports included calm clinician behavior and redundant intraoperative resourcing. CONCLUSIONS Safety threats and resilience supports were found to be systematic in the surgical setting. Identified safety threats should be prioritized for remediation, and clinician behaviors that contribute to fostering resilience should be valued and protected.
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Bajpai S, Lindeman B. The Trainee's Role in Patient Safety: Training Residents and Medical Students in Surgical Patient Safety. Surg Clin North Am 2020; 101:149-160. [PMID: 33212075 DOI: 10.1016/j.suc.2020.09.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
"The focus on patient safety offers a new framework not only for delivering health care but also for training physicians. Medical school and surgical graduate medical education must transition to a more holistic approach by teaching technical and nontechnical skills. Formalized safety curricula can be developed by adopting recommended guidelines and content from national and international organizations, existing validated practices of training programs, frequent simulation exercises, and objective evaluation tools."
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Affiliation(s)
- Swara Bajpai
- Department of Surgery, 1808 7th Avenue South, BDB 202, Birmingham, AL 35294, USA
| | - Brenessa Lindeman
- Endocrine Surgery, General Surgery, Department of Surgical Oncology, BDB 603, Birmingham, AL, USA.
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Koike D, Nomura Y, Nagai M, Matsunaga T, Yasuda A. Bundle interventions including nontechnical skills for surgeons can reduce operative time and improve patient safety. Int J Qual Health Care 2020; 32:522-530. [PMID: 32648898 PMCID: PMC7654384 DOI: 10.1093/intqhc/mzaa074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/01/2020] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE This study aimed to determine if introducing nontechnical skills to surgical trainees during surgical education can reduce the operation time and contribute to patient safety. DESIGN Quality improvement initiatives using the KAIZEN as a problem-solving method. SETTING Department of surgery in a referral and educational hospital. PARTICIPANTS Surgical team and quality management team. INTERVENTION The KAIZEN was used as a problem-solving method between 2015 and 2018 to reduce the operation time. First, baseline measurement was performed to understand the current situations in our department. To achieve continuous improvement, periodical feedback of the current status was obtained from all staff. Bundles, including nontechnical skills, were established. Briefing and debriefing were performed by the surgical team. MAIN OUTCOME MEASURES Excessively long operation rates with a standard procedure. RESULTS We included 1573 operations in this initiative. Excessively long operation rates were reduced in all types of surgeries, from 27.1% to 15.2% for herniorrhaphy (P = 0.005), 58.3-40.0% for gastrectomy (P = 0.03), 50.0-4.1% for total gastrectomy (P = 0.12), 65.6-45.0% for colectomy (P = 0.004), 67.8-43.2% for high anterior resection (P = 0.02) and 69.6-47.9% for low anterior resection (P = 0.03). The adherence to briefing and debriefing were improved, and majority of the surgeons favored the bundle elements. CONCLUSIONS The KAIZEN initiative was effective in clinical healthcare settings. In the event of scaling-up this initiative, the educational program for physicians should include project management strategies and leadership skills.
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Affiliation(s)
- Daisuke Koike
- Department of Surgery, Asahi General Hospital, 1326, I, Asahi, Chiba 289-2511, Japan
- Total Quality Management Center, Asahi General Hospital, 1326, I, Asahi, Chiba 289-2511, Japan
- Department of Quality and Safety in Healthcare, Fujita Health University, 1-98, Dengakugakubo, Kutsukake-cho, Toyoake, Aichi 470-1192, Japan
- ASUISHI Project, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya 466-8550, Japan
| | - Yukihiro Nomura
- Department of Surgery, Asahi General Hospital, 1326, I, Asahi, Chiba 289-2511, Japan
| | - Motoki Nagai
- Department of Surgery, Asahi General Hospital, 1326, I, Asahi, Chiba 289-2511, Japan
| | - Takashi Matsunaga
- Total Quality Management Center, Asahi General Hospital, 1326, I, Asahi, Chiba 289-2511, Japan
| | - Ayuko Yasuda
- Department of Quality and Safety in Healthcare, Fujita Health University, 1-98, Dengakugakubo, Kutsukake-cho, Toyoake, Aichi 470-1192, Japan
- ASUISHI Project, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya 466-8550, Japan
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Abstract
OBJECTIVES Operating rooms (ORs) and surgical settings are potential sources of sentinel adverse events. To better understand the characteristics of errors in OR processes, we performed prospective risk analysis. METHODS The study was mixed qualitative and quantitative research. We used the Healthcare Failure Mode and Effect Analysis (HFMEA) method to analyze the selected perioperative, operative, and postoperative processes in the OR via a 2-round Delphi technique. We identified the most prominent failure modes according to a Hazard Decision Matrix, analyzed and categorized proposed possible causes, and provided solutions to mitigate hazard scores. RESULTS Ten important processes and 7 subprocesses within the OR were selected and mapped, and 187 failure modes were identified and scored on the basis of severity and probability. A total of 36 potential failure modes were highlighted as high-risk failures and moved to decision trees for further analyses. CONCLUSION Developing policy for the familiarization of new personnel designing a checklist for accurate gases counting; drafting comprehensive presurgical posters; preparing all necessary equipment in difficult intubation; developing instruction for monthly checking of the OR equipment; and developing the evaluation criteria of staff performance are examples of solutions that are proposed to improve the quality of OR processes.
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Garosi E, Kalantari R, Zanjirani Farahani A, Zuaktafi M, Hosseinzadeh Roknabadi E, Bakhshi E. Concerns About Verbal Communication in the Operating Room: A Field Study. HUMAN FACTORS 2020; 62:940-953. [PMID: 31306042 DOI: 10.1177/0018720819858274] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To assess verbal communication patterns which could contribute to poor performance among surgical team members in an operating room. BACKGROUND There exist certain challenges in communication in health care settings. Poor communication can have negative effects on the performance of a surgical team and patient safety. A communication pattern may be associated with poor performance when the process of sending and receiving information is interrupted or the content of conversation is not useful. METHOD This cross-sectional field study was conducted with 54 surgical teams working in two Iranian hospitals during 2015. Two observers recorded all verbal communications in an operating room. An in-depth assessment of various annotated transcripts by an expert panel was used to assess verbal communication patterns in the operating room. RESULTS Verbal communication patterns which could contribute to poor performance were observed in 63% of the surgeries, categorized as communication failures (17 events), protests (23 events), and irrelevant conversations (164 events). The anesthesiologists and the circulating nurses had the most concerning communication patterns. The failure of devices and poor planning were important factors that contributed to concerning patterns. CONCLUSION Concerning patterns of verbal communication are not rare in operating rooms. Analyzing the annotated transcripts of surgeries can conduce to identifying all these patterns, and their causes. Concerning communication patterns can be reduced in the operating room by providing interventions, properly planning for surgeries, and fixing defective devices. APPLICATION The method used in this study can be followed to assess communication problems in operating rooms and to find solutions.
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Kempfle JS, Panda A, Hottin M, Vinik K, Kozin ED, Ito CJ, Remenschneider AK. Effect of Powered Air-Purifying Respirators on Speech Recognition Among Health Care Workers. Otolaryngol Head Neck Surg 2020; 164:87-90. [DOI: 10.1177/0194599820945685] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Powered air-purifying respirators (PAPRs) are used as personalized protective equipment for health care personnel. PAPRs offer health care workers added protection when dealing with patients who have high-risk infectious disease such as COVID-19. Unfortunately, PAPRs can produce notable levels of background noise. We hypothesize that PAPR use may be associated with increased hearing thresholds and impaired word discrimination and may ultimately have a negative impact on effective communication. Herein, we (1) determined sound levels generated by PAPRs and (2) measured hearing thresholds and word discrimination with and without operational PAPRs. All participants had normal hearing. When the PAPR was operational, mean ± SD thresholds increased from 4.5 ± 3.6 to 38.6 ± 5.6 dB HL ( P < .001). Word discrimination dropped from 100% in all participants in quiet to a mean 48% ± 14% with operational PAPR ( P < .001). Thus, we find that use of PAPR hoods results in hearing impairment comparable to moderate to severe hearing loss, and we suspect that users will experience communication difficulties as a result. Level of Evidence. Prospective study.
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Affiliation(s)
- Judith S. Kempfle
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
- Department of Otolaryngology, UMass Memorial Medical Center, Worcester, Massachusetts, USA
- Department of Otolaryngology, University Medical Center, Tübingen, Germany
| | - Ashwin Panda
- University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Mary Hottin
- Department of Audiology, UMass Memorial Medical Center, Worcester, Massachusetts, USA
| | - Kevin Vinik
- Department of Otolaryngology, UMass Memorial Medical Center, Worcester, Massachusetts, USA
| | - Elliott D. Kozin
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
| | - Christopher J. Ito
- Department of Otolaryngology, UMass Memorial Medical Center, Worcester, Massachusetts, USA
- University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Aaron K. Remenschneider
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
- Department of Otolaryngology, UMass Memorial Medical Center, Worcester, Massachusetts, USA
- University of Massachusetts Medical School, Worcester, Massachusetts, USA
- Department of Audiology, UMass Memorial Medical Center, Worcester, Massachusetts, USA
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Frasier LL, Pavuluri Quamme SR, Wiegmann D, Greenberg CC. Evaluation of Intraoperative Hand-Off Frequency, Duration, and Context: A Mixed Methods Analysis. J Surg Res 2020; 256:124-130. [PMID: 32688079 DOI: 10.1016/j.jss.2020.06.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 05/27/2020] [Accepted: 06/16/2020] [Indexed: 01/03/2023]
Abstract
BACKGROUND Hand-offs in the operating room contribute to poor communication, reduced team function, and may be poorly coordinated with other activities. Conversely, they may represent a missed opportunity for improved communication. We sought to better understand the coordination and impact of intraoperative hand-offs. METHODS We prospectively audio-video (AV) recorded 10 operations and evaluated intraoperative hand-offs. Data collected included percentage of time team members were absent due to breaks, relationships between hand-offs and intraoperative events (incision, surgical counts), and occurrences of simultaneous hand-offs. We also identified announcement that a hand-off had occurred and anchoring, in which team members not involved in the hand-off participated and provided information. RESULTS Spanning 2919 min of audio-video data, there were 74 hand-offs (range, 4-14 per case) totaling 225.2 min, representing 7.7% of time recorded. Thirty-two (45.1%) hand-offs were interrupted or delayed because of competing activities; eight hand-offs occurred during an instrument or laparotomy pad count. Six cases had simultaneous hand-offs; two cases had two episodes of simultaneous hand-offs. Eight hand-offs included an announcement. Seven included anchoring. Evaluating both temporary and permanent hand-offs, one or more original team members was absent for 40.7% of time recorded and >one team member was absent for 20.5% of time recorded. CONCLUSIONS Intraoperative hand-offs are frequent and not well coordinated with intraoperative events including counts and other hand-offs. Anchoring and announced hand-offs occurred in a small proportion of cases. Future work must focus on optimizing timing, content, and participation in intraoperative hand-offs.
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Affiliation(s)
- Lane L Frasier
- University of Wisconsin-Madison Wisconsin Surgical Outcomes Research (WiSOR) Program, Madison, Wisconsin
| | - Sudha R Pavuluri Quamme
- University of Wisconsin-Madison Wisconsin Surgical Outcomes Research (WiSOR) Program, Madison, Wisconsin
| | - Douglas Wiegmann
- University of Wisconsin-Madison Wisconsin Surgical Outcomes Research (WiSOR) Program, Madison, Wisconsin; University of Wisconsin-Madison Department of Industrial & Systems Engineering, Madison, Wisconsin
| | - Caprice C Greenberg
- University of Wisconsin-Madison Wisconsin Surgical Outcomes Research (WiSOR) Program, Madison, Wisconsin; University of Wisconsin-Madison Department of Industrial & Systems Engineering, Madison, Wisconsin.
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Abstract
OBJECTIVE With advancements in surgical equipment and procedures, human-system interactions in operating rooms affect surgeon workload and performance. Workload was measured across surgical specialties using surveys to identify potential predictors of high workload for future performance improvement. SUMMARY BACKGROUND DATA Surgical instrumentation and technique advancements have implications for surgeon workload and human-systems interactions. To understand and improve the interaction of components in the work system, NASA-Task Load Index can measure workload across various fields. Baseline workload measurements provide a broad overview of the field and identify areas most in need of improvement. METHODS Surgeons were administered a modified NASA-Task Load Index survey (0 = low, 20 = high) following each procedure. Patient and procedural factors were retrieved retrospectively. RESULTS Thirty-four surgeons (41% female) completed 662 surgery surveys (M = 14.85, SD = 7.94), of which 506 (76%) have associated patient and procedural data. Mental demand (M = 7.7, SD = 5.56), physical demand (M = 7.0, SD = 5.66), and effort (M = 7.8, SD = 5.77) were the highest rated workload subscales. Surgeons reported difficulty levels higher than expected for 22% of procedures, during which workload was significantly higher (P < 0.05) and procedural durations were significantly longer (P > 0.001). Surgeons reported poorer perceived performance during cases with unexpectedly high difficulty (P < 0.001). CONCLUSIONS When procedural difficulty is greater than expected, there are negative implications for mental and physical demand that result in poorer perceived performance. Investigations are underway to identify patient and surgical variables associated with unexpected difficulty and high workload. Future efforts will focus on re-engineering the surgical planning process and procedural environment to optimize workload and performance for improved surgical care.
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Stucky CH, De Jong MJ, Kabo FW, Kasper CE. A Network Analysis of Perioperative Communication Patterns. AORN J 2020; 111:627-641. [DOI: 10.1002/aorn.13044] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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AORN
Position Statement on Managing Distractions and Noise During Perioperative Patient Care. AORN J 2020. [DOI: 10.1002/aorn.13064] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Hilt AD, Kaptein AA, Schalij MJ, van Schaik J. Teamwork and Safety Attitudes in Complex Aortic Surgery at a Dutch Hospital: Cross-Sectional Survey Study. JMIR Hum Factors 2020; 7:e17131. [PMID: 32267238 PMCID: PMC7177441 DOI: 10.2196/17131] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 02/03/2020] [Accepted: 02/14/2020] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Improving teamwork in surgery is a complex goal and difficult to achieve. Human factors questionnaires, such as the Safety Attitudes Questionnaire (SAQ), can help us understand medical teamwork and may assist in achieving this goal. OBJECTIVE This paper aimed to assess local team and safety culture in a cardiovascular surgery setting to understand how purposeful teamwork improvements can be reached. METHODS Two cardiovascular surgical teams performing complex aortic treatments were assessed: an endovascular-treatment team (ETT) and an open-treatment team (OTT). Both teams answered an online version of the SAQ Dutch Edition (SAQ-NL) consisting of 30 questions related to six different domains of safety: teamwork climate, safety climate, job satisfaction, stress recognition, perceptions of management, and working conditions. In addition, one open-ended question was posed to gain more insight into the completed questionnaires. RESULTS The SAQ-NL was completed by all 23 ETT members and all 13 OTT members. Team composition was comparable for both teams: 57% and 62% males, respectively, and 48% and 54% physicians, respectively. All participants worked for 10 years or more in health care. SAQ-NL mean scores were comparable between both teams, with important differences found between the physicians and nonphysicians of the ETT. Nonphysicians were less positive about the safety climate, job satisfaction, and working climate domains than were the physicians (P<.05). Additional education on performed procedures, more conjoined team training, as well as a hybrid operating room were suggested by participants as important areas of improvement. CONCLUSIONS Nonphysicians of a local team performing complex endovascular aortic aneurysm surgery perceived safety climate, job satisfaction, and working conditions less positively than did physicians from the same team. Open-ended questions suggested that this is related to a lack of adequate conjoined training, lack of adequate education, and lack of an adequate operating room. With added open-ended questions, the SAQ-NL appears to be an assessment tool that allows for developing strategies that are instrumental in improving quality of care.
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Affiliation(s)
- Alexander D Hilt
- Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands
| | - Ad A Kaptein
- Department of Medical Psychology, Leiden University Medical Center, Leiden, Netherlands
| | - Martin J Schalij
- Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands
| | - Jan van Schaik
- Department of Vascular Surgery, Leiden University Medical Center, Leiden, Netherlands
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Gabrielli M, Valera L, Barrientos M. Audio and panoramic video recording in the operating room: legal and ethical perspectives. JOURNAL OF MEDICAL ETHICS 2020; 47:medethics-2019-106056. [PMID: 32241807 DOI: 10.1136/medethics-2019-106056] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Revised: 03/16/2020] [Accepted: 03/20/2020] [Indexed: 06/11/2023]
Abstract
INTRODUCTION The idea of video recording (VR) in the operating room (OR) with panoramic cameras and microphones is a new concept that is changing the approach to medical activities in the OR. However, VR in the OR has brought up many concerns regarding patient privacy and has highlighted legal and ethical issues that were never previously exposed. AIM To review the literature concerning these aspects and provide a better ethical and legal understanding of the new challenges concerning VR in the OR. CONCLUSIONS There is a disparity between the two main legal models concerning VR in the OR, namely the European legal system (General Data Protection Regulation (GDPR)) and the American legal framework (Health Insurance Portability and Accountability Act (HIPAA)). This difference mainly deals with two distinct bioethical paradigms: GDPR places a strong emphasis on protecting patients' privacy to improve the public health system, whereas HIPAA indicates the need to generate protocols to safeguard the risks connected to medical activity and patient privacy. Following from this point, we may argue that, at the ethical and bioethical level, GDPR and HIPAA depend mainly on two different ethical models: a perspective based on moral acquaintances and weak proceduralism, respectively. It is worth noting the importance of developing additional guidelines concerning different world regions to avoid the ethical problems that may emerge when simply applying a foreign paradigm to a very different culture.
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Affiliation(s)
- Mauricio Gabrielli
- Department of Digestive Surgery, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Luca Valera
- Department of Philosophy, Bioethics Centre, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Marcelo Barrientos
- Department of Law, Insurance Research Center, Pontificia Universidad Católica de Chile, Santiago, Chile
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