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Burtscher MJ, Koch A, Weigl M. Intraoperative teamwork and occupational stress during robot-assisted surgery: An observational study. APPLIED ERGONOMICS 2024; 121:104368. [PMID: 39146909 DOI: 10.1016/j.apergo.2024.104368] [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: 01/18/2024] [Revised: 06/28/2024] [Accepted: 08/07/2024] [Indexed: 08/17/2024]
Abstract
Robot-assisted surgery (RAS) differs from traditional OR set-ups in several ways such as operation of technology and obstructed team communication that potentially affect surgical staff's stress experiences. The current study investigates the effects of key intraoperative job demands and resources on mental workload and perceived stress in RAS. We focused on the role of intraoperative teamwork as a resource that potentially reduces occupational stress. Combining standardized expert observations in the OR with healthcare providers' self-reports, the study involved two types of robot-assisted, urological interventions. The sample consisted of 73 observed surgeries and included 242 post-operative surveys on perceived stress and mental workload from surgeons and surgical nurses. Multilevel regression analyses reveal differential effects for stress and workload. Importantly, whereas better surgical teamwork was associated with lower stress, it was unrelated to workload. Our findings provide a nuanced picture of occupational stress in RAS, particularly regarding the role of intraoperative teamwork.
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Affiliation(s)
- Michael J Burtscher
- Department of Applied Psychology, Zurich University of Applied Sciences (ZHAW), Switzerland; Department of Psychology, University of Zurich, Switzerland.
| | - Amelie Koch
- Institute for Patient Safety, University Hospital Bonn, Germany
| | - Matthias Weigl
- Institute for Patient Safety, University Hospital Bonn, Germany
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Kanji FF, Marselian A, Burch M, Jain M, Cohen TN. Challenges With Robot-Assisted Surgery Setup for Complex Minimally Invasive Upper Gastrointestinal Surgery. Am Surg 2024; 90:2403-2410. [PMID: 38642023 DOI: 10.1177/00031348241248696] [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: 04/22/2024]
Abstract
BACKGROUND The utilization of robot-assisted approaches to surgery has increased significantly over the last two decades. This has introduced novel complexities into the operating room environment, requiring management of new challenges and workflow adaptation. This study aimed to analyze challenges in the surgical setup for complex upper gastrointestinal robot-assisted surgery (UGI-RAS) and identify opportunities for solutions. METHODS Direct observations of surgical setup processes for UGI-RAS were performed by a trained Human Factors researcher at a non-profit academic medical center in Southern California. Setup tasks were subdivided into five phases: (1) before wheels-in; (2) patient transfer and anesthesia induction; (3) patient preparation; (4) surgery preparation; and (5) robot docking. Start/end times for each phase/task were documented along with workflow disruption (FD) narratives and timestamps. Setup tasks and FDs were analyzed using descriptive statistics. RESULTS Twenty UGI-RAS setup procedures were observed between May-November 2023: sleeve gastrectomy +/- hiatal hernia repair (n = 9, 45.00%); para-esophageal hernia repair +/- fundoplication (n = 8, 40.00%); revision to Roux-en-Y gastric bypass (n = 2, 10.00%); and gastric band removal (n = 1, 5.00%). Frequent FDs included planning breakdowns (n = 20, 29.85%), equipment/supply management (n = 17, 25.37%), patient care coordination (n = 8, 11.94%), and equipment challenges (n = 8, 11.94%). Eleven of 20 observations were first-start cases, of which 10 experienced delayed starts. DISCUSSION Interventions aimed at improving workflows during UGI-RAS setup include performing pre-operative team huddles and conducting trainings aimed at team coordination and equipment challenges. These solutions could result in improved teamwork, efficiency, and communication while reducing case start delays and turnover time.
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Affiliation(s)
- Falisha F Kanji
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Aleeque Marselian
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Miguel Burch
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Monica Jain
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Tara N Cohen
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
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Wong SW, Crowe P. Workflow disruptions in robot-assisted surgery. J Robot Surg 2023; 17:2663-2669. [PMID: 37815757 PMCID: PMC10678816 DOI: 10.1007/s11701-023-01728-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 09/24/2023] [Indexed: 10/11/2023]
Abstract
Surgical flow disruptions are unexpected deviations from the natural progression which can potentially compromise the safety of the operation. Separation of the surgeon from the patient and team members is the main contributor for flow disruptions (FDs) in robot-assisted surgery (RAS). FDs have been categorised as communication, coordination, surgeon task considerations, training, equipment/ technology, external factors, instrument changes, and environmental factors. There may be an association between FDs and task error rate. Intervention to counter FDs include training, operating room adjustments, checklists, teamwork, communication improvement, ergonomics, technology, guidelines, workflow optimisation, and team briefing. Future studies should focus on identifying the significant disruptive FDs and the impact of interventions on surgical flow during RAS.
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Affiliation(s)
- Shing Wai Wong
- Department of General Surgery, Prince of Wales Hospital, Sydney, NSW, Australia.
- Randwick Campus, School of Clinical Medicine, The University of New South Wales, Sydney, NSW, Australia.
| | - Philip Crowe
- Department of General Surgery, Prince of Wales Hospital, Sydney, NSW, Australia
- Randwick Campus, School of Clinical Medicine, The University of New South Wales, Sydney, NSW, Australia
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Bjøro B, Ballestad I, Rustøen T, Fosmark MH, Bentsen SB. Positioning patients for robotic-assisted surgery: A qualitative study of operating room nurses' experiences. Nurs Open 2023; 10:469-478. [PMID: 36631733 PMCID: PMC9834175 DOI: 10.1002/nop2.1312] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 12/21/2021] [Accepted: 07/29/2022] [Indexed: 01/16/2023] Open
Abstract
AIM One of the challenges of robotic-assisted surgery is related to positioning of the patient on the operating table. Technological developments place increased demands on operating room nurses' competence to prevent positioning injuries and ensuring care quality. Therefore, the aim of the present study was to describe operating room nurses' experiences when positioning the patients for robotic-assisted surgery. DESIGN A descriptive qualitative design. METHODS Seven operating room nurses with experience in robotic-assisted surgery were included at a university hospital. Data were obtained through individual interviews and analysed using qualitative content analysis. The Consolidated Criteria for Reporting Qualitative research COREQ checklist was used. RESULTS We identified three categories, (a) patient positioning is challenging during robotic-assisted surgery, (b) operating room nurses take responsibility for patient positioning during robotic-assisted surgery, but teamwork is important and (c) operating room nurses aim to achieve safe patient positioning during robotic-assisted surgery.
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Affiliation(s)
- Benedikte Bjøro
- Department of Operating Services, Division of Emergencies and Critical CareOslo University HospitalOsloNorway
- Department of Nursing Science, Faculty of Medicine, Institute of Health and SocietyUniversity of OsloOsloNorway
| | - Ingvild Ballestad
- Department of Health and Caring SciencesWestern Norway University of Applied SciencesBergenNorway
| | - Tone Rustøen
- Department of Nursing Science, Faculty of Medicine, Institute of Health and SocietyUniversity of OsloOsloNorway
- Department of Research and Development, Division of Emergencies and Critical CareOslo University HospitalOsloNorway
| | - Monica Hetlesæther Fosmark
- Faculty of Health SciencesUniversity of StavangerStavangerNorway
- Operating DepartmentHelse Stavanger HFStavangerNorway
| | - Signe Berit Bentsen
- Department of Operating Services, Division of Emergencies and Critical CareOslo University HospitalOsloNorway
- Department of Health and Caring SciencesWestern Norway University of Applied SciencesBergenNorway
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Poulsen JL, Bruun B, Oestergaard D, Spanager L. Factors affecting workflow in robot-assisted surgery: a scoping review. Surg Endosc 2022; 36:8713-8725. [PMID: 35739430 DOI: 10.1007/s00464-022-09373-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 05/28/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND Robot-assisted surgery is expanding worldwide. Most research in this field concentrates on surgeons' technical skills and patient outcome, but research from open and laparoscopic surgery shows that teamwork is crucial for patient safety. Team composition is changed in robot-assisted surgery with the surgeon placed away from the bedside, potentially altering teamwork and workflow in the operating theatre. This scoping review aimed to explore how factors affecting workflow as well as team members' social and cognitive skills during robot-assisted surgery are reported in the literature. METHODS A systematic search was performed in the databases Medline, EMBASE, PsycINFO, and Web of Science. Reports were screened according to the Preferred Reporting Item for Systematic reviews and Meta-Analysis for Scoping Review guidelines. Inclusion criteria were robot-assisted surgery, multi-professional teams, and workflow, flow disruptions, or non-technical skills. RESULTS A total of 12,527 references were screened, and 24 articles were included in the review. Articles were heterogeneous in terms of aim, methods and focus. The studies concentrated on two main fields: flow disruptions and the categorization of their causes and incidences; and non-technical skills describing the challenges of communication and effects on situation awareness. CONCLUSION Many studies focused on flow disruptions and found that communication, coordination, training, and equipment/technology were the most frequent causes. Another focus of studies was non-technical skills-primarily communication and situation awareness. Future studies could focus on how to prevent the most harmful flow disruptions and develop interventions for improving workflow.
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Affiliation(s)
- Jannie Lysgaard Poulsen
- Copenhagen Academy for Medical Education and Simulation (CAMES), Center for Human Resources and Education, The Capital Region of Denmark, Copenhagen, Denmark.
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
| | - Birgitte Bruun
- Copenhagen Academy for Medical Education and Simulation (CAMES), Center for Human Resources and Education, The Capital Region of Denmark, Copenhagen, Denmark
| | - Doris Oestergaard
- Copenhagen Academy for Medical Education and Simulation (CAMES), Center for Human Resources and Education, The Capital Region of Denmark, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Lene Spanager
- Copenhagen Academy for Medical Education and Simulation (CAMES), Center for Human Resources and Education, The Capital Region of Denmark, Copenhagen, Denmark
- Department of Surgery, North Zealand Hospital, Hilleroed, Denmark
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An interdisciplinary review of AI and HRM: Challenges and future directions. HUMAN RESOURCE MANAGEMENT REVIEW 2022. [DOI: 10.1016/j.hrmr.2022.100924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Yamada K, Kogure N, Ojima H. Learning curve for robotic bedside assistance for rectal cancer: application of the cumulative sum method. J Robot Surg 2021; 16:1027-1035. [PMID: 34779988 DOI: 10.1007/s11701-021-01322-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 10/16/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND This investigation assesses the learning curve for dedicated bedside assistance at a facility that recently adopted robot-assisted rectal resection. METHODS Data from patients with rectal cancer who underwent robotic rectal resections from September 2019 through April 2020 were retrospectively analyzed. Before starting robotic surgery, we set the rule that a console surgeon would not enter the sterile field and all of those maneuvers would be left to a dedicated physician. Docking time was analyzed using the cumulative sum (CUSUM) method to evaluate the learning curve. Different phases in the learning curve were identified according to CUSUM plot configuration. A comparison was made of phases 1 and 2 combined, and phase 3. RESULT The procedures were performed in 30 patients. Median docking time, console time was 13 min. A total of nine patients had histories of abdominal surgery. CUSUM analysis of docking time demonstrated 3 phases. Each docking time was longer in Phase 1 (the first 3 cases) than the average docking time over the all cases. The docking time in Phase 2 (the 9 middle cases) approximated the average time over the all cases. Phase 3 (the remaining 18 cases) showed further improvement of the docking procedure and time was reduced. A comparison of Phases 1 and 2 combined, and Phase 3, revealed that Phase 3 had a significantly higher rate of history of abdominal surgery. CONCLUSION Docking manipulation proficiency was achieved in approximately 10 cases without the influence of surgical difficulty.
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Affiliation(s)
- Kazunosuke Yamada
- Department of Gastroenterological Surgery, Gunma Prefectural Cancer Center, 617-1, Nishimachi, Oota, Gunma, 373-0828, Japan.
| | - Norimichi Kogure
- Department of Gastroenterological Surgery, Gunma Prefectural Cancer Center, 617-1, Nishimachi, Oota, Gunma, 373-0828, Japan
| | - Hitoshi Ojima
- Department of Gastroenterological Surgery, Gunma Prefectural Cancer Center, 617-1, Nishimachi, Oota, Gunma, 373-0828, Japan
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Schreyer J, Koch A, Herlemann A, Becker A, Schlenker B, Catchpole K, Weigl M. RAS-NOTECHS: validity and reliability of a tool for measuring non-technical skills in robotic-assisted surgery settings. Surg Endosc 2021; 36:1916-1926. [PMID: 33844085 PMCID: PMC8505574 DOI: 10.1007/s00464-021-08474-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 03/26/2021] [Indexed: 12/24/2022]
Abstract
Background Non-technical skills (NTS) are essential for safe surgical practice as they impact workflow and patient outcomes. Observational tools to measure operating room (OR) teams’ NTS have been introduced. However, there are none that account for the specific teamwork challenges introduced by robotic-assisted surgery (RAS). We set out to develop and content-validate a tool to assess multidisciplinary NTS in RAS. Methodology Stepwise, multi-method procedure. Observations in different surgical departments and a scoping literature review were first used to compile a set of RAS-specific teamwork behaviours. This list was refined and expert validated using a Delphi consensus approach consisting of qualitative interviews and a quantitative survey. Then, RAS-specific behaviours were merged with a well-established assessment tool on OR teamwork (NOTECHS II). Finally, the new tool—RAS-NOTECHS—was applied in standardized observations of real-world procedures to test its reliability (inter-rater agreement via intra-class correlations). Results Our scoping review revealed 5242 articles, of which 21 were included based on pre-established inclusion criteria. We elicited 16 RAS-specific behaviours from the literature base. These were synthesized with further 18 behavioural markers (obtained from 12 OR-observations) into a list of 26 behavioural markers. This list was reviewed by seven RAS experts and condensed to 15 expert-validated RAS-specific behavioural markers which were then merged into NOTECHS II. For five observations of urologic RAS procedures (duration: 13 h and 41 min), inter-rater agreement for identification of behavioural markers was strong. Agreement of RAS-NOTECHS scores indicated moderate to strong agreement. Conclusions RAS-NOTECHS is the first observational tool for multidisciplinary NTS in RAS. In preliminary application, it has been shown to be reliable. Since RAS is rapidly increasing and challenges for effective and safe teamwork remain at the forefront of quality and safety of surgical care, RAS-NOTECHS may contribute to training and improvement efforts in technology-facilitated surgeries. Supplementary Information The online version contains supplementary material available at 10.1007/s00464-021-08474-2.
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Affiliation(s)
- Julia Schreyer
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Ziemssenstrasse 1, 80336, Munich, Germany. .,Institute for Medical Information Processing, Biometry and Epidemiology (IBE), LMU Munich, Munich, Germany.
| | - Amelie Koch
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Ziemssenstrasse 1, 80336, Munich, Germany
| | - Annika Herlemann
- Department of Urology, University Hospital Grosshadern, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Armin Becker
- Department of Urology, University Hospital Grosshadern, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Boris Schlenker
- Department of Urology, University Hospital Grosshadern, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Ken Catchpole
- Department of Anesthesia and Perioperative Medicine, Medical University of South Carolina, Charleston, USA
| | - Matthias Weigl
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Ziemssenstrasse 1, 80336, Munich, Germany.,Institute for Patient Safety, University Hospital, Bonn University, Bonn, Germany
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Ivarsson J, Åberg M. Role of requests and communication breakdowns in the coordination of teamwork: a video-based observational study of hybrid operating rooms. BMJ Open 2020; 10:e035194. [PMID: 32461294 PMCID: PMC7259866 DOI: 10.1136/bmjopen-2019-035194] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES This study investigated the functional role of 'requests' in the coordination of surgical activities in the operating room (OR). A secondary aim was to describe, closely, instances of potential miscommunication to scrutinise how so-called conversational repairs were used to address and prevent mistakes. DESIGN Non-participant video-based observations. SETTING Team coordination around image acquisitions (digital subtraction angiography) done during endovascular aortic repair (EVAR) procedures in a hybrid OR. METHODS The study followed and documented a total of 72 EVAR procedures, out of which 12 were video-recorded (58 hours). The results were based on 12 teams operating during these recorded surgeries and specifically targeted all sequences involving controlled apnoea. In total, 115 sequences were analysed within the theoretical framework of conversation analysis. RESULTS The results indicated a simple structure of communication that can enable the successful coordination of work between different team members. Central to this analysis was the distinction between immediate requests and pre-requests. The results also showed how conversational repairs became key in establishing joint understanding and, therefore, how they can function as crucial resources in safety management operations. CONCLUSION The results suggest the possibility of devising an interactional framework to minimise problems with communication, thereby enabling the advancement of patient safety. By making the distinction between different types of requests explicit, certain ambiguities can be mitigated and some misunderstandings avoided. One way to accomplish this practically would be to tie various actions to clearer and more distinct forms of expression.
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Affiliation(s)
- Jonas Ivarsson
- Department of Applied Information Technology, University of Gothenburg, Goteborg, Sweden
| | - Mikaela Åberg
- Department of Education, Communication and Learning, University of Gothenburg, Goteborg, Sweden
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