Implementation of simulation-based crisis training in robotic thoracic surgery: how to improve safety and performance?

Multicenter evaluation of patient safety incidents in lung surgery: The Epithor Patient Safety Incident study

OBJECTIVE

To determine the incidence of patient safety incidents (PSIs) occurring during perioperative care for lung surgery and their influence on postoperative outcomes at 90 days.

METHODS

A multicenter study was conducted in three French thoracic surgery departments. Consecutive patients older than age 18 years, who had lung surgery (open, video-assisted, or robotic) for benign or malignant diseases were included. PSIs occurring during lung surgery were reported in Epithor, the French national thoracic database. The primary outcome was the incidence of perioperative PSI. Secondary outcomes were the rates of complications, readmission, and mortality at 90 days. All data were prospectively entered in the Epithor database.

RESULTS

From January 1, 2021, to December 31, 2021, 1919 surgical procedures were screened and finally, 953 procedures were included. PSIs were observed in 305 out of 953 procedures (32%) cumulating a total number of 369 PSIs. PSI were related to human factors in 179 lout of 369 (48.5%), organization in 101 out of 369 (27.4%), and technology in 85 out of 369 (23%). PSIs were categorized as near-miss events in 97 (26%), no harm incidents (HI) in 125 (34%), mild HI in 83 (22%), moderate HI in 39 (11%), severe HI in 21 (6%), and mortality in 4 (1%). The relative risk of outcome at 90 days was significantly increased according to PSI severity: no PSI/near-miss versus no-HI/HI: relative risk, 2.02 (95% CI, 1.70-2.40) for complications, 2.51 (95% CI, 1.57-8.30) for readmission, and 3.09 (95% CI, 1.15-8.30) for mortality.

CONCLUSIONS

Incidence of PSIs in thoracic surgery may occur in approximately one-third of procedures. Human factors play a crucial role in the occurrence of these PSIs.

Interprofessional education in cardiothoracic surgery: a narrative review

Interprofessional education, an approach where healthcare professionals from various disciplines learn with, from, and about each other, is widely recognized as an important strategy for improving collaborative practice and patient outcomes. This narrative review explores the current state and future directions of interprofessional education in cardiothoracic surgery. We conducted a literature search using the PubMed, Scopus, and Web of Science databases, focusing on English-language articles published after 2000. Our qualitative synthesis identified key themes related to interprofessional education interventions, outcomes, and challenges. The integration of interprofessional education in cardiothoracic surgery training programs varies across regions, with a common focus on teamwork and interpersonal communication. Simulation-based training has emerged as a leading modality for cultivating these skills in multidisciplinary settings, with studies showing improvements in team performance, crisis management, and patient safety. However, significant hurdles remain, including professional socialization, hierarchies, stereotypes, resistance to role expansion, and logistical constraints. Future efforts in this field should prioritize deeper curricular integration, continuous faculty development, strong leadership support, robust outcome evaluation, and sustained political and financial commitment. The integration of interprofessional education in cardiothoracic surgery offers considerable potential for enhancing patient care quality, but realizing this vision requires a multifaceted approach. This approach must address individual, organizational, and systemic factors to build an evidence-based framework for implementation.

Emergent robotic surgery conversions: improving operating room team performance through high fidelity simulations

Background

Although robotic surgery has gained popularity, safety concerns remain due to potential delay in addressing intraoperative hemorrhages since the surgeon is not at the bedside. This study aimed to test whether a training program for emergency robotic undocking protocols improved the performance of thoracic operating room (OR) teams.

Methods

An emergency undocking protocol and checklists were created for massive hemorrhage during robotic thoracic surgery. In phase I, two OR teams participated in in-situ simulations of the scenarios in the OR without knowledge of the protocols. In phase II, the protocol and checklists were introduced to four different OR teams by either high-fidelity lab simulation or video-based didactic sessions. The teams' performances were tested with in-situ OR simulations. Performance assessments included the number of missed critical steps, participant-reported feedback, and timeliness of crucial steps.

Results

All teams successfully converted from robot-assisted to open, with the attending at bedside within five minutes from the decision to convert, regardless of phase or education type. Phase I (control) teams had an average of 2.55 critical misses per team while the average was 0.25 for phase II teams (P=0.08). There was no significant difference between phases in time required for the surgeon to be at the bedside (average 132.2 seconds, P=0.64).

Conclusions

Targeted education can lead to improved team performance. This study shows that high-fidelity simulation and didactic sessions can both be used to effectively teach emergency undocking protocols.

Simulation in thoracic surgery-A mini review of a vital educational tool to maximize peri-operative care and minimize complications

Thoracic surgery is an increasingly expanding field, and the addition of national screening programs has resulted in increasing operative numbers and complexity. Thoracic surgery overall has an approximately 2% mortality and 20% morbidity with common specific complications including persistent air leak, pneumothorax, and fistulas. The nature of the surgery results in complications being unique to thoracic surgery and often very junior members of the surgical team feel underprepared to deal with these complications after very little exposure during their medical school and general surgical rotations. Throughout medicine, simulation is being increasingly used as a method to teach the management of complicated, rare, or significant risk occurrences and has shown significant benefits in learner confidence and outcomes. In this mini review we explain the learning theory and benefits of simulation learning. We also discuss the current state of simulation in thoracic surgery and its potential future in aiding complication management and patient safety.