Sahil Sharma1, Teodor Grantcharov2, James J Jung2. 1. Department of Surgery, International Centre for Surgical Safety, Li Ka Shing Knowledge Institute, University of Toronto, St. Michael's Hospital, 209 Victoria Street, 8th Floor East, Toronto, ON, M5B 1T8, Canada. sshar68@uwo.ca. 2. Department of Surgery, International Centre for Surgical Safety, Li Ka Shing Knowledge Institute, University of Toronto, St. Michael's Hospital, 209 Victoria Street, 8th Floor East, Toronto, ON, M5B 1T8, Canada.
Abstract
BACKGROUND: Device-related interruptions in the operating room (OR) may create stress among health care providers and delays. Although non-technical skills (NTS) of the OR teams, such as situational awareness and communication, are expected to influence device-related interruptions, empirical data on this relationship are limited. METHODS: We performed a prospective cohort study of 144 consecutive elective laparoscopic operations during 13 months. A data capture system called the OR Black Box® was used to characterize device-related interruptions, NTS, and distractions. Device-related interruptions were classified according to a priori established categories. Positive and negative NTS instances were identified according to validated measurement tools specific for nurses and surgeons. We assessed the relationship between NTS and device-related interruptions after adjusting for potential confounders. RESULTS: A total of 86 device-related interruptions occurred in 48 of 144 operations (33%). They were most frequently classified as device failure (54%) followed by improper assembly (19%) and disconnection (14%). Medians of 1 [interquartile range (IQR) 0-3] and 1 (IQR 0-2) negative NTS instance per operation were demonstrated by nurses and surgeons, respectively. Medians of 28 (IQR 15-38) and 40 (IQR 28-118) positive NTS instances per operation were demonstrated by nurses and surgeons. In a multivariable analysis, a higher frequency of negative NTS instances demonstrated by nurses was associated with device-related interruptions after risk adjustment (Odds Ratio 1.33, p = 0.02). CONCLUSIONS: In elective laparoscopic operations, an increased likelihood of device-related interruptions in the OR was associated with more frequent negative NTS demonstrations by nursing teams.
BACKGROUND: Device-related interruptions in the operating room (OR) may create stress among health care providers and delays. Although non-technical skills (NTS) of the OR teams, such as situational awareness and communication, are expected to influence device-related interruptions, empirical data on this relationship are limited. METHODS: We performed a prospective cohort study of 144 consecutive elective laparoscopic operations during 13 months. A data capture system called the OR Black Box® was used to characterize device-related interruptions, NTS, and distractions. Device-related interruptions were classified according to a priori established categories. Positive and negative NTS instances were identified according to validated measurement tools specific for nurses and surgeons. We assessed the relationship between NTS and device-related interruptions after adjusting for potential confounders. RESULTS: A total of 86 device-related interruptions occurred in 48 of 144 operations (33%). They were most frequently classified as device failure (54%) followed by improper assembly (19%) and disconnection (14%). Medians of 1 [interquartile range (IQR) 0-3] and 1 (IQR 0-2) negative NTS instance per operation were demonstrated by nurses and surgeons, respectively. Medians of 28 (IQR 15-38) and 40 (IQR 28-118) positive NTS instances per operation were demonstrated by nurses and surgeons. In a multivariable analysis, a higher frequency of negative NTS instances demonstrated by nurses was associated with device-related interruptions after risk adjustment (Odds Ratio 1.33, p = 0.02). CONCLUSIONS: In elective laparoscopic operations, an increased likelihood of device-related interruptions in the OR was associated with more frequent negative NTS demonstrations by nursing teams.
Authors: Steven Yule; Rhona Flin; Nicola Maran; David Rowley; George Youngson; Simon Paterson-Brown Journal: World J Surg Date: 2008-04 Impact factor: 3.352
Authors: Sonal Arora; Louise Hull; Nick Sevdalis; Tanya Tierney; Debra Nestel; Maria Woloshynowych; Ara Darzi; Roger Kneebone Journal: Am J Surg Date: 2010-01 Impact factor: 2.565
Authors: Angela M Ingraham; Suresh K Agarwal; Hee Soo Jung; Amy E Liepert; Ann P O'Rourke; John E Scarborough Journal: Ann Surg Date: 2018-12 Impact factor: 12.969
Authors: Mathijs D Blikkendaal; Sara R C Driessen; Sharon P Rodrigues; Johann P T Rhemrev; Maddy J G H Smeets; Jenny Dankelman; John J van den Dobbelsteen; Frank Willem Jansen Journal: Surg Endosc Date: 2016-05-20 Impact factor: 4.584