Barriers to safety and efficiency in robotic surgery docking.
Flow disruptions
Human factors
Robotics
Safety
Surgery
Teamwork
Journal
Surgical endoscopy
ISSN: 1432-2218
Titre abrégé: Surg Endosc
Pays: Germany
ID NLM: 8806653
Informations de publication
Date de publication:
01 2022
01 2022
Historique:
received:
02
09
2020
accepted:
18
12
2020
pubmed:
21
1
2021
medline:
3
3
2022
entrez:
20
1
2021
Statut:
ppublish
Résumé
The introduction of new technology into the operating room (OR) can be beneficial for patients, but can also create new problems and complexities for physicians and staff. The observation of flow disruptions (FDs)-small deviations from the optimal course of care-can be used to understand how systems problems manifest. Prior studies showed that the docking process in robotic assisted surgery (RAS), which requires careful management of process, people, technology and working environment, might be a particularly challenging part of the operation. We sought to explore variation across multiple clinical sites and procedures; and to examine the sources of those disruptions. Trained observers recorded FDs during 45 procedures across multiple specialties at three different hospitals. The rate of FDs was compared across surgical phases, sites, and types of procedure. A work-system flow of the RAS docking procedure was used to determine which steps were most disrupted. The docking process was significantly more disrupted than other procedural phases, with no effect of hospital site, and a potential interaction with procedure type. Particular challenges were encountered in room organization, retrieval of supplies, positioning the patient, and maneuvering the robot. Direct observation of surgical procedures can help to identify approaches to improve the design of technology and procedures, the training of staff, and configuration of the OR environment, with the eventual goal of improving safety, efficiency and teamwork in high technology surgery.
Sections du résumé
BACKGROUND
The introduction of new technology into the operating room (OR) can be beneficial for patients, but can also create new problems and complexities for physicians and staff. The observation of flow disruptions (FDs)-small deviations from the optimal course of care-can be used to understand how systems problems manifest. Prior studies showed that the docking process in robotic assisted surgery (RAS), which requires careful management of process, people, technology and working environment, might be a particularly challenging part of the operation. We sought to explore variation across multiple clinical sites and procedures; and to examine the sources of those disruptions.
METHODS
Trained observers recorded FDs during 45 procedures across multiple specialties at three different hospitals. The rate of FDs was compared across surgical phases, sites, and types of procedure. A work-system flow of the RAS docking procedure was used to determine which steps were most disrupted.
RESULTS
The docking process was significantly more disrupted than other procedural phases, with no effect of hospital site, and a potential interaction with procedure type. Particular challenges were encountered in room organization, retrieval of supplies, positioning the patient, and maneuvering the robot.
CONCLUSIONS
Direct observation of surgical procedures can help to identify approaches to improve the design of technology and procedures, the training of staff, and configuration of the OR environment, with the eventual goal of improving safety, efficiency and teamwork in high technology surgery.
Identifiants
pubmed: 33469695
doi: 10.1007/s00464-020-08258-0
pii: 10.1007/s00464-020-08258-0
pmc: PMC8286975
mid: NIHMS1668814
doi:
Types de publication
Journal Article
Research Support, U.S. Gov't, P.H.S.
Langues
eng
Sous-ensembles de citation
IM
Pagination
206-215Subventions
Organisme : AHRQ HHS
ID : R01 HS026491
Pays : United States
Informations de copyright
© 2021. The Author(s), under exclusive licence to Springer Science+Business Media, LLC part of Springer Nature.
Références
Ergonomics. 2018 Jan;61(1):26-39
pubmed: 28271956
J Thorac Cardiovasc Surg. 2000 Apr;119(4 Pt 1):661-72
pubmed: 10733754
J Chiropr Med. 2016 Jun;15(2):155-63
pubmed: 27330520
Appl Ergon. 2019 Jul;78:270-276
pubmed: 29478667
Surgery. 2007 Nov;142(5):658-65
pubmed: 17981185
Br J Anaesth. 2017 Dec 1;119(suppl_1):i72-i84
pubmed: 29161400
Can J Urol. 2017 Jun;24(3):8814-8821
pubmed: 28646936
Anaesthesia. 2016 Aug;71(8):948-54
pubmed: 27396248
J Surg Res. 2016 Oct;205(2):296-304
pubmed: 27664876
Ergonomics. 2006 Apr 15-May 15;49(5-6):567-88
pubmed: 16717010
AORN J. 2020 Jan;111(1):87-96
pubmed: 31886556
World J Surg. 2018 Nov;42(11):3599-3607
pubmed: 29845381
JSLS. 2016 Jul-Sep;20(3):
pubmed: 27493469
BMJ Open. 2019 Jun 14;9(6):e028635
pubmed: 31203248
Ann Surg Oncol. 2009 Jun;16(6):1480-7
pubmed: 19290486
BJU Int. 2016 Jul;118(1):132-9
pubmed: 26800347
Eur J Obstet Gynecol Reprod Biol. 2018 Apr;223:8-13
pubmed: 29428480
Urology. 2018 Apr;114:105-113
pubmed: 29371162
World J Surg. 2017 Aug;41(8):1943-1949
pubmed: 28357497
BMJ Qual Saf. 2017 Dec;26(12):1015-1021
pubmed: 28971880
Appl Ergon. 2019 Jul;78:293-300
pubmed: 29609835
Anesth Analg. 2017 Sep;125(3):846-851
pubmed: 28598918
Surg Endosc. 2016 Feb;30(2):559-566
pubmed: 26091986
Int J Med Robot. 2010 Mar;6(1):57-60
pubmed: 20047195
Surg Endosc. 2016 Sep;30(9):3749-61
pubmed: 26675938