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Webster CS, Mahajan R, Weller JM. Anaesthesia and patient safety in the socio-technical operating theatre: a narrative review spanning a century. Br J Anaesth 2023; 131:397-406. [PMID: 37208283 PMCID: PMC10375501 DOI: 10.1016/j.bja.2023.04.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 04/11/2023] [Accepted: 04/17/2023] [Indexed: 05/21/2023] Open
Abstract
We review the development of technology in anaesthesia over the course of the past century, from the invention of the Boyle apparatus to the modern anaesthetic workstation with artificial intelligence assistance. We define the operating theatre as a socio-technical system, being necessarily comprised of human and technological parts, the ongoing development of which has led to a reduction in mortality during anaesthesia by an order of four magnitudes over a century. The remarkable technological advances in anaesthesia have been accompanied by important paradigm shifts in the approach to patient safety, and we describe the inter-relationship between technology and the human work environment in the development of such paradigm shifts, including the systems approach and organisational resilience. A better understanding of emerging technological advances and their effects on patient safety will allow anaesthesia to continue to be a leader in both patient safety and in the design of equipment and workspaces.
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Affiliation(s)
- Craig S Webster
- Department of Anaesthesiology, School of Medicine, University of Auckland, Auckland, New Zealand; Centre for Medical and Health Sciences Education, University of Auckland, Auckland, New Zealand.
| | - Ravi Mahajan
- Apollo Hospitals Group, Chennai, India; University of Nottingham, Nottingham, UK
| | - Jennifer M Weller
- Centre for Medical and Health Sciences Education, University of Auckland, Auckland, New Zealand; Department of Anaesthesia, Auckland City Hospital, Auckland, New Zealand
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Loftus TJ, Tighe PJ, Ozrazgat-Baslanti T, Davis JP, Ruppert MM, Ren Y, Shickel B, Kamaleswaran R, Hogan WR, Moorman JR, Upchurch GR, Rashidi P, Bihorac A. Ideal algorithms in healthcare: Explainable, dynamic, precise, autonomous, fair, and reproducible. PLOS DIGITAL HEALTH 2022; 1:e0000006. [PMID: 36532301 PMCID: PMC9754299 DOI: 10.1371/journal.pdig.0000006] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Established guidelines describe minimum requirements for reporting algorithms in healthcare; it is equally important to objectify the characteristics of ideal algorithms that confer maximum potential benefits to patients, clinicians, and investigators. We propose a framework for ideal algorithms, including 6 desiderata: explainable (convey the relative importance of features in determining outputs), dynamic (capture temporal changes in physiologic signals and clinical events), precise (use high-resolution, multimodal data and aptly complex architecture), autonomous (learn with minimal supervision and execute without human input), fair (evaluate and mitigate implicit bias and social inequity), and reproducible (validated externally and prospectively and shared with academic communities). We present an ideal algorithms checklist and apply it to highly cited algorithms. Strategies and tools such as the predictive, descriptive, relevant (PDR) framework, the Standard Protocol Items: Recommendations for Interventional Trials-Artificial Intelligence (SPIRIT-AI) extension, sparse regression methods, and minimizing concept drift can help healthcare algorithms achieve these objectives, toward ideal algorithms in healthcare.
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Affiliation(s)
- Tyler J. Loftus
- Department of Surgery, University of Florida Health, Gainesville, Florida, United States of America
- Precision and Intelligent Systems in Medicine (PrismaP), University of Florida, Gainesville, Florida, United States of America
| | - Patrick J. Tighe
- Departments of Anesthesiology, Orthopedics, and Information Systems/Operations Management, University of Florida Health, Gainesville, Florida, United States of America
| | - Tezcan Ozrazgat-Baslanti
- Precision and Intelligent Systems in Medicine (PrismaP), University of Florida, Gainesville, Florida, United States of America
- Department of Medicine, University of Florida Health, Gainesville, Florida, United States of America
| | - John P. Davis
- Department of Surgery, University of Virginia, Charlottesville, Virginia, United States of America
| | - Matthew M. Ruppert
- Precision and Intelligent Systems in Medicine (PrismaP), University of Florida, Gainesville, Florida, United States of America
- Department of Medicine, University of Florida Health, Gainesville, Florida, United States of America
| | - Yuanfang Ren
- Precision and Intelligent Systems in Medicine (PrismaP), University of Florida, Gainesville, Florida, United States of America
- Department of Medicine, University of Florida Health, Gainesville, Florida, United States of America
| | - Benjamin Shickel
- Precision and Intelligent Systems in Medicine (PrismaP), University of Florida, Gainesville, Florida, United States of America
- Department of Medicine, University of Florida Health, Gainesville, Florida, United States of America
| | - Rishikesan Kamaleswaran
- Department of Biomedical Informatics, Emory University School of Medicine, Atlanta, Georgia, United States of America
| | - William R. Hogan
- Department of Health Outcomes & Biomedical Informatics, College of Medicine, University of Florida, Gainesville, Florida, United States of America
| | - J. Randall Moorman
- Department of Medicine, University of Virginia, Charlottesville, Virginia, United States of America
| | - Gilbert R. Upchurch
- Department of Surgery, University of Florida Health, Gainesville, Florida, United States of America
| | - Parisa Rashidi
- Precision and Intelligent Systems in Medicine (PrismaP), University of Florida, Gainesville, Florida, United States of America
- Departments of Biomedical Engineering, Computer and Information Science and Engineering, and Electrical and Computer Engineering, University of Florida, Gainesville, Florida, United States of America
| | - Azra Bihorac
- Precision and Intelligent Systems in Medicine (PrismaP), University of Florida, Gainesville, Florida, United States of America
- Department of Medicine, University of Florida Health, Gainesville, Florida, United States of America
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Webster CS, Weller JM. Data visualisation and cognitive ergonomics in anaesthesia and healthcare. Br J Anaesth 2021; 126:913-915. [PMID: 33589230 DOI: 10.1016/j.bja.2021.01.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 01/13/2021] [Indexed: 11/30/2022] Open
Affiliation(s)
- Craig S Webster
- Centre for Medical and Health Sciences Education, School of Medicine, University of Auckland, Auckland, New Zealand; Department of Anaesthesiology, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.
| | - Jennifer M Weller
- Centre for Medical and Health Sciences Education, School of Medicine, University of Auckland, Auckland, New Zealand; Department of Anaesthesia, Auckland City Hospital, Auckland, New Zealand
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Effects of surgical flow disruptions on surgeons' resources: a pilot study. Surg Endosc 2020; 34:4525-4535. [PMID: 31720810 DOI: 10.1007/s00464-019-07239-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Accepted: 10/28/2019] [Indexed: 01/25/2023]
Abstract
BACKGROUND Minimally invasive surgery requires surgeons to allocate more attention and efforts than open surgery. A surgeon's pool of resource is affected by the multiple occurrences of interruptions and distractions in the operating room. Surgical flow disruption has been addressed from a quantitative perspective. However, little is known on its impact on the surgeons' physiological resources. METHODS Three physiological markers, heat flux (HF), energy expenditure in metabolic equivalent of tasks and galvanic skin response were recorded using body sensor monitoring during the 21 surgical operations. The three markers, respectively, represent: stress, energy mobilization and task engagement. A total of 8 surgeons with different levels of expertise (expert vs. novice) were observed performing 21 surgical procedures categorized as short versus long. Factors of distractions were time-stamped, and triangulated with physiological markers. Two cases illustrate the impact of surgical flow disruptions on the surgeons. RESULTS The results indicate that expert surgeons' mental schemata are better organized than novices. Additionally, the physiological markers indicate that novice surgeons display a higher HF at the start (tendency p = .059) and at the end of procedures (p = .001) when compared to experts. However, during longer procedures, expert surgeons have higher HF at the start (p = .041) and at the end (p = .026), than at the start and end of a short procedure. CONCLUSION Data collected during this pilot study showed that interruptions and disruptions affect novice and expert surgeons differently. Surgical flow disruption appears to be taxing on the surgeons' mental, emotional and physiological resources; as a function of the length and nature of the disruptions. Several training curricula have incorporated the use of virtual reality programs to train surgeons to cope with the new technology and equipment. We recommend integrating interruptions and distractions in virtual reality training programs as these impact the surgeons' pool of resources.
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“It’s like holding a human heart”: the design of Vital + Morph, a shape-changing interface for remote monitoring. AI & SOCIETY 2018. [DOI: 10.1007/s00146-017-0752-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Pernek I, Ferscha A. A survey of context recognition in surgery. Med Biol Eng Comput 2017; 55:1719-1734. [DOI: 10.1007/s11517-017-1670-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Accepted: 06/15/2017] [Indexed: 11/30/2022]
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Schostek S, Zimmermann M, Schurr MO, Prosst RL. Design and Performance of a Low-Cost Telemetric Laparoscopic Tactile Grasper. Surg Innov 2015; 23:291-7. [PMID: 26546367 DOI: 10.1177/1553350615615440] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Tactile feedback is completely lost in laparoscopic surgery, which would provide information about tissue compliance, texture, structural features, and foreign bodies. We developed a system with artificial tactile feedback for laparoscopic surgery that consists of a telemetric tactile laparoscopic grasper, a remote PC with customized software, and a commercial video-mixer. A standard, nonsensorized laparoscopic grasper was customized to allow the integration of a tactile sensor and its electronics. The tactile sensor and the electronics module were designed to be detachable from the instrument. These parts are lightweight and wireless, thus not impeding the use of the device as surgical instrument. The remaining system components used to generate visualization of the tactile data do not influence the workflow in the operating room. The overall system design of the described instrumentation allows for easy implementation in an operating room environment. The fabrication of the tactile sensor is relatively easy and the production costs are low. With this telemetric laparoscopic grasper instrument, systematic preclinical studies can be performed in which surgeons execute surgical tasks that are derived from clinical reality. The experience gained from these investigations could then be used to define the requirements for any further development of artificial tactile feedback systems.
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Affiliation(s)
| | | | - Marc O Schurr
- novineon Healthcare Technology Partners GmbH, Tuebingen, Germany Steinbeis University Berlin, IHCI Institute, Tuebingen, Germany
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Sketching Awareness: A Participatory Study to Elicit Designs for Supporting Ad Hoc Emergency Medical Teamwork. Comput Support Coop Work 2015; 24:1-38. [PMID: 25870498 DOI: 10.1007/s10606-014-9210-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Prior CSCW research on awareness in clinical settings has mostly focused on higher-level team coordination spanning across longer-term trajectories at the department and inter-department levels. In this paper, we offer a perspective on what awareness means within the context of an ad hoc, time- and safety-critical medical setting by looking at teams treating severely ill patients with urgent needs. We report findings from four participatory design workshops conducted with emergency medicine clinicians at two regional emergency departments. Workshops were developed to elicit design ideas for information displays that support awareness in emergency medical situations. Through analysis of discussions and clinicians' sketches of information displays, we identified five features of teamwork that can be used as a foundation for supporting awareness from the perspective of clinicians. Based on these findings, we contribute rich descriptions of four facets of awareness that teams manage during emergency medical situations: team member awareness, elapsed time awareness, teamwork-oriented and patient-driven task awareness, and overall progress awareness. We then discuss these four awareness types in relation to awareness facets found in the CSCW literature.
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Liu D, Jenkins SA, Sanderson PM, Fabian P, Russell WJ. Monitoring with head-mounted displays in general anesthesia: a clinical evaluation in the operating room. Anesth Analg 2010; 110:1032-8. [PMID: 20357147 DOI: 10.1213/ane.0b013e3181d3e647] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Patient monitors in the operating room are often positioned where it is difficult for the anesthesiologist to see them when performing procedures. Head-mounted displays (HMDs) can help anesthesiologists by superimposing a display of the patient's vital signs over the anesthesiologist's field of view. Simulator studies indicate that by using an HMD, anesthesiologists can spend more time looking at the patient and less at the monitors. We performed a clinical evaluation testing whether this finding would apply in practice. METHODS Six attending anesthesiologists provided anesthesia to patients undergoing rigid cystoscopy. Each anesthesiologist performed 6 cases alternating between standard monitoring using a Philips IntelliVue MP70 and standard monitoring plus a Microvision Nomad ND2000 HMD. The HMD interfaced wirelessly with the MP70 monitor and displayed waveform and numerical vital signs data. Video was recorded during all cases and analyzed to determine the percentage of time, frequency, and duration of looks at the anesthesia workstation and at the patient and surgical field during various anesthetic phases. Differences between the display conditions were tested for significance using repeated-measures analysis of variance. RESULTS Video data were collected from 36 cases that ranged from 17 to 75 minutes in duration (median 31 minutes). When participants were using the HMD, compared with standard monitoring, they spent less time looking toward the anesthesia workstation (21.0% vs 25.3%, P = 0.003) and more time looking toward the patient and surgical field (55.9% vs 51.5%, P = 0.014). The HMD had no effect on either the frequency of looks or the average duration of looks toward the patient and surgical field or toward the anesthesia workstation. CONCLUSIONS An HMD of patient vital signs reduces anesthesiologists' surveillance of the anesthesia workstation and allows them to spend more time monitoring their patient and surgical field during normal anesthesia. More research is needed to determine whether the behavioral changes can lead to improved anesthesiologist performance in the operating room.
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Affiliation(s)
- David Liu
- School of Information Technology and Electrical Engineering, The University of Queensland, Brisbane, Australia.
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Schostek S, Schurr MO, Buess GF. Review on aspects of artificial tactile feedback in laparoscopic surgery. Med Eng Phys 2009; 31:887-98. [PMID: 19595620 DOI: 10.1016/j.medengphy.2009.06.003] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2008] [Revised: 06/10/2009] [Accepted: 06/12/2009] [Indexed: 10/20/2022]
Abstract
Since direct manual tissue palpation is not possible in laparoscopic surgery, feedback information on tactile tissue properties is considerably diminished. Restoring part of the surgeon's sense of touch through devices capable of providing artificial tactile feedback (ATF) is an active field of applied research and development. Despite more than two decades of research, technical development of such devices is still basic, and pre-clinical as well as clinical experience is limited. This article provides an overview of the technological aspects of ATF in laparoscopic surgery, gives background information on principles of human perception of related feedback information, and reviews current research attempts in the field of ATF systems in laparoscopic surgery, broken down into three main system components: tactile sensor, display, and data processing. Tactile sensors have been developed to measure tissue compliance, reveal hidden structures or foreign bodies in tissue through measurement of pressure distribution, and to identify and locate arteries by detecting their pulsation. Furthermore, different solutions for presenting tactile data to the surgeon have been developed. Visual and auditory displays are easy to implement into the operating room equipment, while tactile displays still suffer from difficulties concerning their performance and requirements for clinical usability. The role of the data processing system as the linking component in an artificial tactile feedback system has been identified as crucial for effectiveness of the system and easy reception of tactile data by the surgeon. The investigations on theoretical and technological foundations of ATF have led to an extensive database in recent years. An application-driven development approach will likely be a driving factor in the future evolution of this field.
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Ferris T, Sarter N. Supporting Anesthetic Monitoring through Tactile Display of Physiological Parameters. ACTA ACUST UNITED AC 2009. [DOI: 10.1177/154193120905302202] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Breakdowns in anesthetic monitoring are a frequent contributor to critical incidents in the Operating Room (OR). They can be attributed to a lack of effective attention guidance when traditional visual and auditory display methods are used to present patient physiological data. The current experiment therefore examines the effectiveness of tactile displays to better support anesthetic monitoring. Participants played the role of anesthesiologist in a desktop simulation of an OR environment. They were responsible for completing a visually-demanding intubation task while concurrently monitoring and managing a set of physiological parameters which were displayed using traditional methods. Three tactile display designs redundantly communicated the state and dynamics of one critical physiological parameter, blood pressure. Initial results show improved performance on the intubation and monitoring tasks for all tactile display conditions when compared to conditions with visual and auditory displays only. The most effective tactile patterns communicated both current state and trend information for blood pressure. The findings from this study can be applied to the design of tactile displays for monitoring tasks not only in the OR but in other complex, data-rich environments, such as aviation or process control.
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Affiliation(s)
- Thomas Ferris
- Center for Ergonomics, Department of Industrial and Operations Engineering University of Michigan, Ann Arbor, MI
| | - Nadine Sarter
- Center for Ergonomics, Department of Industrial and Operations Engineering University of Michigan, Ann Arbor, MI
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