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Lefetz O, Baste JM, Hamel JF, Mordojovich G, Lefevre-Scelles A, Coq JM. Robotic surgery and work-related stress: A systematic review. APPLIED ERGONOMICS 2024; 117:104188. [PMID: 38301320 DOI: 10.1016/j.apergo.2023.104188] [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: 04/20/2023] [Revised: 11/24/2023] [Accepted: 11/28/2023] [Indexed: 02/03/2024]
Abstract
Despite robot-assisted surgery (RAS) becoming increasingly common, little is known about the impact of the underlying work organization on the stress levels of members of the operating room (OR) team. To this end, assessing whether RAS may impact work-related stress, identifying associated stress factors and surveying relevant measurement methods seems critical. Using three databases (Scopus, Medline, Google Scholar), a systematic review was conducted leading to the analysis of 20 articles. Results regarding OR team stress levels and measurement methods were heterogeneous, which could be explained by differing research conditions (i.e., lab. vs. real-life). Relevant stressors such as (in)experience with RAS and quality of team communication were identified. Development of a common, more reliable methodology of stress assessment is required. Research should focus on real-life conditions in order to develop valid and actionable knowledge. Surgical teams would greatly benefit from discussing RAS-related stressors and developing team-specific strategies to handle them.
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Affiliation(s)
- Ophélie Lefetz
- Univ Rouen Normandie, CRFDP, UR 7475, F-76000, Rouen, France.
| | - Jean-Marc Baste
- Faculté de Médecine et de Pharmacie, Université de Rouen, 22 Boulevard Gambetta, CS, 76183, Rouen Cedex 1, France; Rouen University Hospital, Department of general and thoracic surgery, F-76000, Rouen, France; Normandie Univ, UNIROUEN, INSERM, U1096, Rouen University Hospital, Rouen, France
| | | | - Gerardo Mordojovich
- Clínica Alemana de Santiago, Av. Vitacura 5951, Vitacura, Región Metropolitana, Santiago, Chile; Hospital de la Fuerza Aérea de Chile, Santiago, Chile; Universidad Mayor de Santiago, Santiago, Chile
| | - Antoine Lefevre-Scelles
- Rouen University Hospital, Department of intensive care, anesthesia and perioperative medicine, F-76000, Rouen, France; Rouen University Hospital, Emergency Care Training Center (CESU-76A) of Emergency medical service (SAMU-76A), F-76000, Rouen, France
| | - Jean-Michel Coq
- Univ Rouen Normandie, CRFDP, UR 7475, F-76000, Rouen, France
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MohammadiGorji S, Joseph A, Mihandoust S, Ahmadshahi S, Allison D, Catchpole K, Neyens D, Abernathy JH. Anesthesia Workspaces for Safe Medication Practices: Design Guidelines. HERD-HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL 2024; 17:64-83. [PMID: 37553817 DOI: 10.1177/19375867231190646] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/10/2023]
Abstract
BACKGROUND Studies show that workspace for the anesthesia providers is prone to interruptions and distractions. Anesthesia providers experience difficulties while performing critical medication tasks such as medication preparation and administration due to poor ergonomics and configurations of workspace, equipment clutter, and limited space which ultimately may impact patient safety, length of surgery, and cost of care delivery. Therefore, improving design of anesthesia workspace for supporting safe and efficient medication practices is paramount. OBJECTIVES The objective of this study was to develop a set of evidence-based design guidelines focusing on design of anesthesia workspace to support safer anesthesia medication tasks in operating rooms (ORs). METHODS Data collection was based on literature review, observation, and coding of more than 30 prerecorded videos of outpatient surgical procedures to identify challenges experienced by anesthesia providers while performing medication tasks. Guidelines were then reviewed and validated using short survey. RESULTS Findings are summarized into seven evidence-based design guidelines, including (1) locate critical tasks within a primary field of vision, (2) eliminate travel into and through the anesthesia zone (for other staff), (3) identify and demarcate a distinct anesthesia zone with adequate space for the anesthesia provider, (4) optimize the ability to reposition/reconfigure the anesthesia workspace, (5) minimize clutter from equipment, (6) provide adequate and appropriately positioned surfaces for medication preparation and administration, and (7) optimize task and surface lighting. CONCLUSION This study finds many areas for improving design of ORs. Improvements of anesthesia work area will call for contribution and cooperation of entire surgical team.
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Affiliation(s)
- Soheyla MohammadiGorji
- Interior Design, FINA, College of Health & Social Sciences, San Francisco State University, CA, USA
| | - Anjali Joseph
- Center for Health Facilities Design and Testing, School of Architecture, College of Architecture, Arts and Humanities, Clemson University, SC, USA
| | - Sahar Mihandoust
- Center for Health Facilities Design and Testing, School of Architecture, College of Architecture, Arts and Humanities, Clemson University, SC, USA
| | - Seyedmohammad Ahmadshahi
- Center for Health Facilities Design and Testing, School of Architecture, College of Architecture, Arts and Humanities, Clemson University, SC, USA
| | - David Allison
- Center for Health Facilities Design and Testing, School of Architecture, College of Architecture, Arts and Humanities, Clemson University, SC, USA
| | - Ken Catchpole
- Center for Health Facilities Design and Testing, School of Architecture, College of Architecture, Arts and Humanities, Clemson University, SC, USA
- Department of Anesthesia and Perioperative Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - David Neyens
- Department of Industrial Engineering, College of Engineering, Computing and Applied Sciences, Clemson University, SC, USA
| | - James H Abernathy
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins Medicine, Baltimore, MD, USA
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3
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Compère V, Croizat G, Popoff B, Allard E, Durey B, Dureuil B, Besnier E, Clavier T, Selim J. Clinical impact of task interruptions on the anaesthetic team and patient safety in the operating theatre. Br J Anaesth 2023:S0007-0912(23)00251-9. [PMID: 37344339 DOI: 10.1016/j.bja.2023.05.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 05/04/2023] [Accepted: 05/12/2023] [Indexed: 06/23/2023] Open
Affiliation(s)
- Vincent Compère
- Department of Anaesthesiology and Critical Care, Rouen University Hospital, Rouen, France; Normandy University, UNIROUEN, INSERM, Mont-Saint-Aignan, France; Department of Anaesthesiology, Le Havre Hospital, Le Havre, France.
| | - Gautier Croizat
- Department of Anaesthesiology and Critical Care, Rouen University Hospital, Rouen, France
| | - Benjamin Popoff
- Department of Anaesthesiology and Critical Care, Rouen University Hospital, Rouen, France
| | - Etienne Allard
- Department of Anaesthesiology, Le Havre Hospital, Le Havre, France
| | - Benjamin Durey
- Department of Anaesthesiology and Critical Care, Rouen University Hospital, Rouen, France
| | - Bertrand Dureuil
- Department of Anaesthesiology and Critical Care, Rouen University Hospital, Rouen, France
| | - Emmanuel Besnier
- Department of Anaesthesiology and Critical Care, Rouen University Hospital, Rouen, France; Normandy University, UNIROUEN, INSERM, Rouen, France
| | - Thomas Clavier
- Department of Anaesthesiology and Critical Care, Rouen University Hospital, Rouen, France; Normandy University, UNIROUEN, INSERM, Rouen, France
| | - Jean Selim
- Department of Anaesthesiology and Critical Care, Rouen University Hospital, Rouen, France; Normandy University, UNIROUEN, INSERM, Rouen, France
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Boriosi JP, Eickhoff JC, Bryndzia C, Peters M, Hollman GA. An exploratory study of distractions during the induction phase of pediatric procedural sedation with propofol. Paediatr Anaesth 2023; 33:466-473. [PMID: 36815455 DOI: 10.1111/pan.14649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 01/31/2023] [Accepted: 02/19/2023] [Indexed: 02/24/2023]
Abstract
INTRODUCTION Distractions are a leading cause of disturbance to workflow during medical care. Distractions affecting the anesthetic team in the operating room are frequent and have a negative impact on patient care one-fifth of the time. The objective of this study was to evaluate the frequency, source, target, and impact of distractions during the induction phase of pediatric procedural sedation outside the operating room. METHODS Distractions were analyzed during propofol induction for oncology procedures from 45 video recordings. Distraction was defined as any event that disturbs or has potential to disturb the sedation team from performing their primary tasks. The type of distraction was cataloged into communication, coordination, extraneous events, equipment, layout, and usability. A five-point Likert scale was used to quantify the impact on the sedation team or its members. RESULTS All patients had a diagnosis of acute lymphocytic leukemia and had a mean age of 8.4 years. Five hundred and sixty-seven distractions occurred and averaged 12.6 events (±5.6) per induction (mean induction time 3 min 12 s). Extraneous events were most common, accounting for 55% (312/567) of all distractions. Most distractions had an impact on the sedation team's workflow, resulting in multitasking (46%, n = 262), and in either brief or complete disruption from a primary task (17%). Sedation nurses were impacted most often, 62% of the time. Coordination and usability issues resulted in the greatest negative impact, mean ± SD, 3.7 ± 1.0 and 3.5 ± 0.9, respectively. There was no significant association between distractions and adverse events or induction length. DISCUSSION Distractions are common during procedural sedation, with extraneous events being most frequent. Coordination issues within the team and usability problems had the greatest negative impact on sedation team workflow. Nurses were the most frequent target. CONCLUSION Distractions impacted sedation team workflow but had no association with patient outcomes.
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Affiliation(s)
- Juan P Boriosi
- Department of Pediatrics, University of Wisconsin, Madison, USA
| | - Jens C Eickhoff
- Department of Biostatistics, University of Wisconsin, Madison, USA
| | | | - Megan Peters
- Department of Pediatrics, University of Wisconsin, Madison, USA
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Rothman BS, Bledsoe S, Rice MJ. Turn Your Attention to Distractions. Anesth Analg 2022; 134:266-268. [PMID: 35030122 DOI: 10.1213/ane.0000000000005836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Brian S Rothman
- From the Department of Anesthesiology, Surgery, and Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Sandy Bledsoe
- Department of Risk and Insurance Management, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Mark J Rice
- Department of Anesthesiology, Vanderbilt University School of Medicine, Nashville, Tennessee
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Compère V, Besnier E, Clavier T, Byhet N, Lefranc F, Jegou F, Sturzenegger N, Hardy JB, Dureuil B, Elie T. Evaluation of the Time Spent by Anesthetist on Clinical Tasks in the Operating Room. Front Med (Lausanne) 2022; 8:768919. [PMID: 35111774 PMCID: PMC8801532 DOI: 10.3389/fmed.2021.768919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 12/20/2021] [Indexed: 11/13/2022] Open
Abstract
Background Changes in the health system in Western countries have increased the scope of the daily tasks assigned to physicians', anesthetists included. As already shown in other specialties, increased non-clinical burden reduces the clinical time spent with patients. Methods This was a multicenter, prospective, observational study conducted in 6 public and private hospitals in France. The primary endpoint was the evaluation by an external observer of the time spent per day (in minutes) by anesthetists on clinical tasks in the operating room. Secondary endpoints were the time spent per day (in minutes) on non-clinical organizational tasks and the number of task interruptions per hour of work. Results Between October 2017 and April 2018, 54 anesthetists from six hospitals (1 public university hospital, two public general hospitals and three private hospitals) were included. They were followed for 96 days corresponding to 550 hours of work. The proportion of overall clinical time was 62% (58% 95%CI [53; 63] for direct care. The proportion of organizational time was higher in public hospitals (11% in the university hospital (p < 0.001) and 4% in general hospitals (p < 0.01)) compared to private hospitals (1%). The number of task interruptions (1.5/h ± 1.4 in all hospitals) was 4 times higher in the university hospital (2.2/h ± 1.6) compared to private hospitals (0.5/h ± 0.3) (p < 0.05). Conclusions Most time in the operating room was spent on clinical care with a significant contrast between public and private hospitals for organizational time.
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Affiliation(s)
- Vincent Compère
- Department of Anaesthesiology and Intensive Care, Rouen University Hospital, Rouen, France
- Normandie Université, UNIROUEN, INSERM U982, Mont-Saint-Aignan, France
- *Correspondence: Vincent Compère
| | - Emmanuel Besnier
- Department of Anaesthesiology and Intensive Care, Rouen University Hospital, Rouen, France
| | - Thomas Clavier
- Department of Anaesthesiology and Intensive Care, Rouen University Hospital, Rouen, France
- Normandie Université, UNIROUEN, INSERM U982, Mont-Saint-Aignan, France
| | - Nicolas Byhet
- Department of Anaesthesiology, Dieppe General Hospital, Dieppe, France
| | - Florent Lefranc
- Department of Anaesthesiology, Hôpital privé de l'estuaire, Le Havre, France
| | - Frederic Jegou
- Department of Anaesthesiology, Clinique du Cèdre, Bois-Guillaume, France
| | | | | | - Bertrand Dureuil
- Department of Anaesthesiology and Intensive Care, Rouen University Hospital, Rouen, France
| | - Thomas Elie
- Department of Anaesthesiology and Intensive Care, Rouen University Hospital, Rouen, France
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7
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Keller S, Yule S, Smink DS, Zagarese V, Safford S, Parker SH. Episodes of strain experienced in the operating room: impact of the type of surgery, the profession and the phase of the operation. BMC Surg 2020; 20:318. [PMID: 33287776 PMCID: PMC7720529 DOI: 10.1186/s12893-020-00937-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 10/29/2020] [Indexed: 11/10/2022] Open
Abstract
Background Strain episodes, defined as phases of higher workload, stress or negative emotions, occur everyday in the operating room (OR). Accurate knowledge of when strain is most intense for the different OR team members is imperative for developing appropriate interventions. The primary goal of the study was to investigate temporal patterns of strain across surgical phases for different professionals working in the OR, for different types of operations. Methods We developed a guided recall method to assess the experience of strain from the perspective of operating room (OR) team members. The guided recall was completed by surgeons, residents, anesthesiologists, circulating nurses and scrub technicians immediately after 113 operations, performed in 5 departments of one hospital in North America. We also conducted interviews with 16 surgeons on strain moments during their specific operation types. Strain experiences were related to surgical phases and compared across different operation types separately for each profession in the OR. Results We analyzed 693 guided recalls. General linear modeling (GLM) showed that strain varied across the phases of the operations (defined as before incision, first third, middle third and last third) [quadratic (F = 47.85, p < 0.001) and cubic (F = 8.94, p = 0.003) effects]. Phases of operations varied across professional groups [linear (F = 4.14, p = 0.001) and quadratic (F = 14.28, p < 0.001) effects] and surgery types [only cubic effects (F = 4.92, p = 0.001)]. Overall strain was similar across surgery types (F = 1.27, p = 0.28). Surgeons reported generally more strain episodes during the first and second third of the operations; except in vascular operations, where no phase was associated with significantly higher strain levels, and emergency/trauma surgery, where strain episodes occurred primarily during the first third of the operation. Other professional groups showed different strain time patterns. Conclusions Members of the OR teams experience strain differently across the phases of an operation. Thus, phases with high concentration requirements may highly vary across OR team members and no single phase of an operation can be defined as a “sterile cockpit” phase for all team members.
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Affiliation(s)
- Sandra Keller
- Fralin Biomedical Research Institute at Virginia Tech Carilion, Roanoke, VA, USA.
| | - Steven Yule
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA, USA.,STRATUS Center for Medical Simulation, Boston, MA, USA.,Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.,Department of Clinical Surgery, University of Edinburgh, Edinburgh, Scotland, UK
| | - Douglas S Smink
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA, USA.,Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Vivian Zagarese
- Department of Psychology, Virginia Tech, Blacksburg, VA, USA
| | - Shawn Safford
- Division of Paediatric Surgery, Virginia Tech Carilion School of Medicine, Roanoke, VA, USA.,Center for Simulation, Research and Patient Safety, Carilion Clinic, Roanoke, VA, USA
| | - Sarah Henrickson Parker
- Fralin Biomedical Research Institute at Virginia Tech Carilion, Roanoke, VA, USA.,Department of Psychology, Virginia Tech, Blacksburg, VA, USA.,Center for Simulation, Research and Patient Safety, Carilion Clinic, Roanoke, VA, USA
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8
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Gui JL, Nemergut EC, Forkin KT. Distraction in the operating room: A narrative review of environmental and self-initiated distractions and their effect on anesthesia providers. J Clin Anesth 2020; 68:110110. [PMID: 33075633 DOI: 10.1016/j.jclinane.2020.110110] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 09/28/2020] [Accepted: 10/10/2020] [Indexed: 10/23/2022]
Abstract
The operating room (OR) is a busy environment with multiple opportunities for distraction. A well-trained anesthesiologist or certified registered nurse anesthetist (CRNA) should remain focused on providing excellent patient care despite these potential distractions. The purpose of this narrative review is to present the multiple types of OR distractions and evaluate each for their level of distraction and their likely impact on patient safety. Distractions in the OR are common and numerous types of distractions exist. Loud OR background noise can lead to miscommunication within the OR team. In several studies, OR noise has been shown to decrease vigilance and possibly delay recognition of non-routine events. The most commonly observed distracting events are "small talk" and staff entering and exiting the OR and most intense distracting events are faulty or unavailable equipment. Phone and pager use can be particularly distracting. Self-initiated distractions can be seen as unprofessional and can negatively impact patient safety. The impact of OR distractions on patient outcomes deserves more vigorous investigation. We must provide anesthesia trainees with the skills to remain vigilant despite numerous and varied OR distractions while also attempting to reduce such OR distractions to improve patient safety. Further research is needed to inform the institution of policies to lessen unnecessary OR distractions.
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Affiliation(s)
- Jane L Gui
- Department of Anesthesiology, Mount Sinai West-St. Luke's Hospital, 1000 Tenth Avenue, New York, NY 10019, USA.
| | - Edward C Nemergut
- Department of Anesthesiology, Department of Neurosurgery, University of Virginia Health System, P.O. Box 800710, Charlottesville, VA 22908, USA.
| | - Katherine T Forkin
- Department of Anesthesiology, University of Virginia Health System, P.O. Box 800710, Charlottesville, VA 22908, USA.
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Goy RWL, Ithnin F, Lew E, Sng BL. Exploring the challenges of task-centred training in obstetric anaesthesia in the operating theatre environment. Int J Obstet Anesth 2019; 39:88-94. [PMID: 30852134 DOI: 10.1016/j.ijoa.2019.02.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Revised: 01/26/2019] [Accepted: 02/07/2019] [Indexed: 11/24/2022]
Abstract
BACKGROUND Task-centred learning forms the basis of procedural training in obstetric anaesthesia. We observed that our residents were not building their competence from experiential practice in the operating theatre. We used a broad-based framework to explore the challenges encountered by the residents and clinical supervisors in the learning and teaching of obstetric anaesthesia. METHODS The study was conducted at the KK Women's and Children's Hospital, Singapore, from 1 December 2016 to 30 June 2017. A semi-structured interview format was used in the focus group and individual interviews. Information collection continued until data saturation was reached. The interviews were analysed and the challenges were identified. Fourteen residents and five clinical supervisors participated in the focus group and individual interviews respectively. FINDINGS The operating theatre constituted a stressful learning and teaching environment for the participants. Five categories of challenges were identified: (1) clinical conditions, (2) concerns about maternal risk and outcomes, (3) reluctance of the residents to vocalise their learning needs, (4) poor feedback, and (5) lack of opportunities for inter-professional practice. These collective challenges reduced the quality of task-centred learning and the effectiveness of supervisor teaching. We described some strategies to overcome these challenges (dedicated trainee lists, obstetric anaesthesia reflective diary, active mentoring system and in-situ simulation). CONCLUSIONS Our study described the challenges of obstetric anaesthesia training in the operating theatre environment in an Asian healthcare setting. Research is needed on the influence of supervisors' concern about maternal risks and their teaching behaviours.
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Affiliation(s)
- R W L Goy
- Women's Anaesthesia, KK Women's and Children's Hospital, Singapore.
| | - F Ithnin
- Women's Anaesthesia, KK Women's and Children's Hospital, Singapore
| | - E Lew
- Women's Anaesthesia, KK Women's and Children's Hospital, Singapore
| | - B L Sng
- Women's Anaesthesia, KK Women's and Children's Hospital, Singapore
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10
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Widmer LW, Keller S, Tschan F, Semmer NK, Holzer E, Candinas D, Beldi G. More Than Talking About the Weekend: Content of Case-Irrelevant Communication Within the OR Team. World J Surg 2018; 42:2011-2017. [PMID: 29318356 PMCID: PMC5990573 DOI: 10.1007/s00268-017-4442-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND Case-irrelevant communication (CIC) is defined as "any conversation" irrelevant to the case. It includes small talk, but also communication related to other work issues besides the actual task. CIC during surgeries is generally seen as distracting, despite a lack of knowledge about the content of CIC and its regulation in terms of adjustments to the situation of CIC. Primary goal of the study was to evaluate CIC content; secondary goal was to evaluate whether surgical teams regulate CIC according to different concentration demands of surgical procedures. METHODS In 125 surgeries, 1396 CIC events were observed. CIC were content coded into work-related CIC (pertaining to other tasks or work in general) and social CIC (pertaining to acquaintance talk, gossip, or private conversation). The impact of different phases and the difficulty of the surgical procedure on CIC were assessed. RESULTS Work-related CIC were significantly more frequent (2.49 per hour, SD = 2.17) than social CIC (1.42 per hour, SD = 2.17). Across phases, frequency of work-related CIC was constant, whereas social CIC increased significantly across phases. In surgeries assessed as highly difficult by the surgeons, social CIC were observed at a lower frequency, and less work-related CIC were observed during the main phase compared to surgeries assessed as less difficult. CONCLUSION The high proportion of work-related CIC indicates that surgical teams deal with other tasks during surgeries. Surgical teams adapt CIC according to the demands of the procedure. Hospital policies should support these adaptations rather than attempt to suppress CIC entirely.
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Affiliation(s)
- Lukas W Widmer
- Department of Visceral Surgery and Medicine, University Hospital of Bern, 3010, Bern, Switzerland
| | - Sandra Keller
- University of Neuchâtel, Institute of Work and Organizational Psychology, Neuchâtel, Switzerland
| | - Franziska Tschan
- University of Neuchâtel, Institute of Work and Organizational Psychology, Neuchâtel, Switzerland
| | - Norbert K Semmer
- Department of Psychology, University of Berne, Bern, Switzerland
| | - Eliane Holzer
- University of Neuchâtel, Institute of Work and Organizational Psychology, Neuchâtel, Switzerland
| | - Daniel Candinas
- Department of Visceral Surgery and Medicine, University Hospital of Bern, 3010, Bern, Switzerland
| | - Guido Beldi
- Department of Visceral Surgery and Medicine, University Hospital of Bern, 3010, Bern, Switzerland.
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Abstract
The concept of clinical workflow borrows from management and leadership principles outside of medicine. The only way to rethink clinical workflow is to understand the neuroscience principles that underlie attention and vigilance. With any implementation to improve practice, there are human factors that can promote or impede progress. Modulating the environment and working as a team to take care of patients is paramount. Clinicians must continually rethink clinical workflow, evaluate progress, and understand that other industries have something to offer. Then, novel approaches can be implemented to take the best care of patients.
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12
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Impact of disruptions on anaesthetic workflow during anaesthesia induction and patient positioning: A prospective study. Eur J Anaesthesiol 2018; 33:581-7. [PMID: 27227550 DOI: 10.1097/eja.0000000000000484] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Work disruption in operating rooms hinders flow of patients and increases chances of error. Previous studies have largely considered the types of disruption occurring in operating rooms, but have not analysed systematically the objective impact of disruption. OBJECTIVE The objective was to evaluate the impact of disruption on time efficiency in preoperative anaesthetic work in the operating room and to link disruption to failures in co-ordination of care. DESIGN Prospective, cross-sectional and observational study. SETTING Disruptions were evaluated in operating rooms of five hospitals across three countries: Australia (one community hospital, one teaching hospital); Thailand (two community hospitals); China (one teaching hospital). PARTICIPANTS The preoperative phase of anaesthesia induction/patient positioning of 64 surgical patients across specialities was prospectively evaluated (Australia = 33; Thailand = 12; China = 10). Further, interviews were carried out with 16 consultant anaesthetists and surgeons and 13 senior operating room nurses involved in the care of these patients. MAIN OUTCOME MEASURES Disruptions were identified by trained observers in real time during the preoperative phase; four types of care co-ordination problems were identified from the interviews with senior anaesthetists, surgeons and nurses, and linked to the disruptions. Descriptive analyses of time efficiency were performed. RESULTS Complete data were available from 55 cases. Good inter-observer agreement was obtained across measurements (range 74 to 92%). An average of three disruptions per case during the preoperative phase, were observed (range 2 to 9). 'Disruption types': disruptive staff activities were associated with most timewasting (median = 1 min per case, range 0 min 0 s to 4 min 45 s per case). 'Care co-ordination problems': co-ordination lapses within the operating room team, and between them and the preoperative team were associated with most timewasting (median = 1 min per case, range 0 min 0 s to 5 min 0 s per case). CONCLUSION The study quantifies time inefficiencies affecting anaesthetic work during the preoperative phase. Work disruption wastes time and is preventable.
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13
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Almghairbi DS, Sharp L, Griffiths R, Evley R, Gupta S, Moppett IK. An observational feasibility study of a new anaesthesia drug storage tray. Anaesthesia 2018; 73:356-364. [PMID: 29437211 DOI: 10.1111/anae.14187] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/21/2017] [Indexed: 11/29/2022]
Abstract
Drug errors in the anaesthetic domain remain a serious cause of iatrogenic harm. To help reduce this issue, we explored the potential safety impact of using a simple colour-coded tray for anaesthetic drug preparation and storage. Over a six-month period, three different trained researchers observed 30 cases at three NHS Trusts. Ten observations involved standard drug trays in 'normal' practice, and 20 observations, involved 'Rainbow trays' before and after their introduction. We conducted 20 semi-structured interviews immediately after completing the Rainbow tray observation with the anaesthetists involved. All discussions and detailed notes taken were transcribed, qualitatively analysed using line-by-line coding and then synthesised into narrative themes. We found that using standard, single compartment trays enabled quick, cheap, and portable drug preparation and storage, but was linked to potential or actual harmful errors, such as syringe swaps. Rainbow trays were perceived to be easy to use and effective at all three sites, aiding drug identification and separation, and hence likely to reduce drug error and increase patient safety. We have demonstrated that it is feasible to introduce a new colour-coded compartmentalised Rainbow drugs tray into clinical practice at three NHS hospitals in England. Further research is needed into their effect on the prevalence of drug error.
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Affiliation(s)
- D S Almghairbi
- Division of Clinical Neuroscience, Anaesthesia and Critical Care, University of Nottingham, Nottingham, UK
| | - L Sharp
- Pilgrim Hospital, Boston, UK
| | - R Griffiths
- Peterborough City Hospital, Peterborough, UK
| | - R Evley
- Division of Clinical Neuroscience, Anaesthesia and Critical Care, University of Nottingham, Nottingham, UK
| | - S Gupta
- Nottingham University Hospitals, Nottingham, UK
| | - I K Moppett
- Division of Clinical Neuroscience, Anaesthesia and Critical Care, University of Nottingham, Nottingham, UK
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Affiliation(s)
- I K Moppett
- Anaesthesia and Critical Care Section, Division of Clinical Neuroscience, University of Nottingham, Nottingham, UK
| | - S T Shorrock
- Centre for Human Factors and Sociotechnical Systems, University of the Sunshine Coast, Qld, Australia
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McCurdie T, Sanderson P, Aitken LM. Traditions of research into interruptions in healthcare: A conceptual review. Int J Nurs Stud 2016; 66:23-36. [PMID: 27951432 DOI: 10.1016/j.ijnurstu.2016.11.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Revised: 11/06/2016] [Accepted: 11/06/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Researchers from diverse theoretical backgrounds have studied workplace interruptions in healthcare, leading to a complex and conflicting body of literature. Understanding pre-existing viewpoints may advance the field more effectively than attempts to remove bias from investigations. OBJECTIVE To identify research traditions that have motivated and guided interruptions research, and to note research questions posed, gaps in approach, and possible avenues for future research. METHODS A critical review was conducted of research on interruptions in healthcare. Two researchers identified core research communities based on the community's motivations, philosophical outlook, and methods. Among the characteristics used to categorise papers into research communities were the predominant motivation for studying interruptions, the research questions posed, and key contributions to the body of knowledge on interruptions in healthcare. In cases where a paper approached an equal number of characteristics from two traditions, it was placed in a blended research community. RESULTS A total of 141 papers were identified and categorised; all papers identified were published from 1994 onwards. Four principal research communities emerged: epidemiology, quality improvement, cognitive systems engineering (CSE), and applied cognitive psychology. Blends and areas of mutual influence between the research communities were identified that combine the benefits of individual traditions, but there was a notable lack of blends incorporating quality improvement initiatives. The question most commonly posed by researchers across multiple communities was: what is the impact of interruptions? Impact was measured as a function of task time or risk in the epidemiology tradition, situation awareness in the CSE tradition, or resumption lag (time to resume an interrupted task) in the applied cognitive psychology tradition. No single question about interruptions in healthcare was shared by all four of the core communities. CONCLUSIONS Much research on workplace interruptions in healthcare can be described in terms of fundamental values of four distinct research traditions and the communities that bring the values and methods: of those research traditions to their investigations. Blends between communities indicate that mutual influence has occurred as interruptions research has progressed. It is clear from this review that there is no single or privileged perspective to study interruptions. Instead, these findings suggest that researchers investigating interruptions in healthcare would benefit from being more aware of different perspectives from their own, especially when they consider workplace interventions to reduce interruptions.
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Affiliation(s)
- Tara McCurdie
- School of Information Technology and Electrical Engineering, The University of Queensland, Brisbane 4072, Australia.
| | - Penelope Sanderson
- Schools of Information Technology and Electrical Engineering, of Psychology, and of Medicine, The University of Queensland, Brisbane, Australia
| | - Leanne M Aitken
- School of Nursing & Midwifery, Menzies Health Institute Queensland, Griffith University, Brisbane, Australia; School of Health Sciences, City University London, London, United Kingdom
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Abstract
The interpretation of medical images across medical specialties is critical to patient care. As technology changes, so does health care, and clinicians today are increasingly viewing medical images in a variety of environments. Although access to such data is useful, even clinicians with expertise in image interpretation make errors. These errors may become more frequent as clinician workdays become longer and the number of images to be interpreted becomes larger. To prevent errors in medical image interpretation, we need to understand the underlying perceptual and cognitive mechanisms that guide image interpretation. We can then use what is learned to develop better training methods, automated image analysis, and processing tools. We can devise methods to reduce clinician fatigue and stress, and develop practice guidelines thereby improving patient care and outcomes.
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Abstract
PURPOSE OF REVIEW Despite the benefits of rapidly advancing therapeutic and diagnostic possibilities, the perioperative setting still exposes patients to significant risks of adverse events and harm. Anesthesiologists are in midstream of perioperative care and can make significant contributions to patient safety and patient outcomes. This article reviews recent research results outlining the current trends of perioperative patient harm and summarizes the evidence in favor of patient safety practices. RECENT FINDINGS Adverse events and patient harm continue to be frequent in the perioperative period. Adverse events occur in about 30% of hospital admissions, are associated with higher mortality, and may be preventable in more than 50%. Evidence-based recommendations are available for many patient safety issues. No magic bullet practices exist, but promising targets include the prevention and limitation of perioperative infections and of complications of airway and respiratory management, the maintenance of achieved safety standards, the use of checklists, and others. SUMMARY Current research provides growing evidence for the effectiveness of several patient safety practices designed to prevent or diminish perioperative adverse events and patient harm. Future investigations will hopefully fill the numerous persisting knowledge gaps.
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Affiliation(s)
- Johannes Wacker
- Institute of Anesthesia and Intensive Care, Hirslanden Clinic, Zurich
| | - Sven Staender
- Department of Anesthesia and Intensive Care Medicine, Regional Hospital Maennedorf, Maennedorf, Switzerland
- Department of Anesthesiology, Perioperative Medicine, and Critical Care Medicine, Paracelsus Medical University, Salzburg, Austria
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20
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Haydar B. Harm attributable to research distraction? Challenging conclusions on caudal epinephrine. Paediatr Anaesth 2014; 24:1313-4. [PMID: 25378046 DOI: 10.1111/pan.12563] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Bishr Haydar
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI, USA.
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Cook TM, Andrade J, Bogod DG, Hitchman JM, Jonker WR, Lucas N, Mackay JH, Nimmo AF, O'Connor K, O'Sullivan EP, Paul RG, Palmer JHM, Plaat F, Radcliffe JJ, Sury MRJ, Torevell HE, Wang M, Hainsworth J, Pandit JJ. The 5th National Audit Project (NAP5) on accidental awareness during general anaesthesia: patient experiences, human factors, sedation, consent and medicolegal issues. Anaesthesia 2014; 69:1102-16. [DOI: 10.1111/anae.12827] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/15/2014] [Indexed: 11/30/2022]
Affiliation(s)
- T. M. Cook
- Department of Anaesthesia and Intensive Care Medicine; Royal United Hospital; Bath UK
| | - J. Andrade
- Department of Psychology; School of Psychology and Cognition Institute; Plymouth University; Plymouth UK
| | - D. G. Bogod
- Nottingham University Hospitals NHS Trust; Nottingham UK
| | | | - W. R. Jonker
- Department of Anaesthesia, Intensive Care and Pain Medicine; Sligo Regional Hospital; Sligo Ireland
| | - N. Lucas
- Northwick Park Hospital; Harrow Middlesex UK
| | | | - A. F. Nimmo
- Department of Anaesthesia; Royal Infirmary of Edinburgh; Edinburgh UK
| | | | | | - R. G. Paul
- Adult Intensive Care Unit; Royal Brompton Hospital; London UK
| | | | - F. Plaat
- Department of Anaesthesia; Imperial College NHS Trust; London UK
| | - J. J. Radcliffe
- Department of Neuroanaesthesia; National Hospital for Neurology and Neurosurgery; University College Hospitals London Trust; London UK
| | - M. R. J. Sury
- Department of Anaesthesia; Great Ormond Street Hospital NHS Foundation Trust; London UK
| | - H. E. Torevell
- Bradford Teaching Hospitals NHS Foundation Trust; Bradford UK
| | - M. Wang
- Department of Clinical Psychology; University of Leicester; Leicester UK
| | | | - J. J. Pandit
- Nuffield Department of Anaesthesia; Oxford University Hospitals NHS Trust; Oxford UK
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Cook TM, Andrade J, Bogod DG, Hitchman JM, Jonker WR, Lucas N, Mackay JH, Nimmo AF, O'Connor K, O'Sullivan EP, Paul RG, Palmer JHMG, Plaat F, Radcliffe JJ, Sury MRJ, Torevell HE, Wang M, Hainsworth J, Pandit JJ. 5th National Audit Project (NAP5) on accidental awareness during general anaesthesia: patient experiences, human factors, sedation, consent, and medicolegal issues. Br J Anaesth 2014; 113:560-74. [PMID: 25204696 DOI: 10.1093/bja/aeu314] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The 5th National Audit Project (NAP5) of the Royal College of Anaesthetists and the Association of Anaesthetists of Great Britain and Ireland into accidental awareness during general anaesthesia (AAGA) yielded data related to psychological aspects from the patient, and the anaesthetist, perspectives; patients' experiences ranged from isolated auditory or tactile sensations to complete awareness. A striking finding was that 75% of experiences were for <5 min, yet 51% of patients [95% confidence interval (CI) 43-60%] experienced distress and 41% (95% CI 33-50%) suffered longer term adverse effect. Distress and longer term harm occurred across the full range of experiences but were particularly likely when the patient experienced paralysis (with or without pain). The patient's interpretation of what is happening at the time of the awareness seemed central to later impact; explanation and reassurance during suspected AAGA or at the time of report seemed beneficial. Quality of care before the event was judged good in 26%, poor in 39%, and mixed in 31%. Three-quarters of cases of AAGA (75%) were judged preventable. In 12%, AAGA care was judged good and the episode not preventable. The contributory and human factors in the genesis of the majority of cases of AAGA included medication, patient, and education/training. The findings have implications for national guidance, institutional organization, and individual practice. The incidence of 'accidental awareness' during sedation (~1:15,000) was similar to that during general anaesthesia (~1:19,000). The project raises significant issues about information giving and consent for both sedation and anaesthesia. We propose a novel approach to describing sedation from the patient's perspective which could be used in communication and consent. Eight (6%) of the patients had resorted to legal action (12, 11%, to formal complaint) at the time of reporting. NAP5 methodology provides a standardized template that might usefully inform the investigation of claims or serious incidents related to AAGA.
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Affiliation(s)
- T M Cook
- Department of Anaesthesia and Intensive Care Medicine, Royal United Hospital, Bath, UK
| | - J Andrade
- School of Psychology and Cognition Institute, Plymouth University, Plymouth, UK
| | - D G Bogod
- Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - J M Hitchman
- Member Royal College of Anaesthetists' Lay Committee, London, UK
| | - W R Jonker
- Department of Anaesthesia, Intensive Care and Pain Medicine, Sligo Regional Hospital, Sligo, Ireland
| | - N Lucas
- Northwick Park Hospital, Harrow, Middlesex, UK
| | | | - A F Nimmo
- Department of Anaesthesia, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - K O'Connor
- Bristol School of Anaesthesia, Bristol, UK
| | | | - R G Paul
- Adult Intensive Care Unit, Royal Brompton Hospital, London, UK
| | | | - F Plaat
- Imperial College NHS Trust, London, UK
| | - J J Radcliffe
- Department of Neuroanaesthesia, National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
| | - M R J Sury
- Great Ormond Street Hospital NHS Foundation Trust, London, UK
| | - H E Torevell
- Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - M Wang
- University of Leicester, Leicester, UK
| | - J Hainsworth
- Leicestershire Partnership NHS Trust, Leicester, UK
| | - J J Pandit
- Nuffield Department of Anaesthetics, Oxford University Hospitals NHS Trust, Oxford, UK
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