1
|
Catchpole K, Cohen T, Alfred M, Lawton S, Kanji F, Shouhed D, Nemeth L, Anger J. Human Factors Integration in Robotic Surgery. HUMAN FACTORS 2024; 66:683-700. [PMID: 35253508 DOI: 10.1177/00187208211068946] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
OBJECTIVE Using the example of robotic-assisted surgery (RAS), we explore the methodological and practical challenges of technology integration in surgery, provide examples of evidence-based improvements, and discuss the importance of systems engineering and clinical human factors research and practice. BACKGROUND New operating room technologies offer potential benefits for patients and staff, yet also present challenges for physical, procedural, team, and organizational integration. Historically, RAS implementation has focused on establishing the technical skills of the surgeon on the console, and has not systematically addressed the new skills required for other team members, the use of the workspace, or the organizational changes. RESULTS Human factors studies of robotic surgery have demonstrated not just the effects of these hidden complexities on people, teams, processes, and proximal outcomes, but also have been able to analyze and explain in detail why they happen and offer methods to address them. We review studies on workload, communication, workflow, workspace, and coordination in robotic surgery, and then discuss the potential for improvement that these studies suggest within the wider healthcare system. CONCLUSION There is a growing need to understand and develop approaches to safety and quality improvement through human-systems integration at the frontline of care.Precis: The introduction of robotic surgery has exposed under-acknowledged complexities of introducing complex technology into operating rooms. We explore the methodological and practical challenges, provide examples of evidence-based improvements, and discuss the implications for systems engineering and clinical human factors research and practice.
Collapse
Affiliation(s)
- Ken Catchpole
- Medical University of South Carolina, Charleston, USA
| | - Tara Cohen
- Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | | | - Sam Lawton
- Medical University of South Carolina, Charleston, USA
| | | | | | - Lynne Nemeth
- Medical University of South Carolina, Charleston, USA
| | | |
Collapse
|
2
|
Zamudio J, Woodward J, Kanji FF, Anger JT, Catchpole K, Cohen TN. Demands of surgical teams in robotic-assisted surgery: An assessment of intraoperative workload within different surgical specialties. Am J Surg 2023; 226:365-370. [PMID: 37330385 DOI: 10.1016/j.amjsurg.2023.06.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 06/02/2023] [Accepted: 06/05/2023] [Indexed: 06/19/2023]
Abstract
BACKGROUND Current approaches to assessing workload in robotic-assisted surgery (RAS) focus on surgeons and lack real-world data. Understanding how workload varies by role and specialty aids in identifying effective ways to optimize workload. METHODS SURG-TLX surveys with six domains of workload were administered to surgical staff at three sites. Staff reported workload perceptions for each domain on a 20-point Likert scale, and aggregate scores were determined per participant. RESULTS 188 questionnaires were obtained across 90 RAS procedures. Significantly higher aggregate scores were reported for gynecology (Mdn = 30.00) (p = 0.034) and urology (Mdn = 36.50) (p = 0.006) than for general (Mdn = 25.00). Surgeons reported significantly higher scores for task complexity (Mdn = 8.00) than both technicians (Mdn = 5.00) (p = 0.007), and nurses (Mdn = 5.00). CONCLUSIONS Staff reported significantly higher workload during urology and gynecology procedures, and experienced significant differences in domain workload by role and specialty, elucidating the need for tailored workload interventions.
Collapse
Affiliation(s)
- Jennifer Zamudio
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, 90048, USA.
| | - Jeffrey Woodward
- Department of Anesthesia and Perioperative Medicine, Medical University of South Carolina, Charleston, SC, 29425, USA.
| | - Falisha F Kanji
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, 90048, USA.
| | - Jennifer T Anger
- Department of Urology, University of California San Diego, La Jolla, CA, 92037, USA.
| | - Ken Catchpole
- Department of Anesthesia and Perioperative Medicine, Medical University of South Carolina, Charleston, SC, 29425, USA.
| | - Tara N Cohen
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, 90048, USA.
| |
Collapse
|
3
|
Zamudio J, Kanji FF, Lusk C, Shouhed D, Sanchez BR, Catchpole K, Anger JT, Cohen TN. Identifying Workflow Disruptions in Robotic-Assisted Bariatric Surgery: Elucidating Challenges Experienced by Surgical Teams. Obes Surg 2023; 33:2083-2089. [PMID: 37147465 PMCID: PMC10162850 DOI: 10.1007/s11695-023-06620-4] [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] [Received: 02/02/2023] [Revised: 04/24/2023] [Accepted: 04/25/2023] [Indexed: 05/07/2023]
Abstract
PURPOSE Bariatric surgery is an effective and durable treatment for weight loss for patients with extreme obesity. Although traditionally approached laparoscopically, robotic bariatric surgery (RBS) has unique benefits for both surgeons and patients. Nonetheless, the technological complexity of robotic surgery presents new challenges for OR teams and the wider clinical system. Further assessment of the role of RBS in delivering quality care for patients with obesity is necessary and can be done through a human factors approach. This observational study sought to investigate the impact of RBS on the surgical work system via the study of flow disruptions (FDs), or deviations from the natural workflow progression. MATERIALS AND METHODS RBS procedures were observed between October 2019 and March 2022. FDs were recorded in real time and subsequently classified into one of nine work system categories. Coordination FDs were further classified into additional sub-categories. RESULTS Twenty-nine RBS procedures were observed at three sites. An average FD rate of 25.05 (CI = ± 2.77) was observed overall. FDs were highest between insufflation and robot docking (M = 29.37, CI = ± 4.01) and between patient closing and wheels out (M = 30.00, CI = ± 6.03). FD rates due to coordination issues were highest overall, occurring once every 4 min during docking (M = 14.28, CI = ± 3.11). CONCLUSION FDs occur roughly once every 2.4 min and happen most frequently during the final patient transfer and robot docking phases of RBS. Coordination challenges associated with waiting for staff/instruments not readily available and readjusting equipment contributed most to these disruptions.
Collapse
Affiliation(s)
- Jennifer Zamudio
- Department of Surgery, Cedars-Sinai Medical Center, 6500 Wilshire Blvd, Los Angeles, CA, 90048, USA.
| | - Falisha F Kanji
- Department of Surgery, Cedars-Sinai Medical Center, 6500 Wilshire Blvd, Los Angeles, CA, 90048, USA
| | - Connor Lusk
- Department of Anesthesia and Perioperative Medicine, Medical University of South Carolina, Charleston, SC, 29425, USA
| | - Daniel Shouhed
- Department of Surgery, Cedars-Sinai Medical Center, 436 N Bedford Dr Suite 311, Beverly Hills, CA, 90210, USA
| | - Barry R Sanchez
- Department of Surgery, Ventura County Medical Center, 300 Hillmont Ave, Ventura, CA, 93003, USA
| | - Ken Catchpole
- Department of Anesthesia and Perioperative Medicine, Medical University of South Carolina, Charleston, SC, 29425, USA
| | - Jennifer T Anger
- Department of Urology, University of California San Diego, 9400 Campus Point Drive #7897, La Jolla, CA, 92037, USA
| | - Tara N Cohen
- Department of Surgery, Cedars-Sinai Medical Center, 8700 Beverly Blvd, Los Angeles, CA, 90048, USA
| |
Collapse
|
4
|
Cohen TN, Anger JT, Kanji FF, Zamudio J, DeForest E, Lusk C, Avenido R, Yoshizawa C, Bartkowicz S, Nemeth LS, Catchpole K. A Novel Approach for Engagement in Team Training in High-Technology Surgery: The Robotic-Assisted Surgery Olympics. J Patient Saf 2022; 18:570-577. [PMID: 35797490 PMCID: PMC9391262 DOI: 10.1097/pts.0000000000001056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION There is ongoing interest in the development of technical and nontechnical skills in healthcare to improve safety and efficiency; however, barriers to developing and delivering related training programs make them difficult to implement. Unique approaches to training such as "serious games" may offer ways to motivate teams, reinforce skill acquisition, and promote teamwork. Given increased challenges to teamwork in robotic-assisted surgery (RAS), researchers aimed to develop the "RAS Olympics," a game-based educational competition to improve skills needed to successfully perform RAS. METHODS This pilot study was conducted at an academic medical center in Southern California. Robotic-assisted surgery staff were invited to participate in the "RAS Olympics" to develop their skills and identify opportunities to improve processes. Impact of the activity was assessed using surveys and debriefs. RESULTS Sixteen operating room team members participated and reacted favorably toward the RAS-Olympics (average score, 4.5/5). They enjoyed the activity, would recommend all staff participate, felt that it was relevant to their work, and believed that they practiced and learned new techniques that would improve their practice. Confidence in skills remained unchanged. Participants preferred the RAS Olympics to traditional training because it provided an interactive learning environment. CONCLUSIONS The successful implementation of the RAS Olympics provided insight into new opportunities to engage surgical staff members while also training technical and nontechnical skills. Furthermore, this shared experience allowed surgical staff members to gain a greater appreciation for their teammates and an understanding of the current challenges and methods to improve teamwork and communication while promoting safety and efficiency in RAS.
Collapse
Affiliation(s)
- Tara N. Cohen
- Research Scientist and Associate Professor, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA 90069
| | - Jennifer T. Anger
- Vice Chair of Research, Gender Affirming Surgery, Urologic Reconstruction, and Female Pelvic Medicine, University of California San Diego, Department of Urology, 9400 Campus Point Drive #7897, La Jolla, CA 92037
| | - Falisha F. Kanji
- Clinical Research Assistant, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA 90069
| | - Jennifer Zamudio
- Clinical Research Assistant, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA 90069
| | - Elise DeForest
- Program Assistant, Department of Anesthesia and Perioperative Medicine, Medical University of South Carolina, Charleston, SC 29425
| | - Connor Lusk
- Postdoctoral Scholar, Department of Anesthesia and Perioperative Medicine, Medical University of South Carolina, Charleston, SC 29425
| | - Ray Avenido
- Robotic Surgery Specialist, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, 90048
| | - Christine Yoshizawa
- Assistant Nurse Manager, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, 90048
| | - Stephanie Bartkowicz
- Clinical Nurse IV, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, 90048
| | - Lynne S. Nemeth
- Professor, College of Nursing, Medical University of South Carolina, Charleston, SC
| | - Ken Catchpole
- Endowed Chair in Clinical Practice and Human Factors, Department of Anesthesia and Perioperative Medicine, Medical University of South Carolina, Charleston, SC
| |
Collapse
|
5
|
Alfred M, Del Gaizo J, Kanji F, Lawton S, Caron A, Nemeth LS, Alekseyenko AV, Shouhed D, Savage S, Anger JT, Catchpole K, Cohen T. A better way: training for direct observations in healthcare. BMJ Qual Saf 2022; 31:744-753. [DOI: 10.1136/bmjqs-2021-014171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 08/07/2022] [Indexed: 11/03/2022]
Abstract
Direct observation is valuable for identifying latent threats and elucidating system complexity in clinical environments. This approach facilitates prospective risk assessment and reveals workarounds, near-misses and recurrent safety problems difficult to diagnose retrospectively or via outcome data alone. As observers are an instrument of data collection, developing effective and comprehensive observer training is critical to ensuring the reliability of the data collection and reproducibility of the research. However, methodological rigour for ensuring these data collection properties remains a key challenge in direct observation research in healthcare. Although prior literature has offered key considerations for observational research in healthcare, operationalising these recommendations may pose a challenge and unless guidance is also provided on observer training. In this article, we offer guidelines for training non-clinical observers to conduct direct observations including conducting a training needs analysis, incorporating practice observations and evaluating observers and inter-rater reliability. The operationalisation of these guidelines is described in the context of a 5-year multisite observational study investigating technology integration in the operating room. We also discuss novel tools developed during the course our project to support data collection and examine inter-rater reliability among observers in direct observation studies.
Collapse
|