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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] [What about the content of this article? (0)] [Affiliation(s)] [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.
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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
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Samost-Williams A, Lusk C, Catchpole K. Taking a Resilience Engineering Approach to Perioperative Handoffs. Jt Comm J Qual Patient Saf 2023:S1553-7250(23)00086-7. [PMID: 37137755 DOI: 10.1016/j.jcjq.2023.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 03/28/2023] [Accepted: 03/30/2023] [Indexed: 04/08/2023]
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Lusk C, Catchpole K, Neyens DM, Goel S, Graham R, Elrod N, Paintlia A, Alfred M, Joseph A, Jaruzel C, Tobin C, Heinke T, Abernathy JH. Improving safety in the operating room: Medication icon labels increase visibility and discrimination. Appl Ergon 2022; 104:103831. [PMID: 35717790 PMCID: PMC9724395 DOI: 10.1016/j.apergo.2022.103831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 06/09/2022] [Accepted: 06/12/2022] [Indexed: 06/15/2023]
Abstract
Misreading labels, syringes, and ampoules is reported to make up a 54.4% of medication administration errors. The addition of icons to medication labels in an operating room setting could add additional visual cues to the label, allowing for improved discrimination, visibility, and easily processed information that might reduce medication administration errors. A multi-disciplinary team proposed a method of enhancing visual cues and visibility of medication labels applied to vasoactive medication infusions by adding icons to the labels. Participants were 1.12 times more likely to correctly identify medications from farther away (p < 0.001, AOR = 1.12, 95% CI: 1.02, 1.22) with icons. When icons were present, participants were 2.16 times more likely to be more confident in their identifications (p < 0.001, AOR = 2.16, 95%CI: 1.80, 2.57). Carefully designed icons may offer an additional method for identifying medications, and thus reducing medication administration errors.
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Affiliation(s)
- Connor Lusk
- Department of Anesthesia and Perioperative Medicine, Medical University of South Carolina, Charleston, SC, USA.
| | - Ken Catchpole
- Department of Anesthesia and Perioperative Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - David M Neyens
- Department of Industrial Engineering, Department of Bioengineering, Clemson University, Clemson, SC, USA
| | - Swati Goel
- Center for Health Facilities Design and Testing, School of Architecture, Clemson University, Clemson, SC, USA
| | - Riley Graham
- College of Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Nicolas Elrod
- College of Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Amanjot Paintlia
- College of Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Myrtede Alfred
- Department of Mechanical and Industrial Engineering, University of Toronto, Toronto, ON, CA, USA
| | - Anjali Joseph
- Center for Health Facilities Design and Testing, School of Architecture, Clemson University, Clemson, SC, USA
| | - Candace Jaruzel
- College of Health Professions, Medical University of South Carolina, Charleston, SC, USA
| | - Catherine Tobin
- Department of Anesthesia and Perioperative Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Timothy Heinke
- Department of Anesthesia and Perioperative Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - James H Abernathy
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins, Baltimore, MD, USA
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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] [What about the content of this article? (0)] [Affiliation(s)] [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.
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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
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Catchpole K, Lusk C, Weigl M, Anger J, Cohen T. Addressing misconceptions of flow disruption studies in "Is non-stop always better? Examining assumptions behind the concept of flow disruptions in studies of robot-assisted surgery". J Robot Surg 2021; 16:989-990. [PMID: 34626319 DOI: 10.1007/s11701-021-01318-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 10/03/2021] [Indexed: 10/20/2022]
Abstract
This letter to the editor provides a response to "Is non-stop always better? Examining assumptions behind the concept of flow disruptions in studies of robot-assisted surgery." The authors provide much needed clarification on misconceptions of flow disruption studies. The evolving methodology is not aimed at creating a "non-stop" flow, or optimizing efficiency, but understanding the clinical process from a systems perspective.
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Affiliation(s)
- Ken Catchpole
- Department of Anesthesia and Perioperative Medicine, Medical University of South Carolina, 167 Ashley Ave., Suite 301, MSC 912, Charleston, SC, 29425, USA
| | - Connor Lusk
- Department of Anesthesia and Perioperative Medicine, Medical University of South Carolina, 167 Ashley Ave., Suite 301, MSC 912, Charleston, SC, 29425, USA.
| | - Matthias Weigl
- Institute for Patient Safety, Bonn University Hospital, Bonn, Germany
| | - Jennifer Anger
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Tara Cohen
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
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Delclos GL, Arif AA, Aday L, Carson A, Lai D, Lusk C, Stock T, Symanski E, Whitehead LW, Benavides FG, Antó JM. Validation of an asthma questionnaire for use in healthcare workers. Occup Environ Med 2006; 63:173-9. [PMID: 16497858 PMCID: PMC2078145 DOI: 10.1136/oem.2005.021634] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Previous studies have described increased occurrence of asthma among healthcare workers, but to our knowledge there are no validated survey questionnaires with which to study this occupational group. AIMS To develop, validate, and refine a new survey instrument on asthma for use in epidemiological studies of healthcare workers. METHODS An initial draft questionnaire, designed by a multidisciplinary team, used previously validated questions where possible; the occupational exposure section was developed by updating health services specific chemical lists through hospital walk-through surveys and review of material safety data sheets. A cross-sectional validation study was conducted in 118 non-smoking subjects, who also underwent bronchial challenge testing, an interview with an industrial hygienist, and measurement of specific IgE antibodies to common aeroallergens. RESULTS The final version consisted of 43 main questions in four sections. Time to completion of the questionnaire ranged from 13 to 25 minutes. Test-retest reliability of asthma and allergy items ranged from 75% to 94%, and internal consistency for these items was excellent (Cronbach's alpha > or = 0.86). Against methacholine challenge, an eight item combination of asthma related symptoms had a sensitivity of 71% and specificity of 70%; against a physician diagnosis of asthma, this same combination showed a sensitivity of 79% and specificity of 98%. Agreement between self-reported exposures and industrial hygienist review was similar to previous studies and only moderate, indicating the need to incorporate more reliable methods of exposure assessment. Against the aerollergen panel, the best combinations of sensitivity and specificity were obtained for a history of allergies to dust, dust mite, and animals. CONCLUSIONS Initial evaluation of this new questionnaire indicates good validity and reliability, and further field testing and cross-validation in a larger healthcare worker population is in progress. The need for development of more reliable occupational exposure assessment methods that go beyond self-report is underscored.
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Affiliation(s)
- G L Delclos
- The University of Texas School of Public Health, Houston, Texas 77030, USA.
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Pressel SL, Davis BR, Wright JT, Geraci TS, Kingry C, Ford CE, Piller LB, Bettencourt J, Kimmel B, Lusk C, Parks H, Simpson LM, Nwachuku C, Furberg CD. Operational aspects of terminating the doxazosin arm of The Antihypertensive and Lipid Lowering Treatment to Prevent Heart Attack Trial (ALLHAT). Control Clin Trials 2001; 22:29-41. [PMID: 11165421 DOI: 10.1016/s0197-2456(00)00109-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The Antihypertensive and Lipid Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) is a randomized, practice-based trial sponsored by the National Heart, Lung, and Blood Institute (NHLBI). The double-blind, active-controlled component of ALLHAT was designed to determine whether the rate of the primary outcome-a composite of fatal coronary heart disease and nonfatal myocardial infarction-differs between diuretic (chlorthalidone) treatment and each of three other classes of antihypertensive drugs: a calcium antagonist (amlodipine), an angiotensin-converting enzyme inhibitor (lisinopril), and an alpha-adrenergic blocker (doxazosin) in high-risk hypertensive persons ages 55 years and older. In addition, 10,377 ALLHAT participants with mild to moderate hypercholesterolemia were also enrolled in a randomized, open-label trial designed to determine whether lowering serum LDL cholesterol with an HMG CoA reductase inhibitor (pravastatin) will reduce all-cause mortality as compared to a control group receiving "usual care." In January 2000, an independent data review committee recommended discontinuing the doxazosin treatment arm. The NHLBI director promptly accepted the recommendation. This article discusses the steps involved in the orderly closeout of one arm of ALLHAT and the dissemination of trial results. These steps included provisional preparations; the actual decision process; establishing a timetable; forming a transition committee; preparing materials and instructions; informing 65 trial officers and coordinators, 628 active clinics and satellite locations, 313 institutional review boards, over 42,000 patients, and the general public; reporting detailed trial results; and monitoring the closeout process. Control Clin Trials 2001;22:29-41
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Affiliation(s)
- S L Pressel
- The University of Texas Health Science Center School of Public Health, Houston, TX, USA.
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Lusk C. Geriatric mental health education in Canada SKIPs into the 21st century. J Gerontol Nurs 1999; 25:37-42. [PMID: 10578764 DOI: 10.3928/0098-9134-19990501-13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The Skills Immersion Program (SKIP) provides an educational opportunity for staff nurses who face the challenge of caring for residents who present with psychiatric and behavioral problems in long-term care (LTC) facilities within British Columbia, Canada. With the aging population and an increase in the number of individuals waiting for placement in care facilities, care providers are in substantial need of advanced education and training in the field of geriatric psychiatry nursing. Nurses working in LTC facilities in Canada are not prepared to manage the changing acuity levels and complex needs of their residents. The SKIP was developed by nurses, primarily for nurses, at St. Vincent's Hospital in Vancouver, British Columbia, Canada. Nurses who participate in the SKIP acquire an enhanced knowledge base in geriatric psychiatry nursing and gain access to assessment tools that will assist staff to increase the quality of care for their residents.
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Affiliation(s)
- C Lusk
- Royal Arch Masonic Home Intermediate Care Facility, Vancouver, British Columbia, Canada
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Zou W, Lusk C, Messer D, Lane R. Fat contents of cereal foods: comparison of classical with recently developed extraction techniques. J AOAC Int 1999; 82:141-50. [PMID: 10028683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
Eight cereal products ranging from a fat-free ready-to-eat (RTE) cereal (frosted flakes) to a full-fat high-ratio cake mix were subjected to analyte separation by anhydrous diethyl ether extraction (EE), acid hydrolysis/mixed ether extraction (AH), solid-phase extraction (SPE), and supercritical fluid extraction (SFE) with CO2 and with CO2 modified with 15% ethanol (SFEmod). Gravimetric analyses of extracts indicated higher (P < or = 0.05) crude fat values by AH than by EE, SFE, or SFEmod. Extractions followed by fatty acid methyl ester analysis also produced higher (P < or = 0.05) triglyceride means by AH than by other methods used for heat-treated RTE cereals and for ready-to-cook (RTC) cream of wheat. Therefore, for labeling purposes, AH seems most appropriate because in most cases it achieves higher triglyceride values than extraction with solvent(s) alone. SFE and SPE, on the other hand, yield fat values similar to those obtained by EE and offer the advantages of reduced solvent volume, short extraction times, and ease of laboratory automation.
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Affiliation(s)
- W Zou
- University of Alabama, Department of Human Nutrition, Tuscaloosa 35487-0158, USA
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