An ethnographic study on the impact of a novel telemedicine-based support system in the operating room

Abstract

Objective The Anesthesiology Control Tower (ACT) for operating rooms (ORs) remotely assesses the progress of surgeries and provides real-time perioperative risk alerts, communicating risk mitigation recommendations to bedside clinicians. We aim to identify and map ACT-OR nonroutine events (NREs)—risk-inducing or risk-mitigating workflow deviations—and ascertain ACT’s impact on clinical workflow and patient safety. Materials and Methods We used ethnographic methods including shadowing ACT and OR clinicians during 83 surgeries, artifact collection, chart reviews for decision alerts sent to the OR, and 10 clinician interviews. We used hybrid thematic analysis informed by a human-factors systems-oriented approach to assess ACT’s role and impact on safety, conducting content analysis to assess NREs. Results Across 83 cases, 469 risk alerts were triggered, and the ACT sent 280 care recommendations to the OR. 135 NREs were observed. Critical factors facilitating ACT’s role in supporting patient safety included providing backup support and offering a fresh-eye perspective on OR decisions. Factors impeding ACT included message timing and ACT and OR clinician cognitive lapses. Suggestions for improvement included tailoring ACT message content (structure, timing, presentation) and incorporating predictive analytics for advanced planning. Discussion ACT served as a safety net with remote surveillance features and as a learning healthcare system with feedback/auditing features. Supporting strategies include adaptive coordination and harnessing clinician/patient support to improve ACT’s sustainability. Study insights inform future intraoperative telemedicine design considerations to mitigate safety risks. Conclusion Incorporating similar remote technology enhancement into routine perioperative care could markedly improve safety and quality for millions of surgical patients.

An Intraoperative Telemedicine Program to Improve Perioperative Quality Measures

“…Interactions between the ACT and OR clinicians evolved during the study . Initially, ACT clinicians filtered and communicated alerts to OR clinicians via phone calls because EHR-integrated messaging tools were not widely used by OR clinicians.…”

“…Descriptions of how the ACT interface was developed and adapted to clinician feedback to improve acceptability and usability have been published previously. 16 , 18 , 19 The ACT protocols were refined with clinician stakeholders to maximize the value of recommendations. The ACT clinicians used a dashboard to prioritize review of high-acuity cases and cases with active alerts.…”

“…9,10,14 Clinical decision support tools for intraoperative care have been found to improve some quality outcomes. 15 However, findings from previous studies 16,17 have emphasized the burden of alert fatigue, which reduces the benefit of decision support. Filtering of decision support alerts by telemedicine clinicians may mitigate alert fatigue and reduce oversights in care.…”

The Role of Human and Organizational Factors in the Pursuit of One Digital Health

“…Some papers also described systems that could be classified as complementary structures in that they supported other processes. Abraham et al studied an anaesthesia control tower that remotely monitors surgery to assist with supporting factors such as situational awareness as part of reducing potential errors or other adverse events [46]. Komenda et al developed a control centre for ICU monitoring that provides information on capacities of intensive care in real time as well as a module for online entering and overall record-keeping of requirements on medications for COVID-19 patients [33].…”

Experiences of the Telemedicine and eHealth Conferences in Poland—A Cross-National Overview of Progress in Telemedicine

“…The constant development of modern technologies is quickly reflected in telemedicine in the form of many new tools and solutions such as artificial intelligence [107][108][109][110], wearable medical devices and sensors [111][112][113][114][115][116], health-related Internet of Things (IoT) [117][118][119], implantable medical devices operated by telemedicine, augmented reality [120][121][122][123][124][125], virtual reality [124,[126][127][128][129] and support medical decision making [108,[130][131][132]. Changes in physicians' attitudes toward the use of telemedicine solutions devices lead to changes in medical practice [133,134].…”