Developing an Observational Tool for Reliably Identifying Work System Factors in the Operating Room that Impact Cardiac Surgical Care

Abstract

The objective of this study is to develop a reliable Tablet-PC based observational tool for identifying work systems factors that impact cardiac surgical care. Using the tool we observed 26 open heart surgeries over a five-month period. In thirteen of the 26 observations, both observers stood in the same location and in the other thirteen cases the observers stood in different locations within the operation room (OR). The surgical cases typically last five hours and were conducted in multiple operating rooms within the hospital and with mixed surgical teams. There was an average of 8.49 flow disruptions per hour related to work system factors with an average of 42.45 disruptions per case. Results revealed that inter-rater reliability in identifying work system factors that disrupted surgical flow was roughly 87% when observers were standing in the same location. However, when standing in different locations, the reliability decreased to an average of 75%.

Flow Disruptions in Trauma Surgery: Type, Impact, and Affect

“…Using a Tablet-PC data collection tool based on a previous version described elsewhere (Blocker et al, 2010); information about any event that disrupted the flow of the trauma care process was collected. Flow disruptions were time-stamped and categorized by observers in real time according to (1) type of flow disruption; (2) the potential and/or actual impact of the flow disruption on a scale from 1 to 5(1=no impact; 2=acknowledge/no delay; 3= momentary delay; 4=moderate delay; 5=full case cessation); (3) the trauma team member affected by the flow disruption; (4) the description of the flow disruption; and (5) the location of the observer.…”

A Markov chain approach to study flow disruptions on surgery in emergency care

“…These types are referred to as types 1 to 10 (corresponding to states 1 to 10) in this study, as shown in Table I. Using a Tablet-PC data collection tool [6], information about flow disruptions in the trauma care process is collected. A total of 1759 flow disruptions are identified across 87 trauma cases during a tenweek period.…”

Gaze and viewing patterns in microsurgery

“…Several tools and methodologies have been developed and applied in surgery to quantify interruptions in surgical procedures (Zheng et al 2008;Parker et al 2010;Sutton et al 2010;Blocker et al 2010). Parker et al (2010) developed a surgical flow disruption tool that categorizes disruption events into 1) technical factors, 2) environmental factors, 3) technology and instruments, 4) training and procedures, 5) teamwork, and 6) others.…”

“…Parker et al (2010) developed a surgical flow disruption tool that categorizes disruption events into 1) technical factors, 2) environmental factors, 3) technology and instruments, 4) training and procedures, 5) teamwork, and 6) others. Using similar disruption categories, Blocker et al (2010) created a tablet-based application that observers used to quantify disruptions in cardiac surgery. Video techniques have also been developed and successfully applied to identify laparoscopic surgery disruptions.…”