Factors compromising safety in surgery: stressful events in the operating room

Arora, Sonal; Hull, Louise; Sevdalis, Nick; Tierney, Tanya; Nestel, Debra; Woloshynowych, Maria; Darzi, Ara; Kneebone, Roger

doi:10.1016/j.amjsurg.2009.07.036

Cited by 155 publications

(119 citation statements)

References 18 publications

Supporting

Mentioning

117

Contrasting

Unclassified

Order By: Relevance

“…Studies demonstrate improved performance during crisis simulation is associated with lower levels of stress (Wetzel et al 2010). In addition, significantly increased levels of stress can potentially impair learning in the simulated environment (Harvey et al 2012), and lead to adverse events in theatre (Arora, Hull, et al 2010). Stress is known to adversely affect both technical and non-technical skills (Doleman et al 2016), which has implications for the assessment of these skills in trainees within simulated environments.…”

Section: Introductionmentioning

confidence: 99%

Simulation fails to replicate stress in trainees performing a technical procedure in the clinical environment

et al. 2016

View full text Add to dashboard Cite

A note on versions:The version presented here may differ from the published version or from the version of record. If you wish to cite this item you are advised to consult the publisher's version. Please see the repository url above for details on accessing the published version and note that access may require a subscription. Abstract IntroductionSimulation based training (SBT) has become an increasingly important method by which doctors learn. Stress has an impact upon learning, performance, technical, and non-technical skills. However, there are currently no studies that compare stress in the clinical and simulated environment. We aimed to compare objective (heart rate variability, HRV) and subjective (state trait anxiety inventory, STAI) measures of stress theatre with a simulated environment. MethodsHRV recordings were obtained from eight anaesthetic trainees performing an uncomplicated rapid sequence induction at pre-determined procedural steps using a wireless Polar RS800CX monitor © in an emergency theatre setting. This was repeated in the simulated environment. Participants completed an STAI before and after the procedure. ResultsEight trainees completed the study. The theatre environment caused an increase in objective stress vs baseline (p=0.004). There was no significant difference between average objective stress levels across all time points (p=0.20) between environments.However, there was a significant interaction between the variables of objective stress 2 and environment (p=0.045). There was no significant difference in subjective stress (p=0.27) between environments. DiscussionSimulation was unable to accurately replicate the stress of the technical procedure. This is the first study that compares the stress during SBT with the theatre environment and has implications for the assessment of simulated environments for use in examinations, rating of technical and non-technical skills, and stress management training.

show abstract

Section: Introductionmentioning

confidence: 99%

Simulation fails to replicate stress in trainees performing a technical procedure in the clinical environment

et al. 2016

View full text Add to dashboard Cite

show abstract

“…Surgeons' stress, even in optimized conditions like training on models, can negatively impact on psychomotor performance and safety in the operating theater [6,7,8,9]. Indeed, the operator's personal life-threatening complications like professional burnout have been described in obstetrics and gynecology residents [27] as in other specialties [28].…”

Section: Discussionmentioning

confidence: 99%

“…Numerous stressors have been identified in surgical contexts such as distractions, communication failures, and deficient teamwork or equipment problems [5,6]. These stressful events can impair the surgeons' performance and compromise safety in surgery even though teaching, simulating on models, and self-flooding were developed by analogy to safety-critical industries [5,6,7,8]. …”

Section: Introductionmentioning

confidence: 99%

Stress Experienced by Obstetrics and Gynecology Residents during Planned Laparoscopy: A Prospective, Multicentric, Observational, Blinded, and Comparative Study

Ducarme¹,

Bricou²,

Chanelles³

et al. 2015

Gynecol Obstet Invest

View full text Add to dashboard Cite

Aims: To describe heart rate (HR) variations in surgical residents during laparoscopy and to assess their intraoperative stress. Methods: We performed a prospective, multicentric, observational, blinded, and comparative analysis of the HR in 75 obstetrics and gynecology residents during planned laparoscopy for infertility in five teaching hospitals with assisted reproductive technology centers. The surgical residents had neither heart disease nor were under medical treatment or using tobacco or drugs. We describe HR variations at 9 preselected operative steps using real-time noninvasive measures of the HR during laparoscopy. Results: Residents performed 124 laparoscopies for unexplained infertility. Their HR increased significantly during the introduction of the Palmer needle, umbilical port and second port, and during abdominopelvic exploration and dye test compared to the baseline HR, the HR after hand washing, at the end of surgery and during skin suture (91.6 ± 1.9, 104.8 ± 2.3, 95.3 ± 2.2, 93.7 ± 2.5, 90.7 ± 1.7 vs. 83.2 ± 1.6, 88.6 ± 1.9, 87.4 ± 2.1, 88.2 ± 1.9 bpm, respectively, p < 0.02). Conclusion: Our results point to a potential stress for the surgeon assessed by HR variations during planned laparoscopy compared to the baseline HR before surgery. This ‘static' stress can be repeated on the same day.

show abstract

“…Robot surgery has increased the pressure on surgeons [15], allowing (but at the same also obligating) them to work with more than two instruments, executing interventions that previously could not be carried out via minimally invasive surgery. While this may have advantages for the patient, the pressure on the surgeon rises since the operations become more elaborate, requiring ever more advanced skills and knowledge.…”

Section: Conclusion and Discussionmentioning

confidence: 99%

“…An operating team working in a technologically complex operating room relies heavily on the surgeon, who is under increasing pressure to perform [15]. The surgical team cannot proceed without the surgeons, whose only communication medium is their voice and the actions of their tools, which the rest of the team can follow on screen.…”

Section: B the Or Teammentioning

confidence: 99%

Identifying barriers in telesurgery by studying current team practices in robot-assisted surgery

Elprama¹,

Kilpi²,

Duysburgh³

et al. 2013

Proceedings of the ICTs for Improving Patients Rehabilitation Research Techniques

View full text Add to dashboard Cite

Abstract-This paper investigates challenges in current practices in robot-assisted surgery. In addition, by using the method of proxy technology assessment, we provide insights into the current barriers to wider application of robot-assisted telesurgery, where the surgeon and console are physically remote from the patient and operating team. Research in this field has focused on the financial and technological constraints that limit such application; less has been done to clarify the complex dynamics of an operating team that traditionally works in close symbiosis. Results suggest that there are implications for working practices in transitioning from traditional robot-assisted surgery to remote robotic surgery that need to be addressed, such as possible communication problems which might have a negative impact on patient outcomes.

show abstract

Factors compromising safety in surgery: stressful events in the operating room

Cited by 155 publications

References 18 publications

Simulation fails to replicate stress in trainees performing a technical procedure in the clinical environment

Simulation fails to replicate stress in trainees performing a technical procedure in the clinical environment

Stress Experienced by Obstetrics and Gynecology Residents during Planned Laparoscopy: A Prospective, Multicentric, Observational, Blinded, and Comparative Study

Identifying barriers in telesurgery by studying current team practices in robot-assisted surgery

Contact Info

Product

Resources

About