Surgical technology and operating-room safety failures: a systematic review of quantitative studies

Weerakkody, Ruwan; Cheshire, Nicholas; Riga, Celia; Lear, Rachael; Hamady, Mohammed S; Moorthy, Krishna; Darzi, Ara; Vincent, Charles; Bicknell, Colin

doi:10.1136/bmjqs-2012-001778

Cited by 81 publications

(59 citation statements)

References 40 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Since laparoscopic cholecystectomy is usually performed in approximately an hour and in general is being considered as one of the lesser advanced procedures in surgery, this rate seems also comparable to the 6.3-8.5 equipment-related disturbances we found. Nevertheless, although it is known that laparoscopic surgery is prone to instrumentrelated disturbances [9], this number leaves substantial room for improvement, and apparently this needs to be realized by other solutions than performing minimal invasive surgery in an integrated OR instead of a conventional OR.…”

Section: Discussionmentioning

confidence: 99%

“…This resembles 23.5 % of the errors in the OR [9]. Additionally, they found that procedures that are more dependent on technology and/or equipment tended to show approximately three times higher equipment-related error rates [9]. Furthermore, during laparoscopic surgery, 47 % of the communication is equipment related, compared with 39 % during open surgery [10].…”

mentioning

confidence: 94%

See 1 more Smart Citation

Surgical Flow Disturbances in Dedicated Minimally Invasive Surgery Suites: An Observational Study to Assess Its Supposed Superiority Over Conventional Suites

Blikkendaal

Driessen

Rodrigues

et al. 2016

Journal of Minimally Invasive Gynecology

View full text Add to dashboard Cite

Background Minimally invasive surgery (MIS) is frequently compromised by surgical flow disturbances due to technology-and equipment-related failures. Compared with MIS in a conventional cart-based OR, performing MIS in a dedicated integrated operating room (OR) is supposed to be beneficial to patient safety. The aim of this study was to compare a conventional OR with an integrated OR with regard to the incidence and effect of equipmentrelated surgical flow disturbances during an advanced laparoscopic gynecological procedure [laparoscopic hysterectomy (LH)]. Methods Using video recording, 40 LHs performed between November 2010 and April 2012 (20 in a conventional cart-based OR and 20 in an integrated OR) were analyzed by two different observers. Outcome measures were the number, duration and effect (on a seven-point ordinal scale) of the surgical flow disturbances (e.g., malfunctioning, intraoperative repositioning, setup device). Results A total of 103 h and 45 min was observed. The interobserver agreement was high (kappa .85, p \ .001). Procedure time was not significantly different (NS) [conventional OR vs. integrated OR, minutes ± standard deviation (SD), mean 161 ± 27 vs. 150 ± 34]. A total of 1651 surgical flow disturbances were observed (mean ± SD per procedure 40.8 ± 19.4 vs. 41.8 ± 15.9, NS). The mean number of surgical flow disturbances per procedure with regard to equipment was 6.3 ± 3.7 versus 8.5 ± 4.0, NS. No clinically relevant differences in the mean effect of these disturbances on the surgical flow between the two OR setups were observed. Conclusions Performing LH in an integrated OR did not reduce the number of surgical flow disturbances nor the effect of these disturbances. Furthermore, in the integrated OR, repositioning of the monitors was a frequent and timeconsuming source of disturbance. In order to maintain the high standard of surgical safety, the entire surgical team has to be aware that by performing surgery in an integrated OR different potential source for disruption arise.

show abstract

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 94%

Surgical Flow Disturbances in Dedicated Minimally Invasive Surgery Suites: An Observational Study to Assess Its Supposed Superiority Over Conventional Suites

Blikkendaal

Driessen

Rodrigues

et al. 2016

Journal of Minimally Invasive Gynecology

View full text Add to dashboard Cite

show abstract

“…A previous study has shown that there is a large amount of hazards throughout the entire delivery process of surgical instruments 15. The unavailability of surgical instruments represented around 40% of equipment-related incidents in the OR 16 17. Each incident induces an average of 12 min of extra work for the OR team and 5 min of delay,16 and moreover, it increases the potential for errors in the OR 18 19.…”

Section: Introductionmentioning

confidence: 99%

Just-in-time delivery of sterilised surgical instruments

et al. 2016

View full text Add to dashboard Cite

The unavailability of the required surgical instruments at the start of a procedure is undesirable. It causes delays and stress in the operating room (OR), which can lead to additional risks for the patients. Issues with availability of surgical instruments may become visible just before the start of the procedure but are induced earlier in the delivery process. Therefore, efficient and safe supply chain management is essential. Just in time (JIT) is a concept widely applied in industrial sectors to improve efficiency and quality. The aim of this study is to design a JIT process for the delivery of surgical instruments and to assess the potential risks. The JIT delivery process of surgical instruments was designed for a Dutch hospital working with an external Central Sterile Supply Department (CSSD). Hazards (ie, sources of potential adverse events) were identified according to the Healthcare Failure Mode and Effects Analysis (HFMEA) methodology. The risks of applying JIT principles to the delivery of surgical instruments were compared to the risks involved with the current situation of the hospital at the time of this study (supply-driven delivery). The results showed that the total (high-)risk score of the JIT situation was similar to that of the current situation, although the number of (high-risk) hazards was slightly higher. However, almost half of the hazards were ‘controlled’ (when actions to remove the hazard were taken later in the process), in contrast to the current situation in which only about 10% of the (high-risk) hazards were ‘controlled’. The JIT delivery of surgical instruments is expected to present less risks compared to the current situation. The multiple requirements for information technology support and a higher level of trust between the CSSD and OR department should be taken into account in order to improve the supply chain management of surgical instruments.

show abstract

“…An English study admitted that 16% of patients hospitalized are victims of some kind of medical error and that half of these errors are attributed either to mistakes regarding procedures that precede the surgery or to technological and equipment failures 7 . In France, medical errors are seen and studied rigorously and the legal system has already identified the most common errors considering their typology.…”

Section: Nuances and Challenges Of Medical Malpractice Inmentioning

confidence: 99%

“…The evolution of medical sciences has made available a major technological framework to benefit humans 1,[2][3][4][5][6][7] . Brazil currently sees an abrupt increase in the search for clinical interventions, whose justifications range from those which are truly needed to others targeting aesthetical improvements 8 .…”

Section: Nuances and Challenges Of Medical Malpractice In Brazil: Vicmentioning

confidence: 99%

Nuances e desafios do erro médico no Brasil: as vítimas e seus olhares

Mendonça¹,

Custódio

2016

Rev. Bioét.

View full text Add to dashboard Cite

Medical malpractice refers to the circumstance of harming a person as the result of medical performance based on a reckless, negligent or inexpert approach. In Brazil, while the number of such cases is increasing, discussion of the subject is almost absent. The present study sought to elucidate some of the challenges found in the situations of the victims of medical malpractice. The experience of the victims was accessed through a semi-structured interview. The confusion of individuals when they discovered they had become victims was noted, as well as a difficulty in accepting the status of victim. The effects of the malpractice led to transformations both in behavior and in attitudes, such as a lack of confidence in medical professionals. It is therefore necessary to create strategies to help and care for the mental health of victims of medical malpractice. Keywords: Medical errors. Stress, psychological. Narration. ResumoNuances e desafios do erro médico no Brasil: as vítimas e seus olhares O erro médico refere-se a uma circunstância que atinge a pessoa em decorrência de atuação médica baseada em atitude imprudente, negligente ou imperita. No Brasil tem crescido o número de casos, mas a discussão a respeito da vítima é quase inexistente. Este trabalho buscou elucidar alguns dos desafios presentes na situação das vítimas de erro médico. Utilizando uma entrevista semiestruturada, foi possível conhecer as experiências das vítimas e perceber de que maneira enfrentaram os desafios impostos. Observou-se a perplexidade ao descobrir-se vítima, e a dificuldade em aceitar-se como tal. As mudanças impostas pelo erro acarretaram transformações comportamentais e de atitudes, como a falta de confiança nos profissionais médicos. Sofrimento e sentimentos negativos passam a fazer parte da vivência dessas pessoas. Dessa maneira, é necessário criar estratégias que permitam auxílio e cuidado da saúde mental das pessoas envolvidas com o erro médico. Palavras-chave: Erros médicos. Estresse psicológico. Narrativa. Resumen Matices y desafíos del error médico en Brasil: las víctimas y sus miradasEl error médico se refiere a una circunstancia que afecta a una persona como resultado de una operación médica basada en actitudes imprudentes, negligentes o de impericia. En Brasil se ha incrementado el número de casos, pero la discusión en relación a la víctima es casi inexistente. Este estudio tuvo como objetivo dilucidar algunos de los desafíos presentes en la situación de las víctimas de errores médicos. A partir del empleo de una entrevista semi-estructurada, fue posible el acceso a las experiencias de las víctimas y se logró una aproximación a los modos en que enfrentaron los desafíos impuestos. Se observó la perplejidad de estas personas al percibirse como víctimas y la dificultad en aceptarse en tanto tales. Las transformaciones impuestas por el error dieron lugar a cambios en los comportamientos y las actitudes, por ejemplo, la falta de confianza en los profesionales de la medicina. El sufrimiento y los sentimientos negativos...

show abstract

Surgical technology and operating-room safety failures: a systematic review of quantitative studies

Cited by 81 publications

References 40 publications

Surgical Flow Disturbances in Dedicated Minimally Invasive Surgery Suites: An Observational Study to Assess Its Supposed Superiority Over Conventional Suites

Surgical Flow Disturbances in Dedicated Minimally Invasive Surgery Suites: An Observational Study to Assess Its Supposed Superiority Over Conventional Suites

Just-in-time delivery of sterilised surgical instruments

Nuances e desafios do erro médico no Brasil: as vítimas e seus olhares

Contact Info

Product

Resources

About