The effect of distractions in the operating room during endourological procedures

Contains fulltext : 98421.pdf (publisher's version ) (Closed access)BACKGROUND: Professionals working in the operating room (OR) are subject to various distractions that can be detrimental to their task performance and the quality of their work. This study aimed to quantify the frequency, nature, and effect on performance of (potentially) distracting events occurring during endourological procedures and additionally explored urologists' and residents' perspectives on experienced ill effects due to distracting factors. METHODS: First, observational data were collected prospectively during endourological procedures in one OR of a teaching hospital. A seven-point ordinal scale was used to measure the level of observed interference with the main task of the surgical team. Second, semistructured interviews were conducted with eight urologists and seven urology residents in two hospitals to obtain their perspectives on the impact of distracting factors. RESULTS: Seventy-eight procedures were observed. A median of 20 distracting events occurred per procedure, which corresponds to an overall rate of one distracting event every 1.8 min. Equipment problems and procedure-related and medically irrelevant communication were the most frequently observed causes of interruptions and identified as the most distracting factors in the interviews. Occurrence of distracting factors in difficult situations requiring high levels of concentration was perceived by all interviewees as disturbing and negatively impacting performance. The majority of interviewees (13/15) thought distracting factors impacted more strongly on residents' compared to urologists' performance due to their different levels of experience. CONCLUSION: Distracting events occur frequently in the OR. Equipment problems and communication, the latter both procedure-related and medically irrelevant, have the largest impact on the sterile team and regularly interrupt procedures. Distracting stimuli can influence performance negatively and should therefore be minimized. Further research is required to determine the direct effect of distraction on patient safety

Risk factors in patient safety: minimally invasive surgery versus conventional surgery

Background This study aimed to identify the frequency of events in the different patient safety risk domains during minimally invasive surgery (MIS) and conventional surgery (CS). Methods A convenience sample of gynecologic MIS and CS was observed. Events were observed and categorized into one of the predefined patient safety risk domains. Results A total of 53 procedures were observed: 26 CS and 27 MIS procedures. The general characteristics were comparable between the two groups. A large number of environmental events were observed, averaging one every 2.5 min. Technical events and events of an organizational nature occurred more often in MIS (P < 0.01) than in CS (P < 0.01). The relative risk for the occurrence of one or more technical events in MIS compared with CS was 1.7, and the risk for two or more technical events was 4.1. A time out according to protocol showed no relationship to the occurrence of the different types of patient safety-related events. Conclusion The technological complexity inherent in MIS makes this type of surgery more prone to technology-related problems than CS, even in a specially designed minimally invasive surgical suite. A regular time-out procedure developed for CS lacks the attention necessary for the complex technology used in MIS and therefore is insufficient for MIS procedures briefing. Incorporating a specially designed technology checklist in a regular briefing protocol could be a solution to decrease the number of events in MIS.Biomechanical EngineeringMechanical, Maritime and Materials Engineerin

Do absorption and realistic distraction influence performance of component task surgical procedure?

Background. Surgeons perform complex tasks while exposed to multiple distracting sources that may increase stress in the operating room (e.g., music, conversation, and unadapted use of sophisticated technologies). This study aimed to examine whether such realistic social and technological distracting conditions may influence surgical performance. Methods. Twelve medical interns performed a laparoscopic cholecystectomy task with the Xitact LC 3.0 virtual reality simulator under distracting conditions (exposure to music, conversation, and nonoptimal handling of the laparoscope) versus nondistracting conditions (control condition) as part of a 2 x 2 within-subject experimental design. Results. Under distracting conditions, the medical interns showed a significant decline in task performance (overall task score, task errors, and operating time) and significantly increased levels of irritation toward both the assistant handling the laparoscope in a nonoptimal way and the sources of social distraction. Furthermore, individual differences in cognitive style (i.e., cognitive absorption and need for cognition) significantly influenced the levels of irritation experienced by the medical interns. Conclusion. The results suggest careful evaluation of the social and technological sources of distraction in the operation room to reduce irritation for the surgeon and provision of proper preclinical laparoscope navigation training to increase security for the patient.Industrial DesignIndustrial Design Engineerin

Gaze training enhances laparoscopic technical skill acquisition and multi-tasking performance: A randomized, controlled study

Background: The operating room environment is replete with stressors and distractions that increase the attention demands of what are already complex psychomotor procedures. Contemporary research in other fields (e.g., sport) has revealed that gaze training interventions may support the development of robust movement skills. This current study was designed to examine the utility of gaze training for technical laparoscopic skills and to test performance under multitasking conditions. Methods: Thirty medical trainees with no laparoscopic experience were divided randomly into one of three treatment groups: gaze trained (GAZE), movement trained (MOVE), and discovery learning/control (DISCOVERY). Participants were fitted with a Mobile Eye gaze registration system, which measures eye-line of gaze at 25 Hz. Training consisted of ten repetitions of the "eye-hand coordination" task from the LAP Mentor VR laparoscopic surgical simulator while receiving instruction and video feedback (specific to each treatment condition). After training, all participants completed a control test (designed to assess learning) and a multitasking transfer test, in which they completed the procedure while performing a concurrent tone counting task. Results: Not only did the GAZE group learn more quickly than the MOVE and DISCOVERY groups (faster completion times in the control test), but the performance difference was even more pronounced when multitasking. Differences in gaze control (target locking fixations), rather than tool movement measures (tool path length), underpinned this performance advantage for GAZE training. Conclusions: These results suggest that although the GAZE intervention focused on training gaze behavior only, there were indirect benefits for movement behaviors and performance efficiency. Additionally, focusing on a single external target when learning, rather than on complex movement patterns, may have freed-up attentional resources that could be applied to concurrent cognitive tasks. © 2011 The Author(s).published_or_final_versionSpringer Open Choice, 21 Feb 201

Designing immersive surgical training against information technology-related overload in the operating room

On a theoretical level, this dissertation demonstrates that the “classical” conceptualization of overload in the field of Information Systems being an excessive amount of information is too simplistic. Based on the Emotional-Cognitive Overload Model by Rutkowski and Saunders (2011) this dissertation outlines the importance of the personal mental organization of Long-Term Memory (LTM) and the congruence of the information stimulus with cognitive schemata encoded in LTM.

Immersive training: Breaking the bubble and measuring the heat

Background Minimal access surgery and, lately, single-incision laparoscopic procedures are challenging and demanding with regard to the skills of the surgeon performing the procedures. This article presents the results of an investigation of the performance and attention focus of 21 medical interns and surgical residents training in an immersive context. That is, training ‘in situation’, representing more realistically the demands imposed on the surgeons during minimal access surgery. Methods Twenty-one medical interns and surgical residents participated in simulation trainings in an integrated operating room for laparoscopic surgery. Various physiological measures of body heat expenditure were gathered as indicators of mental strain and attention focus. Results The results of the Mann–Whitney test indicated that participants with a poor performance in the two laparoscopic cholecystectomy cases had a significantly (U = 3, p = 0.038) higher heat flux at the start of the procedure (mean 107.08, standard deviation [SD] 24.34) than those who excelled in the two cases (mean 62.64, SD 23.41). Also, the average frontal head temperature of the participants who failed at the task was significantly lower (mean 33.27, SD 0.52) than those who performed well (mean 33.92, SD 0.27). Conclusions Surgeons cannot operate in a bubble; thus, they should not be trained in one. Combining heat flux and frontal head temperature could be a good measure of deep involvement and attentional focus during performance of simulated surgical tasks

Immersive training:Breaking the bubble and measuring the heat

Background Minimal access surgery and, lately, single-incision laparoscopic procedures are challenging and demanding with regard to the skills of the surgeon performing the procedures. This article presents the results of an investigation of the performance and attention focus of 21 medical interns and surgical residents training in an immersive context. That is, training ‘in situation’, representing more realistically the demands imposed on the surgeons during minimal access surgery. Methods Twenty-one medical interns and surgical residents participated in simulation trainings in an integrated operating room for laparoscopic surgery. Various physiological measures of body heat expenditure were gathered as indicators of mental strain and attention focus. Results The results of the Mann–Whitney test indicated that participants with a poor performance in the two laparoscopic cholecystectomy cases had a significantly (U = 3, p = 0.038) higher heat flux at the start of the procedure (mean 107.08, standard deviation [SD] 24.34) than those who excelled in the two cases (mean 62.64, SD 23.41). Also, the average frontal head temperature of the participants who failed at the task was significantly lower (mean 33.27, SD 0.52) than those who performed well (mean 33.92, SD 0.27). Conclusions Surgeons cannot operate in a bubble; thus, they should not be trained in one. Combining heat flux and frontal head temperature could be a good measure of deep involvement and attentional focus during performance of simulated surgical tasks