Characterization of device-related interruptions in minimally invasive surgery: need for intraoperative data and effective mitigation strategies

Jung, James J.; Kashfi, Arash; Sharma, Sahil; Grantcharov, Teodor P.

doi:10.1007/s00464-018-6254-5

Cited by 13 publications

(8 citation statements)

References 30 publications

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“…Safe and fast MIMVS starts with excellent surgeons, and in our opinion technical innovation is no substitute for suboptimal surgical skills. In contrast, high-tech support for moderately competent surgeons may create serious additional risks, including the interruption of workflow [ 78 ].…”

Section: Discussionmentioning

confidence: 99%

At the Crossroads of Minimally Invasive Mitral Valve Surgery—Benching Single Hospital Experience to a National Registry: A Plea for Risk Management Technology

Cocchieri

Wetering

Tuijl

et al. 2022

JCDD

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Almost 30 years after the first endoscopic mitral valve repair, Minimally Invasive Mitral Valve Surgery (MIMVS) has become the standard at many institutions due to optimal clinical results and fast recovery. The question that arises is can already good results be further improved by an Institutional Risk Management Performance (IRMP) system in decreasing risks in minimally invasive mitral valve surgery (MIMVS)? As of yet, there are no reports on IRMP and learning systems in the literature. (2) Methods: We described and appraised our five-year single institutional experience with MIMVS in isolated valve surgery included in the Netherlands Heart Registry (NHR) and investigated root causes of high-impact complications. (3) Results: The 120-day and 12-month mortality were 1.1% and 1.9%, respectively, compared to the average of 4.3% and 5.3% reported in the NHR. The regurgitation rate was 1.4% compared to 5.2% nationwide. The few high-impact complications appeared not to be preventable. (4) Discussion: In MIMVS, freedom from major and minor complications is a strong indicator of an effective IRMP but remains concealed from physicians and patients, despite its relevance to shared decision making. Innovation adds to the complexity of MIMVS and challenges surgical competence. An IRMP system may detect and control new risks earlier. (5) Conclusion: An IRMP system contributes to an effective reduction of risks, pain and discomfort; provides relevant input for shared decision making; and warrants the safe introduction of new technology. Crossroads conclusions: investment in machine learning and AI for an effective IRMP system is recommended and the roles for commanding and operating surgeons should be considered.

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Section: Discussionmentioning

confidence: 99%

At the Crossroads of Minimally Invasive Mitral Valve Surgery—Benching Single Hospital Experience to a National Registry: A Plea for Risk Management Technology

Cocchieri

Wetering

Tuijl

et al. 2022

JCDD

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“… 10 The authors identified device failure, improper assembly of devices and absent or wrong devices as being the most frequent causes of intraoperative device-related interruptions. 11 A black box system in the OR has been used to detect previously missed or unreported intraoperative needle injuries, 12 and assess team performance in the OR. 13 The technology we are proposing to implement uses a similar data capture and analytic platform.…”

Section: Is There Evidence For This Technology?mentioning

confidence: 99%

Pushing boundaries of video review in trauma: using comprehensive data to improve the safety of trauma care

Nolan

Hicks

Petrosoniak

et al. 2020

Trauma Surg Acute Care Open

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Adverse events and lapses in safety are identified after the fact and often discussed through postevent review. These rounds rely on personal recollection, information from patient charts and incident reports that are limited by retrospective data collection. This results in recall bias and inaccurate or insufficient detail related to timeline, incidence and nature adverse events. To better understand the interplay of the complex team and task-based challenges in the trauma bay, we have developed a synchronized data capture and analysis platform called the Trauma Black Box (Surgical Safety Technologies, Toronto). This system continuously acquires audiovisual, patient physiological and environmental data from a sophisticated array of wall-mounted cameras, microphones and sensors. Expert analysts and software-based algorithms then populate a data timeline of case events from start to finish, retaining a handful of anonymized video clippings to supplement the review. These data also provide a consistent and reliable method to track specific quality metrics, such as time to trauma team assembly or time to blood product arrival. Furthermore, data can also be linked to patients’ electronic medical records to explore relationships between initial trauma resuscitation and downstream patient-oriented outcomes. A video capture and data analysis system for the trauma bay overcomes the inherent deficiencies in the current standard for evaluating patient care in the trauma bay and offers exciting potential to enhance patient safety through a comprehensive data collection system.

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“…19 A crosssectional study of elective laparoscopic general surgery cases between April 2014 and 2016 using the OR Black Box identified 30% of cases that contained a devicerelated interruption. 20 These interruptions were most common in sleeve gastrectomy and oncologic gastrectomy. 20 This surgical data recording system also demonstrated a significantly better ability to identify and report veress needle injuries when compared with traditional chart review.…”

Section: Technology Features and Use Casesmentioning

confidence: 99%

“…20 These interruptions were most common in sleeve gastrectomy and oncologic gastrectomy. 20 This surgical data recording system also demonstrated a significantly better ability to identify and report veress needle injuries when compared with traditional chart review. 21 Using the OR Black Box, 12 veress needle injuries were identified as opposed to 3 through traditional chart review, and 47 near misses were identified as opposed to 0 by chart review analysis.…”

Section: Technology Features and Use Casesmentioning

confidence: 99%

“…27 The aforementioned studies suggest that information collected via surgical data recording systems can benefit physicians and improve patient safety in a multitude of ways, allowing surgeons to review and critique their surgical technique, distractions, and interpersonal dynamics, which enable discussion of performance improvement, situational awareness and judgment in light of an adverse event, along with more targeted teaching mechanisms and opportunities. [20][21][22][26][27][28]…”

Section: Technology Features and Use Casesmentioning

confidence: 99%

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An Interdisciplinary Review of Surgical Data Recording Technology Features and Legal Considerations

2019

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Surgical data recording technology has great promise to generate patient safety and quality data that can be utilized to potentially reduce medical errors. Variations of these systems aim to improve surgical technique, develop better training simulation, and promote adverse event investigation similar to the aims of black box technology utilized in other industries. However, many unknowns remain for surgical data recording utilization in operating rooms and clinical settings in the United States. This includes the need to appropriately design systems so they collect meaningful and useful data that can be discussed by surgical team members in an open and safe environment to optimize clinical care processes. In order to better understand the clinical and regulatory environment for surgical data recording systems, we conducted an interdisciplinary review to identify key technology approaches, and assess legal and regulatory implications associated with this potentially disruptive technology. We found technology ranging from audio and visual data, to systems utilizing mobile applications, and kinematic data capture. The data collected present legal questions over ownership of information and privacy, along with regulatory issues at the federal and state levels. The benefits of these data should be balanced with the need to develop appropriate policies and regulations that protect the interests of both clinicians and patients in order to encourage further innovation and better realize the potential of surgical data recording technology to improve clinical decision making and patient safety outcomes.

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Characterization of device-related interruptions in minimally invasive surgery: need for intraoperative data and effective mitigation strategies

Cited by 13 publications

References 30 publications

At the Crossroads of Minimally Invasive Mitral Valve Surgery—Benching Single Hospital Experience to a National Registry: A Plea for Risk Management Technology

At the Crossroads of Minimally Invasive Mitral Valve Surgery—Benching Single Hospital Experience to a National Registry: A Plea for Risk Management Technology

Pushing boundaries of video review in trauma: using comprehensive data to improve the safety of trauma care

An Interdisciplinary Review of Surgical Data Recording Technology Features and Legal Considerations

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