Development of an In Situ Thoracic Surgery Crisis Simulation Focused on Nontechnical Skill Training

Bierer, Joel; Memu, Eustatiu; Leeper, W. Robert; Fortin, Dalilah; Fréchette, Éric; Inculet, Richard; Malthaner, Richard

doi:10.1016/j.athoracsur.2018.01.058

Cited by 24 publications

(18 citation statements)

References 10 publications

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“…An in situ intraoperative crisis simulation model for thoracic surgical emergencies was created, implemented, and demonstrated to be effective as a proof of concept at identifying latent threats to patient safety and differentiating the nontechnical skills of trainees and consultant surgeons [5]. We have developed a comprehensive in situ intraoperative crisis simulation program for our thoracic surgery team.…”

Section: Discussionmentioning

confidence: 99%

Crisis checklist (Code Red) for the management of cardiac arrest during minimally invasive thoracic surgery: case report

Rinieri

Selim

Guillou

et al. 2020

J Cardiothorac Surg

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Background: The management of cardiac arrest during video assisted thoracic surgery is challenging. Checklist use improve the management of operating-room crises. Case presentation: Cardiac arrest (asystole) occurred during anatomical pulmonary resection by minimally invasive surgery. Conversion to thoracotomy was decided (thoracic surgeon and anesthesiologist conjointly) to check for absence of cardiac bleeding and to start cardiac massage (4 min no-flow). After few minutes, ventricular fibrillation occurred and persisted despite shocks. Extracorporeal life support with veno-arterial extracorporeal membrane oxygenation allowed a return of spontaneous circulation (45 min low-flow). Conclusions: The patient survived without central neurologic deficit due to perfect team work process using a crisis checklist (strengthened by a comprehensive simulation program with crisis resource management).

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Section: Discussionmentioning

confidence: 99%

Crisis checklist (Code Red) for the management of cardiac arrest during minimally invasive thoracic surgery: case report

Rinieri

Selim

Guillou

et al. 2020

J Cardiothorac Surg

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“…Therefore, training for the management of this risky situation before it arises has major benefits for the entire team. Appropriate decision making, communication, and inter-professional skills are vital for positive patient outcomes in both routine and crisis scenarios (11,12). Before the surgery, the surgeon must prepare by reviewing the scenarios in which emergency conversion should be performed after bleeding control and the injury can be repaired using the robotic approach.…”

Section: Simulationmentioning

confidence: 99%

Pulmonary artery repair during robotic lung resection: narrative review and management

Pagès¹,

Gutiérrez²,

Baste³

2022

J Vis Surg

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Minimally invasive surgery is currently the standard of care for the surgical management of early-stage lung cancer. The generalization of robotic and video-assisted thoracic surgery (VATS) for lung cancer resection, emphasize the problem of the management of major intraoperative complications. Here in, we report our experience regarding the management of major bleeding occurring during robotic lung cancer resection. We sought to define an appropriate approach to manage pulmonary artery injury (PAI) and to prevent the occurrence of vascular injury. The intraoperative management of these injuries is based on crisis scenario that must be repeated and prepared beforehand including the whole team of anesthesiologist and nurses, highlighting the role of team communication. Moreover, it emphasizes the function of the assistant who is close to the patient; he had to help the main surgeon to control the bleeding before the main surgeon can perform conversion thoracotomy if the vessel could not be repaired robotically. Moreover, we reported the different methods of prevention of vascular injuries that need to be taught. Prevention is based on surgical and case control simulation with the whole team in the operating room, training with robot simulators to improve technical aspects and preoperative planning using 3-dimensional imaging to investigate more precisely the disposition of the pulmonary arteries and veins.

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“…Nontechnical practice assessments have predominantly occurred within simulated environments and relied on trained human observers [37,38]. Investigators have not evaluated whether video understanding could provide an objective alternative for high-fidelity assessments of nontechnical practices in real-world operative environments, generalizable across hospitals with varied operating room layouts and camera configurations.…”

Section: Nontechnical Practicesmentioning

confidence: 99%

Novel Assessments of Technical and Nontechnical Cardiac Surgery Quality: Protocol for a Mixed Methods Study (Preprint)

Likosky¹,

Yule²,

Mathis³

et al. 2020

Preprint

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BACKGROUND Of the 150,000 patients annually undergoing coronary artery bypass grafting surgery, 35% develop complications that increase mortality 5-fold and expenditures by 50%. Differences in patient risk and operative approach explain only 2% of hospital variation in some complications. The intraoperative phase remains understudied as a source of variation, despite its complexity and amenability to improvement. OBJECTIVE The objectives of this study are to: (i) investigate the relationship between peer assessments of intraoperative technical skills and non-technical practices with risk-adjusted complication rates and (ii) evaluate the feasibility of using computer-based metrics to automate the assessment of important intraoperative technical skills and non-technical practices. METHODS This multi-center study will use video-recording, established peer assessment tools, electronic health record data, registry data and a high-dimensional computer vision approach to: (1) investigate the relationship between peer assessments of surgeon technical skills and variability in risk-adjusted patient adverse events; (2) investigate the relationship between peer assessments of intraoperative team-based non-technical practices and variability in risk-adjusted patient adverse events; (3) use quantitative and qualitative methods to explore the feasibility of using objective, data-driven computer-based assessments to automate the measurement of significant, intraoperative determinants of risk-adjusted patient adverse events. RESULTS The project was funded by the National Heart, Lung and Blood Institute in 2019 and enrollment for the overall project is expected to begin in 2020. CONCLUSIONS We anticipate this project will substantially increase our ability to assess determinants of variation in complication rates by specifically studying a surgeon’s technical skills and operating room team member non-technical practices. These findings may provide effective targets for future trials or quality improvement initiatives to enhance the quality and safety of cardiac surgical patient care. CLINICALTRIAL -

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Development of an In Situ Thoracic Surgery Crisis Simulation Focused on Nontechnical Skill Training

Cited by 24 publications

References 10 publications

Crisis checklist (Code Red) for the management of cardiac arrest during minimally invasive thoracic surgery: case report

Crisis checklist (Code Red) for the management of cardiac arrest during minimally invasive thoracic surgery: case report

Pulmonary artery repair during robotic lung resection: narrative review and management

Novel Assessments of Technical and Nontechnical Cardiac Surgery Quality: Protocol for a Mixed Methods Study (Preprint)

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