Measuring Safety and Efficiency in the Operating Room: Development and Validation of a Metric for Evaluating Task Execution in the Operating Room

Russ, Stephanie; Arora, Sonal; Wharton, Rupert; Wheelock, Ana; Hull, Louise; Sharma, Eshaa; Darzi, Ara; Vincent, Charles; Sevdalis, Nick

doi:10.1016/j.jamcollsurg.2012.12.013

Cited by 24 publications

(20 citation statements)

References 29 publications

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“…This could be accomplished at an institutional-level by improving coordination of the operative team and limiting unnecessary delays. (25–27) At the surgeon level, improving technical skill and operative efficiency may potentially be addressed by emerging strategies that promote continued skill acquisition and refinement. For example, surgeon coaching or mentoring programs are possible strategies recently proposed to address this issue.…”

Section: Discussionmentioning

confidence: 99%

Influence of median surgeon operative duration on adverse outcomes in bariatric surgery

Reames

Bacal

Krell

et al. 2015

Surgery for Obesity and Related Diseases

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Background Evidence suggests that prolonged operative time adversely affects surgical outcomes. However, whether faster surgeons have better outcomes is unclear, as a surgeon’s speed could reflect skill and efficiency, but may alternatively reflect haste. Objectives This study evaluates whether median surgeon operative time is associated with adverse surgical outcomes following laparoscopic Roux-en-Y gastric bypass. Methods We performed a retrospective cohort study using statewide clinical registry data from the years 2006 to 2012. Surgeons were ranked by their median operative time and grouped into terciles. Multivariable logistic regression with robust standard errors was used to evaluate the influence of median surgeon operative time on 30-day surgical outcomes, adjusting for patient and surgeon characteristics, trainee involvement, concurrent procedures, and the complex interaction between these variables. Results A total of 16,344 patients underwent surgery during the study period. Compared to surgeons in the fastest tercile, slow surgeons required 53 additional minutes to complete a gastric bypass procedure [median (Interquartile range) 139 (133–150) vs. 86 (69–91), p<0.001]. After adjustment for patient characteristics only, slow surgeons had significantly higher adjusted rates of any complication, prolonged length of stay, ED visits or readmissions, and venous thromboembolism (VTE). After further adjustment for surgeon characteristics, resident involvement, and the interaction between these variables, slow surgeons had higher rates of any complication (10.5% vs. 7.1%, p=0.039), prolonged length of stay (14.0% vs. 4.4%, p=0.002), and VTE (0.39% vs. 0.22%, p<0.001). Conclusions Median surgeon operative duration is independently associated with adjusted rates of certain adverse outcomes following laparoscopic Roux-en-Y gastric bypass. Improving surgeon efficiency while operating may reduce operative time and improve the safety of bariatric surgery.

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Section: Discussionmentioning

confidence: 99%

Influence of median surgeon operative duration on adverse outcomes in bariatric surgery

Reames

Bacal

Krell

et al. 2015

Surgery for Obesity and Related Diseases

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“…[1][2][3][4] For perforator flap breast reconstruction, intraoperative pathways can lead to improvements in operative time, cost, quality measures, and staff satisfaction, but such success is dependent on developing a team-based model of health care delivery, which must focus on interdisciplinary communication, enhanced efficiency through standardization of practice, and eliminating unnecessary steps, especially for lengthy procedures.…”

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confidence: 99%

Implementation and Analysis of a Lean Six Sigma Program in Microsurgery to Improve Operative Throughput in Perforator Flap Breast Reconstruction

Hultman

Kim

Lee

et al. 2016

Annals of Plastic Surgery

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A Six Sigma program in microsurgical breast reconstruction was associated with better operational and financial outcomes. These incremental gains were maintained over the course of the study, suggesting that these benefits were due, in part, to process improvements. However, continued reductions in total operative time and length of stay, well after the intervention period, support the possibility that "learning curve" phenomenon may have contributed to the improvement in these outcomes.

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“…A study conducted by Russ et al had similar objectives and described the Metric for Evaluating Task Execution in the Operating Room (METEOR) as an easy to use tool to allow surgical teams to self-assess their performance, in order to track surgical hazards, and to be able to evaluate safety [30]. However, their checklist is quite extensive (up to 80 items) and does not cover concerns regarding instruments and devices.…”

Section: Discussionmentioning

confidence: 99%

Measuring surgical safety during minimally invasive surgical procedures: a validation study

et al. 2018

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BackgroundDuring the implementation of new interventions (i.e., surgical devices and technologies) in the operating room, surgical safety might be compromised. Current safety measures are insufficient in detecting safety hazards during this process. The aim of the study was to observe whether surgical teams are capable of measuring surgical safety, especially with regard to the introduction of new interventions.MethodsA Surgical Safety Questionnaire was developed that had to be filled out directly postoperative by three surgical team members. A potential safety concern was defined as at least one answer between (strongly) disagree and indifferent. The validity of the questionnaire was assessed by comparison with the results from video analysis. Two different observers annotated the presence and effect of surgical flow disturbances during 40 laparoscopic hysterectomies performed between November 2010 and April 2012.ResultsThe surgeon reported a potential safety concern in 16% (85/520 questions). With respect to the scrub nurse and anesthesiologist, this was both 9% (46/520). With respect to the preparation, functioning, and ease of use of the devices in 37.5–47.5% (15–19/40 procedures) a potential safety concern was reported by one or more team members. During procedures after which a potential safety concern was reported, surgical flow disturbances lasted a higher percentage of the procedure duration [9.3 ± 6.2 vs. 2.9 ± 3.7% (mean ± SD), p < .001]. After procedures during which a new instrument or device was used, more potential safety concerns were reported (51.2 vs. 23.1%, p < .001).ConclusionsPotential safety concerns were especially reported during procedures in which a relatively high percentage of the duration consisted of surgical flow disturbances and during procedures in which a new instrument or device was used. The Surgical Safety Questionnaire can act as a validated tool to evaluate and maintain surgical safety during minimally invasive procedures, especially during the introduction of a new intervention.Electronic supplementary materialThe online version of this article (10.1007/s00464-018-6021-7) contains supplementary material, which is available to authorized users.

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Measuring Safety and Efficiency in the Operating Room: Development and Validation of a Metric for Evaluating Task Execution in the Operating Room

Cited by 24 publications

References 29 publications

Influence of median surgeon operative duration on adverse outcomes in bariatric surgery

Influence of median surgeon operative duration on adverse outcomes in bariatric surgery

Implementation and Analysis of a Lean Six Sigma Program in Microsurgery to Improve Operative Throughput in Perforator Flap Breast Reconstruction

Measuring surgical safety during minimally invasive surgical procedures: a validation study

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