Multicentre observational study of surgical system failures in aortic procedures and their effect on patient outcomes

Lear, Rachael; Riga, Celia; Godfrey, Anthony; Falaschetti, Emanuela; Cheshire, Nicholas; Herzeele, Isabelle Van; Norton, Christine; Vincent, Charles; Darzi, Ara; Bicknell, Colin; Gohel, M.S.; Hayes, Paul D.; Joseph, Thomas; Sowinski, A; Wilson, Timothy R.; Chong, Patrick; Gerrard, David; Croucher, Andrea; Bown, Matthew J.; Gokani, V.J.; McCarthy, Mark J.; Brightwell, Robert; Meyer, Fredric B.; Burrows, Mandy; Renton, Sophie; Das, Somak; Parsapour, S; Nordon, Ian M.; Baxter, Stephen; Shearman, C.P.; Jenkins, Michael; Modarai, Bijan; Clarke, Simon J.; Thompson, Alastair; Cavanagh, Stephen J.; Gibson, Angela; Coleman, Zoe

doi:10.1002/bjs.10275

Cited by 27 publications

(24 citation statements)

References 14 publications

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“…Seven of these were undertaken in the UK. 19,21,22,24e26,29 There were four descriptive studies, 19,26,28,29 one case control, 25 one cohort, 27 five cross sectional studies, 20e22,24,30 and one randomised control trial (RCT). 23 Seven studies measured the impact of an intervention designed to improve surgical quality and safety.…”

Section: Study Characteristicsmentioning

confidence: 99%

“…19,21,25,28,29 Four papers addressed carotid endarterectomy (CEA) 19,21,22,26 and four papers included lower limb bypass graft (LL BG). 19,21,26,30 Seven papers addressed organisational factors, 20,21,23,24,27,28,30 five papers addressed work environment factors, 19,20,25,29,30 and five papers addressed team factors. 19,22,25,26,29 Eight papers measured patient outcomes 20,21,23,24,27e30 and four papers measured surrogate markers of surgical quality and safety (including intra-operative errors or procedural problems, and operating time).…”

Section: Study Characteristicsmentioning

confidence: 99%

“…19,21,26,30 Seven papers addressed organisational factors, 20,21,23,24,27,28,30 five papers addressed work environment factors, 19,20,25,29,30 and five papers addressed team factors. 19,22,25,26,29 Eight papers measured patient outcomes 20,21,23,24,27e30 and four papers measured surrogate markers of surgical quality and safety (including intra-operative errors or procedural problems, and operating time). 19,22,25,26 Quality assessment Eight of twelve papers reported single centre studies, 19,21e 27 and of these, two had sample sizes of less than 20 cases.…”

Section: Study Characteristicsmentioning

confidence: 99%

“…Team factors. Five papers e all from the UK -examined the relationship between team factors and quality and safety 19,22,25,26,29 ; all five papers addressed team factors in the operating room. One study measured the impact of these factors on patient outcomes.…”

Section: Factors Influencing Quality and Safety In Arterial Surgerymentioning

confidence: 99%

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The Impact of System Factors on Quality and Safety in Arterial Surgery: A Systematic Review

Lear

Godfrey

Riga

et al. 2017

European Journal of Vascular and Endovascular Surgery

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A small number of heterogenous studies have evaluated the relationship between system factors and quality or safety in arterial surgery. There is some evidence of an association between system factors and patient outcomes, but there is more work to be done to fully understand this relationship. Future research would benefit from consistency in definitions, the use of validated assessment tools, measurement of clinically relevant endpoints, and adherence to national reporting guidelines.

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Section: Study Characteristicsmentioning

confidence: 99%

Section: Study Characteristicsmentioning

confidence: 99%

Section: Study Characteristicsmentioning

confidence: 99%

Section: Factors Influencing Quality and Safety In Arterial Surgerymentioning

confidence: 99%

See 2 more Smart Citations

The Impact of System Factors on Quality and Safety in Arterial Surgery: A Systematic Review

Lear

Godfrey

Riga

et al. 2017

European Journal of Vascular and Endovascular Surgery

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“…Many healthcare tasks and procedures can be simulated using computer technology for training purposes and provide novices with a way to improve or maintain their skills [6–8]. In addition to technical skill acquisition, we know that the errors made in the clinical environment are also related to non-technical skills [9] and hence there is a need to understand the relationship between skill and cognitive load during procedures. For example, a high cognitive load may affect the non-technical leadership skills of the operator in the clinical environment.…”

Section: Introductionmentioning

confidence: 99%

Wearable technology-based metrics for predicting operator performance during cardiac catheterisation

et al. 2019

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IntroductionUnobtrusive metrics that can auto-assess performance during clinical procedures are of value. Three approaches to deriving wearable technology-based metrics are explored: (1) eye tracking, (2) psychophysiological measurements [e.g. electrodermal activity (EDA)] and (3) arm and hand movement via accelerometry. We also measure attentional capacity by tasking the operator with an additional task to track an unrelated object during the procedure.MethodsTwo aspects of performance are measured: (1) using eye gaze and psychophysiology metrics and (2) measuring attentional capacity via an additional unrelated task (to monitor a visual stimulus/playing cards). The aim was to identify metrics that can be used to automatically discriminate between levels of performance or at least between novices and experts. The study was conducted using two groups: (1) novice operators and (2) expert operators. Both groups made two attempts at a coronary angiography procedure using a full-physics virtual reality simulator. Participants wore eye tracking glasses and an E4 wearable wristband. Areas of interest were defined to track visual attention on display screens, including: (1) X-ray, (2) vital signs, (3) instruments and (4) the stimulus screen (for measuring attentional capacity).ResultsExperts provided greater dwell time (63% vs 42%, p = 0.03) and fixations (50% vs 34%, p = 0.04) on display screens. They also provided greater dwell time (11% vs 5%, p = 0.006) and fixations (9% vs 4%, p = 0.007) when selecting instruments. The experts’ performance for tracking the unrelated object during the visual stimulus task negatively correlated with total errors (r = − 0.95, p = 0.0009). Experts also had a higher standard deviation of EDA (2.52 µS vs 0.89 µS, p = 0.04).ConclusionsEye tracking metrics may help discriminate between a novice and expert operator, by showing that experts maintain greater visual attention on the display screens. In addition, the visual stimulus study shows that an unrelated task can measure attentional capacity.Trial registration This work is registered through clinicaltrials.gov, a service of the U.S. National Health Institute, and is identified by the trial reference: NCT02928796.

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Patientensicherheit

Debus¹,

Grundmann²,

Heilberger³

2017

Good Clinical Practice in Der Gefäßchirurgie

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Multicentre observational study of surgical system failures in aortic procedures and their effect on patient outcomes

Abstract: Failure in aortic procedures is frequently caused by issues with team-working and equipment, and is associated with patient harm. Multidisciplinary team training, effective use of technology and new-device accreditation may improve patient outcomes.

Cited by 27 publications

References 14 publications

The Impact of System Factors on Quality and Safety in Arterial Surgery: A Systematic Review

The Impact of System Factors on Quality and Safety in Arterial Surgery: A Systematic Review

Wearable technology-based metrics for predicting operator performance during cardiac catheterisation

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