Advertisement

Frequency of Device-Related Interruptions Using a Scalable Assessment Tool

      Abstract

      Background

      Surgical devices are implicated in approximately 15% of intraoperative interruptions and 25% of errors. Device-related interruptions (DRIs) are therefore an important target for surgical quality improvement, but scalable measurement methodologies are lacking. The researchers therefore developed, pilot tested, and refined a simple tool for assessing intraoperative DRIs.

      Methods

      Five DRI categories achieved face validity with frontline providers and surgical safety experts: improper/challenging assembly, device failure, loss of sterility, disconnection, and absent/wrong device. A data collection tool was created based on these categories as well as a free-text section to capture emergent DRI categories. After a brief training session, the tool was pilot tested by observers at a large academic referral center.

      Results

      In a sample of 210 operations, observers noted 66 DRIs across 39 cases. DRIs were most common in colorectal (38.0 per 100 cases), gynecologic (33.3 per 100 cases), and hepatopancreatobiliary surgery (32.1 per 100 cases). Device failure accounted for 30.3% of observed DRIs. Three emergent categories were identified: user unfamiliarity with the device (15.2%), video display malfunction (4.5%), and physical breakage of the device (1.5%).

      Conclusion

      Measurement of DRIs by novice observers is a feasible and scalable approach to support quality improvement efforts focusing on surgical devices. This approach could provide actionable insights to improve device safety, such as informing educational and training programs, optimizing surgical tray composition, and improving the physical layout of the operating room.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Joint Commission Journal on Quality and Patient Safety
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Wiegmann DA
        • et al.
        Disruptions in surgical flow and their relationship to surgical errors: an exploratory investigation.
        Surgery. 2007; 142: 658-665
        • Weerakkody RA
        • et al.
        Surgical technology and operating-room safety failures: a systematic review of quantitative studies.
        BMJ Qual Saf. 2013; 22: 710-718
        • Gawande AA
        • et al.
        Analysis of errors reported by surgeons at three teaching hospitals.
        Surgery. 2003; 133: 614-621
        • Jung JJ
        • et al.
        Characterization of device-related interruptions in minimally invasive surgery: need for intraoperative data and effective mitigation strategies.
        Surg Endosc. 2019; 33: 717-723
        • Antoniadis S
        • et al.
        Identification and interference of intraoperative distractions and interruptions in operating rooms.
        J Surg Res. 2014; 188 (May 1): 21-29
        • Healey AN
        • Sevdalis N
        • Vincent CA.
        Measuring intra-operative interference from distraction and interruption observed in the operating theatre.
        Ergonomics. 2006; 49 (Apr 15–May 15): 589-604
        • Albayati MA
        • et al.
        Identification of patient safety improvement targets in successful vascular and endovascular procedures: analysis of 251 hours of complex arterial surgery.
        Eur J Vasc Endovasc Surg. 2011; 41: 795-802
        • Buzink SN
        • et al.
        Risk-sensitive events during laparoscopic cholecystectomy: the influence of the integrated operating room and a preoperative checklist tool.
        Surg Endosc. 2010; 24: 1990-1995
        • Catchpole KR
        • et al.
        Identification of systems failures in successful paediatric cardiac surgery.
        Ergonomics. 2006; 49 (Apr 15–May 15): 567-588
        • Catchpole KR
        • et al.
        Improving patient safety by identifying latent failures in successful operations.
        Surgery. 2007; 142: 102-110
        • Verdaasdonk EGG
        • et al.
        Can a structured checklist prevent problems with laparoscopic equipment?.
        Surg Endosc. 2008; 22: 2238-2243
        • Boström J
        • Yacoub A
        • Schramm J.
        Prospective collection and analysis of error data in a neurosurgical clinic.
        Clin Neurol Neurosurg. 2010; 112: 314-319
        • Chappy S.
        Perioperative patient safety: a multisite qualitative analysis.
        AORN J. 2006; 83 (871–874, 877–888): 891-897
        • Evans SM
        • et al.
        Attitudes and barriers to incident reporting: a collaborative hospital study.
        Qual Saf Health Care. 2006; 15: 39-43
        • Lagoo J
        • et al.
        Development and feasibility testing of a Device Briefing Tool and training to improve patient safety during introduction of new devices in operating rooms: best practices and lessons learned.
        J Surg Res. 2019; 244: 579-586