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.
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.
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%).
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.