Dissecting Cardiac Surgery A Video-based Recall Protocol to Elucidate Team Cognitive Processes in the Operating Room
Dissecting Cardiac Surgery A Video-based Recall Protocol to Elucidate Team Cognitive Processes in the Operating Room
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DOI：
10.1097/sla.0000000000003489
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发表时间：
2021-08-01
影响因子：
9
通讯作者：
Yule, Steven J.
中科院分区：
文献类型：
--
作者：
Dias, Roger D.;Zenati, Marco A.;Yule, Steven J.
目的：本研究的目的是从不同团队角色（外科医生、麻醉师和灌注师）的角度阐明外科手术中涉及的认知过程，并提供术中认知过程的全面汇编。背景数据总结：非技术技能在手术团队的表现中起着至关重要的作用，了解手术术中阶段的认知过程对于提高手术室（OR）中患者的安全性至关重要。方法：混合方法的方法，包括半结构化访谈9主题专家。认知任务分析是建立在冠状动脉旁路移植术程序的分层分割和提示回忆协议使用视频小插曲。结果如下：共确定了137个独特的外科认知过程，包括33个决策点，23个关键通信，43个陷阱和38个策略。自我报告的认知工作量变化很大，这取决于团队角色和手术步骤。开发了一个基于网络的仪表板，提供了一个集成的可视化团队的认知过程中的OR，让读者直观地与研究结果进行交互。结论：本研究通过从多个OR团队成员的角度明确心脏手术术中阶段涉及的相关认知过程，推进了当前的知识体系。通过在交互式仪表板中显示研究结果，我们以创新的方式为学员提供新知识，可用于提高学习效果。此外，本研究中使用的方法可用于深入了解手术室中手术不良事件和错误的认知因素。
Objective: The aim of this study was to elucidate the cognitive processes involved in surgical procedures from the perspective of different team roles (surgeon, anesthesiologist, and perfusionist) and provide a comprehensive compilation of intraoperative cognitive processes. Summary Background Data: Nontechnical skills play a crucial role in surgical team performance and understanding the cognitive processes underlying the intraoperative phase of surgery is essential to improve patient safety in the operating room (OR). Methods: A mixed-methods approach encompassing semistructured interviews with 9 subject-matter experts. A cognitive task analysis was built upon a hierarchical segmentation of coronary artery bypass grafting procedures and a cued-recall protocol using video vignettes was used. Results: A total of 137 unique surgical cognitive processes were identified, including 33 decision points, 23 critical communications, 43 pitfalls, and 38 strategies. Self-report cognitive workload varied substantially, depending on team role and surgical step. A web-based dashboard was developed, providing an integrated visualization of team cognitive processes in the OR that allows readers to intuitively interact with the study findings. Conclusions: This study advances the current body of knowledge by making explicit relevant cognitive processes involved during the intraoperative phase of cardiac surgery from the perspective of multiple OR team members. By displaying the research findings in an interactive dashboard, we provide trainees with new knowledge in an innovative fashion that could be used to enhance learning outcomes. In addition, the approach used in the present study can be used to deeply understand the cognitive factors underlying surgical adverse events and errors in the OR.