The Application of Human Factors Engineering to Reduce Operating Room Turnover in Robotic Surgery.
The Application of Human Factors Engineering to Reduce Operating Room Turnover in Robotic Surgery.
复制标题
人因工程学在机器人手术中应用减少手术室周转率。
DOI：
10.1007/s00268-022-06487-z
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发表时间：
2022
影响因子：
2.6
通讯作者：
Shouhed,Daniel
中科院分区：
文献类型：
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作者：
Cohen,TaraN;Anger,JenniferT;Shamash,Kevin;Catchpole,KennethR;Avenido,Raymund;Ley,EricJ;Gewertz,BruceL;Shouhed,Daniel
在机器人手术中，与周转时间相关的挑战被放大了。先进技术的引入增加了本已复杂的围手术期环境的复杂性。我们应用人为因素方法来开发系统的、数据驱动的干预措施，以减少机器人手术的周转时间。方法对某三级医院40例机器人手术患者进行观察[干预前20例（2018年1月至2018年4月），干预后20例（2019年1月至2019年6月）]。周转时间的组成部分，包括清洁、仪器和房间设置、机器人准备、流程中断和主要延误，都被记录和分析。采用问卷调查和焦点小组调查员工对机器人手术周转时间的看法。一个由人为因素专家和医生组成的多学科小组制定了有针对性的干预措施。比较干预前和干预后的流失率。结果中转时间中位数为67 min（平均72 min，标准差24 min），严重延误22例（1.1例/例）。最大的贡献是仪器设置（25.5分钟）和清洁（25分钟）。干预措施包括一个电子仪表板，用于报告周转时间，明确指定角色和同时完成任务，手术室清洁的流程标准化，以及通过月度报告实现数据透明度。干预后的人员流失率显著缩短（U= 57.5,p= 0.000），并出现了10次重大延误。结论通过人为因素分析，提出了改善离职时间的干预措施。干预后出现了显著的改善，周转时间减少了26分钟，重大延误减少了50%以上。未来干预和进一步改善周转时间的机会包括针对术前和术后护理阶段。
BackgroundChallenges associated with turnover time are magnified in robotic surgery. The introduction of advanced technology increases the complexity of an already intricate perioperative environment. We applied a human factors approach to develop systematic, data-driven interventions to reduce robotic surgery turnover time.MethodsResearchers observed 40 robotic surgery turnovers at a tertiary hospital [20 pre-intervention (Jan 2018 to Apr 2018), 20 post-intervention (Jan 2019 to Jun 2019)]. Components of turnover time, including cleaning, instrument and room set-up, robot preparation, flow disruptions, and major delays, were documented and analyzed. Surveys and focus groups were used to investigate staff perceptions of robotic surgery turnover time. A multidisciplinary team of human factors experts and physicians developed targeted interventions. Pre- and post-intervention turnovers were compared.ResultsMedian turnover time was 67 min (mean: 72, SD: 24) and 22 major delays were noted (1.1/case). The largest contributors were instrument setup (25.5 min) and cleaning (25 min). Interventions included an electronic dashboard for turnover time reporting, clear designation of roles and simultaneous completion of tasks, process standardization of operating room cleaning, and data transparency through monthly reporting. Post-intervention turnovers were significantly shorter (U= 57.5,p= .000) and ten major delays were noted.ConclusionsHuman factors analysis generated interventions to improve turnover time. Significant improvements were seen post-intervention with a reduction in turnover time by a 26 min and decrease in major delays by over 50%. Future opportunities to intervene and further improve turnover time include targeting pre- and post-operative care phases.