An ethnographic study on the impact of a novel telemedicine-based support system in the operating room
An ethnographic study on the impact of a novel telemedicine-based support system in the operating room
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DOI：
10.1093/jamia/ocac138
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发表时间：
2022-08-19
影响因子：
6.4
通讯作者：
Avidan, Michael S.
中科院分区：
文献类型：
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作者：
Abraham, Joanna;Meng, Alicia;Avidan, Michael S.
目的手术室麻醉控制塔（ACT）远程评估手术进展，提供实时围手术期风险预警，向床边临床医生传达风险缓解建议。我们的目标是识别和绘制ACT- or非常规事件(NREs)-风险诱导或风险缓解工作流程偏差-并确定ACT对临床工作流程和患者安全的影响。材料和方法我们使用人种学方法，包括在83例手术中跟踪ACT和OR的临床医生，收集人工制品，对发送到OR的决策警报进行图表审查，以及对10名临床医生进行访谈。我们采用以人为因素系统为导向的混合主题分析方法来评估ACT对安全的作用和影响，并进行内容分析来评估NREs。结果在83个病例中，触发了469个风险警报，ACT向手术室发送了280条护理建议。共观察NREs 135例。促进ACT在支持患者安全方面发挥作用的关键因素包括提供后备支持和提供手术室决策的新视角。阻碍ACT的因素包括信息时机、ACT和OR临床医生的认知失误。改进建议包括调整ACT消息内容（结构、时间、表示），并结合预测分析进行高级规划。Discussion ACT作为具有远程监控功能的安全网，以及具有反馈/审计功能的学习型医疗保健系统。支持战略包括适应性协调和利用临床医生/患者支持来提高acts的可持续性。研究结果为未来术中远程医疗设计提供参考，以降低安全风险。结论在常规围手术期护理中引入类似的远程技术增强，可显著提高数百万手术患者的安全性和质量。
Objective The Anesthesiology Control Tower (ACT) for operating rooms (ORs) remotely assesses the progress of surgeries and provides real-time perioperative risk alerts, communicating risk mitigation recommendations to bedside clinicians. We aim to identify and map ACT-OR nonroutine events (NREs)-risk-inducing or risk-mitigating workflow deviations-and ascertain ACT's impact on clinical workflow and patient safety. Materials and Methods We used ethnographic methods including shadowing ACT and OR clinicians during 83 surgeries, artifact collection, chart reviews for decision alerts sent to the OR, and 10 clinician interviews. We used hybrid thematic analysis informed by a human-factors systems-oriented approach to assess ACT's role and impact on safety, conducting content analysis to assess NREs. Results Across 83 cases, 469 risk alerts were triggered, and the ACT sent 280 care recommendations to the OR. 135 NREs were observed. Critical factors facilitating ACT's role in supporting patient safety included providing backup support and offering a fresh-eye perspective on OR decisions. Factors impeding ACT included message timing and ACT and OR clinician cognitive lapses. Suggestions for improvement included tailoring ACT message content (structure, timing, presentation) and incorporating predictive analytics for advanced planning. Discussion ACT served as a safety net with remote surveillance features and as a learning healthcare system with feedback/auditing features. Supporting strategies include adaptive coordination and harnessing clinician/patient support to improve ACT's sustainability. Study insights inform future intraoperative telemedicine design considerations to mitigate safety risks. Conclusion Incorporating similar remote technology enhancement into routine perioperative care could markedly improve safety and quality for millions of surgical patients.