Intra-operative disruptions, surgeon's mental workload, and technical performance in a full-scale simulated procedure
Intra-operative disruptions, surgeon's mental workload, and technical performance in a full-scale simulated procedure
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DOI：
10.1007/s00464-015-4239-1
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发表时间：
2016-02-01
影响因子：
3.1
通讯作者：
Catchpole, Ken
中科院分区：
文献类型：
--
作者：
Weigl, Matthias;Stefan, Philipp;Catchpole, Ken
手术流程中断经常发生，并危及围手术期护理和手术性能。到目前为止，对外科医生术中中断的主观和认知影响以及对性能的固有后果的见解是不一致的。本研究旨在探讨手术流程中断对外科医生术中工作量和技术性能的影响。在一个全尺寸的OR模拟中，19名外科医生被随机分配到两种中断场景（电话与患者不适）中的任何一种。使用具有计算机化的高保真人体模型的混合虚拟现实模拟器，所有外科医生都接受了进行椎体成形术手术的培训，随后在实验条件下进行了此类手术。收集了主观工作负荷和技术性能的标准化指标（套管针定位偏离专家定义的标准、X线采集次数和持续时间）。模拟中断情况下的术中工作负荷显著高于培训课程（p < .01）。与患者不适场景中的同事相比，打电话场景中的外科医生经历的注意力分散明显更多（p < .05）。然而，外科医生的工作量往往会增加，因为他们会因患者不适而分心。两种中断情景之间的技术性能没有显著差异。我们发现外科医生的术中工作量和技术表现之间存在显著相关性，例如，心理工作量增加的外科医生往往表现更差（β = 0.55，p = 0.04）。脑力负荷的增加与技术表现的下降有关。我们基于模拟的研究结果强调需要建立平稳的手术流程，其特征在于低水平的过程偏差和中断。
Surgical flow disruptions occur frequently and jeopardize perioperative care and surgical performance. So far, insights into subjective and cognitive implications of intra-operative disruptions for surgeons and inherent consequences for performance are inconsistent. This study aimed to investigate the effect of surgical flow disruption on surgeon's intra-operative workload and technical performance.In a full-scale OR simulation, 19 surgeons were randomly allocated to either of the two disruption scenarios (telephone call vs. patient discomfort). Using a mixed virtual reality simulator with a computerized, high-fidelity mannequin, all surgeons were trained in performing a vertebroplasty procedure and subsequently performed such a procedure under experimental conditions. Standardized measures on subjective workload and technical performance (trocar positioning deviation from expert-defined standard, number, and duration of X-ray acquisitions) were collected.Intra-operative workload during simulated disruption scenarios was significantly higher compared to training sessions (p < .01). Surgeons in the telephone call scenario experienced significantly more distraction compared to their colleagues in the patient discomfort scenario (p < .05). However, workload tended to be increased in surgeons who coped with distractions due to patient discomfort. Technical performance was not significantly different between both disruption scenarios. We found a significant association between surgeons' intra-operative workload and technical performance such that surgeons with increased mental workload tended to perform worse (beta = .55, p = .04).Surgical flow disruptions affect surgeons' intra-operative workload. Increased mental workload was associated with inferior technical performance. Our simulation-based findings emphasize the need to establish smooth surgical flow which is characterized by a low level of process deviations and disruptions.