Human Factors and Systems Integration in High Technology Surgery (HF-SIgHTS)

项目摘要 手术仍然是一项高风险的奋进，每年有超过4000起“从不”事件， 意外伤害的机会。虽然新的外科技术旨在使患者受益， 可能会引入意想不到的新的复杂性和错误模式， 组织可能没有准备。高科技手术最普遍的例子之一是机器人 辅助手术（RAS），这已经证明了好处，但也引入了一系列新的挑战， 在团队中额外强调沟通、技术和程序知识， 手术室的可用空间。我们将评估多种干预措施，以解决这些具体问题， 挑战，测试团队合作培训，任务设计和工作空间管理的新方法， 在4个不同的医院地点单独和联合使用。将在个体（使用 干预;工作量）、过程（手术持续时间和中断）和系统（并发症和安全性 文化）水平。定性访谈和观察将用于了解执行情况， 干预措施的传播。最后，来自680例计划手术观察的数据-最大的直接 进行的观察研究-将用于通过探索机制来模拟事故原因， 这些小的无害的过程问题会串联成更严重的风险和最终的伤害。这将 从根本上提高我们对创新手术技术如何安全部署的理解， 整合在复杂的临床工作系统中。

PROJECT SUMMARY Surgery remains a high-risk endeavor, with upwards of 4000 “never” events per year, and multiple additional opportunities for accidental injuries. Though new surgical technologies are intended to benefit patients, they can introduce unexpected new complexities and error modes for which operating room (OR) teams and host organizations may be unprepared. One of the most ubiquitous exemplars of high-technology surgery is robotic assisted surgery (RAS), which has demonstrated benefit, but also introduces a range of new challenges that place additional stresses on communication, technical and procedural knowledge within the team, and the available space in the operating room. We will evaluate multiple interventions to address these specific challenges, testing new approaches to teamwork training, task design, and workspace management both individually and in combination, at 4 different hospital sites. The effects will be evaluated at individual (use of intervention; workload), process (surgical durations and disruptions) and systems (complications and safety culture) levels. Qualitative interviews and observations will be used to understand the implementation and spread of the interventions. Finally, data from the 680 planned surgical observations – the largest direct observation study ever conducted – will be used to model accident causation by exploring the mechanism by which small innocuous process problems concatenate into more serious risks and eventual injuries. This will fundamentally improve our understanding of how innovative surgical technologies can be safely deployed and integrated within complex clinical work systems.