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The impact of preventable disruption on the operative time for minimally invasive surgery

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Abstract

Background

Current ergonomic studies show that disruption exposes surgical teams to stress and musculoskeletal disorders. This study considers minimally invasive surgery as a sociotechnical process subjected to a variety of disruption events other than those recognized by ergonomic science. The research takes into consideration the impact of preventable disruption on operating time rather than on the physical and emotional status of the surgical team.

Methods

Events inside operating rooms that disturbed operative time were recorded for 17 minimally invasive surgeries. The disruption events were classified into four main areas: prerequisite requirements, work design, communication during surgery, and other. Each area was further classified according to sources of disruption. Altogether, 11 sources of disruption were identified: patient record, protocol and policy, surgical requirements and surgeon preferences, operating table and patient positioning, arrangement of instruments, lighting, monitor, clothing, surgical teamwork, coordination, and other.

Results

Disruption prolonged operative time by more than 32%. Teamwork forms the main source of disruption followed by operating table and patient positioning and arrangement of instruments. These three sources represented approximately 20% of operative time. Failure to follow principles of work design had a significant negative impact, lengthening operative time by approximately 15%. Although lighting and monitors had a relatively small impact on operative time, these factors could create inconvenience and stress within the surgical teams. In addition, the effect of failure to follow surgical protocols and policies or having incomplete patient records may have a limited effect on operative time but could have serious consequences.

Conclusion

This report demonstrates that preventable disruption caused an increase in operative time and forced surgeons and patients to endure unnecessary delay of more than 32%. Such additional time could be used to deal with the pressure of emergency cases and to reduce waiting lists for elective surgery.

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References

  1. Vereczkei A, Feussner H, Negele T, Fritzsche F, Seitz T, Bubb H, Horvath OP (2004) Ergonomic assessment of the static stress confronted by surgeons during laparoscopic cholecystectomy. Surg Endosc 18:1118–1122

    Article  PubMed  CAS  Google Scholar 

  2. Cho MS, Min BS, Hong YK, Lee WJ (2011) Single-site versus conventional laparoscopic appendectomy: comparison of short-term operative outcomes. Surg Endosc 25:36–40

    Article  PubMed  Google Scholar 

  3. Miller DJ, Nelson CA, Oleynikov D (2009) Shortened OR time and decreased patient risk through use of a modular surgical instrument with artificial intelligence. Surg Endosc 23:1099–1105

    Article  PubMed  Google Scholar 

  4. Verdaasdonk EGG, Stassen LPS, van der Elst M, Karesten TM, Dankelman J (2007) Problems with technical equipment during laparoscopic surgery: an observational study. Surg Endosc 21:275–279

    Article  PubMed  CAS  Google Scholar 

  5. Verdaasdonk EGG, Dankelman J, Lang JF, Stassen LPS (2008) Transfer validity of laparoscopic knot-tying training on a VR simulator to a realistic environment: a randomized controlled trial. Surg Endosc 22:1636–1642

    Article  PubMed  CAS  Google Scholar 

  6. Kohn LT, Corrigan JM, Donaldson MS (2000) To err is human: building a safer health system. A report of the committee on quality of health care in America, Institute of Medicine. National Academy Press, Washington, DC

    Google Scholar 

  7. Wiegmann DA, El Bardissi AW, Dearani JA, Daly RC, Sundt TM (2007) Disruptions in surgical flow and their relationship to surgical errors: an exploratory investigation. Surgery 142:658–665

    Article  PubMed  Google Scholar 

  8. Reason JT, Carthey J, De Leval MR (2001) Diagnosing vulnerable system syndrome: an essential prerequisite to effective risk management. Br Med J 10:ii21–ii25

    Google Scholar 

  9. Manser T, Howard SK, Gaba DM (2008) Adaptive coordination in cardiac anaesthesia: a study of situational changes in coordination patterns using a new observation system. Ergonomics 15:1153–1178

    Article  Google Scholar 

  10. van Det MJ, Meijerink WJ, Hoff C, Totte ER, Pierie JP (2009) Optimal ergonomics for laparoscopic surgery in minimally invasive surgery suites: a review and guidelines. Surg Endosc 23:1279–1285

    Article  PubMed  Google Scholar 

  11. Seagull FJ, Sutton E, Lee T, Godinez C, Lee G, Park A (2010) A validated subjective rating of display quality: the Maryland Visual Comfort Scale. Surg Endosc. doi:10.1007/s00464-00010-01220-x

  12. Manasnayakorn S, Cuschiert A, Hanna GB (2009) Ergonomic assessment of optimal operating table height for hand-assisted laparoscopic surgery. Surg Endosc 23:783–789

    Article  PubMed  Google Scholar 

  13. Manasnayakorn S, Cuschieri A, Hanna GB (2008) Ideal manipulation angle and instrument length in hand-assisted laparoscopic surgery. Surg Endosc 22:924–929

    Article  PubMed  CAS  Google Scholar 

  14. Szeto GP, Ho P, Ting AC, Poon JT, Tsang RC, Cheng SW (2010) A study of surgeons’ postural muscle activity during open laparoscopic, and endovascular surgery. Surg Endosc 24:1712–1721

    Article  PubMed  CAS  Google Scholar 

  15. Wauben LS, van Veelen MA, Gossot D, Gossens RH (2006) Application of ergonomics guidelines during minimally invasive surgery: a questionnaire survey of 284 surgeons. Surg Endosc 20(8):1267–1274

    Article  Google Scholar 

  16. Matern U, Koneczny S (2007) Safety, hazards, and ergonomics in the operating room. Surg Endosc 21:1965–1969

    Article  PubMed  Google Scholar 

  17. Etchells E, O’Neill C, Bernstein M (2003) Patient safety in surgery: error detection and prevention. World J Surg 27:936–941

    Article  PubMed  Google Scholar 

  18. Sevdalis N, Forrest D, Undre S, Darzi A, Vincent C (2008) Annoyances, disruptions, and interruptions in surgery: the Disruptions in Surgery Index (DiSI). World J Surg 32:1643–1650

    Article  PubMed  Google Scholar 

  19. Blom EM, Verdaasdonk EGG, Stassen LPS, Stassen HG, Wieringa PA, Dankelman J (2007) Analysis of verbal communication during teaching in operating room and the potentials for surgical training. Surg Endosc 21:1560–1566

    Article  PubMed  CAS  Google Scholar 

  20. Carayon P (2006) Human factors of complex sociotechnical systems. Appl Ergon 37:525–535

    Article  PubMed  Google Scholar 

  21. Phillips NF (2004) Berry and Kohn’s operating room technique, 10th ed. Mosby, St. Louis

  22. Johnson C, Allen RH, Sonderman TA, Wedgwood ID (2007) Attacking waste and variation hospital-wide: a comprehensive lean sigma development. Available at: http://www.iienet.org/uploadedFiles/SHS/Lean%20Sigma%20Deployment%20Columbus%20Regional%20Hospital%20Charles%20Johnson.pdf, viewed on February 2010

  23. Jones D, Mitchell A (2006) Lean thinking for the NHS. National Health Service (NHS) Confederation Report, London

  24. Joosten T, Bongers I, Janssen R (2009) Application of lean thinking to health care: issues and observations. Int J Qual Health Care 21(5):341–347

    Article  PubMed  Google Scholar 

  25. ILO (1995) Introduction to work study, 4th edn. International Labour Office, Geneva

    Google Scholar 

  26. Yin RK (2009) Case study research: design and methodology. SAGE Publication, Thousand Oaks

Download references

Acknowledgment

This research is part of a project entitled Adapted Lean Thinking for Health Care Services. The project has been partially sponsored by the University of Southern Queensland and approved by the Human Research Ethic Committee, Toowoomba and Darling Down Health Service District, Australia. The author gratefully acknowledges the thoughtful time and effort of Queensland Health Project Liaison Officer Ms Sylvia Johnson and all the surgical teams that participated in this study.

Disclosure

Latif Al-Hakim has no conflicts of interest or financial ties to disclose.

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  1. University of Southern Queensland, Toowoomba, QLD, 4350, Australia

    Latif Al-Hakim

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Correspondence to Latif Al-Hakim.

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Al-Hakim, L. The impact of preventable disruption on the operative time for minimally invasive surgery. Surg Endosc 25, 3385–3392 (2011). https://doi.org/10.1007/s00464-011-1735-9

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  • DOI: https://doi.org/10.1007/s00464-011-1735-9

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