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Non-technical skills and device-related interruptions in minimally invasive surgery

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Abstract

Background

Device-related interruptions in the operating room (OR) may create stress among health care providers and delays. Although non-technical skills (NTS) of the OR teams, such as situational awareness and communication, are expected to influence device-related interruptions, empirical data on this relationship are limited.

Methods

We performed a prospective cohort study of 144 consecutive elective laparoscopic operations during 13 months. A data capture system called the OR Black Box® was used to characterize device-related interruptions, NTS, and distractions. Device-related interruptions were classified according to a priori established categories. Positive and negative NTS instances were identified according to validated measurement tools specific for nurses and surgeons. We assessed the relationship between NTS and device-related interruptions after adjusting for potential confounders.

Results

A total of 86 device-related interruptions occurred in 48 of 144 operations (33%). They were most frequently classified as device failure (54%) followed by improper assembly (19%) and disconnection (14%). Medians of 1 [interquartile range (IQR) 0–3] and 1 (IQR 0–2) negative NTS instance per operation were demonstrated by nurses and surgeons, respectively. Medians of 28 (IQR 15–38) and 40 (IQR 28–118) positive NTS instances per operation were demonstrated by nurses and surgeons. In a multivariable analysis, a higher frequency of negative NTS instances demonstrated by nurses was associated with device-related interruptions after risk adjustment (Odds Ratio 1.33, p = 0.02).

Conclusions

In elective laparoscopic operations, an increased likelihood of device-related interruptions in the OR was associated with more frequent negative NTS demonstrations by nursing teams.

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Authors and Affiliations

  1. Department of Surgery, International Centre for Surgical Safety, Li Ka Shing Knowledge Institute, University of Toronto, St. Michael’s Hospital, 209 Victoria Street, 8th Floor East, Toronto, ON, M5B 1T8, Canada

    Sahil Sharma, Teodor Grantcharov & James J. Jung

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  1. Sahil Sharma
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  2. Teodor Grantcharov
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Correspondence to Sahil Sharma.

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Disclosures

Dr. Teodor Grantcharov holds intellectual property ownership of Surgical Safety Technologies Inc. and is supported by research grants from Medtronic Canada, Ethicon Canada, Baxter Canada, Olympus Canada, Takeda Canada, and Intuitive Surgical. Dr. James J. Jung and Mr. Sahil Sharma have no conflicts of interest or financial ties to disclose.

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Sharma, S., Grantcharov, T. & Jung, J.J. Non-technical skills and device-related interruptions in minimally invasive surgery. Surg Endosc 35, 4494–4500 (2021). https://doi.org/10.1007/s00464-020-07962-1

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