Flow disruptions during delivery room intubation of neonates with congenital diaphragmatic hernia.

Aim: Flow disruptions (FDs) are deviations in the progression of care that compromise safety and efficiency of a specific process. Neonatal intubation is a life-saving high-risk procedure required for delivery room (DR) management of neonates with moderate to severe congenital diaphragmatic hernia (CDH). This study evaluated FDs during DR intubation of neonates with CDH and their association with process and outcome measures.

Coordination patterns as markers of brittleness (and resilience) in complex systems: a sterile processing case study.

Coordination underpins adaptive capacity in resilient systems. However, research on specific patterns of coordination as they relate to adaptive capacity is relatively scarce. The study focuses on the Sterile Processing Department (SPD) as an exemplar of a large complex system with significant coordination challenges.

Retained Central Venous Catheter Guidewires: Interviews With Clinicians Who Have Made the Error.

Objectives: Central venous catheter whole guidewire retention is a serious, preventable patient safety incident that should not occur. Complications include guidewire migration, potentially resulting in cardiac perforation and tamponade. Despite national policy designed to prevent guidewire retention, this error still occurs.

Miscommunication associated with flow disruptions in the robotic operating room.

Background: Miscommunication in the robotic operating room occurs up to 3 times per hour and is a significant contributor to patient harm. In robotic surgery, environmental distractors exacerbate miscommunication and flow disruptions, elevating the risk of patient harm.

Methods: We directly observed 75 robotic surgeries and assessed miscommunication associated with flow disruptions using a custom observational instrument.

Using SEIPS 101 Tools to Model Surgical Count Processes.

Objectives: Retained foreign objects (RFOs) are a frequent sentinel event that may cause significant harm to patients. The surgical count is the primary prevention measure for RFOs, yet there has been limited research into the system factors that interact in this process. The objective of this study is to create SEIPS 101 tools that help to better understand the contributing systems factors.

Rethinking Anesthesia Medication "Errors": The OR-SMART Patient Safety Learning Laboratory.

Purpose: We combine the results of multiple studies to describe a systems engineering approach to a well-recognized patient safety problem. The goal of the Operating Room Systems-based Medication Administration error Reduction Team (OR-SMART) patient safety learning laboratory was to study the anesthesia medication work system to identify the characteristics of technologies and interventions that might feasibly reduce anesthesia medication errors.

Scope: The work was conducted at 2 large urban academic medical centers: Johns Hopkins (JHU) and the Medical University of South Carolina (MUSC).

Modeling anesthesia medication delivery using the SEIPS 101 tools.

Reducing the risk of patient harm during anesthesia medication administration in perioperative settings has been a long-term goal in patient safety. SEIPS 101 tools, provide a series of practice-orientated techniques to apply systems model in real clinical practice, potentially offering a straightforward approach to mapping perioperative medication delivery systems. Data was collected during direct observations of thirty-eight anesthetics, totaling over 100 h on anesthesia providers' common tasks and interactions with people, environments, tools, and technologies.

Proposing Design Evaluation Metrics for Anesthesia Providers' Workspace in Ambulatory Surgical Settings.

This paper describes the development and utilization of two design evaluation metrics aimed to measure design performance for improving circulation and workflow, situational awareness, and visibility for medication-related activities for anesthesia providers' within their workspace in operating rooms. Proactive performance evaluation of the design of critical areas such as operating rooms can help improve the safety of patients and staff workflows. This paper builds on previous work on task-switching behaviors in anesthesia workspaces to develop performance-based design evaluation metrics for anesthesia providers' workspaces based on their tasks performed during the patient preparation, intra-operative, and post-operative phases of the surgery, considering the presence of multiple anesthesia providers.

Speech communication interference in the robotic operating room.

Miscommunication in the OR is a threat to patient safety and surgical efficiency. Our objective was to measure the frequency and causes of communication interference between robotic team members. We observed 78 robotic surgeries over 215 h.

Developing methods to identify resilience and improve communication about diagnosis in pediatric primary care.

Communication underlies every stage of the diagnostic process. The Dialog Study aims to characterize the pediatric diagnostic journey, focusing on communication as a source of resilience, in order to ultimately develop and test the efficacy of a structured patient-centered communication intervention in improving outpatient diagnostic safety. In this manuscript, we will describe protocols, data collection instruments, methods, analytic approaches, and theoretical frameworks to be used in to characterize the patient journey in the Dialog Study.

Revealing complex interdependencies in surgical instrument reprocessing using SEIPS 101 tools.

Sterile Processing Departments (SPDs) must clean, maintain, store, and organize surgical instruments which are then delivered to Operating Rooms (ORs) using a Courier Network, with regular coordination occurring across departmental boundaries. To represent these relationships, we utilized the Systems Engineering Initiative for Patient Safety (SEIPS) 101 Toolkit, which helps model how health-related outcomes are affected by healthcare work systems. Through observations and interviews which built on prior work system analyses, we developed a SEIPS 101 journey map, PETT scan, and tasks matrices to represent the instrument reprocessing work system, revealing complex interdependencies between the people, tools, and tasks occurring within it.

The impact of resident training on robotic operative times: is there a July Effect?

It is unknown whether the July Effect (a theory that medical errors and organizational inefficiencies increase during the influx of new surgical residents) exists in urologic robotic-assisted surgery. The aim of this study was to investigate the impact of urology resident training on robotic operative times at the beginning of the academic year. A retrospective chart review was conducted for urologic robotic surgeries performed at a single institution between 2008 and 2019.

Healthcare team resilience during COVID-19: a qualitative study.

Background: Resilience, in the field of Resilience Engineering, has been identified as the ability to maintain the safety and the performance of healthcare systems and is aligned with the resilience potentials of anticipation, monitoring, adaptation, and learning. In early 2020, the COVID-19 pandemic challenged the resilience of US healthcare systems due to the lack of equipment, supply interruptions, and a shortage of personnel. The purpose of this qualitative research was to describe resilience in the healthcare team during the COVID-19 pandemic with the healthcare team situated as a cognizant, singular source of knowledge and defined by its collective identity, purpose, competence, and actions, versus the resilience of an individual or an organization.

The movement of syringes and medication during anesthesiology delivery: An observational study in laparoscopic surgeries.

The movements of syringes and medications during an anesthetic case have yet to be systematically documented. We examine how syringes and medication move through the anesthesia work area during a case. We conducted a video-based observational study of 14 laparoscopic surgeries.

The IDEAL framework for surgical robotics: development, comparative evaluation and long-term monitoring.

The next generation of surgical robotics is poised to disrupt healthcare systems worldwide, requiring new frameworks for evaluation. However, evaluation during a surgical robot's development is challenging due to their complex evolving nature, potential for wider system disruption and integration with complementary technologies like artificial intelligence. Comparative clinical studies require attention to intervention context, learning curves and standardized outcomes.

Speech Communication Interference in the Operating Room.

Introduction: Operating room communication is frequently disrupted, raising safety concerns. We used a Speech Interference Instrument to measure the frequency, impact, and causes of speech communication interference (SCI) events.

Methods: In this prospective study, we observed 40 surgeries, primarily general surgery, to measure the frequency of SCI, defined as "group discourse disrupted according to the participants, the goals, or the physical and situational context of the exchange.

Anesthesia Workspaces for Safe Medication Practices: Design Guidelines.

Background: Studies show that workspace for the anesthesia providers is prone to interruptions and distractions. Anesthesia providers experience difficulties while performing critical medication tasks such as medication preparation and administration due to poor ergonomics and configurations of workspace, equipment clutter, and limited space which ultimately may impact patient safety, length of surgery, and cost of care delivery. Therefore, improving design of anesthesia workspace for supporting safe and efficient medication practices is paramount.

Associations of flow disruptions with patient, staff, and process outcomes: a prospective observational study of robotic-assisted radical prostatectomies.

Background: Technological advancements in the operating room (OR) have sparked new challenges for surgical workflow, OR professionals, and patient safety. Disruptive events are frequent across all surgical specialties, but little is known about their effects on patient outcomes and the influence of systemic factors. The aim was to explore the associations of intraoperative flow disruptions (FDs) with patient outcomes, staff workload, and surgery duration.

Demands of surgical teams in robotic-assisted surgery: An assessment of intraoperative workload within different surgical specialties.

Background: Current approaches to assessing workload in robotic-assisted surgery (RAS) focus on surgeons and lack real-world data. Understanding how workload varies by role and specialty aids in identifying effective ways to optimize workload.

Methods: SURG-TLX surveys with six domains of workload were administered to surgical staff at three sites.

Identifying Workflow Disruptions in Robotic-Assisted Bariatric Surgery: Elucidating Challenges Experienced by Surgical Teams.

Purpose: Bariatric surgery is an effective and durable treatment for weight loss for patients with extreme obesity. Although traditionally approached laparoscopically, robotic bariatric surgery (RBS) has unique benefits for both surgeons and patients. Nonetheless, the technological complexity of robotic surgery presents new challenges for OR teams and the wider clinical system.

Anticipating adaptation: tracking the impact of planned and unplanned adaptations during the implementation of a complex population-based genomic screening program.

In 2021, the Medical University of South Carolina (MUSC) launched In Our DNA SC. This large-scale initiative will screen 100,000 individuals in South Carolina for three preventable hereditary conditions that impact approximately two million people in the USA but often go undetected. In anticipation of inevitable changes to the delivery of this complex initiative, we developed an approach to track and assess the impact of evaluate adaptations made during the pilot phase of program implementation.