Does your team know how to respond safely to an operating room fire? Outcomes of a virtual reality, AI-enhanced simulation training.

BACKGROUND: Operating room (OR) fires are rare but devastating events requiring immediate and effective response. Virtual Reality (VR) simulation training can provide a safe environment for practice of skills in such highly stressful situation. This study assessed interprofessional participants' ability to respond to VR-simulated OR fire scenarios, attitudes, numbers of attempt of the VR simulation do participants need to successfully respond to OR fires and does prior experience, confidence level, or professional role predict the number of attempts needed to demonstrate safety and pass the simulation. METHODS: 180 surgical team members volunteered to participate in this study at Beth Israel Deaconess Medical Center, Boston, MA. Each participant completed five VR OR simulation trials; the final two trials incorporated AI assistance. Primary outcomes were performance scores, number of attempts needed to pass, and pre- and post-survey results describing participant confidence and experiences. Differences across professional or training role were assessed using chi-square tests and analyses of variance. Differences in pass rates over time were assessed using repeated measures logistic regression. RESULTS: One hundred eighty participants completed simulation testing; 170 (94.4%) completed surveys. Participants included surgeons (17.2%), anesthesiologists (10.0%), allied health professionals (41.7%), and medical trainees (31.1%). Prior to training, 45.4% of participants reported feeling moderately or very confident in their ability to respond to an OR fire. Eight participants (4.4%) responded safely on the first simulation attempt. Forty-three participants (23.9%) passed by the third attempt (VR only); an additional 97 participants (53.9%) passed within the 4-5th attempt (VR with AI assistance). CONCLUSIONS: Providers are unprepared to respond to OR fires. VR-based simulation training provides a practical platform for individuals to improve their knowledge and performance in the management of OR fires with a 79% pass rate in our study. A VR AI approach to teaching this essential skill is innovative, feasible, and effective.

Unintended consequences for patients denied bariatric surgery: a 12-year follow-up.

BACKGROUND: Many patients who seek weight loss surgery are denied an operation because of insurance barriers, psychological concerns, and poor medical fitness for surgery. OBJECTIVE: The aim of this cohort study was to study the causes and outcomes of selected patients denied metabolic and bariatric surgery (MBS). SETTING: Academic, accredited bariatric program. METHODS: From January to December 2007, a multidisciplinary, accredited MBS program denied 107 patients surgery. Twelve years later a retrospective chart review and phone survey was conducted. Qualitative and quantitative analysis was performed using Χ2 and t test, respectively. RESULTS: Forty patients either declined participation or were lost to follow-up. Of 64 remaining patients, 13 patients were noted to have been ineligible for surgery by National Institutes of Health criteria. Three additional patients were excluded from the study. Of the remaining 51 denied patients, 24 patients (47%) ultimately underwent MBS at a later date. These patients had less severe hypertension (P < .05), hyperlipidemia (P < .05), diabetes (P < .05), and pain (P < .05) in comparison to those who never underwent MBS. All 24 patients were alive at 12-year follow-up compared with the 27 patients who did not undergo MBS, of which 12 (44%) were deceased at 12-year follow-up (P < .05). Of note, 10 of the remaining 15 living patients who did not undergo MBS are eligible today based on National Institutes of Health consensus criteria. CONCLUSION: This study found that most patients who were initially turned away from MBS ultimately satisfied qualification criteria. Those who are denied MBS represent a vulnerable group of patients who may never seek MBS again despite eventually qualifying. These patients may benefit from continued follow-up and counseling to achieve weight loss.