System Factors Affecting Patient Safety in the OR: An Analysis of Safety Threats and Resiliency.

OBJECTIVE: The objective of this study is to determine the characteristics and frequency of intraoperative safety threats and resilience supports using a human factors measurement tool. BACKGROUND: Human factors analysis can provide insight into how system elements contribute to intraoperative adverse events. Empiric evidence on safety threats and resilience in surgical practice is lacking. METHODS: A cross-sectional study of 24 patients undergoing elective laparoscopic general surgery at a single center in the Netherlands from May to November, 2017 was conducted. Video, audio, and patient physiologic data from all included procedures were obtained through a multichannel synchronized recording device. Trained analysts reviewed the recordings and coded safety threats and resilience supports. The codes were categorized into 1 of 6 categories (person, task, tools and technology, physical environment, organization, and external environment). RESULTS: A median of 14 safety threats [interquartile range (IQR) 11-16] and 12 resilience supports (IQR 11-16) were identified per case. Most safety threat codes (median 9, IQR 7-12) and resilience support codes (median 10, IQR 7-12) were classified in the person category. The organization category contained a median of 2 (IQR 1-2) safety threat codes and 2 (IQR 2-3) resilience support codes per case. The tools and technology category contributed a small number of safety threats (median 1 per case, IQR 0-1), but rarely provided resilience support. CONCLUSIONS: Through a detailed human factors analysis of elective laparoscopic general surgery cases, this study provided a quantitative analysis of the existing safety threats and resilience supports in a modern endoscopic operating room.

Development of a Model for Video-Assisted Postoperative Team Debriefing.

BACKGROUND: Video-assisted debriefing may be a powerful tool to improve surgical team performance. Nevertheless, a true operating team debriefing culture is lacking to date. This study aimed to find evidence on how to debrief the surgical team and develop a model suitable for debriefing using a video and medical data recorder (MDR) in the operating room (OR). METHODS: A review of the PubMed and Embase databases and Cochrane Library was performed. The identified literature was studied and combined with a conceptual framework to develop a model for postoperative video-assisted team debriefing. Thirty-five surgical cases were recorded with an MDR and debriefed with the operating team using the proposed debrief model and a standardized video-assisted performance report. A questionnaire was used to assess the participants' satisfaction with this debrief model. RESULTS: Debrief models and methods are extensively described in the current medical literature. An overview was provided. The OR team needs a structured debrief model, minimizing resource, effort, and motivational constraints. A structured six-step team debrief model suitable for video-assisted OR team debriefing was developed. The model was tested in 35 multidisciplinary MDR-assisted debriefing sessions and the debriefing sessions were overall rated with a mean of 7.8 (standard deviation 1.4, 10-point Likert scale) by participants. CONCLUSIONS: Debriefing surgical teams using a video and MDR in the OR requires a model on how to use such recordings optimally. To date, no such model existed. The proposed debrief model was tested using a multisource MDR and may be used to facilitate OR debriefing across various settings.

Pain patterns in chronic pancreatitis: a nationwide longitudinal cohort study.

OBJECTIVE: Pain in chronic pancreatitis is subdivided in a continuous or intermittent pattern, each thought to represent a different entity, requiring specific treatment. Because evidence is missing, we studied pain patterns in a prospective longitudinal nationwide study. DESIGN: 1131 patients with chronic pancreatitis (fulfilling M-ANNHEIM criteria) were included between 2011 and 2018 in 30 Dutch hospitals. Patients with continuous or intermittent pain were compared for demographics, pain characteristics, quality of life (Short-Form 36), imaging findings, disease duration and treatment. Alternation of pain pattern and associated variables were longitudinally assessed using a multivariable multinomial logistic regression model. RESULTS: At inclusion, 589 patients (52%) had continuous pain, 231 patients (20%) had intermittent pain and 311 patients (28%) had no pain. Patients with continuous pain had more severe pain, used more opioids and neuropathic pain medication, and had a lower quality of life. There were no differences between pain patterns for morphological findings on imaging, disease duration and treatment. During a median follow-up of 47 months, 552 of 905 patients (61%) alternated at least once between pain patterns. All alternations were associated with the Visual Analogue Scale pain intensity score and surgery was only associated with the change from pain to no pain. CONCLUSION: Continuous and intermittent pain patterns in chronic pancreatitis do not seem to be the result of distinctly different pathophysiological entities. The subjectively reported character of pain is not related to imaging findings or disease duration. Pain patterns often change over time and are merely a feature of how severity of pain is experienced.