[Clinical efficiency and the influence of human factors on ear, nose, and throat navigation systems]. / Ist der Vorteil eines Navigationssystems in der HNO-Chirurgie messbar? Ein Konzept zur Evaluation ergonomischer und chirurgischer Erfolgsparameter.

BACKGROUND: The aim of this study was to evaluate the Navibase navigation system for ear, nose, and throat (ENT) surgery. A new methodology for evaluating surgical and human factors is developed. PATIENTS AND METHODS: The evaluation is based on 102 ENT surgical applications, including 89 cases of functional endoscopic sinus surgery (FESS). The evaluation of surgical and human factors was performed by seven ENT surgeons. To evaluate surgical performance, level of quality (LOQ) in the 89 cases of FESS was determined, comparing the surgeon's own impressions with those of the navigation system on a scale from 0 to 100 and further comparing them with clinical results. Intraoperative changes in surgical strategy were documented. The human factors of total confidence (trust), situation awareness, skill set requirement and workload shift were recorded as level of reliance (LOR). RESULTS: The maximum deviation amounted to 1.93 mm. Averaging the quality of information resulted in an LOQ of 63.59. Every second application of the navigation system (47.9%) led to a change in surgical strategy. Total confidence showed a positive evaluation of 3.35 points in LOR. CONCLUSION: Application-relevant information relevant to the application beyond only technical details permits comparison with other assisting systems.

Role transition for patient care vice presidents: from a single entity to a system focus.

The authors describe the process used and outcomes achieved by five patient care vice presidents who became a cohesive working group after the system integration of their separate organizations. Overcoming the hurdles that face any emerging group, these nurse executives developed a common patient-centered care delivery system and common leadership structure. They committed to four major leadership roles with common obligations and expectations for patient care vice presidents and hospital presidents, and role changes in terms of time spent as coach, interventionist, and crisis manager.