Measuring and evaluating standardization of scrub nurse instrument table setups: a multi-center study.

OBJECTIVES: In-depth knowledge about surgical processes is a crucial prerequisite for future systems in operating rooms and the advancement of standards and patient safety in surgery. A holistic approach is required, but research in the field of surgical instrument tables, standardized instrument setups and involved personnel, such as nurses, is sparse in general. The goal of this study is to evaluate whether there is an existing standard within clinics for an instrument table setup. We also evaluate to which extent it is known to the personnel and whether it is accepted. MATERIALS AND METHODS: The study makes use of the Nosco Trainer, a scrub nurse training and simulation system developed to analyze various aspects of the workplace of scrub nurses. The system contains a virtual instrument table, which is used to perform and record instrument table setups. We introduce a metric which delivers a measurable score for the similarity of surgical instrument table setups. The study is complemented with a questionnaire covering related aspects. RESULTS: Fifteen scrub nurses of the Otolaryngology departments at three clinics in Germany and Switzerland performed a table setup for a Functional Endoscopic Sinus Surgery intervention and completed the questionnaire. The analysis of the developed metric with a leave one out cross-validation correctly allocated 14 of the 15 participants to their clinic. DISCUSSION: In contrast to the identified similarities of table setups within clinics with the collected data, only a third of the participants confirmed in the questionnaire that there is an existing table setup standard for Functional Endoscopic Sinus Surgery interventions in their facility, but almost three quarters would support a written standard and acknowledge its possible benefits for trainees and new entrants in the operating room. CONCLUSIONS: The structured analysis of the surgical instrument table using a data-driven metric for comparison is a novel approach to gain deeper knowledge about intra-operative processes. The insights can contribute to patient safety by improving the workflow between surgeon and scrub nurse and also open the way for goal-oriented standardization.

Design and evaluation of an eye tracking support system for the scrub nurse.

BACKGROUND: The availability of an increasing number of medical devices in the digital operating room has led to increased interaction demands of the surgical staff. To counteract the risk of bacterial contamination induced by device interactions, touchless interaction techniques are required. Support systems based on eye tracking enable interaction while maintaining sterility and freeing the hands to manipulate surgical instruments. METHODS: A system using eye tracking glasses was developed. In an evaluation, participants completed tasks using gaze gestures. Three use cases were evaluated in an intraoperative setup. System performance, user acceptance, and workload were measured. RESULTS: The system was evaluated in a laboratory environment with 26 participants. The precision of the gaze gesture recognition is 97.9%, and the true positive rate is 98.5%. The participants rated the system useful and were satisfied. CONCLUSIONS: Touchless interaction ensures sterility, although the increasing availability of medical devices in the operating room.

Auditory display as feedback for a novel eye-tracking system for sterile operating room interaction.

PURPOSE: The growing number of technical systems in the operating room has increased attention on developing touchless interaction methods for sterile conditions. However, touchless interaction paradigms lack the tactile feedback found in common input devices such as mice and keyboards. We propose a novel touchless eye-tracking interaction system with auditory display as a feedback method for completing typical operating room tasks. Auditory display provides feedback concerning the selected input into the eye-tracking system as well as a confirmation of the system response. METHODS: An eye-tracking system with a novel auditory display using both earcons and parameter-mapping sonification was developed to allow touchless interaction for six typical scrub nurse tasks. An evaluation with novice participants compared auditory display with visual display with respect to reaction time and a series of subjective measures. RESULTS: When using auditory display to substitute for the lost tactile feedback during eye-tracking interaction, participants exhibit reduced reaction time compared to using visual-only display. In addition, the auditory feedback led to lower subjective workload and higher usefulness and system acceptance ratings. CONCLUSION: Due to the absence of tactile feedback for eye-tracking and other touchless interaction methods, auditory display is shown to be a useful and necessary addition to new interaction concepts for the sterile operating room, reducing reaction times while improving subjective measures, including usefulness, user satisfaction, and cognitive workload.

Design and evaluation of an interactive training system for scrub nurses.

OBJECTIVE: The current trend toward increasingly integrated technological support systems and the rise of streamlined processes in the OR have led to a growing demand for personnel with higher levels of training. Although simulation systems are widely used and accepted in surgical training, they are practically non-existent for perioperative nursing, especially scrub nursing. This paper describes and evaluates an interactive OR environment simulation to help train scrub nurses. METHODS: A system comprising multiple computers and monitors, including an interactive table and a touchscreen combined with a client-server software solution, was designed to simulate a scrub nurse's workplace. The resulting demonstrator was evaluated under laboratory conditions with a multicenter interview study involving three participating ear, nose, and throat (ENT) departments in Germany and Switzerland. RESULTS: The participant group of 15 scrub nurses had an average of 12.8 years hands-on experience in the OR. A series of 22 questions was used to evaluate various aspects of the demonstrator system and its suitability for training novices. DISCUSSION: The system received very positive feedback. The participants stated that familiarization with instrument names and learning the instrument table setup were the two most important technical topics for beginners. They found the system useful for acquiring these skills as well as certain non-technical aspects. CONCLUSIONS: Interactive training through simulation is a new approach for preparing novice scrub nurses for the challenges at the instrument table in the OR. It can also improve the lifelong training of perioperative personnel. The proposed system is currently unique in its kind. It can be used to train both technical and non-technical skills and, therefore, contributes to patient safety. Moreover, it is not dependent on a specific type of surgical intervention or medical discipline.

Intra-operative surgical instrument usage detection on a multi-sensor table.

PURPOSE: Automatic detection, classification and recording of operating room (OR) activities in real time during a surgical procedure requires a wide range of sensors to gather information on the activities of the surgeon and staff, the patient, and the OR equipment. The surgical instrument currently being used is an important parameter used to assess the instantaneous operating room status. An automated system was developed that detects unmodified surgical instruments in real time using a sensor-based table. METHODS: A multi-sensor operating room table was designed featuring a 2D camera, digital scale, and infrared camera. Software was developed to detect and record the sequence of changes on the table during a surgical procedure. The detection rates were evaluated under laboratory conditions by recording the observed instrument usage in 27 functional endoscopic sinus surgeries (FESS). RESULTS: The detection rate achieved using video-based detection alone was 84.9 %. The total detection rate achieved with the combined approach using both video- and weight-based information was 90.3 %. CONCLUSION: A multi-sensor table-based automated instrument tracking system was developed that provides a foundation for the intra-operative detection of surgical instruments without modifying the instruments in the surgical tray. This system was tested and found to satisfy clinical FESS requirements with a reasonable accuracy. This system may also be useful to improve patient safety, for example to prevent instruments being left in the patient.