Dataset Information

Stepwise development of a simulation environment for operating room teams: the example of vertebroplasty.

ABSTRACT: Background:Despite the growing importance of medical simulation in education, there is limited guidance available on how to develop medical simulation environments, particularly with regard to technical and non-technical skills as well as to multidisciplinary operating room (OR) team training. We introduce a cognitive task analysis (CTA) approach consisting of interviews, structured observations, and expert consensus to systematically elicit information for medical simulator development. Specifically, our objective was to introduce a guideline for development and application of a modified CTA to obtain task demands of surgical procedures for all three OR professions with comprehensive definitions of OR teams' technical and non-technical skills. Methods:To demonstrate our methodological approach, we applied it in vertebroplasty, a minimally invasive spine procedure. We used a CTA consisting of document reviews, in situ OR observations, expert interviews, and an expert consensus panel. Interviews included five surgeons, four OR nurses, and four anesthetists. Ten procedures were observed. Data collection was carried out in five OR theaters in Germany. Results:After compiling data from interviews and observations, we identified 6 procedural steps with 21 sub-steps for surgeons, 20 sub-steps for nurses, and 22 sub-steps for anesthetists. Additionally, we obtained information on 16 predefined categories of intra-operative skills and requirements for all three OR professions. Finally, simulation requirements for intra-operative demands were derived and specified in the expert panel. Conclusions:Our CTA approach is a feasible and effective way to elicit information on intra-operative demands and to define requirements of medical team simulation. Our approach contributes as a guideline to future endeavors developing simulation training of technical and non-technical skills for multidisciplinary OR teams.

SUBMITTER: Pfandler M

PROVIDER: S-EPMC6158852 | biostudies-other | 2018

REPOSITORIES: biostudies-other

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Stepwise development of a simulation environment for operating room teams: the example of vertebroplasty.

Pfandler Michael M Stefan Philipp P Wucherer Patrick P Lazarovici Marc M Weigl Matthias M

Advances in simulation (London, England) 20180926

<h4>Background</h4>Despite the growing importance of medical simulation in education, there is limited guidance available on how to develop medical simulation environments, particularly with regard to technical and non-technical skills as well as to multidisciplinary operating room (OR) team training. We introduce a cognitive task analysis (CTA) approach consisting of interviews, structured observations, and expert consensus to systematically elicit information for medical simulator development. ...[more]

PMID: 30275986

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Project description:BackgroundSince operating rooms are a major bottleneck resource and an important revenue driver in hospitals, it is important to use these resources efficiently. Studies estimate that between 60 and 70% of hospital admissions are due to surgeries. Furthermore, staffing cannot be changed daily to respond to changing demands. The resulting high complexity in operating room management necessitates perpetual process evaluation and the use of decision support tools. In this study, we evaluate several management policies and their consequences for the operating theater of the University Hospital Augsburg.MethodsBased on a data set with 12,946 surgeries, we evaluate management policies such as parallel induction of anesthesia with varying levels of staff support, the use of a dedicated emergency room, extending operating room hours reserved as buffer capacity, and different elective patient sequencing policies. We develop a detailed simulation model that serves to capture the process flow in the entire operating theater: scheduling surgeries from a dynamically managed waiting list, handling various types of schedule disruptions, rescheduling and prioritizing postponed and deferred surgeries, and reallocating operating room capacity. The system performance is measured by indicators such as patient waiting time, idle time, staff overtime, and the number of deferred surgeries.ResultsWe identify significant trade-offs between expected waiting times for different patient urgency categories when operating rooms are opened longer to serve as end-of-day buffers. The introduction of parallel induction of anesthesia allows for additional patients to be scheduled and operated on during regular hours. However, this comes with a higher number of expected deferrals, which can be partially mitigated by employing additional anesthesia teams. Changes to the sequencing of elective patients according to their expected surgery duration cause expectable outcomes for a multitude of performance indicators.ConclusionsOur simulation-based approach allows operating theater managers to test a multitude of potential changes in operating room management without disrupting the ongoing workflow. The close collaboration between management and researchers in the design of the simulation framework and the data analysis has yielded immediate benefits for the scheduling policies and data collection efforts at our practice partner.

Dataset Information

Stepwise development of a simulation environment for operating room teams: the example of vertebroplasty.

Publications

Stepwise development of a simulation environment for operating room teams: the example of vertebroplasty.

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