A Conceptual Model For Tool Handling In The Operation Room

Abstract

Background & Objectives: There are 98,000 deaths in the US annually due to errors in the delivery of healthcare causing inpatient mortality and morbidity. Among these errors, ineffective team interaction in the operating room (OR) accounts for one of the main causes. Recently, it has been suggested that developing a conceptual model of verbal and non-verbal exchanges in the OR could lead to a better understanding of the dynamics among the surgical team, and this in turn, could result in a reduction in miscommunication in the OR. In this work, we describe the main principles characterizing the Object-Process Methodology (OPM). This methodology enables to describe the complex interactions between surgeons and the surgical staff while delivering surgical instruments during a procedure. The main objective of such a conceptual model is to assess when and how errors occur during the requests and delivery of instruments, and how to avoid those. Methods: The conceptual model was constructed from direct observations of surgical procedures and eventual miscommunications cases in the OR. While the interactions in the OR are rather complex, the compact ontology of OPM allows stateful objects and processes to interact mutually and generate measurable outcomes. The instances modeled are related to verbal and non-verbal communication (e.g. gestures, proxemics) and the potential mistakes are modeled as processes that deviate for the “blue ocean” scenario. The OPM model was constructed through an iterative process of data collection through observation, modeling, brainstorming, and synthesis. This conceptual model provides the basis for new theories and frameworks needed to characterize operating OR communication. Results: The model adopted can accurately express the intricate that take place in the OR during a surgical procedure. A key component of the conceptual model is the ability to specify the features at various levels of detail, and each level represented through a different diagram. Nevertheless, each diagram is contextually linked to all the others. The resulting model, thus, provides a powerful and expressive ontology of verbal and non-verbal communication exchanges in the OR. Concretely, the model is validated through structured questionnaires, which allows assessing the level of consensus for criteria such as flexibility, accuracy, and it generality. Conclusion: A conceptual model was presented describing the tools handling processes during operations conducted at the OR. The focus is placed on communication exchanges between the main surgeon and the surgical technician. The objective is to create a tool to debug and identify the exact circumstances in which surgical delivery errors can happen. Our next step is the implementation of robotic assistant for the OR, which can deliver and retrieve surgical instruments. A necessary requirement for the introduction of such cybernetic solution is the development of a concise specification of these interactions in the OR. The development of this conceptual model can have a significant impact in both the reduction in tool-handling-related errors, and the formal designing robots which could complement surgical technicians in their routine tool handling activities during surgery.