Abstract
The Observational Clinical Human Reliability Assessment (OCHRA) can be used to score errors during surgical procedures. To construct an OCHRA-checklist, steps, substeps, and hazards of a surgical procedure need to be defined. A step-by-step framework was developed to segment surgical procedures into steps, substeps, and hazards. The first aim of this study was to investigate if the step-by-step framework could be used to construct an accurate Lichtenstein open inguinal hernia repair (LOIHR) stepwise description. The second aim was to investigate if the OCHRA-checklist based on this stepwise description was accurate and useful for surgical training and assessment. Ten expert surgeons rated statements regarding the accuracy of the LOIHR stepwise description, the accuracy, and the usefulness of the LOIHR OCHRA-checklist (eight, seven, and six statements, respectively) using a 5-point Likert scale. One-sample Wilcoxon signed-rank test was used to compare the outcomes to the neutral value of 3. The accuracy of the stepwise description and the accuracy and usefulness of the OCHRA-checklist were rated statistically significantly higher than the neutral value of 3 (median 4.75 [5.00-4.00] with p=.009, median 5.00 [5.00-4.00] with p=.012, median 4.00 [5.00-4.00] with p=.047, respectively). The experts rated the OCHRA-checklist to be useful for the training (5.00 [5.00-4.00], p=.009), and assessment (4.50 [5.00-4.00], p=.010) of surgical residents. This preliminary study showed that the stepwise LOIHR description constructed using the step-by-step framework was found to be accurate. The LOIHR OCHRA-checklist developed using the stepwise description was also accurate, and particularly useful for the training and assessment of proficiency of surgical residents.
Highlights
Adverse events are frequent within the surgical field
Five of the ten experts have performed individually more than 3000 open inguinal hernia repairs and have published individually more than 50 hernia-related papers
What is the total amount of open inguinal hernia repairs performed in your clinic annually? (n)
Summary
A systematic review reported surgical adverse events in approximately 14% of pa tients, which were potentially preventable in more than one-third of cases [1]. These adverse events are mainly due to human errors. The second aim was to investigate if the OCHRA-checklist based on this stepwise description was accurate and useful for surgical training and assessment. The LOIHR OCHRA-checklist developed using the stepwise descrip tion was accurate, and useful for the training and assessment of proficiency of surgical residents
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