Abstract
ObjectivesIn-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 MethodsThe 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.ResultsFifteen 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.DiscussionIn 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.ConclusionsThe 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.
Highlights
Standardization of surgical interventions with the goal of streamlining processes while improving patient safety is a topic that has been tackled from various angles
Traditional approaches for improving patient safety by reducing ineffective and inefficient surgical processes are the development of surgical guidelines [1] and operating room (OR) standards [2]
The topic of how to set up the instrument table for an intervention is typically taught on the job by a senior scrub nurse supervising the newcomers. 66.7% stated that they set up the table as they were trained for it (Q6.4), compared to 33.3% who stated they were following an in-house standard (Q6.5)
Summary
Standardization of surgical interventions with the goal of streamlining processes while improving patient safety is a topic that has been tackled from various angles. Traditional approaches for improving patient safety by reducing ineffective and inefficient surgical processes are the development of surgical guidelines [1] and operating room (OR) standards [2]. These approaches could potentially benefit from novel process analysis methods and implementation strategies. International Journal of Computer Assisted Radiology and Surgery (2022) 17:479–485 nizing methods such as Lean Management and Six Sigma techniques [6] Both analysis and organization are means to get closer to the aspired operating room of the future, which is dependent on the integrity of processes and procedural standards to acquire increased safety, efficacy and cost-effectiveness [7]. The necessity of including a wider range in the efforts for standardization has already been recognized, but detailed research on many influential factors is still missing
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