Abstract
Background
Interruptions in operative flow are known to increase team stress and errors in the
operating room. Device-related interruptions are an increasing area of focus for surgical
safety, but common safety processes such as the Surgical Safety Checklist do not adequately
address surgical devices. We assessed the impact of the Device Briefing Tool, a communication
instrument for surgical teams, on device-related interruptions in a large academic
referral center in Singapore.
Methods
The Device Briefing Tool was implemented in 4 general surgery departments, with 4
additional departments serving as a comparator group. Trained observers evaluated
device-related interruption incidence in live operations at baseline and after implementation.
Changes in device-related interruption frequency were assessed in each group using
Poisson regression, with and without adjustment for surgical department and device
complexity. Subgroup analyses assessed the impact of the Device Briefing Tool by device
type.
Results
A total of 210 operations were evaluated by observers. In the Device Briefing Tool
group, there were 38.6 and 27.2 device-related interruptions per 100 cases at baseline
and after Device Briefing Tool implementation, respectively (difference –23%, P = .0047, adjusted difference –28%, P = .0013). Device-related interruption frequency in the comparator group remained
stable across study periods. Point estimates indicated reductions in device-related
interruptions for all device types, reaching statistical significance for circular
staplers (–26%, P = .0049).
Conclusion
Implementation of the Device Briefing Tool was associated with a 28% reduction in
device-related interruptions. Proactive approaches to improving surgical device safety
are crucial in the technology-driven landscape of modern surgical care. Future efforts
will assess formal integration of the Device Briefing Tool into institution-wide surgical
safety processes.
Graphical abstract
Graphical Abstract
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to SurgeryAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Error, stress, and teamwork in medicine and aviation: cross sectional surveys.BMJ. 2000; 320: 745-749
- The effect of interruption duration and demand on resuming suspended goals.J Exp Psychol Appl. 2008; 14: 299-313
- Identification and interference of intraoperative distractions and interruptions in operating rooms.J Surg Res. 2014; 188: 21-29
- Disruptions in surgical flow and their relationship to surgical errors: an exploratory investigation.Surgery. 2007; 142: 658-665
- Surgical technology and operating-room safety failures: a systematic review of quantitative studies.BMJ Qual Saf. 2013; 22: 710-718
- Safe Use of Surgical Staplers and Staples: Letter to Health Care Providers.United States Food and Drug Administration, 2019
- Development and feasibility testing of a device briefing tool and training to improve patient safety during introduction of new devices in operating rooms: best practices and lessons learned.J Surg Res. 2019; 244: 579-586
- Utility of a device briefing tool to improve surgical safety.J Surg Res. 2022; 280: 218-225
- SQUIRE 2.0 (Standards for QUality Improvement Reporting Excellence): revised publication guidelines from a detailed consensus process.BMJ Qual Saf. 2016; 25: 986-992
- Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies.BMJ. 2007; 335: 806-808
- Characterization of device-related interruptions in minimally invasive surgery: need for intraoperative data and effective mitigation strategies.Surg Endosc. 2019; 33: 717-723
- Frequency of device-related interruptions using a scalable assessment tool.Jt Comm J Qual Patient Saf. 2022; 48: 534-538
- Using human factors engineering to improve patient safety in the cardiovascular operating room.Work. 2012; 41: 1801-1804
- Medical devices.https://www.who.int/health-topics/medical-devicesDate accessed: December 13, 2021
- Recently approved devices.https://www.fda.gov/medical-devices/device-approvals-denials-and-clearances/recently-approved-devicesDate accessed: December 14, 2021
- High incidence of technical errors involving the EEA circular stapler: a single institution experience.J Am Coll Surg. 2010; 210: 331-335
- Perception of safety of surgical practice among operating room personnel from survey data is associated with all-cause 30-day postoperative death rate in South Carolina.Ann Surg. 2017; 266: 658-666
- Implementation of safety checklists in surgery: a realist synthesis of evidence.Implement Sci. 2015; 10: 137
- Commentary: Checklist fatigue? A unique opportunity in cardiac surgical care: the impact of a voluntary, cardiac surgery-specific safety checklist.J Thorac Cardiovasc Surg. 2020; 159: 1891-1892
Article info
Publication history
Published online: January 10, 2023
Accepted:
December 11,
2022
Publication stage
In Press Corrected ProofIdentification
Copyright
© 2022 Elsevier Inc. All rights reserved.
