When Surgery Stops: A Quantitative Video Analysis of Workflow During Laparoscopic Surgery

Introduction: Interruptions in surgical workflow has been shown to lead to OR inefficiencies and patient injury; however, we lack knowledge as to what causes these interruptions and to what degree these interruption affect the procedure time (PT). Workflow is a result of teamwork, thus interruptions were analyzed based on their effect on the teamwork rather than individual performance. This project analyzed 5 cases of laparoscopic surgery to identify team activities inside the OR that are not directly related to the on-going surgery (non-surgery related activities – NSRA) and examine their impact on surgical workflow.
Methods: We have captured 25 cases of laparoscopic anti-reflux surgeries performed by an expert laparoscopic surgeon at Legacy Health System in 2006. For all 25 cases both the room view and the laparoscope view were recorded and synchronized with the audio. As a pilot study 5 of these cases have been analyzed. From these 5 cases we have identified all of the NSRA occurring in the OR. The NSRA are further categorized based on their impact on PT. The duration of the NSRA along with the PT was calculated using JVideo (analysis software).
Results:Average procedure time of these 5 cases is 120 min. The most common NSRA occurring in the OR during surgery was talking, which occurred in the OR for 22.3 ±14.0 min. on average (18.6% of procedure time), followed by instrument change (11.0 ± 4.5; 9.2%), phone call/page (10.2 ± 13.4; 8.5%), and shift/break or position change (2.4 ± 1.2; 2%). Not all NSRA stop the workflow of the surgery, in most instances surgery continued while some of the surgical team were participating in NSRA. On average NSRA stopped surgery 4.1 min per case (3.4%). Stops in surgical workflow are mainly caused by instrument inavailability and surgeons and assistants changing positions.
Discussion: All NSRA affect the surgical performance in someway. NSRA that don’t stop the workflow are still unfavorable because they can distract the surgical team and decrease team performance. NSRA that delay surgical workflow lengthen PT, which increases costs. In this project NSRA stopped surgical workflow for 4.1 min. This is likely due to the superior work of a dedicated team. We expect this number will go up when surgery is performed by an non-dedicated team on a wider range of surgical procedures. By identifying NSRA that delay surgical workflow we can implement measures to prevent the delay of surgery and increase OR efficiency.

Session: Podium Presentation

Program Number: S054

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