Ambulatory Movements, Team Dynamics and Interactions during Robot-Assisted Surgery.
- Citation:
- Ahmad, N., A. A. Hussein, L. Cavuoto, M. Sharif, J. C. Allers, N. Hinata, B. Ahmad, J. G. Kozlowski, Z. Hashmi, A. Bisantz, et al., "Ambulatory Movements, Team Dynamics and Interactions during Robot-Assisted Surgery.", BJU international, 2016 Jan 22.
Abstract:
OBJECTIVE: To analyze ambulatory movements and team dynamics during robot-assisted surgery (RAS), and investigate whether congestion of the physical space associated with RA technology led to workflow challenges, or predisposed to errors and adverse events.
METHODS: With IRB approval, we retrospectively reviewed 10 recorded RA radical prostatectomies in a single operating room (OR). OR was divided into 8 zones, and all movement were tracked and described in terms of start and end zones, duration, personnel, and purpose. Movement were further classified into avoidable (can be eliminated/improved) and unavoidable (necessary for completion of the procedure).
RESULTS: Mean operative time was 166 minutes, of which ambulation constituted 27 minutes (16%). A total of 2,896 ambulatory movements were identified (mean=290 ambulatory movements/procedure). Most of movements were procedure-related (31%), and were performed by the circulating nurse. We identified 11 main pathways in the OR (Figure 1); the heaviest traffic was between the Circulating Nurse Zone, Transit Zone and Supply-1 Zone.Fifty percent of ambulatory movements were found to be avoidable.
CONCLUSION: More than half of the movements during RAS can be eliminated with an improved OR setting. More studies are needed to design an evidence-based OR layout that enhances access, workflow and patient safety. This article is protected by copyright. All rights reserved.
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