Surgical innovation
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Surgical innovation · Jun 2007
Surgical robotics for patient safety in the perioperative environment: realizing the promise.
Surgery is at a crossroads of complexity. However, there is a potential path toward patient safety. One such course is to leverage computer and robotic assist techniques in the reduction and interception of error in the perioperative environment. ⋯ The paper will briefly review the current status of surgical robotics and summarize any conclusions that can be reached to date based on existing research. It will then lay out a roadmap for future research to determine how surgical robots should be optimally designed and integrated into the perioperative workflow and process. Successful movement down this path would involve focused efforts and multiagency collaboration to address the research priorities outlined, thereby realizing the full potential of surgical robotics to augment human capabilities, enhance task performance, extend the reach of surgical care, improve health care quality, and ultimately enhance patient safety.
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Surgical innovation · Jun 2007
Improving operating room and perioperative safety: background and specific recommendations.
The 1999 Institute of Medicine report To Err Is Human put a spotlight on death from preventable medical errors. Surgically related errors are second only to medication errors as the most frequent cause of error-related death. Although many hospitals have ongoing programs to improve medication safety, most hospitals are not focused in a meaningful way on operating room (OR) safety despite the import of the OR to the hospital's finances and despite clearly efficacious available technologies. ⋯ Actual adverse events are relatively rare in any given OR suite, but near misses are rather common. It is possible to learn much from evaluating near misses (along with adverse events) with root-cause analyses and then instituting changes in processes and systems to assist humans from making their inevitable errors. This article outlines approaches that when combined can markedly improve safety in the OR.
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Surgical innovation · Dec 2006
The effect of direct-from-recovery room discharge of laparoscopic cholecystectomy patients on recovery room workload.
Ambulatory laparoscopic cholecystectomy pathways move patients through the hospital without encountering delays caused by congested inpatient bed units. However, redirecting patients to a direct discharge pathway might not be beneficial if recovery capacity is further taxed by additional workload. In this study, we attempt to assess the operational impact on recovery room workload of directly discharging laparoscopic cholecystectomy patients to home. ⋯ The times (mean; 95% confidence interval) to meet objective criteria for adequate pain control (3.5 minutes [2.1 to 5.9] versus 4.0 minutes [2.6 to 6.1]) and readiness for discharge from phase 1 recovery (8.1 minutes [4.8 to 13.6] versus 6.1 minutes [4.0 to 9.5]) were not different between the groups. The number and distribution of interventions documented in the recovery process were not different between groups, nor was there a difference in recovery room length of stay (158 minutes [138 to 182] versus 149 minutes [132 to 167]). In our study, recovery room records reveal little if any increased workload associated with the direct-to-home discharge of laparoscopic cholecystectomy patients.
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Surgical innovation · Sep 2006
ReviewTraining teams for the perioperative environment: a research agenda.
A research agenda for investigating the impact of team-work training on patient safety in the perioperative environment is presented. The current status of teamwork training is reviewed briefly, and conclusions based on existing research are presented. We present a roadmap for future research on how teamwork training should be structured, delivered, and evaluated to optimize patient safety in the operating room. ⋯ However, simply installing a team structure without addressing the organizational context of care--the culture--does not automatically ensure it will operate effectively. Factors associated with the design of teamwork training, measures of training effectiveness, and the assessment process that should be explored in near-term work (1 to 2 years) are addressed. We also address the impact of the organizational environment, including the role of institutional support and culture, that need to be explored in longer term research (3 to 5 years).
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Surgical innovation · Sep 2006
Case ReportsTherapeutic endoscopic retrograde cholangiopancreatography for the treatment of Fasciola hepatica presenting as biliary obstruction.
Human infection with the Fasciola hepatica liver fluke is a rare cause of biliary obstruction, especially within the United States. Humans can become accidental hosts of this parasite by ingesting contaminated drinking water or plants. ⋯ During the chronic stage of infection, the parasite may remain asymptomatic for many years. This article presents a case of biliary obstruction due to Fasciola hepatica that was diagnosed and treated successfully with endoscopic retrograde cholangiopancreatography.