Simulated laparoscopic operating room crisis: An approach to enhance the surgical team performance

被引：57

作者：

Powers, Kinga A. ^{[1
]}

Rehrig, Scott T. ^{[1
]}

Irias, Noel ^{[3
]}

Albano, Hedwig A. ^{[4
]}

Malinow, Andrew ^{[3
]}

Jones, Stephanie B. ^{[5
]}

Moorman, Donald W. ^{[1
]}

Pawlowski, John B. ^{[5
]}

Jones, Daniel B. ^{[1
,2
]}

机构：

[1] Harvard Univ, Sch Med, Dept Surg, Sect Minimally Invas Surg,Beth Israel Deaconnness, Boston, MA 02115 USA

[2] Beth Israel Deaconess Med Ctr, Carl J Shapiro Simulat & Skills Ctr, Boston, MA 02215 USA

[3] Harvard Univ, Sch Med, Beth Israel Deaconess Med Ctr, Carl J Shapiro Simulat & Skills Ctr, Boston, MA 02115 USA

[4] Harvard Univ, Sch Med, Beth Israel Deaconess Med Ctr, Dept Nursing, Boston, MA 02115 USA

[5] Harvard Univ, Sch Med, Beth Israel Deaconess Med Ctr, Dept Anaesthesia, Boston, MA 02115 USA

来源：

SURGICAL ENDOSCOPY AND OTHER INTERVENTIONAL TECHNIQUES | 2008年 / 22卷 / 04期

关键词：

simulation; team training; laparoscopy; education; surgery;

D O I：

10.1007/s00464-007-9678-x

中图分类号：

R61 [外科手术学];

学科分类号：

摘要：

Objective Diminishing human error and improving patient outcomes is the goal of task training and simulation experience. The fundamentals of laparoscopic surgery (FLS) is a validated tool to assess technical laparoscopic skills. We hypothesize that performance in a crisis depends on technical skills and team performance. The aim of this study was to develop and validate a high-fidelity simulation model of a laparoscopic crisis scenario in a mock endosuite environment. Methods To establish the feasibility of the model as well as its face and construct validity, the scenario evaluated the performances of FLS-certified surgeon experts (n = 5) and non-FLS certified novices (n = 5) during a laparoscopic crisis scenario, in a mock endosuite, on a simulated abdomen. Likert scale questionnaires were used for validity assessments. Groups were compared using previously validated rating scales on technical and nontechnical performance. Objective outcome measures assessed were: time to diagnose bleeding (TD), time to inform the team to convert (TT), and time to conversion to open (TC). SAS software was used for statistical analysis. Results Median scores for face validity were 4.29, 4.43, 4.71 (maximum 5) for the FLS, non-FLS, and nursing groups, respectively, with an inter-rater reliability of 93%. Although no difference was observed in Veress needle safety and laparoscopic equipment set up, there was a significant difference between the two groups in their overall technical and nontechnical abilities (p < 0.05), specifically in identifying bleeding, controlling bleeding, team communication, and team skills. There was a trend towards a difference between the two groups for TD, TT, and TC. While experts controlled bleeding in a shorter time, they persisted longer laparoscopically. Conclusions Our evidence suggests that face and construct validity are established for a laparoscopic crisis simulation in a mock endosuite. Technical and nontechnical performance discrimination is observed between novices and experts. This innovative multidisciplinary simulation aims at improving error/problem recognition and timely initiation of appropriate and safe responses by surgical teams.

引用

页码：885 / 900

页数：16

共 34 条

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