A pilot study of non-routine events in gynecological surgery

Type, impact, and effect

Katherine E. Law, Emily A. Hildebrand, Hunter J. Hawthorne, M. Susan Hallbeck, Russell Branaghan, Sean C. Dowdy, Renaldo C. Blocker

Research output: Contribution to journalArticle

Abstract

Objective: Quantifying non-routine events (NREs) assists with identify underlying sociotechnical factors that could lead to adverse events. NREs are considered any event that is unusual or atypical during surgical procedures. This study aimed to use prospective observations to characterize the occurrence of non-routine events in gynecological surgeries. Methods: Observational data were collected prospectively within one surgical gynecology department over a five month period. Researchers captured NREs in real time using a validated tablet PC-based tool according to the NRE type, impact, whom was affected, and duration. Researchers also noted what surgical approach (i.e. open, laparoscopic, robotic) was used. Results: Across 45 surgical cases, 554 non-routine events (M = 12.31 NREs per case, SD = 9.81) were identified. The majority of non-routine events were external interruptions (40.3%), teamwork (26.7%), or equipment (21.3%). The circulating nurse was most frequently affected by NREs (43.2%) followed by the entire surgical team (13.7%). There was no statistically significant difference in non-routine events based on surgical approach. Conclusion: Non-routine events are prevalent in the gynecological surgical setting. Identifying the sociotechnical factors that influence non-routine events are important in determining interventions that will combat the associated risks. Interventions focusing on teamwork, managing external interruptions, and coordinating equipment may have the greatest impact to reduce or eliminate NREs in gynecological surgeries.

Original languageEnglish (US)
JournalGynecologic Oncology
DOIs
StateAccepted/In press - Jan 1 2018

Fingerprint

Gynecologic Surgical Procedures
Research Personnel
Equipment and Supplies
Robotics
Gynecology
Tablets
Nurses

Keywords

  • Gynecological surgery
  • Human factors
  • Non-routine events
  • Teamwork

ASJC Scopus subject areas

  • Oncology
  • Obstetrics and Gynecology

Cite this

Law, K. E., Hildebrand, E. A., Hawthorne, H. J., Hallbeck, M. S., Branaghan, R., Dowdy, S. C., & Blocker, R. C. (Accepted/In press). A pilot study of non-routine events in gynecological surgery: Type, impact, and effect. Gynecologic Oncology. https://doi.org/10.1016/j.ygyno.2018.11.035

A pilot study of non-routine events in gynecological surgery : Type, impact, and effect. / Law, Katherine E.; Hildebrand, Emily A.; Hawthorne, Hunter J.; Hallbeck, M. Susan; Branaghan, Russell; Dowdy, Sean C.; Blocker, Renaldo C.

In: Gynecologic Oncology, 01.01.2018.

Research output: Contribution to journalArticle

Law, Katherine E. ; Hildebrand, Emily A. ; Hawthorne, Hunter J. ; Hallbeck, M. Susan ; Branaghan, Russell ; Dowdy, Sean C. ; Blocker, Renaldo C. / A pilot study of non-routine events in gynecological surgery : Type, impact, and effect. In: Gynecologic Oncology. 2018.
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abstract = "Objective: Quantifying non-routine events (NREs) assists with identify underlying sociotechnical factors that could lead to adverse events. NREs are considered any event that is unusual or atypical during surgical procedures. This study aimed to use prospective observations to characterize the occurrence of non-routine events in gynecological surgeries. Methods: Observational data were collected prospectively within one surgical gynecology department over a five month period. Researchers captured NREs in real time using a validated tablet PC-based tool according to the NRE type, impact, whom was affected, and duration. Researchers also noted what surgical approach (i.e. open, laparoscopic, robotic) was used. Results: Across 45 surgical cases, 554 non-routine events (M = 12.31 NREs per case, SD = 9.81) were identified. The majority of non-routine events were external interruptions (40.3{\%}), teamwork (26.7{\%}), or equipment (21.3{\%}). The circulating nurse was most frequently affected by NREs (43.2{\%}) followed by the entire surgical team (13.7{\%}). There was no statistically significant difference in non-routine events based on surgical approach. Conclusion: Non-routine events are prevalent in the gynecological surgical setting. Identifying the sociotechnical factors that influence non-routine events are important in determining interventions that will combat the associated risks. Interventions focusing on teamwork, managing external interruptions, and coordinating equipment may have the greatest impact to reduce or eliminate NREs in gynecological surgeries.",
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