J. Sujka1, W. Havron1, K. Safcsak1, I. Bhullar1 1Orlando Regional Medical Center,Department Of Surgical Education,Orlando, FL, USA
Introduction:
~~Advances in technology have improved access to physicians and increased demand for immediate response regarding patient care. These interruptions have become accepted even in the operating room. The purpose of this study was to use simulation based operative distractions during laparoscopic cholecystectomies (LC) to determine if these interruptions affected operative time, operative safety, and appropriate management of pager issue.
Methods:
~~Utilizing a Simbionix Lap Mentor II simulator we tested 10 surgical resident volunteers (PGY 2-5) with previous experience in LC. Each resident performed 2 training modules to familiarize themselves with the simulator followed by 6 simulated LC; 3 with interruptions (INT) and 3 with no interruptions (NO-INT). The order of the 6 LC was randomized for each resident. During the INT cholecystectomy a page interruption was sent to the resident pager which was answered by the examiner. Effective management of the pager-issue was determined on a pass/fail basis based on appropriate questions asked and effective resolution of issue. These pages were timed to coincide with the dissection of critical view of safety and clipping of the cystic duct. Data was also collected by the simulator for the following operative endpoints: time to completion of LC, safety and efficiency of cautery, instrument movement, total cautery time, and complications of common bile duct injury and gallbladder perforation.
Results:
~~10 surgical residents were tested: 2 PGY-II, 3 PGY-III, 3 PGY-IV, and 2 PGY-V. There was no significant difference in the total time (minutes) required to complete the LC between the two groups, (NO-INT vs. INT, 6.3 ± 2.7 vs. 6.2 ± 2.2, p=0.9). There were no major complications of common bile duct injury in either group. Although a higher number of gallbladder perforation complications occurred in the NO-INT group this did not reach significance. There was no significant difference between the two groups for the operative end points: safety and efficiency of cautery, average left or right instrument movement (cm/sec), and total cautery time (secs). However, the residents failed to adequately address and resolve the patient issues of the pager interruption. The patient on the floor suffered and did not receive adequate care. Nine out of the 10 residents failed to ask the appropriate questions and 9 of the 10 residents failed to effectively manage the patient problem. The mean failure rate for questioning was 45% and for resolving the issue 28%.
Conclusion:
~~Although pager interruptions did not affect the operative patient (time to completion or complications), there were significant failures in the appropriate evaluation and management of the pager issue and floor patient. Consideration for diversion of floor patient care issues to fellow residents not in the operating room to improve quality and safety of patient care requires further study.