scholarly journals A realist process evaluation of robot-assisted surgery: integration into routine practice and impacts on communication, collaboration and decision-making

2017 ◽  
Vol 5 (20) ◽  
pp. 1-140 ◽  
Author(s):  
Rebecca Randell ◽  
Stephanie Honey ◽  
Jon Hindmarsh ◽  
Natasha Alvarado ◽  
Joanne Greenhalgh ◽  
...  
Keyword(s):  
Decision Making ◽  
Process Evaluation ◽  
Video Recording ◽  
Team Training ◽  
Routine Practice ◽  
Successful Implementation ◽  
Robot Assisted ◽  
Cancer Trial ◽  
The Impact ◽  
Robot Assisted Surgery

BackgroundThe implementation of robot-assisted surgery (RAS) can be challenging, with reports of surgical robots being underused. This raises questions about differences compared with open and laparoscopic surgery and how best to integrate RAS into practice.ObjectivesTo (1) contribute to reporting of the ROLARR (RObotic versus LAparoscopic Resection for Rectal cancer) trial, by investigating how variations in the implementation of RAS and the context impact outcomes; (2) produce guidance on factors likely to facilitate successful implementation; (3) produce guidance on how to ensure effective teamwork; and (4) provide data to inform the development of tools for RAS.DesignRealist process evaluation alongside ROLARR. Phase 1 – a literature review identified theories concerning how RAS becomes embedded into practice and impacts on teamwork and decision-making. These were refined through interviews across nine NHS trusts with theatre teams. Phase 2 – a multisite case study was conducted across four trusts to test the theories. Data were collected using observation, video recording, interviews and questionnaires. Phase 3 – interviews were conducted in other surgical disciplines to assess the generalisability of the findings.FindingsThe introduction of RAS is surgeon led but dependent on support at multiple levels. There is significant variation in the training provided to theatre teams. Contextual factors supporting the integration of RAS include the provision of whole-team training, the presence of handpicked dedicated teams and the availability of suitably sized operating theatres. RAS introduces challenges for teamwork that can impact operation duration, but, over time, teams develop strategies to overcome these challenges. Working with an experienced assistant supports teamwork, but experience of the procedure is insufficient for competence in RAS and experienced scrub practitioners are important in supporting inexperienced assistants. RAS can result in reduced distraction and increased concentration for the surgeon when he or she is supported by an experienced assistant or scrub practitioner.ConclusionsOur research suggests a need to pay greater attention to the training and skill mix of the team. To support effective teamwork, our research suggests that it is beneficial for surgeons to (1) encourage the team to communicate actions and concerns; (2) alert the attention of the assistant before issuing a request; and (3) acknowledge the scrub practitioner’s role in supporting inexperienced assistants. It is beneficial for the team to provide oral responses to the surgeon’s requests.LimitationsThis study started after the trial, limiting impact on analysis of the trial. The small number of operations observed may mean that less frequent impacts of RAS were missed.Future workFuture research should include (1) exploring the transferability of guidance for effective teamwork to other surgical domains in which technology leads to the physical or perceptual separation of surgeon and team; (2) exploring the benefits and challenges of including realist methods in feasibility and pilot studies; (3) assessing the feasibility of using routine data to understand the impact of RAS on rare end points associated with patient safety; (4) developing and evaluating methods for whole-team training; and (5) evaluating the impact of different physical configurations of the robotic console and team members on teamwork.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

Research on the Consumer Demand of Decision Making in the E-Commence System Building Process

2011 ◽  
Vol 71-78 ◽  
pp. 2895-2898
Author(s):  
Jian Min Xie ◽  
Qin Qin
Keyword(s):  
Decision Making ◽  
Rough Set ◽  
Consumer Satisfaction ◽  
Rough Set Theory ◽  
Consumer Demand ◽  
Successful Implementation ◽  
Business Decision ◽  
Building Process ◽  
Demand Reduction ◽  
The Impact

In the process of developing e-commerce system, enterprises are able to accurately understand and grasp the needs of the user enterprise that is the key to the successful implementation of e-commerce. Based on this, the article proposed a new method which was based on the process of developing consumer demand for e-business decision-making though a rough set theory. This new approach is built using rough set decision model to calculate the different needs of the impact on consumer satisfaction, come to an important degree of each demand and the demand reduction order. This method overcomes the traditional rough set method cumbersome bottlenecks, and helps operating; cases studies show that the proposed method is simple and effective.

scholarly journals Understanding and applying practitioner and patient views on the implementation of a novel automated Computer-Aided Risk Score (CARS) predicting the risk of death following emergency medical admission to hospital: qualitative study

BMJ Open ◽  
2019 ◽  
Vol 9 (4) ◽  
pp. e026591
Author(s):  
Judith Dyson ◽  
Claire Marsh ◽  
Natalie Jackson ◽  
Donald Richardson ◽  
Muhammad Faisal ◽  
...  
Keyword(s):  
Risk Score ◽  
Blood Test ◽  
Unintended Consequences ◽  
Early Warning Score ◽  
Routine Practice ◽  
Successful Implementation ◽  
Risk Of Death ◽  
Emergency Medical ◽  
Computer Aided ◽  
The Impact

ObjectivesThe Computer-Aided Risk Score (CARS) estimates the risk of death following emergency admission to medical wards using routinely collected vital signs and blood test data. Our aim was to elicit the views of healthcare practitioners (staff) and service users and carers (SU/C) on (1) the potential value, unintended consequences and concerns associated with CARS and practitioner views on (2) the issues to consider before embedding CARS into routine practice.SettingThis study was conducted in two National Health Service (NHS) hospital trusts in the North of England. Both had in-house information technology (IT) development teams, mature IT infrastructure with electronic National Early Warning Score (NEWS) and were capable of integrating NEWS with blood test results. The study focused on emergency medical and elderly admissions units. There were 60 and 39 acute medical/elderly admissions beds at the two NHS hospital trusts.ParticipantsWe conducted eight focus groups with 45 healthcare practitioners and two with 11 SU/Cs in two NHS acute hospitals.ResultsStaff and SU/Cs recognised the potential of CARS but were clear that the score should not replace or undermine clinical judgments. Staff recognised that CARS could enhance clinical decision-making/judgments and aid communication with patients. They wanted to understand the components of CARS and be reassured about its accuracy but were concerned about the impact on intensive care and blood tests.ConclusionRisk scores are widely used in healthcare, but their development and implementation do not usually involve input from practitioners and SU/Cs. We contributed to the development of CARS by eliciting views of staff and SU/Cs who provided important, often complex, insights to support the development and implementation of CARS to ensure successful implementation in routine clinical practice.

scholarly journals Feasibility Assessment for Implementation of Heart Failure Clinical Caremaps using Electronic Medical Records in Primary Practice

2014 ◽  
Vol 4 (2) ◽  
pp. 40-44
Author(s):  
Ritesh Gupta ◽  
Catherine Demers ◽  
Norman Archer ◽  
Karim Keshavjee
Keyword(s):  
Decision Making ◽  
Electronic Medical Records ◽  
Medical Records ◽  
Beta Blockers ◽  
Successful Implementation ◽  
Optimal Care ◽  
Management Tools ◽  
Feasibility Assessment ◽  
Pilot Work ◽  
The Impact

Objectives: The primary aim of this project is to evaluate the impact and level of use of Electronic Medical Records (EMRs) by family physicians (FPs) specifically with respect to HF management. This study provides pilot work towards successful implementation of HF clinical caremaps in EMRs to support decision making for FPs.Methods: A survey questionnaire was sent to 207 FPs from which 42 (20%) replies were received. The survey included questions on demographic information of the FP's practice, specifics about HF patients and their management, EMR use and whether they have improved management in HF patients.  Results: Among the 42 FPs who responded, 39 (93%) practice in the urban area of Hamilton and each have over 10 confirmed HF patients at their family practices, supporting the need for proper management of HF at the primary care level. FPs expressed concerns about difficulty in treating HF preserved vs. systolic HF, in managing HF patients with renal insufficiency and difficulty in the use of beta blockers. There was no consensus on whether EMRs have helped in improving the management of HF patients.Conclusions: There is a perceived need for management tools which can be integrated into EMRs to provide decision making support for FPs in managing HF.  Tools such as caremaps may help provide optimal care in managing HF patients as per the Canadian Cardiovascular Society guidelines.

Do surgeon non-technical skills correlate with teamwork-related outcomes during robot-assisted surgery?

BMJ Leader ◽  
2019 ◽  
Vol 3 (3) ◽  
pp. 69-74
Author(s):  
Youseff Ahmed ◽  
Zaeem Lone ◽  
Ahmed A Hussein ◽  
Yingdong Feng ◽  
Hijab Khan ◽  
...  
Keyword(s):  
Decision Making ◽  
Clinical Outcomes ◽  
Situational Awareness ◽  
Mental Workload ◽  
Pearson Correlation ◽  
Technical Skills ◽  
Robot Assisted ◽  
Perceived Performance ◽  
Nasa Tlx ◽  
The Impact

IntroductionTo evaluate the impact of non-technical skills (NTS) on team performance, workload and clinical outcomes.MethodsThe operating room (OR) environment of 20 robot-assisted radical prostatectomies performed by three different surgeons was recorded. Trained observers assessed NTS utilising the Non-Technical Skills for Surgeons (NOTSS) questionnaire. Associations between NOTSS scores, teamwork attributes (anticipation and inconveniences), workload (measured by National Aeronautics and Space Administration-Task Load Index (NASA-TLX)) and clinical outcomes (operative time, blood loss and surgical complexity) were determined using logistic regression and Pearson correlation.Results1780 requests were observed, 703 (39%) were non-verbal. Utilisation of non-verbal requests differed significantly among surgeons (26%, 36% and 44%, p<0.001). Anticipation was significantly associated with ‘Situational Awareness’ (OR 2.59, 95% CI 1.52 to 4.38, p<0.001), ‘Decision Making’ (OR 0.42, 95% CI 0.33 to 0.55, p<0.001) and ‘Communication and Teamwork’ (OR 0.43, 95% CI 0.25 to 0.74, p=0.002) domains. Inconveniences were significantly associated with ‘Situational Awareness’ (OR 0.21, 95% CI 0.08 to 0.59, p=0.003), ‘Decision Making’ (OR 2.73, 95% CI 1.53 to 4.86, p<0.001), and ‘Leadership’ (OR 0.62, 95% CI 0.41 to 0.94, p=0.03). There was a significant positive correlation between NOTSS scores and perceived physical and mental workload measures of NASA-TLX, as well as self-perceived performance. There was no significant association between NOTSS scores and any of the investigated clinical outcomes.ConclusionNTS in the OR were associated with team efficiency, fewer surgical flow disruptions and an improved self-perceived performance.

scholarly journals How do team experience and relationships shape new divisions of labour in robot-assisted surgery? A realist investigation

2019 ◽  
pp. 136345931987411 ◽  
Author(s):  
Rebecca Randell ◽  
Joanne Greenhalgh ◽  
Jon Hindmarsh ◽  
Stephanie Honey ◽  
Alan Pearman ◽  
...  
Keyword(s):  
New Technologies ◽  
Contextual Factors ◽  
Video Recording ◽  
Safety Data ◽  
Division Of Labour ◽  
Structured Interviews ◽  
Robot Assisted ◽  
Empirical Examination ◽  
Surgical Teams ◽  
Robot Assisted Surgery

Safe and successful surgery depends on effective teamwork between professional groups, each playing their part in a complex division of labour. This article reports the first empirical examination of how introduction of robot-assisted surgery changes the division of labour within surgical teams and impacts teamwork and patient safety. Data collection and analysis was informed by realist principles. Interviews were conducted with surgical teams across nine UK hospitals and, in a multi-site case study across four hospitals, data were collected using a range of methods, including ethnographic observation, video recording and semi-structured interviews. Our findings reveal that as the robot enables the surgeon to do more, the surgical assistant’s role becomes less clearly defined. Robot-assisted surgery also introduces new tasks for the surgical assistant and scrub practitioner, in terms of communicating information to the surgeon. However, the use of robot-assisted surgery does not redistribute work in a uniform way; contextual factors of individual experience and team relationships shape changes to the division of labour. For instance, in some situations, scrub practitioners take on the role of supporting inexperienced surgical assistants. These changes in the division of labour do not persist when team members return to operations that are not robot-assisted. This study contributes to wider literature on divisions of labour in healthcare and how this is impacted by the introduction of new technologies. In particular, we emphasise the need to pay attention to often neglected micro-level contextual factors. This can highlight behaviours that can be promoted to benefit patient care.

The Impact of Marketing Language on Patient Preference for Robot-Assisted Surgery

2014 ◽  
Vol 22 (1) ◽  
pp. 15-19 ◽  
Author(s):  
Peter R. Dixon ◽  
Robert C. Grant ◽  
David R. Urbach
Keyword(s):  
Patient Preference ◽  
Robot Assisted ◽  
The Impact ◽  
Robot Assisted Surgery

scholarly journals Shared decision making in mental health: prospects for personalized medicine

2009 ◽  
Vol 11 (4) ◽  
pp. 455-463 ◽  
Keyword(s):  
Mental Health ◽  
Decision Making ◽  
Personalized Medicine ◽  
Shared Decision Making ◽  
Clinical Care ◽  
Biological Data ◽  
Current Status ◽  
Routine Practice ◽  
Shared Decision ◽  
The Impact

This paper describes the shared decision-making model, reviews its current status in the mental health field, and discusses its potential impact on personalized medicine. Shared decision making denotes a structured process that encourages full participation by patient and provider. Current research shows that shared decision making can improve the participation of mental health patients and the quality of decisions in terms of knowledge and values. The impact of shared decision making on adherence, illness self-management, and health outcomes remains to be studied. Implementing shared decision making broadly will require re-engineering the flow of clinical care in routine practice settings and much greater use of information technology. Similar changes will be needed to combine genomic and other biological data with patients' values and preferences and with clinicians' expertise. The future of personalized medicine is clearly linked with our ability to create the infrastructure and cultural receptivity to these changes.

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