AK
A.M. Kooijmans
info
Please Note
<p>This page displays the records of the person named above and is not linked to a unique person identifier. This record may need to be merged to a profile.</p>
4 records found
1
This thesis is to provide an interdisciplinary overview of the implementation of labour-saving technology in the OR, using surgical instrument counting as an illustrative case.
In Chapter 2, we present the current situation of surgical instrument counting in clinical practice. Through observations, we found that OR nurses use various strategies and counting techniques to manage disruptions and limit workload. We also found that there is limited interest in the use of supportive technology during a surgical procedure; nurses prefer this support in the preparatory and closing phases of surgery.
In Chapter 3, we dive deeper into the current use of labour-saving technology. In Part 1 we focus on weighing systems (i.e., scales). Introduced around twenty years ago, they were meant to standardise and automate surgical instrument counting. Instruments are weighed before and after a surgery, and if the weight matches, the instruments are complete. Around a quarter of Dutch hospitals still use a weighing system in their instrument lifecycle, but many mention that it is unreliable. This triggered us to investigate further. We visited several hospitals throughout the country to see how the system is used. We found that each hospital adapted their workflow in a unique way to accommodate the limitations of the weighing system, with a varying degree of success, or fidelity. It turns out that this fidelity is higher in hospitals where communication between departments and different user groups occurs more smoothly, thereby increasing trust in the system’s accuracy.
In Part 2 of this chapter we focus on a different technology, introduced around ten years ago in the Reinier de Graaf hospital in Delft: DORA (Digital Operating Room Assistant). DORA was developed to improve efficiency surrounding medical devices situated in the OR. In case of a device malfunctioning, DORA allows for an immediate error report to the technical department instead of OR staff having to call a technician. In our evaluation study, we found that while most OR users are satisfied, some issues remain that nudge people to the old way of reporting device malfunctions. Technicians are less satisfied, as the relatively short battery life of the sensor requires them to find devices in the operating rooms just to replace a battery. However, the added value of the system when these issues are resolved is clear, as developments of a new DORA system are underway.
Chapter 4 presents the uniformity and variations in surgical counting protocols among Dutch hospitals. Two-thirds of all hospitals participated in this study, showing that surgical instrument counting is an important topic in the field. Compared to a similar study performed in 2006, various improvements have been made to increase standardisation and patient safety. However, perceived high-risk situations have remained largely unchanged, such as staff changes and emergency situations. In addition, most hospitals describe a shared responsibility of the instrument count in their protocol, a policy we speculate could contribute to uncertainty and unsafe practice. We also found that a quarter of hospitals use a weighing system in their instrument workflow, with half of them noting that this system is unreliable in its purpose to count instruments.
So far, no technology has managed to fully replace the manual process of surgical instrument counting. However, with continued interest and development of technologies for this application, such as computer vision algorithms, this might still happen in the near future. In Chapter 5, we analyse jurisprudence and legal precedence to determine who is actually responsible for instrument counting. According to national guidelines, the instrumenting nurse is responsible for performing the instrument count. Looking further, however, the surgeon and the hospital are liable for damages following a retained instrument. Adding to that, new technological innovations will likely make use of artificial intelligence (AI), where the way in which an algorithm comes to an output often remains unclear. Legal experts and lawmakers have not yet worked out how this will relate to the responsibility and liability of users in the medical context. ...
In Chapter 2, we present the current situation of surgical instrument counting in clinical practice. Through observations, we found that OR nurses use various strategies and counting techniques to manage disruptions and limit workload. We also found that there is limited interest in the use of supportive technology during a surgical procedure; nurses prefer this support in the preparatory and closing phases of surgery.
In Chapter 3, we dive deeper into the current use of labour-saving technology. In Part 1 we focus on weighing systems (i.e., scales). Introduced around twenty years ago, they were meant to standardise and automate surgical instrument counting. Instruments are weighed before and after a surgery, and if the weight matches, the instruments are complete. Around a quarter of Dutch hospitals still use a weighing system in their instrument lifecycle, but many mention that it is unreliable. This triggered us to investigate further. We visited several hospitals throughout the country to see how the system is used. We found that each hospital adapted their workflow in a unique way to accommodate the limitations of the weighing system, with a varying degree of success, or fidelity. It turns out that this fidelity is higher in hospitals where communication between departments and different user groups occurs more smoothly, thereby increasing trust in the system’s accuracy.
In Part 2 of this chapter we focus on a different technology, introduced around ten years ago in the Reinier de Graaf hospital in Delft: DORA (Digital Operating Room Assistant). DORA was developed to improve efficiency surrounding medical devices situated in the OR. In case of a device malfunctioning, DORA allows for an immediate error report to the technical department instead of OR staff having to call a technician. In our evaluation study, we found that while most OR users are satisfied, some issues remain that nudge people to the old way of reporting device malfunctions. Technicians are less satisfied, as the relatively short battery life of the sensor requires them to find devices in the operating rooms just to replace a battery. However, the added value of the system when these issues are resolved is clear, as developments of a new DORA system are underway.
Chapter 4 presents the uniformity and variations in surgical counting protocols among Dutch hospitals. Two-thirds of all hospitals participated in this study, showing that surgical instrument counting is an important topic in the field. Compared to a similar study performed in 2006, various improvements have been made to increase standardisation and patient safety. However, perceived high-risk situations have remained largely unchanged, such as staff changes and emergency situations. In addition, most hospitals describe a shared responsibility of the instrument count in their protocol, a policy we speculate could contribute to uncertainty and unsafe practice. We also found that a quarter of hospitals use a weighing system in their instrument workflow, with half of them noting that this system is unreliable in its purpose to count instruments.
So far, no technology has managed to fully replace the manual process of surgical instrument counting. However, with continued interest and development of technologies for this application, such as computer vision algorithms, this might still happen in the near future. In Chapter 5, we analyse jurisprudence and legal precedence to determine who is actually responsible for instrument counting. According to national guidelines, the instrumenting nurse is responsible for performing the instrument count. Looking further, however, the surgeon and the hospital are liable for damages following a retained instrument. Adding to that, new technological innovations will likely make use of artificial intelligence (AI), where the way in which an algorithm comes to an output often remains unclear. Legal experts and lawmakers have not yet worked out how this will relate to the responsibility and liability of users in the medical context. ...
This thesis is to provide an interdisciplinary overview of the implementation of labour-saving technology in the OR, using surgical instrument counting as an illustrative case.
In Chapter 2, we present the current situation of surgical instrument counting in clinical practice. Through observations, we found that OR nurses use various strategies and counting techniques to manage disruptions and limit workload. We also found that there is limited interest in the use of supportive technology during a surgical procedure; nurses prefer this support in the preparatory and closing phases of surgery.
In Chapter 3, we dive deeper into the current use of labour-saving technology. In Part 1 we focus on weighing systems (i.e., scales). Introduced around twenty years ago, they were meant to standardise and automate surgical instrument counting. Instruments are weighed before and after a surgery, and if the weight matches, the instruments are complete. Around a quarter of Dutch hospitals still use a weighing system in their instrument lifecycle, but many mention that it is unreliable. This triggered us to investigate further. We visited several hospitals throughout the country to see how the system is used. We found that each hospital adapted their workflow in a unique way to accommodate the limitations of the weighing system, with a varying degree of success, or fidelity. It turns out that this fidelity is higher in hospitals where communication between departments and different user groups occurs more smoothly, thereby increasing trust in the system’s accuracy.
In Part 2 of this chapter we focus on a different technology, introduced around ten years ago in the Reinier de Graaf hospital in Delft: DORA (Digital Operating Room Assistant). DORA was developed to improve efficiency surrounding medical devices situated in the OR. In case of a device malfunctioning, DORA allows for an immediate error report to the technical department instead of OR staff having to call a technician. In our evaluation study, we found that while most OR users are satisfied, some issues remain that nudge people to the old way of reporting device malfunctions. Technicians are less satisfied, as the relatively short battery life of the sensor requires them to find devices in the operating rooms just to replace a battery. However, the added value of the system when these issues are resolved is clear, as developments of a new DORA system are underway.
Chapter 4 presents the uniformity and variations in surgical counting protocols among Dutch hospitals. Two-thirds of all hospitals participated in this study, showing that surgical instrument counting is an important topic in the field. Compared to a similar study performed in 2006, various improvements have been made to increase standardisation and patient safety. However, perceived high-risk situations have remained largely unchanged, such as staff changes and emergency situations. In addition, most hospitals describe a shared responsibility of the instrument count in their protocol, a policy we speculate could contribute to uncertainty and unsafe practice. We also found that a quarter of hospitals use a weighing system in their instrument workflow, with half of them noting that this system is unreliable in its purpose to count instruments.
So far, no technology has managed to fully replace the manual process of surgical instrument counting. However, with continued interest and development of technologies for this application, such as computer vision algorithms, this might still happen in the near future. In Chapter 5, we analyse jurisprudence and legal precedence to determine who is actually responsible for instrument counting. According to national guidelines, the instrumenting nurse is responsible for performing the instrument count. Looking further, however, the surgeon and the hospital are liable for damages following a retained instrument. Adding to that, new technological innovations will likely make use of artificial intelligence (AI), where the way in which an algorithm comes to an output often remains unclear. Legal experts and lawmakers have not yet worked out how this will relate to the responsibility and liability of users in the medical context.
In Chapter 2, we present the current situation of surgical instrument counting in clinical practice. Through observations, we found that OR nurses use various strategies and counting techniques to manage disruptions and limit workload. We also found that there is limited interest in the use of supportive technology during a surgical procedure; nurses prefer this support in the preparatory and closing phases of surgery.
In Chapter 3, we dive deeper into the current use of labour-saving technology. In Part 1 we focus on weighing systems (i.e., scales). Introduced around twenty years ago, they were meant to standardise and automate surgical instrument counting. Instruments are weighed before and after a surgery, and if the weight matches, the instruments are complete. Around a quarter of Dutch hospitals still use a weighing system in their instrument lifecycle, but many mention that it is unreliable. This triggered us to investigate further. We visited several hospitals throughout the country to see how the system is used. We found that each hospital adapted their workflow in a unique way to accommodate the limitations of the weighing system, with a varying degree of success, or fidelity. It turns out that this fidelity is higher in hospitals where communication between departments and different user groups occurs more smoothly, thereby increasing trust in the system’s accuracy.
In Part 2 of this chapter we focus on a different technology, introduced around ten years ago in the Reinier de Graaf hospital in Delft: DORA (Digital Operating Room Assistant). DORA was developed to improve efficiency surrounding medical devices situated in the OR. In case of a device malfunctioning, DORA allows for an immediate error report to the technical department instead of OR staff having to call a technician. In our evaluation study, we found that while most OR users are satisfied, some issues remain that nudge people to the old way of reporting device malfunctions. Technicians are less satisfied, as the relatively short battery life of the sensor requires them to find devices in the operating rooms just to replace a battery. However, the added value of the system when these issues are resolved is clear, as developments of a new DORA system are underway.
Chapter 4 presents the uniformity and variations in surgical counting protocols among Dutch hospitals. Two-thirds of all hospitals participated in this study, showing that surgical instrument counting is an important topic in the field. Compared to a similar study performed in 2006, various improvements have been made to increase standardisation and patient safety. However, perceived high-risk situations have remained largely unchanged, such as staff changes and emergency situations. In addition, most hospitals describe a shared responsibility of the instrument count in their protocol, a policy we speculate could contribute to uncertainty and unsafe practice. We also found that a quarter of hospitals use a weighing system in their instrument workflow, with half of them noting that this system is unreliable in its purpose to count instruments.
So far, no technology has managed to fully replace the manual process of surgical instrument counting. However, with continued interest and development of technologies for this application, such as computer vision algorithms, this might still happen in the near future. In Chapter 5, we analyse jurisprudence and legal precedence to determine who is actually responsible for instrument counting. According to national guidelines, the instrumenting nurse is responsible for performing the instrument count. Looking further, however, the surgeon and the hospital are liable for damages following a retained instrument. Adding to that, new technological innovations will likely make use of artificial intelligence (AI), where the way in which an algorithm comes to an output often remains unclear. Legal experts and lawmakers have not yet worked out how this will relate to the responsibility and liability of users in the medical context.
Background
Many technologies have been developed to aid in surgical instrument counting, but wide adoption is rare. A technology that has been widely adopted around 20 years ago is the weighing scale. Lessons can be extracted from its sustainment and fidelity, and applied to the development and implementation of new laboursaving technologies in healthcare.
Methods
We conducted semi-structured interviews with experienced staff in four hospitals that use weighing systems in their surgical instrument cycle, which we analysed according to the Matrixed Multiple Case Study (MMCS) methodology. Hospitals were designated a low, medium, or high sustainment and fidelity score, after which influencing factors were identified. These factors were categorised according to the i-PARIHS domains of Innovation, Recipient, Context, and Facilitation. Within-site analysis and cross-site analysis was performed to identify influencing factors associated with a high or low level of sustainment or fidelity.
Results
All hospitals showed a high sustainment. Two hospitals showed low fidelity, and two showed high fidelity. Twenty-one total influencing factors were identified, divided among all i-PARIHS domains. All hospitals experienced similar limitations of the technology, and all hospitals showed signs of facilitation efforts during the implementation phase. In low-fidelity hospitals, interdepartmental coordination and trust in technology were limited, in contrast to high-fidelity hospitals. A large and/or complex surgical instrument inventory hindered fidelity of the weighing system.
Conclusions
20 years after implementation, there is varying success concerning the fidelity of weighing systems for surgical instrument counting. All participating hospitals have adapted their workflow to the limitations of the technology in different ways. Given the relative straight-forwardness of weighing scales as a technology, our findings underline the complexity of implementation processes, regardless of the complexity of the innovation. ...
Many technologies have been developed to aid in surgical instrument counting, but wide adoption is rare. A technology that has been widely adopted around 20 years ago is the weighing scale. Lessons can be extracted from its sustainment and fidelity, and applied to the development and implementation of new laboursaving technologies in healthcare.
Methods
We conducted semi-structured interviews with experienced staff in four hospitals that use weighing systems in their surgical instrument cycle, which we analysed according to the Matrixed Multiple Case Study (MMCS) methodology. Hospitals were designated a low, medium, or high sustainment and fidelity score, after which influencing factors were identified. These factors were categorised according to the i-PARIHS domains of Innovation, Recipient, Context, and Facilitation. Within-site analysis and cross-site analysis was performed to identify influencing factors associated with a high or low level of sustainment or fidelity.
Results
All hospitals showed a high sustainment. Two hospitals showed low fidelity, and two showed high fidelity. Twenty-one total influencing factors were identified, divided among all i-PARIHS domains. All hospitals experienced similar limitations of the technology, and all hospitals showed signs of facilitation efforts during the implementation phase. In low-fidelity hospitals, interdepartmental coordination and trust in technology were limited, in contrast to high-fidelity hospitals. A large and/or complex surgical instrument inventory hindered fidelity of the weighing system.
Conclusions
20 years after implementation, there is varying success concerning the fidelity of weighing systems for surgical instrument counting. All participating hospitals have adapted their workflow to the limitations of the technology in different ways. Given the relative straight-forwardness of weighing scales as a technology, our findings underline the complexity of implementation processes, regardless of the complexity of the innovation. ...
Background
Many technologies have been developed to aid in surgical instrument counting, but wide adoption is rare. A technology that has been widely adopted around 20 years ago is the weighing scale. Lessons can be extracted from its sustainment and fidelity, and applied to the development and implementation of new laboursaving technologies in healthcare.
Methods
We conducted semi-structured interviews with experienced staff in four hospitals that use weighing systems in their surgical instrument cycle, which we analysed according to the Matrixed Multiple Case Study (MMCS) methodology. Hospitals were designated a low, medium, or high sustainment and fidelity score, after which influencing factors were identified. These factors were categorised according to the i-PARIHS domains of Innovation, Recipient, Context, and Facilitation. Within-site analysis and cross-site analysis was performed to identify influencing factors associated with a high or low level of sustainment or fidelity.
Results
All hospitals showed a high sustainment. Two hospitals showed low fidelity, and two showed high fidelity. Twenty-one total influencing factors were identified, divided among all i-PARIHS domains. All hospitals experienced similar limitations of the technology, and all hospitals showed signs of facilitation efforts during the implementation phase. In low-fidelity hospitals, interdepartmental coordination and trust in technology were limited, in contrast to high-fidelity hospitals. A large and/or complex surgical instrument inventory hindered fidelity of the weighing system.
Conclusions
20 years after implementation, there is varying success concerning the fidelity of weighing systems for surgical instrument counting. All participating hospitals have adapted their workflow to the limitations of the technology in different ways. Given the relative straight-forwardness of weighing scales as a technology, our findings underline the complexity of implementation processes, regardless of the complexity of the innovation.
Many technologies have been developed to aid in surgical instrument counting, but wide adoption is rare. A technology that has been widely adopted around 20 years ago is the weighing scale. Lessons can be extracted from its sustainment and fidelity, and applied to the development and implementation of new laboursaving technologies in healthcare.
Methods
We conducted semi-structured interviews with experienced staff in four hospitals that use weighing systems in their surgical instrument cycle, which we analysed according to the Matrixed Multiple Case Study (MMCS) methodology. Hospitals were designated a low, medium, or high sustainment and fidelity score, after which influencing factors were identified. These factors were categorised according to the i-PARIHS domains of Innovation, Recipient, Context, and Facilitation. Within-site analysis and cross-site analysis was performed to identify influencing factors associated with a high or low level of sustainment or fidelity.
Results
All hospitals showed a high sustainment. Two hospitals showed low fidelity, and two showed high fidelity. Twenty-one total influencing factors were identified, divided among all i-PARIHS domains. All hospitals experienced similar limitations of the technology, and all hospitals showed signs of facilitation efforts during the implementation phase. In low-fidelity hospitals, interdepartmental coordination and trust in technology were limited, in contrast to high-fidelity hospitals. A large and/or complex surgical instrument inventory hindered fidelity of the weighing system.
Conclusions
20 years after implementation, there is varying success concerning the fidelity of weighing systems for surgical instrument counting. All participating hospitals have adapted their workflow to the limitations of the technology in different ways. Given the relative straight-forwardness of weighing scales as a technology, our findings underline the complexity of implementation processes, regardless of the complexity of the innovation.
Surgical instrument counting
Current practice and staff perspectives on technological support
Background: Surgical instrument counting is a manual, attention-intensive task of the operating room (OR) nurse. Many labour-saving technologies have been proposed, but implementation remains challenging. Knowledge of current counting methods and staff preferences could guide future developments towards effective application. Approach: We observed OR nurses counting materials and instruments in 50 surgical procedures performed by various surgical specialties in a regional teaching hospital in Delft, The Netherlands. Additionally, we surveyed them on their preferences concerning the methods of counting. Key findings: Variations in approaches of surgical counting were observed, with OR nurses using multiple strategies and counting techniques to manage disruptions and limit workload. Interest in using supportive technology is limited to the preoperative and postoperative phase. Relevance: This research relates observational data to staff preferences. Our findings may guide future developments of labour-saving innovations regarding surgical counting towards developing more effective applications and to ensure successful implementation.
...
Background: Surgical instrument counting is a manual, attention-intensive task of the operating room (OR) nurse. Many labour-saving technologies have been proposed, but implementation remains challenging. Knowledge of current counting methods and staff preferences could guide future developments towards effective application. Approach: We observed OR nurses counting materials and instruments in 50 surgical procedures performed by various surgical specialties in a regional teaching hospital in Delft, The Netherlands. Additionally, we surveyed them on their preferences concerning the methods of counting. Key findings: Variations in approaches of surgical counting were observed, with OR nurses using multiple strategies and counting techniques to manage disruptions and limit workload. Interest in using supportive technology is limited to the preoperative and postoperative phase. Relevance: This research relates observational data to staff preferences. Our findings may guide future developments of labour-saving innovations regarding surgical counting towards developing more effective applications and to ensure successful implementation.
Validation of the portable virtual reality training system for robotic surgery (PoLaRS)
A randomized controlled trial
Journal article
(2021)
-
Sem F. Hardon, Anton Kooijmans, Roel Horeman, Maarten van der Elst, Alexander L.A. Bloemendaal, Tim Horeman
Background: As global use of surgical robotic systems is steadily increasing, surgical simulation can be an excellent way for robotic surgeons to acquire and retain their skills in a safe environment. To address the need for training in less wealthy parts of the world, an affordable surgical robot simulator (PoLaRS) was designed. Methods: The aim of this pilot study is to compare learning curve data of the PoLaRS prototype with those of Intuitive Surgical’s da Vinci Skills Simulator (dVSS) and to establish face- and construct validity. Medical students were divided into two groups; the test group (n = 18) performing tasks on PoLaRS and dVSS, and the control group (n = 20) only performing tasks on the dVSS. The performance parameters were Time, Path length, and the number of collisions. Afterwards, the test group participants filled in a questionnaire regarding both systems. Results: A total of 528 trials executed by 38 participants were measured and included for analyses. The test group significantly improved in Time, Path Length and Collisions during the PoLaRS test phase (P ≤ 0.028). No differences was found between the test group and the control group in the dVSS performances during the post-test phase. Learning curves showed similar shapes between both systems, and between both groups. Participants recognized the potential benefits of simulation training on the PoLaRS system. Conclusions: Robotic surgical skills improved during training with PoLaRS. This shows the potential of PoLaRS to become an affordable alternative to current surgical robot simulators. Validation with similar tasks and different expert levels is needed before implementing the training system into robotic training curricula.
...
Background: As global use of surgical robotic systems is steadily increasing, surgical simulation can be an excellent way for robotic surgeons to acquire and retain their skills in a safe environment. To address the need for training in less wealthy parts of the world, an affordable surgical robot simulator (PoLaRS) was designed. Methods: The aim of this pilot study is to compare learning curve data of the PoLaRS prototype with those of Intuitive Surgical’s da Vinci Skills Simulator (dVSS) and to establish face- and construct validity. Medical students were divided into two groups; the test group (n = 18) performing tasks on PoLaRS and dVSS, and the control group (n = 20) only performing tasks on the dVSS. The performance parameters were Time, Path length, and the number of collisions. Afterwards, the test group participants filled in a questionnaire regarding both systems. Results: A total of 528 trials executed by 38 participants were measured and included for analyses. The test group significantly improved in Time, Path Length and Collisions during the PoLaRS test phase (P ≤ 0.028). No differences was found between the test group and the control group in the dVSS performances during the post-test phase. Learning curves showed similar shapes between both systems, and between both groups. Participants recognized the potential benefits of simulation training on the PoLaRS system. Conclusions: Robotic surgical skills improved during training with PoLaRS. This shows the potential of PoLaRS to become an affordable alternative to current surgical robot simulators. Validation with similar tasks and different expert levels is needed before implementing the training system into robotic training curricula.