MRC Centre for Transplantation, King's College London, King's Health Partners, Department of Urology, Guy's Hospital, London, UK.
BJU Int. 2013 Jun;111(7):1161-74. doi: 10.1111/bju.12010. Epub 2013 Apr 19.
To identify and assess potential hazards in robot-assisted urological surgery. To develop a comprehensive checklist to be used in operating theatres with robotic technology.
Healthcare Failure Mode and Effects Analysis (HFMEA), a risk assessment tool, was used in a urology operating theatre with innovative robotic technology in a UK teaching hospital between June and December 2011. A 15-member multidisciplinary team identified 'failure modes' through process mapping and flow diagrams. Potential hazards were rated according to severity and frequency and scored using a 'hazard score matrix'. All hazards scoring ≥8 were considered for 'decision tree' analysis, which produced a list of hazards to be included in a surgical safety checklist.
Process mapping highlighted three main phases: the anaesthesia phase, the operating phase and the postoperative handover to recovery phase. A total of 51 failure modes were identified, 61% of which had a hazard score ≥8. A total of 22 hazards were finalised via decision tree analysis and were included in the checklist. The focus was on hazards specific to robotic urological procedures such as patient positioning (hazard score 12), port placement (hazard score 9) and robot docking/de-docking (hazard score 12).
HFMEA identified hazards in an operating theatre with innovative robotic technologies which has led to the development of a surgical safety checklist. Further work will involve validation and implementation of the checklist.
识别和评估机器人辅助泌尿外科手术中的潜在危险。开发一种综合检查表，用于配备机器人技术的手术室。
医疗保健失效模式和影响分析（HFMEA）是一种风险评估工具，于 2011 年 6 月至 12 月在英国一所教学医院配备创新机器人技术的泌尿科手术室中使用。一个由 15 名多学科成员组成的团队通过流程映射和流程图识别“失效模式”。根据严重程度和频率对潜在危险进行评分，并使用“危险评分矩阵”进行评分。所有危险评分≥8 的均被认为需要进行“决策树”分析，该分析产生了一份包含在手术安全检查表中的危险清单。
流程映射突出了三个主要阶段：麻醉阶段、手术阶段和术后交接恢复阶段。共确定了 51 种失效模式，其中 61%的失效模式具有≥8 的危险评分。通过决策树分析最终确定了 22 个危险，并将其纳入检查表。重点是针对机器人泌尿外科手术的特定危险，如患者定位（危险评分 12）、端口放置（危险评分 9）和机器人对接/脱接（危险评分 12）。
HFMEA 确定了配备创新机器人技术的手术室中的危险，这导致了手术安全检查表的开发。进一步的工作将包括检查表的验证和实施。
