Bazzi May, Lundgren Solveig M, Hellström Mikael, Fridh Isabell, Ahlberg Karin, Bergbom Ingegerd
Institute of Health and Care Sciences, Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden.
Department of Radiology, Sahlgrenska University Hospital and Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden.
J Multidiscip Healthc. 2019 Jun 10;12:453-464. doi: 10.2147/JMDH.S197727. eCollection 2019.
A hybrid operating room (OR) is a surgical OR with integrated imaging equipment and the possibility to serve both open surgery and image-guided interventions. This study aimed to investigate the work processes and types of collaboration in a hybrid OR during endovascular aortic repair (EVAR). Data consisted of video recordings from nine procedures, with a total recording time of 48 hrs 39 mins. The procedures were divided into four episodes (Acts). A qualitative cross-case analysis was conducted, resulting in a typical case. The type of collaboration during specific tasks was discussed and determined based on Thylefors´ team typology. An extensive amount of safety activities occurred in the preparation phase (Acts 1 and 2), involving a number of staff categories. After the skin incision (Act 3), the main activities were performed by fewer staff categories, while some persons had a standby position and there were persons who were not at all involved in the procedure. The different specialist staff in the hybrid OR worked through different types of collaboration: multi-, inter- and transprofessional. The level of needed collaboration depended on the activity performed, but it was largely multiprofessional and took place largely in separate groups of specialties: anesthesiology, surgery and radiology. Waiting time and overlapping tasks indicate that the procedures could be more efficient and safe for the patient. This study highlights that the three expertise specialties were required for safe treatment in the hybrid OR, but the extent of interprofessional activities was limited. Our results provide a basis for the development of more effective procedures with closer and more efficient interprofessional collaboration and reduction of overlapping roles. Considerable waiting times, traffic flow and presence of people who were not involved in the patient care are areas of further investigation.
杂交手术室是一种配备了集成成像设备的外科手术室，能够同时进行开放手术和影像引导介入手术。本研究旨在调查杂交手术室在血管腔内主动脉修复术（EVAR）期间的工作流程及协作类型。数据包括来自9例手术的视频记录，总记录时长为48小时39分钟。这些手术被分为四个阶段（行为）。进行了定性跨案例分析，得出了一个典型案例。基于蒂勒福斯的团队类型学对特定任务期间的协作类型进行了讨论和确定。在准备阶段（行为1和2）发生了大量安全活动，涉及多个工作人员类别。皮肤切开后（行为3），主要活动由较少的工作人员类别执行，而一些人员处于待命状态，还有一些人员根本没有参与手术过程。杂交手术室中不同的专科工作人员通过不同类型的协作开展工作：多专业、跨专业和超专业协作。所需协作的程度取决于所执行的活动，但主要是多专业协作，且很大程度上发生在不同的专业小组中：麻醉学、外科学和放射学。等待时间和任务重叠表明，这些手术对患者而言可以更高效、更安全。本研究强调，在杂交手术室中进行安全治疗需要这三个专业领域的专业知识，但跨专业活动的程度有限。我们的研究结果为开发更有效的手术流程提供了基础，这种流程具有更紧密、更高效的跨专业协作，并减少角色重叠。相当长的等待时间、交通流量以及未参与患者护理的人员的存在是需要进一步研究的领域。
