Cammer Natasha C, Mascarenhas Kristen M, Delgado-Landino Marianfeli C, Horn Danielle B, Araya Roxanna J, Epstein Richard H, Corvington Jean R, Marudo Catherine P, Stein Alecia L, Maga Joni M
Anesthesiology, Perioperative Medicine, and Pain Management, University of Miami Miller School of Medicine, Miami, USA.
Center for Patient Safety, University of Miami/Jackson Memorial Hospital, Jackson Health System, Miami, USA.
Cureus. 2024 Mar 18;16(3):e56367. doi: 10.7759/cureus.56367. eCollection 2024 Mar.
To improve situational awareness in the operating room (OR), a virtual online operating room of hazards (ROH) with deliberately placed risks was created. We hypothesized that subjects first participating in the virtual online ROH would identify more hazards during an in-person ROH exercise in a physical OR than those in the control group who only received didactic training.
We conducted a randomized controlled trial at a major academic medical center, enrolling 48 pre-clinical medical students with no previous OR exposure during their classes. Control and experimental group subjects participated in a brief, online didactic orientation session conducted live over Zoom (Zoom Video Communications, Inc., San Jose, CA) to learn about latent hazards in the OR. Experimental group subjects further interacted with a virtual online operating ROH in which latent hazards were present. The fraction of deliberately created latent hazards placed in a physical, in-person OR identified by subjects was calculated.
Experimental group subjects identified a significantly larger fraction of the created hazards (41.3%) than the control group (difference = 16.4%, 95% CI: 11.3% to 21.4%, P < 0.0001). There was no difference in the number of non-hazards misidentified as hazards between the groups.
Participation in the virtual online environment resulted in greater recognition of latent operating room hazards during a simulation conducted in a physical, in-person OR than in a didactic experience alone. Because creating an in-room experience to teach the identification of latent hazards in an OR is resource-intensive and requires removing the OR from clinical use, we recommend the virtual online approach described for training purposes. Adding items most misidentified as hazards is suggested for future implementation.
为提高手术室的情景意识，创建了一个带有故意设置风险的虚拟在线手术室危害环境（ROH）。我们假设，与仅接受理论培训的对照组相比，首先参与虚拟在线ROH的受试者在实体手术室进行的现场ROH练习中能识别出更多危害。
我们在一家大型学术医疗中心进行了一项随机对照试验，招募了48名临床前医学生，他们在课程学习期间此前未接触过手术室。对照组和实验组受试者参加了一次简短的在线理论指导课程，通过Zoom（Zoom Video Communications公司，加利福尼亚州圣何塞）进行直播，以了解手术室中的潜在危害。实验组受试者进一步与存在潜在危害的虚拟在线手术室ROH进行互动。计算受试者在实体现场手术室中识别出的故意设置的潜在危害的比例。
实验组受试者识别出的已设置危害的比例（41.3%）显著高于对照组（差异 = 16.4%，95%置信区间：11.3%至21.4%，P < 0.0001）。两组之间误将非危害识别为危害的数量没有差异。
与仅接受理论培训相比，参与虚拟在线环境能使受试者在实体现场手术室进行的模拟中更好地识别手术室潜在危害。由于创建一个用于教授识别手术室潜在危害的室内体验资源密集，且需要将手术室从临床使用中移除，我们建议采用本文所述的虚拟在线方法用于培训目的。建议在未来实施中增加那些最常被误识别为危害的项目。
