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The minimal invasive surgery operation room: elements which indicate risks for the quality and safety

Weideveld, J.J.M. (2008) The minimal invasive surgery operation room: elements which indicate risks for the quality and safety.

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Abstract:	Background Minimal invasive surgery or keyhole surgery is an important development in surgery and is the overall name for all endoscopic procedures. The benefits of minimal invasive surgery have been well re surgery methods and therefore demands other technical skills of the operating staff, equipment and instrumentation [36]. This has led and leads to new problems during these high-tech procedures, creating opportunities for errors or complications to occur [86]. invasieve ch This study contains a critical review on the quality of minimal invasive surgery in the Netherlands. The study assessed the manner in which patient safety is assured, the quality of the procedures in terms of practitioners skills and training. The Academic Medical Center St Radboud in Nijmegen introduced a dedicated minimal invasive surgery operation room. There is also a multidisciplinary monthly meeting to discuss subjects about and surrounding laparoscopic and minimal invasive surgery. The research question: Which elements indicate risks for the quality and safety in a minimal invasive surgery operation room? How are these elements prioritized in the hospital? is answered by means of an qualitative explorative research in this thesis. Method and data collection A systematic literature review has been performed to get more insight and understanding from previous performed studies. The systematic literature review was also input for the expert analysis. To assess the knowledge of the experts in the hospital the Delphi method (repetition with controlled feedback) is used. Three interview cycles and one plenary discussion were held to explore and prioritized the elements which can indicate risks for the quality and safety (patient and employee) of the minimal invasive surgery operation room. In the first round the current situation was explored and together with the systematic literature review this was the input for the second interview cycle. In the first interview cycle and the literature review 89 elements and 14 points of emphasis have been formulated. In the second interview cycle these elements have been ranked and prioritized. The third cycle the results of this ranking and prioritizing are discussed with the experts to validate the results. In the fourth and last cycle a plenary group discussion was held, about the elements which are clustered into four groups. Results of analysis Out of the 89 elements, by means of the four cycles, 30 elements which indicate risks were ranked by the experts of the hospital. These elements had a stated priority above four and were all applicable to the hospital. For each element the Hospital Specific Priority Size (mean divided by the standard deviation) has been calculated so that the level of consensus was of influence on the final raking of the element. Conclusion The elements are clustered into four clusters (organization, training, instrumentation and complication) according to the subcommittees of the multidisciplinary laparoscopic committee and provide incentives for the subcommittees. The minimal invasive surgery operation room needs to be organized more adequately, basic skills for the training of future and currently active surgeons should be made, the instrumentation and communication about instrumentation needs to be improved together with the involved departments and complications need to be registered and evaluated. Coordination, communication and mutual agreement are the basic principles the hospital should work on. Discussion There are several factors that had influence on the execution of this research. The Health Care Inspectorate report of November 2007 and the purchase of the Da Vinci robot. The expert analysis via the Delphi method, The original distinction between risk elements and point of emphasis. All these factors have influence on the validity of this research. Recommendation The multidisciplinary laparoscopic committee should discuss the elements which indicate risks and perform a Health Failure Mode and Effect Analysis to get more insight in the root cause and effect of the elements.
Item Type:	Essay (Master)
Clients:	Universities Medical Center Nijmegen St Radboud, Nijmegen
Faculty:	BMS: Behavioural, Management and Social Sciences
Subject:	85 business administration, organizational science
Programme:	Health Sciences MSc (66851)
Link to this item:	https://purl.utwente.nl/essays/59209
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