sutures newsletter


P and T Approvals, FDA Warnings

Pharmacy Focus

See highlights of the Oct. 7 meeting of the Pharmacy and Therapeutics Committee. Also, the U.S. Food and Drug Administration has issued warnings about lenalidomide, duloxetine hydrochloride, alglucosidase alfa and methoxy polyethylene glycol-epoetin beta.

Mark Your Calendar

Grand Rounds

Click here to view a schedule of all upcoming grand rounds.

Educational Schedule

Click the PDF link below to see the Department of Surgery's educational schedule.

Educational Schedule - December 2014 (PDF)

Surgery Scheduling

Click the "read more" for hours and contact information for surgery scheduling.

Share Your News

Know an interesting colleague we should profile? A story we should tell? Submit your ideas, meetings and events for consideration.

Click here to submit your news to Sutures

Integrating People, Systems, Technology to Optimize Care

By Ken Catchpole, PhD
Director of Surgical Safety and Human Factors Research

Human factors research helps us to understand how human performance is mediated by the tasks, technologies, teams, environment and organization in which work is conducted. A variety of research recognizes that successful outcomes relate to a broad range of parameters — such as case volume, teamwork, protocols, bundles and checklists — as well as the skills of individual clinicians. Human factors, or ergonomics, helps us to design tasks, technology and training to make things easier to do right and more difficult to do wrong. Cedars-Sinai has been growing steadily its reputation and capability in this area.

Under our OR 360 initiative, which seeks to re-engineer technology and teamwork for 21st-century care, we recently completed a large Department of Defense-funded research project that developed methods to improve the reliability and safety of trauma care and acute-care handoffs. Some of this work has been published, with much more to come.

The project also has led to the development of a smartphone app that has been successfully tested in simulation and has been commercialized. We are anticipating trials next year at Cedars-Sinai and one other site, possibly in the Paris area. Results of this work can be seen, for example, in the transfers to the adult and congenital heart surgery services, which we continue to support.

Our second area of work is in device testing to ensure usability and safety. In March this year, we were contracted to test a new drug-delivery device in simulated patient and operating room settings. We were extremely grateful that a range of clinical and nonclinical staff volunteered to participate, and the findings identified vital improvements. A relatively simple design change addressed a key problem with the technology, which has since been extremely successful. This demonstrated the value of realistic testing with representative users, because you don't always know what people are going to do with technology.

This philosophy also is being applied to near-term development and implementation of several other operating room technologies. We are now working with a number of startups developing blood-loss monitoring, hand washing, communication technology, augmented reality, intraoperative imaging and even the design of flooring. Some of these projects focus on implementation and design, others on understanding the effects on behavior and decision making of new technologies, and occasionally we seek to identify clinical high-value applications for basic technologies.

Longer-term research also is developing this approach for robotic surgery, in which we are using direct observation in the operating room to examine the effects on process performance of technology design, experience and patient factors. For example, we find that robotic surgery changes communication, equipment and training requirements, which can extend learning curves and reduce safety and efficiency. As we prepare our results for publication, we are enthusiastic to be working with the manufacturer — Intuitive Surgical — to consider new approaches to design and training.

Academic output this year has continued apace, with published data on the use of checklists, teamwork and teamwork training, briefings on length of stay, and a computational model of how small intraoperative events concatenate to create more serious problems in trauma care. We have published book chapters on safety culture, outcomes in congenital heart surgery and the application of human factors models in safety, along with several posters and podium presentations on our handoff and robotic surgery work. We have been invited to speak about our work at a range of conferences nationally, and in the U.K. and Australia.

The value of human factors in healthcare is just starting to be recognized, and we can proudly say at Cedars-Sinai that we are leading the charge.