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Recording Horizontal Saccade Performances Accurately in Neurological Patients Using Electro-oculogram
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Capturing intraoperative process deviations using a direct observational approach: the glitch method.

Lauren Morgan1, Eleanor Robertson, Mohammed Hadi

  • 1Quality, Reliability, Safety and Teamwork Unit, Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK.

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|November 28, 2013
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Summary
This summary is machine-generated.

A new "glitch count" method reliably identifies technical process imperfections during surgery. These glitches, often distractions, occur most in early operation stages and vary more by hospital site than surgical specialty.

Keywords:
SURGERYpatient safetyprocess of carequality improvement

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Area of Science:

  • Surgical Process Improvement
  • Patient Safety Research
  • Healthcare Quality Management

Background:

  • Technical process imperfections, or glitches, can impact surgical safety.
  • A reliable method is needed to quantify these glitches for analysis and improvement.

Purpose of the Study:

  • To develop and validate a sensitive tool for enumerating technical process imperfections during surgical operations.
  • To evaluate the frequency, type, and patterns of glitches in various surgical settings.

Main Methods:

  • Prospective cohort study involving direct observation of surgical procedures.
  • Utilized a "glitch count" method to record technical imperfections across five hospital sites.
  • Included staff from various surgical specialties and roles in the observation.

Main Results:

  • The glitch count method demonstrated construct and face validity with good inter-observer agreement (κ=0.7).
  • 429 operations yielded 5742 glitches (mean 14/operation), with rates varying by site more than specialty.
  • Distractions were the most common glitch type; 40% of glitches occurred in the first quarter of operations.

Conclusions:

  • The glitch count method is a reliable and sensitive tool for collecting data on surgical process imperfections.
  • Glitches are more prevalent in the initial phase of surgery.
  • Hospital environment and work systems appear to influence surgical processes more than the specific surgical specialty.