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Published on: February 11, 2019
Medical Error Avoidance in Intraoperative Neurophysiological Monitoring: The Communication Imperative
Stan Skinner1, Robert Holdefer, John J McAuliffe
1*Department of Intraoperative Neurophysiology, Abbott Northwestern Hospital, Minneapolis, Minnesota, U.S.A.; †Department of Rehabilitation Medicine, School of Medicine, University of Washington, Seattle, Washington, U.S.A.; ‡Department of Anesthesia, Cincinnati Children's Hospital, Medical Center, The University of Cincinnati, Cincinnati, Ohio, U.S.A.; and §Section of Neurosurgery, Department of Neurological Sciences and Movement, University Hospital, University of Verona, Verona, Italy.
Error reduction in intraoperative neuromonitoring relies on system design and clear communication. Enhancing collaboration and situational awareness among neurophysiologists and surgeons minimizes errors during procedures.
Area of Science:
- Medicine
- Neuroscience
- Systems Engineering
Background:
- Error avoidance in medicine shares principles with complex systems design.
- Intraoperative neuromonitoring (IONM) faces unique error reduction challenges due to dual roles of neurophysiologists and surgeons.
- The interventional cascade (test → interpretation → communication → intervention → outcome) highlights potential error points.
Purpose of the Study:
- To explore error reduction strategies in intraoperative neuromonitoring.
- To identify key factors influencing error rates in IONM.
- To propose methods for improving safety and reliability in IONM.
Main Methods:
- Review of error-reduction concepts applicable to complex systems.
- Analysis of the neurophysiologist-surgeon interaction within the interventional cascade.
- Examination of evidence from observational and controlled trials on operating room collaboration.
Main Results:
- Forgiving design and system redundancy are key error-reduction concepts for IONM.
- Optimized communication, collaboration, and situational awareness significantly reduce errors.
- Checklists and trusted communication channels enhance safety.
Conclusions:
- Effective error reduction in IONM requires robust communication and collaboration.
- Supervising neurophysiologists must foster situational awareness and trusted interactions.
- Technological aids like teleconnections can support collaboration when in-person availability is limited.
