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One in Four Surgical Errors Stems From Technology, Study Says

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WHO

A quarter of surgical errors can be traced back to equipment or technology failures, but most are due to human mistakes, not inherent problems with the tech, according to a new review.

“I think personally if readers think of their experiences in the operating room they will not be entirely surprised,” said senior author Colin Bicknell of the department of surgery and cancer at Imperial College London.

Tech errors are largely preventable, and as surgery relies more and more on technological solutions they deserve more attention, he said.

“Technology adds so much to an operation, but the added complexity and experience required to get it running efficiently is significant and the small problems that occur time and time again are often quickly fixed by expert teams,” Bicknell told HeathBiz Decoded. “We, as surgeons, have come to accept this when actually we need to make sure the operations continue to run as smoothly as possible.”

Bicknell’s systematic review in BMJ Quality and Safety last month examined the 28 best published reports of operating room errors, which do not include all operating room errors, because many are not reported, the authors note.

Tech errors are largely preventable.

There were three types of reports: Errors recorded by a third-party observer of the operation who noted small and large problems, pre-op incident reports of serious errors with measurable consequences, and malpractice claims post-surgery.

Studies with an independent observer averaged 12 errors per operation, compared to less than one error per operation when results were self-reported by surgical staff.

For both categories, about 25 percent of the incidents were due to equipment failure.

Most commonly, the technology was not configured or set up properly before surgery, which accounted for 43 percent of the errors. In 37 percent of cases necessary equipment simply wasn’t available in the operating room, and in 33 percent of cases the equipment itself malfunctioned.

That means more than 70 percent of errors stemmed from human mistakes, either not procuring or configuring necessary technology pre-surgery.

Pediatric heart surgery had the highest equipment-related error rate, with an average of four incidents per operation, likely because it is extremely complex and requires more technology than general surgeries, Bicknell said.

“The first item on any safety checklist should be a highly trained team” – Colin Bicknell, Department of Surgery and Cancer, Imperial College London

“Surgical checklists” seemed to significantly reduce error rates in the operating room. Checklists reduced equipment errors by an average of 49 percent.

In the U.S. and U.K., all operations should be accompanied by a World Health Organization safety checklist (pictured above), developed in 2008.

But Bicknell and his coauthors suggest that checklist may need additions in line with the rise of technology in the operating room. The new checkpoints should come from future studies, they say.

Meanwhile, error rates bring into questions the need for more and more technological solutions if they haven’t shown significant benefit over traditional methods.

“Clearly if expensive technology adds nothing then there are strong arguments against it,” Bicknell said. “The technology must add something clinically to the operation to be useful in terms of accuracy or improved outcomes.”

The studies he collected didn’t include any cases of robotic surgery with the controversial “Da Vinci” system, but the results could be extrapolated to procedures of that high level of complexity.

The results of the study should refocus the surgical community on training and team coordination integrating tech into the operating room, since so many errors could be prevented with better organization and understanding of tech, he said.

The first item on any safety checklist should be a highly trained team, he said.