Analysis of User-Induced Risks in the Neurosurgical OR

Abstract: In the last decades, the number of user interfaces in the OR has considerably increased. Additionally, time pressure forces the surgeons to perform tasks in parallel. The major objective of our work, in the framework of the OR.NET project, was therefore to analyze the present situation in the neurosurgical OR in order to identify potential use-oriented risks and additionally provide proposals for appropriate countermeasures. We analyzed the workflow of 25 neurosurgical procedures with the workflow analysis tool mAIXflow and developed questionnaires for surgeons and nurses. We found that the usage of the navigation system, the CUSA ultrasonic aspirator, and the PACS-PC induced potential risks. Furthermore, various disruptive factors have been identified, such as phone calls during the intervention, longer absence of the unsterile nurse or shifted foot switches. The aforementioned problems may lead to risks, such as erroneous treatment of the patient, a prolongation of anesthesia, or use errors, due to an inappropriate cognitive workload of the surgeon. For risk reduction in case of use deficiencies, we propose the use of a sterile integrated user interface in a networked OR. To enhance communication, team-trainings could be helpful, and the setup of a mailbox could reduce the number of intraoperative phone calls.

Keywords: Workflow Analysis, Usability Evaluation, Neurosurgery, Human-Machine-Interaction, Risk Analysis, Communication, Handling Errors, networked OR

DOI: 10.54941/ahfe100483

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