Investigators from Indiana University School of Medicine Department of Surgery in Indianapolis and Purdue University School of Industrial Engineering at West Lafayette are researching how wearable sensors can facilitate modeling and assessment of surgery teamwork. They received a $1.6 million grant from the Agency for Healthcare Research and Quality (1R01HS028026) to study how improving non-technical skills such as teamwork and communication can improve performance and outcomes.
Dimitrios Stefanidis, MD, PhD, vice chair of surgical education and professor of surgery at IU School of Medicine, will collaborate with Denny Yu, PhD, assistant professor of industrial engineering at Purdue University, who is an adjunct assistant professor of surgery at IU School of Medicine, as principal investigator.
Non-technical skills encompass teamwork, communication, decision-making, situational awareness and leadership that impact patient safety in surgery. Lack of these skills is the most frequent cause for patient safety events that affect patient mortality, post-operative pain and quality of life. Lapses in communication, teamwork and leadership have been shown to account for 60% of major perioperative complications, most of which are related to communication failures.
Stefanidis says surgery is a “team sport” and that patient safety and favorable outcomes are dependent on several factors, including technical skill, clinical decision-making of the surgeon and the performance of the surgical team.
“How the team works together, how well the team members communicate with each other, how aware everyone is of their surroundings, and how strong the leadership of the surgeon is,” all play a role in the success of a surgery,” Stefanidis said. “While surgery is very safe today, improving processes and outcomes is an essential goal of the surgical teams.”
Stefanidis said developing objective and reliable non-technical skill measures through this study promises to provide the means that will enable surgical teams to improve their collaborative work and ultimately benefit patients.
Yu said their multidisciplinary research team can work together to identify solutions using sensors and artificial intelligence algorithms that can help automate the assessment of this important, commonly overlooked skill among surgical teams.
“We currently have preliminary evidence that sensors can help predict non-technical skills. Our next steps are to refine our sensor system and validate with more experiments,” Yu said. “If successful, this work could help hospitals nationwide train and assess non-technical skills.”
The grant was established to aid ongoing educational and research partnerships to develop novel technological solutions for pressing health care challenges.
Current approaches to improving teamwork skills have relied on observation-based assessment tools by expert coaches. Despite proven benefits on patient outcomes, implementation of training in surgery is limited, especially for health institutions with limited resources and non-technical skill expertise. Presently, non-technical skills assessments require trained observers and are time-consuming and resource-intensive to obtain. Importantly, these assessments are subject to multiple assessment biases by the observer, which threaten their objectivity and value. These limitations are a key barrier to wide implementation.
Automated real-time sensing-based approaches that do not require a trained observer could provide objective, quantifiable and continuous measurements of non-technical skills, permitting more widespread adoption. Based on the critical and complex nature of the work of surgical teams, an enhanced, multi-dimensional approach to improving non-technical skills is an important step toward improving overall surgical performance.
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