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The Journal of Cardiovascular Surgery 2023 February;64(1):82-92

DOI: 10.23736/S0021-9509.22.12226-3


lingua: Inglese

Assessing endovascular team performances in a hybrid room using the Black Box system: a prospective cohort study

Bart DOYEN 1, Gilles SOENENS 1, Blandine MAUREL 2, Adrien HERTAULT 3, Lauren GORDON 4, Peter VLERICK 5, Frank VERMASSEN 1, Teodor GRANTCHAROV 6, 7, Isabelle van HERZEELE 1

1 Department of Thoracic and Vascular Surgery, Ghent University Hospital, Ghent, Belgium; 2 Department of Vascular Surgery, University Hospital Centre of Nantes, Nantes, France; 3 Department of Vascular Surgery, Valenciennes General Hospital, Valenciennes, France; 4 Department of Surgery, University of Toronto, Toronto, ON, Canada; 5 Department of Work, Organization and Society, Ghent University, Ghent, Belgium; 6 Department of Surgery, Stanford University, Stanford, CA, USA; 7 Clinical Excellence Research Center, Stanford University, Stanford, CA, USA

BACKGROUND: The hybrid room (HR) is a complex, high-risk environment, requiring teams (surgeons, anesthesiologists, nurses, technologists) to master various skills, including the ‘As Low As Reasonably Achievable’ principle of radiation safety. This prospective single center cohort reports the first use of the Operating Room Black Box (ORBB) in a HR. This medical data recording system captures procedural and audio-visual data to facilitate structured team performance analysis.
METHODS: Patients planned for endovascular repair of an infrarenal abdominal aortic aneurysm (EVAR) or treatment of symptomatic iliac-femoral-popliteal atherosclerotic disease (Peripheral Vascular Interventions or PVI) were included. Validated measures and established assessment tools were used to assess (non-)technical skills, radiation safety performance and environmental distractions.
RESULTS: Six EVAR and sixteen PVI procedures were captured. Technical performance for one EVAR was rated 19/35 on the procedure-specific scale, below the ‘acceptable’ score of 21. Technical skills were rated above acceptable in all PVI procedures. Shared decision making and leadership were rated highly in 12/22 cases, whereas surgical communication and nurses’ task management were rated low in 14/22 cases. Team members rarely stepped back from the C-arm during digital subtraction angiography. Radiation safety behavior was scored below ‘acceptable’ in 14/22 cases. A median (interquartile range) number of 12 (6-23) auditory distractions was observed per procedure.
CONCLUSIONS: The ORBB facilitates holistic workplace-based assessment of endovascular performance in a HR by combining objective assessment parameters and rating scale-based evaluations. Strengths and weaknesses were identified in team members’ (non-)technical and radiation safety practices. This technology has the potential to improve vascular surgical practice, though human input remains crucial. (NCT04854278).

KEY WORDS: Quality improvement; Patient safety; Endovascular procedures; Vascular surgery procedures

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