First Advisor

Dr Carol Wallman

College

Rueckert-Hartman College for Health Professions

Degree Name

Doctor of Nursing Practice

Document Type

Thesis - Open Access

Number of Pages

50 pages

Abstract

Multidisciplinary team communication in robotic surgery presents several safety considerations for the intraoperative surgical patient. It is an important consideration since the surgeon and the operating room team are geographically distanced with the surgeon at the console, and the other team members situated at the patient bedside. Scrubbed team members are performing such functions as positioning the robotic arms as well as exchanging instruments, while the remaining interprofessional team members are coordinating multiple patient care activities. It therefore becomes imperative that the recognition of the potential for miscommunication is of paramount importance, and strategies need to be generated that will provide data to keep our patients safe. A Robotic Team High Reliability Organization’s Communication Evaluation Tool was formulated by incorporating a previously purchased High Reliability Organization’s (HRO) program at a North-East Level 1 Trauma Center in New Jersey and combining and implementing a previously valid reliable Interpersonal and Cognitive Assessment for Robotic Surgery or ICARS tool to construct a communication program that would improve the robotic team’s safety culture. The project population sample included 11 gynecologic surgical residents and 12 robotic staff team members consisting of 2 surgical technicians, 5 nurses and 5 Registered Nurse First Assistants (RNFA’s). Each participant provided demographic data via a questionnaire, a 15-question multiple choice pretest, observed and participated in an educational power point presentation, completed a posttest which consisted of the same 15 question pretest, and was evaluated by both the DNP student and surgeon who scored the participants on an ICARS tool Likert scale by recording 28 components of observational data from a provided scenario. A t-test was run for both residents and staff to document aggregate pre/posttest documentation indicating a statistically significant improvement in mean scores for both populations. Reliability statistics provided high Cronbach’s Alpha scores for the Pre/posttest tool, and a high interrater reliability between the DNP student and surgeon evaluator. Paired samples t-test for the ICARS aggregate were split for staff robotic cases to compare the DNP student or Principal Investigator (PI) and the Surgeon Co-Principal Investigator (Co PI). The staff t-test that was run on number of robotic cases which indicated that the number of robotic cases completed by the staff was statistically significant since all staff completed 21 or more cases. A split t-test on the ICARS for the residents for years in program and number of robotic cases revealed a statistically significant difference. This was run on year two residents only due to number of cases. Since ICARS staff evaluation was performed first on a Wednesday and the residents on Friday by PI and Co-PI, results indicated improved interrater reliability between the testing of staff and residents. Thematic analysis revealed themes related to interprofessional teamwork and communication, safety measures unique to robotic surgery, and the importance of an HRO program. Limitations of the study included sample size, use of a simulated operating room (OR) rather than live surgery, only gynecologic surgical residents, all of the robotic OR staff who had participated in the project had been involved in 21 or more robotic cases, as opposed to the residents who had a varied number of cases, SPSS only analyzing residents in year 2 of the program, and finally, in the ICARS observational evaluation, an anesthesia provider was not part of the team participating in the study. The findings of the project supported instituting a formalized program on robotic team communication utilizing this project since it’s statistically significant data, along with evidence-based practice supporting education, has provided proactive solutions to eliminating communication barriers leading to best practices.

Date of Award

Spring 2023

Location (Creation)

Colorado (state); Denver (county); Denver (inhabited place)

Rights Statement

All content in this Collection is owned by and subject to the exclusive control of Regis University and the authors of the materials. It is available only for research purposes and may not be used in violation of copyright laws or for unlawful purposes. The materials may not be downloaded in whole or in part without permission of the copyright holder or as otherwise authorized in the “fair use” standards of the U.S. copyright laws and regulations.

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