Characterization of surgical flow disruptions in orthopedic surgery using a human factors approach

Abstract

Background

Efficient and safe perioperative care is critical to optimizing surgical outcomes and reducing preventable errors. Orthopedic procedures, ranging from minimally invasive techniques to complex surgeries, place significant cognitive and physical demands on surgical teams. Disruptions in workflow can compromise efficiency, coordination, and patient safety. This study aimed to systematically identify and categorize surgical flow disruptions to inform quality improvement efforts.

Method

Forty orthopedic surgeries were observed. A human factors taxonomy was used to classify disruptions, and descriptive statistical analysis was applied.

Result

Of the 2343 total disruptions observed, Interruptions (46.39 %) were the most frequent, followed by communication failures (33.25 %), coordination challenges (13.19 %), layout inefficiencies (5.25 %), equipment issues (1.20 %), and usability concerns (0.73 %). This translated into one disruption every 3.7 min for the 40 surgeries.

Conclusions

Addressing surgical flow disruptions proactively can enhance perioperative efficiency, safety, and team coordination. This study presents system vulnerabilities, enabling the possibility of shifting the focus from reactive error analysis to proactive mitigation strategies.