OPERATING THEATRE TECHNOLOGIES
Better feedback for improved outcomes
Colin Dobbyne MIET, an experienced product designer, and the founder of Big Blue Solutions, says he is ‘passionate about empowering clinicians to make better decisions by connecting operating theatres to create a constant feedback loop for research and development’. This, he explained, would enable data collected during surgery to be gathered, shared, and reflected upon, to inform future surgeries. In this article, he looks at how new technology could make this a reality ‘sooner rather than later’.
In the operating theatre, knowledge is power; the power to save lives – yours, mine, whoever happens to be on the table. In the world of the surgeon, knowing what you need to do, what the possible risks are, and how you can manage them, and, equally importantly, being empowered to make informed decisions quickly and calmly, are all vital. I often refer to the aviation industry when I am talking or writing about this subject. You will recall the Indonesian Lion Air Flight 610 that crashed last October, killing all 189 crew and passengers. This was reportedly due to a sensor fault that caused the plane, a Boeing 737 Max 8, to dive uncontrollably. There was a known fault in the Manoeuvring Characteristics Augmentation System (MCAS), but tragically it was not known widely enough. More importantly, there was a procedure to override it, and it was controllable – albeit in a complicated and ultimately crude fashion that required the cutting of power to the motor that was driving the nose down.
Once warned
What is not so well known is that a near- miss, caused by the very same fault, occurred the day before, and, as on Flight 610, the crew had no idea how to correct it. Fortunately, in the cockpit on this flight was a pilot hitching a ride, known as ‘deadheading’, who had recently been trained on the MCAS fault, and when the crew were frantically flicking through pages of manuals (as did the crew of the fateful crash), he stepped in, knowing precisely what to do, and saved all the passengers and crew.
Obviously, we cannot expect to double up on surgeons, or have ‘deadheads’ on- hand during every surgical procedure, but with technology we can certainly improve the shared knowledge base, and, crucially, provide easy access to it. Imagine if this ‘deadhead’, or any crew member, had been able to post, log, or record, that day, the near-miss event and the corrective action. Perhaps one of the crew that
The author says one of the main reasons for having to have aircraft blinds up on take-off and landing is that the pilot then has ‘the potential benefit of around 500 additional image sensors looking for fires or other hazards in the event of a crash – in the heads of the passengers’.
crashed may have picked up that post or notification and consequently had that crucial piece of knowledge – or if they had searched some Cloud-based pilot database live during the crisis. If a similar scenario happened again, all of the crew, and perhaps even some of the passengers, might have been aware of what to do, thanks to the media coverage, and the distribution of knowledge.
Pitfalls of over-reliance on AI Everyone is talking about Artificial Intelligence (AI) and machine learning in surgery etc. I think it is all too easy and obvious to suggest that AI and robots will replace surgeons - the MCAS system and software is pretty sophisticated, but it took the freak presence of a human pilot to rescue the situation. My preference is rather to to have our able surgeons empowered with knowledge – with instant access to the combined knowledge and collective intelligence of thousands of surgeons, so that they can input details of a sudden adverse condition, and receive opinion and advice,
immediately. It is still for the surgeon to decide and act, but those decisions and actions could be so much better in critical situations if they had instant access to this knowledge.
Maybe one day it will change, but for now I believe in the intelligence of the informed surgeon over the apparent infinite knowledge, yet inexperience, of AI and machine learning. Let’s not skip this step of giving surgeons a chance to work with access to the very knowledge base that AI needs – in so doing, they will actually build and record the vast knowledge required for AI to work effectively. Nor should we prematurely jump to automated control, only to painfully discover all of the fault conditions that will lead to fatalities.
Sensory or analytical systems In my designs, I prefer to have sensory or analytical systems (‘actors’) to provide an alert or a notification that a potential fault or crisis is in place and inform the surgeon; he or she then has choices – to act within his or her current limit of
October 2019 Health Estate Journal 31
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