Samen het ict-wiel uitvinden

Wetenschappers kunnen maar beter samenwerken met hun collega’s uit andere disciplines als ze voor hun onderzoek ict-toepassingen bedenken. Er komt een centrum om hen daarbij te helpen.

Hoe sla je informatie op? Hoe doorzoek je die informatie? Hoe deel je samen relevante gegevens? Die vragen spelen in vrijwel alle wetenschappelijke disciplines. Alfa-, bèta- en gammawetenschappers zouden samen naar oplossingen kunnen zoeken, maar ze hebben de neiging om allemaal zelf het wiel uit te vinden, stellen onderzoeksfinancier NWO en ict-stichting SURF.

Daar willen ze graag verandering in brengen. Ze investeren zes miljoen euro in het Netherlands eScience Center. “Het doel van de organisatie is het zichtbaar maken van de krachtige academische en technologische eScience-omgeving in Nederland”, schrijven ze, waarbij eScience ‘enhanced science’ betekent, oftewel verrijkte wetenschap.
Het centrum moet ook een stimulans voor multidisciplinair onderzoek zijn. “Een katalysator voor samenwerking over wetenschappelijke domeinen heen”, zoals hoogleraar Jacob de Vlieg van de programmacommissie het uitdrukt.
Het nieuwe centrum wordt gevestigd op het Science Park Amsterdam, waar ook andere ict-initiatieven worden ontplooid.

What operation are we performing? Which side do we operate on? Has the patient received antibiotics? These may all seem like superfluous questions to surgeons, their assistants and anesthetists, because of course they must know what they are about to do, what leg to cut off, what antibiotics have been administered. Yet, mistakes do happen.
The Dutch Health Care Inspectorate has therefore recently decided that operating theater personnel must implement a ‘time out procedure’ to prevent errors.

If it was up to Linda Wauben, a PhD student working at both the Erasmus Medical Centre and TU Delft’s faculty of Industrial Design Engineering, this new procedure would not become a boring routine, but rather be a role playing exercise in which each actor has specific questions to ask and answer.
In a short video she shows, you can see the medics slightly grinning behind their surgical masks. “We didn’t order any packed blood cells, did we?” the surgeon asks. “No we didn’t”,  replies the assistant. “What operation are we going to perform?” she then asks, with a playful glint in her eyes.
The role play Wauben developed for her PhD research, which she will defend on April 12, is called ‘Time Out Procedure plus Debriefing’ (TOPplus), and it is currently being used in the operating theatres of 16 hospitals across the Netherlands. Medics ‘play’ the procedure just prior to operating on the patient.
“At first people have to get used to it”, says Wauben, thereby explaining the medical team’s playful smiles. And because each type of operation and hospital is different, and everybody has their own way of working, Wauben and the medics have fine tuned the role plays.

If you think this approach of co-designing to increase ‘Safety in the Operating Theatre’ (the title of Wauben’s dissertation) is already innovative enough, then you are in for a shock. The researcher wants everything that happens in the operating theatre to be registered, just like the black box system used in aviation.
“Preferably I’d like to record all patient data (heart rate, oxygen level), images of the surgical field, and also the verbal and non-verbal communication of the operating team. These recordings can then be used for generating the post-operative notes, to learn from errors – if an error was made – or be used in the education or training of the surgical team.”

“When I give lectures at congresses I get very varied reactions to this idea”, Wauben says. “Some surgeons don’t want all their actions to be filmed. I understand that. This requires a change in hospital culture.”
Despite the reluctance of some surgeons to adopt this black box approach, Wauben did analyze footage of operations. She studied video images that were taken during laparoscopic surgery, also known as minimally invasive surgery. She watched and analyzed 125 videos of gallbladders being removed. She knows the drill. “When I watched ‘Grey’s Anatomy’ last night, I knew the doctors had made an error when a patient turned all yellow; they had by accident cut the common bile duct.”

Laparoscopic surgery is a fairly new technique in which abdominal operations are performed through small incisions. A camera and trocars are entered through these incisions. A trocar is a kind of hollow punch that acts as a guide tube. Through this tube, long-handled medical instruments, such as graspers, are introduced into the body.

Needless to say, to be skillful with these long, unwieldy instruments, one needs lots of practice. Because of this, the Health Care Inspectorate decided in 2007 that critical parts of the operation, like the moment before transecting important structures of the gallbladder, need to be monitored attentively (the so called ‘critical view of safety’).

Wauben checked whether there was a good visual available at all critical stages of the gall bladder operation. “This is a first small step towards a black box. We started by registering what the surgeon saw at that moment”, says Wauben. “Maybe step by step people start to get used to the idea.” 

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