3D operating theatre

I stand in the operating theatre and look around. There’s the operating table and the large anaesthetic machine. If I move around I see the suction machine, the diathermy and all the other equipment. The illusion is complete, as long as I am wearing the 3D glasses.

The operating theatre in fact only exists in virtual reality. The virtual operating theatre is a research tool in a project which aims to improve the work environment, patient safety and efficiency in the operating theatres of the future.

Doctoral student Christofer Rydenfält has talked to his ees, staff from the surgery department at Helsingborg Hospital, in front of one of these virtual reality images. It offers a number of advantages, in his view.

“It is a good idea to ‘be’ in the environment you are discussing. It prompts thoughts and ideas which would not have come up in a normal office. And we of course cannot use a real operating theatre, because they are in constant use.”

Christofer Rydenfält is working on a project called OpDesign 2012. It is about operating theatres, but less about their technical equipment and more about how the staff work together and how the work is organised. His dual background is therefore well suited to the project.

“I have a Bachelor’s degree in Psychology and an MSc in Computer Science. This project is about both people and technology, with a focus on meetings between people around the technology”, he explains.

The surgery department in Helsingborg was built in the 1970s and will soon be in need of renovation. Therefore, Per-Anders Larsson, consultant and research manager at the hospital, got in touch with LTH researchers Per Odenrick and Gerd Johansson at the Division of Ergonomics and Aerosol Technology. A lot of work has been done at the division on issues relating to work organisation, learning in the workplace and interaction between people and machines.

“There is a lot of research on new medical techniques. Less is known about what happens when these new techniques are introduced in the health service”, says Per-Anders Larsson.
During an operation, a lot of people with different areas of expertise have to work together and there are many tasks that have to be carried out in a certain order.

“No doubt everyone does their best in their work. Nevertheless, we know that important information doesn’t always get through to those who need it, and a lot of time is sometimes spent waiting. There is room for improvement”, he says.

The waiting times before an operation are one of the things Christofer Rydenfält has addressed in his s. Different professions have different views of the reasons – the surgeon thinks the anaesthetists don’t do their preparations fast enough, while the anaesthetists think the surgeon doesn’t get started on time. Some ees also mention the disturbance caused by unnecessary talking in the operating theatre and the lack of understanding of necessary tasks that have to be done outside the theatre.

Communication failings mean that such everyday annoyances are rarely aired.

“It is difficult to gain an organisational consensus among the professional groups, who often do not meet outside the operating theatre. There, with a patient on the operating table, it is not the place to start a discussion”, says Christofer Rydenfält.

A solution could be having set operating teams, whose staff could get to know one another properly. This would be difficult to achieve, however, considering on-call duty and holidays which require more flexible rotas.

“However, if it isn’t possible to have a team for every operating theatre, perhaps the department’s 280 employees could be divided into a couple of smaller groups‘ Or could other methods be tried to arrange meetings between staff outside the operating theatre’” wonders Christofer Rydenfält.

He has also studied a WHO-recommended method where a checklist of questions is gone through before each operation, including checking it is the right patient, that the incision is made in the right place, that any necessary medication has been given and that any complications have been foreseen. The members of the operating team should also introduce themselves to one another.

“The latter is often skipped or taken later while working. It is probably presumed that everyone knows everyone and that the introductions are merely formal”, says Christofer Rydenfält.

He sees a round of introductions as an important way to create a sense of inclusion and allow space for comments, and one which should not be skipped.

He also thinks the checklist should be expanded so that it not only contains questions for the surgeon and anaesthetists, but also a question for the theatre nurses and healthcare assistant. This would not only be for the sake of equality, but also to make everyone feel more involved.

Christofer Rydenfält is now continuing his research by analysing 100 hours of film from various operations. Doctoral student Hillevi Hemphälä is studying light and lamps in the operating theatre and Professor Mats Bohgard will be studying the particles contained in the air. Meanwhile, an ‘innovation group’ at the hospital, made up of staff from different professions, has begun to discuss the researchers’ findings in relation to their own ideas and needs.

“In the long term, we hope that the research will lead to patients who undergo operations being healthier and having less complications, and to resources being able to stretch to even more patients, with the same level of safety and a good working environment”, says Per-Anders Larsson in Helsingborg.

Visualisation in healthcare

The OpDesign project – financed by the Gorthon Foundation – is not the only one in its field at the Division of Ergonomics and Aerosol Technology.

There is also a project called “Visualisation in healthcare”, which is run by Professor Gerd Johansson, senior lecturer Elisabeth Hornyánszky Dalholm and doctoral student Johanna Persson.

The researchers are collaborating with two units within Region Skåne: the paediatric accident and emergency unit at Kristianstad Hospital and the infection clinic at Skåne University Hospital in Malmö. The first collaboration is about testing different ways to get an overview of patient flows within the unit using computers, in order to make it easier to identify and remove bottlenecks. The second collaboration is about the use of ventilators at the infection clinic. The aim is to develop a 3D game which teaches the staff to manage certain special and unusual situations that can be critical for patients if dealt with incorrectly.

- Ingela Björk

Photo captions: Christofer Rydenfält wears special glasses to see the surrounding virtual environment as a three dimensional room.

Good lamps are important during an operation, says Per-Anders Larsson. A study of light and lamps also forms part of the project.