CUSP Research
By Leslie Johnston & Kiran Lokhande
Aims of our research:
 To model the OR environment as an information system that
unifies the different roles of the surgical team members with
a common goal.
 Use this model to guide future designs of integrated
information displays to support team work and decision making.
 A novel approach to visualizing the complex information flow
is also presented.
Examples of inefficient communication flow:
 Only 3.4% of all alarms within the OR environment
cause an anesthesiologist to act upon or change
some part of the system.
 Inefficient Re-stocking: circulation nurse may have
to learn room to find unavailable equipment
Problems that can arise:
 Wrong site surgery
 Objects(mainly sponges) left in the body of a
patient
 Despite counting procedures
 Operation on wrong patient
Choosing a work domain to observe
 Viewed as a geometric figure, the ant’s path is
irregular, complex, hard to describe. But its
complexity is really a complexity in the surface of
the beach, not a complexity in the ant (Simon,
1981, p.64).
Our research thus far
 Surgeries we have observed:
 Sigmoid Colectomy
 Gastrectomy
 Surgeries we have researched online/at BIDMC Simulation &
Skills Center
 Sigmoid colectomy
 Gastrecomy
 Lap band surgery
 Lap cholecystectomy
 Lap gastric bypass
 Lap hernia
 Lap nissen fundoplication
 Where:
 Cambridge Health Alliance
 Beth Israel Deaconess Medical Center
Preliminary task analyses
Equipment Analysis Example:
Name
Function
When Used How Used
Bovie
Electrosurgical
Unit
Cauterization when making
incisions to stop bleeding. Does it
actually make the incisions?
Throughout
surgery
Press tip against Surgeons
tissue, click
button to activate
Blade
Make initial incision (midline
incision)
Retractor
Hold back skin/tissue/organs
At the beginning,
after prepping
patient
After initial
incision, for
remainder of
surgery
Bookwalter
Hold retractors to hold incision open After initial
incision, for
remainder of
surgery
Holding tissues aside/in place,
Throughout
suturing
surgery
Press blade
Surgeons
against
skin/tissue
Curve malleable Surgeons
end to hook
around layers of
tissue to be
pulled back,
attach to
bookwalter
Attach to poles
Surgeons
mounted on bed,
attach retractors
Clamp
Used By
Surgeons, surg
tech
Display/Type Other
of Info
Is there a light when
it is being activated?
What about displays
on the machine?
N/A
N/A
Varying
degrees of
malleability,
varying sizes
(length/width)
N/A
Varying sizes
N/A
Varying
sizes/shapes
(e.g. rightangle, curved)
Surgeon:
Initial Diagram:
• Change gown and
gloves
• Remove hernia sacks
and suture tissue
• Remove bookwalter
• Use stitches to sew
up incision
Nurse:
• Count pieces of
equipment with Surg
Tech
• Put away unused and
used equipment
• Help transfer patient
from surgical bed to
portable bed
• Mop floor of
operating room
Anesthesiologist:
Step 6: Close
incision &
end
procedure
• Maintain vitals and
attend to alarms of
EKG monitor
• Revive patient
• Adjust monitors and
turn them off (?)
Surg Tech:
• Count pieces of equipment
with Nurse
• Collect needle ends of
stitches and store in box to
keep count
• Put away unused and used
equipment
• Help transfer patient from
surgical bed to portable
bed
Asst. Surgeon:
• Assist in removal of hernia
sacks and suturing
• Change gown and gloves
• Assist in removal of
bookwalter
• Help tie stitches in closing
of incision
OR Layout:
Removal of Section of Colon
Creation of Circular-Stapled Anastomosis
Future Work:
 Interviews with members of the surgical team to verify
diagrams and supplement with information needed for
internal decision-making processes
 Continued expansion of information relationship diagrams to
create a modified and improved structure and to test
applicability to a variety of scenarios
 Develop innovative ways of displaying information
relationships that will be constructive to the operating room
environment
Works cited
 Simon, H.A. (1981). The sciences of the artificial
(2nd ed.). Cambridge, MA: MIT Press.