gms | German Medical Science

Objective: The neurosurgical OR is characterized by a high number of medical devices with complex user interfaces and handling concepts. Integrated OR systems offer central user interfaces to support device handling, but these proprietary solutions are expensive and inflexible for device substitution and addition. Open standards for device interconnection can help to overcome these limitations and offer various options to enhance Human-Machine-Interaction (HMI) in the OR.

Method: Within the OR.NET project, funded by the German BMBF, an entire integrated OR has been built and usability tests regarding different handling concepts have been performed with 36 volunteers (21 surgeons, 8 nurses, 7 students). In addition general concepts were discussed in expert groups.

Results: The range of functions offered at the surgical cockpit supplies the surgeon with a high level of autonomy and allows the supervision of neurophysiological and vital parameters, which was appreciated by the surgeons. The display of high priority patient alarms on the screen potentially enhances the cooperation between surgery and anaesthesiology. First tests with 7 surgeons show that the display of technical alarms and warnings on a screen helps to identify the cause of a problem in 4.3 sec with a success ratio of 62%, whereas in the conventional setting 8.2sec were necessary with a success ratio of only 15,6%. User tests of the 3D interactive panel of the OR table with 7 students and 8 nurses showed that the handling of the OR table was 60% (students) and 35% (nurses) faster in comparison to the hand-held remote control. In 68,8% (students) and 60,5% (nurses) fewer handling errors occurred. Furthermore the implemented “Mayfield-Lock”, which allows locking certain joints of the table in case a Mayfield Clamp is used, was said to help prevent patient injury. The concept of the universal footswitch was rated to be a helpful and promising tool and 9 of 10 surgeons stated that they can imagine situations in the OR where this footswitch could be a clear improvement over the present situation, in which numerous single footswitches are used.

Conclusions: Open standards for the interconnection of medical devices and information systems in the OR and in the clinic open new paths for Human-Machine-Interaction and provide the surgeon and the OR personnel with access to information systems and numerous device panels. Adequate usability concepts can help the surgeons to refocus on their main task: treatment of the patient.