Accuracy and usefulness in assessing proficiency of the observational clinical human reliability assessment checklist of the open inguinal hernia repair procedure: A cross-sectional study. (October 2020) - Nazari, T.
Abstract: Background: The Observational Clinical Human Reliability Assessment (OCHRA) can be used to score errors during surgical procedures. To construct an OCHRA-checklist, steps, substeps, and hazards of a surgical procedure need to be defined. A step-by-step framework was developed to segment surgical procedures into steps, substeps, and hazards. The first aim of this study was to investigate if the step-by-step framework could be used to construct an accurate Lichtenstein open inguinal hernia repair (LOIHR) stepwise description. The second aim was to investigate if the OCHRA-checklist based on this stepwise description was accurate and useful for surgical training and assessment. Materials and methods: Ten expert surgeons rated statements regarding the accuracy of the LOIHR stepwise description, the accuracy, and the usefulness of the LOIHR OCHRA-checklist (eight, seven, and six statements, respectively) using a 5-point Likert scale. One-sample Wilcoxon signed-rank test was used to compare the outcomes to the neutral value of 3. Results: The accuracy of the stepwise description and the accuracy and usefulness of the OCHRA-checklist were rated statistically significantly higher than the neutral value of 3 (median 4.75 [5.00–4.00] with p = .009, median 5.00 [5.00–4.00] with p = .012, median 4.00 [5.00–4.00] with p = .047, respectively). The experts rated the OCHRA-checklist to be useful for the training (5.00 [5.00–4.00], p = .009), and assessment (4.50 [5.00–4.00], p = .010) of surgical residents. Conclusion: This preliminary study showed that the stepwise LOIHR description constructed using the step-by-step framework was found to be accurate. The LOIHR OCHRA-checklist developed using the stepwise description was also accurate, and particularly useful for the training and assessment of proficiency of surgical residents. Highlights: Observational Clinical Human Reliability Assessment (OCHRA) scores errors in surgical procedures. The developed step-by-step framework segments surgical procedures into steps, substeps and hazards. In this study, the open inguinal hernia repair was used as it is a common procedure for training residents. Experts found the stepwise open inguinal hernia repair description constructed using the step-by-step framework accurate. Experts found the open inguinal hernia repair OCHRA-checklist accurate and useful for training surgical residents.