A qualitative human factors investigation of the impact of intraoperative CT-based navigation on interprofessional work in the operating theatre.

Objectives: Intraoperative CT-based navigation (iCT) is increasingly used in complex spine surgeries. We examined the impact of this technology on interprofessional work in the operating room (OR). Methods: Single-site qualitative study. We interviewed surgeons, anesthesiologists, and nurses involved in spine surgeries with iCT. We modeled the work system using the SEIPS framework and conducted inductive content analysis. Results: We interviewed 20 professionals. All participants agreed on the benefits of iCT for surgical outcomes. However, it came with ergonomic challenges. The imaging system is a large piece of equipment. Its installation in a preexisting OR resulted in limitations of movements around the patient and in the room. Anesthesiologic and surgical teams required additional time to discuss patient positioning and ensure sufficient space for everyone, as well as adequate access to airways for anesthesiologists and anesthesia nurses. With the new technology also came new tasks. Surgeons usually managed the initial image acquisition, but to avoid desterilization during the procedure, nurses also had to learn to use the equipment. Permanent staff members progressively developed expertise; however, with high turnover among nurses and the use of agency staff, it proved difficult to ensure that surgical nurses were consistently trained in the use of the equipment. Over time, anesthetic and surgical teams adjusted their practices to balance the surgical benefits of the technology with ergonomic concerns. Conclusion: Implementing iCT can disrupt work systems and requires careful consideration of human and organizational factors in the OR to ensure patient safety. Multicentric studies would be needed.