Gary Sutkin, M.D., brings years of advanced surgical knowledge to his team of mostly non-medical experts.
A research lab at the School of Medicine has a different approach to making surgeries safer.
In the U.S. airline industry, after decades of improvements and strategies designed to reduce the risks of flying, the accepted standard is making risks as low as reasonably possible. Today, airline travel is among the safest forms of transportation in the world.
At the University of Missouri-Kansas City School of Medicine, Gary Sutkin, M.D., professor of surgery and associate dean for women’s health, has adopted the same standard when it comes to errors in the operating room.
“Human error is inevitable,” Sutkin said. “It can’t be eliminated in the operating room, but it can be minimized. So that’s our term — as low as reasonably possible. The airline industry has the exact same motto. They know they can’t get human error down to zero, but they can get it pretty close.”
Sutkin’s efforts have led to the creation of his Surgical Innovations Laboratory at the School of Medicine. Nicknamed the Surgilab, it’s where Sutkin and his team take a different approach to medical research. The team itself is an innovation, drawing from several non-medical disciplines to explore ways to stamp out risks by improving operating room procedures.
Gathered around the lab’s conference table might be a biomedical engineer, a theater professor, a medical student, a mechanical engineer or even a communications specialist, all studying a surgical procedure displayed on a bank of video monitors.
In addition to observing the technical aspects of the medical operation, these researchers watch the movements and non-verbal communications of the surgeons, assistants, nurses and technicians throughout the procedure, looking for ways the OR team can more effectively work together to make the surgery safer for the patient.
“Human error is inevitable. It can’t be eliminated in the operating room, but it can be minimized.” – Gary Sutkin
“We try to be different in our approaches to science. We try to be iconoclastic,” said Sutkin. “These are big problems that have eluded solutions. They challenge us to ask how we can make surgeries safer. Our belief is the only way we’re going to solve these problems is with new approaches. That’s why we want to be different. That is why our lab looks the way it does.”
Two bean bag chairs sit on a colorful carpet in one corner of Sutkin’s third-floor think tank. A nearby bookcase is filled with props that Sutkin uses to help explain the technical aspects of surgical procedures to the non-medical members of the team. The Surgilab’s video monitors fill one wall at the end of the conference table. Blue, red and orange chairs surround the table, the different colors representing the different ideas that come from team members with various backgrounds.
All of it is by design, Sutkin explains, to foster an atmosphere of creativity.
During a work session, Fizza Mahmud, Sutkin’s research assistant, hands him a can of Play-Doh from a box on the bookshelf. Sutkin shapes it into a model of part of the human anatomy and then uses that to describe to his team how a surgical instrument is used — or misused — during an operation.
“We’re one big community here trying to make surgery safer by cutting down on errors and improving communication,” Sutkin said. “The operating room is such a high-risk environment. You have all these people from different backgrounds trying to work together, all with the same goal: to have an effective, safe surgery. But they have to communicate well to do that.”
Margaret Brommelsiek, Ph.D., brings her different perspective to the research team as a communications professional. An associate research professor in the School of Nursing and Health Studies and director of Interprofessional Education for the Health Sciences, Brommelsiek has extensive experience in applying interprofessional communication to health professions education and interprofessional clinical practice.
Her surgical experience, on the other hand, is limited to the two times in her life that she was a patient.
“I’m looking at things more from the patient’s perspective than from the surgeon’s perspective, and that brings a different lens to the research,” Brommelsiek said. “It’s a different kind of critical thinking. We’re learning to look for non-verbal cues that occur during a surgery. What is the context of what happened in the operating room? What informed the conversation that goes on during the surgery?”
Sutkin said it was his interest in the social sciences that led him to the idea of the Surgilab. It brings together researchers from different disciplines that wouldn’t typically seem to have a correlation to medicine.
“Sometimes it’s when you take two different ideas that you come up with something really interesting and novel,” he said. “That’s what I like about having people from different backgrounds come together.”
Sutkin’s work began while he was a member of the faculty at the University of Pittsburgh School of Medicine. It was there that he began working with a cognitive psychologist who, he said, brought a different way of thinking to the research arena.
Those differences helped spark new thoughts about how to approach surgeries and patient safety.
“Some of our best ideas came from those different approaches,” Sutkin said. “Usually it happened where she’d say something and I’d say, ‘Well, that’s just crazy.’ Then, I’d think about it and realize, wait a second, that’s crazy smart.”
One high-risk surgery Sutkin’s team is scrutinizing inserts a supportive mesh sling under a woman’s urethra. The procedure requires only a small incision but can result in a bladder injury or, worse, a potentially fatal perforation of a bowel or blood vessel.
“The most serious injuries occur in less than 1 percent of these surgeries, but that’s still too much,” Sutkin said.
To see which surgical motions most often result in such errors — and better teach how to avoid such motions and injuries — the team will use motion sensors to detect and analyze Sutkin’s motions as he performs the procedure repeatedly on a 3D model.
Sutkin’s team also is working with third-year medical student Debolina Kanjilal to create a theoretical model that links surgical techniques to adverse operating room outcomes. The idea is to find common themes among errors in all types of surgeries and find a way to eliminate them.
Sutkin and Kanjilal have developed a flowchart that fills a whiteboard on one wall. Arrows outline the progression of a typical surgery and deviations from prescribed techniques that lead to errors and adverse patient outcomes. The information is derived from a continuing series of interviews with local surgeons that Kanjilal has spent hours conducting.
“What we see is that surgeons more often tend to do a procedure the way they’re taught, or the way they’ve been doing it for a long time, even if there may be evidence for doing it another way,” Kanjilal said. “As humans, it’s difficult for us to change if we’ve been doing something one way for years.”
In 2016, Sutkin moved to Kansas City and joined the UMKC School of Medicine. With the support of the school’s dean, Steven L. Kanter, M.D., he immediately went to work establishing his Surgilab.
“Coming to UMKC, I was trying to replicate that relationship between surgeon, scientist and social scientist,” Sutkin said. “We’ve come up with more good ideas here.”
The overall goal of the Surgilab, Sutkin said, is to find the links between variables involved in surgeries and adverse effects and make corrections that will help surgeons maintain the immense trust that patients place in them every time they walk into an operating room.
“Human error is a part of any high-risk industry,” Sutkin said. “Whether it’s aviation, the railway industry or surgery, safety incidents are going to happen. You’re never going to get it down to zero, but you’re always trying to make it lower and lower.”
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Researchers look to shorten the learning curve in the operating room
Fizza Mahmud calls it an “ah-ha” moment. It’s that epiphany that happens when a medical resident in training is struggling to learn a surgical move and the light bulb suddenly clicks on.
“We have film clips proving that there are certain moments that happen in the operating room, where the attending is telling the resident how to do something but the resident is trying to figure out on his own how to do it,” Mahmud said. “And then it just happens, in a second. They figure it out, ‘Oh, that’s how I’m supposed to do it.’ ”
A research assistant in the UMKC School of Medicine Surgical Innovations Lab, Mahmud works closely with lab director Gary Sutkin, M.D., professor of surgery and associate dean for women’s health. They have watched numerous surgical procedures to better understand the learning curve that occurs in the operating room.
It’s something every surgeon experiences, Sutkin said, learning how to not make surgical mistakes.
“I definitely experienced that early in my surgical career,” Sutkin said. “I look at how long it took me to learn from my mistakes and I think, that’s too long.”
That’s why Mahmud and Sutkin spend hours studying videos of surgeries, looking for something that can help young surgeons shorten that learning curve and discover the correct and safest methods as quickly as possible.
Mahmud and Sutkin attended an Association of American Medical Colleges conference in March where they were invited to present their latest findings in a meeting of the Central Group on Educational Affairs.
One issue among surgeons, Sutkin said, is consistency in performing challenging surgical techniques that are hard to replicate time after time. Back in the Surgical Innovations Lab, he and Mahmud continue to search for new ways to make surgical procedures more standard, more consistent and ultimately more safe.
“Our scientific ‘ah-ha’ moments come here at this conference table