Intra-Operative Process Mapping & Surgical Education - Where We Are Headed

Lecture Summary: The development of efficient surgical care delivery systems has become one of the focal points of the Montefiore Spine Study Group. The bulk of clinical spine research aimed at understanding the determinants of surgical outcome has focused on the perioperative phase of care, such as predictive analytics in patient selection, comparative effectiveness in procedure selection, postoperative care paradigms and rehabilitation measures. It becomes evident that clinical outcome variability may be a reflection not only of patient selection but also of procedural variability. To confound the issue further, there is compelling data to suggest that there is performance variability among surgeons performing the same procedure. This has been illustrated clearly in variance analysis reports at Montefiore Medical Center. Despite any promising clinical advancement, the surgical community has never widely implemented a unifying methodology to understand and reduce both procedural and performance variance. Borrowing from industrial engineering and operations research, process mapping can be feasibly utilized in the intraoperative phase of surgical care. With this in mind, we have begun to develop and implement mechanisms that detect and minimize surgical performance variance through a method described as intraoperative process mapping. This has been demonstrated to be useful in reducing operative time especially with prolonged, multistep surgeries. It has also been utilized to gauge the resident’s progress and proficiency over time. The cadaver-based bio-skills training platform will allow for the rehearsal of intraoperative process mapping techniques prior to implementation in real-time operating room settings. We are optimistic that this can be further investigated in these two settings and will translate into enhanced efficiency in surgical care delivery.