Roger Daglius Dias

Harvard Medical School | Brigham and Women's Hospital · Emergency Medicine

Providing care for simulated emergency patients may induce considerable acute stress in physicians. However, the acute stress provoked in a real-life emergency room is not well known. Our aim was to assess acute stress responses in residents during real emergency care and investigate the related personal and situational factors. A cross-sectional o...

Background: Surgeons in the operating theatre deal constantly with high-demand tasks that require simultaneous processing of a large amount of information. In certain situations, high cognitive load occurs, which may impact negatively on a surgeon's performance. This systematic review aims to provide a comprehensive understanding of the different...

Purpose: To identify the different machine learning (ML) techniques that have been applied to automate physician competence assessment and evaluate how these techniques can be used to assess different competence domains in several medical specialties. Method: In May 2017, MEDLINE, EMBASE, PsycINFO, Web of Science, ACM Digital Library, IEEE Xplor...

Objectives Variability in cardiopulmonary arrest training and management leads to inconsistent outcomes during in-hospital cardiac arrest. Existing clinical decision aids, such as American Heart Association (AHA) advanced cardiovascular life support (ACLS) pocket cards and third-party mobile apps, often lack comprehensive management guidance. We de...

BACKGROUND Innovations in emergency medical services and prehospital care have led to improvement in patient outcomes over the past several decades, including a reduction in early deaths following traumatic injuries and improved survival from out-of-hospital cardiac arrest following early initiation of BLS procedures. However, there remain signific...

Importance Assessing nontechnical skills in operating rooms (ORs) is crucial for enhancing surgical performance and patient safety. However, automated and real-time evaluation of these skills remains challenging. Objective To explore the feasibility of using motion features extracted from surgical video recordings to automatically assess nontechni...

Medical errors are the third leading cause of death, right after cancer and heart diseases, causing around 250,000 deaths every year. Approximately 40% of these errors happen in the operating room (OR) and 50% of the resulting complications are avoidable. Most errors are related to communication. Effective communication among team members during ca...

The integration of Artificial Intelligence (AI) into clinical decision support systems (CDSS) marks a significant advancement in the pursuit of enhanced patient care and operational efficiency in high-stakes environments, such as the operating room (OR) [1]. However, the complexity and often "black box" nature of these AI systems pose substantial c...

In high-risk high-stakes environments, such as the cardiac operating room (OR), the cognitive processes of each surgical team member, as well as alignments or misalignments between team members play a critical role in team performance and consequent patient care quality. This study's goal was to investigate the cognitive processes of cardiac surger...

Objectives The proposed study aims to assess users’ perceptions of a surgical safety checklist (SSC) reimplementation toolkit and its impact on SSC attitudes and operating room (OR) culture, meaningful checklist use, measures of surgical safety, and OR efficiency at 3 different hospital sites. Background The High-Performance Checklist toolkit (too...

Introduction Surgeons strive to continually enhance performance. Currently, assessment relies on subjective, retrospective methods-hindering real-time improvement and error prevention. Learning from sports, surgeons can utilise surgical sabermetrics for data-driven analysis. Cognitive load(CogL) impacts performance, with overload impairing skills a...

Space travel has transformed in the past several years. Given the burgeoning market for space tourism, in-flight medical emergencies are likely to be expected. Ultrasound is one of the few diagnostic and therapeutic modalities available for astronauts in space. However, while point-of-care ultrasound (POCUS) is available, there is no current standa...

Background: The impact of quality improvement initiatives Program (QIP) on coronary artery bypass grafting surgery (CABG) remains scarce, despite improved outcomes in other surgical areas. This study aims to evaluate the impact of a package of QIP on mortality rates among patients undergoing CABG. Materials and methods: This prospective cohort s...

Objective To evaluate the current evidence for surgical sabermetrics: digital methods of assessing surgical non-technical skills and investigate the implications for enhancing surgical performance. Background Surgeons need high-quality, objective, and timely feedback to optimise performance and patient safety. Digital tools to assess non-technical...

This study focuses on understanding the influence of cognitive biases in the intraoperative decision-making process within cardiac surgery teams, recognizing the complexity and high-stakes nature of such environments. We aimed to investigate the perceived prevalence and impact of cognitive biases among cardiac surgery teams, and how these biases ma...

Introduction: Leading hospital code teams is stressful for resident physicians, and variability in training and experience may result in inconsistent care and outcomes. Nearly all bedside aids like AHA advanced cardiovascular life support (ACLS) pocket cards and third-party ACLS mobile apps lack step-by-step guidance or reminders. Our team designed...

Background Managing acute pain is a common challenge in the emergency department (ED). Though widely used in perioperative settings, ED‐based ultrasound‐guided nerve blocks (UGNBs) have been slow to gain traction. Here, we develop a low‐cost, low‐fidelity, simulation‐based training curriculum in UGNBs for emergency physicians to improve procedural...

Current methods for assessing the performance of surgical teams, such as observational rating scales and team self-assessments, have significant limitations. Existing methods primarily focus on subjective evaluations of surgical team performance or use an unstructured and descriptive method, resulting in inaccurate, biased evaluations. A computer v...

The advent of artificial intelligence (AI) and machine learning (ML) has revolutionized the field of medicine. Although highly effective, the rapid expansion of this technology has created some anticipated and unanticipated bioethical considerations. With these powerful applications, there is a necessity for framework regulations to ensure equitabl...

The cardiac operating room (OR) is a high-risk, high-stakes environment inserted into a complex socio-technical healthcare system. During cardiopulmonary bypass (CPB), the most critical phase of cardiac surgery, the perfusionist has a crucial role within the interprofessional OR team, being responsible for optimizing patient perfusion while coordin...

Objectives: In-hospital cardiac arrests are common and associated with high mortality. Smartphone applications offer quick access to algorithms and timers but often lack real-time guidance. This study assesses the impact of the Code Blue Leader application on the performance of providers leading cardiac arrest simulations. Methods: This open-lab...

Clinical alarm and decision support systems that lack clinical context may create nonactionable nuisance alarms that are not clinically relevant and can cause distractions during the most difficult moments of a surgery. We present a novel, interoperable, real-time system for adding contextual awareness to clinical systems by monitoring the heart-ra...

Background: Several human factors impact the intraoperative performance of surgical teams. Non-technical skills (NTS) and workflow disruptions are related to patient safety in the operating room. In this study, we investigated the NTS of surgical teams and the frequency of distractions during separation from bypass, a critical phase of cardiac surg...

Background: Surgical procedures take place in high-risk and complex environments, where multiple specialized professionals work together to deliver effective care to patients. Therefore, teamwork is essential for the successful performance of open surgery or laparoscopic surgery. Team performance during a surgical procedure varies depending on the...

Brief periods of extreme gravitational transition are anticipated during interplanetary spaceflight, including transitions between microgravity, hypogravity, and hypergravity. Rapid sensorimotor adaptation will occur following these G-transitions which may affect astronaut performance including gaze control and dynamic visual acuity. Significant de...

This article highlights the importance of considering Cognitive Load (CL) and Cognitive Load Theory (CLT) during surgical training, focusing on the acquisition of intra-operative skills. It describes the basis of CLT with the overarching aim of describing CLT-based techniques to enhance current training strategies and surgical performance, many of...

INTRODUCTION: Spaceflight has detrimental effects on human health, imposing significant and unique risks to crewmembers due to physiological adaptations, exposure to physical and psychological stressors, and limited capabilities to provide medical care. Previous research has proposed and evaluated several strategies to support and mitigate the risk...

Introduction: Previous studies suggest promising use of motion analysis to assess surgical psychomotor skills. This study aims to provide preliminary evidence on the feasibility of using a motion capture (mocap) system for objective assessment of a surgeon’s technical skills during ureteroscopic procedures. Methods: Motion data of two participant...

Introduction Surgeons need high fidelity, high quality, objective, non-judgemental and quantitative feedback to measure their performance in order to optimise their performance and improve patient safety. This can be provided through surgical sabermetrics, defined as ‘advanced analytics of digitally recorded surgical training and operative procedur...

Medical events can affect space crew health and compromise the success of deep space missions. To successfully manage such events, crew members must be sufficiently prepared to manage certain medical conditions for which they are not technically trained. Extended Reality (XR) can provide an immersive, realistic user experience that, when integrated...

Introduction Literature has shown cognitive overload which can negatively impact learning and clinical performance in surgery. We investigated learners’ cognitive load during simulation-based trauma team training using an objective digital biomarker. Methods A cross-sectional study was carried out in a simulation center where a 3-h simulation-base...

Purpose Articulated hand pose tracking is an under-explored problem that carries the potential for use in an extensive number of applications, especially in the medical domain. With a robust and accurate tracking system on surgical videos, the motion dynamics and movement patterns of the hands can be captured and analyzed for many rich tasks. Meth...

Excessive intra-operative noise in cardiac surgery has the potential to serve as source of distraction and additional cognitive workload for the surgical team, and may interfere with optimal performance. The separation from bypass phase is a technically complex phase of surgery, making it highly susceptible to communication breakdowns due to high c...

Situational awareness (SA) at both individual and team levels, plays a critical role in the operating room (OR). During the pre-incision time-out, the entire OR team comes together to deploy the surgical safety checklist (SSC). Worldwide, the implementation of the SSC has been shown to reduce intraoperative complications and mortality among surgica...

Several studies have reported low adherence and high resistance from clinicians to adopt digital health technologies into clinical practice, particularly the use of computer-based clinical decision support systems. Poor usability and lack of integration with the clinical workflow have been identified as primary issues. Few guidelines exist on how t...

Objectives The aim of this study was to conduct the translation and cross-cultural adaptation of the original Team Emergency Assessment Measure (TEAM) tool into the Brazilian Portuguese language and investigate the internal consistency, inter-rater reliability, and concurrent validity of this new version (bp-TEAM). Methods Independent medical tran...

Objective Our primary aim was to investigate crew performance during medical emergencies with and without ground-support from a flight surgeon located at mission control. Background There are gaps in knowledge regarding the potential for unanticipated in-flight medical events to affect crew health and capacity, and potentially compromise mission s...

Purpose: War negatively impacts health professional education when healthcare is needed most. The aims of this scoping review are to describe the scope of barriers and targeted interventions to maintaining health professional education during war and summarize the research. Methods: We conducted a scoping review between June 20, 2018, and August...

Objective:. The aims of this study were to describe the process of integrating 2 established training programs, Nontechnical skills for surgeons, and a traditional essential surgical skills course and to measure the impact of this integrated course on the behaviors of interprofessional surgical teams in Rwandan district hospitals. Background:. Surg...

Introdução A falta de estratégias proativas de cuidados influenciam a fragmentação dos cuidados, desparametrização de processos e prolongamento de tempos hospitalares, 1 enquanto evidências mostraram que protocolos multiprofissionais baseados em evidências executados por equipes sincronizadas, com padronização de processos, proatividade e cuidados...

The cardiac surgery operating room (OR) is a complex sociotechnical environment requiring the seamless integration of human-human and human-machine teams. Perfusionists in particular play a critical role in ensuring patient stability by operating the cardiopulmonary bypass (CPB) machine. Goal-directed perfusion (GDP) (oxygen delivery [DO2] ≥ 280 mL...

Space travel imposes significant risks to crew health due to physiological adaptations, exposure to physical and psychological stressors, and limited capabilities to provide medical care. When medical emergencies occur, appropriate use of diagnostic and procedural guidance tools are crucial countermeasures against the risks of injury and mission fa...

The cardiac surgery operating room is a high-risk and complex environment in which multiple experts work as a team to provide safe and excellent care to patients. During the cardiopulmonary bypass phase of cardiac surgery, critical decisions need to be made and the perfusionists play a crucial role in assessing available information and taking a ce...

Objective (s): This study aimed to develop the Perfusionists’ Intraoperative Non-Technical Skills (PINTS) tool, specifically to the perfusionists’ context, and test its inter-rater reliability. Methods An expert panel was convened to review existing surgical non-technical skills taxonomies and develop the PINTS tool. During a workshop held at a na...

Objective: Evaluate how emotional intelligence (EI) has been measured among surgeons and to investigate interventions implemented for improving EI. Summary background: EI has relevant applications in surgery given its alignment with non-technical skills. In recent years, EI has been measured in a surgical context to evaluate its relationship wit...

Background Familiarity among cardiac surgery team members may be an important contributor to better outcomes and thus serve as a target for enhancing outcomes. Methods Adult cardiac surgical procedures (n = 4,445) involving intraoperative providers were evaluated at a tertiary hospital between 2016 and 2020. Team familiarity (mean of prior cardiac...

While the influence of surgical flow disruptions (SFDs) on surgical performance has been observed in live cardiovascular surgery and their influence on cognitive workload has been evaluated in high-fidelity simulations, the relationship between SFDs and cognitive workload of surgical providers in the live cardiac surgery operating room has yet to b...

Shared mental models are critical to team success; however, in practice, team members may have misaligned models due to a variety of factors. In safety-critical domains (e.g., aviation, healthcare), lack of shared mental models can lead to preventable errors and harm. Towards the goal of mitigating such preventable errors, here, we present a Bayesi...

Shared mental models are critical to team success; however, in practice, team members may have misaligned models due to a variety of factors. In safety-critical domains (e.g., aviation, healthcare), lack of shared mental models can lead to preventable errors and harm. Towards the goal of mitigating such preventable errors, here, we present a Bayesi...

Surgical time-outs are designed to promote situation awareness, teamwork, and error prevention. The pre-incision time-out in particular aims to facilitate shared mental models prior to incision. Objective, unbiased measures to confirm its effectiveness are lacking. We hypothesized that providers' mental workload would reveal team psychophysiologica...

Objective: To assess the impact of intensive care unit bed availability, distractors and choice framing on intensive care unit admission decisions. Methods: This study was a randomized factorial trial using patient-based vignettes. The vignettes were deemed archetypical for intensive care unit admission or refusal, as judged by a group of expert...

Background As surgical systems are forced to adapt and respond to new challenges, so should the patient safety tools within those systems. We sought to determine how the WHO SSC might best be adapted during the COVID-19 pandemic. Methods 18 Panelists from five continents and multiple clinical specialties participated in a three-round modified Delp...

Shared mental models are critical to team success; however, in practice, team members may have misaligned models due to a variety of factors. In safety-critical domains (e.g., aviation, healthcare), lack of shared mental models can lead to preventable errors and harm. Towards the goal of mitigating such preventable errors, here, we present a Bayesi...

Objective Nontechnical skills, such as situation awareness, decision making, leadership, communication, and teamwork play a crucial role on the quality of care and patient safety in the operating room (OR). In our previous work, we developed an interdisciplinary training program, based on the NOTSS (Non-Technical Skills for Surgeons) taxonomy. The...

Articulated hand pose tracking is an underexplored problem that carries the potential for use in an extensive number of applications, especially in the medical domain. With a robust and accurate tracking system on in-vivo surgical videos, the motion dynamics and movement patterns of the hands can be captured and analyzed for rich tasks including sk...

With the tremendous advances in technology and computational systems that occurred in the last three decades, we have integrated novel technologies in virtually all human activities, with the ultimate goal of improving performance and enhancing safety in the workplace. As a high-stakes, high-risk human activity, with increasing level of complexity,...

Objective This novel preliminary study sought to capture dynamic changes in heart rate variability (HRV) as a proxy for cognitive workload among perfusionists while operating the cardiopulmonary bypass (CPB) pump during real-life cardiac surgery. Background Estimations of operators’ cognitive workload states in naturalistic settings have been deri...

Effectiveness of computer vision techniques has been demonstrated through a number of applications, both within and outside healthcare. The operating room environment specifically is a setting with rich data sources compatible with computational approaches and high potential for direct patient benefit. The aim of this review is to summarize major t...

Monitoring healthcare providers' cognitive workload during surgical procedures can provide insight into the dynamic changes of mental states that may affect patient clinical outcomes. The role of cognitive factors influencing both technical and non-technical skill are increasingly being recognized, especially as the opportunities to unobtrusively c...

Cardiac surgery is one of the most complex specialties in medicine, akin to a complex sociotechnical system. Patient outcomes are vulnerable to surgical flow disruptions (SFDs), a source of preventable harm. Healthcare providers’ (HCPs) sympathetic activation secondary to emotional states represent an underappreciated source of SFDs. This study’s o...

Introduction Trauma patients are complex and diverse with the team leader playing a crucial role in team performance. Trauma team leadership (TTL) skills are critical according to many studies, yet no assessment tool has been developed for this important skill set. The aim of this study was to develop and validate a TTL assessment tool for use in b...

The tremendous and rapid technological advances that humans have achieved in the last decade have definitely impacted how surgical tasks are performed in the operating room (OR). As a high-tech work environment, the contemporary OR has incorporated novel computational systems into the clinical workflow, aiming to optimize processes and support the...

Objectives: This study aimed to narratively summarize the literature reporting on the effect of teamwork and communication training interventions on culture and patient safety in emergency department (ED) settings. Methods: We searched PubMed, EMBASE, Psych Info CINAHL, Cochrane, Science Citation Inc, the Web of Science, and Educational Resource...

Objective Mirrored psychophysiological change in cognitive workload indices may reflect shared mental models and effective healthcare team dynamics. In this exploratory analysis, we investigated the frequency of mirrored changes, defined as concurrent peaks in heart rate variability (HRV) across team members, during cardiac surgery. Design Objecti...

Cardiac surgery represents a complex sociotechnical environment relying on a combination of technical and non-technical team-based expertise. Surgical flow disruptions (SFDs) may be influenced by a variety of sources, including social, environmental, and emotional factors affecting healthcare providers (HCPs). Many of these factors can be readily o...

Surgical processes are rapidly being adapted to address the COVID-19 pandemic, with changes in procedures and responsibilities being made to protect both patients and medical teams. These process changes put new cognitive demands on the medical team and increase the likelihood of miscommunication, lapses in judgment, and medical errors. We describe...

BACKGROUND Of the 150,000 patients annually undergoing coronary artery bypass grafting surgery, 35% develop complications that increase mortality 5-fold and expenditures by 50%. Differences in patient risk and operative approach explain only 2% of hospital variation in some complications. The intraoperative phase remains understudied as a source of...