Standardized instrument setup shortens operating time and reduces interruptions in laparoscopic gastrointestinal surgery: A single-centre randomized control trial

Table 3 Specific content of the instrument management plan for the observation group (safety instrumented system mode)

Dimension	Specific plan description	Analysis of plan advantages
Management philosophy	Process-oriented management centering on the optimized surgical process, solidify best practices into standard operating procedures to ensure stable and reliable instrument management quality for each surgery	Repeatability and stability: Minimize variations caused by human factors to the greatest extent and ensure a baseline for the quality of collaborative work
Instrument table layout	Standardized zoned positioning layout: (1) High-frequency operation area: The area closest to the nurse directly in front, where high-frequency instruments (e.g., main operating trocar, atraumatic grasping forceps, dissecting forceps, electric hook/ultrasonic scalpel) are placed; (2) Medium-Frequency operation area: The areas on both sides of the high-frequency area, where medium-frequency instruments (e.g., needle holders, scissors, suction devices, Hem-o-lok forceps) are placed; (3) Low-frequency/standby area: The distal end of the instrument table, where special and standby instruments (e.g., stapler components, special retractors) are placed; and (4) Uniform orientation: All instrument handles face the nurse, and the functional jaws are oriented in the same direction, maintained in a “ready for handover” state	Fixed positioning and ergonomic compliance: Greatly shorten the search path and decision-making time, reduce unnecessary movements such as turning around and bending over, lower the nurse’s workload, and improve handover speed
Instrument preparation logic	Process-specific kits: (1) Pneumoperitoneum establishment kit: Pneumoperitoneum needle, first trocar, laparoscope, pneumoperitoneum tube; (2) Dissection and anatomy kit: Ultrasonic scalpel, dissecting forceps, atraumatic grasping forceps, suction device; (3) Anastomosis preparation kit: Stapler, cutting stapler, needle holder, suture thread; and (4) Predictive preparation: Nurses, based on the surgical progress, place the PSK for the next stage within easy reach before the current stage is about to end	Concurrent engineering and proactive preparation: Transform “passively waiting for instructions” into “proactively anticipating needs” to achieve the state of “instruments waiting for the surgeon”. Fundamentally reduce waiting-related interruptions during surgery and ensure extremely smooth processes
Handover and communication method	Standardized passing protocol: (1) Silent tacit handover: For high-frequency instruments (e.g., ultrasonic scalpel, dissecting forceps), form a conditioned reflex through training where the nurse hands over the instrument as soon as the surgeon reaches out; (2) Verbal confirmation handover (ticket-style): When handing over special or valuable instruments, clearly report the name and status (e.g., linear cutting stapler, green staple cartridge installed), and the surgeon must give a brief confirmation (e.g., Okay) upon receipt; and (3) Closed-loop communication: Ensure instructions are clearly received and correctly executed	Noise reduction, efficiency improvement, and safety enhancement: Reduce noise interference and the risk of mishearing caused by verbal instructions. Closed-loop communication significantly improves the accuracy and safety of information transmission. Silent tacit understanding greatly enhances team cohesion and surgical rhythm
Staff training and onboarding	Systematic training and certification: (1) Theoretical training: Learn the concept of the SIS plan, layout diagrams, PSK lists, and SPP processes; (2) Simulation drills: Conduct high-intensity, repetitive drills in a simulated operating room until muscle memory is formed; and (3) Assessment and certification: Formulate objective scoring criteria (e.g., preparation time, handover accuracy), and only those who achieve a 100% passing rate in the assessment are eligible for on-the-job qualification	Shortened growth cycle: Enable new nurses to get rid of dependence on specific trainers, quickly reach a qualified level through standardized training, and ensure the homogenization and high level of the overall collaborative quality of the team
Emergency and special situation handling	Standardized emergency procedures: (1) Instrument malfunction: Immediately activate standby instruments, move the malfunctioning instrument to a specific area, and handle it uniformly after the surgery; (2) Additional instrument request: Circulating nurses quickly locate and hand over instruments according to the pre-set “Instrument List” to avoid blind searching on the sterile table; and (3) Surgical procedure change: Initiate the pre-determined “expanded instrument kit” procedure	Note: The original table lacks content for “analysis of plan advantages” in this dimension. It is recommended to supplement relevant advantages based on actual scenarios, such as “clear response guidelines: Ensure rapid, orderly, and error-free handling of emergencies, minimize surgical delays caused by unexpected situations, and enhance the team’s ability to respond to risks”