168 DEVELOPMENT OF A PREOPERATIVE PROTOCOL TO ENHANCE OPERATING ROOM TEAM FUNCTION: THE SAFETY PREP™

BackgroundPatient safety depends on effective teamwork. The similarity of team members’ mental models - or their shared understanding–regarding clinical tasks is likely to influence the effectiveness of teamwork. Mental models have not been measured in the complex, high-acuity environment of the operating room (OR), where professionals of different backgrounds must work together to achieve the best surgical outcome for each patient. Therefore, we aimed to explore the similarity of mental models of task sequence and of responsibility for task within multidisciplinary OR teams.MethodsWe developed a computer-based card sorting tool (Momento) to capture the information on mental models in 20 six-person surgical teams, each comprised of three subteams (anaesthesia, surgery, and nursing) for two simulated laparotomies. Team members sorted 20 cards depicting key tasks according to when in the procedure each task should be performed, and which subteam was primarily responsible for each task. Within each OR team and subteam, we conducted pairwise comparisons of scores to arrive at mean similarity scores for each task.ResultsMean similarity score for task sequence was 87 % (range 57–97 %). Mean score for responsibility for task was 70 % (range = 38–100 %), but for half of the tasks was only 51 % (range = 38–69 %). Participants believed their own subteam was primarily responsible for approximately half the tasks in each procedure.ConclusionsWe found differences in the mental models of some OR team members about responsibility for and order of certain tasks in an emergency laparotomy. Momento is a tool that could help elucidate and better align the mental models of OR team members about surgical procedures and thereby improve teamwork and outcomes for patients.Electronic supplementary materialThe online version of this article (doi:10.1186/s12909-016-0752-8) contains supplementary material, which is available to authorized users.

ABSTRACTMaintaining job satisfaction across the team in the operating room (OR) is essential for reducing staff turnover, stress, burnout, medical errors and increasing patient satisfaction. This literature review explores factors impacting on job satisfaction for OR team members, with a specific focus on nurses, anaesthetists and surgeons. A literature search from January 1997 to November 2017 was conducted using databases CINHAL, psychINFO, Medline and ABI/inform. Surgeon, anaesthetist, OR nurse and OR team job satisfaction studies were included. The search yielded 48 studies. Dominant contributing factors for all three disciplines included: work conditions, support and acknowledgement from management, and fulfilment from the clinical role. Career prospects, research opportunities, autonomy, utilising the full extent of one’s skills, team dynamics/communication, pressure from management, and social support systems were also identified as significant for specific disciplines within the team. This review highlights the importance of addressing factors relating to job satisfaction from an ‘OR team’ perspective and considering the inter-relationship between roles. Further research into ‘team satisfaction’ in the OR, its measurement and its relationship with retention and productivity would be of benefit.

Evaluation of a passive arm-support exoskeleton for surgical team members: Results from live surgeries

The impact of planning and communication on unplanned costs in surgical episodes of care: Implications for reducing waste in hospital operating rooms

Communication failures between multidisciplinary teams can impact efficiency, performance, and morale. Academic operating rooms (ORs) often have surgical, anesthesia, and nursing teams, each teaching multiple trainees. Incorrectly identifying name and "rank" (postgraduate year [PGY]) of resident trainees can disrupt performance evaluations and team morale and even potentially impair delivery of quality care when miscommunication errors proliferate. Our OR-based survey asked 50 participants (18 surgeons, 14 anesthesiologists, and 18 nursing members), to recall basic identification data including provider names and PGY levels from their recent collaborating OR teams. Participants also weighed in on the importance of using accurate "names and ranks" for all OR participants. Each service reliably knew their own team members' names and rank. However, surgery and anesthesia teams displayed decreased knowledge about their lower level trainees, whereas nursing teams performed best, identifying all level nurses present. Deficits occurred whenever participants tried recalling basic identifying data about contributors from any other collaborating team. Typically, misidentified participants were lower level PGY residents working on other teams' services. All survey respondents desired improving systems to better remember "names and ranks" identifications among OR participants, citing both safety and team morale benefits. Many fail to know the names and ranks of contributors among members of different OR teams. Even our most reliable nursing team was inconsistent at identification information from collaborating practitioners. Despite universally acknowledged benefits, participants rarely learned basic background identification data beyond their own team. Those surveyed all desired improving identifications with suggestions including sterile name and rank tags and proper notification of entry and exit from the OR. Because successful collaborations require appropriate level task delegations, participants believed knowing a resident's name and rank is important not only for team bonding but also for safety. Academia furthermore demands fair performance evaluations, and displaying them clearly improves recall. Refining our own identified gaps in OR communications may demonstrate improved teamwork and safer task delegations and perhaps even stimulate other performance benefits for academic ORs.

The aim of this study was to elucidate the cognitive processes involved in surgical procedures from the perspective of different team roles (surgeon, anesthesiologist, and perfusionist) and provide a comprehensive compilation of intraoperative cognitive processes. Nontechnical skills play a crucial role in surgical team performance and understanding the cognitive processes underlying the intraoperative phase of surgery is essential to improve patient safety in the operating room (OR). A mixed-methods approach encompassing semistructured interviews with 9 subject-matter experts. A cognitive task analysis was built upon a hierarchical segmentation of coronary artery bypass grafting procedures and a cued-recall protocol using video vignettes was used. A total of 137 unique surgical cognitive processes were identified, including 33 decision points, 23 critical communications, 43 pitfalls, and 38 strategies. Self-report cognitive workload varied substantially, depending on team role and surgical step. A web-based dashboard was developed, providing an integrated visualization of team cognitive processes in the OR that allows readers to intuitively interact with the study findings. This study advances the current body of knowledge by making explicit relevant cognitive processes involved during the intraoperative phase of cardiac surgery from the perspective of multiple OR team members. By displaying the research findings in an interactive dashboard, we provide trainees with new knowledge in an innovative fashion that could be used to enhance learning outcomes. In addition, the approach used in the present study can be used to deeply understand the cognitive factors underlying surgical adverse events and errors in the OR.

The operating room (OR) is a complex environment in which highly trained individuals perform cognitively demanding tasks. Distractions in this environment may lead to deleterious effects, as a loss of situational awareness can interfere with surgical procedures. The present study aims to quantify the frequency and nature of distracting events associated with personal electronic devices (PEDs) during twenty elective orthopedic surgery cases. PED use was coded using a real-time, custom data collection tool beginning in the pre-operative area and terminating at the time of handoff with the post-anesthesia care team. PED use accounted for 242 flow disruptions in the OR. The vendor showed the highest frequency of flow disruptions (73), followed by the circulating nurse (52) and the certified registered nurse anesthetist (CRNA) (52). Thus, taking a proactive safety approach to account for intraoperative distractions associated with PEDs among OR team members will be critical to ensure high-quality patient care.

Disruptions in Surgical Workflow: Perceptions and Implications

To explore the prerequisites for operating room nurses to carry out infection prevention interventions during the intraoperative phase. Integrative review. Whittemore and Knafl's method guided this integrative review. Database searches were conducted in PubMed, CINAHL, EBSCO, Embase and Web of Science's Core Collection. The initial search took place on April 12, 2022, with complementary searches on November 11, 2024. Four categories emerged from the analysis of the 18 included studies. These categories encompassed the intrapersonal prerequisites of the operating room nurses, interpersonal prerequisites within the operating room team, adherence to guidelines and supportive conditions. Prerequisites for infection prevention interventions during the intraoperative phase included the professional competence of operating room nurses, a supportive team and sufficient resources provided by management, such as adequate equipment and time for planning and implementation. Ensuring patient safety requires operating room nurses to embrace their leadership roles and adhere to evidence-based recommendations. The PRISMA 2020 statement. For patient safety, management should strive to ensure that the necessary prerequisites are in place to provide safe intraoperative infection prevention. This study offers valuable insights for the global community of operating room nurses, operating room team members and managers regarding the essential prerequisites for safe infection prevention for vulnerable patients during the intraoperative phase. No patient or public contribution was included in this study. No patient or public contribution was included in this study.

We investigated the impact of repetitive training using high-fidelity simulation (HFS) at the point of care on the teamwork attitudes of operating room (OR) personnel. Members of the general surgical OR teams at an academic medical center participated in two half-day point-of-care HFS team training sessions. Module 1 targeted teamwork competencies; Module 2 included a preoperative briefing strategy. Modules were separated by 1 month. For each training, participants completed pre- and postsession questionnaires that included a 15-item self-efficacy tool targeting teamwork competencies using a 6-point Likert-type scale. Pre- and postsession mean scores were compared with a t test. Matched pre- and postsessions questionnaires were collected from 38 and 39 participants for Module 1 and Module 2, respectively. Mean item improvement from pre- to posttraining was 0.43 units (range, 0.23 to 0.69 units) for Module 1 and 0.42 units (range, 0.15 to 0.53 units) for Module 2. After Bonferroni adjustment, statistically significant improvement in scores from pre- to posttraining increased from four items after Module 1 to nine items after Module 2. Repetitive training of interdisciplinary OR teams through HFS at the point of care increases the effectiveness of promoting attitudinal change toward team-based competencies among participants.

Fire in Labor and Delivery: Simulation Case Scenario

BackgroundSurgical safety may be improved using a medical data recorder (MDR) for the purpose of postoperative team debriefing. It provides the team in the operating room (OR) with the opportunity to look back upon their joint performance objectively to discuss and learn from suboptimal situations or possible adverse events. The aim of this study was to investigate the satisfaction of the OR team using an MDR, the OR Black Box®, in the OR as a tool providing output for structured team debriefing.MethodsIn this longitudinal survey study, 35 gastro-intestinal laparoscopic operations were recorded using the OR Black Box® and the output was subsequently debriefed with the operating team. Prior to study, a privacy impact assessment was conducted to ensure alignment with applicable legal and regulatory requirements. A structured debrief model and an OR Back Box® performance report was developed. A standardized survey was used to measure participant’s satisfaction with the team debriefing, the debrief model used and the performance report. Factor analysis was performed to assess the questionnaire’s quality and identified contributing satisfaction factors. Multivariable analysis was performed to identify variables associated with participants’ opinions.ResultsIn total, 81 team members of various disciplines in the OR participated, comprising 35 laparoscopic procedures. Mean satisfaction with the OR Black Box® performance report and team debriefing was high for all 3 identified independent satisfaction factors. Of all participants, 98% recommend using the OR Black Box® and the outcome report in team debriefing.ConclusionThe use of an MDR in the OR for the purpose of team debriefing is considered to be both beneficial and important. Team debriefing using the OR Black Box® outcome report is highly recommended by 98% of team members participating.

Medical team training (MTT) has been touted as a way to improve teamwork and patient safety in the operating room (OR). OR personal completed a 1-day intensive MTT training. A standardized briefing/debriefing/perioperative routine was developed, including documentation of OR miscues, delays, and a case score (1-5) assigned by the OR team. A multidisciplinary MTT committee reviewed and rectified any systems problems identified. Debriefing items were analyzed comparing baseline data with 12 and 24-month follow-up. A safety attitudes questionnaire was administered at baseline and 1 year. A total of 4863 MTT debriefings were analyzed. One year following MTT, case delays decreased (23% to 10%, P < 0.0001), mean case score increased (4.07-4.87, P < 0.0005), and both changes were sustained at 24 months. One-year and 24-month follow-up data demonstrated decreased frequency of preoperative delays (16%-7%, P = 0.004), hand-off issues (5.4%-0.3%, P < 0.0001), equipment issues/delays (24%-7%, P < 0.0001), cases with low (<3) case scores (23%-3%, P < 0.0005), and adherence to timing guidelines for prophylactic antibiotic administration improved (85%-97%, P < 0.0001). Surveys documented perception of improved teamwork and patient safety. A major systems issue regarding perioperative medication orders was identified and corrected. MTT produced sustained improvement in OR team function, including decreased delays and improved case scores. When combined with a high-level debriefing/problem-solving process, MTT can be a foundation for improving OR performance. This is the largest case analysis of MTT and one of the few to document an impact of MTT on objective measures of operating room function and patient safety.

Measuring Variation in Use of the WHO Surgical Safety Checklist in the Operating Room: A Multicenter Prospective Cross-Sectional Study

BackgroundEfficient resource management in the operating room (OR) contributes significantly to healthcare expenditure and revenue generation for health systems. We aim to assess the influence that surgeon, anesthesiology, and nursing team assignments and time of day have on turnover time (TOT) in the OR.MethodsWe performed a retrospective review of elective cases at a single academic hospital that were completed between Monday and Friday between the hours of 0700 and 2359 from July 1, 2017, through March 31, 2018. Emergent cases and unplanned, add-on cases were excluded. Data regarding patient characteristics, OR teams, TOT, and procedure start and end times were collected and analyzed.ResultsA total of 2174 total cases across 13 different specialties were included in our study. A multivariate regression of relevant variables affecting TOT was performed. Consecutive specialty (p < 0.0001), consecutive surgeon (p < 0.0001), anesthesiologist (p < 0.0001), and prior case ending before 1400 (p < 0.0001) were independent predictors of lower TOT. A receiver operating characteristic analysis demonstrated an area under the curve of 0.848 and a cutoff of 1400 having the highest sensitivity and specificity for TOT difference.ConclusionsTOT can be significantly affected by the time of the day the procedure is performed. Staffing availability during late procedures and the differences in how OR team staff are scheduled may affect OR efficiency. Additional studies may be needed to determine the long-term implications of changes implemented to decrease organizational operational costs related to the OR.