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Irving D, Page B, Carthey J, Higham H, Undre S, Vincent C. Adaptive strategies used by surgical teams under pressure: an interview study among senior healthcare professionals in four major hospitals in the United Kingdom. Patient Saf Surg 2024; 18:8. [PMID: 38383433 PMCID: PMC10880194 DOI: 10.1186/s13037-024-00390-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 02/06/2024] [Indexed: 02/23/2024] Open
Abstract
BACKGROUND Healthcare systems are operating under substantial pressures, and often simply cannot provide the standard of care they aspire to within the available resources. Organisations, managers, and individual clinicians make constant adaptations in response to these pressures, which are typically improvised, highly variable and not coordinated across clinical teams. The purpose of this study was to identify and describe the types of everyday pressures experienced by surgical teams and the adaptive strategies they use to respond to these pressures. METHODS We conducted interviews with 20 senior multidisciplinary healthcare professionals from surgical teams in four major hospitals in the United Kingdom. The interviews explored the types of everyday pressures staff were experiencing, the strategies they use to adapt, and how these strategies might be taught to others. RESULTS The primary pressures described by senior clinicians in surgery were increased numbers and complexity of patients alongside shortages in staff, theatre space and post-surgical beds. These pressures led to more difficult working conditions (e.g. high workloads) and problems with system functioning such as patient flow and cancellation of lists. Strategies for responding to these pressures were categorised into increasing or flexing resources, controlling and prioritising patient demand and strategies for managing the workload (scheduling for efficiency, communication and coordination, leadership, and teamwork strategies). CONCLUSIONS Teams are deploying a range of strategies and making adaptations to the way care is delivered. These findings could be used as the basis for training programmes for surgical teams to develop coordinated strategies for adapting under pressure and to assess the impact of different combinations of strategies on patient safety and surgical outcomes.
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Affiliation(s)
- Dulcie Irving
- Department of Experimental Psychology, University of Oxford, Oxford, UK.
| | - Bethan Page
- Department of Experimental Psychology, University of Oxford, Oxford, UK
- Cicely Saunders Institute, King's College London, London, UK
| | | | - Helen Higham
- Nuffield Department of Anaesthetics, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Shabnam Undre
- Department of Urology, East and North Hertfordshire NHS Foundation Trust, Stevenage, UK
| | - Charles Vincent
- Department of Experimental Psychology, University of Oxford, Oxford, UK
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Tietschert M, Higgins S, Haynes A, Sadun R, Singer SJ. Safe Surgery Checklist Implementation: Associations of Management Practice and Safety Culture Change. Adv Health Care Manag 2024; 22:117-140. [PMID: 38262013 DOI: 10.1108/s1474-823120240000022006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2024]
Abstract
Designing and developing safe systems has been a persistent challenge in health care, and in surgical settings in particular. In efforts to promote safety, safety culture, i.e., shared values regarding safety management, is considered a key driver of high-quality, safe healthcare delivery. However, changing organizational culture so that it emphasizes and promotes safety is often an elusive goal. The Safe Surgery Checklist is an innovative tool for improving safety culture and surgical care safety, but evidence about Safe Surgery Checklist effectiveness is mixed. We examined the relationship between changes in management practices and changes in perceived safety culture during implementation of safe surgery checklists. Using a pre-posttest design and survey methods, we evaluated Safe Surgery Checklist implementation in a national sample of 42 general acute care hospitals in a leading hospital network. We measured perceived management practices among managers (n = 99) using the World Management Survey. We measured perceived preoperative safety and safety culture among clinical operating room personnel (N = 2,380 (2016); N = 1,433 (2017)) using the Safe Surgical Practice Survey. We collected data in two consecutive years. Multivariable linear regression analysis demonstrated a significant relationship between changes in management practices and overall safety culture and perceived teamwork following Safe Surgery Checklist implementation.
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Jurado-Román A, Mashayekhi K, Rumoroso JR, Brilakis ES. The Psychology of Chronic Total Occlusions and Complex High-Risk Procedures (CHIP) Operators. JACC Cardiovasc Interv 2023; 16:2169-2172. [PMID: 37704303 DOI: 10.1016/j.jcin.2023.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 06/06/2023] [Indexed: 09/15/2023]
Affiliation(s)
| | - Kambis Mashayekhi
- Department for Internal Medicine and Cardiology, Heartcenter Lahr, Lahr, Germany
| | - Jose R Rumoroso
- Cardiology Department, Galdakao Hospital, Galdakao, Vizcaya, Spain
| | - Emmanouil S Brilakis
- Center for Advanced Coronary Interventions, Minneapolis Heart Institute, Minneapolis, Minnesota, USA
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Irani S, Haraczy A, Juratli L, Landschulz A, Chinnusamy S, Byrnes M, Sinco B, Edwards S, Duby A, Kwakye G. Elucidating academic surgical staff perspectives of medical student learning in the operating room: An embedded mixed methods study. Am J Surg 2023; 226:148-154. [PMID: 36966016 DOI: 10.1016/j.amjsurg.2023.03.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 02/04/2023] [Accepted: 03/13/2023] [Indexed: 03/17/2023]
Abstract
BACKGROUND The operating room (OR) is a complex environment for medical students. Little is known about the OR staff's perception of medical students. METHODS We utilized an embedded mixed methods design to characterize surgical staff perceptions of students at an academic institution. We surveyed 408 OR nursing/technician staff with 16 follow-up interviews. RESULTS 139 respondents. 91.3% reported having daily-to-weekly interactions with medical students. Yet, only 37.9% agreed that "patient care is better when medical students are part of the team." 25.2% felt confident that they knew what a student's education entails outside the OR. 93.5% agreed that interprofessional training between physicians and OR staff should be included in educational programs. 54% agreed that their responsibilities include medical student training in the OR setting. CONCLUSIONS Despite an overall desire for teamwork, this study highlights a lack of knowledge of each others' roles. To improve OR culture and team dynamics, concerted efforts need to be made around interprofessional training.
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Affiliation(s)
- Sanaya Irani
- University of Michigan Medical School, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109, USA.
| | - Alexandra Haraczy
- University of Michigan Medical School, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109, USA
| | - Lena Juratli
- University of Michigan Medical School, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109, USA
| | - Alexander Landschulz
- University of Michigan Medical School, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109, USA
| | - Sadhana Chinnusamy
- University of Michigan Medical School, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109, USA
| | - Mary Byrnes
- Department of Surgery, University of Michigan, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109, USA; Center for Healthcare Outcomes and Policy (CHOP), North Campus Research Complex, 2800 Plymouth Road, Building 16, Ann Arbor, MI, 48109, USA
| | - Brandy Sinco
- Center for Healthcare Outcomes and Policy (CHOP), North Campus Research Complex, 2800 Plymouth Road, Building 16, Ann Arbor, MI, 48109, USA
| | - Sydney Edwards
- Department of Surgery, University of Michigan, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109, USA
| | - Ashley Duby
- Department of Surgery, University of Michigan, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109, USA
| | - Gifty Kwakye
- Department of Surgery, University of Michigan, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109, USA
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Mihalj M, Corona A, Andereggen L, Urman RD, Luedi MM, Bello C. Managing bottlenecks in the perioperative setting: Optimizing patient care and reducing costs. Best Pract Res Clin Anaesthesiol 2022; 36:299-310. [DOI: 10.1016/j.bpa.2022.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 05/27/2022] [Indexed: 10/18/2022]
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Yokoyama K, Yamamoto G, Liu C, Sugiyama O, Santos LHO, Kuroda T. Recognition of Instrument Passing and Group Attention for Understanding Intraoperative State of Surgical Team. ADVANCED BIOMEDICAL ENGINEERING 2022. [DOI: 10.14326/abe.11.37] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Improving Interprofessional Teamwork in Plastic Surgery: A Novel Approach to Microsurgical Skills Training. Plast Surg Nurs 2021; 41:203-207. [PMID: 34871287 DOI: 10.1097/psn.0000000000000399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Shared mental models between surgeons and nurses allow them to effectively communicate and react to intraoperative complications. Microsurgery poses unique challenges that include the use of an operating microscope, fine instruments, and a restricted view of the operative field. We designed and delivered a microsurgical skills session for surgical nurses consisting of an introduction to the operating microscope and 3 practical stations involving increasingly complex motor tasks designed to highlight the importance of instrument handling and improve awareness of microsurgical challenges. Consultant plastic surgeons acted as scrub persons to add an element of role-reversal. All participants enjoyed the training session and felt that it improved their understanding of microsurgery and was relevant and helpful to their day-to-day role. All attendees reported that they would partake in similar sessions in the future. Our work suggests that role-reversal and skills-based education and training are valuable tools in improving multidisciplinary collaboration during microsurgery. Increasing shared knowledge of complex procedures encourages effective teamwork and communication, which leads to improved efficiency and better patient care. Our study is a first step toward development of a standardized microsurgical skills course for plastic surgical nurses and has broader implications for interprofessional education across all surgical specialties.
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He W, Jiang X, Zheng B. Synchronization of Pupil Dilations Correlates With Team Performance in a Simulated Laparoscopic Team Coordination Task. Simul Healthc 2021; 16:e206-e213. [PMID: 33534401 DOI: 10.1097/sih.0000000000000548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Modern surgery crucially relies on teamwork between surgeons and assistants. The science of teamwork has been and is being studied extensively although the use of specific objective methodologies such as shared pupil dilations has not been studied as sufficiently as subjective methods. In this study, we investigated team members' shared pupil dilations as a surrogate for surgeon's team performance during a simulated laparoscopic procedure. METHODS Fourteen subjects formed dyad teams to perform a simulated laparoscopic object transportation task. Both team members' pupil dilation and eye gaze were tracked simultaneously during the procedure. Video analysis was used to identify key event movement landmarks for subtask segmentation to facilitate data analysis. Three levels of each teams' performance were determined according to task completion time and accuracy (object dropping times). The determined coefficient of determination (R2) was used to calculate the similarity in pupil dilations between 2 individual members' pupil diameters in each team. A mixed-design analysis of variance was conducted to explore how team performance level and task type were correlated to joint pupil dilation. RESULTS The results showed that pupil dilations of higher performance teams were more synchronized, with significantly higher similarities (R2) in pupil dilation patterns between team members than those of lower performance teams (0.36 ± 0.22 vs. 0.21 ± 0.14, P < 0.001). CONCLUSIONS Levels of pupil dilation synchronization presented among teams reflect differences in performance levels while executing simulated laparoscopic tasks; this demonstrated the potential of using joint pupil dilation as an objective indicator of surgical teamwork performance.
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Affiliation(s)
- Wenjing He
- From the Department of Surgery (W.H.), University of Manitoba, Winnipeg, Manitoba; Department of Computer Science (X.J.), Memorial University of Newfoundland, St. John's, Newfoundland and Labrador; and Department of Surgery (B.Z.), University of Alberta, Edmonton, Alberta, Canada
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Ber R, London D, Senan S, Youssefi Y, Harter DH, Golfinos JG, Pacione D. Perioperative team communication through a mobile app for improving coordination and education in neurosurgery cases. J Neurosurg 2021; 136:1157-1163. [PMID: 34560644 DOI: 10.3171/2021.4.jns21485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 04/13/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Miscommunication and poor coordination among surgical teams are known causes of preventable medical harms and operating room inefficiencies and inhibit surgical training. Technology may help overcome these challenges. This study used the personal experience of one of the authors as a former Air Force F-15 pilot to design a combat aviation pre- and postoperative communication workflow in the neurosurgery department and tested its effect on safety, efficiency, and education. The authors hypothesized that the adoption of this workflow through a tailored technological platform will increase compliance and improve the chances of sustainability. METHODS Data were prospectively collected from neurosurgery cases before (January-May 2020) and after (June-October 2020) implementation of this workflow. Briefing and debriefing were executed using a custom mobile platform and were defined as nonmandatory for all participants. All faculty and residents who operated at NYU Langone Medical Center (Tisch campus) during the intervention period were enrolled on the platform. Primary outcomes were morbidity and mortality per the department's criteria, and intraoperative last-minute requests as reported by operating room staff in a double-blinded fashion. Secondary outcomes were user responses on the subjective questionnaires. RESULTS Data were collected from 637 and 893 cases during the preintervention and intervention periods, respectively. The average briefing rates for residents and surgeons were 71% and 81%, respectively, and the average debriefing rates for residents and surgeons were 67% and 88%. There was no significant difference in preoperative risk score between the preintervention and intervention patient populations (p = 0.24). The rate of intraoperative last-minute requests significantly decreased from 16.6% (35/211) to 10.5% (35/334, p = 0.048). There was no significant change in morbidity and mortality between the preintervention and intervention periods. On subjective questionnaires there was a statistically significant improvement in safety, efficiency, and educational aspects of the cases during the intervention period. CONCLUSIONS Implementation of aviation-like structured team communication practices in the neurosurgery department through a technological platform improved education and communication between surgical teams and led to a reduction in last-minute surgical requests that could impact costs.
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Affiliation(s)
| | | | - Samya Senan
- 2Perioperative Services, NYU School of Medicine, New York, New York
| | - Yasmin Youssefi
- 2Perioperative Services, NYU School of Medicine, New York, New York
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Gupta R, Tat Q, O'Brien J, Shaw M, Cumbler E, McPherson R, de la Cruz D, Dua A, Yi JA. Utilization of lean project management principles and health informatics to reduce operating room delays in a vascular surgery practice. Am J Surg 2021; 223:176-181. [PMID: 34465448 DOI: 10.1016/j.amjsurg.2021.07.040] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 07/19/2021] [Accepted: 07/20/2021] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Perioperative inefficiency can increase cost. We describe a process improvement initiative that addressed preoperative delays on an academic vascular surgery service. METHODS First case vascular surgeries from July 2019-January 2020 were retrospectively reviewed for delays, defined as late arrival to the operating room (OR). A stakeholder group spearheaded by a surgeon-informaticist analyzed this process and implemented a novel electronic medical records (EMR) preoperative tool with improved preoperative workflow and role delegation; results were reviewed for 3 months after implementation. RESULTS 57% of cases had first case on-time starts with average delay of 19 min. Inappropriate preoperative orders were identified as a dominant delay source (average delay = 38 min). Three months post-implementation, 53% of first cases had on-time starts with average delay of 11 min (P < 0.05). No delays were due to missing orders. CONCLUSIONS Inconsistent preoperative workflows led to inappropriate orders and delays, increasing cost and decreasing quality. A novel EMR tool subsequently reduced delays with projected savings of $1,200/case. Workflow standardization utilizing informatics can increase efficiency, raising the value of surgical care.
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Affiliation(s)
- Ryan Gupta
- Department of Surgery, University of Colorado Anschutz School of Medicine, Aurora, CO, USA
| | - Quy Tat
- University of Colorado Anschutz School of Medicine, Aurora, CO, USA
| | | | - Maxwell Shaw
- University of Colorado Hospital, Aurora, CO, USA
| | - Ethan Cumbler
- Department of Surgery, University of Colorado Anschutz School of Medicine, Aurora, CO, USA; Division of Hospital Medicine, University of Colorado Anschutz School of Medicine, Aurora, CO, USA
| | - Rachel McPherson
- Division of Vascular Surgery, University of Colorado Anschutz School of Medicine, Aurora, CO, USA
| | | | - Anahita Dua
- Division of Vascular Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Jeniann A Yi
- Division of Vascular Surgery, University of Colorado Anschutz School of Medicine, Aurora, CO, USA.
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Pasarakonda S, Grote G, Schmutz JB, Bogdanovic J, Guggenheim M, Manser T. A Strategic Core Role Perspective on Team Coordination: Benefits of Centralized Leadership for Managing Task Complexity in the Operating Room. HUMAN FACTORS 2021; 63:910-925. [PMID: 32119581 DOI: 10.1177/0018720820906041] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
OBJECTIVE We examine whether surgical teams can handle changes in task requirements better when their formal leader and strategic core role holder-that is, the main surgeon-is central to team coordination. BACKGROUND Evidence regarding the benefits of shared leadership for managing complex tasks is divided. We tested whether a strategic core role holder's centrality in team coordination helps teams to handle different types of task complexity. METHOD We observed coordination as specific leadership behavior in 30 surgical teams during real-life operations. To assess the strategic core role holder's coordination centrality, we conducted social network analyses. Task complexity (i.e., surgical difficulty and unexpected events) and surgical goal attainment were rated in a questionnaire. RESULTS In the critical operation phase, surgical difficulty impaired goal attainment when the strategic core role holder's coordination centrality was low, while this effect was nonsignificant when his/her coordination centrality was high. Unexpected events had a negative effect on surgical goal attainment. However, coordination centrality of the strategic core role holder could not help manage unexpected events. CONCLUSION The results indicate that shared leadership is not beneficial when teams face surgical difficulty during the critical operation phase. In this situation, team coordination should rather be centralized around the strategic core role holder. Contrarily, when unexpected events occur, centralizing team coordination around a single leader does not seem to be beneficial for goal attainment. APPLICATION Leaders and team members should be aware of the importance of distributing leadership differently when it comes to managing different types of task complexity.
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Affiliation(s)
| | | | | | | | | | - Tanja Manser
- 30805 University of Applied Science and Arts Northwestern Switzerland, Olten, Switzerland
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12
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Skråmm SH, Smith Jacobsen IL, Hanssen I. Communication as a non-technical skill in the operating room: A qualitative study. Nurs Open 2021; 8:1822-1828. [PMID: 33631059 PMCID: PMC8186708 DOI: 10.1002/nop2.830] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 12/11/2020] [Accepted: 01/31/2021] [Indexed: 11/21/2022] Open
Abstract
Aim The aim of this study was to explore how operating room nurses (ORNs) experience operating room (OR) team communication concerning non‐technical skills. Design Based on the Scrub Practitioners List of Intraoperative Non‐Technical Skill (SPLINTS), qualitative individual in‐depth semi‐structured interviews were conducted with 11 ORNs in a Norwegian university hospital. Braun and Clarke's six analytic phases for thematic data analysis were used. Results Surgeons being unprepared or demanding different instruments than the preoperative information indicates, cause stress and frustration. So does noise and brusquely or poor communication. Ensuring good information flow within the entire team is important. When silence is required, the ORNs communicate with gestures, looks and nods. Creating a positive and secure team culture facilitates discussions, questions and information sharing. Conclusion Inappropriate dynamics, inaccurate and/or disrespectful communication and noise may reduce patient safety. Interdisciplinary team training may bring attention to the value of communication as a non‐technical skill.
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Park J, Heo J, Kim WH. Establishing Surgical Care Sustainability in Sub-Saharan Africa for Global Child Health: Insights From Pediatric Cardiac Surgical Capacity-Building Programs in Ethiopia and Côte d'Ivoire. Front Pediatr 2021; 9:806019. [PMID: 35096714 PMCID: PMC8795907 DOI: 10.3389/fped.2021.806019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Accepted: 12/17/2021] [Indexed: 11/13/2022] Open
Abstract
The global surgery research team of the JW LEE Center for Global Medicine, Seoul National University College of Medicine, introduced team-based health workforce training programs for pediatric cardiac surgery in Ethiopia and Côte d'Ivoire. A team-based collaborative capacity-building model was implemented in both countries, and details of the program design and delivery were documented. The research team shared their experiences and identified achievements, lessons, and challenges for cardiac surgical interventions in Sub-Saharan Africa. Future directions were put forward to advance and strengthen the low-and middle-income countries "Safe Surgery."
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Affiliation(s)
- Jayoung Park
- Program in Global Surgery and Implementation Science, JW LEE Center for Global Medicine, Seoul National University College of Medicine, Seoul, South Korea.,Department of Human Systems Medicine, Seoul National University College of Medicine, Seoul, South Korea
| | - Jongho Heo
- Program in Global Surgery and Implementation Science, JW LEE Center for Global Medicine, Seoul National University College of Medicine, Seoul, South Korea.,National Assembly Futures Institute, Seoul, South Korea
| | - Woong-Han Kim
- Program in Global Surgery and Implementation Science, JW LEE Center for Global Medicine, Seoul National University College of Medicine, Seoul, South Korea.,Department of Thoracic and Cardiovascular Surgery, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, South Korea
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Robertson JM, Dias RD, Gupta A, Marshburn T, Lipsitz SR, Pozner CN, Doyle TE, Smink DS, Musson DM, Yule S. Medical Event Management for Future Deep Space Exploration Missions to Mars. J Surg Res 2020; 246:305-314. [DOI: 10.1016/j.jss.2019.09.065] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 06/15/2019] [Accepted: 09/30/2019] [Indexed: 11/28/2022]
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Teunissen C, Burrell B, Maskill V. Effective Surgical Teams: An Integrative Literature Review. West J Nurs Res 2019; 42:61-75. [PMID: 30854942 DOI: 10.1177/0193945919834896] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
It is imperative to understand the factors that contribute to effective surgical teams. The aim of this integrative review was to evaluate the aids and barriers for perioperative teams in functioning effectively, preventing adverse events, and fostering a culture of safety. The literature search was undertaken of 15 databases, which resulted in 70 articles being included. It was found perioperative teamwork was not widely understood. Findings indicated barriers to effective surgical teams comprised of confusion in tasks and responsibilities, existing hierarchies and prevailing misconceptions and understanding among team members. Although numerous quality initiatives exist, the introduction of protocols and checklists, team effectiveness in the perioperative setting is still insufficient and challenges in establishing effective surgical teams continue. Further research is recommended to obtain a comprehensive perception of environmental influences and barriers surgical teams encounter in the delivery of safe quality care.
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AORN
Position Statement on Orientation of the Registered Nurse and Surgical Technologist to the Perioperative Setting*. AORN J 2018. [DOI: 10.1002/aorn.12293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Ziman R, Espin S, Grant RE, Kitto S. Looking beyond the checklist: An ethnography of interprofessional operating room safety cultures. J Interprof Care 2018; 32:575-583. [PMID: 29630424 DOI: 10.1080/13561820.2018.1459514] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
The Surgical Safety Checklist (SSC) has been adopted in operating rooms (OR) worldwide to reduce medical errors, increase patient safety and improve interprofessional communication. Despite often high compliance rates, recent studies suggested the SSC has not been associated with significant reductions in operative mortality or complications. This ethnographic study sought to understand this disconnection through approximately 50 hours of observation in the OR and 10 in-depth semi-structured interviews with surgeons, nurses, and anaesthesiologists in orthopaedic surgery. Inductive thematic analysis was used to analyse the data. By spending time in the OR and listening to the staff, this study was able to look beyond what "ought" to be happening in the OR and garner a deep understanding of the realities of OR work that acknowledges the complexities of surgical culture in which the SSC is being implemented. This study found SSC compliance was influenced by the perceived (un)importance of individual checklist items within the orthopaedic setting. Additionally, there remains a need to further explore patients' involvement in their operative experience.
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Affiliation(s)
- Roxanne Ziman
- a Daphne Cockwell School of Nursing, Faculty of Community Services , Ryerson University , Toronto , Ontario , Canada
| | - Sherry Espin
- a Daphne Cockwell School of Nursing, Faculty of Community Services , Ryerson University , Toronto , Ontario , Canada
| | - Rachel E Grant
- b Faculty of Education , University of Ottawa , Ottawa , Ontario , Canada
| | - Simon Kitto
- c Department of Innovation in Medical Education , University of Ottawa , Ottawa , Ontario , Canada.,d Office of Continuing Professional Development, Faculty of Medicine , University of Ottawa , Ottawa , Ontario , Canada
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The effectiveness of assertiveness communication training programs for healthcare professionals and students: A systematic review. Int J Nurs Stud 2017; 76:120-128. [DOI: 10.1016/j.ijnurstu.2017.09.001] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2017] [Revised: 08/19/2017] [Accepted: 09/03/2017] [Indexed: 11/21/2022]
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21
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Valooran GJ, Sebastian R. Modular training in cardiothoracic residency—practical considerations to revive and streamline Indian training systems. Indian J Thorac Cardiovasc Surg 2017. [DOI: 10.1007/s12055-017-0595-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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van Eijk RPA, van Veen-Berkx E, Kazemier G, Eijkemans MJC. Effect of Individual Surgeons and Anesthesiologists on Operating Room Time. Anesth Analg 2017; 123:445-51. [PMID: 27308953 DOI: 10.1213/ane.0000000000001430] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Variability in operating room (OR) time causes overutilization and underutilization of the available ORs. There is evidence that for a given type of procedure, the surgeon is the major source of variability in OR time. The primary aim was to quantify the variability between surgeons and anesthesiologists. As illustration, the value of modeling the individual surgeons and anesthesiologist for OR time prediction was estimated. METHODS OR data containing 16,480 cases were obtained from a general surgery department. The total amount of variability in OR time accounted for by the type of procedure, first and second surgeon, and the anesthesiologist was determined with the use of linear mixed models. The effect on OR time prediction was evaluated as reduction in overtime and idle time per case. RESULTS Differences between first surgeons can account for only 2.9% (2.0%-4.2%) of the variability in OR time. Differences between anesthesiologists can account for 0.1% (0.0%-0.3%) of the variability in OR time. Incorporating the individual surgeons and anesthesiologists led to an average reduction of overtime and idle time of 1.8 (95% confidence interval, 1.7-2.0, 10.5% reduction) minutes and 3.0 (95% confidence interval, 2.8%-3.2, 17.0% reduction) minutes, respectively. CONCLUSIONS In comparison with the type of procedure, differences between surgeons account for a small part of OR time variability. The impact of differences between anesthesiologists on OR time is negligible. A prediction model incorporating the individual surgeons and anesthesiologists has an increased precision, but improvements are likely too marginal to have practical consequences for OR scheduling.
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Affiliation(s)
- Ruben P A van Eijk
- From the *Department of Biostatistics and Research Support, University Medical Center Utrecht, Utrecht, The Netherlands; †Department of Operating Rooms, Erasmus University Medical Center, Rotterdam, The Netherlands; and ‡Department of Surgery, VU Medical Center, Amsterdam, The Netherlands
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Moradi K, Najarkolai AR, Keshmiri F. Interprofessional Teamwork Education: Moving Toward the Patient-Centered Approach. J Contin Educ Nurs 2017; 47:449-460. [PMID: 27699433 DOI: 10.3928/00220124-20160920-06] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Accepted: 06/24/2016] [Indexed: 11/20/2022]
Abstract
HOW TO OBTAIN CONTACT HOURS BY READING THIS ISSUE Instructions: 1.3 contact hours will be awarded by Villanova University College of Nursing upon successful completion of this activity. A contact hour is a unit of measurement that denotes 60 minutes of an organized learning activity. This is a learner-based activity. Villanova University College of Nursing does not require submission of your answers to the quiz. A contact hour certificate will be awarded after you register, pay the registration fee, and complete the evaluation form online at http://goo.gl/gMfXaf. In order to obtain contact hours you must: 1. Read the article, "Interprofessional Teamwork Education: Moving Toward the Patient-Centered Approach," found on pages 449-460, carefully noting any tables and other illustrative materials that are included to enhance your knowledge and understanding of the content. Be sure to keep track of the amount of time (number of minutes) you spend reading the article and completing the quiz. 2. Read and answer each question on the quiz. After completing all of the questions, compare your answers to those provided within this issue. If you have incorrect answers, return to the article for further study. 3. Go to the Villanova website to register for contact hour credit. You will be asked to provide your name, contact information, and a VISA, MasterCard, or Discover card number for payment of the $20.00 fee. Once you complete the online evaluation, a certificate will be automatically generated. This activity is valid for continuing education credit until September 30, 2019. CONTACT HOURS This activity is co-provided by Villanova University College of Nursing and SLACK Incorporated. Villanova University College of Nursing is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's Commission on Accreditation. OBJECTIVES Explain the recommended framework in teaching and implementing interprofessional competencies. Identify suggested core competencies to implement interprofessional collaborative practice. DISCLOSURE STATEMENT Neither the planners nor the author have any conflicts of interest to disclose. BACKGROUND The aim of this study is to develop and contextualize a competency framework for interprofessional teamwork in Iran. METHOD The study was conducted in three phases. First, the competencies of interprofessional teamwork were extracted from the literature. In the second phase, the content validity of the initial framework was assessed by the experts through the Delphi rounds. Content validity ratio (CVR) and item-level content validity index (I-CVI) were used for quantitative analysis. Finally, in the third phase, the importance and utility of interprofessional teamwork competencies were assessed by the experts. RESULTS Initial framework was constructed with 28 competencies. Quantitative analysis by CVR indicated a score of less than .49 for three items. These items were excluded from the framework. The I-CVI for all items in the framework was higher than .78. The final framework was developed and validated with 16 competencies. DISCUSSION The developed framework is recommended for teaching and assessment of interprofessional teamwork competencies. J Contin Educ Nurs. 2016;47(10):449-460.
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Erestam S, Haglind E, Bock D, Andersson AE, Angenete E. Changes in safety climate and teamwork in the operating room after implementation of a revised WHO checklist: a prospective interventional study. Patient Saf Surg 2017; 11:4. [PMID: 28163786 PMCID: PMC5282777 DOI: 10.1186/s13037-017-0120-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Accepted: 01/06/2017] [Indexed: 02/08/2023] Open
Abstract
Background Inter-professional teamwork in the operating room is important for patient safety. The World Health Organization (WHO) checklist was introduced to improve intraoperative teamwork. The aim of this study was to evaluate the safety climate in a Swedish operating room setting before and after an intervention, using a revised version of the WHO checklist to improve teamwork. Methods This study is a single center prospective interventional study. Participants were personnel working in operating room teams including surgeons, anesthesiologists, scrub nurses, nurse anaesthetists and nurse assistants. The study started with pre-interventional observations of the WHO checklist use followed by education on safety climate, the WHO checklist, and non-technical skills in the operating room. Thereafter a revised version of the WHO checklist was introduced. Post-interventional observations regarding the performance of the WHO checklist were carried out. The Safety Attitude Questionnaire was used to assess safety climate at baseline and post-intervention. Results At baseline we discovered a need for improved teamwork and communication. The participants considered teamwork to be important for patient safety, but had different perceptions of good teamwork between professions. The intervention, a revised version of the WHO checklist, did not affect teamwork climate. Adherence to the revision of the checklist was insufficient, dominated by a lack of structure. Conclusions There was no significant change in teamwork climate by use of the revised WHO checklist, which may be due to insufficient implementation, as a lack of adherence to the WHO checklist was detected. We found deficiencies in teamwork and communication. Further studies exploring how to improve safety climate are needed. Trial registration NCT02329691.
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Affiliation(s)
- Sofia Erestam
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.,SSORG - Scandinavian Surgical Outcomes Research Group, Sahlgrenska University Hospital, SE-416 85 Gothenburg, Sweden
| | - Eva Haglind
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.,SSORG - Scandinavian Surgical Outcomes Research Group, Sahlgrenska University Hospital, SE-416 85 Gothenburg, Sweden
| | - David Bock
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.,SSORG - Scandinavian Surgical Outcomes Research Group, Sahlgrenska University Hospital, SE-416 85 Gothenburg, Sweden
| | | | - Eva Angenete
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.,SSORG - Scandinavian Surgical Outcomes Research Group, Sahlgrenska University Hospital, SE-416 85 Gothenburg, Sweden
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Stewart-Parker E, Galloway R, Vig S. S-TEAMS: A Truly Multiprofessional Course Focusing on Nontechnical Skills to Improve Patient Safety in the Operating Theater. JOURNAL OF SURGICAL EDUCATION 2017; 74:137-144. [PMID: 27663080 DOI: 10.1016/j.jsurg.2016.06.020] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2016] [Revised: 05/24/2016] [Accepted: 06/28/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND Possessing adequate nontechnical skills (NTS) in operating theaters is of increasing interest to health care professionals, yet these are rarely formally taught. Teams make human errors despite technical expertise and knowledge, compromising patient safety. We designed a 1-day, multiprofessional, multidisciplinary course to teach, practice, and apply these skills through simulation. METHODS The course, "S-TEAMS," comprised a morning of lectures, case studies, and interactive teamworking exercises. The afternoon divided the group into multiprofessional teams to rotate around simulated scenarios. During the scenarios, teams were encouraged to focus on NTS, including communication strategies, situational awareness, and prompts such as checklists. A thorough debrief with experienced clinician observers followed. Data was collected through self-assessments, immediate and 6-month feedback to assess whether skills continued to be used and their effect on safety. FINDINGS In total, 68 health care professionals have completed the course thus far. All participants felt the course had a clear structure and that learning objectives were explicit. Overall, 95% felt the scenarios had good or excellent relevance to clinical practice. Self-assessments revealed a 55% increase in confidence for "speaking up" in difficult situations. Long-term data revealed 97% of the participants continued to use the skills, with 88% feeling the course had prevented them from making errors. Moreover, 94% felt the course had directly improved patient safety. CONCLUSIONS There is a real demand and enthusiasm for developing NTS within the modern theater team. The simple and easily reproducible format of S-TEAMS is sustainable and inclusive, and crucially, the skills taught continue to be used in long term to improve patient safety and teamworking.
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Affiliation(s)
- Emma Stewart-Parker
- Department of General Surgery, Croydon University Hospital, Croydon, Surrey, United Kingdom.
| | | | - Stella Vig
- Department of General Surgery, Croydon University Hospital, Croydon, Surrey, United Kingdom
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Tschan F, Seelandt JC, Keller S, Semmer NK, Kurmann A, Candinas D, Beldi G. Impact of case-relevant and case-irrelevant communication within the surgical team on surgical-site infection. Br J Surg 2015; 102:1718-25. [DOI: 10.1002/bjs.9927] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Revised: 05/20/2015] [Accepted: 07/31/2015] [Indexed: 12/21/2022]
Abstract
Abstract
Background
Surgical-site infections (SSIs) are the most common complications after surgery. An influence from talking and distractions during surgery on patient outcomes has been suggested, but there is limited evidence. The aim of this prospective observational study was to assess the relationship between intraoperative communication within the surgical team and SSI, and between intraoperative distractions and SSI.
Methods
This prospective observational study included patients undergoing elective, open abdominal procedures. For each procedure, intraoperative case-relevant and case-irrelevant communication, and intraoperative distractions were observed continuously on site. The influence of communication and distractions on SSI after surgery was assessed using logistic regressions, adjusting for risk factors.
Results
A total of 167 observed procedures were analysed; their mean(s.d.) duration was 4·6(2·1) h. A total of 24 SSIs (14·4 per cent) were diagnosed. Case-relevant communication during the procedure was independently associated with a reduced incidence of organ/space SSI (propensity score-adjusted odds ratio 0·86, 95 per cent c.i. 0·77 to 0·97; P = 0·014). Case-irrelevant communication during the closing phase of the procedure was independently associated with increased incidence of incisional SSI (propensity score-adjusted odds ratio 1·29, 1·08 to 1·55; P = 0·006). Distractions had no association with SSI.
Conclusion
More case-relevant communication was associated with fewer organ/space SSIs, and more case-irrelevant communication during wound closure was associated with incisional SSI.
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Affiliation(s)
- F Tschan
- Institute of Work and Organizational Psychology, University of Neuchâtel, Neuchâtel, Bern, Switzerland
| | - J C Seelandt
- Institute of Work and Organizational Psychology, University of Neuchâtel, Neuchâtel, Bern, Switzerland
| | - S Keller
- Institute of Work and Organizational Psychology, University of Neuchâtel, Neuchâtel, Bern, Switzerland
| | - N K Semmer
- Institute of Psychology, University of Bern, Bern, Switzerland
| | - A Kurmann
- Department of Visceral Surgery and Medicine, Bern University Hospital, University of Bern, Bern, Switzerland
| | - D Candinas
- Department of Visceral Surgery and Medicine, Bern University Hospital, University of Bern, Bern, Switzerland
| | - G Beldi
- Department of Visceral Surgery and Medicine, Bern University Hospital, University of Bern, Bern, Switzerland
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Siu J, Maran N, Paterson-Brown S. Observation of behavioural markers of non-technical skills in the operating room and their relationship to intra-operative incidents. Surgeon 2014; 14:119-28. [PMID: 25022767 DOI: 10.1016/j.surge.2014.06.005] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2014] [Revised: 06/10/2014] [Accepted: 06/16/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND The importance of non-technical skills in improving surgical safety and performance is now well recognised. Better understanding is needed of the impact that non-technical skills of the multi-disciplinary theatre team have on intra-operative incidents in the operating room (OR) using structured theatre-based assessment. The interaction of non-technical skills that influence surgical safety of the OR team will be explored and made more transparent. METHODS Between May-August 2013, a range of procedures in general and vascular surgery in the Royal Infirmary of Edinburgh were performed. Non-technical skills behavioural markers and associated intra-operative incidents were recorded using established behavioural marking systems (NOTSS, ANTS and SPLINTS). Adherence to the surgical safety checklist was also observed. RESULTS A total of 51 procedures were observed, with 90 recorded incidents - 57 of which were considered avoidable. Poor situational awareness was a common area for surgeons and anaesthetists leading to most intra-operative incidents. Poor communication and teamwork across the whole OR team had a generally large impact on intra-operative incidents. Leadership was shown to be an essential set of skills for the surgeons as demonstrated by the high correlation of poor leadership with intra-operative incidents. Team-working and management skills appeared to be especially important for anaesthetists in the recovery from an intra-operative incident. CONCLUSION A significant number of avoidable incidents occur during operative procedures. These can all be linked to failures in non-technical skills. Better training of both individual and team in non-technical skills is needed in order to improve patient safety in the operating room.
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Affiliation(s)
- Joey Siu
- Department of Surgery and Anaesthetics, Royal Infirmary of Edinburgh, Little France Crescent, Edinburgh EH16 4SA, Scotland, UK.
| | - Nikki Maran
- Department of Surgery and Anaesthetics, Royal Infirmary of Edinburgh, Little France Crescent, Edinburgh EH16 4SA, Scotland, UK
| | - Simon Paterson-Brown
- Department of Surgery and Anaesthetics, Royal Infirmary of Edinburgh, Little France Crescent, Edinburgh EH16 4SA, Scotland, UK
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Erestam S, Erichsen A, Derwinger K, Kodeda K. A survey of surgeons' perception and awareness of intraoperative time utilization. Patient Saf Surg 2014; 8:30. [PMID: 25006350 PMCID: PMC4086263 DOI: 10.1186/1754-9493-8-30] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Accepted: 06/19/2014] [Indexed: 12/14/2022] Open
Abstract
Background Surgical teams’ awareness of the time needed to perform specific phases of a surgical procedure is likely to improve communication in the operating theatre and benefit patient safety. The aim of this study was to assess surgeons’ awareness of time utilization and the actual time needed to perform specific phases of an operation. Methods A survey was conducted to examine the method and design for a larger study. Interviews were conducted with 18 surgeons, and surgical time was measured during 21 colon cancer resections. Correlation analyses were performed to explore the factors that might affect operating time. Results The surgical phase with the greatest variation in time was dissection/resection (43–308 minutes). On a group level, no statistically significant differences were found between estimated and measured surgical procedural times for partial or full resections (160.4 versus 173.0 minutes, p = 0.539). However, interindividual variation was substantial. There was a positive significant correlation between long duration of dissection/resection and longer time to close the abdomen (r = 0.464, p = 0.039), as well as between long duration of a hand-sewn anastomosis and time needed to close the abdomen (r = 0.536, p = 0.018). Conclusions It can be difficult for a single surgeon to estimate the time required for a partial or full surgical procedure. A larger study might provide additional time estimates and identify variables that affect surgical time. The data could be of interest in the planning and scheduling of surgical resources, thus improving theatre team communication and patient safety.
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Affiliation(s)
- Sofia Erestam
- Institute of Health and Care Sciences, Sahlgrenska University Hospital, Campus Östra, Gothenburg, Sweden ; Department of Anaesthesia, Surgery, and Intensive Care, Sahlgrenska University Hospital, Campus Östra, Gothenburg, Sweden
| | - Annette Erichsen
- Institute of Health and Care Sciences, Sahlgrenska University Hospital, Campus Östra, Gothenburg, Sweden ; Department of Anaesthesia, Surgery, and Intensive Care, Sahlgrenska University Hospital, Campus Östra, Gothenburg, Sweden
| | - Kristoffer Derwinger
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Campus Östra, Gothenburg, Sweden ; Department of Colorectal Surgery, Sahlgrenska University Hospital, Campus Östra, Gothenburg, Sweden
| | - Karl Kodeda
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Campus Östra, Gothenburg, Sweden ; Department of Colorectal Surgery, Sahlgrenska University Hospital, Campus Östra, Gothenburg, Sweden
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Passauer-Baierl S, Baschnegger H, Bruns C, Weigl M. Interdisziplinäre Teamarbeit im OP: Identifikation und Erfassung von Teamarbeit im Operationssaal. ZEITSCHRIFT FUR EVIDENZ FORTBILDUNG UND QUALITAET IM GESUNDHEITSWESEN 2014; 108:293-8. [DOI: 10.1016/j.zefq.2013.05.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/26/2012] [Revised: 05/07/2013] [Accepted: 05/17/2013] [Indexed: 10/26/2022]
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Tan SB, Pena G, Altree M, Maddern GJ. Multidisciplinary team simulation for the operating theatre: a review of the literature. ANZ J Surg 2013; 84:515-22. [PMID: 24299531 DOI: 10.1111/ans.12478] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/28/2013] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Analyses of adverse events inside the operating theatre has demonstrated that many errors are caused by failure in non-technical skills and teamwork. While simulation has been used successfully for teaching and improving technical skills, more recently, multidisciplinary simulation has been used for training team skills. We hypothesized that this type of training is feasible and improves team skills in the operating theatre. METHODS A systematic search of the literature for studies describing true multidisciplinary operating theatre team simulation was conducted in November and December 2012. We looked at the characteristics and outcomes of the team simulation programmes. RESULTS 1636 articles were initially retrieved. Utilizing a stepwise evaluation process, 26 articles were included in the review. The studies reveal that multidisciplinary operating theatre simulation has been used to provide training in technical and non-technical skills, to help implement new techniques and technologies, and to identify latent weaknesses within a health system. Most of the studies included are descriptions of training programmes with a low level of evidence. No randomized control trial was identified. Participants' reactions to the training programme were positive in all studies; however, none of them could objectively demonstrate that skills acquired from simulation are transferred to the operating theatre or show a demonstrable benefit in patient outcomes. CONCLUSION Multidisciplinary operating room team simulation is feasible and widely accepted by participants. More studies are required to assess the impact of this type of training on operative performance and patient safety.
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Affiliation(s)
- Shaw Boon Tan
- University of Adelaide, Department of Surgery, Royal Adelaide Hospital, Adelaide, South Australia, Australia
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The Imperial Paediatric Emergency Training Toolkit (IPETT) for use in paediatric emergency training: Development and evaluation of feasibility and validity. Resuscitation 2013; 84:831-6. [DOI: 10.1016/j.resuscitation.2012.11.013] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2012] [Revised: 11/12/2012] [Accepted: 11/13/2012] [Indexed: 12/11/2022]
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Hignett S, Carayon P, Buckle P, Catchpole K. State of science: human factors and ergonomics in healthcare. ERGONOMICS 2013; 56:1491-503. [PMID: 23926898 DOI: 10.1080/00140139.2013.822932] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
UNLABELLED The past decade has seen an increase in the application of human factors and ergonomics (HFE) techniques to healthcare delivery in a broad range of contexts (domains, locations and environments). This paper provides a state of science commentary using four examples of HFE in healthcare to review and discuss analytical and implementation challenges and to identify future issues for HFE. The examples include two domain areas (occupational ergonomics and surgical safety) to illustrate a traditional application of HFE and the area that has probably received the most research attention. The other two examples show how systems and design have been addressed in healthcare with theoretical approaches for organisational and socio-technical systems and design for patient safety. Future opportunities are identified to develop and embed HFE systems thinking in healthcare including new theoretical models and long-term collaborative partnerships. HFE can contribute to systems and design initiatives for both patients and clinicians to improve everyday performance and safety, and help to reduce and control spiralling healthcare costs. PRACTITIONER SUMMARY There has been an increase in the application of HFE techniques to healthcare delivery in the past 10 years. This paper provides a state of science commentary using four illustrative examples (occupational ergonomics, design for patient safety, surgical safety and organisational and socio-technical systems) to review and discuss analytical and implementation challenges and identify future issues for HFE.
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Affiliation(s)
- Sue Hignett
- a Loughborough Design School, Loughborough University , Loughborough Leics LE11 3TU , UK
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Suliman A, Klaber RE, Warren OJ. Exploiting opportunities for leadership development of surgeons within the operating theatre. Int J Surg 2013. [DOI: 10.1016/j.ijsu.2012.11.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Kurmann A, Tschan F, Semmer NK, Seelandt J, Candinas D, Beldi G. Human factors in the operating room – The surgeon's view. TRENDS IN ANAESTHESIA AND CRITICAL CARE 2012. [DOI: 10.1016/j.tacc.2012.07.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Gillespie BM, Chaboyer W, Fairweather N. Interruptions and Miscommunications in Surgery: An Observational Study. AORN J 2012; 95:576-90. [DOI: 10.1016/j.aorn.2012.02.012] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2011] [Revised: 11/06/2011] [Accepted: 02/27/2012] [Indexed: 01/10/2023]
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Abstract
PURPOSE The purpose of this paper is to identify if aspects of organizational culture may indicate a new terrain in the cultural influences-quality healthcare relationship. This research stems from the author's belief that viewing the role of head of department or directorate as pivotal to health care management is critical to health care planning and quality healthcare delivery. DESIGN/METHODOLOGY/APPROACH Interviews were undertaken among 50 professional clinician and non-clinician managers working in the role of head of department, in acute care hospitals in Ireland. The sample was drawn from the total population of 850 managers, utilized in a previous survey study. FINDINGS Organizational culture is more complex than was previously thought. Several cultural influences such as excellence in care delivery, ethical values, involvement, professionalism, value-for-money, cost of care, commitment to quality and strategic thinking were found to be key cultural determinants in quality care delivery. RESEARCH LIMITATIONS/IMPLICATIONS Health care managers perceive that in order to deliver quality focused care they need to act in a professional, committed manner and to place excellence at the forefront of care delivery, whilst at the same time being capable of managing the tensions that exist between cost effectiveness and quality of care. These tensions require further research in order to determine if quality of care is affected in a negative manner by those tensions. ORIGINALITY/VALUE Originality relates to the new cultural terrain presented in this paper that recognizes the potential of health service managers to influence the organizations' culture and through this influence to take a greater part in ensuring that quality health care is delivered to their patients. It also seems to be important that value-for-money is viewed as an ethical means of delivering healthcare, and not as a conflict between quality and cost.
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Affiliation(s)
- Marie Carney
- School of Nursing, Royal College of Surgeons in Ireland, Dublin, Ireland.
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Belyansky I, Martin TR, Prabhu AS, Tsirline VB, Howley LD, Phillips R, Sindram D, Heniford BT, Stefanidis D. Poor Resident-Attending Intraoperative Communication May Compromise Patient Safety. J Surg Res 2011; 171:386-94. [DOI: 10.1016/j.jss.2011.04.011] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2011] [Revised: 03/22/2011] [Accepted: 04/05/2011] [Indexed: 11/17/2022]
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Glavin RJ. Human performance limitations (communication, stress, prospective memory and fatigue). Best Pract Res Clin Anaesthesiol 2011; 25:193-206. [DOI: 10.1016/j.bpa.2011.01.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2011] [Accepted: 01/28/2011] [Indexed: 11/28/2022]
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Enhancing Communication in Surgery Through Team Training Interventions: A Systematic Literature Review. AORN J 2010; 92:642-57. [DOI: 10.1016/j.aorn.2010.02.015] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2010] [Revised: 02/20/2010] [Accepted: 02/28/2010] [Indexed: 11/17/2022]
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Pera M. [Leadership and teamwork: an efficient and necessary combination in current surgery]. Cir Esp 2010; 87:337-8. [PMID: 20346447 DOI: 10.1016/j.ciresp.2010.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2010] [Accepted: 02/17/2010] [Indexed: 11/25/2022]
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Abstract
AIMS This paper aims to introduce the topic of human factors to nursing management and to identify areas where it can be applied to patient safety. BACKGROUND Human factors is a discipline established in most safety critical industries and uses knowledge about human behaviour in the analysis and design of complex systems, yet it is relatively new to many in healthcare. EVALUATION Most safety critical industries have developed tools and techniques to apply human factors to system design, and these have been reviewed together with those resources already available for use in healthcare. KEY ISSUES Models of human behaviour such as the nature and patterns of human error, information processing, decision-making and team work have clear applications to healthcare. Human factors focus on a system view of safety, and propose that safety should, where possible, be 'designed in'. Other interventions such as building defences, mitigating hazards and education and training should only be used where design solutions cannot be found. CONCLUSIONS Simple human factors principles such as: designing for standardization; the involvement of users and staff in designing services and procuring equipment; understanding how errors occur; and the workarounds that staff will inevitably take are vital considerations in improving patient safety. IMPLICATIONS FOR NURSING MANAGEMENT Opportunities for the application of human factors to healthcare and improved patient safety are discussed. Some existing tools and techniques for applying human factors in nursing management are also presented.
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Affiliation(s)
- Beverley Norris
- National Patient Safety Agency, 4-8 Maple Street, London, UK.
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Gillespie BM, Chaboyer W, Wallis M, Chang HYA, Werder H. Operating theatre nurses’ perceptions of competence: a focus group study. J Adv Nurs 2009; 65:1019-28. [PMID: 19291189 DOI: 10.1111/j.1365-2648.2008.04955.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- Brigid M Gillespie
- Research Centre for Clinical & Community Practice Innovation, Griffith University, Gold Coast, Queensland, Australia.
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Dickinson I, Watters D, Graham I, Montgomery P, Collins J. Guide to the Assessment of Competence and Performance in Practising Surgeons. ANZ J Surg 2009; 79:198-204. [DOI: 10.1111/j.1445-2197.2008.04839.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Mackintosh N, Berridge EJ, Freeth D. Supporting structures for team situation awareness and decision making: insights from four delivery suites. J Eval Clin Pract 2009; 15:46-54. [PMID: 19239581 DOI: 10.1111/j.1365-2753.2008.00953.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
RATIONALE, AIMS AND OBJECTIVES 'Human factors' (non-technical skills such as communication and teamwork) have been strongly implicated in adverse events during labour and delivery. The importance of shared 'situation awareness' between team members is highlighted as a key factor in patient safety. Arising from an ethnographic study of safety culture in the delivery suites of four UK hospitals, the aim of this study is to describe the main mechanisms supporting team situation awareness (TSA) and examine contrasting configurations of supports. METHODS Stage I: 177 hours of lightly structured non-participant observation (sensitizing concepts: safety culture, non-technical skills, teamwork and decision making) analysed to identify a core organizing concept, main supporting categories and preliminary conceptual models. Stage II: (approximately 11 months after first observations) 104 hours of observation to test and elaborate stage I analyses. RESULTS Handover, whiteboard use and a coordinator role emerged as the key processes facilitating work and team coordination. The interplay between these supporting processes and the contextual features of each site promoted or inhibited TSA. Three configurations of supports for TSA were evident. These are described. CONCLUSIONS Context configurations of supporting mechanisms and artefacts influence TSA, with implications for the maintenance of patient safety on delivery suites. A balanced model of supports for TSA is commended. Examining contrasting configurations helps reveal how local mechanisms or organizational, environmental and temporal factors might be manipulated to improve TSA.
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