Using the Operating Room Black Box to Assess Surgical Team Member Adaptation Under Uncertainty: An Observational Study.

Journal

Annals of surgery
ISSN: 1528-1140
Titre abrégé: Ann Surg
Pays: United States
ID NLM: 0372354

Informations de publication

Date de publication:
09 Jan 2024
Historique:
medline: 9 1 2024
pubmed: 9 1 2024
entrez: 9 1 2024
Statut: aheadofprint

Résumé

Identify how surgical team members uniquely contribute to teamwork and adapt their teamwork skills during instances of uncertainty. The importance of surgical teamwork in preventing patient harm is well documented. Yet, little is known about how key roles (nurse, anesthesiologist, surgeon, medical trainee) uniquely contribute to teamwork during instances of uncertainty, particularly when adapting to and rectifying an intraoperative adverse event (IAE). Audio-visual data of 23 laparoscopic cases from a large community teaching hospital were prospectively captured using OR Black Box®. Human factors researchers retrospectively coded videos for teamwork skills (backup behaviour, coordination, psychological safety, situation assessment, team decision making, leadership) by team role under two conditions of uncertainty: associated with an IAE versus no IAE. Surgeons identified IAEs. 1015 instances of teamwork skills were observed. Nurses adapted to IAEs by expressing more backup behaviour skills (5.3x increase; 13.9 instances/h during an IAE vs. 2.2 instances/h when no IAE) while surgeons and medical trainees expressed more phycological safety skills (surgeons:3.6x increase; 30.0 instances/h vs. 6.6 instances/h and trainees 6.6x increase; 31.2 instances/h vs. 4.1 instances/h). All roles expressed less situation assessment skills during an IAE versus no IAE. ORBB enabled the assessment of critically important details about how team members uniquely contribute during instances of uncertainty. Some teamwork skills were amplified, while others dampened, when dealing with IAEs. Knowledge of how each role contributes to teamwork and adapts to IAEs should be used to inform the design of tailored interventions to strengthen interprofessional teamwork.

Sections du résumé

OBJECTIVE OBJECTIVE
Identify how surgical team members uniquely contribute to teamwork and adapt their teamwork skills during instances of uncertainty.
SUMMARY/BACKGROUND DATA UNASSIGNED
The importance of surgical teamwork in preventing patient harm is well documented. Yet, little is known about how key roles (nurse, anesthesiologist, surgeon, medical trainee) uniquely contribute to teamwork during instances of uncertainty, particularly when adapting to and rectifying an intraoperative adverse event (IAE).
METHODS METHODS
Audio-visual data of 23 laparoscopic cases from a large community teaching hospital were prospectively captured using OR Black Box®. Human factors researchers retrospectively coded videos for teamwork skills (backup behaviour, coordination, psychological safety, situation assessment, team decision making, leadership) by team role under two conditions of uncertainty: associated with an IAE versus no IAE. Surgeons identified IAEs.
RESULTS RESULTS
1015 instances of teamwork skills were observed. Nurses adapted to IAEs by expressing more backup behaviour skills (5.3x increase; 13.9 instances/h during an IAE vs. 2.2 instances/h when no IAE) while surgeons and medical trainees expressed more phycological safety skills (surgeons:3.6x increase; 30.0 instances/h vs. 6.6 instances/h and trainees 6.6x increase; 31.2 instances/h vs. 4.1 instances/h). All roles expressed less situation assessment skills during an IAE versus no IAE.
CONCLUSIONS CONCLUSIONS
ORBB enabled the assessment of critically important details about how team members uniquely contribute during instances of uncertainty. Some teamwork skills were amplified, while others dampened, when dealing with IAEs. Knowledge of how each role contributes to teamwork and adapts to IAEs should be used to inform the design of tailored interventions to strengthen interprofessional teamwork.

Identifiants

DOI: 10.1097/SLA.0000000000006191 PMID: 38193296
pubmed: 38193296
doi: 10.1097/SLA.0000000000006191
pii: 00000658-990000000-00737
doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Informations de copyright

Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.

Déclaration de conflit d'intérêts

The authors report no conflicts of interest.

Auteurs

Taylor Incze (T)

Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.

Sonia J Pinkney (SJ)

Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.

Cherryl Li (C)

Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.

Usmaan Hameed (U)

Department of Surgery, North York General Hospital, Toronto, Ontario, Canada.

M Susan Hallbeck (MS)

Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Health Care Delivery Research, Surgery, Mayo Clinic, Minnesota, USA.

Teodor P Grantcharov (TP)

Department of Surgery, Clinical Excellence Research Centre, Stanford University, Stanford, California, USA.

Patricia L Trbovich (PL)

Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.
Humanera, Office of Research and Innovation, North York General Hospital, Toronto, Ontario, Canada.

Classifications MeSH