Parker, Sarah

Surgical team members are typically defined by professional roles. In many surgical teams, membership changes as staffing decisions are subject to considerations other than keeping surgical teams consistent. These considerations may include staffing patterns on the day of surgery and at the time of a surgical case. Teamwork skill training and safety culture have been emphasized, although much is known about the contribution to team performance from team consistency. We review the literature on cognitive and psychosocial benefits of consistent surgical teams. Although empirical evidence base for consistent surgical teams is lacking, we believe that the theoretical justifications may lay the groundwork for future research on the impact of deliberate staffing decisions by organizations, to complement the current emphasis on individual teamwork knowledge, skills and attitude. We also outline some of barriers based on our experience in our respective healthcare organizations.

AbstractBackgroundMany researchers have previously explored the correlation between surgical flow disruptions and adverse events in cardiac surgery; however, there is no reliable tool to prospectively categorize surgical flow disruptions and the conditions that predispose a surgical team to adverse events.MethodsTwo independent raters of different medical and human factors expertise observed 12 cardiovascular operations and iteratively designed a surgical flow disruption tool (SFDT) to characterize surgical flow disruptions and the latent factors that contribute to adverse events. Categories to characterize surgical flow disruptions were created based on human factors models of human error. After the design period, both raters observed ten surgical cases using the tool to assess validity and inter‐rater reliability.ResultsRating agreement (weighted kappa) for each category across the ten surgeries was moderate to very high, resulting in strong inter‐rater reliability for each category on the surgical flow disruption tool. Use of the SFDT was simple and clear for observers of diverse backgrounds, including human factors experts and medical personnel.ConclusionsThis research depicts the development and utility of a tool to analyze surgical flow disruptions in the cardiovascular operating room with satisfactory inter‐rater reliability. This tool is an important first step in systematically categorizing and measuring surgical flow disruptions and their impact on patient safety in the operating room.