Operating room clinicians' ratings of workload: a vignette simulation study

Area of Science:

• Healthcare Management
• Patient Safety
• Surgical Operations

Background:

• Increased clinician workload is linked to medical errors and patient harm.
• The Quality and Workload Assessment Tool (QWAT) measures anticipated and perceived clinical workload in surgical procedures.
• QWAT utilizes ratings of individual and team case difficulty from all operating room (OR) team members.

Purpose of the Study:

• To evaluate the interrater reliability and agreement of QWAT ratings.
• To assess QWAT ratings from OR clinicians who reviewed case vignettes versus those involved in actual cases.

Main Methods:

• Thirty-six OR clinicians (anesthesia providers, surgeons, nurses) rated 6 cases using QWAT.
• Clinicians reviewed vignettes with case synopses and intraoperative data.
• Ratings were compared to those from clinicians involved in the actual surgical cases.

Main Results:

• Surgeons demonstrated higher interrater reliability on QWAT than nurses or anesthesia providers.
• No significant differences were found between actual and vignette-based ratings for anticipated workload.
• Differences emerged in perceived workload for median/difficult cases among provider types.

Conclusions:

• QWAT case difficulty items appear reliable and valid for assessing surgeon clinical workload.
• More evidence is needed to demonstrate QWAT validity for non-surgeon OR clinicians due to vignette limitations.