Identifying Variability in Mental Models Within and Between Disciplines Caring for the Cardiac Surgical Patient.

Area of Science:

• Cardiovascular Surgery
• Healthcare Communication
• Patient Safety

Background:

• The cardiac operating room (OR) is a complex, multidisciplinary environment.
• Effective communication is crucial for efficient perioperative care of cardiac surgical patients.
• Variability in understanding critical time points may indicate a lack of a shared mental model.

Purpose of the Study:

• To identify and rank critical time points during perioperative care for cardiac surgery.
• To assess inter- and intra-disciplinary response variability regarding the importance of these time points.
• To evaluate response variability as a correlate for a shared mental model among care teams.

Main Methods:

• Delphi technique employed with panelists from three institutions.
• Panelists identified critical time points, categorized as pause points (PPs).
• Importance of PPs rated on a visual analog scale; response variability analyzed using interquartile ranges (IQRs).

Main Results:

• Twelve critical time points (PPs) were identified, with the highest consensus on: before surgical incision, before aortic cannulation, before cardiopulmonary bypass (CPB) initiation, before CPB separation, and OR to intensive care unit (ICU) transfer.
• Variability in perceived importance ranged from low (before surgical incision) to high (8 other PPs).
• Significant variation in perceived importance of PPs existed between and within disciplines and institutions.

Conclusions:

• Cardiac surgical teams recognize distinct critical time points.
• High variability in the perceived importance of these time points suggests a lack of a shared mental model.
• Absence of a shared mental model may contribute to preventable errors in the cardiac OR.