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

Taylor Incze¹, Sonia J Pinkney¹, Cherryl Li¹

¹Dalla Lana School of Public Health, Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.

Annals of Surgery

|January 9, 2024

Summary

This summary is machine-generated.

Surgical team members adapt teamwork skills during uncertainty. Nurses increased backup behavior, while surgeons and trainees enhanced psychological safety during adverse events.

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Area of Science:

Healthcare research
Human factors engineering
Surgical safety

Background:

Effective surgical teamwork is crucial for patient safety.
Limited understanding exists on how specific roles (nurse, anesthesiologist, surgeon, trainee) contribute to teamwork during uncertainty and intraoperative adverse events (IAEs).

Purpose of the Study:

To identify unique contributions of surgical team members to teamwork.
To understand how teamwork skills adapt during uncertainty, specifically in response to IAEs.

Main Methods:

Prospective audiovisual data collection from 23 laparoscopic surgeries using OR Black Box.
Retrospective coding of teamwork skills (backup behavior, coordination, psychological safety, situation assessment, team decision-making, leadership) by role.
Comparison of teamwork skills during uncertainty with and without IAEs, identified by surgeons.

Main Results:

1015 teamwork instances observed.
Nurses showed a 5.3x increase in backup behavior during IAEs.
Surgeons and trainees demonstrated increased psychological safety skills during IAEs, while all roles showed decreased situation assessment.

Conclusions:

OR Black Box effectively captured role-specific teamwork adaptations during uncertainty.
Certain teamwork skills were amplified (e.g., backup behavior, psychological safety), while others were dampened (e.g., situation assessment) during IAEs.
Findings can inform tailored interventions to improve interprofessional surgical teamwork.