SAFETY CULTURE

Assessing the team's perception on human factors in the operating environment

Published on

June 1, 2021

American Journal of Surgery

Anne Sophie H M van Dalen, Mitchell Goldenberg, Teodor P Grantcharov, Marlies P Schijven
Anne Sophie H M van Dalen, Mitchell Goldenberg, Teodor P Grantcharov, Marlies P Schijven
Anne Sophie H M van Dalen, Mitchell Goldenberg, Teodor P Grantcharov, Marlies P Schijven

Overview

This international multi-center survey study, conducted at St. Michael's Hospital (Toronto) and Amsterdam UMC, investigated human factors in the operating room environment using the Human Factors Analysis and Classification System (HFACS) framework. The researchers collected 507 questionnaires across 117 elective laparoscopic procedures, including gastric bypasses, fundoplications, hernia repairs, colorectal resections, and adrenalectomies. Participants included staff surgeons, residents, fellows, anesthesiology team members, nurses, and medical students, all of whom completed the Surgical Team Assessment Record (STAR) questionnaire after each case.

The study revealed notable disparities in team members' perceptions of human factors in the operating room. Surgical fellows consistently rated aspects lower than other team members, giving significantly lower scores (median 3/5 vs 4/5) for personal readiness, ability to handle unexpected events, and team communication. Staff surgeons were more likely to identify operational issues, with 51.3% noting distractions and 60.5% reporting aberrations during surgery. These problems were primarily technical in nature, including inadequate anastomosis closure, bleeding, small bowel injury, equipment malfunction, and poor trocar placement. The researchers suggest that the lower ratings from fellows might be related to career-related stress and stability concerns, which could impact surgical safety and team performance.

Results

Several significant findings emerged regarding human factors in the operating room. Surgical fellows rated their personal readiness, ability to handle unexpected events, and team communication significantly lower (median 3/5) compared to other team members (median 4/5). Staff surgeons more frequently identified distractions (51.3%) and aberrations (60.5%) during surgery compared to other team members, with these issues primarily relating to technological problems such as inadequate anastomosis closure (n=20), bleeding (n=16), small bowel injury (n=10), equipment malfunction (n=9), and poor trocar placement (n=6). The study included 507 questionnaires completed across 117 elective laparoscopic procedures, including gastric bypasses, fundoplications, hernia repairs, colorectal resections, and adrenalectomies, with participation from various team members including staff surgeons, residents, fellows, anesthesiology team members, nurses, and medical students.

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Copyright. All Rights Reserved 2024
Copyright. All Rights Reserved 2024