PATIENT SAFETY
Understanding safety threats and resilience supports in the operating room
Published on
Oct 25, 2025
BMJ Open
Cecil Chikezie, Sonia Pinkney, Mark Fan, Joseph A Cafazzo, Teodor Grantcharov, Patricia Trbovich
Overview
This mixed-methods study seeks to systematically identify and understand the complex system-level factors that influence intraoperative patient safety. Despite widespread surgical quality improvement efforts, preventable intraoperative adverse events (iAEs) continue to occur. Using a human factors framework, the study investigates both safety threats (STs) — the conditions that contribute to risk — and resilience supports (RSs) — the behaviors and mechanisms that enable recovery or prevention of harm.
The research integrates quantitative and qualitative data from 120 surgical video recordings across four hospitals using the OR Black Box®, which captures multimodal operating room data. These findings are further contextualized through clinician interviews, offering a holistic view of how operating room teams adapt to and manage challenges in real time.
Results
Preliminary results highlight that intraoperative safety is influenced by a dynamic interplay between human, technological, and environmental factors. Common safety threats identified include communication breakdowns, workflow interruptions, and equipment availability issues, while key resilience supports involve anticipatory communication, team coordination, and the proactive use of safety technologies (such as radiofrequency sponge detection wands).
Cross-site comparisons reveal that certain institutional practices and technologies effectively mitigate recurring threats. Interviews underscore the importance of local culture and team dynamics in shaping resilience behaviors. Together, these findings suggest that enhancing intraoperative safety requires not only minimizing system vulnerabilities but also actively strengthening the adaptive capacities of surgical teams.
Peer-reviewed Research
