Sylvain Boet1,2,3, Cole Etherington4,5, Agnes Crnic1, Julie Kenna6, James Jung7,8, Martin Cairns1, Glen Posner9, Teodor Grantcharov7,8. 1. Department of Anesthesiology and Pain Medicine, University of Ottawa, Ottawa, ON, Canada. 2. Clinical Epidemiology Program, Ottawa Hospital Research Institute - Centre for Practice Changing Research, 501 Smyth Rd, Ottawa, ON, K1H 8L6, Canada. 3. Department of Innovation in Medical Education, University of Ottawa, Ottawa, ON, Canada. 4. Department of Anesthesiology and Pain Medicine, University of Ottawa, Ottawa, ON, Canada. coetherington@ohri.ca. 5. Clinical Epidemiology Program, Ottawa Hospital Research Institute - Centre for Practice Changing Research, 501 Smyth Rd, Ottawa, ON, K1H 8L6, Canada. coetherington@ohri.ca. 6. The Ottawa Hospital, Main Operating Room, Ottawa, ON, Canada. 7. Department of Surgery, University of Toronto, Toronto, ON, Canada. 8. International Centre for Surgical Safety, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada. 9. Department of Obstetrics, Gynecology and Newborn Care, University of Ottawa, Ottawa, ON, Canada.
Abstract
BACKGROUND: While the operating room (OR) has significantly benefited from aviation strategies to improve safety, the rate of avoidable human errors remains relatively high. One key aviation strategy that has yet to be formally established in the OR is the "sterile cockpit" rule, which prohibits all non-essential behaviours during critical moments of a flight. Applying this rule to the OR may enhance patient safety, but the critical moments of surgery need to be defined first. METHODS: This study used a modified Delphi methodology to determine critical moments during surgery according to OR team members across institutions, professions, and specialties. Analysis occurred after each round. The stopping criterion was consensus on 80% of survey items or no change in the mean score for any individual item between two consecutive rounds. RESULTS: The first round included 304 respondents. Of these, 115 completed the second-round survey, and 75 completed all three rounds (27 nurses, 29 anesthesiologists, 19 surgeons). Critical moments obtained by consensus were: induction of anesthesia; emergence from anesthesia; preoperative briefing; final counts at the end of the procedure; anesthesiologist- or surgeon-relevant intraoperative event; handovers; procedure-specific high-risk surgical moments; crisis resource management situations; medication and equipment preparation; and key medication administration. CONCLUSIONS: By defining the most critical moments of surgery, future research can determine the relative importance of behaviour and actions at each stage and target interventions to these stages.
BACKGROUND: While the operating room (OR) has significantly benefited from aviation strategies to improve safety, the rate of avoidable human errors remains relatively high. One key aviation strategy that has yet to be formally established in the OR is the "sterile cockpit" rule, which prohibits all non-essential behaviours during critical moments of a flight. Applying this rule to the OR may enhance patient safety, but the critical moments of surgery need to be defined first. METHODS: This study used a modified Delphi methodology to determine critical moments during surgery according to OR team members across institutions, professions, and specialties. Analysis occurred after each round. The stopping criterion was consensus on 80% of survey items or no change in the mean score for any individual item between two consecutive rounds. RESULTS: The first round included 304 respondents. Of these, 115 completed the second-round survey, and 75 completed all three rounds (27 nurses, 29 anesthesiologists, 19 surgeons). Critical moments obtained by consensus were: induction of anesthesia; emergence from anesthesia; preoperative briefing; final counts at the end of the procedure; anesthesiologist- or surgeon-relevant intraoperative event; handovers; procedure-specific high-risk surgical moments; crisis resource management situations; medication and equipment preparation; and key medication administration. CONCLUSIONS: By defining the most critical moments of surgery, future research can determine the relative importance of behaviour and actions at each stage and target interventions to these stages.
Authors: Marieke Zegers; Martine C de Bruijne; Bertus de Keizer; Hanneke Merten; Peter P Groenewegen; Gerrit van der Wal; Cordula Wagner Journal: Patient Saf Surg Date: 2011-05-20