Distractions in the operating room can contribute to errors. Based on survey responses from 160 healthcare workers, this study examined perceived distractions in the operating room. All participants ranked auditory distractions as the most distracting and visual distractions as the least distracting, but the top five distractors fell into the equipment and environmental categories – (excessive heat/cold, team member unavailability, poor ergonomics, equipment unavailability, and competitive demand for equipment). Phone calls/pagers/beepers were also cited as a common distractor. 

Operating rooms are high-risk work environments. Improper use of energy-based surgical devices can increase risks of surgical fires. This commentary describes an initiative to address this safety concern by educating physicians and staff who work in the operating room environment about how to safely use the equipment. A past WebM&M commentary discussed operating room fires and how to prevent them.

Simulation has been explored as a way to improve teamwork, crisis management, and technical skills in surgery. This review analyzes the evidence base on surgical simulation and identifies areas of progress, including curricula development, training techniques, and feedback methods. However, there is still a lack of data confirming the impact of simulation interventions on patient outcomes.

Surgical fires, though rare, can be particularly serious. This commentary analyzes factors that increase risks of these incidents, such as the presence of volatile substances in the operating room, use of highly-specialized technologies, and insufficient clinician experience with equipment.

Simulation training for operating room (OR) teams is an effective tool for improving teamwork and communication, but can be resource intensive and expensive. Due to these barriers, most simulation programs have only included trainees. For this study, a malpractice insurer provided the financial and administrative resources necessary to develop a standardized OR simulation training curriculum that involved active participation of attending surgeons and anesthesiologists. The group provided modest compensation for physicians' time and achieved wide participation. This teamwork curriculum covered principles of communication, assertiveness, and use of the WHO surgical safety checklist. Nearly all (93%) participants thought that the training would help them provide safer care. Dr. David Gaba discussed simulation training in a recent AHRQ WebM&M interview.

… validated to ensure their effectiveness. … Brindley PG, Jones DB, Grantcharov T, de Gara C. Can J Surg. …

A rapid response team model that relied on clinical triggers to summon the primary team caring for the patient—rather than a dedicated, separate team—resulted in sustained reductions in unexpected inpatient mortality over a 4-year period.

The majority of practicing surgeons surveyed in this study were unaware of risk factors and preventive methods for surgical fires.

Communication failures in the surgical setting are a known threat to patient safety and the second most common root cause of adverse events (following technical errors). This study implemented a set of tailored policy and education initiatives at 4 teaching hospitals in an effort to increase timely and consistent resident–attending communication and promote attending visits with surgical patients. Investigators analyzed more than 200 critical events and 1300 patient cases and noted significant improvements in communication between residents and attendings. The number of patients not visited by attendings on weekends decreased by half, and the improved communications resulted in attending-level changes in patient management a third of the time. An accompanying editorial [see link below] discusses the study’s findings and emphasizes the importance of simply setting clear and explicit expectations for communication. A past AHRQ WebM&M perspective discusses surgical safety with this study’s senior author, Dr. Atul Gawande.

Medical errors have a lasting effect on patients and their families but can also leave providers—the "second victim"—with a similar emotional toll. Error disclosure is increasingly viewed as an essential skill for physicians just as training curriculums and guidelines continue to emerge. This study describes an interactive educational curriculum for trainees and faculty physicians that teaches error disclosure, apology, and explores the human impact of error. Among the participants, 62% of trainees and 88% of faculty reported making a medical error, while 62% and 78% of them, respectively, did not apologize, citing the lack of training to do so. The authors share the development of their curriculum, its evaluation, and also provide a tool to address practical issues related to communication and professionalism following an adverse event. Past AHRQ WebM&M perspectives have discussed error disclosure and new developments in the field.

Communication failures are a common cause of patient harm in both medical and surgical settings. Patterns of communication breakdown in surgical settings have led to implementation of checklists and briefings as interventions to reduce such harm. This prospective study examined communication breakdowns between surgical residents and their supervising attendings in the pre- and postoperative periods to identify opportunities for improvement. Investigators discovered that one-third of critical patient events were not communicated to attending surgeons. The residents reported no barriers to calling their attending, but felt that this was not necessary for safe patient care in 76% of the events. When discussions did occur, the attendings changed management in 33% of cases. The authors conclude that residents fail to adequately engage their attending surgeons in patient care despite the attending surgeons' receptiveness and interest in being contacted. Further research is required to determine if these findings represent pure communication failures, challenges in trainee oversight, or a culture of safety issue.

This study compared the performance of surgeons younger and older than 55 in a simulated operative setting to demonstrate that age in itself is an arbitrary predictor of skill assessment. The authors advocate for simulation as a potential tool to evaluate performance in the context of re-credentialing.

In this study of simulated cholecystectomies, surgical residents felt ill-trained to disclose both complications (common bile duct injury) and serious incidental findings (gallbladder cancer) encountered during a cholecystectomy. Most concerning, a large proportion of residents did not adequately describe potential complications when obtaining informed consent.

A multidisciplinary simulation, using a high-fidelity surgical simulator, was used to assess performance of experts and novices in dealing with a technical mishap.

The authors introduce a number of surgical simulation methods and discuss how training curricula should evolve to best incorporate simulation technology.

This discussion of patient safety from a surgical perspective highlights issues involving hierarchy, human factors, and multidisciplinary team training as opportunities to reduce medical errors in surgery.