Advertisement

World Journal of Surgery

, Volume 43, Issue 2, pp 431–438 | Cite as

Relationships Between Expertise, Crew Familiarity and Surgical Workflow Disruptions: An Observational Study

  • Pierre-Louis HenauxEmail author
  • Estelle Michinov
  • Julie Rochat
  • Brivael Hémon
  • Pierre Jannin
  • Laurent Riffaud
Original Scientific Report

Abstract

Background

Teamwork is an essential factor in reducing workflow disruption (WD) in the operating room. Team familiarity (TF) has been recognized as an antecedent to surgical quality and safety. To date, no study has examined the link between team members’ role and expertise, TF and WD in surgical setting. This study aimed to examine the relationships between expertise, surgeon–scrub nurse familiarity and WD.

Methods

We observed a convenience sample of 12 elective neurosurgical procedures carried out by 4 surgeons and 11 SN with different levels of expertise and different degrees of familiarity between surgeons and SN. We calculated the number of WD per unit of coding time to control for the duration of operation. We explored the type and frequency of WD, and the differences between the surgeons and SN. We examined the relationships between duration of WD, staff expertise and surgeon–scrub nurse familiarity.

Results

9.91% of the coded surgical time concerned WD. The most frequent causes of WD were distractions (29.7%) and colleagues’ interruptions (25.2%). This proportion was seen for SN, whereas teaching moments and colleagues’ interruptions were the most frequent WD for surgeons. The WD was less high among expert surgeons and less frequent when surgeon was familiar with SN.

Conclusions

The frequency of WD during surgical time can compromise surgical quality and patient safety. WD seems to decrease in teams with high levels of surgeon–scrub nurse familiarity and with development of surgical expertise. Favoring TF and giving feedback to the team about WD issues could be interesting ways to improve teamwork.

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

References

  1. 1.
    Jannin P, Morandi X (2007) Surgical models for computer-assisted neurosurgery. NeuroImage 37(3):783–791CrossRefGoogle Scholar
  2. 2.
    Wiegmann DA, ElBardissi AW, Dearani JA et al (2007) Disruptions in surgical flow and their relationship to surgical errors: an exploratory investigation. Surgery 142(5):658–665CrossRefGoogle Scholar
  3. 3.
    Al-Hakim L, Xiao J, Sengupta S (2017) Ergonomics perspective for identifying and reducing internal operative flow disruption for laparoscopic urological surgery. Surg Endosc 31(12):5043–5056CrossRefGoogle Scholar
  4. 4.
    Palmer G, Abernathy JH, Swinton G et al (2013) Realizing improved patient care through human-centered operating room designa human factors methodology for observing flow disruptions in the cardiothoracic operating room. J Am Soc Anesthesiol 119(5):1066–1077CrossRefGoogle Scholar
  5. 5.
    Shouhed D, Blocker R, Gangi A et al (2014) Flow disruptions during trauma care. World J Surg 38(2):314–321.  https://doi.org/10.1007/s00268-013-2306-0 CrossRefGoogle Scholar
  6. 6.
    Sevdalis N, Healey AN, Vincent CA (2007) Distracting communications in the operating theatre. J Eval Clin Pract 13(3):390–394CrossRefGoogle Scholar
  7. 7.
    Sevdalis N, Wong HWL, Arora S et al (2012) Quantitative analysis of intraoperative communication in open and laparoscopic surgery. Surg Endosc 26(10):2931–2938CrossRefGoogle Scholar
  8. 8.
    Allers JC, Hussein AA, Ahmad N et al (2016) Evaluation and Impact of workflow interruptions during robot-assisted surgery. Urology 92:33–37CrossRefGoogle Scholar
  9. 9.
    Rivera-Rodriguez AJ, Karsh B-T (2010) Interruptions and distractions in healthcare: review and reappraisal. Qual Saf Health Care 19(4):304–312CrossRefGoogle Scholar
  10. 10.
    Lingard L, Espin S, Whyte S et al (2004) Communication failures in the operating room: an observational classification of recurrent types and effects. Qual Saf Health Care 13(5):330–334CrossRefGoogle Scholar
  11. 11.
    Leonard M, Graham S, Bonacum D (2004) The human factor: the critical importance of effective teamwork and communication in providing safe care. Qual Saf Health Care 13(Suppl 1):i85–i90CrossRefGoogle Scholar
  12. 12.
    Haynes AB, Weiser TG, Berry WR et al (2009) A surgical safety checklist to reduce morbidity and mortality in a global population. N Engl J Med 360(5):491–499CrossRefGoogle Scholar
  13. 13.
    Gillespie BM, Marshall AP, Gardiner T et al (2016) Impact of workflow on the use of the surgical safety checklist: a qualitative study. ANZ J Surg 86(11):864–867CrossRefGoogle Scholar
  14. 14.
    Weigl M, Müller A, Vincent C et al (2012) The association of workflow interruptions and hospital doctors’ workload: a prospective observational study. BMJ Qual Saf 21(5):399–407CrossRefGoogle Scholar
  15. 15.
    Webber SS, Crews Klimoski RJ (2004) A distinct type of work team. J Bus Psychol 18(3):261–279CrossRefGoogle Scholar
  16. 16.
    Thomas MJW, Petrilli RM (2006) Crew Familiarity: operational experience, non-technical performance, and error management. Aviat Space Environ Med 77(1):41–45Google Scholar
  17. 17.
    Patterson PD, Weaver MD, Landsittel DP et al (2016) Teammate familiarity and risk of injury in emergency medical services. Emerg Med J 33(4):280–285CrossRefGoogle Scholar
  18. 18.
    Maruthappu M, Duclos A, Zhou CD et al (2016) The impact of team familiarity and surgical experience on operative efficiency: a retrospective analysis. J R Soc Med 109(4):147–153CrossRefGoogle Scholar
  19. 19.
    Kurmann A, Keller S, Tschan-Semmer F et al (2014) Impact of team familiarity in the operating room on surgical complications. World J Surg 38(12):3047–3052.  https://doi.org/10.1007/s00268-014-2680-2 CrossRefGoogle Scholar
  20. 20.
    Smith-Jentsch KA, Kraiger K, Cannon-Bowers JA et al (2009) Do familiar teammates request and accept more backup? Transactive memory in air traffic control. Hum Factors 51(2):181–192CrossRefGoogle Scholar
  21. 21.
    Alderson D (2010) Developing expertise in surgery. Med Teach 32(10):830–836CrossRefGoogle Scholar
  22. 22.
    Cohen TN, Cabrera JS, Sisk OD et al (2016) Identifying workflow disruptions in the cardiovascular operating room. Anaesthesia 71(8):948–954CrossRefGoogle Scholar
  23. 23.
    Widmer LW, Keller S, Tschan F, Semmer NK, Holzer E, Candinas D, Beldi G (2018) More than talking about the weekend: content of case-irrelevant communication within the OR team. World J Surg 42(7):2011–2017.  https://doi.org/10.1007/s00268-017-4442-4 CrossRefGoogle Scholar
  24. 24.
    Parker SEH, Laviana AA, Wadhera RK et al (2010) Development and evaluation of an observational tool for assessing surgical flow disruptions and their impact on surgical performance. World J Surg 34(2):353–361.  https://doi.org/10.1007/s00268-009-0312-z CrossRefGoogle Scholar
  25. 25.
    ElBardissi AW, Duclos A, Rawn JD et al (2013) Cumulative team experience matters more than individual surgeon experience in cardiac surgery. J Thorac Cardiovasc Surg 145(2):328–333CrossRefGoogle Scholar
  26. 26.
    Daniel Patterson P, Arnold RM, Abebe K et al (2011) Variation in emergency medical technician partner familiarity. Health Serv Res 46(4):1319–1331CrossRefGoogle Scholar
  27. 27.
    Kang E, Massey D, Gillespie BM (2015) Factors that influence the non-technical skills performance of scrub nurses: a prospective study. J Adv Nurs 71(12):2846–2857CrossRefGoogle Scholar
  28. 28.
    Wegner DM, Transactive memory: A contemporary analysis of the group mind (1987) In: Mullen G, Goethals G (eds) Theories of group behavior. Springer, New York, pp 185–208CrossRefGoogle Scholar
  29. 29.
    Michinov E, Olivier-Chiron E, Rusch E et al (2008) Influence of transactive memory on perceived performance, job satisfaction and identification in anaesthesia teams. BJA Br J Anaesth 100(3):327–332CrossRefGoogle Scholar
  30. 30.
    Koh RYI, Park T, Wickens CD (2014) An investigation of differing levels of experience and indices of task management in relation to scrub nurses’ performance in the operating theatre: analysis of video-taped caesarean section surgeries. Int J Nurs Stud 51(9):1230–1240CrossRefGoogle Scholar
  31. 31.
    Sieweke J, Zhao B (2015) The impact of team familiarity and team leader experience on team coordination errors: a panel analysis of professional basketball teams. J Organ Behav 36(3):382–402CrossRefGoogle Scholar

Copyright information

© Société Internationale de Chirurgie 2018

Authors and Affiliations

  1. 1.Department of NeurosurgeryRennes University HospitalRennes Cedex 9France
  2. 2.INSERM MediCIS, Unit U1099 LTSI, Faculty of MedicineRennes 1 UniversityRennes CedexFrance
  3. 3.LP3C (Laboratoire de Psychologie : Cognition, Comportement, Communication) - EA 1285Univ RennesRennesFrance

Personalised recommendations