Advertisement

Fundamentals of Acceptable Behavior in the Operating Room (Etiquette)

  • Annie P. Ehlers
  • Andrew S. Wright
Chapter

Abstract

This chapter aims to be an introduction into the fundamentals of behavior and communication in the OR, often referred to as “OR etiquette.” We review the evidence behind the increased understanding of the importance of behavior and communication in the OR, including a discussion on the importance of the “safety culture.” Next, we describe the key team members that are encountered in the OR to provide a basic framework for new medical students and residents. Also included is a discussion on communication, skills of leadership and followership, methods of giving and receiving feedback, and available programs for improving team communication and culture. Finally, we provide a few pointers for how OR etiquette can enhance the experience for all. While nothing can substitute the value of spending time in the OR learning these skills firsthand, understanding these basic tenets is an important first step for medical students and residents beginning their surgical training.

Keywords

Teamwork Communication Patient safety 

Recommended Readings

  1. Gawande A. The checklist manifesto: how to get things right. New York: Metropolitan Books; 2010.Google Scholar
  2. Institute of Medicine (IOM). To err is human: building a safer health system. Washington, DC: The National Academies Press; 2000.Google Scholar
  3. Yule S, Paterson-Brown S. Surgeons’ non-technical skills. Surg Clin North Am. 2012;92(1):37–50.CrossRefPubMedGoogle Scholar
  4. “TeamSTEPPS.” Available at https://www.ahrq.gov/teamstepps.

References

  1. 1.
    Institute of Medicine (IOM). To err is human: building a safer health system. Washington, DC: The National Academies Press; 2000.Google Scholar
  2. 2.
    Molina G, Berry WR, Lipsitz SR, Edmondson L, Li Z, Neville BA, et al. Perception of safety of surgical practice among operating room personnel from survey data is associated with all-cause 30-day postoperative death rate in South Carolina. Ann Surg. 2017;266(4):658–66.CrossRefPubMedGoogle Scholar
  3. 3.
    Birkmeyer NJ, Finks JF, Greenberg CK, McVeigh A, English WJ, Carlin A, et al. Safety culture and complications after bariatric surgery. Ann Surg. 2013;257(2):260–5.CrossRefPubMedGoogle Scholar
  4. 4.
    Haynes AB, Weiser TG, Berry WR, Lipsitz SR, Breizat AH, Dellinger EP, et al. A surgical safety checklist to reduce morbidity and mortality in a global population. N Engl J Med. 2009;360(5):491–9.CrossRefPubMedGoogle Scholar
  5. 5.
    WHO surgical safety checklist and implementation manual. Available from, http://www.who.int/patientsafety/safesurgery/ss_checklist/en/.
  6. 6.
    Pugel AE, Simianu VV, Flum DR, Patchen Dellinger E. Use of the surgical safety checklist to improve communication and reduce complications. J Infect Public Health. 2015;8(3):219–25.CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Haugen AS, Softeland E, Almeland SK, Sevdalis N, Vonen B, Eide GE, et al. Effect of the World Health Organization checklist on patient outcomes: a stepped wedge cluster randomized controlled trial. Ann Surg. 2015;261(5):821–8.CrossRefPubMedGoogle Scholar
  8. 8.
    Erestam S, Haglind E, Bock D, Andersson AE, Angenete E. Changes in safety climate and teamwork in the operating room after implementation of a revised WHO checklist: a prospective interventional study. Patient Saf Surg. 2017;11:4.CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Zingiryan A, Paruch JL, Osler TM, Hyman NH. Implementation of the surgical safety checklist at a tertiary academic center: Impact on safety culture and patient outcomes. Am J Surg. 2016;214(2):193–7.CrossRefPubMedGoogle Scholar
  10. 10.
    Biffl WL, Gallagher AW, Pieracci FM, Berumen C. Suboptimal compliance with surgical safety checklists in Colorado: a prospective observational study reveals differences between surgical specialties. Patient Saf Surg. 2015;9(1):5.CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Russ S, Rout S, Caris J, Mansell J, Davies R, Mayer E, et al. Measuring variation in use of the WHO surgical safety checklist in the operating room: a multicenter prospective cross-sectional study. J Am Coll Surg. 2015;220(1):1–11.e4.CrossRefPubMedGoogle Scholar
  12. 12.
    Gitelis ME, Kaczynski A, Shear T, Deshur M, Beig M, Sefa M, et al. Increasing compliance with the World Health Organization surgical safety checklist-a regional health system’s experience. Am J Surg. 2017;214(1):7–13.CrossRefPubMedGoogle Scholar
  13. 13.
    Gibbons A, Bryant D. Followership: the forgotten part of doctors’ leadership. BMJ Careers. 2012;19:2012.Google Scholar
  14. 14.
    Klingensmith ME. Leadership and followership in surgical education. Am J Surg. 2016;213(2):207–11.CrossRefPubMedGoogle Scholar
  15. 15.
    Yule S, Paterson-Brown S. Surgeons’ non-technical skills. Surg Clin North Am. 2012;92(1):37–50.CrossRefPubMedGoogle Scholar
  16. 16.
    Hull L, Arora S, Aggarwal R, Darzi A, Vincent C, Sevdalis N. The impact of nontechnical skills on technical performance in surgery: a systematic review. J Am Coll Surg. 2012;214(2):214–30.CrossRefPubMedGoogle Scholar
  17. 17.
    Team STEPPS. Available from, https://www.ahrq.gov/teamstepps/index.html.
  18. 18.
    Langenfeld SJ, Cook G, Sudbeck C, Luers T, Schenarts PJ. An assessment of unprofessional behavior among surgical residents on Facebook: a warning of the dangers of social media. J Surg Educ. 2014;71(6):e28–32.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of SurgeryUniversity of WisconsinMadisonUSA

Personalised recommendations