Patient safety in the operating room has improved in the last few decades, however significant risks remain.
Operative environments can be acutely stressful, with heavy workloads and high-risk decision making. Healthy team dynamics are critical in this context.
Ahead of the Operating Theatre Management Conference, Dr. Nicole Yap, a Breast Surgeon and Deputy Chair of Victorian section at the Royal Australasian College of Surgeons says, “Distractions and interruptions in the operative setting may lead to a loss of concentration and therefore safety.
“Individual communication and leadership abilities vary and if not highly capable in these areas, team members are more likely to make errors in stressful situations, or become mentally lethargic, particularly after long shifts. This can lead to action-based, decision-based and communication-based errors.
“Adverse events can be immediate, or subtle and delayed. Immediate examples include administration of the wrong dose of anaesthetic drug, inadvertently incising important structures (vessel, nerve, ureter), or even a “sharps ” injury to anyone within the team.
“Delayed examples include, deep vein thrombosis, due to a lack of anticoagulation, or mechanical calf compression; infection, secondary to a lack of administration of prophylactic antibiotics due to pre op check list (team time-out) not being carried out. In addition, surgical products may be accidentally left within the patient”.
All of these events can be avoided when the team is concentrating and due diligence procedures are carried out, she argues.
Traditionally the Surgeon is the leader of the operating unit, closely followed by the Anaethetist/Anaesthetic nurse, Scrub nurse/ Scout nurse, Surgical assistant/Registrar, Technician and Patient. However, Dr. Yap believes all play an integral part in patient safety, advocacy and clinical outcomes.
“Importantly, team communication and information sharing are critical for optimising team performance”, she continues. “All those in the operative team must accurately understand their owns tasks and equipment, as well as the tasks, responsibilities and capabilities of the other team members”.
Dr. Yap defines teamwork as the, “Interrelated behaviours, actions, cognitions and attitudes that facilitate the required work to be completed”. She believes that performance relies on the characteristics of team members, including personal skills and attributes, reputation and expertise; and on workplace factors, such as staffing levels, the working environment, and protocols such as Team Time Out.
“Team time out addresses correct patient, correct procedure, correct side, and potential allergies, prior to commencement of surgery. This should occur between the patient and two team members, one of which includes the surgeon”.
Effective leadership and staff morale are also important aspects, she highlights. “These promote a range of behaviours including mutual support and back-up, as well as reduced staff turnover. Low staff turnover isn’t just symptomatic of an effective working team – it fosters it”.
Royal Australasian College of Surgeons has taken a proactive approach to bolstering team dynamics, with online modules and mandatory face-to-face roleplay, including the “Operating with Respect Workshop”.
“It’s important that clinical leaders acquire leadership skills in order to successfully communicate a direction for the teamwork, clarify the team’s objectives and interact with the team members”, adds Dr. Yap.
The Royal Australasian College of Surgeons has commenced Leadership workshops for its fellows to improve skills in communication, clarifying team members responsibilities, managing and evaluating individuals’ roles and performance, and recognising and addressing issues within the team.
It has also been using the Aviation industry training module to team training within the healthcare industry. Anaesthesia also use this model with the use of simulators where crisis scenarios are enacted and operators performance observed and assessed.
Dr. Nicole Yap is a Breast cancer and reconstructive surgeon, and Deputy Chair VRC at the Royal Australasian College of Surgeons and will be sharing details of RACS’s proactive approach to risk reduction at the Operating Theatre Management Conference, due to take place 29-30 July 2019 in Melbourne.