H. T. Jackson1, J. Lee1 1George Washington University School Of Medicine And Health Sciences,Surgery,Washington, DC, USA
Introduction:
Implementation of surgical site markings, time outs, procedure checklists, and team improvement strategies are all steps that the medical community have taken to improve patient safety in the operating room (OR). Time outs have been shown to improve communication and patient safety in the operating room. While patient safety in the OR is a responsibility of all surgical team members, we believe the surgeon, who ultimately decides when a patient requires surgery, has an increased responsibility to be an active advocate for patient safety. Studies examining the role of the surgeon as the leader of these safety efforts are lacking.
Methods:
A survey study was undertaken to examine the perceptions of surgical team members (nurses, anesthesiologists, residents, surgeons) about the surgical time out (STO) process. Team members were queried specifically about attending surgeon initiation and completion of the STO checklist. Two-tailed t-test for independent groups was performed to examine differences in perceptions. A parallel observational study of the STO was conducted to determine concordance between perception and observation. Chi square analysis was used to examine associations between engagement and the STO initiation and completion process. Logistic regression was used to examine the association of independent variables in predicting STO engagement.
Results:
Surgeons reported a significantly higher incidence of self-completion of the STO when compared to anesthesiologists, nurses and residents (Surgeon vs. Anesthesiologist: p <0.0001; Surgeon vs. OR Nurse: p<0.0001; Surgeon vs. Resident: p value= 0.021). The observational study of 138 STOs showed that the STO was initiated and completed by someone other than the surgeon 54% of the time. When the surgeon did initiate and complete the STO, engagement was much higher (p=0.0003). When the surgeon required prompting or did not perform any STO component, the odds of high engagement were reduced by 82% and 88%, respectively (p=.0007, .0004).
Conclusion:
Surgeon leadership, not just involvement, is a critical component of team engagement in patient safety initiatives in the OR. Encouraging the involvement of the surgeon as the primary team leader in these initiatives could lead to a more optimal and safe OR environment.