Operating room team members' views of workload, case difficulty, and nonroutine events.

Interventions such as mandatory "time-outs" have contributed to intraoperative safety but improvements are still necessary. We present data provided by 3 professions always present in the intraoperative setting that suggest next steps in the quest for improvements. We describe the differences and similarities in operating room (OR) nurses', anesthesia providers', and surgeons' beliefs about team function, case difficulty, nonroutine event (NRE), and error causation using a qualitative design at 3 Veterans' Administration hospitals. Intraoperative errors are costly in lives, suffering, and dollars. A quality improvement tenet states that workers are a rich information source regarding the context within which quality can be improved. Identifying and describing OR providers' beliefs are necessary steps in devising novel approaches to quality improvement. Intraoperative NRE and error prevention opportunities exist within and outside of the OR. There may be "cascade" and "perfect storm conditions" before and during operative procedures that increase the likelihood of NREs. Confirmation of these phenomena could improve prediction and prevention of NREs. Exploration of differences in team definition and team performance ratings by provider type may also identify avenues for improvement.