Henaux Pierre-Louis, Michinov Estelle, Rochat Julie, Hémon Brivael, Jannin Pierre, Riffaud Laurent
Department of Neurosurgery, Rennes University Hospital, 2, rue Henri Le Guilloux, 35033, Rennes Cedex 9, France.
INSERM MediCIS, Unit U1099 LTSI, Faculty of Medicine, Rennes 1 University, 2 Avenue du Professeur Léon Bernard, 35043, Rennes Cedex, France.
World J Surg. 2019 Feb;43(2):431-438. doi: 10.1007/s00268-018-4805-5.
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.
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.
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.
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.
团队合作是减少手术室工作流程中断（WD）的重要因素。团队熟悉度（TF）已被视为手术质量和安全的前提条件。迄今为止，尚无研究探讨手术环境中团队成员的角色和专业知识、TF与WD之间的联系。本研究旨在探讨专业知识、外科医生-洗手护士熟悉度与WD之间的关系。
我们观察了由4名外科医生和11名洗手护士进行的12例择期神经外科手术的便利样本，这些外科医生和洗手护士具有不同水平的专业知识，且外科医生与洗手护士之间的熟悉程度不同。我们计算了每单位编码时间内的WD数量，以控制手术持续时间。我们探讨了WD的类型和频率，以及外科医生和洗手护士之间的差异。我们研究了WD持续时间、工作人员专业知识和外科医生-洗手护士熟悉度之间的关系。
9.91%的编码手术时间涉及WD。WD最常见的原因是分心（29.7%）和同事的干扰（25.2%）。洗手护士的情况是这样，而教学时刻和同事的干扰对外科医生来说是最常见的WD。在专家外科医生中WD较少，当外科医生熟悉洗手护士时WD频率较低。
手术期间WD的频率可能会影响手术质量和患者安全。在外科医生-洗手护士熟悉度高且外科专业知识发展的团队中，WD似乎会减少。促进TF并就WD问题向团队提供反馈可能是改善团队合作的有趣方法。
