Etherington Nicole, Usama Aya, Patey Andrea M, Trudel Chantal, Przybylak-Brouillard Antoine, Presseau Justin, Grimshaw Jeremy M, Boet Sylvain
Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
School of Industrial Design, Carleton University, Ottawa, Ontario, Canada.
BMJ Open Qual. 2019 Aug 1;8(3):e000686. doi: 10.1136/bmjoq-2019-000686. eCollection 2019.
Systematically observing clinical performance in the operating room (OR) to support patient safety initiatives faces numerous logistical and methodological challenges. These may be solved by new audio-video recording technologies like the OR Black Box, which is a tool similar to black boxes in aviation. This study aimed to identify barriers and enablers that may influence patients', clinicians' and senior leadership team members' support of the OR Black Box in order to guide its future implementation.
Patients, clinicians and senior leadership team members were recruited to participate in semistructured interviews informed by the theoretical domains framework (TDF) to identify factors relevant to planning OR Black Box implementation. Deidentified interview transcripts were analysed in duplicate following a TDF coding structure.
Data saturation was achieved at 15 patients, 17 clinicians and 9 senior leadership team members. Seven domains were relevant for patients, nine for clinicians and four for senior leadership. Knowledge and Beliefs about consequences were barriers and enablers for all three groups. Memory, attention and decision processes and Social influences were enablers for both clinicians and senior leadership. Environmental context and resources, Emotion and Behavioural regulation were found to be barriers and enablers for both clinicians and patients. Social/professional role and identity and Reinforcement were enablers for patients only and Optimism and Intentions were barriers and enablers to clinicians.
While most stakeholders were supportive of the OR Black Box, we identified many key areas that need to be addressed during its implementation. It is critical to ensure all stakeholders have adequate and accurate information about the OR Black Box system and research goals, and that the OR Black Box is positioned as a patient safety initiative for learning from and improving practice.
在手术室（OR）中系统地观察临床操作以支持患者安全举措面临诸多后勤和方法学挑战。这些挑战可通过新型音频视频记录技术来解决，如手术室黑匣子，它是一种类似于航空领域黑匣子的工具。本研究旨在确定可能影响患者、临床医生和高级领导团队成员对手术室黑匣子支持度的障碍因素和促进因素，以指导其未来的实施。
招募患者、临床医生和高级领导团队成员参与基于理论领域框架（TDF）的半结构化访谈，以确定与手术室黑匣子实施规划相关的因素。按照TDF编码结构对去识别化的访谈记录进行双人分析。
对15名患者、17名临床医生和9名高级领导团队成员进行访谈后实现了数据饱和。七个领域与患者相关，九个与临床医生相关，四个与高级领导相关。对后果的知识和信念对所有三组来说既是障碍因素也是促进因素。记忆、注意力和决策过程以及社会影响对临床医生和高级领导来说都是促进因素。环境背景与资源、情绪和行为调节对临床医生和患者来说既是障碍因素也是促进因素。社会/职业角色与身份以及强化仅对患者是促进因素，而乐观和意图对临床医生来说既是障碍因素也是促进因素。
虽然大多数利益相关者支持手术室黑匣子，但我们确定了其实施过程中许多需要解决的关键领域。确保所有利益相关者拥有关于手术室黑匣子系统和研究目标的充分且准确的信息，以及将手术室黑匣子定位为一项用于学习和改进实践的患者安全举措至关重要。
