Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
Department of Anesthesiology and Pharmacology, Toxicology, and Neurosciences, Louisiana State University School of Medicine, 1501 Kings Hwy, Shreveport, LA, 71103, USA.
Curr Pain Headache Rep. 2020 Aug 18;24(10):60. doi: 10.1007/s11916-020-00896-2.
Surgical flow disruptions (SFD) are deviations from the progression of a procedure which can be potentially compromising to the safety of the patient. Investigators have previously demonstrated that SFDs can increase the likelihood of error. To date, there has been no investigation into flow disruptions through the eyes of clinicians in the operating room. This study, therefore, attempted to better understand SFDs and their impact from the perspective of operating room team members.
After Institutional Review Board approval, a survey was sent to operating room team members including surgeons, anesthesia providers, nurses, and surgical technologists. The survey was developed to assess the perceived frequency and consequences of SFDs, and the ability to report and perceive the efficacy of reporting to management. Among 111 survey participants, 65% reported that surgical flow disruptions happen either "several times a day" or "every procedure." Forty percent ranked poor communication as the most frequent cause of SFDs. Ten percent reported equipment failure was the most frequent cause of SFDs. Respondents who identified as attending surgeons felt impacts on patient safety and staff burnout was the most likely consequence of SFDs. Scrub technicians and nurses felt that economic consequences were the most likely result. Forty-four percent did not feel reporting led to effective change. Thirty-five percent did not believe they could report issues without adverse consequences. Flow disruptions represent patterns or accumulations of disruptions which may highlight weak points in surgical systems and potential causes of staff burnout and medical error. The data in the present investigation demonstrate that OR team members recognize surgical flow disruptions are an important issue and believe poor communication and equipment problems are a significant factor. Our data additionally suggest the groups surveyed do not feel safe or productive in reporting flow disruptions.
手术流程中断（SFD）是指手术过程中的偏差，可能会危及患者的安全。研究人员之前已经证明，SFD 会增加出错的可能性。迄今为止，还没有人从手术室临床医生的角度研究流程中断。因此，本研究试图从手术室团队成员的角度更好地了解 SFD 及其影响。
在获得机构审查委员会批准后，向手术室团队成员（包括外科医生、麻醉师、护士和外科技术员）发送了一份调查。该调查旨在评估 SFD 的感知频率和后果，以及报告和感知向管理层报告的效果的能力。在 111 名调查参与者中，65%的人报告说手术流程中断“每天几次”或“每次手术”。40%的人将沟通不畅列为 SFD 最常见的原因。10%的人报告设备故障是 SFD 最常见的原因。认为自己是主治外科医生的受访者认为，SFD 对患者安全和员工倦怠的影响最大。刷手技术员和护士认为经济后果最有可能是结果。44%的人认为报告不会导致有效改变。35%的人认为他们不能在没有不利后果的情况下报告问题。流程中断代表着可能突出手术系统薄弱环节和员工倦怠和医疗错误潜在原因的中断模式或积累。本调查中的数据表明，手术室团队成员认识到手术流程中断是一个重要问题，并认为沟通不畅和设备问题是一个重要因素。我们的数据还表明，接受调查的群体在报告流程中断时感到不安全或没有成效。
