Simulation for Operating Room Safety (SIMORS): Interdisciplinary Team Training in Nontechnical Skills and OR Safety (1090-004215) (To be presented during the session entitled, Research Abstract Oral: Debriefing, Communication & Teamwork)
Start time: Friday, January 22, 2021, 8:00 AM End time: Friday, January 22, 2021, 9:00 AM Session Type: Research Abstracts (Completed Studies)
Safety in the operating room (OR) involves integral collaboration and coordination between surgery, anesthesia and nursing disciplines. However, surgical teams are especially susceptible to breakdowns in information sharing. While intraoperative errors and personnel factors such as fatigue and inexperience frequently contribute to OR errors, a reported 43% of adverse events are attributable to communication failures (2). Our team sought to develop a simulation program that would teach the importance of sign out completion and promote teamwork. We hypothesized that a simulation program designed to encourage interdisciplinary teamwork and highlight potential areas of communication breakdown would improve attitudes of utilizing the surgical safety checklist (SSC) and OR safety culture. We also hypothesized that simulation is an effective teaching tool for interdisciplinary OR teams.
Simulation sessions were conducted with an interprofessional surgical team consisting of an attending and resident anesthesiologist, attending and resident surgeon, and 2 OR nurses (circulator and scrub nurse/tech). Using a high-fidelity simulation mannequin, an advanced 3D printed model, and a mock operating room, each team completed a surgical case divided into 3 phases. Unexpected events including a crisis (intra-abdominal hemorrhage) occurred throughout the phases, requiring cooperation and communication to prevent harm to the patient. The anesthesiologists were asked to respond to vital sign changes with appropriate medications and resuscitative therapies. The surgeons were asked to resect a retroperitoneal lymph node and tumor, aided by electrocautery and suction. Investigators administered a survey before, immediately after, and approximately six months after participation in the simulation experience to elicit opinions of OR safety culture, SSC usage, and OR team simulation.
One hundred forty participants completed the pre- and post- simulation experience survey, and 40 completed the interval survey. At the interval survey, consistently performing the debriefing (sign out) portion of the SSC was reported by 94% of surgeons, but only 50% of anesthesia participants (p<0.001). Participants reported feeling more empowered after the experience (p<0.01), which was sustained on the 6 months inquiry. Before the experience, 82% of participants agreed that simulation is an effective tool to teach OR safety, which improved to 100% afterward (p<0.001) and 95% after six months.
Simulation can be an effective teaching tool for interdisciplinary OR teams. Overall, participants felt empowered after completing the simulation, but differences remain between disciplines. Members of the surgical team reported differing levels of engagement in sign-out and debriefing activity, suggesting a need for additional simulation experiences to improve collaboration and communication. Education of OR teams as an interprofessional group rather than singular disciplines can provide opportunity for teamwork and shared decision making. Participants discussed the need for realistic high-fidelity simulation activities to practice skills and the need for ongoing simulation experiences.