Assessing Surgical Teamwork Competencies During Moments of Uncertainty Using OR Black Box

Abstract

Teamwork is an essential aspect to maintaining high-quality healthcare. This is especially true during times of uncertainty, when collaborative problem solving is necessary for clinical teams to adapt and deliver safe and effective care. We conducted a prospective observational study using audio/visual analysis captured by OR Black Box. Human factors experts transcribed and coded the videos using an evidence-based teamwork framework, specific to healthcare. We identified teamwork competencies that were either present or absent during moments of uncertainty in the operating room. Four main team roles (nurses, anesthesiologists, surgeons and trainees) were studied. We identified 3539 instances of teamwork, during 180 hours of surgical observation, and categorized them into 7 competencies. Team leadership was expressed significantly more often by surgeons compared to other team members whereas backup behaviour was expressed significantly more by nurses. Understanding how each team role uniquely contributes to teamwork can help develop specific and actionable teamwork interventions, which could ultimately lead to increased safety in the OR.