Résultat de la recherche
Assessing distractors and teamwork during surgery: developing an event-based method for direct observation
Adverse effect of noise in the operating theatre on surgical-site infection
Abstract Background: The aim of this pilot study was to evaluate the noise level in an operating theatre as a possible surrogate marker for intraoperative behaviour, and to detect any correlation between sound level and subsequent surgical-site infection (SSI). Methods: The sound level was measured during 35 elective open abdominal procedures. The noise intensity was registered digitally in decibels (dB) every second. A standard questionnaire was used to evaluate the behaviour of the surgical team during the operation. The primary outcome parameter was the SSI rate within 30 days of surgery. Results: The overall rate of SSI was six of 35 (17 per cent). Demographic parameters and duration of operation were not significantly different between patients with, or without SSI. The median sound level (43·5 (range 26·0–60·0) versus 25·0 (25·0–60·0) dB; P = 0·040) and median level above baseline (10·7 (0·6–33·3) versus 0·6 (0·5–10·8); P = 0·001) were significantly higher for patients who developed a SSI. The sound level was at least 4 dB above the median in 22·5 per cent of the peaks in patients with SSI compared with 10·7 per cent in those without (P = 0·029). Talking about non-surgery-related topics was associated with a significantly higher sound level (P = 0·024). Conclusion: Intraoperative noise volume was associated with SSI. This may be due to a lack of concentration, or a stressful environment, and may therefore represent a surrogate parameter by which to assess the behaviour of a surgical team. Copyright © 2011 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.
Human Factors in the operating room - the surgeons view
The quality of surgical performance depends not only on the technical skills of the surgical team, but also on non-technical skills. Identification and improvement of such non-technical skills is an important aim to improve overall surgical outcomes. Non technical skills primarily include three factors. The first factor is efficient communication among a multidisciplinary team. This requires strong leadership and coor- dination of role-related tasks for the surgical team members. The second factor is coping with distractors in the operating room. Distractors may impact team performance and must be identified and reduced to ensure maximum concentration in the most of unavoidable distractions. The third factor is the impact of stress and fatigue of the surgical team. Potential methods of addressing these topics include training, procedural support for human factors requirements, and specified phases for information reflection as well as for mental recovery