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Improving the work of surgeons: identifying sources of stress and introduction of a tool to facilitate good teamwork in the operating room
Maison d'édition
Neuchâtel
Date de parution
2019
Mots-clés
Résumé
This dissertation is composed of three papers and four manuscripts. The papers form the first main topic of this thesis, identifying sources of stress. The manuscripts form the second main topic, introduction of a tool to facilitate good teamwork in the operating room. The first paper (The workday of hospital surgeons: What they do, what makes them satisfied, and the role of core tasks and administrative tasks; a diary study) aimed to relate everyday work experiences of surgeons to felt stress. For this, 105 surgeons responded to a general questionnaire regarding their working conditions, 87 of them also participated in a diary study. Surgeons worked a mean of 11.86 hours per day. About one fifth each was spent on tasks directly related to surgery (21.2%) and to patients (21.7%); about ten percent (10.4%) on meetings and communicating about patients, and somewhat less than one fifth (18.6%) on documentation and administration. Performing surgery – a surgeon’s core activity- was rated as the most, and administration as the least attractive task. The higher the percentage of administrative work, the lower was its perceived adequacy. The extent to which the amount of administrative work was perceived as adequate was associated with job satisfaction. The second paper (Noise in the Operating room distracts member of the surgical team. An observational study) examined how noise pollution in operating rooms (OR) may distract members of the surgical team. Especially during phases of high task complexity, noise can jeopardize concentration. Phases of high complexity are related to specific characteristics of the tasks and can therefore be different for the different members of the surgical team. Noise exposure was measured during 110 surgeries and related to self-report of distraction by main and secondary surgeons, scrub nurses and anesthetists participating in the surgeries. Second surgeons were more distracted by noise during the main phase and anesthetists more during the closing phase. The concentration of the other team members were not impaired. The third paper (More than talking about the weekend: content of case-irrelevant communication within the OR team) evaluated the content of case-irrelevant communication (CIC) of the team during surgeries and whether they regulate CIC according to different concentration demands (surgical phases and difficulty of surgery). In 125 surgeries, 1396 CIC events were observed. Workrelated CIC was significantly more frequent (2.49 per hour) than social CIC (1.42 per hour). Across phases, frequency of work-related CIC was constant, whereas social CIC increased significantly. In surgeries rated as highly difficult by the surgeons, less social and work-related CIC were observed. 3 The analyses in the four manuscripts are all part of a larger project, the StOP? project. In this project, the StOP? protocol, an intraoperative briefing aimed at enhancing information exchange within the surgical team, was introduced in surgical departments of four hospitals. At critical moments during each procedure, the leading surgeon interrupted the surgery and informed the team in terms of the current Status (St) and Objectives (O) of the surgery, Problems that may occur (P), and encouraged questions of other team members (?). The first manuscript (Preparation and implementation of intraoperative briefings to enhance teamwork during surgeries: The StOP? Protocol) describes details on the conceptualization and development of the StOP? protocol. To adapt the StOP? protocol to the operation room and pinpoint the right moment for the StOP?, interviews with 23 surgeons were carried out and analyzed. Several surgeons mentioned similar preferred points to conduct a StOP?, such as after initial exposure, before important steps, and before or after anastomosis. The demand of the surgeons for a StOP? nevertheless varied for different kinds of surgeries and local practice. The second manuscript (Context and task-related factors influencing the compliance of surgical teams with an intra-operative briefing intervention) analysed the compliance with the StOP? protocol. Possible positive effects of briefing interventions depend on compliance of the surgical team. Compliance with the StOP? protocol was measured and factors influencing compliance were evaluated. Compliance was measured using a post-surgery questionnaire filled in by scrub nurses. Results of three hospitals show that nurses provided information in 79.1% of eligible surgeries. In these surgeries, compliance rate (at least one StOP? protocol) was 83.6%. Influences on compliance were hospital, urgency (elective vs emergency), duration, and surgical access (minimal invasive vs open surgery). The third manuscript (Two are better than one – Introducing an intra-operative briefing enhances the quality of an established pre-operative briefing: a pre-post intervention study) analysed if and what influences the newly introduced StOP? has on the quality of the already established preoperative timeout (briefing before skin incision). Observers rated the quality of the timeout in 267 surgeries in two hospitals. As compared to the baseline, after the implementation of StOP?, observed timeouts were rated significantly less noisy, higher in engagement, less rushed, in a better social atmosphere and had a higher rate of completion. The fourth manuscript (Supporting situation awareness and ease of speaking up by a short intervention to foster information exchange during surgical procedures: An intervention study) compared situation awareness and ease of speaking up of surgical team members during surgeries before and after the introduction of the StOP?. Members of the OR team filled in self-report questionnaires at the end of 371 surgeries in three hospitals. The intervention improved situation 4 awareness of anaesthesia and circulating nurses. Ease of speaking up was enhanced for scrub nurses, anaesthesia care providers, and circulators. The contribution and implications of each paper and manuscript in means of the dissertation topics are discussed as well as the limitations and future perspectives of the present work.
Notes
Doctorat, Neuchâtel, Faculté des sciences, IPTO
Identifiants
Type de publication
doctoral thesis
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