IMPORTANCE Failure to rescue causes significant morbidity and mortality in the surgical population. Human error is often the underlying cause of failure to rescue. Human error can be reduced by the use of cognitive aids.OBJECTIVES To test the effectiveness of cognitive aids on adherence to best practice in the management of deteriorating postoperative surgical ward patients. DESIGN, SETTING, AND PARTICIPANTS Randomized clinical trial in a simulation setting. Surgical teams consisted of 1 surgeon and 2 nurses from a surgical ward from 4 different hospitals in Amsterdam, the Netherlands. Data were analyzed between February 2, 2017, and December 18, 2018.INTERVENTIONS The teams were randomized to manage 3 simulated deteriorating patient scenarios with or without the use of cognitive aids. MAIN OUTCOMES AND MEASURESThe primary outcome of the study was failure to adhere to best practice, expressed as the percentage of omitted critical management steps. The secondary outcome of the study was the perceived usability of the cognitive aids. RESULTSOf the total participants, 93 were women and 51 were men. Twenty-five surgical teams performed 75 patient scenarios with cognitive aids, and 25 teams performed 75 patient scenarios without cognitive aids. Using the cognitive aids resulted in a reduction of omitted critical management steps from 33% to 10%, which is a 70% (P < .001) reduction. This effect remained significant (odds ratio, 0.63; 95% CI, −0.228 to −0.061; P = .001) in a multivariate analysis. Overall usability (scale of 0-10) of the cognitive aids was scored at a median of 8.7 (interquartile range, 8-9). CONCLUSIONS AND RELEVANCEFailure to comply with best practice management of postoperative complications is associated with worse outcomes. In this simulation study, adherence to best practice in the management of postoperative complications improves significantly by the use of cognitive aids. Cognitive aids for deteriorating surgical patients therefore have the potential to reduce failure to rescue and improve patient outcome.
Background Surgical safety may be improved using a medical data recorder (MDR) for the purpose of postoperative team debriefing. It provides the team in the operating room (OR) with the opportunity to look back upon their joint performance objectively to discuss and learn from suboptimal situations or possible adverse events. The aim of this study was to investigate the satisfaction of the OR team using an MDR, the OR Black Box®, in the OR as a tool providing output for structured team debriefing. Methods In this longitudinal survey study, 35 gastro-intestinal laparoscopic operations were recorded using the OR Black Box® and the output was subsequently debriefed with the operating team. Prior to study, a privacy impact assessment was conducted to ensure alignment with applicable legal and regulatory requirements. A structured debrief model and an OR Back Box® performance report was developed. A standardized survey was used to measure participant’s satisfaction with the team debriefing, the debrief model used and the performance report. Factor analysis was performed to assess the questionnaire’s quality and identified contributing satisfaction factors. Multivariable analysis was performed to identify variables associated with participants’ opinions. Results In total, 81 team members of various disciplines in the OR participated, comprising 35 laparoscopic procedures. Mean satisfaction with the OR Black Box® performance report and team debriefing was high for all 3 identified independent satisfaction factors. Of all participants, 98% recommend using the OR Black Box® and the outcome report in team debriefing. Conclusion The use of an MDR in the OR for the purpose of team debriefing is considered to be both beneficial and important. Team debriefing using the OR Black Box® outcome report is highly recommended by 98% of team members participating.
This serious game showed clear discriminatory ability between different levels of expertise in biliary tract disease management and clear teaching capability. It was perceived as appealing and realistic. Serious gaming has the potential to increase adherence to training programs in surgical residency training and medical school.
Background: Video-assisted debriefing may be a powerful tool to improve surgical team performance. Nevertheless, a true operating team debriefing culture is lacking to date. This study aimed to find evidence on how to debrief the surgical team and develop a model suitable for debriefing using a video and medical data recorder (MDR) in the operating room (OR). Methods: A review of the PubMed and Embase databases and Cochrane Library was performed. The identified literature was studied and combined with a conceptual framework to develop a model for postoperative video-assisted team debriefing. Thirty-five surgical cases were recorded with an MDR and debriefed with the operating team using the proposed debrief model and a standardized video-assisted performance report. A questionnaire was used to assess the participants' satisfaction with this debrief model. Results: Debrief models and methods are extensively described in the current medical literature. An overview was provided. The OR team needs a structured debrief model, minimizing resource, effort, and motivational constraints. A structured six-step team debrief model suitable for video-assisted OR team debriefing was developed. The model was tested in 35 multidisciplinary MDR-assisted debriefing sessions and the debriefing sessions were overall rated with a mean of 7.8 (standard deviation 1.4, 10-point Likert scale) by participants. Conclusions: Debriefing surgical teams using a video and MDR in the OR requires a model on how to use such recordings optimally. To date, no such model existed. The proposed debrief model was tested using a multisource MDR and may be used to facilitate OR debriefing across various settings.
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