Coping with errors in the operating room: Intraoperative strategies, postoperative strategies, and sex differences

Abstract

Background: Prior work has identified intraoperative and postoperative coping strategies among surgeons and has demonstrated surgical errors to have a significant impact on patient outcomes and physicians. Little research has considered which coping strategies are most common among surgeons and if there exist coping strategy differences among sex or training level. Methods: An electronic survey was distributed to surgical faculty and trainees at 3 institutions. Variables included coping techniques after making an error in the operating room. Participants were asked to report the effectiveness of their overall coping strategy. Results: A total of 168 participants (56% male, 45% faculty) experienced an operative error and answered questions regarding coping strategies. The only coping strategy significantly associated with positive ratings of coping effectiveness was, upon error, taking a step back and taking time to think and act (r ¼ 0.17; P ¼ .024). There were differences between men and women in both intra and postoperative coping strategies. Men (mean ¼ 3.69/5, standard error ¼ .09) viewed their overall coping strategy as more effective than women (mean ¼ 3.38/5, standard error ¼ .09), t(158.86) ¼ 2.47; P ¼ .015. Conclusion:Although both male and female surgeons reported making errors in the operating room, differences exist in the strategies surgeons use to cope with these mistakes, and strategies differ in their ratings of effectiveness.

Stops

“…Recent research has called for further investigations into how surgeons cope with intraoperative errors1 and has identified training in error recovery as an important target 12. Consistent with this research,1,12 participants in our interviews indicated a distinct need for more enhanced discussion, formal training, and the development of tools to assist surgeons in coping with intraoperative errors. Hence, here we offer a framework for coping with intraoperative errors that provides both trainees and experienced surgeons with a process that is intended to remove uncertainty and direct surgeons into a potentially more effective coping process—surgical errors could be met with STOPS: Stop, Talk to your Team, Obtain help, Plan, and Succeed.…”

“…17 A hybrid process of inductive and deductive coding was utilized 19 with a priori codes derived from previous literature on surgeon stress and psychological coping. 1,10,12,13,15 Three authors (J.D.D., S.L., M.W.) independently read all the transcripts and met repeatedly to develop and refine codes, code rules, identify code examples, and discuss emergent themes.…”

“…We conducted a thematic analysis 17. A hybrid process of inductive and deductive coding was utilized19 with a priori codes derived from previous literature on surgeon stress and psychological coping 1,10,12,13,15. Three authors (J.D.D., S.L., M.W.)…”

“…The semistructured interview guide was created by the research team in an iterative process drawing from established literature on the topic of coping with intraoperative errors 1,13–15. To start the interview, participants were oriented to the topic of intraoperative errors by asking them to define “intraoperative errors” and to discuss their categorization of errors.…”

“…The semistructured interview guide was created by the research team in an iterative process drawing from established literature on the topic of coping with intraoperative errors. 1,[13][14][15] To start the interview, participants were oriented to the topic of intraoperative errors by asking them to define "intraoperative errors" and to discuss their categorization of errors. If participants did not have a preexisting framework for intraoperative errors, the interviewer provided a definition of errors, indicating "at a basic level errors occur when a procedure goes from normal and routine to abnormal in some way" and a general categorization of either minor errors or major errors.…”