Perioperative Safety: Learning, Not Taking, from Aviation

Neuhaus, Christopher; Hofer, Stefan; Hofmann, Goetz; Wächter, Carsten; Weigand, Markus; Lichtenstern, Christoph

doi:10.1213/ane.0000000000001315

Cited by 18 publications

(10 citation statements)

References 26 publications

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“…Although healthcare is more and more coming to the realization that merely adopting training concepts that have proven successful in other domains does little to improve patient safety (Neuhaus et al 2016;Vincent and Amalberti 2016, p. 7), there is widespread consensus that teamwork constitutes one of the key requirements in today's multidisciplinary and highly complex system of delivering care.…”

Section: Training Teamworkmentioning

confidence: 99%

Medical teamwork and the evolution of safety science: a critical review

2019

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There is widespread consensus that teamwork constitutes one of the key requirements in today's multidisciplinary and highly complex system of delivering care. In recent years, increasing attention has been given to questions of how to define, teach, measure, and improve teamwork in healthcare. However, one cannot help but feel a certain disconnect between this ongoing trend in healthcare with an associated bias towards judgemental and normative language, and contemporary thinking in safety science that explores concepts from complexity thinking, such as emergence and resilience. The aim of this critical review is to contrast prevailing approaches to teamwork in healthcare with current concepts in safety science. After identifying relevant articles through multiple formal search methods, we found that, although current teamwork literature acknowledges a lack of comprehensive investigations linking team training in healthcare and patient outcomes, the predominant strategy to achieve safety remains a traditional, reactive approach that regulates behaviour and constrains performance variability. As this strategy is focussed on competencies, much of the responsibility for unwanted results is pushed towards the 'sharp end' by the quality agenda, emphasizing personal and professional competence while obscuring systemic issues. Teamwork, while indispensable in the highly subspecialized reality of healthcare, is oftentimes reduced to an aggregated set of individual behaviours. It appears that in the current state of entangled quality and safety agendas, medicine has settled for a reductionist and moral approach towards teamwork to manage the associated complexities, thereby accepting a simplistic but intellectually impoverished and ethically questionable understanding of the concept.

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Section: Training Teamworkmentioning

confidence: 99%

Medical teamwork and the evolution of safety science: a critical review

2019

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“…In this regard, it is important to reinforce the difference between semi-structured briefings and checklists, as we have previously done 9 . Checklists, another tool that has been proposed as a preinduction measure to improve safety 20 , are used to verify critical steps in a procedural workflow.…”

Section: Discussionmentioning

confidence: 98%

“…The practical challenge lies in the development and application of tools that help team members with aligning different mental models to arrive at a shared understanding of an upcoming situation. One solution lies in the form of briefings 8,9 , or short and focused, semi-structured opportunities for information exchange. The aim of this study was to assess the influence of a semi-structured briefing on the management of a simulated airway emergency in anesthesiology.…”

Section: Introductionmentioning

confidence: 99%

Impact of a semi-structured briefing on the management of adverse events in anesthesiology: A randomized pilot study.

Neuhaus

Schäfer

Weigand

et al. 2019

Preprint

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Background : Human factors research has identified mental models as a key component for the effective sharing and organization of knowledge. The challenge lies in the development and application of tools that help team members to arrive at a shared understanding of a situation. The aim of this study was to assess the influence of a semi-structured briefing on the management of a simulated airway emergency. Methods : 37 interprofessional teams were asked to perform a simulated rapid-sequence induction in the simulator. Teams were presented with a “cannot ventilate, cannot oxygenate” scenario that ultimately required a cricothyroidotomy. Study group (SG) teams were asked to perform a briefing prior to induction, while controls (CG) were asked to perform their usual routine. Results : We observed no difference in the mean time until cricothyroidotomy (SG 8:31 CG 8:16, p=0.36). There was a significant difference in groups’ choice of alternative means of oxygenation: While SG teams primarily chose supraglottic airway devices, controls initially reverted to mask ventilation (p=0.005). SG teams spent significantly less time with this alternative airway device and were quicker to advance in the airway algorithm. Conclusions : Our study addresses effects on team coordination through a shared mental model as effected by a briefing prior to anesthesia induction. We found measurable improvements in airway management during those stages of the difficult airway algorithm explicitly discussed in the briefing. For those, time spent was shorter and participants were quicker to advance in the airway algorithm.

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“…We previously published the mnemonic TEAM to provide a framework (Fig. 1) for semi-structured briefings in anesthesia [9]: Time-in items: Stress any findings from the sign-in checklist relevant to patient safety.Emergency: In case of a problem during the induction of anesthesia, available personnel and equipment and their location shall be known. This includes pager/phone numbers of physicians and nurses in supervisory roles and the location of the nearest crash/airway cart.Airway: A strategy for securing the patient’s airway, including the risk assessment for aspiration and difficult airway management options, should be discussed, and the required equipment needs to be verified available and checked.Medication: The planned type of anesthesia should be discussed, including the type and estimated dosage of drugs.…”

Section: Methodsmentioning

confidence: 99%

“…The practical challenge lies in the development and application of tools that help team members with aligning different mental models to arrive at a shared understanding of an upcoming situation. One solution lies in the form of briefings [8, 9], or short and focused, semi-structured opportunities for information exchange. The aim of this study was to assess the influence of a semi-structured briefing on the management of a simulated airway emergency in anesthesiology.…”

Section: Introductionmentioning

confidence: 99%

Impact of a semi-structured briefing on the management of adverse events in anesthesiology: a randomized pilot study

et al. 2019

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BackgroundHuman factors research has identified mental models as a key component for the effective sharing and organization of knowledge. The challenge lies in the development and application of tools that help team members to arrive at a shared understanding of a situation. The aim of this study was to assess the influence of a semi-structured briefing on the management of a simulated airway emergency.Methods37 interprofessional teams were asked to perform a simulated rapid-sequence induction in the simulator. Teams were presented with a “cannot ventilate, cannot oxygenate” scenario that ultimately required a cricothyroidotomy. Study group (SG) teams were asked to perform a briefing prior to induction, while controls (CG) were asked to perform their usual routine.ResultsWe observed no difference in the mean time until cricothyroidotomy (SG 8:31 CG 8:16, p = 0.36). There was a significant difference in groups’ choice of alternative means of oxygenation: While SG teams primarily chose supraglottic airway devices, controls initially reverted to mask ventilation (p = 0.005). SG teams spent significantly less time with this alternative airway device and were quicker to advance in the airway algorithm.ConclusionsOur study addresses effects on team coordination through a shared mental model as effected by a briefing prior to anesthesia induction. We found measurable improvements in airway management during those stages of the difficult airway algorithm explicitly discussed in the briefing. For those, time spent was shorter and participants were quicker to advance in the airway algorithm.

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Perioperative Safety: Learning, Not Taking, from Aviation

Cited by 18 publications

References 26 publications

Medical teamwork and the evolution of safety science: a critical review

Medical teamwork and the evolution of safety science: a critical review

Impact of a semi-structured briefing on the management of adverse events in anesthesiology: A randomized pilot study.

Impact of a semi-structured briefing on the management of adverse events in anesthesiology: a randomized pilot study

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