SAFETY CULTURE
System Factors Affecting Intraoperative Risk and Resilience
Published on
December 1, 2020
Annals of Surgery
Overview
This study aims to identify and categorize factors within the complex sociotechnical system of laparoscopic surgery that impact patient safety, either as threats or as supports for system resilience. By analyzing 19 audio/video recordings of surgical procedures, researchers documented 1,083 observations, identifying 79 distinct safety threats and 67 resilience supports. Notably, threats were often linked to the physical environment and equipment, while resilience was largely fostered by clinician behaviors such as proactive team management. The findings emphasize the need to address identified safety threats while also recognizing and protecting behaviors that enhance resilience, ultimately aiming to optimize surgical safety.
The results underscore that both safety threats and resilience supports are systematic within the surgical context. Shared threats, like suboptimal technology design, highlight areas for improvement, while resilience supports, including calm clinician behavior and redundant resources, demonstrate effective practices worth nurturing.
By prioritizing remediation of safety threats and promoting supportive clinician behaviors, the study advocates for a more robust approach to enhancing patient safety in laparoscopic surgery.
Results
A total of 1,083 relevant observations were made over 39.8 hours of operative time, enabling the identification of 79 distinct safety threats and 67 resilience supports within the surgical system. Safety threats associated with the physical environment, tasks, organization, and equipment were prevalent and observed in equal measure, whereas supports for resilience were predominantly attributed to clinician behaviors, including proactive team management and skills coaching. Two subclinical adverse events were identified; shared safety threats included suboptimal technology design, whereas shared resilience supports included calm clinician behavior and redundant intraoperative resourcing.
