Assessing the team's perception on human factors in the operating environment

This international multi-center survey study, conducted at St. Michael's Hospital (Toronto) and Amsterdam UMC, investigated human factors in the operating room environment using the Human Factors Analysis and Classification System (HFACS) framework. The researchers collected 507 questionnaires across 117 elective laparoscopic procedures, including gastric bypasses, fundoplications, hernia repairs, colorectal resections, and adrenalectomies. Participants included staff surgeons, residents, fellows, anesthesiology team members, nurses, and medical students, all of whom completed the Surgical Team Assessment Record (STAR) questionnaire after each case.

The study revealed notable disparities in team members' perceptions of human factors in the operating room. Surgical fellows consistently rated aspects lower than other team members, giving significantly lower scores (median 3/5 vs 4/5) for personal readiness, ability to handle unexpected events, and team communication. Staff surgeons were more likely to identify operational issues, with 51.3% noting distractions and 60.5% reporting aberrations during surgery. These problems were primarily technical in nature, including inadequate anastomosis closure, bleeding, small bowel injury, equipment malfunction, and poor trocar placement. The researchers suggest that the lower ratings from fellows might be related to career-related stress and stability concerns, which could impact surgical safety and team performance.