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Background: High-performing and high-reliability teams are an important component of service delivery. With a focused emphasis on safety in acute care hospitals, understanding the nature of surgical teams and team performance is an essential component to achieving high-quality surgical care. More information is needed about the challenges to effective team functioning in the operating room, the influence of working conditions, and the environmental context on surgical team performance. Purpose: The purpose of this study is to describe the nature of surgical teams and how they perform in the operating room to contribute to a broader knowledge about high-performing and high-reliability teams in health care settings. Methodology/Approach: We conducted a qualitative study involving direct observation and semistructured interviews. Field observations of 10 high-complexity surgeries and face-to-face interviews with 26 members of surgical teams were completed at one university medical center. A conceptual framework derived from the literature was developed to guide the selection of surgeries and surgical teams to be observed. Data were transcribed and analyzed to identify the factors and different conditions that influence the performance of these surgical teams. Findings: The type of coordination and the degree of independent and interdependent coordination vary among the seven observed stages of the surgical process. Most of the surgical teams were ad hoc teams and as such, further challenged by consistently frequent \"hand-offs\" for break relief. Additional role demands influence the situational dynamics which can alter the adaptive capacity of the team. Practice Implications: The surgical event evokes a changing degree of coordination and adaptation to complexity and uncertainty. In such environments, relational coordination through leadership can contribute to a successful surgical result, improvement of the overall process, including error reduction, and enhanced knowledge creation and dissemination, particularly germane in research university teaching hospitals.

The COVID-19 pandemic, led to significant global health challenges. Medical services worldwide had to reconfigure to manage the surge in COVID-19 cases, including oncological abdominal surgery (OAS). This study investigates the impact of the pandemic on the OAS workforce and aims to enhance future healthcare preparedness to potential pandemics. This scoping review followed the methodologies from Arksey & O'Malley and the Joanna Briggs Institute. The search included the databases MEDLINE, CINAHL, Cochrane Library, and Web of Science, with backward citation tracking using Google Scholar™. The results were reported narratively and divided in categories and sub-categories. The reporting followed the PRISMA-ScR guidelines. Fifteen studies were included in this scoping review. Seven studies were conducted in the United Kingdom and eight in the European Union. Key findings include treatment plan alterations such as postponing or cancelling surgeries, referring patients to alternative treatments, and changes in surgical techniques. Organizational challenges included patient and healthcare professionals’ reallocation, resource shortages, and cold site availability. Measures to handle COVID-19 included adherence to guidelines, patient prioritization, and nursing roles. Testing and contamination prevention involved routine testing and the use of protective equipment. Communication shifted to virtual formats, with the introduction of telemedicine and video conferences. The pandemic induced significant psychological stress among surgical teams and highlighted lessons for future pandemics. The COVID-19 pandemic required substantial adjustments in oncological surgery. Keeping up with rapidly changing recommendations was challenging, yet provided valuable lessons for future healthcare management and crisis response. Future pandemic preparedness strategies should include innovative solutions that unburden healthcare professionals. •The review highlights the postponement and cancellation of surgeries during the COVID-19 pandemic.•Telemedicine and virtual communication were deemed beneficial during the pandemic, reducing costs and travel time, though concerns about patient privacy and technical issues were noted.•Hospitals adapted alternative treatments due to limited resources, with strategies varying based on surgeons' experiences, while some procedures like laparoscopy were avoided to reduce aerosolization risk.•Psychological stress among surgical teams was prevalent, with some experiencing depression or leaving their jobs due to irregular work patterns and emotional burdens in prioritizing patients.•The review calls for improved healthcare infrastructure, digital solutions, and international collaboration to enhance future pandemic preparedness, emphasizing the potential of AI in disaster management.

BackgroundNon-technical skills (NTS) are essential for safe surgical practice as they impact workflow and patient outcomes. Observational tools to measure operating room (OR) teams’ NTS have been introduced. However, there are none that account for the specific teamwork challenges introduced by robotic-assisted surgery (RAS). We set out to develop and content-validate a tool to assess multidisciplinary NTS in RAS.MethodologyStepwise, multi-method procedure. Observations in different surgical departments and a scoping literature review were first used to compile a set of RAS-specific teamwork behaviours. This list was refined and expert validated using a Delphi consensus approach consisting of qualitative interviews and a quantitative survey. Then, RAS-specific behaviours were merged with a well-established assessment tool on OR teamwork (NOTECHS II). Finally, the new tool—RAS-NOTECHS—was applied in standardized observations of real-world procedures to test its reliability (inter-rater agreement via intra-class correlations).ResultsOur scoping review revealed 5242 articles, of which 21 were included based on pre-established inclusion criteria. We elicited 16 RAS-specific behaviours from the literature base. These were synthesized with further 18 behavioural markers (obtained from 12 OR-observations) into a list of 26 behavioural markers. This list was reviewed by seven RAS experts and condensed to 15 expert-validated RAS-specific behavioural markers which were then merged into NOTECHS II. For five observations of urologic RAS procedures (duration: 13 h and 41 min), inter-rater agreement for identification of behavioural markers was strong. Agreement of RAS-NOTECHS scores indicated moderate to strong agreement.ConclusionsRAS-NOTECHS is the first observational tool for multidisciplinary NTS in RAS. In preliminary application, it has been shown to be reliable. Since RAS is rapidly increasing and challenges for effective and safe teamwork remain at the forefront of quality and safety of surgical care, RAS-NOTECHS may contribute to training and improvement efforts in technology-facilitated surgeries.

Surgical performance is a team effort. We examine whether the familiarity among laparoscopic team members will influence the procedure time (PT). A team familiarity score (TFS) and an Index of difficulty of surgery (IDS) was calculated for each of the 360 laparoscopic procedures. Simple linear, multiple linear regressions, and random forest regressions were used for data analyses. Simple linear regression shows for every 1% increase in TFS, PT decreases by about 0.24% (p < 0.001); 7% of PT variability can be explained by TFS alone. Multiple linear regression reported that 49% of PT variability can be explained when considering IDS, team size, and TFS as influencing factors. Random forest regression reported that 52% of PT variability can be explained by taking TFS, Team Size, Patient Age, and IDS into the model. Team familiarity makes a small but significant contribution to the enhancing of surgical team performance in laparoscopic procedure. •Familiarity among team members can be calculated by their past team experience.•Correlation between familiarity score and laparoscopic procedure time is reported.•With every 1% increase in team familiarity score, procedure time decreases by about 0.24%.•Familiarity makes a small but significant contribution to surgical team performance.

BackgroundCommunication and teamwork failures have frequently been identified as the root cause of adverse events and complications in surgery. Few studies have examined contextual factors that influence teams’ non-technical skills (NTS) in surgery. The purpose of this prospective study was to identify and describe correlates of NTS.MethodsWe assessed NTS of teams and professional role at 2 hospitals using the revised 23-item Non-TECHnical Skills (NOTECHS) and its subscales (communication, situational awareness, team skills, leadership and decision-making). Over 6 months, 2 trained observers evaluated teams’ NTS using a structured form. Interobserver agreement across hospitals ranged from 86% to 95%. Multiple regression models were developed to describe associations between operative time, team membership, miscommunications, interruptions, and total NOTECHS and subscale scores.ResultsWe observed 161 surgical procedures across 8 teams. The total amount of explained variance in NOTECHS and its 5 subscales ranged from 14% (adjusted R2 0.12, p<0.001) to 24% (adjusted R2 0.22, p<0.001). In all models, inverse relationships between the total number of miscommunications and total number of interruptions and teams’ NTS were observed.ConclusionsMiscommunications and interruptions impact on team NTS performance.

The aim of this study was to identify intraoperative risk factors for surgical site infections (SSIs), which are accessible to interventions. We evaluated the effect of extensive intraoperative antiseptic measures and the impact of the behavior of members of the surgical team on SSIs. Standard versus extensive antiseptic measures were randomly assigned in 1,032 surgical patients. The adherence to principles of asepsis by members of the surgical team was assessed prospectively. The rate of SSI was 14% with standard antiseptic measures and 15% with extensive measures ( P = .581). Multivariate analysis identified following independent risk factors: lapses in discipline (odds ratio [OR] 2.02, confidence interval [CI] 1.05–3.88), intestinal anastomosis (OR 6.74, CI 3.42–13.30), duration of operation more than 3 hours (OR 3.34, CI 1.82–6.14), and body mass index >30 kg/m 2 (OR 1.98, CI 1.22–3.20). Extensive measures of antisepsis did not reduce the incidence of SSI. A lapse to adhere to principles of asepsis was identified as an independent risk factor for the development of SSI ( ClinicalTrials.gov number, NCT00555815).

Although preoperative communication is an emerging means through which surgical teams prepare for cases, little is known regarding its current state. This study investigated this topic in a survey of surgical team members. An 11-question survey regarding the current state of and barriers to preoperative communication among surgical team members (surgeons, anesthesiologists, and surgical nurses and technologists) was distributed at a United States academic medical center utilizing the SurveyMonkey online questionnaire tool. Statistical analyses depended on variable type. The response rate was 49.4% (170 of 344 potential responses). All groups strongly agreed that preoperative communication contributes to health care quality and patient outcomes. Surgeons rated their satisfaction with the current state of preoperative communication more favorably than anesthesiologists (p < 0.05). Satisfaction ratings of the current state were suboptimal across groups. The most common selection for the current timing of preoperative communication across groups was before each case (29.4% of respondents) and for optimal timing, the day before a case (31.2%). The most frequently discussed topic across groups was reported to be operating room and nursing details (72.4% of respondents). The greatest barriers to preoperative communication across groups were thought to be a lack of a standard method of communication (52.4% of respondents), lack of time (51.8%), and difficulty in determining the assigned staff for a given case (50.0%). There exist differing perceptions of preoperative communication among surgical team members, which conveys an opportunity for improvement across groups. Coordination of the timing of preoperative communication and standardization of the discussed content could help mitigate current barriers. •Preoperative communication was rated as suboptimal by surgical team members.•Surgeons demonstrated a higher level of current satisfaction than anesthesiologists.•Opinions about current and optimal timing of preoperative communication differed between roles.•Opinions about the content of these discussions varied among roles as well.•Significant barriers to preoperative communication were perceived to exist.

Background Surgical performance, provider health, and patient safety can be compromised when workload demands exceed individual capability on the surgical team. The purpose of this study is to quantify and compare intraoperative workload among surgical team members. Methods Observations were conducted for an entire surgical day for 33 participating surgeons and their surgical team at one medical institution. Workload (mental, physical, case complexity, distractions, and case difficulty) was measured for each surgical team member using questions from validated questionnaires. Statistical analyses were performed with a mixed effects model. Results A total of 192 surgical team members participated in 78 operative cases, and 344 questionnaires were collected. Procedures with high surgeon mental and physical workload included endovascular and gastric surgeries, respectively. Ratings did not differ significantly among surgeons and residents, but scrub nurses physical demand ratings were 14–22 (out of 100) points lower than the surgeons, residents, and surgical assistants. Residents reported the highest mental workload, averaging 19–24 points higher than surgical assistants, scrub nurses, and circulating nurses. Mental and physical demands exceeded 50 points 28–45 % of the time for surgeons and residents. Workload did not differ between minimally invasive and open techniques. Conclusion The workload questionnaires are an effective tool for quantifying intraoperative workload across the surgical team to ensure mental and physical demands do not exceed thresholds where performance may decrease and injury risk increase. This tool has the potential to measure the safety of current procedures and drive design of workload interventions.

Communication failures were a leading cause of sentinel events in the operation room due to frequently the communication breakdown occurs between physicians and nurses. This study explored the perspectives of surgical teams (nurses, physicians, and anaesthesiologists) on interprofessional collaboration and improvement strategies. A surgical team comprising eight perioperative nurses, four surgeons, and four anaesthesiologists from a university-affiliated hospital participated in this qualitative and phenomenological research from December 2018 to April 2019. Data were collected in in-depth interviews and were used in a thematic analysis according to Colaizzi to extract themes and categorised codes with the ATLAS.ti software. The result is presented in three generic categories: Barrier-like disruptive behaviours and lack of coordination of care; consequences by safety threats to the patient; overcoming barriers by shared decision making among professionals, flattened hierarchies, and teamwork/communication training. The conclusion is that different teams’ perspectives can facilitate genuine reflection, discussion, and implementation of targeted interventions to improve operating room interprofessional collaboration and overcome barriers and their consequences. Currently, there is a need to change towards interprofessional collaboration for optimal patient outcomes and to ensure all professionals’ expectations are met.

Background With the frequent occurrence of public health emergencies, conflicts and natural disasters around the world, mobile surgical teams are becoming more crucial. The competency of the operating room (OR) nurse has a substantial impact on the effectiveness and quality of the surgical team’s treatment, still there is limited knowledge about OR nurse competencies in mobile surgical teams. This study aimed to explore the competencies of OR nurses in mobile surgical teams based on the Onion Model. Methods We conducted a qualitative descriptive study of participants from 10 mobile surgical teams in 2022. Twenty-one surgical team members were interviewed, including 15 OR nurses, four surgeons, and two anesthesiologists. Data were collected through semi-structured interviews. The data were analyzed using Mayring’s content analysis. Results Twenty-eight competencies were found in the data analysis, which were grouped into four major domains using the Onion Model. From the outer layer to the inner layer were knowledge and skills, professional abilities, professional quality, and personal traits. The qualitative data revealed several novel competencies, including triage knowledge, self and mutual medical aid, outdoor survival skills, and sense of discipline. Conclusions The application of the Onion Model promotes the understanding of competency and strengthens the theoretical foundations of this study. New competencies can enrich the content of the competencies of OR nurses. The results of this study can be used for clinical recruitment, evaluation and training of OR nurses in mobile surgical teams. This study encourages further research to develop competency assessment tools and training programs for OR nurses.