TY - JOUR
T1 - Measuring Safety and Efficiency in the Operating Room
T2 - Development and Validation of a Metric for Evaluating Task Execution in the Operating Room
AU - Russ, Stephanie
AU - Arora, Sonal
AU - Wharton, Rupert
AU - Wheelock, Ana
AU - Hull, Louise
AU - Sharma, Eshaa
AU - Darzi, Ara
AU - Vincent, Charles
AU - Sevdalis, Nick
N1 - Copyright © 2013 American College of Surgeons. Published by Elsevier Inc. All rights reserved.
PY - 2013/3
Y1 - 2013/3
N2 - BACKGROUND: Although a number of validated tools are available for assessing nontechnical skills and teamwork in the operating room (OR), there are no tools for measuring completion of key OR tasks, which is fundamental to effective teamwork, patient safety, and OR efficiency. This study describes the development and content validation of a new tool (ie, the Metric for Evaluating Task Execution in the Operating Room) for measuring basic task completion during surgical procedures.STUDY DESIGN: The content validity of 106 OR tasks was assessed using 50 real-time observations of general surgical procedures, followed by a process of expert consensus. A panel of 15 OR experts (ie, surgeons, anesthesiologists, and OR nurses) were asked to rate all tasks observed in <70% of procedures for relevance to patient safety and OR efficiency (using scientifically accepted definitions). Tasks rated highly were retained. Those perceived less relevant were removed. A second panel of patient-safety experts refined the tool to remove duplication, ensure usability, and include novel tasks.RESULTS: Twenty-four of the original 106 tasks were observed in <70% of cases. Seven of these were rated highly by the OR experts for relevance to patient safety and efficiency and were retained in the Metric for Evaluating Task Execution in the Operating Room. Of the remaining 17, four were retained and 13 were removed by the patient-safety experts. In the final revision phase, an additional 23 tasks were removed and 10 new tasks added. The final tool consists of 80 OR tasks relating to well-established processes of care.CONCLUSIONS: The Metric for Evaluating Task Execution in the Operating Room is easy to use and can identify specific gaps in safety and/or efficiency in OR processes. Next, we should examine its links with additional measures of OR performance, for example, patient outcomes, list cancellations/delays, and nontechnical skills.
AB - BACKGROUND: Although a number of validated tools are available for assessing nontechnical skills and teamwork in the operating room (OR), there are no tools for measuring completion of key OR tasks, which is fundamental to effective teamwork, patient safety, and OR efficiency. This study describes the development and content validation of a new tool (ie, the Metric for Evaluating Task Execution in the Operating Room) for measuring basic task completion during surgical procedures.STUDY DESIGN: The content validity of 106 OR tasks was assessed using 50 real-time observations of general surgical procedures, followed by a process of expert consensus. A panel of 15 OR experts (ie, surgeons, anesthesiologists, and OR nurses) were asked to rate all tasks observed in <70% of procedures for relevance to patient safety and OR efficiency (using scientifically accepted definitions). Tasks rated highly were retained. Those perceived less relevant were removed. A second panel of patient-safety experts refined the tool to remove duplication, ensure usability, and include novel tasks.RESULTS: Twenty-four of the original 106 tasks were observed in <70% of cases. Seven of these were rated highly by the OR experts for relevance to patient safety and efficiency and were retained in the Metric for Evaluating Task Execution in the Operating Room. Of the remaining 17, four were retained and 13 were removed by the patient-safety experts. In the final revision phase, an additional 23 tasks were removed and 10 new tasks added. The final tool consists of 80 OR tasks relating to well-established processes of care.CONCLUSIONS: The Metric for Evaluating Task Execution in the Operating Room is easy to use and can identify specific gaps in safety and/or efficiency in OR processes. Next, we should examine its links with additional measures of OR performance, for example, patient outcomes, list cancellations/delays, and nontechnical skills.
KW - Checklist
KW - Efficiency, Organizational
KW - Humans
KW - Occupational Health
KW - Operating Rooms
KW - Task Performance and Analysis
U2 - 10.1016/j.jamcollsurg.2012.12.013
DO - 10.1016/j.jamcollsurg.2012.12.013
M3 - Article
C2 - 23357728
SN - 1072-7515
VL - 216
SP - 472
EP - 481
JO - Journal of the American College of Surgeons
JF - Journal of the American College of Surgeons
IS - 3
ER -