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Abstract
Background
Failure to convey time-critical information to team members during surgery diminishes members’ perception of the dynamic information relevant to their task, and compromises shared situational awareness. This research reports the dialog around clinical decisions made by team members in the time-pressured and high-risk context of surgery, and the impact of these communications on shared situational awareness.
Methods
Fieldwork methods were used to capture the dynamic integration of individual and situational elements in surgery that provided the backdrop for clinical decisions. Nineteen semistructured interviews were performed with 24 participants from anesthesia, surgery, and nursing in the operating rooms of a large metropolitan hospital in Queensland, Australia. Thematic analysis was used.
Results
The domain “coordinating decisions in surgery” was generated from textual data. Within this domain, three themes illustrated the dialog of clinical decisions, ie, synchronizing and strategizing actions, sharing local knowledge, and planning contingency decisions based on priority.
Conclusion
Strategies used to convey decisions that enhanced shared situational awareness included the use of “self-talk”, closed-loop communications, and “overhearing” conversations that occurred at the operating table. Behaviors that compromised a team’s shared situational awareness included tunneling and fixating on one aspect of the situation.
Acknowledgments
The research team is grateful to the staff working in the operating rooms at the study site for their willingness to participate. The team also wishes to thank Anne McMurray, Professor Emeritus, for her thoughtful critique of an earlier manuscript. BG gratefully acknowledges the financial assistance of the Griffith University New Researcher Grant and the Research Centre for Clinical and Community Innovation.
Disclosure
The authors report no conflicts of interest in this work.