PS3-03: CHARACTERIZING TEAMWORK IN THE PERIOPERATIVE ENVIRONMENT: A QUALITATIVE ANALYSIS OF INTERPROFESSIONAL PERSPECTIVES
Brittany Hasty, MD, MHPE, Paloma Marin Nevarez, BS, James Lau, MD, MHPE, FACS; Stanford University

Background: Improved teamwork and communication are associated with fewer errors, more efficient procedures, and lower morbidity and mortality. By better characterizing teamwork and communication in the perioperative environment, we can promote behaviors that improve interprofessional practice.

Methods: Perioperative staff (surgeons, anesthesiologists, and nurses) volunteered for individual interviews. Using a conceptual framework for interprofessional teamwork, participants were asked questions in four domains: relational, processual, organizational, and contextual. The interviews were transcribed. Using inductive and deductive approaches, two independent coders identified themes throughout the transcripts to define components of interprofessional teamwork.

Results: From August 2017 to September 2017, 24 participants were interviewed (9 nurses, 8 anesthesiologists, and 8 surgeons). The domain of organizational support included 3 codes: SAFE reports, staff turnover, and patient safety. In regard to patient safety, a surgeon stated, “The most important thing is patient safety and so if a med student pointed out [vital sign changes], it would be very helpful. It doesn’t matter where up in the hierarchy that person is.” The domain of contextual factors contained 4 codes: academic hospital, culture, power dynamic, and wellness. In regard to culture, one anesthesiologist stated, “Most of the time you’re on a first name basis with everyone in the room. That’s not necessarily true for other places.” The domain of processual factors included 4 codes: timeouts, turnovers, speaking out, and incorrect counts.  Regarding speaking out, a surgeon stated, “The worst thing you can do in a case is see something and don’t tell me because you hypothesize that I’ve noticed it too. It’s like TSA, ‘If you see something, say something.’” The team relations domain included 5 codes: communication, collaboration, teamwork, teaching, and support. Regarding teamwork, one nurse stated, “If a they [a surgeon] have multiple cases, upon finishing the first case, I’ll ask them, ‘What equipment or initial things do we need for the next case?’”

Conclusion: Improving interprofessional teamwork is critical to patient safety. Here we have used a qualitative process to characterize teamwork and communication in the perioperative environment. By doing this, we will be able identify areas of improvement and promote areas of best practice.