PS3-07: IMPLEMENTATION OF INTRA-OPERATIVE INSTRUCTIONAL TIMEOUT IMPROVES PROFICIENCY IN SURGICAL STAPLER USAGE BY SURGICAL RESIDENTS
Allan Stolarski, MD1, Na Eun Kim, MD1, Patrick O'Neal, MD2, Vivian Sanchez, MD2, Edward Whang, MD3, Gentian Kristo, MD, MPH, FACS2; 1Boston Medical Center, 2VA Boston Healthcare System, 3Brigham and Women's Hospital
Introduction: With the fragmented rotational structure of training, exposure to surgical staplers is not uniform across surgical residents. Traditionally, educational sessions dedicated to instruction in surgical staplers have taken place outside the operating room. This study implemented and evaluated an intra-operative timeout immediately prior to stapler use in cases with surgical residents.
Methods: During general surgery cases from 6/1/2017 until 12/31/2017, surgical teams, including the surgical attending, surgical resident, and scrub nurse participated in an intra-operative instructional timeout, during which proper use of linear or circular staplers was reviewed. At the conclusion of the timeout, residents were required to demonstrate proper stapler assembly and verbalize all technical steps involved in stapler use. Duration of each timeout was recorded. Immediately following the case, a pre-post survey was administered to each participating junior (R1-R2) or senior (R4-R5) surgical resident. The primary outcome was change in stapler use knowledge by surgical residents. Survey questions with Likert scale responses were analyzed using paired t-tests, and responses from junior residents were compared to those from senior residents with independent t-tests.
Results: Forty-three general surgery cases involved stapler use during the study period and implemented an intra-operative instructional timeout. The educational intervention increased stapler use knowledge significantly in all surgical residents. Prior to the timeout, junior residents reported significantly higher anxiety related to stapler usage compared to their senior counterparts; anxiety scores in junior residents decreased significantly for use of both linear and circular staplers. The mean timeout duration was 2.9 min (SD 0.9 min, range 1.2-4.6 min). All participating surgical residents recommended routine implementation of an instructional timeout prior to intra-operative stapler use.
Conclusions: An intra-operative timeout dedicated to stapler teaching is effective in increasing proficiency and easing anxiety in all levels of surgical residents. Further research is warranted to determine whether this educational intervention would translate into fewer stapler use errors and decreased intra-operative complications.