PS4-12: A MIXED-METHODS ANALYSIS OF IN-SITU INTERPROFESSIONAL OPERATING ROOM SIMULATIONS ON SURGEON CONFIDENCE AND PRACTICE BEHAVIORS
Brittany Hasty, MD, MHPE¹, Eniola Gros, BS², Sara Goldhaber-Fiebert, MD¹, Sarah Hirx, MSN, RN, CNOR¹, Teresa Roman-Micek, CHSOS¹, Ruth Fanning, MB, MRCPI, FFARCSI¹, Mary Lou Jackson, MSN, RN, CNOR¹, James Lau, MD, MHPE, FACS¹; ¹Stanford University, ²St. Louis University

Background: Communication failures in the operating room occur in approximately 30% of procedurally relevant exchanges. Poor teamwork and communication in perioperative teams increases the odds of complication and death. Better teamwork and communication are associated with fewer errors, more efficient procedures, and lower morbidity and mortality. In-situ operating room interprofessional simulations are a meaningful and cost-effective educational modality that may fulfill the need for teamwork and communication training.

Methods: In-situ interprofessional operating room crisis simulations were conducted on a monthly basis at a single academic medical center. The interprofessional teams consisted of attending surgeons, resident surgeons, anesthesia attendings, anesthesia residents, scrub nurses, circulating nurses, anesthesia technicians, and operating room assistants. Simulation participants completed pre- and post-surveys self-assessing their confidence in four crisis-resource management (CRM) domains: communication, utilizing resources, role clarity, and situational awareness. The post-survey included an open-ended question asking participants how the simulation will impact their practice behavior in the operating room.

Results: Between July 2017 and September 2018, 28 surgeons participated in an in-situ simulation and 22 completed both the pre- and the post-surveys. Overall, surgeon confidence significantly improved in all four CRM domains: Communication (3.25 (0.57) vs. 3.61 (0.48); P= <0.001), utilizing resources (3.09 (0.63) vs. 3.57 (0.56); P= <0.001), role clarity (3.10 (0.74) vs. 3.45 (0.65); P= 0.008) , and situational awareness (3.08 (0.61) vs. 3.62 (0.47); P= <0.001). As a result of the simulation, one surgeon reported that they will, “Be more open with communication across the drape and keep an open line of discussion during unexpected events.” Another reported that in a crisis they will, “Pay more attention to what everyone else is doing, not just what I plan to do.”

Conclusions: Here we have shown that monthly in-situ interprofessional operating room simulations improves surgeon confidence and practice behaviors in teamwork and communication. Operating room team members should have opportunities to practice communication skills, reflect on their performance and apply their learning. Interprofessional education is the foundation for developing these skills in OR teams.