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Preoperative Briefing in the Operating Room: Shared Cognition, Teamwork, and Patient Safety

Yael Einav, PhD; Daniel Gopher, PhD; Itzik Kara, RN, BSN, MHA; Orna Ben-Yosef, RN, BSN; Margaret Lawn, RN; Neri Laufer, MD; Meir Liebergall, MD; Yoel Donchin, MD
Author and Funding Information

From the Department of Industrial Engineering (Dr Einav), the Research Center for Work Safety and Human Engineering (Dr Gopher), Technion, Haifa; the Surgical Nursing Department (Mr Kara, Mss Ben-Yosef and Lawn), the Department of Obstetrics and Gynecology (Dr Laufer), the Orthopedic Surgery Department (Dr Liebergall), and the Patient Safety Unit, Department of Anesthesiology and Critical Care Medicine (Dr Donchin), Hadassah Hebrew University Medical Center, Jerusalem, Israel.

Correspondence to: Yael Einav, Research Center for Work Safety and Human Engineering, Technion, Haifa 32000, Israel; e-mail: yaeleinav@gmail.com


For editorial comments see page 250

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/site/misc/reprints.xhtml).


© 2010 American College of Chest Physicians


Chest. 2010;137(2):443-449. doi:10.1378/chest.08-1732
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Contemporary preoperative team briefings conducted to improve patient safety focus mainly on supplying identification details regarding the patient and the surgical procedure. Drawing on cognitive theory principles, in this study a briefing protocol was developed that presents a broader perspective model of the patient and the planned procedure. In addition to customary identification details and drug sensitivities, the new briefing also includes review of significant background information, needed equipment, planned surgery stages, and so forth. The briefing content was developed following 130 continuous, nonstructured observations conducted in gynecologic and orthopedic operating rooms. The briefing form was designed as a large poster hung in a visible position on the operating room wall. The poster guides the team members (ie, nurses, surgeons, and anesthesiologists) in their conduct. Briefing is conducted orally, and no written records are required. The number of nonroutine events (ie, situations that, if not corrected, might lead to patient harm) observed in the 130 surgeries conducted without briefing was compared with the number of events in 102 surgeries in which briefing was conducted. There was a 25% reduction in the number of nonroutine events when briefing was conducted and a significant increase in the number of surgeries in which no nonroutine event was observed. Team members evaluated the briefing as most valuable for their own work, the teamwork, and patient safety. Following the study, the new briefing format was accepted and adopted for routine use. Team briefings designed to supply a broader-perspective surgery model may be an easy-to-apply tool to reduce the number of nonroutine events during surgery and increase patient safety.

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