Presentation
HE13 - Mapping Interactions and Critical Points Through a Multidisciplinary Surgical Process Analysis Identifies Orthopaedic Team Challenges
SessionPoster Session 1
DescriptionBackground & Purpose
Surgical performance is a key factor in the success of operative interventions, affecting patient outcomes and operating room (OR) efficiency. In orthopaedics, this is dependent on the skills of the individual surgeons, nurses, anesthesiologists, and radiation technologists. However, the multidisciplinary nature of OR performance is often overlooked when studying surgical processes. Including interdisciplinary interactions and identifying critical points may yield a more comprehensive workflow understanding and reveal existing challenges. As such, the aim of this study was to conduct a multidisciplinary surgical process analysis of orthopaedic teams undertaking operative hip fracture repair.
Methods
We conducted a process analysis using an ethnographic approach that incorporated observations and semi-structured interviews. The observations were of hip fracture fixation procedures, both in-person and via intraoperative recordings. Intraoperative recordings were captured using the OR Black Box, which includes audio, video (from five perspectives), fluoroscopic imaging, and patient vitals. To generate the multidisciplinary workflow, each step in the surgical case was annotated identifying the roles of surgeons, anesthesiologists, nurses, and radiation technologists and their interactions. All case annotations were reviewed and compiled to build a process analysis map. Semi-structured interviews were conducted with experts in each of the four disciplines. Two members of the research team analyzed the interview data inductively to identify critical points in the workflow and recurring themes. The researchers ensured intercoder reliability through dialogue and consensus.
Results & Discussion
A process analysis map was created from the intraoperative recording annotations and in-person observations, including phases, steps, and activities conducted by each discipline in chronological order. Five themes were identified from the interview data critical to the surgical process: the main responsibilities of each discipline; system-level, case-specific, and interdisciplinary challenges; the impact/consequences of challenges on individual workflows; the critical points for each of the disciplines; and a breakdown of the OR culture. The intricacies of collaborations were represented visually on the map through interdisciplinary connections. Critical points encountered by each discipline, representing moments of high focus, were also highlighted on the map. Challenges related to interdisciplinary communication, lack of extra-disciplinary acknowledgement of discipline-specific critical points, and system-level breakdowns were identified temporally on the process map.
One notable example of an interdisciplinary challenge was identified when considering temporal differences in discipline-specific critical points toward the end of a surgical procedure. For the surgeon, a critical point ends as they finish the technical procedure and begin closing the incision. At this stage, they typically start to relax, evidenced by behaviors such as increasing the music volume, engaging in more frequent and louder conversations, and decreased situational awareness. However, this moment coincides with a critical point for the nursing team where they are focused on surgical counts and a critical point for the anaesthesiologists as they prepare to wake the patient. This misalignment of focus can create a temporary disruption in the workflow and introduces challenges in maintaining clear interdisciplinary communication and awareness. Temporal representation of these critical points on the process map demonstrates how overlapping or non-synchronized critical points contribute to communication breakdowns, inefficiencies and potential risks in the surgical workflow.
Conclusion
We created a multidisciplinary surgical process map that demonstrates interconnections, critical points and challenges present in an orthopaedic OR during hip fracture repair. The inclusion of both discipline-specific and multidisciplinary challenges can be used to inform data-driven quality improvement initiatives and educational interventions, and highlights the need for better communication to reduce workflow disruptions and optimize patient care.
Surgical performance is a key factor in the success of operative interventions, affecting patient outcomes and operating room (OR) efficiency. In orthopaedics, this is dependent on the skills of the individual surgeons, nurses, anesthesiologists, and radiation technologists. However, the multidisciplinary nature of OR performance is often overlooked when studying surgical processes. Including interdisciplinary interactions and identifying critical points may yield a more comprehensive workflow understanding and reveal existing challenges. As such, the aim of this study was to conduct a multidisciplinary surgical process analysis of orthopaedic teams undertaking operative hip fracture repair.
Methods
We conducted a process analysis using an ethnographic approach that incorporated observations and semi-structured interviews. The observations were of hip fracture fixation procedures, both in-person and via intraoperative recordings. Intraoperative recordings were captured using the OR Black Box, which includes audio, video (from five perspectives), fluoroscopic imaging, and patient vitals. To generate the multidisciplinary workflow, each step in the surgical case was annotated identifying the roles of surgeons, anesthesiologists, nurses, and radiation technologists and their interactions. All case annotations were reviewed and compiled to build a process analysis map. Semi-structured interviews were conducted with experts in each of the four disciplines. Two members of the research team analyzed the interview data inductively to identify critical points in the workflow and recurring themes. The researchers ensured intercoder reliability through dialogue and consensus.
Results & Discussion
A process analysis map was created from the intraoperative recording annotations and in-person observations, including phases, steps, and activities conducted by each discipline in chronological order. Five themes were identified from the interview data critical to the surgical process: the main responsibilities of each discipline; system-level, case-specific, and interdisciplinary challenges; the impact/consequences of challenges on individual workflows; the critical points for each of the disciplines; and a breakdown of the OR culture. The intricacies of collaborations were represented visually on the map through interdisciplinary connections. Critical points encountered by each discipline, representing moments of high focus, were also highlighted on the map. Challenges related to interdisciplinary communication, lack of extra-disciplinary acknowledgement of discipline-specific critical points, and system-level breakdowns were identified temporally on the process map.
One notable example of an interdisciplinary challenge was identified when considering temporal differences in discipline-specific critical points toward the end of a surgical procedure. For the surgeon, a critical point ends as they finish the technical procedure and begin closing the incision. At this stage, they typically start to relax, evidenced by behaviors such as increasing the music volume, engaging in more frequent and louder conversations, and decreased situational awareness. However, this moment coincides with a critical point for the nursing team where they are focused on surgical counts and a critical point for the anaesthesiologists as they prepare to wake the patient. This misalignment of focus can create a temporary disruption in the workflow and introduces challenges in maintaining clear interdisciplinary communication and awareness. Temporal representation of these critical points on the process map demonstrates how overlapping or non-synchronized critical points contribute to communication breakdowns, inefficiencies and potential risks in the surgical workflow.
Conclusion
We created a multidisciplinary surgical process map that demonstrates interconnections, critical points and challenges present in an orthopaedic OR during hip fracture repair. The inclusion of both discipline-specific and multidisciplinary challenges can be used to inform data-driven quality improvement initiatives and educational interventions, and highlights the need for better communication to reduce workflow disruptions and optimize patient care.
Event Type
Poster Presentation
TimeMonday, March 314:45pm - 6:15pm EDT
LocationFrontenac Foyer
Digital Health (DH)
Simulation and Education (SE)
Hospital Environments (HE)
Medical and Drug Delivery Devices (MDD)
Patient Safety and Research Initiatives (PS)