Improving Perioperative Staff Confidence As Emergency Manual Readers During Operating Room Emergencies

Abstract

Purpose: This quality improvement (QI) project aimed to evaluate changes in the perceived confidence of multidisciplinary perioperative staff in assuming the role of emergency manual (EM) reader during intraoperative emergencies following an educational training session.Background: Intraoperative emergencies are stressful events that magnify the impact of human factors on clinical performance leading to a deterioration in cognitive function and an elevated risk of error, ultimately deviating from established standards of care (Schild et al., 2019). Emergency manual cognitive aids (EMs) serve as evidence-based, context-specific adjuncts aimed at reducing human error and enhancing team performance during emergencies or crises in the OR (Hepner et al., 2017). Central to the successful application of EMs is the EM “reader” who triggers the manual’s use, guides the intraoperative team through navigating the crisis checklist, and promotes the delivery of best practices by leveraging key non-technical skills such as interpersonal communication and team coordination (Saravana-Bawan et al., 2019). Despite ongoing efforts to familiarize perioperative staff with EM navigation and application, there exists a lack of consensus on the ideal individual to assume the reader role. Methods: A pre-recorded, educational training video detailing EM purpose, navigation, implementation, and role of the reader was provided to perioperative staff at a critical access hospital. Pre- and post-intervention surveys assessed changes in participant baseline knowledge, intent to use, and confidence in assuming the EM role. Results: Of the 17 participants, 57% had never received formal EM training and 41% were unaware that any perioperative team member could assume the reader role. Following training, reported confidence in assuming this role increased from 38% to 81%. The likelihood of utilizing an EM during an emergency rose from 35% to 71% and intent to trigger EM use increased from 24% to 71%. Conclusion: This project supports using a multidisciplinary educational intervention to reinforce EM importance, enhance confidence in its use, and increase the likelihood of perioperative team members assuming the reader role. While the value of EMs is widely recognized, multi-step implementation initiatives are essential for creating a culture of confidence that results in an intent to use when emergencies do arise.