Chanelle Nibbelink
In an operating room, where human life can hang in the balance, communication among members of a surgical team is crucial. But it’s hard to assess how well those team members work together.
The lack of data about this is due in large part to the high-pressure environment, where it’s infeasible to implement conventional survey tools such as questionnaires, write Yale’s Kiran K. Turaga, University of Chicago’s Hunter D. D. Witmer, and a team of researchers. They demonstrate a new way to collect real-time, qualitative data from OR staff—and their method could potentially improve surgical outcomes.
The project was conducted in the Healthcare Analytics Laboratory at Chicago Booth, led by the team’s Dan Adelman. Over a 24-week period in 2021, the team collected feedback at 30 University of Chicago Medicine operating rooms. The researchers installed 120 Smiley Terminals manufactured by the HappyOrNot company. They equipped the ORs with four terminals, one for each member of the surgical team: surgeon, anaesthesiologist, scrub nurse, and circulator (the nurse responsible for ensuring that surgeons have everything they need to perform a procedure). After completing a procedure, team members were asked to assess the teamwork on a 4-point scale: very satisfied, satisfied, dissatisfied, and very dissatisfied. On the terminal, there was a happy or a frowny face associated with each rating.
The researchers collected about 4,100 responses from about 2,100 OR teams. Anesthesiologists were the most satisfied—93 percent of them clicked the smiley faces associated with either “satisfied” or “very satisfied”—followed by surgeons, at 88 percent, and the two types of nurses, at 80 percent or more, the researchers find.
The results indicate a high level of satisfaction with teamwork quality, but the study also has limitations. The overall response rate was only about 32 percent and varied considerably according to the type of surgery. Nearly two-thirds of team members participating in cardiac operations responded, but fewer than a tenth of those in trauma surgeries did. Because no high-performance benchmarks exist, it’s impossible to know how teamwork on these surgical teams stacked up against surgical teams elsewhere.
Regular, continuous care is good for patients, and could also benefit providers and insurers.
How Proactive Healthcare Can Save on CostsThe paper’s primary contribution is proof of concept for continuous qualitative data collection in an OR setting, Turaga says. He pointed to two additional findings as especially important: A higher degree of specialization among scrub nurses was associated with greater overall satisfaction. And when satisfaction with teamwork was highest, quality of care was better.
To get at the role of specialization, the researchers broke out team member feedback by service line—cardiac surgery, neurosurgery, or trauma surgery, for example. Scrub nurses and circulators were assigned an experience score based on the number of surgeries in a given service line they’d assisted with in the previous six months. When scrub nurses and circulators had a higher degree of specialization, other team members were more likely to indicate they were “very satisfied” with the quality of teamwork. In cases where the level of satisfaction with teamwork quality achieved this rating, there was a 15 percent reduction in the length of a patient’s hospital stay. Hospitals commonly use length of stay as a proxy for quality of care because it indicates there were fewer complications or inefficiencies.
Specialization can improve teamwork by making the generally consistent steps of a surgery even more seamless, Turaga says. “There can be almost no talking between a surgeon and a nurse, or a surgeon and a circulator,” he says. “There are times when a surgeon can just reach out a hand, and the other person knows exactly which instrument the surgeon needs without exchanging a word. In these situations, they know what equipment is needed, and the exact amount of equipment needed.”
At the same time, Turaga notes, healthcare institutions seldom take the steps necessary for building OR teams with the level of specialization needed to perform at the highest level. While surgeons and anaesthesiologists must be specialized, nurses often do not receive specialized training for assisting in many types of surgery. Turaga argues that the research findings make the case for a higher degree of specialization in OR teams. This would improve satisfaction, teamwork, and, ultimately, patient care.
Hunter D. D. Witmer, Joshua A. Morris-Levenson, Çağla Keçeli, Frederick A. Godley IV, Ankit Dhiman, Dan Adelman, and Kiran K. Turaga, “Novel Application of a Dynamic, In-Room Survey Platform to Measure Surgical Team Satisfaction,” Annals of Surgery, January 2024.
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