Abstract
BackgroundOperating room (OR) crises are high-acuity events requiring rapid, coordinated management. Medical judgment and decision-making can be compromised in stressful situations, and clinicians may not experience a crisis for many years. A cognitive aid (e.g., checklist) for the most common types of crises in the OR may improve management during unexpected and rare events. While implementation strategies for innovations such as cognitive aids for routine use are becoming better understood, cognitive aids that are rarely used are not yet well understood. We examined organizational context and implementation process factors influencing the use of cognitive aids for OR crises.MethodsWe conducted a cross-sectional study using a Web-based survey of individuals who had downloaded OR cognitive aids from the websites of Ariadne Labs or Stanford University between January 2013 and January 2016. In this paper, we report on the experience of 368 respondents from US hospitals and ambulatory surgical centers. We analyzed the relationship of more successful implementation (measured as reported regular cognitive aid use during applicable clinical events) with organizational context and with participation in a multi-step implementation process. We used multivariable logistic regression to identify significant predictors of reported, regular OR cognitive aid use during OR crises.ResultsIn the multivariable logistic regression, small facility size was associated with a fourfold increase in the odds of a facility reporting more successful implementation (p = 0.0092). Completing more implementation steps was also significantly associated with more successful implementation; each implementation step completed was associated with just over 50% higher odds of more successful implementation (p ≤ 0.0001). More successful implementation was associated with leadership support (p < 0.0001) and dedicated time to train staff (p = 0.0189). Less successful implementation was associated with resistance among clinical providers to using cognitive aids (p < 0.0001), absence of an implementation champion (p = 0.0126), and unsatisfactory content or design of the cognitive aid (p = 0.0112).ConclusionsSuccessful implementation of cognitive aids in ORs was associated with a supportive organizational context and following a multi-step implementation process. Building strong organizational support and following a well-planned multi-step implementation process will likely increase the use of OR cognitive aids during intraoperative crises, which may improve patient outcomes.
Highlights
Operating room (OR) crises are high-acuity events requiring rapid, coordinated management
We identified two dimensions to be of greatest interest because they are important in the surgical environment and because they are amenable to modification: organizational context and implementation process
There were no significant differences in these characteristics between respondents reporting more successful vs. less successful implementation
Summary
Operating room (OR) crises are high-acuity events requiring rapid, coordinated management. The operating room (OR) is a high-acuity patient care environment in which crises, infrequent, occur more commonly than in many other patient care settings. These high-stakes events require rapid, accurate, and coordinated execution of critical steps that can save patient lives. Such crises challenge even the best OR teams since they must optimally handle situations they rarely encounter. The aids do not work in isolation and require a supportive systemic and cultural environment for a successful emergency response in a complex sociotechnical system [8]
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