Identification and Classification of Flow Disruptions in the Operating Room during Two Types of General Surgery Procedures

Abstract

The operating room is one of the most complex work environments in healthcare; it is estimated that at least 7% of adverse events due to medical error occur in the operating room. Flow disruptions are events that cause a “break” in the primary surgical task, or the loss of any team member's situational awareness. From the “systems” perspective, flow disruptions are often a symptom of a latent failure somewhere within the system. An empirical link between flow disruptions and surgical errors in the OR has been established; therefore, identifying and classifying the specific flow disruptions present during different types of procedures should facilitate the development of evidence-based interventions. The goal of this study was to identify and classify flow disruptions during laparoscopic cholecystectomy (camera-assisted gallbladder removal) and open inguinal and umbilical hernia repair procedures. Results of this study include revealed seven categories of disruption that emerged inductively from the data collected. These were: communication, coordination, external/extraneous source, training/supervisory, equipment/supplies, patient factors, and environment.