MP34-20 INFLUENCE OF HIERARCHY IN THE OPERATING ROOM ON RISK COMMUNICATION DURING ROBOT-ASSISTED SURGERY

Abstract

You have accessJournal of UrologySurgical Technology & Simulation: Training & Skills Assessment I (MP34)1 Apr 2020MP34-20 INFLUENCE OF HIERARCHY IN THE OPERATING ROOM ON RISK COMMUNICATION DURING ROBOT-ASSISTED SURGERY Taylor Kunkes, Lora Cavuoto, Jeff Higginbotham, Ann Bisantz, Mohammad Durrani*, Naif Aldhaam, Samantha Maley, Amanda Pasquini, Semiah Smith, Aaron Gorsline, Ahmed Elsayed, Ahmed Hussein, and Khurshid Guru Taylor KunkesTaylor Kunkes More articles by this author , Lora CavuotoLora Cavuoto More articles by this author , Jeff HigginbothamJeff Higginbotham More articles by this author , Ann BisantzAnn Bisantz More articles by this author , Mohammad Durrani*Mohammad Durrani* More articles by this author , Naif AldhaamNaif Aldhaam More articles by this author , Samantha MaleySamantha Maley More articles by this author , Amanda PasquiniAmanda Pasquini More articles by this author , Semiah SmithSemiah Smith More articles by this author , Aaron GorslineAaron Gorsline More articles by this author , Ahmed ElsayedAhmed Elsayed More articles by this author , Ahmed HusseinAhmed Hussein More articles by this author , and Khurshid GuruKhurshid Guru More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000878.020AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: There is paucity of data about the hierarchical culture among the operating room (OR) staff. In this study, we aimed to identify how the surgical team’s hierarchical relationships affect the frequency and timing (proactive vs. reactive) of risk utterances and their influence on situational awareness in the OR. METHODS: Audio-visual recordings and transcriptions of 10 robot-assisted radical prostatectomies were examined for risk utterances between the surgeon, assistant surgeon, bedside assistant, and scrub nurse. Utterances were classified based on the sender-recipient pair (e.g. surgeon to bedside assistant), their timing (proactive vs. reactive), and the NOTECHS situational awareness score. Proactive utterances were produced with the intent to avoid a problem. Reactive utterances were produced with the intent to correct a problem. Utterances made by the surgeon or assistant surgeon were also classified based on their on-console status. Chi-square tests and ANOVAs were used to determine associations between hierarchical status, utterance timing, on-console status, and NOTECHS scores. RESULTS: Of 4,583 examined utterances, 275 (7%) were risk-related. Of these, 64% risk utterances occurred from individuals of higher hierarchal status to individuals of lower status (Table 1). Utterances were significantly more reactive than proactive (p < 0.01). Proactive utterances (M = 2.48) had significantly higher NOTECHS scores than reactive utterances (M = 1.76) (p < 0.01). 52% of the surgeon and trainee surgeon’s utterances were made on-the-console. Utterances were more reactive when on the console and more proactive off the console (p < 0.05). Utterances made by the surgeon or trainee surgeon had significantly higher NOTECHS situational awareness scores when they were off-the-console (M = 2.42) rather than on (M = 1.78). CONCLUSIONS: On-console status has the greatest influence on frequency, timing, and rating of risk utterances, rather than the assumed hierarchical status based on traditional surgical practice. Source of Funding: Roswell Park Alliance Foundation © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e511-e511 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Taylor Kunkes More articles by this author Lora Cavuoto More articles by this author Jeff Higginbotham More articles by this author Ann Bisantz More articles by this author Mohammad Durrani* More articles by this author Naif Aldhaam More articles by this author Samantha Maley More articles by this author Amanda Pasquini More articles by this author Semiah Smith More articles by this author Aaron Gorsline More articles by this author Ahmed Elsayed More articles by this author Ahmed Hussein More articles by this author Khurshid Guru More articles by this author Expand All Advertisement PDF downloadLoading ...