Peripartum Hysterectomy and Operating Room Safety Culture: A Single Institution Experience (007)

Abstract

Objectives: To assess provider and staff perception of safety in the operating room (OR) during peripartum hysterectomies. Methods: The validated short form of the Safety Attitudes Questionnaire (SAQ) was used to assess OR safety culture. For purposes of this study, questions for three domains (Teamwork Climate, Safety Climate, and Working Conditions) were used. The survey was administered to all OR providers and staff following each peripartum hysterectomy performed at our institution from January 2020 to September 2021. Case-specific information and perioperative outcomes were obtained through our institution’s REDCap database. Cases were categorized as scheduled or unscheduled and whether a major immediate postoperative complication occurred. SAQ responses were evaluated by domain. Percent agreement scores (SAQ scores) were calculated by measuring the percentage of positive responses for each item (response of “agree” or “strongly agree” for each positively worded item and “disagree” or “strongly disagree” for each negatively worded item). SAQ scores were calculated for the overall cohort as well as for each provider/staff group. Respondents who answered ≥5 items were included. Scheduled and unscheduled cases were compared. Correlational analyses were used to assess the relationship between SAQ scores and postoperative complications. Significance was considered at p<0.05. We analyzed data using STATA 17.0. Conclusions: SAQ scores for Safety Climate and Teamwork Climate domains in the OR for peripartum hysterectomies were significantly lower for unscheduled cases. SAQ scores are modestly correlated with postoperative outcomes. Given the relatively uncommon but high acuity and complex nature of these cases, institutions should consider safety culture assessments to benchmark current practices. Future efforts should focus on adapting protocols used in scheduled cases for unscheduled cases and developing routine opportunities to train potentially involved providers/staff in these protocols to optimize outcomes and minimize morbidity. Objectives: To assess provider and staff perception of safety in the operating room (OR) during peripartum hysterectomies. Methods: The validated short form of the Safety Attitudes Questionnaire (SAQ) was used to assess OR safety culture. For purposes of this study, questions for three domains (Teamwork Climate, Safety Climate, and Working Conditions) were used. The survey was administered to all OR providers and staff following each peripartum hysterectomy performed at our institution from January 2020 to September 2021. Case-specific information and perioperative outcomes were obtained through our institution’s REDCap database. Cases were categorized as scheduled or unscheduled and whether a major immediate postoperative complication occurred. SAQ responses were evaluated by domain. Percent agreement scores (SAQ scores) were calculated by measuring the percentage of positive responses for each item (response of “agree” or “strongly agree” for each positively worded item and “disagree” or “strongly disagree” for each negatively worded item). SAQ scores were calculated for the overall cohort as well as for each provider/staff group. Respondents who answered ≥5 items were included. Scheduled and unscheduled cases were compared. Correlational analyses were used to assess the relationship between SAQ scores and postoperative complications. Significance was considered at p<0.05. We analyzed data using STATA 17.0. Conclusions: SAQ scores for Safety Climate and Teamwork Climate domains in the OR for peripartum hysterectomies were significantly lower for unscheduled cases. SAQ scores are modestly correlated with postoperative outcomes. Given the relatively uncommon but high acuity and complex nature of these cases, institutions should consider safety culture assessments to benchmark current practices. Future efforts should focus on adapting protocols used in scheduled cases for unscheduled cases and developing routine opportunities to train potentially involved providers/staff in these protocols to optimize outcomes and minimize morbidity.