Introduction
The operating room (OR) is a high-risk environment where adverse events
are likely to happen.1 Adequate surgical care depends
not only on technical skills but also on non-technical skills such as
effective teamwork and communication among healthcare
professionals.2 The surgical team comprises many
different disciplines (e.g. surgical team and anaesthesiology team);
collaboration between these disciplines requires thorough coordination,
planning and cooperation.3 Every team member is
responsible for delivering the best possible care, yet at the same time
each one team member has a different task in the shared OR. Given that
improving team-working ability is associated with reduced technical
errors, enhancing team performance and team-working ability in the OR
should lead to increased patient safety.4 5
Several interventions have been introduced in an attempt to address
adverse events due to technical and non-technical errors in the OR, such
as surgical checklists (e.g. time-out and sign-out) and crew resource
management.6-8 Over the last few years, studies have
shown that these interventions reduce communication failures and adverse
events such as wrong-site surgery (time-out).6-8 The
OR remains an increasingly complex environment. Globally, 16.8% of the
patients undergoing elective surgery develop one or more postoperative
complications and 0.5% die as a result of
complications.9 The majority of in-hospital adverse
events (39.6%) were related to surgery.10 A study of
19 Dutch hospitals showed that 3.1% of patients experienced potentially
preventable harm.11 Surgical departments were
significantly more involved in potentially preventable harm to patients
than non-surgical departments.11
Surgical briefings have contributed in particular to team-working
ability and the teamwork-related sociocultural aspects that checklists
do not address.12 Briefings aim at sharing information
and opening up communication. Exchanging information clarifies
expectations and creates shared mental models, which will reduce
ambiguity and clarify everyone’s role in the team.13Debriefings provide an opportunity to review the operative events and
findings as well as to communicate postoperative plans. It aims at
fostering learner performance, the ability to correct errors, clinical
reasoning through reflection and (peer) feedback.14 15On top of that, Leong et al. 16 show that
perioperative briefing and debriefing also affect team climate
positively.16
While it is generally known that these types of interventions have a
positive effect on patient safety outcomes and teamwork, the long-term
effects are relatively undiscovered.16 Moreover, there
remains resistance from surgical staff towards perioperative briefing
and debriefing.17 For example, they often complain
about the administrative burden of patient safety interventions.
Physicians spend, on average, 1.7 hours per day to non-patient-related
administrative work, which accounts for approximately one-sixth of their
total working hours.18 Additionally, physicians
express mixed attitudes towards the utility of such methods in reducing
morbidity and mortality. It is hard to quantify the effects of
perioperative briefing and debriefing on patient safety
outcomes.19 Moreover, standardised methods for
perioperative briefing and debriefing are lacking and the methods are
rarely evaluated.2
Therefore, the aim of the present study was to evaluate the long-term (5
years) effects of perioperative briefing and debriefing on team climate.
In addition, we explored the experiences and the barriers and
facilitators of the performance of perioperative briefing and debriefing
to explain the found effects and to make recommendations for further
improvement of such surgical safety tools.