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.