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Physical and psychological abuse in Canadian operating rooms

, MSc, , MA, , MBChB, MHPE, FRCPC, On behalf of the Intraoperative Behaviors Research Group

Canadian Journal of Anaesthesia

Springer US

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      Surgical team behaviors and patient outcomes.

      Little evidence exists that links teamwork to patient outcomes. We conducted this study to determine if patients of teams with good teamwork had better outcomes than those with poor teamwork. Observers used a standardized instrument to assess team behaviors. Retrospective chart review was performed to measure 30-day outcomes. Multiple logistic regressions were calculated to assess the independence of the association between teamwork with patient outcome after adjusting for American Society of Anesthesiologists (ASA) score. In univariate analyses, patients had increased odds of complications or death when the following behaviors were exhibited less frequently: information sharing during intraoperative phases, briefing during handoff phases, and information sharing during handoff phases. Composite measures of teamwork across all operative phases were significantly associated with complication or death after adjusting for ASA score (odds ratio 4.82; 95% confidence interval, 1.30-17.87). When teams exhibited infrequent team behaviors, patients were more likely to experience death or major complication.
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        Impact and implications of disruptive behavior in the perioperative arena.

        There is a growing concern about the role of human factor issues and their effect on patient safety and clinical outcomes of care. Problems with disruptive behaviors negatively affect communication flow and team dynamics, which can lead to adverse events and poor quality outcomes. A 25-question survey tool was used to assess the status and significance of disruptive behaviors around perioperative services in a large metropolitan academic medical center. Results were analyzed and compared with those from a national databank to identify areas of concern and opportunities for improvement. Disruptive behaviors were a common occurrence in the perioperative setting. These types of behaviors were most prevalent in attending surgeons. Disruptive behaviors increased levels of stress and frustration, which impaired concentration, impeded communication flow, and adversely affected staff relationships and team collaboration. These events were perceived to increase the likelihood of medical errors and adverse events and to compromise patient safety and quality of care. Disruptive behaviors in the perioperative arena have a significant impact on team dynamics and communication flow, which can have a negative impact on patient care. Organizations need to recognize the prevalence and significance of disruptive behaviors and develop policies and processes to address the issue. Key areas of focus include recognition and awareness, organizational and cultural commitment, implementation of appropriate codes of behavior policies and procedures, and provision of education and training programs to discuss contributing factors and tools to build effective communication and team collaboration skills.

          Author and article information

          Department of Anesthesiology and Perioperative Medicine, College of Medicine, University of Manitoba, Winnipeg, MB Canada

          Can J Anaesth
          Can J Anaesth
          Canadian Journal of Anaesthesia
          Springer US (New York )
          1 December 2016
          1 December 2016
          : 64
          : 2
          : 236-237
          © The Author(s) 2016

          Open AccessThis article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License (, which permits any noncommercial use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

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          © Canadian Anesthesiologists' Society 2017

          Anesthesiology & Pain management


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