Simulation-based Curriculum to Enhance Culture of Safety in Operating Rooms

Study Overview
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Brief Summary
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Communication in the operating room (OR) is a key factor to prevent deleterious events for the patient. French national health authority made the implementation of safety checklist mandatory in operating rooms. The goal of this checklist is to improve teamwork and share key elements for better patient outcomes. Observational studies in the OR showed low compliance to this checklist, either on the way it is used or on the information implemented. The primary objective of this project is to assess the efficacy of a simulation-based curriculum involving OR medical and non-medical personnel in order to improve communication in the OR.

Detailed Description
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Operating theater is a complex system where efficient communication is critical to patient safety. Patient safety check-list are used worldwide as a way to improve communication and teamwork in the operating room in order to decrease perioperative morbidity and mortality. Previous studies have shown that communication failure in the OR may be associated with adverse events. The improvement of safety culture (including communication and team work) may be obtained by simulation based training. The primary objective of this before-after study is to assess the efficacy of a simulation-based curriculum involving OR medical and non medical personnel in order to improve communication in the OR. In brief, in a first period, an audit to assess communication efficacy and teamwork will be realized during 125 surgical procedures. Communication failures and consequences will be recorded using a standardized form filled by trained personnel. In a second phase, all the OR personnel (surgeon, anesthesiologist, nurses) will be invited to participate to a special training on communication and teamwork. This curriculum will include formal presentations and also simulation-based training. Scenarios are built to improve the ability to communicate in specific situations (fire in the OR, haemorrhage, wrong side, anaphylaxis). In a third phase, an audit on communication and teamwork, similar to the first phase will be realized. The primary endpoint is the frequency of surgical interventions having at least one communication failure with a consequence. The investigators expect a significant decrease in the rate of communication failures between phase 1 and 3. A fourth phase will consist in a last audit two years after phase 1 to evaluate long-term effect of this curriculum.

Conditions
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Surgery

Intervention / Treatment
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* Other: Simulation - based curriculum


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: All surgical interventions occuring in Grenoble University Hospital, North site, between November and January Exclusion Criteria: Interventions supposed to last more than 4 hours Interventions in situations of vital emergencies
Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Before simulation-based curriculum<br>125 surgical interventions will be observed and outcomes will be measured before simulation-based curriculum | |
| After simulation-based curriculum<br>125 surgical interventions will be observed and outcomes will be measured after simulation-based curriculum | Other: Simulation - based curriculum<br>* Operating room medical and non-medical members will be asked to carry out a simulation session preceded by an educational maze with videos. Outcomes will be compared and correlated after and before this curriculum<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Frequency of surgical interventions having at least on communication failure with a consequence |  | After 3 months of audit | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Compliance to the safety checklist in the operating room |  | measured during each surgical intervention, before anesthesia, before incision and at the end of surgery | 
| 6 items survey estimating teamwork quality |  | measured at the end of each surgical intervention, an average of 2.5 hours | 
| Number of adverse events occuring in the OR declared to the institution |  | After 3 months of audit | 
| Surgical Apgar score |  | measured at the end of each surgical intervention, an average of 2.5 hours | 
| Nature of communication failure and consequences |  | measured during each surgical procedure, for an average of 2.5 hours | 
| rate of communication failures |  | measured during each surgical procedure, for an average of 2.5 hours | 
| Survey on safety culture for employees working in the OR |  | After 3 months of audit | 
| Count of team members and number of passage in the OR |  | measured during each surgical procedure, for an average of 2.5 hours |