Enhancing Interprofessional Collaboration in Perioperative Setting from the Qualitative Perspectives of Physicians and Nurses

Communication failures were a leading cause of sentinel events in the operation room due to frequently the communication breakdown occurs between physicians and nurses. This study explored the perspectives of surgical teams (nurses, physicians, and anaesthesiologists) on interprofessional collaboration and improvement strategies. A surgical team comprising eight perioperative nurses, four surgeons, and four anaesthesiologists from a university-affiliated hospital participated in this qualitative and phenomenological research from December 2018 to April 2019. Data were collected in in-depth interviews and were used in a thematic analysis according to Colaizzi to extract themes and categorised codes with the ATLAS.ti software. The result is presented in three generic categories: Barrier-like disruptive behaviours and lack of coordination of care; consequences by safety threats to the patient; overcoming barriers by shared decision making among professionals, flattened hierarchies, and teamwork/communication training. The conclusion is that different teams’ perspectives can facilitate genuine reflection, discussion, and implementation of targeted interventions to improve operating room interprofessional collaboration and overcome barriers and their consequences. Currently, there is a need to change towards interprofessional collaboration for optimal patient outcomes and to ensure all professionals’ expectations are met.

A Successful Organized Effort to Improve Operating Room First-Case Starts in a Tertiary Academic Medical Center

Background Operating room (OR) inefficiency drives up cost, decreases revenue, and leads to surgeon, staff, and patient dissatisfaction. Given a low mean first-case start rate in our tertiary academic medical center, we developed a process to improve first-case start rates in an effort to increase OR efficiency. Methods A working group of the OR Executive Committee was constituted to develop and implement a multistep operational plan. This plan was predicated on a sensible staggered start framework, coordination of stakeholder responsibilities, a visual preoperative Stop/Go checklist tool, real-time measurement, and feedback. Results Within 11 days of implementation, 95% of first-start OR cases were tracked to start on time. Throughout the observation period (May 2015-July 2016), the goal of a daily mean 80% on-time start rate was either met or exceeded. Conclusions Implementation of an organized collaborative effort led to dramatic improvements in first OR case on-time rates. Such improvement in OR utilization may lead to an increase in staff and patient satisfaction and cost reduction.