Operating Room Teams Display Acceptable Levels of Patient Safety Behaviors During Surgical Cases

Introduction: Cornerstones of patient safety include reliable safety behaviors proposed by Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS) practices. A better quantification of these behaviors is needed to establish a baseline for future improvement efforts.

Methods: At one large academic medical center, OR Teams were prospectively assigned to be observed during surgical cases, and patient safety behaviors were quantified using the Teamwork Evaluation of Non-Technical Skills (TENTS) instrument. Mean scores of each TENTS behavior were calculated with 95% confidence intervals and compared using a paired t-test with a false discovery rate (FDR) control. Using the TENTS instrument, one hundred one surgical cases were observed by purposefully trained medical student volunteers. The average with 95% confidence interval (CI) of observed safety behaviors quantified using the TENTS instrument (including 20 types of safety behaviors scored 0 = expected but not observed, 1 = observed but poorly performed or counterproductive, 2 = observed and acceptable, and 3 = observed and excellent).

Results: All safety behaviors averaged slightly above 2, and the lower bound of 95% CI was above 2 for all behaviors except one. Statistically significant differences (p < 0.05) were detected between a few safety behaviors, with the lowest-rated safety behavior being "employs conflict resolution" (2.07, 95% CI: 1.96-2.18) and the highest-rated behavior being "willingness to support others across roles" (2.36, 95% CI: 2.27-2.45). There were no significant differences (p > 0.05) based on the number of persons present during the case, case duration, or by surgical department.

Conclusions: Given the persistent patient safety incidents in ORs nationwide, it might be necessary to advance these behaviors from acceptable to exceptional to advance patient safety.