Call Xray

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Call X-ray
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Situational awareness shared mental models

• Only possible if
• Team briefed
• Team technically proficient - cognitive capacity
  not overloaded
• Team feel involved (buy-in)
• Flat hierarchy
• Contributions recognised

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Who leads the theatre team?
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Who leads?

• Once theatre sister now anaesthetist/ scrub
  nurse/ absent surgeon?
• Everybody capable if situationally aware?
• Knowledge is distributed, key is access
• Knowledge is power, sequestration is depowering
• Sharing knowledge of list is empowering for the
  patients sake

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I would like to see more team briefing in
operating theatres
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Briefing formats

• Horizon briefing Stable team, week before list, ½
  hour.
• 2. Functional checklist tick box, pre-list start,
  3-5 mins.
• 3. Team building Collaborative pre-list, whos
  on the team today?, patient issues (personalises
  patient), equipment issues, 10 mins., good for ad
  hoc teams. Coffee room?
• 4. Cumulative Brief-as-you-go. New team members
  briefed.
• Facilitator supported Dedicated theatre nurse
  6/12 part-time (2 days a week) stimulate/
  support/ gather data/ share what is happening in
  other teams.

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Model brief
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Reasons for not briefing
Lack of leader enthusiasm Time restrictions
(delays start) (1 min 42 secs?!) Difficulty in
coordinating staff Other pressing commitments
and priorities (equip./ staffing issues) Junior
staff not empowered enough to ask for briefs
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Relationship between teamwork climate and safety
climate
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Debriefing formats

• Hot edited videotape review 20 minutes.
• Cumulative whiteboard review/ critical incidents
  5-10 minutes. Possibly whilst sewing up?
• End of the list using credit card prompts10-15
  minutes.
• During the list after each patient 3 minutes per
  patient.
• Team building debrief led by any member of team,
  cards as prompts (eg me in your shoes, A
  team) 15 minutes.

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Debriefing methods
What went well? What challenged us? Did we
communicate well? Were we situationally
aware? Was time an issue? Did briefing help? Any
other issues?
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24 self-reviews 124 issues
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Project findings

• Briefing debriefing improves teamwork safety
  climate
• Debrief logs
• Theatre questionnaires
• SAQ scores for teamwork and safety climate
• Communication/ dialogue crucial to establish
  situational awareness
• Non-technical skills need constant practice
• Team appraisal is a possibility (Aviation
  Industry does this)
• Sustainability?
• Create dialogue you will generate empathy!

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• Cornwall TTRM
  project
• Adrian.hobbs_at_rcht.cornwall.nhs.uk
• Alan.bleakley_at_pms.ac.uk