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Relating human factor aspects during surgery to surgical site infection

English title Relating human factor aspects during surgery to surgical site infection
Applicant Tschan Semmer Franziska
Number 138273
Funding scheme Interdisciplinary projects
Research institution IPTO - Institut de Psychologie du Travail et des Organisations Université de Neuchâtel
Institution of higher education University of Neuchatel - NE
Main discipline Psychology
Start/End 01.03.2012 - 31.03.2015
Approved amount 227'372.00
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All Disciplines (2)

Discipline
Psychology
Surgery

Keywords (5)

Surgery; Patient Safety; Distractors; Teamwork; Surgical site infections

Lay Summary (German)

Lead
Lay summary

Hintergrund

Jede Operation birgt ein- in der Regel kleines - Risiko einer unerwünschten Komplikation. Eine der häufigsten Komplikationen nach operativen Eingriffen ist eine Infektion der Operationswunde. Einige der bekannten Risikofaktoren für solche Infektionen sind der Zustand des Patienten oder der Patientin, und die Art und die Dauer des Eingriffs. Eine kürzlich publizierte Studie (Beldi et al., 2009) lässt aber vermuten, dass auch Ablenkungen während einer Operation eine Rolle spielen können. Solche Ablenkungen können mit dem Verhalten des Operationsteams zusammenhängen (z.B. nicht patientenbezogene Kommunikation während der Operation), aber auch mit Geräuschen aller Art (Telefonanrufe, Türöffnungen, herunterfallende Gegenstände). Operationen erfordern aufwändige Technologie und komplexe interdisiplinäre Zusammenarbeit – das kann mit mehr Lärm, mehr Bewegungen im Operationsaal,  oder mit häufigen Gesprächen im Operationssaal verbunden sein, so dass Ablenkungen häufiger auftreten können als man vielleicht vermuten würde. Andererseits erfordern Operationen eine hohe Konzentration von allen Beteiligten, und Ablenkungen könnten die Konzentration gefährden. Zudem erfordert die Situation ein möglichst reibungsloses Zusammenwirken der Beteiligten, und wenn diese Koordination nicht reibungslos funktioniert (auf Grund von Unterbrechungen und Ablenkungen, durch Störungen der zeitlichen Koordination, durch auftretende Irritationen), könnte das Risiko von Komplikationen ebenfalls steigen.

Ziel:

Dieses interdisziplinär (Psychologie und Medizin) geführte Projekt hat zum Ziel, den Zusammenhang von Distraktoren und Unterbrechungen während Operationen sowie den Zusammenhang von Koordination und Kommunikation im Team mit postoperativen Infektionen zu untersuchen. Aus den Ergebnissen sollen geeignete Präventionsmassnahmen abgeleitet werden. Dazu wird das Geschehen im Operationssaal bei langen, offenen Operationen beobachtet, und das Geschehen wird nach einer Reihe von Beobachtungskategorien kodiert. Drei Wochen nach der Operation wird festgestellt, ob eine Infektion vorliegt. Anschliessend wird mittels statistischer Analysen geprüft, ob es Zusammenhänge zwischen spezifischen Ereignissen (z.B. Ablenkungen) und der Infektionshäufigkeit gibt. Weil postoperative Infektionen (glücklicherweise) selten vorkommen, muss eine grosse Anzahl von Operationen beobachtet werden, um gesicherte Resultate zu erhalten.

Bedeutung:

Patientensicherheit und das Vermeiden von Komplikationen ist eines der wichtigsten Anliegen der Medizin. Ergebnisse aus dem Projekt werden zeigen, welche Ablenkungen während Operationen besonders häufig vorkommen, und welche einen negativen oder einen protektiven Effekt für Patienten und Patientinnen haben können. Daraus können Empfehlungen für Operationsteams erarbeitet werden.

Direct link to Lay Summary Last update: 21.02.2013

Responsible applicant and co-applicants

Employees

Publications

Publication
Impact of case-relevant and case-irrelevant communication
Tschan Franziska, Seelandt Julia, Keller Sandra, Kurmann Anita, Candinas Daniel, Beldi Guido (2015), Impact of case-relevant and case-irrelevant communication, in Brithish journal of Surgery, 0-0.
Assessing distractors and teamwork during surgery: Developing an event-based method for direct observation
Seelandt Julia C, Tschan Franziska, Keller Sandra, Beldi Guido, Janni Nadja, Kurmann Anita, Semmer Norbert K (2014), Assessing distractors and teamwork during surgery: Developing an event-based method for direct observation, in BMJ Quality & Safety, online first , 1.
Impact of team familiarity in the operating room on surgical complications
Kurmann Anita, Keller Sandra, Tschan Franziska, Seelandt Julia C, Semmer Norbert K, Candinas Daniel, Beldi Guido (2014), Impact of team familiarity in the operating room on surgical complications, in World Journal of Surgery, (online fir), 1.
Human factors in the operating room – The surgeon's view
Kurmann Anita, Tschan Franziska, Semmer Norbert K., Seelandt Julia, Candinas Daniel, Beldi Guido (2012), Human factors in the operating room – The surgeon's view, in Trends in Anaesthesia and Critical Care, 2(5), 224-227.

Collaboration

Group / person Country
Types of collaboration
Prof. Dr. Stephan U. Marsch Switzerland (Europe)
- in-depth/constructive exchanges on approaches, methods or results

Scientific events

Active participation

Title Type of contribution Title of article or contribution Date Place Persons involved
Drei-Länder Kongress, Karlsruhe, Deutschland Talk given at a conference Der Einfluss intraoperativer Kommunikation in chirurgischen Teams auf postoperative Wundinfektionen 01.05.2015 Karlsruhe, Germany Seelandt Julia;
Journée inaugurale du centre de recherche sur les interactions sociales de l'Université de Neuchâtel (2015-01) Poster External visitors interrupting surgical teams : do they trigger changes in the communication patterns in the operating room? 29.01.2015 Neuchâtel, Switzerland Keller Sandra; Beldi Guido; Semmer Norbert Karl; Tschan Semmer Franziska; Seelandt Julia;
8th International Meeting on Behavioural Sciences Applied to Surgery and Acute Care Settings Poster Perceived quality of cooperation: The general climate does not converge with perceived cooperaton quality in surgeries 20.11.2014 London , Great Britain and Northern Ireland Tschan Semmer Franziska; Keller Sandra; Semmer Norbert Karl; Beldi Guido; Seelandt Julia;
8 th International Meeting on Behavioural Sciences Applied to Surgery And Acute Care Settings Talk given at a conference Effects of noise peaks on teamwork: Noise inhibits case-relevant but not case-irrelevant communication among the surgical team 20.11.2014 London , Great Britain and Northern Ireland Beldi Guido; Keller Sandra; Tschan Semmer Franziska; Semmer Norbert Karl;
8th International Meeting on Behavioural Sciences Applied to Surgery and Acute Care Settings Talk given at a conference Takling may help or hinder: Case-relevant and case-irrelevant communication during surgeries and surgeical site infections 20.11.2014 London, Great Britain and Northern Ireland Semmer Norbert Karl; Keller Sandra; Beldi Guido; Seelandt Julia; Tschan Semmer Franziska;
9th Annual INGRoup Conference 2014; Raleigh, NC; USA Talk given at a conference Impact of distractors and noise on the amount of case-relevant and case-irrelevant communication during long, open, abdominal surgeries 17.07.2014 Raleigh, NC, United States of America Seelandt Julia; Tschan Semmer Franziska; Beldi Guido; Semmer Norbert Karl; Keller Sandra;
Joint Annual Meeting 2014 Swiss Society of Neurosurgery Talk given at a conference Human Factors im Operationssaal - Einflüsse von Konzentration, Stress und Teamarbeit auf Outcomes 12.06.2014 Zürich , Switzerland Tschan Semmer Franziska;
Swiss Society of Neurosurgery Joint Annual Meeting 2014 Talk given at a conference Human Factors im Operationssaal - Einflüsse auf Konzentration, Stress und Teamarbeit und auf Outcomes 12.06.2014 Zürich , Switzerland Tschan Semmer Franziska;
101. Jahreskongress der Schweizerischen Gesellschaft für Chirurgie Talk given at a conference Influences on perceived teamwork quality in the OR 21.05.2014 Bern, Switzerland Seelandt Julia; Tschan Semmer Franziska; Semmer Norbert Karl; Keller Sandra; Beldi Guido;
101. Jahreskongress der Schweizerischen Gesellschaft für Chirurgie Talk given at a conference Teamwork reduces physiological stress in junior surgeons 21.05.2014 Bern, Switzerland Tschan Semmer Franziska; Keller Sandra; Semmer Norbert Karl; Seelandt Julia; Beldi Guido;
11th EAHOP Conference, London Talk given at a conference Impact of communication within the surgical team on srugical site infections: Integrating content, time and task 14.04.2014 London, Great Britain and Northern Ireland Keller Sandra; Tschan Semmer Franziska; Beldi Guido; Semmer Norbert Karl; Seelandt Julia;
Colloque de l'institut de psychologie du travail et des organisations, Université de Neuchâtel (2013-10) Individual talk Noise in the operating room 03.10.2013 Neuchâtel, Switzerland Keller Sandra;
13th Congress of the Swiss Psychological Sociaty Talk given at a conference Quality of teamwork experienced in the Operating Room 11.09.2013 Basel, Switzerland Keller Sandra; Semmer Norbert Karl; Seelandt Julia; Tschan Semmer Franziska; Beldi Guido;
13th Congress of the Swiss Psychological Society Talk given at a conference Noise in the operating room: can it really be avoided and which factors could change its impact on perceived teamwork? 11.09.2013 Basel, Switzerland Tschan Semmer Franziska; Seelandt Julia; Beldi Guido; Keller Sandra;
8th Annual INGRoup Conference, Atlanta Poster Quality of teamwork experienced in the Operating Room (OR) 11.07.2013 Chicago, United States of America Keller Sandra; Semmer Norbert Karl; Beldi Guido; Tschan Semmer Franziska; Seelandt Julia;
8th annual INGRoup Conference, Atlanta, USA. Talk given at a conference Noise in the operating room: Behaviors associated with noise and impact of noise on perceived quality of collaboration in surgical teams. 11.07.2013 Atlanta, United States of America Beldi Guido; Seelandt Julia; Tschan Semmer Franziska; Keller Sandra; Semmer Norbert Karl;
SMIC - Safety management in contect - Cross-industry learning for theory and practice Poster Impact of communication within the surgical team on surgical site infections 17.06.2013 Ascona, Monte Verità, Switzerland Seelandt Julia; Semmer Norbert Karl; Beldi Guido; Tschan Semmer Franziska;
100. Jahreskongress der Schweizerischen Gesellschaft für Chirurgie Talk given at a conference Stressfaktoren währnd der Operation und deren Einfluss auf das Outcome 13.06.2013 Bern , Switzerland Seelandt Julia; Beldi Guido; Semmer Norbert Karl; Tschan Semmer Franziska;
100. Jahreskongress der Schweizerischen Gesellschaft für Chirurgie, Bern Talk given at a conference Impact of teamwork on surgical site infection 12.06.2013 Bern , Switzerland Beldi Guido; Semmer Norbert Karl; Seelandt Julia; Tschan Semmer Franziska;
100. Jahreskongress der Schweizerischen Gesellschaft für Chirurgie Talk given at a conference Impact of communication within the surgical team on surgical site infections 12.06.2013 Bern , Switzerland Beldi Guido; Seelandt Julia; Tschan Semmer Franziska; Semmer Norbert Karl;
NCCR Affective Sciences, Geneva, Annual Research Forum Poster Observed tension and tension release influence perceived teamwork quality in the operating room 22.04.2013 Geneva, Switzerland Seelandt Julia; Tschan Semmer Franziska; Semmer Norbert Karl; Beldi Guido;
6th International Workshop on Behavioural Science Applied to Acute Care Teams Poster Quality of collaboration influences concentration in the OR 02.11.2012 Kopenhagen, Denmark, Denmark Semmer Norbert Karl; Beldi Guido; Tschan Semmer Franziska; Seelandt Julia;
Deutscher Kongress für Psychologie, Bielefeld Talk given at a conference Kommunikation und distraktoren im OP: Angriff auf die Konzentration ? 23.09.2012 Bielefeld, Germany Seelandt Julia; Beldi Guido; Tschan Semmer Franziska; Semmer Norbert Karl;
7th Annual INGRoup Conference, Atlanta Talk given at a conference Threats for concentration in the Operating Room: Different types of distractors affect concentration ability and stress in a multidisciplinary team in accordance with task requirements 12.07.2012 Chicago, United States of America Tschan Semmer Franziska; Semmer Norbert Karl; Beldi Guido; Keller Sandra; Seelandt Julia;
American Cancer Society: The role of health care teams in cancer care Talk given at a conference Medical Team Performance 16.05.2012 NCI, Washington DC, United States of America Seelandt Julia; Beldi Guido; Semmer Norbert Karl; Tschan Semmer Franziska;


Knowledge transfer events

Active participation

Title Type of contribution Date Place Persons involved
Rencontre Neuchâtel Patient Safety (2015 03 13) 13.03.2015 Neuchâtel , Switzerland Tschan Semmer Franziska;
Colloque des anesthésistes du chuv - communication et distracteurs dans la salle d'opération - et notre étude 22.01.2015 Lausanne, Switzerland Tschan Semmer Franziska;
Abteilung für Viszerale Chirurgie Kantonnspital Chur, impact of structured communication in the operating room on surgical site infection. A multicenter study 20.01.2015 Chur, Switzerland Keller Sandra; Tschan Semmer Franziska; Beldi Guido; Semmer Norbert Karl;
Observations en salle d'opération (2014-10-16) - Colloque Chirurgiens CHUV 16.10.2014 Lausanne , Switzerland Keller Sandra;
Séminaire travail de groupe dans le domaine médical, Université de Neuchâtel, semestre d'automne 2014. 15.09.2014 Neuchâtel, Switzerland Tschan Semmer Franziska; Keller Sandra;
Colloques du DGOG (2014-11) 11.09.2014 Lausanne, Switzerland Tschan Semmer Franziska;
Donnerstag Colloque Chirurgiepflege CHUV: Communication Structurée dans la salle d'opération et complications 11.09.2014 Lausanne, Switzerland Semmer Norbert Karl; Tschan Semmer Franziska; Beldi Guido; Keller Sandra;
Was Psychologen im INO machen - Weiterbildung Operationspersonal Inselspital 23.04.2013 Inselspital Bern, Switzerland Beldi Guido; Tschan Semmer Franziska; Seelandt Julia;
Gynäkologie Operationspflege Weiterbildung 27.02.2013 Inselspital Bern , Switzerland Tschan Semmer Franziska;
53. Berner Anästhesie Symposium 21.11.2012 Bern, Switzerland Tschan Semmer Franziska;
Kadertag Gesundheitswesen Kanton St.Gallen 21.06.2012 Wil, St.Gallen, Switzerland Semmer Norbert Karl; Tschan Semmer Franziska;
INO Meeting Viszeral: The last 15 minutes of surgery 07.06.2012 Inselspital Bern , Switzerland Tschan Semmer Franziska; Semmer Norbert Karl; Beldi Guido; Seelandt Julia;


Communication with the public

Communication Title Media Place Year
Video/Film Séquence de vidéo de présentation du centre de recherche sur les interactions sociales de l'Universi Western Switzerland 2014

Awards

Title Year
Award for the best oral presentation at the 8th International Meeting on Behavioural Sciences Applied to Surgery and Acute Care Settings for the presentation Tschan F et al: Talking may help or hinder: Case-relevant and case-irrelevant communication during surgeries and surgical site infections. University of Neuchatel, Switzerland 2014
7th Annual INGRoup Conference, Chicago, 2012 Outstanding Conference Poster to Julia C. Seelandt, Franziska Tschan, Norbert K. Semmer, Sandra Keller, Anita Kurmann, Daniel Candinas, & Guido Beldi, "Concentration Ability and Stress in the OR: Effects of Distractors and Collaboration Quality" 2012

Associated projects

Number Title Start Funding scheme
156882 Impact of structured communication in the operating room on surgical site infections. A multicenter study. 01.04.2015 Interdisciplinary projects

Abstract

A number of publications have shown a relatively high rate of complications that are related to the treatment and not to the disease, and have identified iatrogenic incidents as an important part of healthcare costs (Brennan, Leape et al. 2004). Therefore, patient safety and minimizing the risk of iatrogrenic harm has become a major concern in health-care. However, several years after their initial publication, one of the main authors of the initial study complains that “progress toward improvement has been frustratingly slow” (p. 18), and calls for more research in this domain (Leape, Berwick et al. 2009). For surgical patients, one important complication may be infections. In fact, surgical patients are more than twice as likely than other patients to acquire a hospital-related infection. Moreover, about half of these infections are surgical site infections (SSI) - infections occurring at the part of the body where the surgery took place. Although patient-related factors and operational procedures are known risk factors for surgical site infections, it is also assumed that human factors also contribute significantly to surgical site infections, specifically the behavior of the medical personnel in terms of communication and coordination. However, little is known about what specific behaviors during surgery may increase or decrease the risk of surgical site infections. Goal of this study is to empirically relate intraoperative distractions and disruptions, but also aspects of teamwork and communication during the surgery, to the occurrence of surgical site infections. Previous research has shown that distractions and interruptions are frequent phenomena in the operating room (OR); they have been found to negatively influence surgical performance. However, an empirical link between distractions and SSI has never been investigated. In a similar vein, there is research investigating teamwork and communication during surgeries, but no research has been done that shows of specific communication behavior during surgeries to be protective or harmful with regard to SSI. However, only empirically based knowledge regarding the relationship of specific behaviors during surgeries to SSI can lead to valid behavioral recommendations that can help surgical teams to further reduce SSI. We will observe a high number (110) of long, open abdominal surgeries, as these bear a particularly high risk for SSI. We will assess intraoperative behavior by using a detailed behavioral observation system specifically developed for this research. It allows assessing different sources of distractions, traffic in the OR, and teamwork behavior that may improve teamwork quality and reduce unhelpful or distracting communication. All of these aspects have been emphasized by other studies, but so far, research that relates these behaviors to patient outcome is scarce. Surgical site infections will be assessed 30 days after the surgery, using well-established methods in this domain. Significance The immediate goal of the project is to empirically establish the relationship between intrasurgical behavior and the development of SSI, and to assess the importance of this link. The final goal of the project, however, is to establish rules and recommendations for surgical teams in order to enable efficient communication and reduce behavior during surgical procedures that may bear a risk for patient outcomes. Such recommendations, based on sound empirical research, can improve patient safety and contribute to the reduction of suffering and health costs due to iatrogenic harm.
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