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Impact of structured communication in the operating room on surgical site infections. A multicenter study.

English title Impact of structured communication in the operating room on surgical site infections. A multicenter study.
Applicant Tschan Semmer Franziska
Number 156882
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 Surgery
Start/End 01.04.2015 - 31.12.2019
Approved amount 600'000.00
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All Disciplines (2)

Discipline
Surgery
Psychology

Keywords (7)

briefing intervention; surgery; patient safety; intrasurgical communication ; surgical site infection; teamwork in surgery; behavioral observation

Lay Summary (German)

Lead
Einfluss von strukturierter Kommunikation im Operationssaal auf postoperative Infektionen.Postoperative Infektionen sind eine der häufigsten Komplikationen nach Operationen. Über Infektionsrisiken, die sich aus Patientenmerkmalen und der Art der Operation ergeben, weiss man viel. Hingegen ist der Zusammenhang zwischen Teamarbeit im Operationsteam und postoperativen Infektionen wenig erforscht.
Lay summary

Inhalt und Ziel des Forschungsprojektes

Operationen erfordern - neben hoher fachlicher Kompetenz – optimale Zusammenarbeit im interdisziplinären Team. Frühere Studien haben gezeigt, dass gute Teamarbeit im Operationssaal – vor allem der Austausch von Informationen - das Komplikationsrisiko nach Operationen beeinflussen kann. Das so genannte Team Time out (ein Informationsaustausch (Briefing) zu Beginn der Operation) ist inzwischen allgemeine Routine. Wir erforschen in diesem Projekt die Wirkung von zwei zusätzlichen kurzen Briefings, in denen das Team innehält und konzentriert und strukturiert Informationen austauscht. Das so genannte StOP-Protokoll wird zu Beginn des Hauptteiles der Operation und vor dem Zunähen durchgeführt.

Fünf chirurgische Abteilungen aus vier Schweizer Spitälern nehmen an der Studie teil, und es werden mehrere tausend Operationen evaluiert. Dabei wird untersucht, ob und wie sich die Kommunikation innerhalb des Operationsteams nach der Einführung des StOP-Protokolls ändert, und ob das StOP-Protokoll einen Einfluss auf die postoperative Infektionsrate hat. Unsere Untersuchungen werden dazu beitragen, die Bedeutung von Teamarbeit und Kommunikation für den Operationsverlauf besser zu verstehen und können einen Beitrag leisten, die Komplikationsrate zu senken.

Direct link to Lay Summary Last update: 30.03.2015

Responsible applicant and co-applicants

Employees

Publications

Publication
“Disruptive behavior” in the operating room: A prospective observational study of triggers and effects of tense communication episodes in surgical teams
Keller Sandra, Tschan Franziska, Semmer Norbert K., Timm-Holzer Eliane, Zimmermann Jasmin, Candinas Daniel, Demartines Nicolas, Hübner Martin, Beldi Guido (2019), “Disruptive behavior” in the operating room: A prospective observational study of triggers and effects of tense communication episodes in surgical teams, in PLOS ONE, 14(12), e0226437-e0226437.
Assessing Perceptions of Teamwork Quality Among Perioperative Team Members
Müller Patrick, Tschan Franziska, Keller Sandra, Seelandt Julia, Beldi Guido, Elfering Achim, Dubach Brigitte, Candinas Daniel, Pereira Diana, Semmer Norbert K. (2018), Assessing Perceptions of Teamwork Quality Among Perioperative Team Members, in AORN Journal, 108(3), 251-262.
Rules for coding scheme development
TschanFranziska, ZimmermannJasmin, Semmer Norbert K (2018), Rules for coding scheme development, in Brauner Elisabeth, Kolbe Michaela, Boos Margarete (ed.), Cambridge University Press, Cambridge , 191-297.
SO_DIC_OR Simultaneous observation of distractions and communication in the operating room
KellerSandra, TschanFranziska (2018), SO_DIC_OR Simultaneous observation of distractions and communication in the operating room, in Boos Margarete, Brauner Elisabeth, Kolbe Michaela (ed.), Cambridge University Press, Cambridge , 518-527.

Scientific events

Active participation

Title Type of contribution Title of article or contribution Date Place Persons involved
BSAS 2020, Webinar, hosted by the Center of Advanced Medical Simulation and Training, the Karolinska Institute and Astrid Lindgrens Childrens Hospital Talk given at a conference StOP? again: Effects of the introductions of the StOP? protocol (an intraoperative briefing to enhance information exchange duringsurgery) on patient and team outcomes 09.10.2020 Online , Sweden Beldi Guido; Keller Sandra; Tschan Semmer Franziska; Holzer Eliane;
15th Virtual 2020 INGRoup conference Talk given at a conference A multicenter Pre-Post Intervention Study to Improve Information Exchange during Surgical Procedures: Effects on the Surgical Team and on Patient Outcomes. 01.10.2020 Virtual , United States of America Beldi Guido; Keller Sandra; Candinas Daniel; Holzer Eliane; Tschan Semmer Franziska;
BSAS 2019, Amsterdam Poster Talking about the time left: A prospective observational study of the accuracy of time-related communication of surgeons 29.11.2019 Amsterdam, Netherlands Holzer Eliane; Keller Sandra; Beldi Guido; Zimmermann Jasmin; Candinas Daniel; Spycher Jasmin; Tschan Semmer Franziska; Huber Patrick Manuel;
BSAS 2019, Amsterdam Talk given at a conference The quality of an intraoperative briefing influences to what extent the surgical team benefits - each professional role profits from different quality aspects. Results of a prospective observational study. 29.11.2019 Amsterdam , Netherlands Holzer Eliane; Tschan Semmer Franziska; Beldi Guido; Keller Sandra; Zimmermann Jasmin;
SGP Kongress 2019, Bern Poster Surgical teams show high compliance with a new intropoerative briefing, but hospital and characteristics of surgery influence compliance 09.09.2019 Bern , Switzerland Tschan Semmer Franziska; Beldi Guido; Keller Sandra; Candinas Daniel; Holzer Eliane;
SGP Kongress 2019, Bern Talk given at a conference Explaining triggers of tensions in tightly cooperating teams: Towards a theory of micro-coordination conflict 09.09.2019 Bern , Switzerland Tschan Semmer Franziska; Keller Sandra;
14th Annual INGRoup conference July 2019, Lisbon Portugal Talk given at a conference Context and task-related factors influencing the compliance of surgical teams with an intraoperative briefing intervention 18.07.2019 Lisabon , Portugal Tschan Semmer Franziska; Candinas Daniel; Zimmermann Jasmin; Beldi Guido; Holzer Eliane; Keller Sandra;
12th International Meeting on Behavioural Sciences Applied to Surgery and Acute Care Settings Talk given at a conference Factors influencing the compliance with the perioperative StOP?-briefing 19.10.2018 München, Germany Zimmermann Jasmin; Holzer Eliane; Candinas Daniel; Tschan Semmer Franziska; Keller Sandra; Beldi Guido;
12th International Meeting on Behavioural Sciences Applied to Surgery and Acute Care Settings, Munich 2018 Talk given at a conference Are Difficulties with Surgeons due to Difficult Surgeons? 19.10.2018 Munich, Germany Keller Sandra; Tschan Semmer Franziska;
51st Kongress of the German Psychological Society, Frankfurt/M., Sept. 19, 2018 Talk given at a conference Die vernachlässigte Rolle der Aufgaben-Ausführung in Theorien zu Team-Konflikten: Der Mikro-Koordinations-Konflikt am Beispiel der Chirurgie. 19.09.2018 Frankfurt am Main , Germany Keller Sandra; Tschan Semmer Franziska;
12th international INGRoup conference, July 2018 Bethesda, USA Poster Two are better than one: Introducing an intra-operative briefing enhances the quality of an established pre-operative briefing 18.07.2018 Washington, DC, United States of America Tschan Semmer Franziska; Candinas Daniel; Holzer Eliane; Zimmermann Jasmin; Beldi Guido; Keller Sandra;
12th international INGRoup conference, July 2018 Bethesda, USA Talk given at a conference Emotions and Incivility During Teamwork 18.07.2018 Washington, DC, United States of America Keller Sandra; Tschan Semmer Franziska;
11th international meeting on Behavioural Science Applied to Surgery and Acute Care Settings, 20-21 October 2017 Talk given at a conference Teamwork in Healthcare – a Swiss perspective 20.10.2017 Zurich , Switzerland Tschan Semmer Franziska;
11th international meeting on Behavioural Science Applied to Surgery and Acute Care Settings, 20-21 October 2017 Talk given at a conference Tensioins in the operating room impact collaboration quality .. but not for everyone 20.10.2017 Zurich, Switzerland Tschan Semmer Franziska; Holzer Eliane; Candinas Daniel; Zimmermann Jasmin; Keller Sandra; Beldi Guido;
11th international meeting on Behavioural Science Applied to Surgery and Acute Care Settings, 20-21 October 2017 Poster Do further breifings during surgery influence the initial timeout? 20.10.2017 Zurich, Switzerland Holzer Eliane; Candinas Daniel; Beldi Guido; Zimmermann Jasmin; Tschan Semmer Franziska; Keller Sandra;
10. Tagung der FG Arbeits-, Organisations- und Wirtschaftspsychologie der DGPs, 2017 Talk given at a conference Spannungen im Operationssaal: Auslöser, Ausdrucksformen; Auswirkungen 13.09.2017 Dresden , Germany Tschan Semmer Franziska; Beldi Guido; Candinas Daniel; Holzer Eliane; Keller Sandra; Zimmermann Jasmin;
10th Conference of the Work, Organizational and Economic Psychology Division of the German Society of Psychology 2017 Talk given at a conference Spannungen im Operationssaal: Impakt von und Einfluss auf Teamprozesse. 13.09.2017 Dresden, Germany Candinas Daniel; Beldi Guido; Zimmermann Jasmin; Tschan Semmer Franziska; Keller Sandra; Holzer Eliane;
10. Tagung der FG Arbeits-, Organisations- und Wirtschaftspsychologie der DGPs, 2017 Talk given at a conference Situation Awareness und Kooperationsqualität in chirurgischen Teams: Effekte einer Intervention zu strukurierter Kommunikation 13.09.2017 Dresden , Germany Keller Sandra; Candinas Daniel; Holzer Eliane; Zimmermann Jasmin; Tschan Semmer Franziska; Beldi Guido;
Konferenz der Schweizer Gesellschaft für Psychologie, Lausanne, Sept. 2017 Talk given at a conference Why do surgeons get tense while operating? : An analysis of tension triggers and their impact on the team 04.09.2017 Lausanne, Switzerland Beldi Guido; Holzer Eliane; Zimmermann Jasmin; Tschan Semmer Franziska; Candinas Daniel; Keller Sandra;
12th international INGRoup conference, 21. July 2017 Talk given at a conference Tensioins in surgical teams and their association with percieved quality of cooperation 21.07.2017 St.Louis, United States of America Zimmermann Jasmin; Holzer Eliane; Tschan Semmer Franziska; Beldi Guido; Candinas Daniel; Keller Sandra;
ICBEN conference, Zurich, 18-22 June 2017 Talk given at a conference Effects of noise on communication and concentration during surgeries: the moderating role of experience and task 18.06.2017 Zurich, Switzerland Beldi Guido; Tschan Semmer Franziska; Candinas Daniel;
ICBEN conference, Zurich, 18-22 June 2017 Poster Interrelatoins between noise and patients' critical stages during surgeries 18.06.2017 Zurich , Switzerland Tschan Semmer Franziska; Beldi Guido; Keller Sandra; Candinas Daniel;
12th International Conference on Occupational Stress and Health June 2017 Talk given at a conference Enhancing Task-Related Communication in the Operating Room: Effects on the Surgical Team 07.06.2017 Minneapolis , United States of America Zimmermann Jasmin; Keller Sandra; Candinas Daniel; Tschan Semmer Franziska; Beldi Guido; Holzer Eliane;
Annual research meeting, Center of Affective Sciences, Geneva, 18-19. 5. 2017 Poster What triggers the expression of negative emotions in the OR? An explorative analysis of observed tense episodes 18.05.2017 Geneva, Switzerland Beldi Guido; Keller Sandra; Holzer Eliane; Tschan Semmer Franziska;
10th international meeting on Behavioural Science Applied to Surgery and Acute Care Settings, 11-12 November, 2016 Poster Triggers of disruptive behaviors in surgeries 11.11.2016 Aberdeen , Great Britain and Northern Ireland Holzer Eliane; Candinas Daniel; Tschan Semmer Franziska; Keller Sandra; Beldi Guido;
10th international meeting on Behavioural Science Applied to Surgery and Acute Care Settings, 11-12 November, 2016 Poster Stress in the operating room: Heart rate variability of trainee surgeons in different phases of visceral surgery 11.11.2016 Aberdeen , Great Britain and Northern Ireland Tschan Semmer Franziska; Beldi Guido; Keller Sandra; Candinas Daniel;
10th international meeting on Behavioural Science Applied to Surgery and Acute Care Settings, 11-12 November, 2016 Poster Adjustable field notes - a 5$ iPad applicatoin to observe team interactions 11.11.2016 Aberdeen , Great Britain and Northern Ireland Keller Sandra; Zimmermann Jasmin; Holzer Eliane; Tschan Semmer Franziska; Beldi Guido;
10th international meeting on Behavioural Science Applied to Surgery and Acute Care Settings, 11-12 November, 2016 Talk given at a conference StOP? - An intervention to introduce intraoperative briefings during surgical procedures 10.11.2016 Aberdeen , Great Britain and Northern Ireland Holzer Eliane; Candinas Daniel; Tschan Semmer Franziska; Keller Sandra; Beldi Guido; Zimmermann Jasmin;
11th INGRoup conference, Helsinki, 2016 Poster Structured communicatoin in the operating room and patient outcomes: Introducing the StOP? protocol in a multicenter study 22.07.2016 Helsinki, Finland Holzer Eliane; Tschan Semmer Franziska; Beldi Guido; Candinas Daniel; Keller Sandra;
Annual research Forum Center of Affective Sciences, 3-4 March 2016 Poster Impact of noise on socio-emotional and task-related communication in the operating room (OR) 03.03.2016 Geneva, Switzerland Candinas Daniel; Keller Sandra; Beldi Guido; Tschan Semmer Franziska;
Annual research Forum Center of Affective Sciences, 3-4 March 2016 Talk given at a conference Illegitimate tasks, social stressors, and socio-emotional aspects of team coordinatoin in the operating room 03.03.2016 Geneva, Switzerland Tschan Semmer Franziska; Beldi Guido;
CRIS, Université de Neuchâtel, 20.1.2016 Talk given at a conference Communications et distractions durant de longues opérations chirurgicales : Etude par observation au bloc opératoire, présentation du projet 20.01.2016 Neuchâtel, Switzerland Keller Sandra;
9th International Meeting on Behavioural Sciences Applied to Surgery and Acute Care Settings, 9th and 10th October 2015 Poster Tschan, F., Semmer, N.K., Keller, S., Huber, S.A., Kurmann, A., Candinas, D., & Beldi, G., (2015, October). The team process influences surgeon's predictions of future complications. An observational study. 09.10.2015 Bonn, Germany Tschan Semmer Franziska; Beldi Guido; Keller Sandra; Candinas Daniel;
9th International Meeting on Behavioural Sciences Applied to Surgery and Acute Care Settings, 9th and 10th October, 2015, Talk given at a conference Keller, S., Tschan, F., Semmer, N.K., Leupi, F., Kurmann, A., Candinas, D., & Beldi, G. (2015, October). Impact of Interruptions by external staff in the operating room on surgical team communication patterns: Does the type of interruption matter? 09.10.2015 Bonn, Germany Tschan Semmer Franziska; Keller Sandra; Beldi Guido; Candinas Daniel;
Conference of the Swiss Society for Psychology, Geneva, September 8th-9th, 2015 Poster Keller, S., Leupi, F., Tschan, F., Semmer, N.K., Candinas, D., Kurmann, A. & Beldi, G. (2015, September). Communication within surgical teams: Interruptions by external staff influence the content of the communication even after the interruption. 08.09.2015 Genf, Switzerland Tschan Semmer Franziska; Beldi Guido; Keller Sandra; Candinas Daniel;
10th Anniversary INGRoup conference, Pittsburgh, PA, July 23-25 2015 Talk given at a conference Tschan, F., Semmer, N.K., Keller, S., Candinas, D., Kurmann, A. & Beldi, G. (2015, July). Surgeons' predictions of postoperative infections. 23.07.2015 Pittsburgh, United States of America Keller Sandra; Candinas Daniel; Tschan Semmer Franziska; Beldi Guido;
10th Anniversary INGRoup conference, Pittsburgh 2015 Talk given at a conference Keller, S., Tschan, F., Semmer, N.K., Leupi, F., Seelandt, J.C., Kurmann, A., Candinas, D. & Beldi, G. (2015, July). Are interruptionsof surgical teams during the procedure always bad? 23.07.2015 Pittsburgh, United States of America Candinas Daniel; Beldi Guido; Keller Sandra; Tschan Semmer Franziska;
12th international INGRoup conference, July 2017 Talk given at a conference Supporting situation awareness by a short intervention to foster information exchange during surgical procedures 20.07.2015 St.Louis, Missouri, United States of America Candinas Daniel; Beldi Guido; Zimmermann Jasmin; Holzer Eliane; Tschan Semmer Franziska; Keller Sandra;


Knowledge transfer events

Active participation

Title Type of contribution Date Place Persons involved
Mini symposium on quality and security of care; HUG Genève, April 18th, 2019 Talk 18.04.2019 Genève , Switzerland Tschan Semmer Franziska;
2ème Forum francophone TeamSTEPPS (Mars 2019) Talk 07.03.2019 Morges, Switzerland Tschan Semmer Franziska;
5. Symposium Retten & Lernen 2018 Talk 30.11.2018 Nottwil , Switzerland Tschan Semmer Franziska;


Awards

Title Year
British Journal of Surgery Prize ; BJS Best Paper Session Jahreskongresses Chirurgie ; Effects of structured intraoperative briefings on patient outcomes: A multicentric before and after study using inverse probability weighting F. Tschan, S. Keller, N. K. Semmer, E. Timm-Holzer, J. Zimmermann, S. A. Huber, S. Wrann, V. Banz, G. A. Prevost, M. Hübner, D. Candinas, N. Demartines, M. Weber, G. Beldi 2021
Best poster award: Tschan, F., Semmer, N.K., Keller, S., Holzer, E., Candinas, D. & Beldi, G. Structured communication in the operating room and patient outcomes: Introducing the StOP? -Protocol in a multicenter Study. Poster presented at the 11th INGRoup Conference, July 2016, Helsinki 2016
Award for best oral presentation: Keller, S., Tschan, F., Semmer, N.K., Leupi, F., Kurmann, A., Candinas, D., & Beldi, G. (2015, October). Impact of Interruptions by external staff in the operating room on surgical team communication patterns: Does the type of interruption matter? Paper presented at the 9th International Meeting on Behavioural Sciences Applied to Surgery and Acute Care Settings, 9th and 10th October, 2015, Bonn, Germany. 2015
Best poster award: Tschan, F., Semmer, N.K., Keller, S., Huber, S.A., Kurmann, A., Candinas, D., & Beldi, G., (2015, October). The team process influences surgeon's predictions of future complications. An observational study. Poster presented at the 9th International Meeting on Behavioural Sciences Applied to Surgery and Acute Care Settings, 9th and 10th October, 2015, Bonn, Germany. 2015

Associated projects

Number Title Start Funding scheme
138273 Relating human factor aspects during surgery to surgical site infection 01.03.2012 Interdisciplinary projects

Abstract

Primary goal: To test the effects of short intrasurgical briefings on patient outcomes (surgical site infections [SSI] , mortality) in a clinical intervention study.Secondary goal: To investigate the effects of intrasurgical briefings on intrasurgical communication, team informedness and quality of teamwork in an observational study. Rationale: To improve patient safety and minimize the risk of iatrogenic harm is a priority in healthcare. SSI is the most frequent, and a very costly, complication after surgery. In a previous study, we established the methodology for intraoperative observations and observed significant relationships between intrasurgical communication and SSI. In particular, we found that increased case-relevant communication during the procedure was associated with a reduction in organ/space SSI, whereas more case-irrelevant communication during the closing phase of the procedure was associated with an increase of incisional SSI. These findings are interpreted in light of previous studies showing that explicit task-relevant communication fosters the development of shared mental models in the team, which facilitates coordination. Conversely, task-irrelevant communication seems to divert attention. Methods: This multicenter prospective two-arm observational study uses an interrupted time-series approach and will be performed in five clinical departments in Switzerland. Data of about 4000 surgeries per year will be included. Baseline measures are performed during 9 months, followed by one month of intervention (introduction and training), which is followed by an evaluation of the intervention during 9 months per center. The intervention comprises clinically applicable, short intrasurgical briefings that foster the exchange of case-relevant communication during surgeries without interfering with the surgical task. A short (2 min) structured team briefing intervention with the acronym StOP? (Status, Objectives, Problems, Questions) will be introduced at specific points of the procedure (after exposing the organs; after team member changes; before closure). Briefings will be accompanied by structural changes in the operating room (transparent draping and delaying the cleaning at the end of the operating) that should improve communication. Pilot trials confirmed the feasibility of the intervention. The secondary goal will be investigated by a study that directly observes communication and teamwork in the OR in comparable surgeries before and after the intervention. About 160 surgeries will be observed.Significance: The study design allows addressing a clinically relevant outcome parameter. We expect that short intrasurgical briefings will - similar to a preoperative time-out - improve quality of surgery, thereby reducing patient complication rates. The project investigates specific aspects of intrasurgical communication and the consequences of attention-focusing interventions on communication patterns in complex tasks of multidisciplinary teams. Interdisciplinary cooperation between medicine and psychology is a prerequisite for this study, because medical and behavioral data will be addressed simultaneously, and the study is based on medical and psychological knowledge.
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