Building shared situational awareness in surgery through distributed dialog

Abstract

Brigid M Gillespie,1 Karleen Gwinner,2 Nicole Fairweather,3 Wendy Chaboyer41NHMRC Research Centre for Clinical Excellence in Nursing Interventions for Hospitalised Patients (NCREN) and Research Centre for Clinical and Community Practice Innovation (RCCCPI), Griffith Health Institute, Griffith University, Queensland, 2Griffith Centre for Cultural Research, Griffith University, Queensland, 3Department of Anaesthesiology, Princess Alexandra Hospital, Queensland, Australia, 4Excellence in Nursing Interventions for Hospitalized Patients (NCREN) Research Centre for Clinical and Community Practice INHMRC Centre of Research Innovation (RCCCPI), Griffith Health Institute, Griffith University Queensland, AustraliaBackground: Failure to convey time-critical information to team members during surgery diminishes members' perception of the dynamic information relevant to their task, and compromises shared situational awareness. This research reports the dialog around clinical decisions made by team members in the time-pressured and high-risk context of surgery, and the impact of these communications on shared situational awareness.Methods: Fieldwork methods were used to capture the dynamic integration of individual and situational elements in surgery that provided the backdrop for clinical decisions. Nineteen semistructured interviews were performed with 24 participants from anesthesia, surgery, and nursing in the operating rooms of a large metropolitan hospital in Queensland, Australia. Thematic analysis was used.Results: The domain "coordinating decisions in surgery" was generated from textual data. Within this domain, three themes illustrated the dialog of clinical decisions, ie, synchronizing and strategizing actions, sharing local knowledge, and planning contingency decisions based on priority.Conclusion: Strategies used to convey decisions that enhanced shared situational awareness included the use of "self-talk", closed-loop communications, and "overhearing" conversations that occurred at the operating table. Behaviors that compromised a team's shared situational awareness included tunneling and fixating on one aspect of the situation.Keywords: shared situational awareness, surgery, distributed dialog