Aliya Ramjaun, MD, CFPC; Melanie Hammond Mobilio, MA; Nicole Wright, MA; Maria Masella, MN; Adam Snyman, MD, FRCPC; Cyril Serrick, MSc, CPC, CCP; Carol-anne Moulton, MD, PhD.

The surgical safety checklist has been credited with improving team situation awareness in the operating room. While the surgical safety checklist may support team situation awareness at the outset of the operative case, intraoperative handoff provides an opportunity for either situation awareness breakdown or, more preferably, situation awareness reinforcement. High-functioning surgical teams demonstrate a high level of continued situation awareness, whereas teams deficient in situation awareness are more likely to be affected by surgical errors and adverse events. To date, no interprofessional intraoperative tools exist to support team situation awareness beyond the surgical safety checklist.

This study was divided into two phases. The first employed qualitative methods to 1) characterize intraoperative handoff processes across surgery, nursing, anesthesia, and perfusion, and 2) identify cultural factors that shaped handoff practices. Data for phase one were collected over 38 observation days and 41 brief interviews. Phase two, informed by phase one, used a modified Delphi process to create a tool for use during intra-operative handoff. Data were analyzed iteratively.

We found that handoff practices were not standardized and rarely involved the entire team. In addition we uncovered cultural factors—specifically assumptions held by participants—that hindered team communication during handoff. Assumptions included: 1) team members are interchangeable, 2) trained individuals are able to determine when it is appropriate to handoff without consulting the OR team. Despite claims of improved teamwork resulting from the surgical safety checklist, many participants held a fragmented view of the OR team, resulting in communication challenges during handoff. Findings from both phases of our study informed the development of multidisciplinary intraoperative handoff tools to facilitate shared team situation awareness and a shared mental model.

Intraoperative handoff occurs frequently, and offers the opportunity for either renewed or fractured team situation awareness beyond the Surgical Safety Checklist.