Anne van Dalen

3 Implementing structured team debriefing using a Black Box in the operating room I 101 of the patient, theORBlack Box®capture of data started when the teamstarted draping, when the patient was hence already under anaesthesia. Recordings were stopped before extubation. Thus, the assumed-to-be more critical moments in anaesthesiology care were not part of the performance report and could not be debriefed using the outcome report. Nevertheless, technical aspects were not the main learning points according to user insights from both surgeons and anaesthesiologists. Take-home-messages, noted during the team debriefing sessions from the anaesthesiologists, were mainly about communication patterns, such as “clear and closed-loop communication is important” and “I should be more specific when asking the surgeon”. In fact, miscommunication has been implicated as one of the major causes of error and adverse outcomes in general surgery. 10, 11 Indeed, these learning aspects need to be taking into account when training surgical teams, which is usually not the case in the separate specialist curricula to date. Authors feel there is an opportunity here for improvement. Apart from training teams in simulative settings jointly, use of the OR Black Box® in team debriefing to look back upon joint performance may help strengthening the surgical safety culture. This, because the OR Black Box® performance report has been built focusing on those aspects regarded to be especially important for joint performance; being human factor skills, like communication and teamwork, next to technical error. 50 Postoperative multidisciplinary debriefing, with the use of the performance report, may hence contribute to prevention of unintentional miscommunication in the OR, especially between the surgeons and anaesthesiologists. 51 Taking into account the different busy work schedules and irregular shifts, planning the team debriefing sessions was difficult sometimes. However, the number of working days between procedure and debriefing session, and number of attending team members did not seem to affect the participant’s satisfaction. Nevertheless, it was decided to reschedule the session, when not enough team members could attend (4 out of 7) to persevere the benefits of multiple viewpoints in the discussion. Several team members quoted; “because of the Black Box, I was more aware of my communication and this actually improved my way of communicating”. Yet, the performance report showed that there was still some “irrelevant chatting” or “loud