Anne van Dalen

118 I Chapter 4 ABSTRACT Introduction: Surgical errors often occur due to human factors related issues. A medical data recorder (MDR) may be used to analyze human factors in the operating room (OR). The aims of this study were to assess intraoperative safety threats and resilience support events by using an MDR. And, to identify frequently discussed safety and quality improvement issues during structured postoperative multidisciplinary debriefings using the MDR outcome report. Methods: In a cross-sectional study, 35 standard laparoscopic procedures were performed and recorded using the MDR. Outcome data was analyzed using the automated Systems Engineering Initiative for Patient Safety (SEIPS) model. The video- assisted MDR outcome report reflects on safety threat and resilience support events (categories: person, tasks, tools and technology, psychical and external environment, and organization). Surgeries were debriefed by the entire team, using this report. Qualitative data analysis was used to evaluate the debriefings. Results: A mean of 52.5 (SD 15.0) relevant events were identified per surgery. Both resilience support and safety threat events were most often related to the interaction between persons (272 out of 360 versus 279 out of 400). During the debriefings, communication failures (also category person) were the main topic of discussion. Conclusions: Patient safety threats identified by theMDR and discussed by theOR team were most frequently related to communication, teamwork and situational awareness. To create an even safer operating culture, educational and quality improvement initiatives should aim at training the entire operating team, as it contributes to a shared mental model of relevant safety issues.