Anne van Dalen

122 I Chapter 4 Outcome and data collection measures The primary outcome focused on using the MDR to identify relevant safety threat and resilience support events in surgery, based on validated rating scales. The specifically for laparoscopic surgery modified and validated SEIPS model was used. 7 12 The modified SEIPS model utilizes over 100 inductively developed codes, related to each of the 6 above mentioned categories; person, tasks, tools and technologies, organization, internal (physical) environment, and external environment. 12 15 A safety threat is in this study defined as any factor that could harm a patient, delay progress, or significantly disrupt the regular workflow. Delay in progress was identified when the surgical analysts saw that no meaningful progress was made during a case. A resilience support reduces the risk of patient harm, prevents a delay or disruption in workflow. The framework considers threats and resilience events from the entire OR workflow system. All events are then characterized in the MDR outcome report according to the categories, subcategories, and the individual SEIPS codes. 7 In Table 2 and 3 all SEIPS categories and subcategories are presented. A full description of the framework can be found Appendix 1. The secondary outcome relates to identifying the most frequently discussed safety and quality improvement issues during the postoperative multidisciplinary debriefing sessions. During the debriefings the video-assisted performance report, including concise qualitative descriptions, were shown to and discussed with the OR team. 28 The study coordinator observed all the debriefing sessions. The study coordinator (AvD) coded (descriptive) the discussed safety threat and resilience support events using the SEIPS category codes in the outcome report. Frequencies of the descriptive codes were reported. Take home messages, feedback, conclusions and general comments of the team members were noted as well and examples are provided.