Anne van Dalen

4 Analyzing and discussing human factors affecting surgical patient safety I 131 Team effectiveness Irrelevant chatting by the surgical team was discussed. The anesthesia teammembers felt that in general, this was a positive thing as it was interpreted as a sign that the surgeons are “relaxed, not stressed, and that the procedure is going according to plan”. However, sometimes the anesthesiologist was actually rather bothered by the noise. It became clear that when there was irrelevant relaxed chatter, it was more difficult to filter out and hear the surgeon’s questions amidst such chatter. This was not always expressed. Nevertheless, surgeons noted there was sometimes ‘tension on the line’, without understanding the reason for it. Another discussed event was the fact that surgeons proceeded with surgery whilst, upon their request, the anesthesiologist was tilting the operating table. Anesthesiologists commented that he or she would always say out loud; “I ammoving the table up/left/right/down”, but was unable to view the monitor showing the laparoscopic field whilst doing so. Anesthesiologists realized that it was simply assumed by them that if the surgeon does not respond, it is safe to move the table. Yet, this was not always the case. The final count of the gauzes, before the sign-out procedure 1 , was also repeatedly discussed.The scrub nurses commented that this is often a ‘chaotic phase’ as the surgeons are closing up the abdomen often asking for assistance of the nurse, who is then in the middle of completing the count. During the debriefings, the team realized this was an unrecognized issue. The nurses commented they appreciated this recognition and would prefer to have a short ‘pause’ during the count. Nurses also realized, they need to ask for such a ‘time out’ actively, as otherwise, it is likely not to happen.