Anne van Dalen

252 I Summary and General Discussion debriefing uses the outcome report, augmented with objective video-assisted feedback, to moderate the session and ensure the process of a safe, efficient and educational debriefing for the entire surgical team. Future studies are needed to evaluate whether the use of the debrief model in video-assisted team debriefing may actually change the behaviour of the participating teammembers and consequently have a positive impact on the number of adverse events in operating room. Part II: Increasing transparency in the operating room The ORBB was used to record 35 laparoscopic abdominal surgical cases, performed by 4 staff surgeons. The ORBB obtained all intra-operative data feeds, including audio-visual and patient physiologic data from views of the surgical field, nursing station, laparoscopic camera, and anaesthesia station, including the anaesthesia patient-monitoring device. Recording began just after the anaesthesia was administered to the patient and ended after skin closure, just before the sterile drapes were removed. The ORBB outcome report comprised video segments of all relevant identified safety threats and resilience support events, coded according to the validated Systems Engineering Initiative for Patient Safety (SEIPS) framework. 9 The video segments included qualitative descriptions of the event. In total, 18 fundoplications, 6 diaphragmatic hernia repairs, 3 elective appendectomies, 3 subtotal colectomies, 2 unilateral adrenalectomies, 2 bilateral adrenalectomies and 1 sigmoid resection were recorded. In these surgical cases, 4 surgeons, 2 surgical fellows, 12 surgical residents, 6 anaesthesiologists, 5 anaesthesiology residents, 9 anaesthesiology nurses, 27 theatre nurses and 16medical interns participated (N = 81). All 35 cases were debriefed with the team and on average, 4 (out of 7–8) team members (median, IQR 3) was able to attend their team debriefing. After each debriefing, the teammembers were asked to complete a survey. In Chapter 3 the participants’ satisfaction with the ORBB and its outcome report used for structured the postoperative multidisciplinary debriefings was assessed with the use of this survey. In total, 151 surveys were completed. This outcome was chosen because, in order to be able to adopt such an innovative system, people working in the OR need to feel comfortable