MCIC Perioperative InitiativeMCIC Perioperative InitiativeFebruary 14, 2006February 14, 2006

Operating Room BriefingsOperating Room Briefings

Briefing Defined

• A briefing is a discussion between two or more people, often a team, using succinct information pertinent to an upcoming event or procedure.

What a Briefing does?

1. Map out the plan of care.

2. Identify Roles and Responsibilities for each team member .

3. Heightens awareness of the situation.

4. Allows the team to plan for the unexpected.

5. Team members needs, and expectations are met.

Briefings Enhance Situational Awareness

• Our ability to have the same understanding of what is occurring during the procedure, and to focus on:

Preparation/ planning and vigilanceWorkload distributionDistraction Avoidance

Effective Briefings

Sets the tone for the day…… organized and efficient versus chaotic

• Encourages participation by all team members• Owned by all team members• Organized in thought regarding the procedure• Establishes competence- who has what skills

who performs what

• Predicts what will happen later• Plans for the unexpected-Contingency Plan (include

equipment, medications, consults)

Communication Techniques

• Use names, make introductions.

• Make “eye contact” with all members of the team.

• Clear and concise language

• Active listening.

• Positive nonverbal-approachable, open.

When to Conduct Briefings

Prior to any procedure.

Beginning of the Day- Morning Briefing (separate tool)

Situational – change in patient status results in deviation from the plan of care

Reporting-off- breaks, shift change

Consider Briefings

–Fatigue or Staffing Challenges–New or change in Team

Members–Experienced and Novices

working side-by-side–Cultural differences

The OR Briefing

1. Introduction of First names and Roles

2. TIME OUT- Review Critical Information

□ Do we have the correct patient?

□ Is the correct side or site marked?

□ Has procedure been agreed upon?

□ Have antibiotics been given?

Surface and Mitigate Hazards

Nursing- Discuss all relevant issues:

• Are all the necessary instruments available?

• Will any specific equipment be considered/needed?

• Plans for break ( New nurse should introduce themselves upon switching)

Surface and Mitigate Hazards

Surgery- Discuss plan for the surgical procedure:• Describe critical steps• Provide the team with pertinent information,

including problems that may be encountered.• Ask team: If something were to go wrong with

this procedure, how could we prevent harm?• Ask Team: Does everyone know how to use the

equipment?

Surface and Mitigate Hazards

Anesthesiology- Discuss all relevant issues:

• Patient comorbid disease that will increase risk.

• Aspects of surgery that increase that risk.

• Availability of Blood Products?

• Interventions to prevent complications such as myocardial infarction or surgical site infection.

END of Briefing

• Surgeon states: “If anyone has a concern during the case, please let me know.”

Briefing-Simplicity in Signing-out:

The Tool:

Why is this patient here?

What are the key issues with this patient?

What am I most worried about?

Tools for Team Use

• AM OR Suite Briefing– Structured tool to assist anesthesia coordinator and charge

nurse to anticipate problems, increase efficiency and improve patient flow

• Debriefing Tool– Facilitates learning from factors that positively or

negatively impacted complications or adverse events in a specific case

• Shadowing Tool– Provides structured approach to identify communication

and collaboration patterns to be improved