A multi-method exploration of surgical incidents in UK context: causes, impact, support, and learning.

Abstract

Introduction: Surgical incidents are events that occur during a surgical or invasive procedure in an operating theatre. When an incident happens, priority is rightly given to supporting the patient and their family. These incidents can also have a profound negative impact on the healthcare professionals involved.
Aim: The overall aim of this PhD programme of work was to explore the impact of surgical incidents on operating theatre staff, what factors might have contributed to their occurrence, and how staff could be better supported following such events.
Methods: The thesis is comprised of four stages. The researcher conducted a systematic review of the of the psychological, emotional, and behavioural impacts of surgical incidents on operating theatre staff (stage one). A second systematic review was carried out to explore what practical tools might help teams deconstruct and learn from safety incidents in various high reliability organisations and whether those tools could be adapted for use in the healthcare system (stage two). The researcher also conducted a retrospective review of surgical incidents to identify what factors might have contributed to the occurrence of serious surgical incidents at a large London NHS Trust (stage three). The researcher then conducted the first qualitative study in the UK to explore the personal, professional, and behavioural impact of surgical incidents on operating theatre staff (both medical and non-medical) and how they could be better supported following a surgical event (stage four).
Results: The researcher found a significant knowledge gap around what structured support systems were currently in place to support theatre staff involved in surgical incidents (stage one). The second systematic review (stage two) revealed how high reliability organisations such as aviation and military use various learning tools such as debriefing, simulation, crew resource management and reporting systems to disseminate safety messages to their staff. The researcher found the following factors, including the task, equipment and resources, teamwork, work environmental, and organisational and management, contributed to the occurrence of surgical incidents (stage three). Theatre protocols were also found to be either unavailable, outdated, or not followed correctly. The lack of effective communication within multidisciplinary teams, and inadequate medical staffing levels were perceived to have also contributed. The researcher conducted 45 interviews with medical and non-medical operating staff (stage four), who emphasised the importance of receiving personalised support soon after the incident. Theatre staff described how the first “go to” person was their peers and reported feeling comforted when their peers empathised with their own experience(s). Other participants found it very difficult to receive support, perceiving it as a sign of weakness. Although family members played an important role in supporting second victims, some participants felt unable to discuss the incident with them, fearing that they might not understand. This study further highlighted unfairness during the investigation process in the treatment of non-medical theatre staff.
Discussion and Conclusion: This study revealed the need for clear support structures to be put in place for theatre staff who have been involved in surgical incidents. Healthcare organisations need to offer timely support to front-line staff following these incidents. They need to encourage multidisciplinary team investigation process to promote fairness and transparency. Senior clinicians should be proactive in offering support to junior colleagues and empathise with their own experiences, thus shifting the competitive culture to one of openness and support. Healthcare organisations should find ways to adapt the learning tools or initiatives used in high reliability organisations following safety incidents. However, the way these tools or initiatives are implemented is critical and so further work is needed to explore how to successfully embed them into healthcare organisations.