STRESS AND OUTCOMES

The relationship of the emotional climate of work and threat to patient outcome in a high-volume thoracic surgery operating room team -- Nurok et al. -- BMJ Quality and Safety

Although I am usually sceptical about touch feely nursy qualitative research papers and although I think the interpretation of the findings in this paper is wrong, I still think the paper is worth a mention  - only because this team is making an attempt to study the effects of what they call the emotional climate in the operating room. There is no doubt that outcomes after complex surgical procedures that involve
several teams are better if control of the situation is retained. A complex high risk cardiac surgical operation is the perfect model to study this. Many teams are involved - scrub nursing team, the anaesthetists, the perfusionists and of course the surgical team. There is sometimes a low but realistic possibility of a horrible adverse event such as uncontrollable major haemorrhage or an on-table death. Stress levels can be painfully and unbearably high. Effective communication between teams in the operating room has now been accepted as being of importance  - the recently introduced WHO check list serves not only as a checklist of necessary procedures but contributes to effective communication between members of the team. The Royal Colleges of Surgeons now run courses on team work in fully equipped mock operating theatre. The aviation industry realised decades ago that a strict hierarchical system in the cockpit together with what the authors would describe as a 'poor emotional climate' contributed to accidents and loss of life. Team resource management training is now compulsory in the major airlines. Although the old fashioned hierarchical system is frowned upon, members of the team still look to the operating surgeon for leadership and guidance. Leadership training for surgical trainees is currently inadequate and needs to improve if newly appointed consultants do not want to find themselves at the wrong end of disciplinary action.