L. Mazur1,2, C. Michell1, L. Butler1, S. Lashani1, A. Kozlow1, C. Greenberg3, L. Marks4,5, T. Ivester5, J. H. Ra6 2University Of North Carolina At Chapel Hill, School Of Information And Library Science, Chapel Hill, NC, USA 3University Of North Carolina At Chapel Hill, Department Of Surgery, Chapel Hill, NC, USA 4University Of North Carolina At Chapel Hill, Department Of Radiation Oncology, School Of Medicine, Chapel Hill, NC, USA 5University Of North Carolina At Chapel Hill, UNC Health, Chapel Hill, NC, USA 6University Of North Carolina At Chapel Hill, Division Of Acute Care Surgery, Department Of Surgery, School Of Medicine, Chapel Hill, NC, USA 1University Of North Carolina At Chapel Hill, Division Of Healthcare Engineering, School Of Medicine, Chapel Hill, NC, USA
Introduction: Foundations of patient safety in the operating rooms (ORs) are reliable safety behaviors as proposed by Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS) practices. The objective of this pilot study was to evaluate the association between an innovative virtual reality (VR) based training on patient safety and TeamSTEPPS behaviors in the operating rooms (ORs) using a validated Teamwork Evaluation of Non-Technical Skills (TENTS) instrument.
Methods: From 10/31/2022 to 02/21/2023 and from 4/17/23 to 8/10/23, 120 surgical cases were observed as part of a pre- vs. post-analysis of our educational intervention. Pre-intervention, 83 physicians (35 attendings, 41 residents, and 7 fellows; 36 female and 47 male) undergo 101 pre-intervention observations and scoring using the TENTS tool. 10 out of 83 (12%) physicians (7 attendings and 3 residents; 5 female and 5 male) volunteered to undergo the immersive VR-based training intervention focused on TeamSTEPPS behaviors and undergo 19 post-intervention observations and scoring using the TENTS tool. Mean scores of each TENTS behavior were calculated with 95% confidence intervals and compared (pre- vs. post-intervention) using analysis of variance (ANOVA; with significance level set at 0.05, two-tailed; with Bonferroni adjustments for multiple comparisons). The primary outcome measure was the observed safety behaviors quantified using the TENTS instrument (including 20 types of safety behaviors scored from 0 = expected but not observed, 1 = observed but poorly performed or counterproductive, 2 = observed and acceptable, and 3 = observed and excellent). Categories of patient safety behaviors included communication, leadership, situation monitoring, and mutual support.
Results: Pre-intervention, all safety behaviors averaged slightly above 2 (range 2.0-2.3), with an overall average of 2.2. Post-intervention, the 10 physicians that underwent our VR-based education showed significant improvements (p<0.0001; Figure 1) in 60% (12/20) of safety behaviors, with an overall average of 2.6 (range 2.3-3.0).
Conclusion: VR-based immersive training intervention focused on TeamSTEPPS behaviors seems effective in improving safety behaviors as quantified by the TENTS tool. Given the persistent patient safety incidents in ORs nationwide (estimated at ≈ 4000 preventable harmful surgical errors per year), innovative and immersive patient safety education programs reduce may offer a scalable interventions, with a long-term goal of reducing patient harm. Additional research must be conducted with larger sample size to establish generatability of our findings.
