S. Ogunnowo1, L. Hoefer2, W. McKinley2, A. Polcari2, S. Estime3, P. Angelos2, J. Cone2 1University Of Chicago, Pritzker School Of Medicine, Chicago, IL, USA 2University Of Chicago, Department Of Surgery, Chicago, IL, USA 3University Of Chicago, Department Of Anesthesia And Critical Care, Chicago, IL, USA
Introduction: Understanding the surgeon-anesthesiologist dyad and the process of decision making in the operating room remains crucial to the delivery of high-quality care. Little is known about the intraoperative decision-making process of both surgeons and anesthesiologists. Thus, we aimed to describe the dynamics between surgeon-anesthesiologist dyads to identify strengths and weaknesses that can be leveraged to improve intraoperative communication.
Methods: Semi-structured interviews were performed with attending trauma surgeons (n=10) and anesthesiologists (n=10) at a single urban level 1 trauma center. Interviews focused on high-acuity trauma resuscitations involving ultra-massive transfusion as a representative case that requires constant communication and real-time, high-stakes decision making by both parties. Interviews were transcribed and inductively coded using Grounded Theory Methodology by two reviewers. Codes were analyzed in NVIVO to generate themes.
Results: Within the operating room, both surgeons and anesthesiologists recognize the importance of open and continuous communication to ensure quality care but decision-making can differ based on the goals and expectations of each party. Three major themes emerged: (1) surgeons focus on technical aspects of the case and tend to be more optimistic about achieving good outcomes for the patient in front of them (2) anesthesiologists report being more conscious of resource limitations but are aware they rarely get to follow patients through to discharge and lack longitudinal relationships, and (3) surgeons are given the final decision to continue care based on their “hands on” understanding of the problem. Both sides agree that while stressors can make communication difficult in the OR, there needs to be space to acknowledge intentions, provide opinions and cultivate an atmosphere of trust and respect.
Conclusion: For surgeons and anesthesiologists, decisions about high-acuity, high-stakes trauma care are not undertaken lightly. Efforts to improve the working relationship and communication between surgeons and anesthesiologists benefit from understanding actual and perceived goals of each party. Ultimately, the surgeon-anesthesiologist relationship benefits from a shared sense of trust, respect, and communication.