Development and evaluation of an observational tool for assessing surgical flow disruptions and their impact on surgical performance

World J Surg. 2010 Feb;34(2):353-61. doi: 10.1007/s00268-009-0312-z.


Background: Many researchers have previously explored the correlation between surgical flow disruptions and adverse events in cardiac surgery; however, there is no reliable tool to prospectively categorize surgical flow disruptions and the conditions that predispose a surgical team to adverse events.

Methods: Two independent raters of different medical and human factors expertise observed 12 cardiovascular operations and iteratively designed a surgical flow disruption tool (SFDT) to characterize surgical flow disruptions and the latent factors that contribute to adverse events. Categories to characterize surgical flow disruptions were created based on human factors models of human error. After the design period, both raters observed ten surgical cases using the tool to assess validity and inter-rater reliability.

Results: Rating agreement (weighted kappa) for each category across the ten surgeries was moderate to very high, resulting in strong inter-rater reliability for each category on the surgical flow disruption tool. Use of the SFDT was simple and clear for observers of diverse backgrounds, including human factors experts and medical personnel.

Conclusions: This research depicts the development and utility of a tool to analyze surgical flow disruptions in the cardiovascular operating room with satisfactory inter-rater reliability. This tool is an important first step in systematically categorizing and measuring surgical flow disruptions and their impact on patient safety in the operating room.

Publication types

  • Evaluation Study

MeSH terms

  • Cardiovascular Diseases / surgery*
  • Cardiovascular Surgical Procedures / adverse effects*
  • Cardiovascular Surgical Procedures / statistics & numerical data
  • Causality
  • Humans
  • Medical Errors / classification*
  • Medical Errors / prevention & control
  • Medical Errors / statistics & numerical data
  • Observation
  • Operating Rooms
  • Patient Care Team / standards
  • Patient Care Team / statistics & numerical data
  • Safety Management
  • Task Performance and Analysis
  • Time Management
  • Workload*