Changing Operating Room Culture: Implementation of a Postoperative Debrief and Improved Safety Culture

World Neurosurg. 2017 Nov;107:597-603. doi: 10.1016/j.wneu.2017.08.090. Epub 2017 Aug 24.


Background: Patient safety is foundational to neurosurgical care. Postprocedural "debrief" checklists have been proposed to improve patient safety, but data about their use in neurosurgery are limited. Here, we implemented an initiative to routinely perform postoperative debriefs and evaluated the impact of debriefing on operating room (OR) safety culture.

Methods: A 10-question safety attitude questionnaire (SAQ) was sent to neurosurgical OR staff at a major academic medical center before and 18 months after the implementation of a postoperative debriefing initiative. Rates of debrief compliance and changes in attitudes before and after the survey were evaluated. The survey used a Likert scale and analyzed with standard statistical methods.

Results: After the debrief initiative, the rate of debriefing increased from 51% to 86% of cases for the neurosurgery service. Baseline SAQ responses found that neurosurgeons had a more favorable perception of OR safety than did anesthesiologists and nurses. After implementation of the postoperative debriefing process, perceptions of OR safety significantly improved for neurosurgeons, anesthesiologists, and nurses. Furthermore, the disparity between nurses and surgeons was no longer significant. After debrief implementation, neurosurgical OR staff had improved perceptions of patient safety compared with surgical services that did not commonly perform debriefing. Debriefing identified OR efficiency concerns in 26.9% of cases, and prevention of potential adverse events/near misses was reported in 8% of cases.

Conclusions: Postoperative debriefing can be effectively introduced into the OR and improves the safety culture after implementation. Debriefing is an effective tool to identify OR inefficiencies and potential adverse events.

Keywords: Checklist; Debriefing; Efficiency; Operating room communication; Patient safety; Postoperative debrief; Safety.

MeSH terms

  • Attitude of Health Personnel
  • Checklist
  • Humans
  • Neurosurgical Procedures / standards
  • Neurosurgical Procedures / trends*
  • Operating Rooms / trends*
  • Organizational Culture*
  • Patient Safety / standards*
  • Postoperative Period
  • Quality of Life
  • Safety Management / standards
  • Safety Management / trends