Defining critical and non-critical moments in the Operating Room: Protocol for a modified Delphi study

Abstract

Background: Many advances in perioperative patient safety have been inspired by the aviation industry. One key protocol from aviation that has yet to be formally established in the operating room (OR) is the ‘sterile cockpit’ rule, which prohibits all non-essential behavior and actions during critical phases of a flight. It has been suggested that the application of a sterile cockpit rule to healthcare could have similar benefits for patient safety;1,2 yet, it remains unclear as to which phases of the surgical process are the most critical.

Methods: After ethical approval, we will use a modified Delphi method to identify the critical moments of the surgical process according to OR team members across institutions, professions and specialties. Providers will be asked to identify the critical moments of surgery relevant to their professional perspective. At least 140 participants will be recruited, with iterative web-based surveys administered. Analysis and consensus will take place after each round. The stopping criterion will be either consensus on 80% of the survey items or no change in the mean score for any individual item between two consecutive rounds among each profession.

Significance: Defining critical moments during surgery will allow future research to determine the relative importance of behavior and actions at each stage. This can potentially enhance the effectiveness of future interventions by enabling the most important moments to be targeted. As a result, interventions to reduce medical errors linked to poor surgical patient outcomes may be greatly enhanced.