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- Page navigation anchor for RE: The art of the urgent intraoperative consultationRE: The art of the urgent intraoperative consultation
Drs Ball, Dixon, and Harvey describe an approach to the “art” of the urgent intra-operative consultation, urging us to consider the cognitive and social elements that support the operating surgeon. When called for an unplanned intraoperative consultation the visiting surgeon augments the collective ability on two fronts: technical skills and non-technical skills (NTS). It is common for the visiting surgeon to concentrate predominantly on the technical elements, either assisting in a dissection that is proving to be a challenge or facilitating dissection in an anatomic region they specialize in. This is especially true in a controlled, non urgent situation. However, as beautifully outlined in this editorial, in environments of duress (hemorrhage, iatrogenic injury, etc..), it is equally, if not more important for the visiting surgeon to demonstrate proficiency in NTS. The impact of these behaviours can be profound. Deficiencies in NTS are linked to poor surgical outcomes. Canadian Medical Protective Association data reveal that surgical specialists encounter most clinical care issues during the intra-operative phase of care and peer expert criticism, in these files, is often related to a lack of, or loss of situational awareness that results in poor decision making. (1)
We propose replacing “art” with “skill”, shifting the emphasis from innate abilities to more learned and reproducible behaviours. These learnable skills are well described by validated frameworks whi...
Show MoreCompeting Interests: Authors are employed by the CMPA Richard Mimeault, full-time Fady Balaa, part-timeReferences
- 1. Surgical Safety in Canada: A 10-year review of CMPA and HIROC medico-legal data https://www.cmpa-acpm.ca/static-assets/pdf/research-and-policy/system-and-practice-improvement/SSC_Detailed_Analysis_Report-e.pdf
- 2. Flin R, Yule S, Paterson-Brown S, Maran N, Rowley D, Youngson G. Teaching surgeons about non-technical skills. Surgeon. 2007 Apr;5(2):86-9. doi: 10.1016/s1479-666x(07)80059-x. PMID: 17450689.
- 3. https://www.rcsed.ac.uk/media/682516/notss-system-handbook-v20.pdf
- 4. Brommelsiek M, Said T, Gray M, Kanter SL, Sutkin G. Absence or presence: Silent discourse in the operating room and impact on surgical team action. Am J Surg. 2021 May;221(5):980-986. doi: 10.1016/j.amjsurg.2020.09.017. Epub 2020 Sep 19. PMID: 32981652
- Page navigation anchor for RE: TABLE OF THOUGHTS FOR THE INTRAOPERATIVE CONSULTATIONRE: TABLE OF THOUGHTS FOR THE INTRAOPERATIVE CONSULTATION
Table 1: Steps for a successful intraoperative consultation.
- Drop what you are doing to help a colleague.
- Determine the urgency of the consultation request.
- Define the procedure and its goals.
- Before arriving, consider the worst-case scenarios for that particular operation. Prepare.
- Upon arrival, obtain a rapid outline of the problem.
- Be calm.
- If time, review the chart and imaging before scrubbing.
- Assess the well being of the patient and team (surgeon, anesthesia, nurses).
- Determine what your primary role is.
- Define a plan, and reestablish the primary surgeon’s role as the leader of the room.
- Be encouraging and create a culture where calling for help is a good thing.
- Take a broad view of the problem; address big picture issues (exposure, anatomy, more help, surgical plan).
- Determine if further help is needed (e.g. other surgical disciplines).
- If the primary surgeon is in distress, encourage them to step away and take a short break.
- In cases of severe adverse events, the surgeon should be supported in discussing the events with the family.
- Clearly outline the postoperative plan and debrief with the surgeon when they are ready.Competing Interests: None declared.References
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