Lack of shared mental model in cardiac surgical team members may contribute to errors

Editor's Note

Cardiac surgical team members recognize distinct critical time points during cardiac surgery, but a high degree of variability exists between members as to the importance of these times, which suggests an absence of a shared mental model, this study finds.

Cardiac team members from three institutions developed a list of critical time points, which were subsequently assigned to 12 pause point (PP) categories. The PPs identified by the highest number of team members were:

• before surgical incision
• before aortic cannulation
• before cardiopulmonary bypass (CPB) initiation
• before CPB separation
• at time of transfer of care from the OR to the ICU.

There was low response variability among ratings for "before surgical incision;" moderate variability for "before separation from CPB," "before transfer from OR table to bed," and "at time of transfer from OR to ICU staff;" and high response variability for the remaining PPs. In addition, the perceived importance of each of these PPs varied between disciplines and institutions.

A lack of a shared mental model could be a factor contributing to preventable errors in cardiac ORs, the authors say.

BACKGROUND: The cardiac operating room is a complex environment requiring efficient and effective communication between multiple disciplines. The objectives of this study were to identify and rank critical time points during the perioperative care of cardiac surgical patients, and to assess varia...