Situational Awareness in the Operating Room
Have you ever been in a tense situation where someone says something or asks a question that is completely inappropriate? You would be lying if you said you haven’t been. This is something that occurs in the operating room as well, and as you can imagine, it’s pretty awkward. When this happens, it is typically just brushed off a the time, but it says a lot about your situational awareness.
I’ll give some examples of times I’ve experienced someone with a lack of situational awareness. The most recent example was during a laparoscopic hand assisted colon resection, after the surgeon gained access to the peritoneum it was discovered that the cancer had unfortunately metastasized throughout the patient’s abdomen and the surgeon decided we would not be moving forward with the colon resection but would be taking other specimens for pathology. The surgeon was discussing how he wasn’t expecting this and how this ‘hit home’ for him. A nurse in the room, obviously not paying attention, was asking what size GIA loads (stapler load for an intestinal stapler used for resection) she should bring into the room. It was obvious at that point that she was not paying attention to what was going on or that she did not understand what was going on. I informed her that we would not be needing them, and that the cancer had spread too far. She seemed shocked.
This next example I did not directly witness but was charge nurse when it had happened. There was an on-pump CABG going and they were getting ready to cannulate the heart and the scrub asked the nurse if she could check when she’d be getting a lunch. The circulator looked straight at her and told her this was not the time for that discussion. There was an obvious disconnect regarding this critical portion of the procedure.
A very common example is when there is any unexpected bleeding and anyone tries to make small talk or even continue a discussion- if there is something going on unexpectedly, whatever it might be, but especially bleeding- stop the discussion immediately and work together to get it stopped.
Before you try to make small talk, tell jokes, or ask questions not related to the procedure you need to read the room. Assess what’s going on. Understand that sometimes surgeon’s just don’t want to engage in small talk and it’s best to just keep it quiet. I personally enjoy the small talk in the rooms and the discussions that come up during procedures, but I do not enjoy when someone is trying to force it.
The biggest thing to understand about this is that this leads the surgeon and sometimes the rest of the team that you are not competent. This type of behavior does not allow for trust to be built, and that’s so important in the OR. If you are unsure if it’s a good time, it’s likely not.
