Terhi Korkiakangas

Communication in the operating theatre.

Communication is extremely important to ensure safe and effective clinical practice. A systematic literature review of observational studies addressing communication in the operating theatre was conducted. The focus was on observational studies alone in order to gain an understanding of actual communication practices, rather than what was reported through recollections and interviews.

Communication in the operating theatre: A systematic literature review of observational research

Communication is extremely important to ensure safe and effective clinical practice. A systematic literature review of observational studies addressing communication in the operating theatre was conducted. The focus was on observational studies alone in order to gain an understanding of actual communication practices, rather than what was reported through recollections and interviews.

Microanalysis of video from the operating room: an underused approach to patient safety research

Video recording technologies offer a powerful way to document what happens in clinical areas.1 Cameras, and to a lesser extent, microphones, can be found in a growing number of modern operating rooms in the USA, UK and other parts of the world. While they could be used to create a detailed record of what happens in and around the operating table, this is still rarely being done; the vast majority of operations are still only documented in written operation notes. When operations are being recorded, it is primarily for educational purposes: for instance, to broadcast a live feed of a surgical demonstration to a remote audience; to provide an ‘adjunct’ to live observation;2 to collect authentic footage for edited, instructional videos on a surgical technique or procedure; to facilitate video enhanced debriefing and coaching; or to formally assess surgical skills. Recently, Makary et al 1 ,3 have proposed that video equipment in the operating room could be used as an auditing tool. They also argue that making video recording a routine occurrence would improve performance and make surgical care more transparent. They propose that a video archive of operations could prove useful for surgeons preparing to operate on a patient who had been operated on before—to check the anatomy and density of adhesions for example. It has also been suggested that when used routinely, video could be used to investigate adverse events.4–6 What has gone relatively unnoticed in these recent discussions about the potential of video in the operating room is the possibilities it opens up for empirical research . While videos can only provide a partial representation of what happened and are always open to interpretation, they do provide a relatively objective, shareable point of reference. Using video, clinical events can be looked at from …

Mobilising a team for the WHO Surgical Safety Checklist: a qualitative video study

Background One challenge identified in the Surgical Safety Checklist literature is the inconsistent participation of operating teams in the safety checks. Less is known about how teams move from preparatory activities into a huddle, and how communication underpins this gathering. The objective of this study is to examine the ways of mobilising teams and the level of participation in the safety checks. Methods Team participation in time-out and sign-out was examined from a video corpus of 20 elective surgical operations. Teams included surgeons, nurses and anaesthetists in a UK teaching hospital, scheduled to work in the operations observed. Qualitative video analysis of team participation was adapted from the study of social interaction. Results The key aspects of team mobilisation were the timing of the checklist, the distribution of personnel in the theatre and the instigation practices used. These were interlinked in bringing about the participation outcomes, the number of people huddling up for time-out and sign-out. Timing seemed appropriate when most personnel were present in the theatre suite; poor timing was marked by personnel dispersed through the theatre. Participation could be managed using the instigation practices, which included or excluded participation within teams. The factors hindering full-team participation at time-out and sign-out were the overlapping (eg, anaesthetic and nursing) responsibilities and the use of exclusive instigation practices. Conclusions The implementation of the Surgical Safety Checklist represents a global concern in patient safety research. Yet how teams huddle for the checks has to be acknowledged as an issue in its own right. Appropriate mobilisation practices can help bringing fuller teams together, which has direct relevance to team training.

The Sally-Anne test: an interactional analysis of a dyadic assessment.

BACKGROUND The Sally-Anne test has been extensively used to examine childrens theory of mind understanding. Many task-related factors have been suggested to impact childrens performance on this test. Yet little is known about the interactional aspects of such dyadic assessment situations that might contribute to the ways in which children respond to the test questions. AIMS To examine the interactional factors contributing to the performance of two children in the Sally-Anne test. To identify the interactional practices used by the tester administering the task and to describe how interactional features can pose challenges in the critical belief and reality questions for both the tester and the testee. METHODS & PROCEDURES The Sally-Anne test was carried out as part of a project examining childrens interactions in a technology-enhanced environment. The present study uses video recordings of two children with communication disorders (one with a current diagnosis of autism spectrum disorder [ASD]) and an adult tester. We draw on a multimodal approach to conversation analysis (CA) to examine the sequential organization of the test questions and answers. OUTCOMES & RESULTS The children drew on diverse resources when producing responses to the test questions: responding verbally, pointing or manually handling objects. The tester treated these responses differently depending on how they were produced. When the child pointed at an object and verbally indicated their response, the tester moved on to the next question apparently accepting the childs answer. When the child manually handled an object or produced a quiet verbal response, the tester repeated the question indicating that the childs actions did not constitute an adequate response to a test question. In response to this, both children modified or changed their previous responses. Through monitoring each other, the tester and the child produced actions highly responsive to the features of each others conduct, which underpinned the conduct of the test itself. CONCLUSIONS & IMPLICATIONS Childrens responses in the test might not be solely indicative of socio-cognitive capacities but also show orientation to interactional nuances. The study proposes that children can demonstrate diverse ways of responding to questions, yet testers may treat these as test-irrelevant behaviours if they do not correspond to the scoring criteria. A video-based CA study can broaden our understanding of childrens pragmatic competencies in responsiveness that may not always embody an expected form. This can have implications for the development of future assessment tasks and revision of existing scoring practices.

An interactional “live eye tracking” study in autism spectrum disorder: combining qualitative and quantitative approaches in the study of gaze

ABSTRACT Recent studies on gaze behaviours in individuals with autism spectrum disorder (ASD) have utilised “live eye tracking.” Such research has focused on generating quantitative eye tracking measurements, which provide limited (if any) qualitative contextual details of the actual interactions in which gaze occurs. This article presents a novel methodological approach that combines live eye tracking with qualitative interaction analysis, multimodally informed conversation analysis. Drawing on eye tracking and wide-angle video recordings, this combination renders visible some of the functions, or what gaze “does,” in interactional situations. The participants include three children with ASD and their adult co-participants during body-movement gaming sessions. The article demonstrates how quantitative eye tracking research can be extended qualitatively using a microanalytic interaction analysis to recontextualise the gaze shifts identified. The findings in this article show that the co-participants treat a child’s gaze shifts differently depending on when these occur in a stream of other action. The study suggests that introducing this qualitative dimension to eye tracking research could increase its ecological validity and offer new insight into gaze behaviours in ASD.