title: Building shared situational awareness in surgery through distributed dialog.
abstract: BACKGROUND
  Failure to convey time-critical information to team members during surgery diminishes members' perception of the dynamic information relevant to their task, and compromises shared situational awareness. This research reports the dialog around clinical decisions made by team members in the time-pressured and high-risk context of surgery, and the impact of these communications on shared situational awareness.
  
  
  METHODS
  Fieldwork methods were used to capture the dynamic integration of individual and situational elements in surgery that provided the backdrop for clinical decisions. Nineteen semistructured interviews were performed with 24 participants from anesthesia, surgery, and nursing in the operating rooms of a large metropolitan hospital in Queensland, Australia. Thematic analysis was used.
  
  
  RESULTS
  The domain "coordinating decisions in surgery" was generated from textual data. Within this domain, three themes illustrated the dialog of clinical decisions, ie, synchronizing and strategizing actions, sharing local knowledge, and planning contingency decisions based on priority.
  
  
  CONCLUSIONS
  Strategies used to convey decisions that enhanced shared situational awareness included the use of "self-talk", closed-loop communications, and "overhearing" conversations that occurred at the operating table. Behaviors that compromised a team's shared situational awareness included tunneling and fixating on one aspect of the situation.
authors: NHMRC Research Centre for Clinical Excellence in Nursing Interventions for Hospitalised Patients (NCREN) and Research Centre for Clinical and Community Practice Innovation (RCCCPI), Griffith Health Institute, Griffith University, Queensland.
authors: Brigid M
authors: BM
authors: Gillespie
authors: Karleen
authors: K
authors: Gwinner
authors: Nicole
authors: N
authors: Fairweather
authors: Wendy
authors: W
authors: Chaboyer
keywords: distributed dialog; shared situational awareness; surgery
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