An investigation of differing levels of experience and indices of task management in relation to scrub nurses' performance in the operating theatre: analysis of video-taped caesarean section surgeries.

BACKGROUND: Literature has identified failures in task management as direct determinants leading to accidents in the operating theatre. However, very few studies have investigated the factors underlying task management that directly influence the performance of the scrub nurses. The traditional belief that expertise is a general indicator of performance has been empirically investigated with varying results, but none has attempted to identify the task management determinants affecting performance, as influenced by the level of expertise.

OBJECTIVES: (1) To examine any difference on task management behaviours between differing levels of experience during surgeries. (2) To correlate indices of task management with levels of performance evaluated by subject matter experts.

DESIGN AND SETTING: 10 experienced and 10 novice scrub nurses were randomly selected from the Obstetrics and Gynaecology Department of a teaching hospital in Singapore. All nurses partook in a caesarean section surgery each, and their work processes were recorded via a scene camera donned by themselves.

PARTICIPANTS: 20 scrub nurses.

METHODS: Two human factors experts independently mapped the task management processes onto a task management timeline, where individual tasks were coded, tallied and compared between levels of expertise.

MAIN OUTCOME MEASURES: Reactive task management (task interruptions, task prioritizations), pro-active task management (anticipation, failures in anticipation), SPLINT scores (performance).

RESULTS: Novice nurses showed lower resistance to interruptions during their tasks (58% more interruptions), especially to interruptions which were not triggered by the surgeon during their surgical counts (90% more interruptions). The novice nurses also displayed poorer/less ability to anticipate the surgeons' needs, taking longer time to handover instruments (39% longer) and making more mistakes (371% more errors). Subject matter experts rated the experienced nurses significantly higher in their cognitive non-technical skills performance than the novice nurses (32% higher).

CONCLUSIONS: Experienced nurses performed better than novice nurses in all aspects of task management indices and expert evaluation. This suggested better task management as effected by expertise, displaying better prioritization, planning and awareness. With these findings, it would be easy and useful to draw causal effects that can in turn guide the design of training, leading to a desirable increase in levels of efficiency and patient safety in the operating theatre.