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The drama in the hybrid OR: Video observations of work processes and staff collaboration during endovascular aortic repair

Journal article
Authors May Bazzi
Solveig M Lundgren
Mikael Hellström
I. Fridh
Karin Ahlberg
Ingegerd Bergbom
Published in Journal of Multidisciplinary Healthcare
Volume 12
Pages 453-464
ISSN 1178-2390
Publication year 2019
Published at Institute of Health and Care Sciences
Institute of Clinical Sciences, Department of Radiology
Pages 453-464
Language en
Keywords Collaboration, Cross case analysis, Hybrid operating room, Tasks, Video recording, Work processes, anesthesiologist, Article, clinical practice, collaborative care team, endovascular aneurysm repair, health care delivery, human, job performance, nurse anesthetist, nursing staff, operating room personnel, patient care, radiographer, safety, surgical technique, videorecording
Subject categories Other Medical Sciences


Introduction: A hybrid operating room (OR) is a surgical OR with integrated imaging equipment and the possibility to serve both open surgery and image-guided interventions. Aim: This study aimed to investigate the work processes and types of collaboration in a hybrid OR during endovascular aortic repair (EVAR). Methods: Data consisted of video recordings from nine procedures, with a total recording time of 48 hrs 39 mins. The procedures were divided into four episodes (Acts). A qualitative cross-case analysis was conducted, resulting in a typical case. The type of collaboration during specific tasks was discussed and determined based on Thylefors' team typology. Results: An extensive amount of safety activities occurred in the preparation phase (Acts 1 and 2), involving a number of staff categories. After the skin incision (Act 3), the main activities were performed by fewer staff categories, while some persons had a standby position and there were persons who were not at all involved in the procedure. Discussion: The different specialist staff in the hybrid OR worked through different types of collaboration: multi-, inter-and transprofessional. The level of needed collaboration depended on the activity performed, but it was largely multiprofessional and took place largely in separate groups of specialties: anesthesiology, surgery and radiology. Waiting time and overlapping tasks indicate that the procedures could be more efficient and safe for the patient. Conclusion: This study highlights that the three expertise specialties were required for safe treatment in the hybrid OR, but the extent of interprofessional activities was limited. Our results provide a basis for the development of more effective procedures with closer and more efficient interprofessional collaboration and reduction of overlapping roles. Considerable waiting times, traffic flow and presence of people who were not involved in the patient care are areas of further investigation. © 2019 Bazzi et al.

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