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304
A. Kiraly et al.
Thrombin, obtained from bovine serum, can be used to
directly stimulate thrombosis of contained systems, and is
predominantly used in a contained space such as a pseudoaneurysm [7].
Mural Repair
All the embolization techniques described to this point have
shared a common characteristic: they rely on sacricing the
vessel to be treated. Thus, they are not suitable when a vessel
being treated must be preserved. In order to treat a vessel that
must be preserved, such as the aorta, central arteries, or the
major arteries of the extremities, covered stents are often
Fig. 35.4 (a) Iatrogenic
injury of external iliac artery
immediately peripheral to the
bifurcation with brisk active
contrast extravasation
(arrows). (b) Covered stent
within the external iliac with
cessation of extravasation
(open white arrow).
CIAcommon iliac artery, EIA
external iliac artery
a
used [4, 5, 10]. Covered stents are also used in the treatment
of pseudoaneurysms when the anatomy is not favorable for
coil embolization or thrombin therapy [7]. As with traditional stents, covered stents are constructed of a lattice of
metal struts, which either self-expands based on metal memory, or is expanded in place using an angioplasty balloon
(Figs.35.4 and 35.5) [7]. Covered stents however feature an
exclusive synthetic membrane which occludes ow into the
covered branch or mural defect. Covered stents are deployed
quickly and typically occlude the site of bleeding immediately with little chance of becoming displaced and occluding
non-target vessels. As such, they are often used as the treatment of choice for large vessel injuries, such as in the aorta
(Fig.35.6) [11].
b
CIA
EIA
35 Interventional Radiology inTrauma
305
Fig. 35.5 (a) Coronal CTA
demonstrating traumatic
injury with resultant abrupt
occlusion of the left
subclavian artery (arrow). (b)
Angiogram demonstrating
proximal mural injury within
the subclavian (focal luminal
outpouching; arrowhead) and
the abrupt occlusion of the
axillary artery distally
(arrow). (c) Subsequent
angiogram demonstrating
multiple covered stents in the
subclavian and axillary
arteries (solid arrow heads)
a
b
c
Fig. 35.6 (a) Sagittal CTA
demonstrating mural injury of
the proximal descending
aortic arch (black arrow) with
associated intramural
hematoma (white arrowhead).
(b) Fluoroscopic image
demonstrating thoracic
endovascular aortic repair
(TEVAR; metal lattice
between the black chevrons).
Note the measuring pigtail
catheter with radiopaque
marking used to appropriately
size the stent (white arrow)
a
Subacute Care oftheTrauma Patient
Many routine procedures performed on all inpatients, including trauma patients, can be performed with image guidance
at decreased risk. The use of ultrasound and uoroscopic
guidance, for example, reduces the risk of complications
(pneumothorax, air embolism, arrhythmias, nerve damage,
and arterial puncture) from 14% to 4% [12]. Given the num-
b
ber of such procedures performed, the use of image guidance
results in a marked decrease in the absolute number of
adverse events related to access.
Similarly, although the placement of thoracostomy tubes
has been done using anatomic landmarks, the use of image
guidance reduces the number of complications seen from
placement (bleeding, infection, pneumothorax, extrapleural
placement, or transgression of the diaphragm; Fig. 35.7)
306
A. Kiraly et al.
Fig. 35.7 (a) Chest
radiograph post non-imaged
guided percutaneous chest
tube insertion demonstrating
tube placement below the
diaphragm (open black arrow)
and (b) conrmation of
malposition within the spleen
(open white arrow)
a
[13]. Although the most common overall indication for pleural drainage is simple pleural effusion, trauma patients may
have need of drainage of blood products, chyle, infected
uid, or GI contents, which increases complexity and the frequency of complications [13]. In particularly complex cases,
CT guidance can be used [13]. Image guidance can also be
used to assess and exchange blocked catheters, which is a
common occurrence [13].
DVT andPulmonary Embolism
Immobility is a major concern in the trauma patient, and
abnormal thrombosis is common. When deep vein thrombosis (DVT) and pulmonary embolism (PE) are present, interventional radiology may be called on for additional treatment
options over and above usual medical management.
While anticoagulation remains the rst-line therapy for
prophylaxis and treatment for DVT, immobile post-operative
patients continue to have a relatively high incidence of DVT
b
(up to 18%), and many of these go on to subsequently suffer
from PE (up to 11%) [14]. Prophylactic placement of an IVC
lter (Fig.35.8) is often performed in such patients, although
a denite advantage has not been demonstrated over optimized medical management [14]. A recently published retrospective meta-analysis demonstrated that prophylactic use of
IVC lters in trauma patients reduce the risk of symptomatic
PE; however, the rates of fatal PE were similar to the control
group [15].
In the case of established DVT or PE, thrombolysis (using
TPA, streptokinase, or other agents) can be directed to the
target areas using catheter-directed administration of the
medication, with the aim to maximize the concentration of
the drug at the site of thrombosis [16]. When the burden of
thrombus is particularly high, a variety of devices can be
employed to disrupt and remove thrombus in both the deep
veins and in the pulmonary arteries using mechanical force,
vacuum, water jets, or a combination of these techniques
(Fig.35.9) [16].
35 Interventional Radiology inTrauma
307
Fig. 35.8 (a) Fluoroscopic
image acquired at the time of
inferior vena cava insertion in
a polytrauma patient from a
right femoral vein approach.
The deployed lter is seen
(black arrow) prior to
withdrawal of the insertion
device (white arrow). (b)
Cook Celect™ Platinum IVC
lter showing primary struts
with retention hooks (arrow
head) and retrieval hook
(chevron)
Fig. 35.9 (a) Coronal and
(b) axial CT images
demonstrating extensive
thrombus within the right
ventricle and extending into
the right and left pulmonary
arteries and segmental/
subsegmental arteries (open
white arrows). (c)
Angiographic images
remonstrating lling defect
within the pulmonary arteries
(solid black arrow). (d and e)
Penumbra Indigo® clot
retrieval system with catheter
(open black arrow heads) and
separator device (open white
arrow) removing clot (solid
black arrows). (f
thrombectomy image
demonstrating clear
pulmonary arteries
) Post-
a
a
b
c
b
d
e
f
308
A. Kiraly et al.
Summary ofSafety Proles
Traditionally, the minimally invasive image-guided procedures described in the chapter have been reserved for hemodynamically stable patients, while those patients requiring
resuscitation or persistent instability were treated with surgical
intervention [17]. However, recent retrospective studies have
demonstrated positive results when comparing hospital survival in patients with both pelvic arterial injuries [17] and solid
organ blunt trauma (spleen and liver) [17, 18]. Specically,
hemodynamically unstable patients who responded to initial
resuscitation treated with embolization had equal in-hospital
survival when compared to laparotomy [17, 18]. As interventional radiology continues to become further integrated into
the trauma team, and therefore the initial management of
trauma patients, new opportunities for optimizing the treatment of trauma patients will become available.
IR intheInterdisciplinary Team
The management of injured patients is a complex endeavor,
engaging a varied team with complementary skills and capabilities [19]. The prompt use of multiple disciplines to manage the evolving needs of the patient leads to better outcomes,
with outcomes exceeding the probability of survival predicted by the literature [2, 20]. As an integrated part of any
diagnostic radiology department, interventional radiology
provides a variety of technical skills and approaches,
including both rapid and precise treatments for both acute
concerns and those encountered in the convalescent period.
Interventional radiologists are also procient in the nontechnical skills of “closed-loop communication” which is a
major driver of the team-based approach [1, 2].
Key Points
• Interventional radiology is crucial in modern trauma
care.
• IR’s integration into trauma teams improves patient
outcomes.
• CT imaging is the preferred modality for initial
trauma workup.
• IR procedures include both vascular and nonvascular interventions.
• Embolization, using a variety of agents and devices,
is a primary IR technique for managing
hemorrhage.
• Non-vascular IR procedures reduce complication
rates in subacute trauma care.
References
1. College A, of, S.Resources for optimal care of the injured patient:
an update. Task force of the committee on trauma, American
College of Surgeons. Bull Am Coll Surg. 1990;75:20–9.
2. Padia SA, etal. Society of interventional radiology position statement on endovascular intervention for trauma. J Vasc Interv Radiol.
2020;31:363–369.e2.
3. Hallinan J, Tan C, Pua U. The role of multidetector computed
tomography versus digital subtraction angiography in triaging care and management in abdominopelvic trauma. SMEDJ.
2016;57:497–502.
4. Bauer JR, Ray CE. Transcatheter arterial embolization in the
trauma patient: a review. Semin Interv Radiol. 2004;21:11–22.
5. Franco DF, Zangan SM.Interventional radiology in pelvic trauma.
Semin Intervent Radiol. 2020;37:44–54.
6. Golzarian J, Siskin GP, Sharafuddin M, Mimura H, Coldwell
DM. Embolization tools. In: Vascular embolotherapy; 2006.
p.15–33.
7. Lopera JE.Embolization in trauma: review of basic principles and
techniques. Semin Intervent Radiol. 2021;38:18–33.
8. Abada HT, Golzarian J. Gelatine sponge particles: handling
characteristics for endovascular use. Tech Vasc Interv Radiol.
2007;10:257–60.
9. Amplatzer Vascular Plug II (AVP II)- Sizing and Specs | Abbott.
https://www.cardiovascular.abbott/us/en/hcp/products/peripheralintervention/amplatzer- family- vascular- plugs/avp/avp- sizingspecs.html.
10. Bozlar U, etal. CT angiography of the upper extremity arterial system: part 1—anatomy, technique, and use in trauma patients. Am J
Roentgenol. 2013;201:745–52.
11. Cullen E, Lantz E, Johnson CM, Young P.Traumatic aortic injury:
CT ndings, mimics, and therapeutic options. Cardiovascular
Diagnosis and Therapy. 2014;4:238–44.
12. Brass P, Hellmich M, Kolodziej L, Schick G, Smith AF.Ultrasound
guidance versus anatomical landmarks for subclavian or femoral
vein catheterization. Cochrane Database Syst Rev. 2015;2018
13. Hogg J, etal. Tube Thoracostomy: a review for the interventional
radiologist. Semin Interv Radiol. 2011;28:039–47.
14. Ho KM, etal. A multicenter trial of vena cava lters in severely
injured patients. N Engl J Med. 2019;381:328–37.
15. Shariff M, Kumar A, Adalja D, Doshi R.Inferior vena cava lters
reduce symptomatic but not fatal pulmonary emboli after major
trauma: a meta-analysis with trial sequential analysis. Eur J Trauma
Emerg Surg. 2021;47:1805–11.
16. Gregorio MAD, etal. Interventional radiology treatment for pulmonary embolism. World J Radiol. 2017;9:295.
17. Tuchayi AM, et al. Comparative effectiveness of pelvic arterial
embolization versus laparotomy in adults with pelvic injuries: a
National Trauma Data Bank analysis. Clin Imaging. 2022;86:75–82.
18. Aoki M, Abe T, Hagiwara S, Saitoh D, Oshima K.Embolization
versus surgery for stabilized patients with solid organ injury. J Vasc
Interv Radiol. 2021;32:1150–1155.e5.
19. Gillman LM, Brindley PG, Blaivas M, Widder S, Karakitsos
D.Trauma team dynamics. J Crit Care. 2016;32:218–21.
20. Kataoka Y, etal. Hybrid treatment combining emergency surgery
and intraoperative interventional radiology for severe trauma.
Injury. 2016;47:59–63.
Communication andLeadership
intheOperating Room
ThomasBlanks andSimonDenning
36
It goes without saying that whilst the operating room (OR)
occupies a key aspect of the major trauma (MT) patients’
journey, it must be placed in the wider context of their care
and their journey through the hospital. Pre-hospital stabilisation, transfer to an MT centre (MTC) and ongoing resuscitation are all covered elsewhere in this book.
Exsanguination is a major component of pre-hospital and
intra-hospital mortality [1] accounting for 33% of deaths.
Damage control surgery (DCS) plays a critical role in the
management of uncontrolled haemorrhage, and expedient
transfer to the OR is, therefore, a core aspect of the patient’s
journey.
Communication within the OR represents a signicant
challenge, even without the time pressures of major traumatic injuries. The Canadian Institute for Health Information
(2016) demonstrated that nearly one in ten surgical patients
suffer complications as a result of error [2]. Leonard, Graham
and Bonacum showed that communication failures are the
most common cause of a series of outcomes—from errors,
adverse events, to malpractice claims [3]. The three most frequently identied root causes of complications from surgery,
as identied by The Joint Commission (2012) from 2010
through to 2011, were listed as human factors, leadership
and communication [4]. The fact that these issues are represented in many developed healthcare environments demonstrates the ongoing challenge represented by this
environment.
It is worth re-iterating that the principles of good communication and leadership remain as important in the OR as
elsewhere. However, there are some specic challenges pertinent to the OR environment that the MT practitioner should
be aware of as these have the potential to both positively and
negatively impact patient care should they not be appreciated. Given the common themes of the solutions for these
T. Blanks · S. Denning (*)
Department of Anaesthesia, Queen’s Medical Centre, Nottingham
University Hospitals NHS Trust, Nottingham, UK
e-mail: thomas.blanks@nhs.net; simon.denning@nhs.net
issues, we will start by discussing the specic barriers to
effective communication and leadership before covering
transferrable solutions.
1. Involvement of non-trauma specialist team members.
2. Hierarchy/responsibility gradients, including perceptions
of such.
3. Specic environmental factors.
1. Involvement of non-trauma specialist team members
Given the unpredictable timing and nature of MT injuries,
it is likely, on occasion, that allied healthcare practitioners
(AHPs) who are not routinely exposed to MT will form a
component of the surgical team. This may include theatre
nurses, runners, anaesthetic nurses or anaesthesiologists and
surgical sub-specialties. The situation may be further complicated by organisation and timing of shift patterns; depending on the time of the event, the trauma team may consist of
members towards the end of their shift and others at the
beginning. Handover of patients between team members
changing shifts adds another element of risk [5].
Given that human performance is demonstrably reduced
in unfamiliar and high-stress situations [6], it is vital to recognise that these team members may not be operating at
peak performance, specically regarding non-technical
skills. Therefore, it is essential that the MT practitioner recognises a crucial aspect of leadership and teamwork—knowing the make-up and skill set of the team in attendance.
This step often begins long before the patient arrives in
the operating room; the rst time the trauma team gather as a
unit will likely follow a trauma call “pre-alert”, or even as the
patient arrives in the emergency department. Whilst core elements of the team, including anaesthesiologists and surgeons, will stay with the patient throughout their trauma
journey, many AHPs will come and go as the patient moves
through the hospital. In the OR, the World Health
Organization (WHO) safety checklist makes clear that team
introductions should form a core part of the initial team
© Springer Nature Switzerland AG 2025
L. Marshall Gillman, S. Widder (eds.), Trauma Team Dynamics, https://doi.org/10.1007/978-3-031-86312-7_36
309
310
T. Blanks and S. Denning
brieng, and we would advocate for situational reports (sitreps) at key moments when the team changes, for example,
when the patient leaves the emergency department or imaging department [7]. It is clear that the development of effective teams working in a stressful scenario begins with
knowing who your team is made up of.
Each individual will have their own strengths and weaknesses, offering different values to the team. The importance of early recognition of skill sets within a team is
consistently associated with high-performing teams outside of the healthcare environment [8]. However, an indepth recognition of team roles and individual team
prociencies such as Belbin [9] is outside the realistic
remit of, or the time available to, the MT practitioner; during clinical practice we must be more adaptable and
explicit about practical skill sets. This applies to both leadership and followership.
2. Hierarchy and responsibility gradients
Within the OR environment, there are a broad range of
professions represented—surgeons, anaesthesiologists,
scrub practitioners and nurses and theatre support workers.
In the context of MT, there is potentially a wider range of
additional professionals such as interventional radiologists
and major trauma specialists.
The presence of a perceived hierarchy is common both
between these groups and within these groups (junior versus
senior staff, for example), and these have a well-recognised
impact on the overall effectiveness of any team [10]. The
willingness of individuals to “speak out” when they perceive
a harm incident occurring/pending is strongly associated
with the hierarchy gradient within their team [11].
It is worth recognising that perceptions of hierarchy are
mismatched between different professional groups.
Consistently, nurses and physicians differ in their perceptions of how well or poorly their team is working and the
impact of the culture within that team [12]. It is critical for
the MT leader to recognise three fundamental principles
relating to the hierarchy gradient and the involvement of
multiple different professional teams in response to MT:
1. The MT leader may perceive their team culture differ-
ently to others within that team.
2. A positive team dynamic is fundamental to high perfor-
mance in a stressful situation.
3. It is a requirement of high-quality leadership to ensure
that an open and transparent system for reporting errors/
harm situations is consistently and repeatedly reinforced
through both word and action. Particularly as the team
members may be rotating in and out of the team at frequent intervals.
It is also worth noting that leadership and hierarchy within
the OR may be uid, and there are numerous, often predictable, moments during surgical cases where leadership transfers to a more appropriate person. An obvious example being
when the anaesthesiologist has safely induced anaesthesia
and transfers leadership, within the OR, to the surgeon who
usually, without any formal handover.
A full discussion around the creation of team climate, culture and attening of hierarchy gradients is covered in more
detail elsewhere however, there are several “quick wins” that
can be readily implemented; for example, the utilisation of
rst names for all team members. This is a well- recognised
approach, when modelled by a leader, that rapidly reduces
hierarchy within a team and enables speaking up. Another
example is that of the debrief. As an opportunity for the team
to informally give feedback to one another about performance and reections, it allows for the development of an
ideal team culture. Managed properly, this is an excellent
opportunity to atten the hierarchy curve.
3. Specic environmental constraints
Practicalities of the OR impact on both non-verbal and
verbal forms of communication; this creates a potential area
for error if not adjusted for.
Non-verbal
Osborne-Smith and Hodgen [13] demonstrated that the
wearing of surgical facemasks inhibits the interpretation of
facial expressions, and it is evident that covering a signicant
proportion of the face will impact non-verbal
communication.
This is only heightened in situations such as the SARSCov- 2 pandemic and the widespread adoption of ltering
facepieces class 3 (FFP 3) or N95 respirators and associated
personal protective equipment (PPE) [14]. There is limited
research pertaining to specic challenges to effective teamworking in PPE; however, Hignett, Welsh and Banerjee [15]
have shown that a wide range of human factors were perceived as impacted by staff—from communication through
the task performance (both gross and ne motor). These
issues were reported as affecting female members of staff
more than male in conjunction with poorer tting equipment.
This is particularly pertinent to the OR as the majority of
aerosol-generating procedures (AGPs) are performed here
and subsequently the proliferation of PPE is particularly
acute. It is the authors’ experience that effective leadership
and team-working are deeply affected by protracted working
in PPE; from the physical impact of dehydration and
36 Communication andLeadership intheOperating Room
311
discomfort, to the impact on verbal and non-verbal
communication.
Verbal
The impact of PPE is also felt with verbal communication.
Benitez, Guemes and Aranda etal. [16] have shown that, in
surgical respondents from a widespread group of healthcare
economies, 54% of respondents felt that PPE had affected
intra-team communication. Also, in this study, it is of note
that 48% of respondents reported that PPE had affected their
decision-making processes. The reason for the impairment
may be apparent; mufing of the voice by masks or noise
interference from fans.
Wider Structural Perspective
With the development of Major Trauma Networks and the
goal of treating a majority of trauma patients in Major
Trauma Centres (MTC), there has been increasing focus on
building and training trauma teams and MT specialists [17].
This begins with national oversight; designation of appropriate MTCs, publication of trauma guidelines and protocols
[18]; and recommendations on team training and skills [19].
At an MTC level, the appointment of identiable Major
Trauma Team leaders and provision of a designated consultant available 24/7 allows for appropriate oversight and planning when major trauma occurs. Whilst MT leaders may
often be surgeons, a multi-disciplinary group including
anaesthesiologists, emergency physicians and intensive care
consultants allows for assimilation and development of different leadership styles. With regular audit and service evaluation, the positives from each specialty leader can be rolled
out to the team.
Naturally, trauma events are unpredictable, and a 24/7
MTC service is essential. OR teams should be maintained in
readiness, with appropriate training, simulation, and day-today emergency work, where possible. MT Leaders should be
able to communicate their plan effectively, along with any
contingency plans and planning for post-operative destination, as the case progresses; adaptability is a key skill and
relies on a low hierarchical gradient for the rapid transfer of
information from the team to the team leader. However, planning and preparing for every single eventuality is a futile task
in time-critical scenarios, and an awareness of potential task
xation should be maintained. Team leadership may need to
be transferred as the patient moves to the OR, and this should
be explicitly stated at the WHO brieng and during any
appropriate sit-reps.
Allocation of tasks to each team member is an important
step in identifying and utilising all resources available, yet
this need not be left until the patient arrives. CRM training
and planning may allow a proportion of this task management to be assigned ahead of time, with only those team
members who are new or unfamiliar with the MT environment requiring more specic focus at the trauma team and
WHO brieng.
Transferrable Solutions
Given the specic challenges covered so far, what tools are
available to mitigate against them? It is important to recognise that although these challenges are intensied in the OR,
they are not unique to it, and therefore, the solutions are also
not unique to this environment.
In order to effectively lead an MT team, a clear and fundamental understanding of non-technical skills is critical.
With respect to the OR, some readily implementable solutions exist to facilitate high-quality leadership and
teamwork:
A. Teamwork
A great MT leader will understand the roles within the
team and how to best utilise them. These might be standardised within a particular institution and training provided
around this team structure. At the heart of the team ethos
should be the understanding that the team can achieve more
than any single individual when they work well together.
This includes a positive response to feedback after events.
Positive team culture allows for honest and constructive criticism whilst engendering a willingness to learn from mistakes. It is imperative that team members feel able to safely
practice their skill sets.
Within the OR, there are many pre-dened roles, and the
teams are well-versed in enacting those roles day-to-day.
Training for major trauma/damage control surgery should
focus on how those roles, and their communication and interaction with team leaders, pivot to provide the best care in
time-critical situations.
Information is often shared in a more direct manner, and
there must be less tolerance of ambiguity. Clear and concise
communication is key when coordinating tasks within the
team and passing information between team members.
The operating room should be notied as early as possible; in some centres, they are part of the trauma team activation, as to the arrival of an MT patient if operative intervention
is anticipated. Potential operation, special equipment
required and patient positioning are all important details to
relay to the operating room team so that they can be adequately prepared. This sometimes requires the recruitment of
additional team members, such as a perfusionist if cell salvage technology is required.
312
T. Blanks and S. Denning
B. Communication
Communication strategies are critical to the clear
exchange of information, and one of the most applicable
strategies is that of closed-loop communication (CLC) as
described by McIntyre and Salas [20]. In essence, this refers
to a structured approach to communication whereby
• The sender initiates a message.
• The receiver interprets and acknowledges the message.
• The sender completes the loop by ensuring that the mes-
sage was received as imparted.
Whilst it can seem laborious to document, in practice it is
a much smoother process, for example:
Surgeon: “Size 10 blade please”
Scrub nurse: “Size 10 blade?”
Surgeon: “Correct, thank you”
This technique has seen widespread adoption throughout
the military, aviation and healthcare industries [21]. There
are multiple training packages for whole team training; however, this technique is valuable when employed during any
time-critical situation. This aligns well with the requirement
for simple, command-driven communication necessitated by
the wearing of PPE.
C. Leadership
One critical tool for the MT leader is that of a brief [22].
Simply put, this pre-event strategy allows the building of a
shared mental model and alignment of the team to short- and
long-term goals. Within the OR, a short-term goal may be
progression towards the next sit-rep, as covered above, with
the long-term goal of completion of damage control surgery
and transfer to the next area of ongoing care. It also allows
the initiation of a team culture that facilitates safe teamwork—that of open, two-way communication and at hierarchy where all can speak out if concerned.
It is inevitable that even the best-laid plan will come
unstuck, as clinical events can rapidly outpace an existing
plan. In this instance, the role of the situational report, sit-up
or huddle is invaluable. These phrases describe a quick-re
opportunity for the team members and leader to recongure
resources, allocate new tasks and refresh the mental model
between the team.
Conclusion
In summary, there is an enormous challenge in transferring
from one clinical environment to another, particularly when
that environment includes some of the specic challenges
that the OR entails. However, the authors are condent that
the solutions for this environment are not uniquely difcult.
These solutions will benet the MT practitioner in all walks
of their practice—be that the OR or beyond.
Key Points
1. Making explicit the unwritten behaviours to ensure
group mental model sharing.
2. Flexibility of the leader role to pre-empt predictable task xation.
3. Place of OR in wider context of trauma journey.
References
1. Cripps MW, Kutcher ME, Daley A, McCreery RC, Greenberg MD,
Cachola LM, etal. Cause and timing of death in massively transfused trauma patients. J Trauma Acute Care Surg [Internet]. 2013
[cited 2021 Jan 31];75(2 SUPPL. 2):S255–S262. Available from:
http://journals.lww.com/01586154- 201308002- 00026.
2. Measuring Patient Harm in Canadian Hospitals [Internet]. 2016
[cited 2021 Jan 31]. Available from: www.cihi.cacopyright@cihi.
caISBN978- 1- 77109- 514- 3.
3. Leonard M.The human factor: the critical importance of effective
teamwork and communication in providing safe care. Qual Saf
Heal Care [Internet]. 2004 [cited 2021 Jan 31];13(suppl_1):i85–90.
Available from: https://pubmed.ncbi.nlm.nih.gov/15465961/
4. NERC Improving Human Performance Sentinel Event Reporting,
Analysis and prevention in healthcare Charles A.Mowll, FACHE,
CSSBB Executive Vice President The Joint Commission. 2012.
5. Boet S, Djokhdem H, Leir SA, Théberge I, Mansour F, Etherington
N.Association of intraoperative anaesthesia handovers with patient
morbidity and mortality: a systematic review and meta-analysis
[Internet]. Vol. 125, Br J Anaesth. Elsevier Ltd; 2020 [cited 2021
Jan 31]. p. 605–613. Available from: http://bjanaesthesia.org/
article/S0007091220304657/fulltext.
6. Harvey A, Bandiera G, Nathens AB, LeBlanc VR.Impact of stress
on resident performance in simulated trauma scenarios. J Trauma
Acute Care Surg. 2012;72(2):497–503.
7. Arul GS, Pugh HEJ, Mercer SJ, Midwinter MJ.Human factors in
decision making in major trauma in Camp Bastion, Afghanistan. Ann
R Coll Surg Engl [Internet]. 2015 [cited 2021 Jan 31];97(4):262–8.
Available from: /pmc/articles/PMC4473862/?report=abstract.
8. Chong E.Role balance and team development: a study of team
role characteristics underlying high and low performing teams.
2007.
36 Communication andLeadership intheOperating Room
313
9. Dill DD.Management Teams: Why they succeed or fail Author:
R. Meredith Belbin. Heinemann, 1981. R&D Manag [Internet].
1982 [cited 2021 Jan 31];12(3):147–8. Available from: http://doi.
wiley.com/10.1111/j.1467- 9310.1982.tb00500.x.
10. Sacks GD, Shannon EM, Dawes AJ, Rollo JC, Nguyen DK,
Russell MM, etal. Teamwork, communication and safety climate:
a systematic review of interventions to improve surgical culture,
vol. 24. BMJ Qual Safe. BMJ Publishing Group; 2015. p.458–67.
11. Pattni N, Arzola C, Malavade A, Varmani S, Krimus L, Friedman
Z.Challenging authority and speaking up in the operating room
environment: a narrative synthesis [Internet]. Vol. 122, Br J Anaesth.
Elsevier Ltd; 2019 [cited 2021 Jan 31]. p.233–244. Available from:
https://pubmed.ncbi.nlm.nih.gov/30686309/
12. Sexton JB, Holzmueller CG, Pronovost PJ, Thomas EJ, McFerran
S, Nunes J, etal. Variation in caregiver perceptions of teamwork climate in labor and delivery units. J Perinatol [Internet]. 2006 [cited
2021 Jan 31];26(8):463–470. Available from: www.jcaho.org
13. Osborne-Smith L, Kyle Hodgen R.Communication in the operating room setting. Annu Rev Nurs Res [Internet]. 2017 [cited 2021
Jan 31];35(1):55–69. Available from: https://pubmed.ncbi.nlm.nih.
gov/27935774/
14. (No Title) [Internet]. [cited 2021 Jan 31]. Available from: https://
assets.publishing.service.gov.uk/government/uploads/system/
uploads/attachment_data/le/954690/Infection_Prevention_and_
Control_Guidance_January_2021.pdf
15. Hignett S, Welsh R, Banerjee J.Human factors issues of working
in personal protective equipment during the COVID-19 pandemic.
Anaesthesia [Internet]. 2021 [cited 2021 Jan 31];76(1):134–135.
Available from: https://onlinelibrary.wiley.com/doi/10.1111/
anae.15198
16. Yánez Benítez C, Güemes A, Aranda J, Ribeiro M, Ottolino P, Di
Saverio S, etal. Impact of personal protective equipment on surgical performance during the COVID-19 pandemic. World J Surg
[Internet]. 2020 [cited 2021 Jan 31];44(9):2842–2847. Available
from: https://doi.org/10.1007/s00268- 020- 05648- 2.
17. Moran CG, Lecky F, Bouamra O, Lawrence T, Edwards A,
Woodford M, etal. Changing the system- major trauma patients and
their outcomes in the NHS (England) 2008–17. EClinicalMedicine.
2018;2–3:13–21.
18. Overview | Major trauma: assessment and initial management |
Guidance | NICE.
19. Overview | Major trauma: service delivery | Guidance | NICE.
20. McIntyre R, Salas E. McIntyre: Team effectiveness and
decision making in organizations. 1995 [cited 2021 Jan
31];149–203. Available from: https://scholar.google.com/scholar_
lookup?hl=en&publication_year=1995&author=+McIntyre%2C
+R.M.author=+E.+Salasauthor=+R.A.+Guzzoauthor=+E.+Salas
&title=Team+Effectiveness+and+Decision+Making+in+Organiz
ations#d=gs_cit&u=%2Fscholar%3Fq%3Dinfo%3A1Vyq9yohSUJ%3Ascholar.google.com%2F%26output%3Dcite%26scirp%3
D0%26hl%3Den.
21. Burke CS.How to turn a team of experts into an expert medical team:
guidance from the aviation and military communities. Qual Saf Heal
Care [Internet]. 2004 [cited 2021 Jan 31];13(suppl_1):i96–104.
Available from: https://pubmed.ncbi.nlm.nih.gov/15465963/
22. TeamSTEPPS Fundamentals Course: Module 4. Leading Teams |
Agency for Healthcare Research and Quality [Internet]. [cited 2021
Jan 31]. Available from: https://www.ahrq.gov/teamstepps/instruc-
tor/fundamentals/module4/slleadership.html#im6