Clinical scienceSurgeons' intraoperative decision making and risk management
Section snippets
Participants
Consultant (attending) surgeons (n = 24) from 3 teaching hospitals in Scotland were invited to participate via e-mail from a senior surgical colleague. The surgeons (21 men, 3 women), aged 35 to 62 years (mean age, 47 ± 7 years), had an average of 10 ± 8 years of experience as attending or consultant surgeons (range, .5–28 years). The specialties included general, orthopedic, vascular, transplant, and urologic surgery.
Procedure
Surgeons were randomly allocated to recall a case from 1 of 4 categories of
Results
The 12 emergency and 12 elective procedures discussed are shown in Table 1. Of the emergency operations, 2 involved trauma patients. Intraoperative decisions and the management of intraoperative risks are discussed in turn.
Comments
Surgeons described key decisions taken using either the rapid, intuitive RPD mode, matching a response to the situation, or a more deliberate comparison of alternative courses of action (labeled analytic).
As suggested by Abernathy and Hamm,18 preference of decision-making strategy may relate more to personal style than to the type of operation (endoscopic or open), context (emergency or elective surgery), the existence of perceived time pressure, or the level of complexity of the situation and
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This work is supported by funding from the Scottish Funding Council (Scottish Patient Safety Research Network).