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Roee Ber, Dennis London, Samya Senan, Yasmin Youssefi, David H. Harter, John G. Golfinos, and Donato Pacione

conservative hierarchical nature of the profession that may be in the way of free communication, 2 these practices are often slow to be adopted and quickly abandoned. As a result, surgical team communication frequently remains optional, unstandardized, and lacking. In this study, we demonstrate a unique, complete workflow of intelligent case-specific and team-specific briefing and debriefing, and ongoing collection and recollection of lessons learned. Because one of the authors of this study spent 20 years in the Air Force as an F-15 pilot, we used his experience and

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Gazanfar Rahmathulla, Pablo F. Recinos, David E. Traul, Rafi Avitsian, Marisa Yunak, Nicole T. Harper, Gene H. Barnett, and Violette Renard Recinos

of personnel from differing backgrounds are involved in patient care in the ioMRI-OR, and communication and understanding need to be flawless for maximal patient safety, necessitating the creation of checklists, briefings, and protocols that can be followed by all. In the United Kingdom between 1990 and 2006, the Medicines and Healthcare Products Regulatory Agency received 163 user incident reports and 58 vigilance reports concerning MRI. 6 The majority of incidents involved radiofrequency burns, followed by projectiles, and lower incidences of cryogen burns

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Richard P. Menger, Christopher M. Storey, Bharat Guthikonda, Symeon Missios, Anil Nanda, and John M. Cooper

.” 7 Upon briefing his cabinet, Dr. Cary Grayson refused to acknowledge or sign the statement of disability, thereby terminating any discussion of potential succession. 11 A stunning debate occurred during a cabinet meeting on October 6, 1919, in which Secretary of State Robert Lansing raised the issue of Article II, Section 1 of the Constitution, which designates the vice president as substitute for the president if the latter is “unable to discharge the powers and duties of his office.” Grayson responded bluntly: Secretary Lansing asked me the direct

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Scott L. Zuckerman, Daniel J. France, Cain Green, Susie Leming-Lee, Shilo Anders, and J Mocco

important performance improvement tool in the military since its introduction during World War II, when it was used to question soldiers returning from a mission. 37 Briefing and debriefing were established practice among fighter pilots years before CRM was initiated by NASA (National Aeronautics and Space Administration) in 1979. 25 Since this time, debriefing has been shown to be an effective educational tool not only in military training but also in medical training. 1 , 2 , 6 , 33 There are several systems-based guidelines that define the debriefing process for

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Editorial

Wrong-site craniotomy

Robert R. Cima

rationale behind the preoperative team briefing being advocated by some organizations. The use of a preoperative team briefing as well as active preprocedural referencing of imaging data, consent forms, and consultation notes are steps that permit the exchange of additional information or questioning of unclear information. In a study by Makary et al., 7 the authors demonstrated that a team briefing significantly improved the team's perception of reducing the potential for a wrong-site/ surgery/person event. Third, never assume that the radiographs being used for surgery

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Bob S. Carter and E. Antonio Chiocca

have adapted with increased virtual interactions in both education and clinical care. One bright spot has been the creation of a daily videoconference “lunchtime lecture” where we have assigned every member of the department (faculty, residents, APPs) to present on a neurosurgical topic. Our medical students, currently unable to pursue their typical clerkship roles, join in. Our daily videoconference is a combination of journal club, operative video teaching, and team briefing, and has become the new way for us to gather and remain connected in common purpose. Even

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Judith M. Wong, Angela M. Bader, Edward R. Laws, A. John Popp, and Atul A. Gawande

and workflow. For example, some teams may prefer that the surgeon initiate the surgical briefing while others may prefer that other members of the surgical team do so. In our preliminary work with checklists designed to assist with management of operating room emergencies, the team leader is not always the same person; rather, he or she is verbally and explicitly designated by the team at the beginning of the emergency. 69 A less tangible benefit of the WHO checklist is incorporation of teamwork by beginning with team member introductions. This step encourages

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Scott L. Zuckerman, Cain S. Green, Kevin R. Carr, Michael C. Dewan, Peter J. Morone, and J Mocco

prophylaxis, stress ulcer prophylaxis, oral care for pts undergoing ventilation, electrolyte repletion, initiation of physical therapy, & documentation of restraint orders; increased pt transfer out of ICU on telemetry & initiation of physical therapy DuBose et al., 2008 trauma surgery examine effectiveness of Quality Rounds Checklist (QRC) tool to increase prophylaxis improvement in 16 measures w/ <95% compliance initially identified Lingard et al., 2008 anesthesiology assess whether structured briefings improve OR communication mean no. of failures per

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Paolo Ferroli, Dario Caldiroli, Francesco Acerbi, Maurizio Scholtze, Alfonso Piro, Marco Schiariti, Eleonora F. Orena, Melina Castiglione, Morgan Broggi, Alessandro Perin, and Francesco DiMeco

to guide postop treatment differentiation of lots & suppliers 8 case cancelled because of latex allergy team working, lack of communication, workload, time pressure, information collection organizational 3 8 medium operation postponed preop surgical briefing 9 surgery cancelled after induction of anesthesia because preop MRI not controlled team working, lack of communication, workload, time pressure, information collection, shortcut human 4 11 significant ineffective induction of anesthesia (intubation, CVC cannulation

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David Cochrane

, there is a real probability that side recognition and identification errors could occur and would not be caught by current checking methods. Fortunately, the chance that all team members and the patient have side discrimination problems is small so that preoperative briefings and “timeouts” are usually effective in recognizing side-identification errors before they reach the patient. Right-left blindness is not associated with right or left handedness. Affected individuals are generally aware of this difficulty and over time develop compensatory mechanisms