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Safer Surgery part 36. There have been few research investigations into how highly trained doctors and nurses work together to achieve safe and efficient anaesthesia and surgery. While there have been major advances in surgical and anaesthetic procedures, there are still significant risks for patients during operations and adverse events are not unknown. Due to rising concern about patient safety, surgeons and anaesthetists have looked for ways of minimising adverse events. | 324 Safer Surgery Video Cameras 1 Wide-angle 2 Narrow angle Operating Theatre Team S 1a Surgeon 1A Assistant surgeon AC Anaesthetic Consultant SN Scrub Nurse CN Circulating nurse Figure 19.1 Video equipment configuration for orthopaedic surgery Source Catchpole et al. 2005 Figure 19.1 . Other relevant data were recorded including operative duration first incision to final closing suture tourniquet time and the composition of the surgical team. For the purposes of the study risk was classified at levels low risk for primary TKR procedures and high risk for TKR revisions. One operation was a TKR revision but was classed at low risk as it involved only the removal of the existing prosthesis. Another operation was a primary knee replacement but was classed as high risk as it required instruments prostheses and techniques used in revision operations. Events were selected for analysis if they were judged to have increased the duration or difficulty of the operation increased the risk to the patient or increased the demand for resources. They were all categorized individually as minor failures. A major failure category was reserved for events which were approaching an incident or accident see Box 19.1 . Where major failures or unusual or complex minor failures occurred brief reviews were conducted with relevant theatre team members at a convenient time following the operation to ensure that the supporting specialist information had been recorded. Video evidence was used to check the results of the observers. Minor failures were grouped into 20 types previously defined for paediatric cardiac surgery Catchpole et al. 2006 Table 19.2 . Observing Failures in Successful Orthopaedic Surgery 325 Table 19.2 Descriptions and examples of minor failure types Failure Description and example Absence Lack of personnel when required. Example circulating nurse is absent when scrub nurse needs more suture material. Coordination communication failure Failures in task coordination and .
