Human performance assessment of multi-organ retrieval with the joint scrub practitioner

Introduction: The National Organ Retrieval Service (NORS) review recommended a Joint Scrub Practitioner for abdominal and cardiac teams during combined organ retrieval. To understand the functional implications, and evaluate feasibility of the joint scrub role we evaluated team performance in simulated multi-organ retrievals. Methods: Two high fidelity simulations were conducted in an operating theatre with porcine organs, en bloc, placed in a mannequin. For DBD simulation an anaesthetic machine provided simulated physiological output. DCD retrieval began with rapid arrival in theatre of the mannequin. Cardiothoracic (lead surgeon) and Abdominal (lead and assistant surgeons; joint scrub practitioner) teams combined for the retrievals. Data collected before, during and after simulations used self-report and expert observers, to assess; attitudinal expectations, anxiety, self-confidence, mental workload, non-technical skills, teamwork, and social validation perceptions. Results: Attitudinal changes regarding feasibility of Joint Scrub Practitioner for DBD and DCD are displayed in Figure 1. There were no significant differences in anxiety or confidence prior to either simulation nor in mental workload afterwards. However variance between simulations for individual members of the team was noted. Non-technical skills were slightly lower in DCD than in DBD (self and expert rating). Global ratings of team performance were significantly (p<.05) lower in DCD than in DBD. Discussion: Measures of attitude indicate less support for the proposed Joint Scrub role for DCD than for DBD multi organ retrieval. Further work to determine feasibility of the NORS recommendations is required. Measures of team performance and individual psychological response can inform feasibility considerations.