46 - Who’s Doing What? Understanding and Delineating Roles During an Operating Room Code

Description: Title: Who's Doing What? Understanding and Delineating Roles During an Operating Room Code

Authors:
Nicholas Farison, MSN, RN, CNOR (farison.nicholas@mayo.edu)

Kyle Dodaro, MSN, RN, CNOR (dodaro.kyle@mayo.edu)

Team Members:
Nikki Bombaci, BSN, RN, CPAN; Heather Danke, APRN, CRNA, DNAP; Allen Foran, MSN, RN; Johanna Heredia; Michael Kendalo, BSN, RN; Brigid Kiley, MS, RN; Kim Howard, MSN; Marisa J. Liepman, M.H.A. RN; Ruthie Mangino, APRN, CNS, DNP, MSN, CNOR; Carol Ritchie, MSN, RN, CNOR; Dr. Christopher Thunberg, M.D.

Project Summary

This quality improvement project aims to increase perioperative staff knowledge of multidisciplinary roles during Operating Room (OR) codes by developing OR specific code guidelines, quarterly code education, mock codes, post code debriefs, and Medical Emergency Response (MER) training. Utilizing the DMAIC framework, the goal is to improve staff knowledge from 30% to 54% by the end of Q4 2025.

Description of Team

This multidisciplinary team includes perioperative nurses, surgical technologists, anesthesiologists, clinical nurse specialists, and Certified Registered Nurse Anesthetists (CRNAs). This multidisciplinary approach ensures all stakeholder roles and responsibilities in the OR are accounted for.

Preparation and Planning

The project was launched in response to staff feedback from an OR code in 2024, which revealed a lack of clarity regarding roles and responsibilities during these events. Using the Define phase of the DMAIC framework, the team identified a knowledge gap in staff understanding of each team member's role during a code.

Assessment

A baseline assessment was conducted via a staff survey distributed to circulating nurses, surgical technologists, and anesthesia providers. The 130 responses (30% response rate) provided quantitative and qualitative data, which was analyzed using a fishbone diagram to identify contributing factors to the knowledge gap.

Implementation

Interventions were selected through an impact-effort grid and included: quarterly education sessions on OR codes, mock codes, post-code debriefs, and reintroduction of MER training. These began in Q2 2025 and focused on delineating roles and responsibilities among anesthesia and nursing team members. In addition, OR specific code guidelines were written and implemented in Q3 2025

Outcomes

Initial staff knowledge of OR code roles was 30%. A power analysis determined a target increase to 54% to achieve statistical significance (α = 0.05, power = 80%). A follow-up survey will be administered in Q4 2025 to measure knowledge improvement. Project completion and evaluation are scheduled for the end of Q4 2025.

Implications for Perioperative Nursing

This project highlights the need for consistent, interdisciplinary education on role clarity during OR codes. By improving understanding role requirements, perioperative nurses can respond more efficiently and confidently in code situations, enhancing both team performance and patient outcomes. The structured approach also provides a scalable model for improving emergency preparedness in other surgical departments.