Who is in Charge Here? Negotiating Fluid Leadership and Team Protocols in a Hybrid Cardiac Operating Room

When an unexpected event occurs in a hybrid cardiac operating room, a minimally invasive heart surgery may need to be transitioned to open-heart surgery emergently. In such cases, an interspecialty team must dynamically shift roles quickly and seamlessly, without compromising patient safety. During this transition, appropriate response can be delayed because there are multiple teams carrying out critical, urgent, interdependent tasks. This paper describes human-factors efforts that employed task analysis, cognitive in-situ walk-throughs, and in-situ simulation to develop operational protocols to address the high-risk event. This series of interventions helped to create safe, effective protocols for seamless transition of leadership in this complex procedure.