Background and goal of study
Increasing complexity regarding technical equipment and patients with comorbidities is a challenge for the multi professional operating room (OR) teams.  Studies have pointed at non-proficient non-technical skills as a cause of adverse events (1) and simulation based teamwork training as a possibility for improvement (2). The aim of this study was to find out how OR staff perceives collaboration in the OR and explore possibilities for learning from a simulation based teamwork training course to the OR. 
Materials and Methods
In a prospective qualitative intervention study 32 experienced OR staff including 5 professions took part in a full day simulation based teamwork training course with non-technical skills training goals. Written informed consent was obtained and the regional ethics committee approved the study. Data was collected during 5 focus group interviews that were audio and video recorded. Transcripts were first analyzed with thematic analysis. In the transcripts the barrier in the OR was often mentioned which led us to perform content analysis using the context units: sides, barrier and screen. 

Results and discussion
Participants described the screen between the sterile field and anaesthesia as barrier in the OR. 
“It is routine to have a time-out and I feel that I know how things are on the other side…but now I realize that I should pay more attention” (surgeon). Non-technical skills were mentioned as a possibility to reduce this barrier. ”It seems like a time-out is a very good method to reduce the barrier between anaesthesia and surgery” (nurse anaesthetist). The teamwork training was mentioned as a possibility to reduce the barrier. “The screen between anaesthesia and operation was brought down a bit (by the training)” (anaesthetist).
The results indicate that OR staff perceive OR teams as divided into sub-teams which is in line with Makary´s findings of diverse views on quality of collaboration by OR staff (3). A divided team can imply inferior conditions for good teamwork and apart from training improvements of OR design (transparent screens, reduced noise) should be considered in order to enhance teamwork. 
Conclusion
Experienced OR staff describe the screen between the sterile field and anaesthesia as a communication barrier indicating a possible risk to patient safety. Simulation based teamwork training is a possibility to reduce the barrier.


08 / To reduce the barrier in the OR - a qualitative intervention study