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The hybrid operating room (OR), which combines a traditional OR with a radiological intervention room, is one example of the technical advancements within hospitals. In a hybrid OR, the staff have to manage the technique confidently in a not completely familiar environment and still be able to care for the vulnerable patient in the safest way. The overall aim of this thesis was to explore and describe the care and work processes, staff interactions, and experiences of both patients and staff in the hybrid OR. Data were collected through 18 individual interviews, nine video recordings of endovascular aortic repairs (EVARs) and five focus group interviews. Data were mainly analyzed qualitatively (hermeneutic, hermeneutic phenomenology and qualitative content analysis) but also with the use of descriptive statistics. The environment in the hybrid OR was experienced as safe by both patients and staff. The patients felt cared for, but a distance to the staff was also evident in the hybrid OR. Moreover, patients expressed an unpredictability mostly related to the time after surgery. The extensive safety preparations, which prolonged the procedures, were evident for the staff. The nursing staff from anesthesia, surgery, and radiology enjoyed working in the hybrid OR but declared that collaboration was largely dependent on individual personalities. The work took place in several separate rather than in one cohesive team and there was also a lack of joint meetings before and after the procedures. Waiting times and uneven division of labor were considered to obstruct collaboration, and also affected the workflow. Some of the nursing staff’s responsibilities, for example the one for communicating with the patient, were found not to be completely clear. Several of the patients’ worries could be preventable with better provided information and communication with the patient throughout the care process. Alternative compositions of the team and better distribution of the responsibilities would likely make the procedures more effective and probably result in higher staff satisfaction. A need for seeing the procedures and the team as a whole was evident and could be improved by team training, education, and team meetings before and after each procedure. An openness to, and insight into, each staff category’s competence would likely improve the interprofessional trust of the team in the hybrid OR.

May Bazzi,1 Solveig M Lundgren,1 Mikael Hellström,2 Isabell Fridh,3 Karin Ahlberg,1 Ingegerd Bergbom11Institute of Health and Care Sciences, Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden; 2Department of Radiology, Sahlgrenska University Hospital and Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden; 3Faculty of Caring Sciences, Work Life & Social Welfare, University of Borås, Borås, SwedenIntroduction: A hybrid operating room (OR) is a surgical OR with integrated imaging equipment and the possibility to serve both open surgery and image-guided interventions.Aim: This study aimed to investigate the work processes and types of collaboration in a hybrid OR during endovascular aortic repair (EVAR).Methods: Data consisted of video recordings from nine procedures, with a total recording time of 48 hrs 39 mins. The procedures were divided into four episodes (Acts). A qualitative cross-case analysis was conducted, resulting in a typical case. The type of collaboration during specific tasks was discussed and determined based on Thylefors´ team typology.Results: An extensive amount of safety activities occurred in the preparation phase (Acts 1 and 2), involving a number of staff categories. After the skin incision (Act 3), the main activities were performed by fewer staff categories, while some persons had a standby position and there were persons who were not at all involved in the procedure.Discussion: The different specialist staff in the hybrid OR worked through different types of collaboration: multi-, inter- and transprofessional. The level of needed collaboration depended on the activity performed, but it was largely multiprofessional and took place largely in separate groups of specialties: anesthesiology, surgery and radiology. Waiting time and overlapping tasks indicate that the procedures could be more efficient and safe for the patient.Conclusion: This study highlights that the three expertise specialties were required for safe treatment in the hybrid OR, but the extent of interprofessional activities was limited. Our results provide a basis for the development of more effective procedures with closer and more efficient interprofessional collaboration and reduction of overlapping roles. Considerable waiting times, traffic flow and presence of people who were not involved in the patient care are areas of further investigation.Keywords: hybrid operating room, work processes, collaboration, tasks, video recording, cross case analysis