Pete's Talk Notes
Below 10,000 Medical
Surgery Stat! The Game
Fatigue: An Organisational Policy
Fatigue ACORN References
Fatigue Mitigation Frameworks
Executive Level Recommendations 1
NUM's Role in Fatigue Management
Tectonic Plate Tetris Workload Theory
High Performance Health Care Teams
Antus Benner psychologica
Human Factors Study
The Art of BTT
BTT Honour Roll
BTTM Brag Board
Steve Bolsin's Letter of Recommendation
Dr Amutha Samuel's Recommendation
February 9, 2014
BTT: Moment or Period?
In the question time following one presentation, we were asked an interesting question:
"Shouldn't 'Below 10,000' refer to a period of time, not a series of 'moments' as we had
presented it in our lecture?"
It was a question worthy of some thought, especially as we hadn't pictured in that way
when envisioning it as an operating theatre tool.
To put it into its original context, BTT refers to the time the plane leaves it's dock until it
reaches an altitude of 10,000 feet.
From an anaesthetic perspective, this would be similar to, for instance, invoking BTT from
the time the patient is wheeled into theatre to begin the anaesthetic, and it would continue
right up until the anaesthetic reaches its maintenance phase.
The analogy is sound (no pun intended).
At this point in time, BTT is a ground-up initiative. It is not a mandated policy imposed on
us from above. Therefore it requires the voluntary engagement of willing participants.
In order to retain it's power, it needs to be fresh, a reminder, a positive collaboration.
Overstating the claim at this point makes the introductory imposition too great and
therefore the threshold for uptake potentially too high.
Of course, if it were a global ratified policy, enforceable by performance management and
disciplinary measures, then it is a completely different matter. Then it can be whatever the
But for us here and now, we prefer the moment to be a gentle reminder that, hey, we are
all on the same team here, and I need your cooperation in order to be able to focus on
MY particular part of the job.
These days, a lot of communication goes on in the induction phase, from surgical counts
to patient positioning instructions to prepping and draping and the connection of leads to a
myriad of equipment.
People are usually maximally engaged during a significant portion of that time, and I would
hate to think that valid discussion may be inhibited because the team members were
'walking on eggshells'."
Let's get used to having the BTT word in our vernacular and the BTT tool in our toolkit.
Use it as you see fit.
Allow people the time to get used to the cultural shift.
Hopefully it won't take long for them to get to the stage where everyone expects certain stages of the procedure will be automatic 'BTT's' and self-police the urge to chatter.
Then I would re-assess the situation and reconsider by asking the question:
"Is where we've got so far good enough?"
"What are the costs and benefits in going that one step further?"
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