Characteristics of the 12 cases discussed (ordered by decision strategy)
| Operation | Decision | Anaesthesia | Time pressure (Y/N) | Patient risk rating | Decision strategy |
|---|---|---|---|---|---|
| Retinal detachment | Intraoperative supra-choroidal haemorrhage. Gas or silicon oil fill?* | General | Y | 3 | RPD |
| Glaucoma drainage device implantation | Eyeball came out of the orbital socket—what was causing this and how could it be dealt with?* | General | N | 3 | RPD |
| Cataract | Tear in the capsule. Was the vitreous coming through, and would an anterior vitrectomy be needed? | Local | N | 2 | RPD |
| Cataract+iris repair | Repair the iris or put in an artificial iris? | General | Y | 2 | RPD |
| Proliferative vitreo-retinopathy | Scar tissue on the surface of the retina. When to stop trying to remove scar tissue? | General | N | 3 | RPD |
| Retinal detachment | Retina was not unfolding after inserting decalin. Take the decalin out and close up or do a retinotomy? | General | N | 3 | RPD |
| Cataract | Needed to take over from trainee surgeon (patient awake). Usual code word was not working—how to alert the trainee without alarming the patient?* | Local | Y | 2 | Analytical |
| Strabismus | Paediatric case where the wrong muscle was accidentally cut. How to fix the mistake?* | General | Y | 3 | Analytical |
| Cataract | Small piece of lens in the bag and ruptured posterior capsule. How to remove the small piece of lens?* | General | Y | 3 | Analytical |
| Cataract | Did not recognise a retrobulbar haemorrhage and decided to continue with the operation. | Local | N | 3 | Analytical |
| Cataract | Lens was not staying in the correct location. Reposition the lens or remove it altogether? | Local | Y | 2 | Analytical |
| Cataract | Haptics supporting the intraocular lens implant broke off. Leave the implant in place or take it out and replace it? | Local | Y | 2 | Analytical |
Risk was quantified on a scale of 1–3.
*Novel situation for the surgeon.
N, no; RPD, recognition primed (intuitive) decision making; Y, yes.