Abstract:
OBJECTIVE:Paediatric cardiac surgery has a low error tolerance and demands high levels of cognitive and technical performance. Growing evidence suggests that further improvements in patient outcomes depend on system factors, in particular, effective team skills. The hypotheses that small intraoperative non-routine events (NREs) can escalate to more serious situations and that effective teamwork can prevent the development of serious situations were examined to develop a method to assess these skills and to provide evidence for improvements in training and performance. METHODS:This mixed-method design, using both quantitative and qualitative measures, relied on trained human factor observers who observed and coded NREs and teamwork elements from the time of patient arrival into the operating room to patient handover to the intensive care unit. Real-time teamwork observations were coupled with microsystem preparedness measures, operative duration, assessed difficulty of the operation and patient outcome measures. Behaviour was rated based on whether it hindered or enhanced teamwork. RESULTS:40 paediatric cardiac surgery cases were observed. Surgeons displayed better teamwork during complicated procedures, particularly during the surgical bypass/repair epoch. More procedural NREs were associated with a more complicated postoperative course (M(uncomplicated)=9.08; M(minor complications)=11.11; M(major morbidity)=14.60, F(2,26)=3.46, p<0.05). Procedural NREs decreased substantially over time (M₁=13.5; M₂=7.1, F(1,37)=33.07, p<0.001). CONCLUSIONS:Structured observation of effective teamwork in the operating room can identify substantive deficiencies in the system and conduct of procedures, even in otherwise successful operations. High performing teams are more resilient displaying effective teamwork when operations become more difficult.
journal_name
BMJ Qual Safjournal_title
BMJ quality & safetyauthors
Schraagen JM,Schouten T,Smit M,Haas F,van der Beek D,van de Ven J,Barach Pdoi
10.1136/bmjqs.2010.048983subject
Has Abstractpub_date
2011-07-01 00:00:00pages
599-603issue
7eissn
2044-5415issn
2044-5423pii
bmjqs.2010.048983journal_volume
20pub_type
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journal_title:BMJ quality & safety
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journal_title:BMJ quality & safety
pub_type: 杂志文章,meta分析,评审
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pub_type: 杂志文章
doi:10.1136/bmjqs-2015-004839
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journal_title:BMJ quality & safety
pub_type: 杂志文章
doi:10.1136/bmjqs-2011-000197
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journal_title:BMJ quality & safety
pub_type: 杂志文章
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journal_title:BMJ quality & safety
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更新日期:2015-08-01 00:00:00
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journal_title:BMJ quality & safety
pub_type: 杂志文章
doi:10.1136/bmjqs-2014-003150
更新日期:2014-11-01 00:00:00
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journal_title:BMJ quality & safety
pub_type: 杂志文章
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journal_title:BMJ quality & safety
pub_type: 杂志文章,评审
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pub_type: 杂志文章,评审
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journal_title:BMJ quality & safety
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更新日期:2011-04-01 00:00:00
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journal_title:BMJ quality & safety
pub_type: 杂志文章
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更新日期:2019-01-01 00:00:00
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journal_title:BMJ quality & safety
pub_type: 杂志文章
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更新日期:2017-06-01 00:00:00
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journal_title:BMJ quality & safety
pub_type: 杂志文章
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更新日期:2018-09-01 00:00:00
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journal_title:BMJ quality & safety
pub_type: 杂志文章
doi:10.1136/bmjqs-2015-004260
更新日期:2017-01-01 00:00:00
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journal_title:BMJ quality & safety
pub_type: 杂志文章
doi:10.1136/bmjqs-2013-001905
更新日期:2013-10-01 00:00:00
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pub_type: 杂志文章
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更新日期:2014-08-01 00:00:00
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pub_type: 杂志文章,评审
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journal_title:BMJ quality & safety
pub_type: 杂志文章
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更新日期:2011-08-01 00:00:00