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Setting Up a Stroke Team Algorithm and Conducting Simulation-based Training in the Emergency Department - A Practical Guide
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Assessing and improving teamwork in cardiac surgery.

Jan Maarten Schraagen1, Ton Schouten, Meike Smit

  • 1TNO Human Factors, PO Box 23, 3769 ZG Soesterberg, The Netherlands. jan_maarten.schraagen@tno.nl

Quality & Safety in Health Care
|December 4, 2010
PubMed
Summary

Human factors observers were trained to assess teamwork in paediatric cardiac surgery (PCS). Rigorous training and assessment led to high inter-rater reliability, improving methods for studying team performance in high-risk surgical environments.

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Area of Science:

  • Human Factors
  • Surgical Safety
  • Team Performance

Background:

  • Paediatric cardiac surgery (PCS) demands high cognitive and technical performance due to its low error tolerance.
  • Intraoperative non-routine events (NREs) and team performance significantly impact surgical outcomes.
  • Developing robust methods to study teamwork in PCS is crucial for enhancing patient safety.

Purpose of the Study:

  • To assess the role of intraoperative non-routine events (NREs) and team performance on paediatric cardiac surgery outcomes.
  • To improve methods for studying teamwork in the operating room (OR) setting.
  • To establish reliable observation protocols for surgical team dynamics.

Main Methods:

  • Human factors observers were trained through immersive experience in 10 paediatric cardiac surgery operations.
  • Observers coded NREs and teamwork from OR arrival to intensive care unit handover.
  • A rigorous training and assessment protocol, including video-based assessments by experts, was implemented.
  • Real-time observations were supplemented with process mapping and questionnaires.

Main Results:

  • High inter-rater reliability (91%) was achieved for teamwork categories (Cohen kappa = 0.77).
  • 68% of events were observed by one observer, while 32% were observed by both.
  • When events were coded by both observers, 76% agreement was reached.
  • Recommendations for observer training and real-time rating were developed.

Conclusions:

  • Paediatric cardiac surgery serves as an ideal model for exploring team performance.
  • Efficient and robust methods for observing teamwork in healthcare settings are needed.
  • The study provides a foundation for more effective teamwork assessment in surgical environments.