Practicality of intraoperative teamwork assessments

Area of Science:

• Medical Simulation
• Teamwork Assessment
• Operating Room Efficiency

Background:

• High-quality operating room (OR) teamwork is crucial for patient safety and efficiency.
• Quantifying teamwork aids in feedback, assessment, and performance improvement.
• Existing instruments assess specific OR disciplines but routine documentation is challenging.

Purpose of the Study:

• To identify the most feasible method for routine OR teamwork documentation during in-situ simulations.
• To compare rater agreement, training costs, and feasibility of different assessment instruments.

Main Methods:

• Five OR teams (anesthesia/surgery residents, nurses, technicians) were videotaped during simulated malignant hyperthermia scenarios.
• Multiple validated instruments were used to assess non-technical skills of individual OR professionals and the team.
• Rater agreement, training time, and hypothetical costs were analyzed for clinicians and non-clinicians.

Main Results:

• Intraclass correlations for rater agreement varied widely (0.17-0.85).
• Clinician and non-clinician agreements were comparable.
• Training costs ranged significantly, from $442 to $6006 per rater, depending on the instrument and rater's background.

Conclusions:

• Achieving high rater agreement necessitates extensive training, which may be prohibitively expensive.
• A cost-effective model for real-time OR teamwork assessment involves a simulation technician and a single clinical rater.
• This combined approach allows for comprehensive documentation of all OR team members' performance.