A prospective study of paediatric cardiac surgical microsystems: assessing the relationships between non-routine events, teamwork and patient outcomes
- 13 April 2011
- journal article
- research article
- Published by BMJ in BMJ Quality & Safety
- Vol. 20 (7), 599-603
- https://doi.org/10.1136/bmjqs.2010.048983
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 (Muncomplicated=9.08; Mminor complications=11.11; Mmajor morbidity=14.60, F(2,26)=3.46, p1=13.5; M2=7.1, F(1,37)=33.07, pConclusions 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.Keywords
This publication has 29 references indexed in Scilit:
- A Surgical Safety Checklist to Reduce Morbidity and Mortality in a Global PopulationThe New England Journal of Medicine, 2009
- An epistemology of patient safety research: a framework for study design and interpretation. Part 3. End points and measurementHeart, 2008
- Teamwork and Error in the Operating RoomAnnals of Surgery, 2008
- The influence of non-technical performance on technical outcome in laparoscopic cholecystectomySurgical Endoscopy, 2007
- Understanding the complexity of redesigning care around the clinical microsystemPublished by BMJ ,2006
- Development of a rating system for surgeons' non-technical skillsMedical Education, 2006
- Identification of systems failures in successful paediatric cardiac surgeryErgonomics, 2006
- Integrating patient safety into the clinical microsystemHeart, 2004
- The Aristotle score: a complexity-adjusted method to evaluate surgical results1European Journal of Cardio-Thoracic Surgery, 2004
- Human Factors Research in Anesthesia Patient Safety: Techniques to Elucidate Factors Affecting Clinical Task Performance and Decision MakingJournal of the American Medical Informatics Association, 2002