Advertisement

World Journal of Surgery

, Volume 31, Issue 7, pp 1373–1381 | Cite as

Observational Teamwork Assessment for Surgery (OTAS): Refinement and Application in Urological Surgery

  • Shabnam UndreEmail author
  • Nick Sevdalis
  • Andrew N. Healey
  • Ara Darzi
  • Charles A. Vincent
Article

Abstract

Background

Teamwork in surgical teams is at the forefront of good practice guidelines and empirical research as an important aspect of safe surgery. We have developed a comprehensive assessment for teamwork in surgery—the Observational Teamwork Assessment for Surgery (OTAS)—and we have tested it for general surgical procedures. The aim of the research reported here was to extend the assessment to urology procedures.

Methods

After refining the original assessment, we used it to observe 50 urology procedures. The OTAS comprises a procedural task checklist that assesses patient, equipment/provisions, and communication tasks as well as ratings on five team behavior constructs (communication, cooperation, coordination, leadership, and monitoring). Teamwork was assessed separately in the surgical, anesthesia, and nursing subteams in the operating theater. We also assessed the reliability of the behavioral scoring.

Results

Regarding task completion, a number of communication and equipment/provisions tasks were not routinely performed during the operations we observed. Regarding teamwork-related behaviors, adequate reliability was obtained in the scoring of behaviors. Anesthetists and nurses obtained their lowest scores on communication. Surgeons’ scores revealed a more complex pattern. In addition to low scores on communication, surgeons’ teamwork behaviors appeared to deteriorate as the procedures were finishing.

Conclusions

Our findings suggest that OTAS is applicable to various branches of surgery. Separate assessment of the subteams in the operating theater provides useful information that can be used to build targeted teamwork training aiming to improve surgical patients’ safety and outcomes.

Keywords

Operating Theater Surgical Team Behavioral Rating Task List Communication Task 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Acknowledgments

The authors thank the BUPA Foundation and the Department of Health: Patient Safety Research Programme for funding this work and the British Academy for supporting the presentation of some of the work at the 26th International Congress of Applied Psychology (Athens, July 2006).

References

  1. 1.
    Vincent C, Moorthy K, Sarker SK, et al. (2004) Systems approaches to surgical quality and safety: from concept to measurement. Ann Surg 239:475–482PubMedCrossRefGoogle Scholar
  2. 2.
    Calland JF, Guerlain S, Adams RB, et al. (2002) A systems approach to surgical safety. Surg Endosc 16:1005–1014PubMedCrossRefGoogle Scholar
  3. 3.
    Healey AN, Sevdalis N, Vincent C (2006) Measuring intra-operative interference from distraction and interruption observed in the operating theater. Ergonomics 49:589–604PubMedCrossRefGoogle Scholar
  4. 4.
    Lingard L, Garwood S, Poenaru D (2004) Tensions influencing operating room team function: does institutional context make a difference. Med Educ 38:691–699PubMedCrossRefGoogle Scholar
  5. 5.
    Lingard L, Reznick R, Espin S, et al. (2002) Team communications in the operating room: talk patterns, sites of tension, and implications for novices. Acad Med 77:232–237PubMedCrossRefGoogle Scholar
  6. 6.
    Lingard L, Espin S, Whyte S, et al. (2004) Communication failures in the operating room: an observational classification of recurrent types and effects. Qual Saf Health Care 13:330–334PubMedCrossRefGoogle Scholar
  7. 7.
    Sevdalis N, Healey AN, Vincent C (2007) Distracting communications in the operating theater. J Eval Clin Pract (in press)Google Scholar
  8. 8.
    Kohn LT, Corrigan JM, Donaldson MS (1999) To Err Is Human: Building a Safer Health System. Washington DC, Institute of Medicine, National Academies PressGoogle Scholar
  9. 9.
    Miller LA (2005) Patient safety and teamwork in perinatal care: resources for clinicians. J Perinat Neonat Nurs 19:46–51Google Scholar
  10. 10.
    Thomas EJ, Sexton JB, Lasky RE, et al. (2006) Teamwork and quality during neonatal care in the delivery room. J Perinatol 26:163–169PubMedCrossRefGoogle Scholar
  11. 11.
    Morey JC, Simon R, Jay GD, et al. (2002) Error reduction and performance improvement in the emergency department through formal teamwork training: evaluation results of the MedTeams project. Health Serv Res 37:1553–1581PubMedCrossRefGoogle Scholar
  12. 12.
    Risser DT, Rice MM, Salisbury ML, et al. (1999) The potential for improved teamwork to reduce medical errors in the emergency department: the MedTeams Research Consortium. Ann Emerg Med 34:373–383PubMedCrossRefGoogle Scholar
  13. 13.
    Sherwood G, Thomas E, Bennett DS, et al. (2002) A teamwork model to promote patient safety in critical care. Crit Care Nurs Clin North Am 14:333–340PubMedCrossRefGoogle Scholar
  14. 14.
    Undre S, Sevdalis N, Healey AN, et al. (2006) Teamwork in the operating theater: cohesion or confusion? J Eval Clin Pract 12:182–189PubMedCrossRefGoogle Scholar
  15. 15.
    Makary MA, Sexton JB, Freischlag JA, et al. (2006) Operating room teamwork among physicians and nurses: teamwork in the eye of the beholder. J Am Coll Surg 202:746–752PubMedCrossRefGoogle Scholar
  16. 16.
    Flin R, Yule S, McKenzie L, et al. (2006) Attitudes to teamwork and safety in the operating theater. Surgeon 4:145–151PubMedCrossRefGoogle Scholar
  17. 17.
    Flin R, Fletcher G, McGeorge P, et al. (2003) Anesthetists’ attitudes to teamwork and safety. Anesthesia 58:233–242CrossRefGoogle Scholar
  18. 18.
    Undre S, Healey AN, Darzi A, et al. (2006) Observational assessment of surgical teamwork: a feasibility study. World J Surg 30:1774–1783PubMedCrossRefGoogle Scholar
  19. 19.
    Healey AN, Undre S, Sevdalis N, et al. (2006) The complexity of measuring interprofessional teamwork in the operating theater. J Interprof Care 20:485–495PubMedCrossRefGoogle Scholar
  20. 20.
    Healey AN, Undre S, Vincent CA (2004) Developing observational measures of performance in surgical teams. Qual Saf Health Care 13(Suppl 1):i33–i40PubMedCrossRefGoogle Scholar
  21. 21.
    Rao AR, Hudd C, Laniado M, et al. (2005) Left or right, get it right! BJU Int 95(s5):95Google Scholar
  22. 22.
    Coxon JP, Pattison SH, Parks JW, et al. (2003) Reducing human error in urology: lessons from aviation. BJU Int 91:1–3PubMedCrossRefGoogle Scholar
  23. 23.
    Lingard L, Espin S, Rubin B, et al. (2005) Getting teams to talk: development and pilot implementation of a checklist to promote interprofessional communication in the OR. Qual Saf Health Care 14:340–346PubMedCrossRefGoogle Scholar

Copyright information

© Société Internationale de Chirurgie 2007

Authors and Affiliations

  • Shabnam Undre
    • 1
    Email author
  • Nick Sevdalis
    • 1
    • 2
  • Andrew N. Healey
    • 1
  • Ara Darzi
    • 3
  • Charles A. Vincent
    • 1
  1. 1.Clinical Safety Research Unit, Department of Bio-Surgery and Surgical TechnologyImperial CollegeLondonUK
  2. 2.National Patient Safety AgencyLondonUK
  3. 3.Department of Bio-Surgery and Surgical TechnologyImperial CollegeLondonUK

Personalised recommendations