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.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Vincent C, Moorthy K, Sarker SK, et al. (2004) Systems approaches to surgical quality and safety: from concept to measurement. Ann Surg 239:475–482
Calland JF, Guerlain S, Adams RB, et al. (2002) A systems approach to surgical safety. Surg Endosc 16:1005–1014
Healey AN, Sevdalis N, Vincent C (2006) Measuring intra-operative interference from distraction and interruption observed in the operating theater. Ergonomics 49:589–604
Lingard L, Garwood S, Poenaru D (2004) Tensions influencing operating room team function: does institutional context make a difference. Med Educ 38:691–699
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 77:232–237
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 13:330–334
Sevdalis N, Healey AN, Vincent C (2007) Distracting communications in the operating theater. J Eval Clin Pract (in press)
Kohn LT, Corrigan JM, Donaldson MS (1999) To Err Is Human: Building a Safer Health System. Washington DC, Institute of Medicine, National Academies Press
Miller LA (2005) Patient safety and teamwork in perinatal care: resources for clinicians. J Perinat Neonat Nurs 19:46–51
Thomas EJ, Sexton JB, Lasky RE, et al. (2006) Teamwork and quality during neonatal care in the delivery room. J Perinatol 26:163–169
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 37:1553–1581
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 34:373–383
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 14:333–340
Undre S, Sevdalis N, Healey AN, et al. (2006) Teamwork in the operating theater: cohesion or confusion? J Eval Clin Pract 12:182–189
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 202:746–752
Flin R, Yule S, McKenzie L, et al. (2006) Attitudes to teamwork and safety in the operating theater. Surgeon 4:145–151
Flin R, Fletcher G, McGeorge P, et al. (2003) Anesthetists’ attitudes to teamwork and safety. Anesthesia 58:233–242
Undre S, Healey AN, Darzi A, et al. (2006) Observational assessment of surgical teamwork: a feasibility study. World J Surg 30:1774–1783
Healey AN, Undre S, Sevdalis N, et al. (2006) The complexity of measuring interprofessional teamwork in the operating theater. J Interprof Care 20:485–495
Healey AN, Undre S, Vincent CA (2004) Developing observational measures of performance in surgical teams. Qual Saf Health Care 13(Suppl 1):i33–i40
Rao AR, Hudd C, Laniado M, et al. (2005) Left or right, get it right! BJU Int 95(s5):95
Coxon JP, Pattison SH, Parks JW, et al. (2003) Reducing human error in urology: lessons from aviation. BJU Int 91:1–3
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 14:340–346
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).
Author information
Authors and Affiliations
Corresponding author
Appendix
Appendix
Communication in the OTAS Assessment. The behavior is assessed on the seven-point behaviorally anchored scale below. The attached exemplars and the demonstrative scenarios aid the observer in allocating a score to each subteam in the operating theater.
Rights and permissions
About this article
Cite this article
Undre, S., Sevdalis, N., Healey, A.N. et al. Observational Teamwork Assessment for Surgery (OTAS): Refinement and Application in Urological Surgery. World J Surg 31, 1373–1381 (2007). https://doi.org/10.1007/s00268-007-9053-z
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00268-007-9053-z