Makary Martin A, Sexton J Bryan, Freischlag Julie A, Holzmueller Christine G, Millman E Anne, Rowen Lisa, Pronovost Peter J
Department of Surgery and Health Policy and Management, Johns Hopkins University School of Medicine, Johns Hopkins Medical Institutions, Baltimore, MD 21224, USA.
J Am Coll Surg. 2006 May;202(5):746-52. doi: 10.1016/j.jamcollsurg.2006.01.017.
Teamwork is an important component of patient safety. In fact, communication errors are the most common cause of sentinel events and wrong-site operations in the US. Although efforts to improve patient safety through improving teamwork are growing, there is no validated tool to scientifically measure teamwork in the surgical setting.
Operating room personnel in 60 hospitals were surveyed using the Safety Attitudes Questionnaire. Surgeons, anesthesiologists, certified registered nurse anesthetists, and operating room nurses rated their own peers and each other using a 5-point Likert scale (1 = very low, 5 = very high).
Overall response rate was 77.1% (2,135 of 2,769). Ratings of teamwork differed substantially by operating room caregiver type, with the greatest differences in ratings shown by physicians: surgeons (F[4, 2058] = 41.73, p < 0.001), and anesthesiologists (F[4, 1990] = 53.15, p < 0.001). The percent of operating room caregivers rating the quality of collaboration and communication as "high" or "very high" was different by caregiver role and whether they were rating a peer or another type of caregiver: surgeons rated other surgeons "high" or "very high" 85% of the time, and nurses rated their collaboration with surgeons "high" or "very high" only 48% of the time.
Considerable discrepancies in perceptions of teamwork exist in the operating room, with physicians rating the teamwork of others as good, but at the same time, nurses perceive teamwork as mediocre. Given the importance of communication and collaboration in patient safety, health care organizations should measure teamwork using a scientifically valid method. The Safety Attitudes Questionnaire can be used to measure teamwork, identify disconnects between or within disciplines, and evaluate interventions aimed at improving patient safety.
团队合作是患者安全的重要组成部分。事实上，沟通失误是美国医疗警戒事件和手术部位错误的最常见原因。尽管通过改善团队合作来提高患者安全的努力不断增加，但在手术环境中，尚无经过验证的科学衡量团队合作的工具。
使用安全态度问卷对60家医院的手术室人员进行了调查。外科医生、麻醉医生、注册护士麻醉师和手术室护士使用5点李克特量表（1 = 非常低，5 = 非常高）对自己的同行和彼此进行评分。
总体回复率为77.1%（2769人中的2135人）。团队合作评分因手术室护理人员类型而异，医生之间的评分差异最大：外科医生（F[4, 2058] = 41.73，p < 0.001）和麻醉医生（F[4, 1990] = 53.15，p < 0.001）。将协作和沟通质量评为“高”或“非常高”的手术室护理人员百分比因护理人员角色以及他们是在评价同行还是其他类型的护理人员而有所不同：外科医生在85%的时间里将其他外科医生评为“高”或“非常高”，而护士仅在48%的时间里将他们与外科医生的协作评为“高”或“非常高”。
手术室中对团队合作的认知存在相当大的差异，医生认为其他人的团队合作良好，但与此同时，护士认为团队合作一般。鉴于沟通与协作在患者安全中的重要性，医疗保健机构应使用科学有效的方法来衡量团队合作。安全态度问卷可用于衡量团队合作、识别不同学科之间或学科内部的脱节情况，并评估旨在提高患者安全的干预措施。
