Williams A L, Lasky R E, Dannemiller J L, Andrei A M, Thomas E J
Center for Clinical Research and Evidence-Based Medicine, University of Texas Medical School at Houston, Houston, Texas, USA.
Qual Saf Health Care. 2010 Feb;19(1):60-4. doi: 10.1136/qshc.2007.025320.
To describe relationships between teamwork behaviours and errors during neonatal resuscitation.
Trained observers viewed video recordings of neonatal resuscitations (n = 12) for the occurrence of teamwork behaviours and errors. Teamwork state behaviours (such as vigilance and workload management, which extend for some duration) were assessed as the percentage of each resuscitation that the behaviour was observed and correlated with the percentage of observed errors. Teamwork event behaviours (such as information sharing, inquiry and assertion, which occur at specific times) were counted in 20-s intervals before and after resuscitation steps, and a generalised linear mixed model was calculated to evaluate relationships between these behaviours and errors.
Resuscitation teams who were more vigilant committed fewer errors (Spearman's rho for vigilance and errors = -0.62, 95% CI -0.07 to -0.87, p = 0.031). Assertions were more likely to occur before errors than correct steps (OR = 1.44, 95% CI 1.10 to 1.89, p = 0.008) and teaching/advising occurred less frequently after errors (OR = 0.59, 95% CI 0.37 to 0.94, p = 0.028). Though not statistically significant, there was less information sharing before errors (OR = 0.90, 95% CI 0.77 to 1.05, p = 0.172).
Vigilance is an important behaviour for error management. Assertion may have caused errors, or perhaps was an indicator for some other factor that caused errors. Teams may have preferred to resolve errors directly, rather than using errors as opportunities to teach their teammates. These observations raise important questions about the appropriate use of some teamwork behaviours and how to include them in team training programmes.
描述新生儿复苏过程中团队协作行为与失误之间的关系。
训练有素的观察员观看新生儿复苏视频记录（n = 12），观察团队协作行为和失误的发生情况。团队协作状态行为（如警觉性和工作量管理，持续一段时间）通过行为被观察到的复苏过程的百分比来评估，并与观察到的失误百分比进行关联。团队协作事件行为（如信息共享、询问和断言，在特定时间发生）在复苏步骤前后以20秒为间隔进行计数，并计算广义线性混合模型以评估这些行为与失误之间的关系。
警觉性更高的复苏团队失误更少（警觉性与失误的斯皮尔曼相关系数=-0.62，95%可信区间-0.07至-0.87，p = 0.031）。断言在失误之前比在正确步骤之前更有可能发生（比值比=1.44，95%可信区间1.10至1.89，p = 0.008），而教学/建议在失误之后发生的频率较低（比值比=0.59，95%可信区间0.37至0.94，p = 0.028）。虽然无统计学意义，但失误之前的信息共享较少（比值比=0.90，95%可信区间0.77至1.05，p = 0.172）。
警觉性是失误管理的重要行为。断言可能导致了失误，或者可能是导致失误的其他一些因素的指标。团队可能更倾向于直接解决失误，而不是将失误作为教导队友的机会。这些观察结果引发了关于一些团队协作行为的恰当使用以及如何将其纳入团队培训计划的重要问题。
