Institute of Social Psychology, London School of Economics, Houghton Street, London WC2A 2AE, UK.
BMJ Qual Saf. 2011 Dec;20(12):1035-42. doi: 10.1136/bmjqs.2010.048561. Epub 2011 Jun 23.
The ability of medical teams to develop and maintain team situation awareness (team SA) is crucial for patient safety. Limited research has investigated team SA within clinical environments. This study reports the development of a method for investigating team SA during the intensive care unit (ICU) round and describes the results.
In one ICU, a sample of doctors and nurses (n = 44, who combined to form 37 different teams) were observed during 34 morning ward rounds. Following the clinical review of each patient (n = 105), team members individually recorded their anticipations for expected patient developments over 48 h. Patient-outcome data were collected to determine the accuracy of anticipations. Anticipations were compared among ICU team members, and the degree of consensus was used as a proxy measure of team SA. Self-report and observational data measured team-member involvement and communication during patient reviews.
For over half of 105 patients, ICU team members formed conflicting anticipations as to whether patients would deteriorate within 48 h. Senior doctors were most accurate in their predictions. Exploratory analysis found that team processes did not predict team SA. However, the involvement of junior and senior trainee doctors in the patient decision-making process predicted the extent to which those team members formed team SA with senior doctors.
A new method for measuring team SA during the ICU round was successfully employed. A number of areas for future research were identified, including refinement of the situation awareness and teamwork measures.
医疗团队发展和维持团队态势感知（team SA）的能力对于患者安全至关重要。有限的研究调查了临床环境中的团队 SA。本研究报告了一种在重症监护病房（ICU）查房期间调查团队 SA 的方法的开发，并描述了结果。
在一个 ICU 中，观察了 34 次晨间查房中的一组医生和护士（n=44，共组成 37 个不同的团队）。在对每个患者（n=105）进行临床检查后，团队成员单独记录了他们对 48 小时内预期患者发展的预期。收集患者结果数据以确定预期的准确性。比较了 ICU 团队成员之间的预期，并将一致性程度用作团队 SA 的代理测量。自我报告和观察数据测量了患者审查期间团队成员的参与度和沟通情况。
对于 105 名患者中的一半以上，ICU 团队成员对患者是否会在 48 小时内恶化形成了相互冲突的预期。资深医生的预测最为准确。探索性分析发现，团队流程并不能预测团队 SA。然而，初级和高级住院医生在患者决策过程中的参与度预测了这些团队成员与资深医生形成团队 SA 的程度。
成功采用了一种在 ICU 查房期间测量团队 SA 的新方法。确定了一些未来研究的领域，包括对态势感知和团队合作措施的改进。
