Division of Hospital Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA.
J Hosp Med. 2012 Nov-Dec;7(9):679-83. doi: 10.1002/jhm.1970. Epub 2012 Sep 7.
Interdisciplinary rounds (IDR) provide a means to assemble hospital team members and improve collaboration. Little is known about teamwork during IDR.
To evaluate and characterize teamwork during IDR.
Cross-sectional observational study.
Six medical units which had implemented structured interdisciplinary rounds (SIDR).
We adapted the Observational Teamwork Assessment for Surgery (OTAS) tool, a behaviorally anchored rating scale shown to be reliable and valid in surgical settings. OTAS provides scores ranging from 0 to 6 (0 = problematic behavior; 6 = exemplary behavior) across 5 domains (communication, coordination, cooperation/backup behavior, leadership, and monitoring/situational awareness) and for prespecified subteams. Two researchers conducted direct observations using the adapted OTAS tool.
We conducted 7-8 independent observations for each unit (total = 44) and 20 joint observations. Inter-rater reliability was excellent at the unit level (Spearman's rho = 0.75), and good across domains (rho = 0.53-0.68) and subteams (rho = 0.53-0.76) with the exception of the physician subteam, for which it was poor (rho = 0.35). Though teamwork scores were generally high, we found differences across units, with a median (interquartile range [IQR]) 4.5 (3.9-4.9) for the lowest and 5.4 (5.3-5.5) for the highest performing unit (P < 0.01). Domain scores differed, with leadership receiving the lowest (median [IQR] = 5.0 [4.6-5.3]), and cooperation/backup behavior and monitoring/situational awareness receiving highest scores (median [IQR] = 5.4 [5.0-5.5] and 5.4 [5.0-5.7]). Differences across subteams were of borderline significance (P = 0.05).
The adapted OTAS instrument demonstrated acceptable reliability for assessing teamwork during SIDR across units, domains, and most subteams. Variation in performance suggests a need to improve consistency of teamwork and emphasizes the importance of leadership.
跨学科查房（IDR）为聚集医院团队成员和改善协作提供了一种手段。关于 IDR 期间的团队合作，我们知之甚少。
评估和描述 IDR 期间的团队合作。
横断面观察性研究。
已实施结构化跨学科查房（SIDR）的六个医疗单位。
我们改编了观察性手术团队评估（OTAS）工具，这是一种在手术环境中被证明可靠和有效的行为锚定评分量表。OTAS 在 5 个领域（沟通、协调、合作/备份行为、领导和监测/情境意识）和特定小组提供 0 到 6 分（0=有问题的行为；6=模范行为）的评分。两位研究人员使用改编后的 OTAS 工具进行了直接观察。
我们对每个单位进行了 7-8 次独立观察（总观察数为 44 次）和 20 次联合观察。单位水平的组内一致性非常好（Spearman's rho = 0.75），在各个领域（rho = 0.53-0.68）和小组（rho = 0.53-0.76）的一致性也很好，但医生小组除外，其一致性较差（rho = 0.35）。尽管团队合作评分普遍较高，但我们发现各单位之间存在差异，评分最低的单位中位数（四分位距 [IQR]）为 4.5（3.9-4.9），评分最高的单位中位数（IQR）为 5.4（5.3-5.5）（P < 0.01）。各领域评分不同，领导力得分最低（中位数 [IQR] = 5.0 [4.6-5.3]），合作/备份行为和监测/情境意识得分最高（中位数 [IQR] = 5.4 [5.0-5.5] 和 5.4 [5.0-5.7]）。小组间的差异具有边缘显著性（P = 0.05）。
改编后的 OTAS 工具在评估 SIDR 期间各单位、各领域和大多数小组的团队合作方面具有可接受的可靠性。绩效的差异表明需要提高团队合作的一致性，并强调领导力的重要性。
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