Organization, Work, Technology Group, ETH Zurich, Zurich, Switzerland.
BMJ Qual Saf. 2013 Jul;22(7):596-605. doi: 10.1136/bmjqs-2012-001319. Epub 2013 Mar 19.
Acute care teams (ACTs) represent action teams, that is, teams in which members with specialised roles must coordinate their actions during intense situations, often under high time pressure and with unstable team membership. Using behaviour observation, patient safety research has been focusing on defining teamwork behaviours-particularly coordination-that are critical for patient safety during these intense situations. As one result of this divergent research landscape, the number, scope and variety of applied behaviour observation taxonomies are growing, making comparison and convergent integration of research findings difficult.
To facilitate future ACT research by presenting a framework that provides a shared language of teamwork behaviours, allows for comparing previous and future ACT research and offers a measurement tool for ACT observation.
Based on teamwork theory and empirical evidence, we developed Co-ACT-the Framework for Observing Coordination Behaviour in ACT. Integrating two previous, extensive taxonomies into Co-ACT, we also suggested 12 behavioural codes for which we determined inter-rater reliability by analysing the teamwork of videotaped anaesthesia teams in the clinical setting.
The Co-ACT framework consists of four quadrants organised along two dimensions (explicit vs implicit coordination; action vs information coordination). Each quadrant provides three categories for which Cohen's κ overall value was substantial; but values for single categories varied considerably.
Co-ACT provides a framework for organising behaviour codes and offers respective categories for succinctly measuring teamwork in ACTs. Furthermore, it has the potential to allow for guiding and comparing ACTs study results. Future work using Co-ACT in different research and training settings will show how well it can generally be applied across ACTs.
急性护理团队（ACTs）代表行动团队，即在高强度情况下，成员必须协调各自具有专业角色的行动，通常在时间压力大且团队成员不稳定的情况下。通过行为观察，患者安全研究一直致力于定义在这些高强度情况下对患者安全至关重要的团队合作行为，特别是协调行为。作为这一发散研究领域的结果之一，应用行为观察分类法的数量、范围和种类都在增加，使得研究结果的比较和趋同整合变得困难。
通过提出一个框架来促进未来的 ACT 研究，该框架提供了团队合作行为的共同语言，允许比较以前和未来的 ACT 研究，并为 ACT 观察提供测量工具。
基于团队合作理论和实证证据，我们开发了 Co-ACT，即急性护理团队中协调行为观察框架。我们将两个以前广泛的分类法整合到 Co-ACT 中，还为其中的 12 个行为代码确定了组内一致性，通过分析临床环境中录像麻醉团队的团队合作，我们分析了这些行为代码。
Co-ACT 框架由四个象限组成，沿着两个维度（显式协调与隐式协调；行动协调与信息协调）组织。每个象限提供三个类别，Cohen's κ 整体值均为显著；但单个类别的值差异很大。
Co-ACT 为组织行为代码提供了一个框架，并提供了简洁测量 ACT 团队合作的相应类别。此外，它有可能指导和比较 ACT 研究结果。未来在不同的研究和培训环境中使用 Co-ACT 将表明它在整个 ACT 中一般应用的效果如何。
