Xiao Yan, Jones Alan, Zhang Beilei Belinda, Bennett Monica, Mears Simon C, Mabrey Jay D, Kennerly Donald
Baylor Scott & White Health, 8080 N. Central Expressway, Suite 500, Dallas, TX, 75206, USA,
World J Surg. 2015 Apr;39(4):890-6. doi: 10.1007/s00268-014-2866-7.
Human factors research has suggested benefits of consistent teams yet no surgical team consistency measures have been established for teamwork improvement initiatives.
Retrospective analysis was conducted of teams performing consecutive elective procedures of unilateral primary total knee and hip replacement between June 2008 and May 2010 at a large tertiary medical center. Surgeons who performed fewer than 50 cases of the procedures during the study period were excluded. A team was defined as consistent when its nurse and surgical technologist members were both among the three most frequent working with the surgeon during the study period. Odds ratios for prolonged operative time (in the longest quartile), prolonged hospital stay (longer than median), and 30-day all-cause readmissions were adjusted for patient characteristics (sex, age, comorbidity, American Society of Anesthesiology status), surgery characteristics (procedures, time of day), and surgeons.
Inconsistent teams performed 61% of the 1,923 cases with eight surgeons, each of which worked with a median of 43.5 (range, 28-58) nurses and 29 (range, 13-47) technologists. Inconsistent teams were associated with higher likelihood of prolonged operative time [odds ratio 1.52, 95% confidence interval (CI) 1.20-1.91], higher likelihood of prolonged hospital stay (odds ratio 1.51, 95% CI 1.23-1.86), and more readmissions (adjusted odds ratio 1.42, 95% CI 1.07-1.89).
Team consistency was an independent predictor of prolonged operative time, prolonged hospital stay, and 30-day hospital readmission in elective, primary, unilateral total knee, and hip replacement procedures, after adjusting for patient and surgery characteristics and surgeons.
人为因素研究表明稳定的团队有诸多益处，但尚未建立手术团队稳定性的衡量标准以推动团队协作改进计划。
对2008年6月至2010年5月期间在一家大型三级医疗中心连续进行单侧初次全膝关节和髋关节置换择期手术的团队进行回顾性分析。排除在研究期间手术量少于50例的外科医生。若一个团队的护士和手术技师成员在研究期间均为与该外科医生合作最频繁的三人之一，则定义该团队为稳定团队。对延长手术时间（最长四分位数）、延长住院时间（长于中位数）和30天全因再入院的比值比进行调整，以考虑患者特征（性别、年龄、合并症、美国麻醉医师协会分级）、手术特征（手术方式、手术时间）和外科医生因素。
不稳定团队完成了1923例手术中的61%，涉及8位外科医生，每位外科医生平均与43.5名（范围28 - 58名）护士和29名（范围13 - 47名）技师合作。不稳定团队与延长手术时间的可能性更高[比值比1.52，95%置信区间（CI）1.20 - 1.91]、延长住院时间的可能性更高（比值比1.51，95%CI 1.23 - 1.86）以及更多再入院情况（调整后比值比1.42，95%CI 1.07 - 1.89）相关。
在调整患者、手术特征和外科医生因素后，团队稳定性是择期、初次、单侧全膝关节和髋关节置换手术中延长手术时间、延长住院时间和30天内再次入院的独立预测因素。
