Li N, Marshall D, Sykes M, McCulloch P, Shalhoub J, Maruthappu M
Department of General Surgery Wexham Park Hospital Slough UK.
Department of Medicine Imperial College London London UK.
BJS Open. 2018 Feb 15;2(2):42-51. doi: 10.1002/bjs5.40. eCollection 2018 Apr.
Teamwork in the operating theatre is becoming increasingly recognized as a major factor in clinical outcomes. Many tools have been developed to measure teamwork. Most fall into two categories: self-assessment by theatre staff and assessment by observers. A critical and comparative analysis of the validity and reliability of these tools is lacking.
MEDLINE and Embase databases were searched following PRISMA guidelines. Content validity was assessed using measurements of inter-rater agreement, predictive validity and multisite reliability, and interobserver reliability using statistical measures of inter-rater agreement and reliability. Quantitative meta-analysis was deemed unsuitable.
Forty-eight articles were selected for final inclusion; self-assessment tools were used in 18 and observational tools in 28, and there were two qualitative studies. Self-assessment of teamwork by profession varied with the profession of the assessor. The most robust self-assessment tool was the Safety Attitudes Questionnaire (SAQ), although this failed to demonstrate multisite reliability. The most robust observational tool was the Non-Technical Skills (NOTECHS) system, which demonstrated both test-retest reliability (P > 0·09) and interobserver reliability (Rwg = 0·96).
Self-assessment of teamwork by the theatre team was influenced by professional differences. Observational tools, when used by trained observers, circumvented this.
手术室团队协作日益被视为临床结果的一个主要因素。已经开发了许多工具来衡量团队协作。大多数工具分为两类：手术室工作人员的自我评估和观察者的评估。缺乏对这些工具的有效性和可靠性的批判性和比较性分析。
按照PRISMA指南检索MEDLINE和Embase数据库。使用评分者间一致性、预测效度和多中心信度的测量方法评估内容效度，并使用评分者间一致性和信度的统计测量方法评估观察者间信度。定量荟萃分析被认为不合适。
最终纳入48篇文章；18篇使用自我评估工具，28篇使用观察工具，还有两项定性研究。不同专业的手术室工作人员对团队协作的自我评估因评估者的专业不同而有所差异。最可靠的自我评估工具是安全态度问卷（SAQ），尽管它未能证明多中心信度。最可靠的观察工具是非技术技能（NOTECHS）系统，它显示了重测信度（P>0·09）和观察者间信度（Rwg=0·96）。
手术室团队对团队协作的自我评估受专业差异影响。由经过培训的观察者使用观察工具可避免这一问题。
