Harvard Medical School, 25 Shattuck Street, Boston, MA 02116, USA.
Harvard Business School, Wyss House, Soldiers Field Road, Boston, MA 02163, USA.
Int J Qual Health Care. 2021 Apr 28;33(2). doi: 10.1093/intqhc/mzab069.
Newly intensified use of personal protective equipment (PPE) in emergency departments presents teamwork challenges affecting the quality and safety of care at the frontlines.
We conducted a qualitative study to categorize and describe barriers to teamwork posed by PPE and distancing in the emergency setting.
We conducted 55 semi-structured interviews between June 2020 and August 2020 with personnel from two emergency departments serving in a variety of roles. We then performed a thematic analysis to identify and construct patterns of teamwork challenges into themes.
We discovered two types of challenges to teamwork: material barriers related to wearing masks, gowns and powered air-purifying respirators, and spatial barriers implemented to conserve PPE and limit coronavirus exposure. Both material and spatial barriers resulted in disrupted communication, roles and interpersonal relationships, but they did so in unique ways. Material barriers muffled information flow, impeded team member recognition and role/task division, and reduced belonging and cohesion while increasing interpersonal strain. Spatial barriers resulted in mediated communication and added physical and emotional distance between teammates and patients.
Our findings identify specific aspects of how intensified PPE use disrupts teamwork and can inform efforts to ensure care quality and safety in emergency settings as PPE use continues during and, potentially beyond, the coronavirus disease-2019 pandemic.
在急诊科，新的个人防护设备（PPE）的使用强度增加，这对前线的护理质量和安全造成了团队合作方面的挑战。
我们进行了一项定性研究，以对 PPE 和在紧急情况下保持距离对团队合作造成的障碍进行分类和描述。
我们在 2020 年 6 月至 8 月期间对两家急诊科的 55 名不同岗位的工作人员进行了半结构化访谈。然后，我们进行了主题分析，以确定并构建出团队合作挑战的主题模式。
我们发现了两种类型的团队合作障碍：与佩戴口罩、长袍和动力空气净化呼吸器有关的物质障碍，以及为了节省 PPE 和限制冠状病毒暴露而实施的空间障碍。物质和空间障碍都导致了沟通、角色和人际关系的中断，但它们的影响方式是独特的。物质障碍阻碍了信息流，阻碍了团队成员的识别和角色/任务分工，减少了归属感和凝聚力，同时增加了人际关系的紧张。空间障碍导致了沟通的中介化，并在队友和患者之间增加了身体和情感上的距离。
我们的研究结果确定了强化 PPE 使用如何破坏团队合作的具体方面，并为在继续使用 PPE 以及可能在新冠疫情过后的紧急情况下确保护理质量和安全方面提供了信息。
