Keller Sandra, Yule Steven, Smink Douglas S, Zagarese Vivian, Safford Shawn, Valea Fidel A, Beldi Guido, Henrickson Parker Sarah
From the Fralin Biomedical Research Institute at Virginia Tech Carilion, Roanoke, VA.
Department of Visceral Surgery and Medicine, Bern University Hospital, University of Bern, Switzerland.
Ann Surg Open. 2023 Sep 12;4(3):e333. doi: 10.1097/AS9.0000000000000333. eCollection 2023 Sep.
To identify which strain episodes are concurrently reported by several team members; to identify triggers of strain experienced by operating room (OR) team members during the intraoperative phase.
OR teams are confronted with many sources of strain. However, most studies investigate strain on a general, rather than an event-based level, which does not allow to determine if strain episodes are experienced concurrently by different team members.
We conducted an event-based, observational study, at an academic medical center in North America and included 113 operations performed in 5 surgical departments (general, vascular, pediatric, gynecology, and trauma/acute care). Strain episodes were assessed with a guided-recall method. Immediately after operations, participants mentally recalled the operation, described the strain episodes experienced and their content.
Based on 731 guided recalls, 461 strain episodes were reported; these refer to 312 unique strain episodes. Overall, 75% of strain episodes were experienced by a single team member only. Among different categories of unique strain episodes, those triggered by task complexity, issues with material, or others' behaviors were typically experienced by 1 team member only. However, acute patient issues (n = 167) and observations of others' strain (n = 12) (respectively, 58.5%; < 0.001 and 83.3%; < 0.001) were often experienced by 2 or more team members.
OR team members are likely to experience strain alone, unless patient safety is at stake. This may jeopardize the building of a shared understanding among OR team members.
确定哪些压力事件是由多名团队成员同时报告的；确定手术室（OR）团队成员在术中阶段所经历压力的触发因素。
手术室团队面临多种压力源。然而，大多数研究是在总体层面而非基于事件的层面上调查压力，这无法确定不同团队成员是否同时经历压力事件。
我们在北美的一家学术医疗中心进行了一项基于事件的观察性研究，纳入了5个外科科室（普通外科、血管外科、儿科、妇科和创伤/急症护理科）进行的113台手术。采用引导回忆法评估压力事件。手术结束后，参与者立即在脑海中回忆手术过程，描述所经历的压力事件及其内容。
基于731次引导回忆，共报告了461起压力事件；这些事件涉及312起独特的压力事件。总体而言，75%的压力事件仅由一名团队成员经历。在不同类别的独特压力事件中，由任务复杂性、材料问题或他人行为引发的事件通常仅由一名团队成员经历。然而，急性患者问题（n = 167）和对他人压力的观察（n = 12）（分别为58.5%；<0.001和83.3%；<0.001）通常由两名或更多团队成员经历。
手术室团队成员可能独自经历压力，除非患者安全受到威胁。这可能会危及手术室团队成员之间达成共同理解。
