Tasks, multitasking and interruptions among the surgical team in an operating room: a prospective observational study
Tasks, multitasking and interruptions among the surgical team in an operating room: a prospective observational study
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DOI：
10.1136/bmjopen-2018-026410
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发表时间：
2019-05-01
期刊：
影响因子：
2.9
通讯作者：
Ekstedt, Mirjam
中科院分区：
文献类型：
--
作者：
Goras, Camilla;Olin, Karolina;Ekstedt, Mirjam
手术室（OR）的工作环境被认为是复杂和动态的，具有高认知要求。手术团队在手术室的完整术前和术中工作过程的多维视图很少描述。本研究的目的是从手术团队的多维角度描述手术过程中任务、多任务处理、中断的类型和频率及其原因。设计前瞻性观察研究，使用活动时间工具的工作观察方法。设置瑞典一家县医院的手术室。参与者OR护士（ORN）（n=10），结果调查对象为麻醉科注册护士（8例）和外科医生（9例）。从多维度来看，手术团队每小时完成64项任务。沟通几乎占所有观察到的任务的一半（45.7%）。就任务时间而言，外科医生和ORN的术中时间主要是直接护理，而RNA的工作则是内部间接护理。总的来说，48.2%的时间花在多任务处理上，最常见的是在ORN和外科医生的工作中进行沟通。每小时发生3.0次中断，最大比例为26.7%，与设备有关。中断是最常见的其次是专业communication.Conclusions手术团队不断处理多任务和中断，工作流程和病人的安全都有潜在的影响。中断后通常是专业交流，这可能反映了一个复杂的适应系统中的相互作用和不断的适应。未来的研究应该集中在理解系统内的复杂性，不同工作流程的设计以及团队如何应对复杂适应系统的挑战。试验注册号2016/264。
Objectives The work context of the operating room (OR) is considered complex and dynamic with high cognitive demands. A multidimensional view of the complete preoperative and intraoperative work process of the surgical team in the OR has been sparsely described. The aim of this study was to describe the type and frequency of tasks, multitasking, interruptions and their causes during surgical procedures from a multidimensional perspective on the surgical team in the OR.Design Prospective observational study using the Work Observation Method By Activity Timing tool.Setting An OR department at a county hospital in Sweden.Participants OR nurses (ORNs) (n=10), registered nurse anaesthetists (RNAs) (n=8) and surgeons (n=9).Results The type, frequency and time spent on specific tasks, multitasking and interruptions were measured. From a multidimensional view, the surgical team performed 64 tasks per hour. Communication represented almost half (45.7%) of all observed tasks. Concerning task time, direct care dominated the surgeons' and ORNs' intraoperative time, while in RNAs' work, it was intra-indirect care. In total, 48.2% of time was spent in multitasking and was most often observed in ORNs' and surgeons' work during communication. Interruptions occurred 3.0 per hour, and the largest proportion, 26.7%, was related to equipment. Interruptions were most commonly followed by professional communication.Conclusions The surgical team constantly dealt with multitasking and interruptions, both with potential impact on workflow and patient safety. Interruptions were commonly followed by professional communication, which may reflect the interactions and constant adaptations in a complex adaptive system. Future research should focus on understanding the complexity within the system, on the design of different work processes and on how teams meet the challenges of a complex adaptive system.Trial registration number 2016/264.