Speaking Up Is Related to Better Team Performance in Simulated Anesthesia Inductions: An Observational Study
Speaking Up Is Related to Better Team Performance in Simulated Anesthesia Inductions: An Observational Study
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DOI：
10.1213/ane.0b013e318269cd32
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发表时间：
2012-11-01
影响因子：
5.7
通讯作者：
Grote, Gucela
中科院分区：
文献类型：
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作者：
Kolbe, Michaela;Burtscher, Michael J.;Grote, Gucela
背景：我们在这项研究中的目标是测试发言（即质疑、纠正或澄清当前程序）与技术团队在麻醉方面的表现之间的关系。假设1：团队成员较高的发言水平与较高的技术团队绩效水平相关。假设 2：团队成员会通过澄清其程序或启动程序变更来对发言做出反应。假设 3：团队合作早期阶段较高的发言水平与后期较高的发言水平相关。 方法：这项前瞻性观察研究涉及 2 人特设麻醉小组，在大型教学医院中进行模拟全身麻醉诱导，并伴有轻微的非常规事件（例如心动过缓）。受试者是注册麻醉护士和住院医师。每个团队由 1 名护士和 1 名住院医师组成。获得同步视频和生命参数记录。两名训练有素的观察员对基于 12 个不同类别的大胆发言以及进一步的团队沟通和协调行为的假设视而不见。所有团队合作指标均量化为在相应团队合作类别上花费的总时间的百分比。两名经验丰富的麻醉师对这些假设视而不见，使用德尔福验证的评级清单评估了技术团队的表现。使用线性回归对假设 1 和 3 进行检验，将住院医师和护士的发言水平作为 2 个独立的预测变量。使用滞后序贯分析对假设 2 进行分析，得到的 Z 值代表条件转换的观察值与其无条件值显着不同的程度。 结果：31 名护士和 31 名住院医师参与。技术团队的表现可以通过护士的发言水平来预测（R-2 = 0.18，P = 0.017），但不能通过住院医师的发言水平来预测（R-2 = 0.19，P = 0.053）；这一结果支持护士的假设 1。支持假设 2，居民通过提供信息（Z = 18.08，P < 0.001）、通过给出指示（Z = 4.74，P < 0.001）和团队成员监控（Z = 3，P = 0.0013）来启动程序变更来澄清程序。同样，护士的反应是通过提供或评估信息来澄清程序（Z = 16.09，P < 0.001；Z = 3.72，P < 0.001），并通过提供帮助来启动程序改变（Z = 0.57，P < 0.001）。表明假设 3 的趋势，护士在插管前的发言水平预测了他们在插管期间的发言水平（R-2 = 0.15，P = 0.034），尽管这没有达到 Bonferroni 校正的显着性水平 P = 0.025。居民中没有发现相应的关系（R-2 = 0.15，P = 0.096）。结论：这项研究提供了经验证据，并展示了直言行为与技术团队绩效之间正向关系的机制。 （麻醉分析 2012；115：1099-108）
BACKGROUND: Our goal in this study was to test the relationship between speaking up-i.e., questioning, correcting, or clarifying a current procedure-and technical team performance in anesthesia. Hypothesis 1: team members' higher levels of speaking up are related to higher levels of technical team performance. Hypothesis 2: team members will react to speaking up by either clarifying their procedure or initiating a procedural change. Hypothesis 3: higher levels of speaking up during an earlier phase of teamwork will be related to higher levels of speaking up during a later phase.METHODS: This prospective observational study involved 2-person ad hoc anesthesia teams performing simulated inductions of general anesthesia with minor nonroutine events (e.g., bradycardia) in a large teaching hospital. Subjects were registered anesthesia nurses and residents. Each team consisted of 1 nurse and 1 resident. Synchronized video and vital parameter recordings were obtained. Two trained observers blinded to the hypotheses coded speaking up and further team communication and coordination behavior on the basis of 12 distinct categories. All teamwork measures were quantified as percentage of total time spent on the respective teamwork category. Two experienced staff anesthesiologists blinded to the hypotheses evaluated technical team performance using a Delphi-validated rating checklist. Hypotheses 1 and 3 were tested using linear regression with residents' and nurses' levels of speaking up as 2 separate predictor variables. Hypothesis 2 was analyzed using lag sequential analysis, resulting in Z values representing the extent to which the observed value for a conditional transition significantly differs from its unconditional value.RESULTS: Thirty-one nurses and 31 residents participated. Technical team performance could be predicted by the level of speaking up from nurses (R-2 = 0.18, P = 0.017) but not from residents (R-2 = 0.19, P = 0.053); this result supports Hypothesis 1 for nurses. Supporting Hypothesis 2, residents reacted to speaking up with clarifying the procedure by providing information (Z = 18.08, P < 0.001), initiating procedural change by giving instructions (Z = 4.74, P < 0.001) and team member monitoring (Z = 3, P = 0.0013). Likewise, nurses reacted with clarifying the procedure by providing or evaluating information (Z = 16.09, P < 0.001; Z = 3.72, P < 0.001) and initiating procedural change by providing assistance (Z = 0.57, P < 0.001). Indicating a trend for Hypothesis 3, nurses' level of speaking up before intubation predicted their level of speaking up during intubation (R-2 = 0.15, P = 0.034), although this did not reach the Bonferroni-corrected significance level of P = 0.025. No respective relationship was found for residents (R-2 = 0.15, P = 0.096).CONCLUSIONS: This study provides empirical evidence and shows mechanisms for the positive relationship between speaking-up behavior and technical team performance. (Anesth Analg 2012;115:1099-108)