tailieunhanh - Safer Surgery part 24

Safer Surgery part 24. There have been few research investigations into how highly trained doctors and nurses work together to achieve safe and efficient anaesthesia and surgery. While there have been major advances in surgical and anaesthetic procedures, there are still significant risks for patients during operations and adverse events are not unknown. Due to rising concern about patient safety, surgeons and anaesthetists have looked for ways of minimising adverse events. | 204 Safer Surgery or the patient s condition. Specifically on the individual level relevant factors include technical competence heterogeneous knowledge Rosen et al. 2008 high work commitment Nyssen et al. 2003 and a variety of attitudes towards the interpersonal aspect of one s work and the effects of stress on performance Flin et al. 2003 . On the team level anaesthetic teams are mostly crew-like Arrow et al. 2000 Tschan et al. 2006 - structured with traditional hierarchies varying size sometimes no previous experience as a team and almost no formal training in teamwork or interaction with one another. Finally the context of anaesthetic teamwork usually includes highly structured organizations and the necessity to be attentive to a range of tasks Leedal and Smith 2007 . Tasks are characterized by routine procedures as well as by rapidly shifting priorities requiring the handling of high risks where failures can potentially endanger human life. Thus as suggested by functional models of teamwork Hackman and Morris 1975 Marks et al. 2001 Wittenbaum et al. 2004 team and task variants influence clinical team performance via the interaction of the anaesthetic team members. Hence this interaction requires coordination in order to realize effective clinical team performance Dickinson and McIntyre 1997 Tschan et al. 2006 . Besides individual medical skills experience and patient factors coordination within the team is a crucial factor influencing the quality and timeliness of a reaction to unexpected complications. This coordination requirement can actually be exacerbated by the crew structure . MacMillan et al. 2004 . In other words without appropriate coordination and effective communication beyond hierarchical constraints the team interaction could cause process losses which in turn would negatively impact team performance Marks et al. 2002 Steiner 1972 . The following section outlines mechanisms of anaesthesia team coordination. Adaptive Coordination in Anaesthesia