tailieunhanh - Safer Surgery part 42

Safer Surgery part 42. 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. | This page has been left blank intentionally Chapter 23 Measuring the Impact of Time Pressure on Team Task Performance Colin F. Mackenzie Shelly A. Jeffcott and Yan Xiao Introduction and Background Surgery often contains crisis-like moments even for scheduled elective procedures. Understanding team performance under time pressure provides a basis for developing counter-measures. However prospective investigation to study team performance under stress is difficult due to the unpredictable nature of crisis events. Time pressure is a hallmark of trauma care where breakdowns in coordination can result in errors which threaten the life of a patient and where decisions are frequently made with high levels of uncertainty Xiao et al. 1998 . Trauma care thus provides a window for us to examine team performance under time stress. Under time pressure problems with errors of commission and omission are particularly apparent when potentially life-saving decisions and actions must be carried out dynamically within a few critical minutes. For example cognitive errors during emergency care were found to be a significant contributor to patient harm. Factors limiting the clinicians ability to make timely and correct diagnoses include multiple concurrent tasks uncertainty changing plans compressed work procedures large workload and complexity Xiao et al. 1996 . In comparison to teams in other domains surgical teams are often ad hoc in nature for a number of reasons in teaching hospitals trainees rotate monthly through different services trainee staff may even come from other institutions to gain experience requirements for specialty services vary from patient to patient nursing and anaesthesia care providers may have different staffing patterns than their surgical colleagues. Under time stress teams may have to split to take care of multiple patients simultaneously. Such changing team composition adds to the challenge of providing optimal team performance under stress because team .