Interdisziplinäre Teamarbeit im Operationssaal: Das Beobachtungsverfahren OTAS-D und erste Anwendungsergebnisse aus Deutschland

 

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Zusammenfassung

Hintergrund: Die Qualität interdisziplinärer Teamarbeit beeinflusst die Leistung des OP-Teams und wirkt sich auf Patientenversorgung und -sicherheit aus. Zur validen und umfassenden Beurteilung der Qualität der Teamarbeit im OP eignen sich Beobachtungsverfahren. Mit der deutschsprachigen Version des Observational Teamwork Assessment for Surgery (OTAS-D) stellen wir ein solches Verfahren vor und präsentieren erste Anwendungsergebnisse aus einer deutschsprachigen Klinik. Material und Methoden: Die Qualität der interdisziplinären Teamarbeit wurde mit dem Beobachtungsverfahren OTAS-D erfasst, das 5 für die Teamarbeit relevante Dimensionen (Kommunikation, Koordination, unterstützendes Verhalten, Führung und Teammonitoring) jeweils für alle OP-Phasen und OP-Subteams bewertet. Beobachtet wurden n = 63 Eingriffe (mehrheitlich allgemein-/viszeralchirurgisch und orthopädisch). Zudem führten die Mitglieder des OP-Teams eine standardisierte Selbsteinschätzung ihrer intraoperativen Teamarbeit durch. Ergebnisse: Die Bewertung der OTAS-D-Verhaltensdimensionen zeigte bedeutsame Unterschiede zwischen den Professionen und auch über die 3 OP-Phasen hinweg. Insgesamt zeigte sich ein mittleres bis gutes Niveau interdisziplinärer Teamarbeit im OP. Bezüglich der Art des Eingriffs (minimalinvasiv vs. offen) und der Fächer ergaben sich keinerlei Bewertungsunterschiede. Mit einer verbesserten Koordination der chirurgischen Ärzte ging eine signifikant bessere Zusammenarbeit des chirurgischen Pflegeteams einher (r = 0,36; p = 0,004). In der Selbstbeurteilung schätzen die Chirurgen und die chirurgische Pflege die intraoperative Teamarbeit deutlich positiver ein als die Anästhesisten. Es fanden sich keine signifikanten Zusammenhänge der Beobachtungen und Selbstbeurteilungen der intraoperativen Teamarbeit. Schlussfolgerung: Mit dem OTAS-D kann die Qualität der interdisziplinären Teamarbeit im OP reliabel erfasst werden. Gleichfalls lässt sich die enge Verknüpfung der OP-Professionen in der Zusammenarbeit im OP-Saal verdeutlichen. Die Limitationen dieser ersten Anwendungsergebnisse werden diskutiert. Das Verfahren erlaubt vielfältige Anwendungen in der chirurgischen Lehre, der Forschung und dem klinischen Qualitätsmanagement.

Abstract

Background: The quality of surgical teamwork contributes to performance of the operating theatre team, service quality and patient safety in surgery. Observational tools are a feasible and reliable way to capture and evaluate teamwork in the operating theatre (OT). We introduce the German version of the Observational Teamwork Assessment for Surgery (OTAS-D) and present the first observational results from German OTs. Methods: Quality of surgical teamwork was assessed with observational teamwork assessment for surgery (OTAS-D). It evaluates five dimensions of OT teamwork: communication, coordination, cooperation/backup behaviour, leadership, and team monitoring/situation awareness. Each dimension is evaluated for each profession (surgical, nursing, and anaesthesia team) as well for each phase of the procedure (pre-, intra-, and post-operative). We observed n = 63 procedures, mainly in abdominal/general and orthopaedic surgery. Additionally, all OT team members scored their individual evaluation of the intra-operative teamwork (standardised 1-item questions). Results: The OTAS-D evaluations showed meaningful results and differences for the OT professions as well as across the different phases of the procedures. Overall, a medium to good level of the OT teamwork was observed. There were no differences in regard to type of surgery (minimally invasive vs. open) or surgical specialties. With an increased coordination of the surgical team we observed a significantly increased cooperation of the nursing team (r = 0.36, p = 0.004). Concerning the OT staffs self-reports, the surgical and nursing teams reported higher scores for quality of surgical teamwork during the procedure than their anaesthesia team members. No significant relationships between observed quality of OT teamwork and self-reports were found. Conclusions: The German version of OTAS-D is a psychometrically robust method to capture the quality of teamwork in operating theatres. It enables the analyses of teamwork between the surgical, nursing and anaesthesia professions in acute surgical care. Limitations of the first application results are considered. Finally, potential applications for surgical teaching, research and quality management are discussed.

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