Managing Nonroutine Events in Anesthesia: The Role of Adaptive Coordination

摘要

Objective: This field study aimed at examining the role of anesthesia teams' adaptive coordination in managing changing situational demands, such as in nonroutine events (NREs). Background: Medical teams' ability to adapt their teamwork (e.g., their coordination activities) to changing situational demands is crucial to team performance and, thus, to patient safety. Whereas the majority of previous studies on the matter have focused on critical but rare events, it has recently been pointed out that the effective management of NREs is a key challenge to medical teams. Hence this study investigated the relationship between coordination activities, NRE occurrence, and team performance. Method: We videotaped 22 anesthesia teams during standard anesthesia induction and recorded data from the vital signs monitor and the ventilator. Coordination was coded by a trained observer using a structured observation system. NREs were recorded by an experienced staff anesthesiologist using all three video streams. Checklist-based team performance assessment was also performed by an experienced staff anesthesiologist. Results: We found that anesthesia teams adapt their coordination activities to changing situational demands. In particular, the increased occurrence of NREs caused an increase in the time the teams spent on task management. A stronger increase in the teams' task management (i.e., more adaptive coordination) was related to their performance. Conclusion: Our results emphasize the importance of adaptive coordination in managing NREs effectively. Application: This study provides valuable information for developing novel team training programs in health care that focus on adaptation to changing task requirements, for example, when faced with NREs.