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Lin MW, Papaconstantinou HT, White BAA. Moving beyond teamwork in the operating room to facilitating mutual professional respect. Proc (Bayl Univ Med Cent) 2022; 36:45-53. [PMID: 36578613 PMCID: PMC9762787 DOI: 10.1080/08998280.2022.2148987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Psychological safety enables the interpersonal risk-taking necessary for providing safer patient care in the operating room (OR). Limited studies look at psychological safety in the OR from the perspectives of each highly specialized team member. Therefore, we investigated each member's perspective on the factors that influence psychological safety in the OR. Interviews were conducted with operative team members of a level 1 trauma center in central Texas. The interviews were transcribed, de-identified, and coded by two investigators independently, and thematic analysis was performed. Responses were collected from 21 participants representing all surgical team roles (attending surgeons, attending anesthesiologists, circulating nurses, nurse anesthetists, scrub techs, and residents). Circulating nurse responses were redacted for confidentiality (n = 1). Six major themes influencing psychological safety in the OR were identified. Psychological safety is essential to better, safer patient care. Establishing a climate of mutual respect and suspended judgment in an OR safe for learning will lay the foundation for achieving psychological safety in the OR. Team exercises in building rapport and mutual understanding are important starting points.
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Affiliation(s)
- Melody W. Lin
- Department of Surgery, Baylor Scott & White Medical Center – Temple, Temple, Texas
| | | | - Bobbie Ann Adair White
- Department of Surgery, Baylor Scott & White Medical Center – Temple, Temple, Texas,Department of Health Professions Education, MGH Institute of Health Professions, Boston, Massachusetts,Corresponding author: Bobbie Ann Adair White, EdD, MA, Health Professions Education, MGH Institute of Health Professions, Charlestown Navy Yard, 36 1st Avenue, Boston, MA02129 (e-mail: , )
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Shen Y, Ge R, Qian X. Robotic "Zero Contact" surgery for occupational protection against infectious disease. Front Public Health 2022; 10:977927. [PMID: 36324448 PMCID: PMC9619066 DOI: 10.3389/fpubh.2022.977927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Accepted: 09/30/2022] [Indexed: 01/25/2023] Open
Affiliation(s)
- Yiling Shen
- Department of Surgical Operating Room, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Rongrong Ge
- Department of Plastic Surgery, Wuxi Dashangmei Plastic Surgery Hospital, Wuxi, China
| | - Xinye Qian
- Department of Surgical Operating Room, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China,Center of Hepatobiliary Pancreatic Disease, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China,School of Clinical Medicine, Tsinghua University, Beijing, China,*Correspondence: Xinye Qian
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Esposito AC, White EM, Rohde SC, Chilakamarry S, Yoo PS. Effect of Surgical Team Communication on Adherence to Opioid Discharge Guidelines in Post-Operative Inpatients. J Surg Educ 2022; 79:740-744. [PMID: 34933817 DOI: 10.1016/j.jsurg.2021.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 10/17/2021] [Accepted: 11/22/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVE Current opioid prescribing guidelines state that post-operative inpatients who do not receive opioids in the 24 hours preceding discharge do not require an opioid prescription on discharge. This study was designed to assess providers' understanding of opioid discharge guidelines and explore drivers of adherence. DESIGN An electronic survey was released which assessed knowledge of opioid discharge guidelines and probed surgical team communication. Kruskal-Wallis tests were used to determine differences between provider types. Spearman's correlation evaluated relationships between estimated and observed adherence to guidelines. SETTING Yale New-Haven Hospital, (tertiary, university-based) PARTICIPANTS: Surgical residents, advanced practice providers (APPs) and attendings who discharged inpatients with opioids between November 2017-August 2019 RESULTS: The response rate was 36% (90/253), including 36% (49/136) of residents, 23% (13/56) of APPs, and 46% (28/61) of attendings. Seventy eight percent of participants believed patients who met the guideline should "never" or "sometimes" receive opioids on discharge. There was a significant difference between attending preferences and what residents (H22 = 202.7, p = 0.0001) and APPs (H22 = 24.6, p = 0.003) believed were the attending's preferences. Eleven percent of attendings preferred their patients to "most of the time" or "always" receive opioids on discharge, while 45% of residents and 54% of APPs reported the same. Overall, 57% of attendings reported they "most of the time" or "always" communicated their discharge preferences while 12% of residents (H22 = -20.4, p = 0.0003) and 8% of APPs (H22 = -23.5, p = 0.003) reported the same. There was no correlation between all groups' estimated adherence to the guidelines and observed adherence (rs = 0.135, p = 0.206). CONCLUSIONS This study demonstrates that surgical residents, APPs, and attendings are aware of the guideline but breakdowns in communication between the attending and the surgical team may contribute to deviation from this guideline. Improving communication may lead to improved adherence to post-operative opioid discharge prescribing guidelines.
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Affiliation(s)
- Andrew C Esposito
- Department of Surgery, Yale School of Medicine, New Haven, Connecticut
| | - Erin M White
- Department of Surgery, Yale School of Medicine, New Haven, Connecticut
| | | | | | - Peter S Yoo
- Department of Surgery, Yale School of Medicine, New Haven, Connecticut.
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Sillero Sillero A, Buil N. Enhancing Interprofessional Collaboration in Perioperative Setting from the Qualitative Perspectives of Physicians and Nurses. Int J Environ Res Public Health 2021; 18:ijerph182010775. [PMID: 34682520 PMCID: PMC8535564 DOI: 10.3390/ijerph182010775] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 09/26/2021] [Accepted: 10/07/2021] [Indexed: 12/16/2022]
Abstract
Communication failures were a leading cause of sentinel events in the operation room due to frequently the communication breakdown occurs between physicians and nurses. This study explored the perspectives of surgical teams (nurses, physicians, and anaesthesiologists) on interprofessional collaboration and improvement strategies. A surgical team comprising eight perioperative nurses, four surgeons, and four anaesthesiologists from a university-affiliated hospital participated in this qualitative and phenomenological research from December 2018 to April 2019. Data were collected in in-depth interviews and were used in a thematic analysis according to Colaizzi to extract themes and categorised codes with the ATLAS.ti software. The result is presented in three generic categories: Barrier-like disruptive behaviours and lack of coordination of care; consequences by safety threats to the patient; overcoming barriers by shared decision making among professionals, flattened hierarchies, and teamwork/communication training. The conclusion is that different teams’ perspectives can facilitate genuine reflection, discussion, and implementation of targeted interventions to improve operating room interprofessional collaboration and overcome barriers and their consequences. Currently, there is a need to change towards interprofessional collaboration for optimal patient outcomes and to ensure all professionals’ expectations are met.
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Affiliation(s)
- Amalia Sillero Sillero
- Nursing School of Mar (ESimar), University of Pompeu Fabra, 08003 Barcelona, Spain
- Correspondence:
| | - Neus Buil
- Department of Perioperative Nursing, Hospital de la Santa Creu i Sant Pau, 08025 Barcelona, Spain;
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Abstract
BACKGROUND Noise in the operating room (OR) contributes to miscommunication among team members and may negatively impact patient outcomes. OBJECTIVES This study aimed to quantify noise levels during endoscopic sinus and skull base surgery. The secondary aim was to understand how OR team members perceive noise during endoscopic sinus and skull base surgery. METHODS Noise levels were measured using the validated phone application SoundMeter X 10.0.4 (r1865) (Faber Acoustical, Utah, USA) at the ear-level of the surgeon, scrub nurse, circulating nurse, and anesthesiologist. At the end of each surgery, OR team members were asked to complete a six-question questionnaire about noise during that surgery. RESULTS One thousand four hundred and two noise measurements were recorded across 353 trials. The loudest mean noise measurement was 84.51 dB and maximum noise measurement was 96.21 dB at the ear-level of the surgeon. Noise was significantly higher at the ear-level of the surgeon and scrub nurse in comparison to the circulating nurse (p = .000) and anesthesiologist (p = .000). Forty percent of questionnaire respondents believed noise was a problem and 38% stated that noise caused communication issues during surgery. CONCLUSION Surgeons and scrub nurses have significantly higher noise exposure in comparison to circulating nurses and anesthesiologists during endoscopic sinus and skull base surgery. For these members of the OR team, noise is also identified as problematic and causing issues with communication. Mechanisms to reduce potential noise may be implemented to improve communication and patient outcomes in endoscopic sinus and skull base surgery.
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Affiliation(s)
- Marc Levin
- Michael G. DeGroote School of Medicine, 3710McMaster University, Hamilton, ON, Canada
| | - Kelvin Zhou
- Michael G. DeGroote School of Medicine, 3710McMaster University, Hamilton, ON, Canada
| | - Ethan C Sommer
- Bachelor of Health Sciences Program, 8431Wilfrid Laurier University, Waterloo, ON, Canada
| | - Hitansh Purohit
- Bachelor of Health Sciences Program, 3710McMaster University, Hamilton, ON, Canada
| | - Jeffery Wells
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, 3710McMaster University, Hamilton, ON, Canada
| | - Jakob Pugi
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, 3710McMaster University, Hamilton, ON, Canada
| | - Doron D Sommer
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, 3710McMaster University, Hamilton, ON, Canada
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Krüger CM, Kramer A, Türler A, Riediger H. Can surgery follow the dictates of the pandemic "keep your distance"? Requirements with COVID-19 for hygiene, resources and the team. GMS Hyg Infect Control 2020; 15:Doc19. [PMID: 32782898 PMCID: PMC7397243 DOI: 10.3205/dgkh000354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Since the beginning of the pandemic, there have been restrictions in the daily care of surgical patients - both elective and emergency. Readying supply capacities and establishing isolation areas and areas for suspected cases in the clinics have led to keeping beds free for treating (suspected) COVID-19 cases. It was therefore necessary to temporarily postpone elective surgery. Now, elective care can be gradually resumed with the second phase of the pandemic in Germany. However, it remains the order of the day to adapt pre-, intra- and post-operative procedures to the new COVID-19 conditions while maintaining specialized hygiene measures. This concerns the correct procedure for the use of personal protective materials as well as process adjustment for parallel treatment of positive and negative patients in the central OR, and handling of aerosols in the operating theater, operating room, and surgical site under consideration of staff and patient protection. Although dealing with surgical smoke in the operating theater has long been criticized, COVID-19 is forcing a renaissance in this area. Finally, the choice of surgical method, whether open surgery or minimally invasive procedures, is critical in determining how many colleagues are exposed to the risk of infection from COVID-19 patients, sometimes for hours. Here, robot-assisted surgery can comply with the pandemic's requirement to "keep your distance" in a unique way, since the surgeon can operate at virtually any distance from the surgical site, at least with regard to aerosol formation and exposure.
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Affiliation(s)
- Colin M Krüger
- Immanuel Klinikum Rüdersdorf, Abt. Chirurgie, Zentrum für Robotik, Rüdersdorf b. Berlin, Germany
| | - Axel Kramer
- Institut für Hygiene und Umweltmedizin, Universitätsmedizin Greifswald, Greifswald, Germany
| | - Andreas Türler
- Johanniter Kliniken Bonn, Abteilung für Viszeralchirurgie, Bonn, Germany
| | - Hartwig Riediger
- Vivantes Humboldt Klinikum, Department für Chirurgie, Berlin, Germany
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Işık I, Gümüşkaya O, Şen S, Arslan Özkan H. The Elephant in the Room: Nurses' Views of Communication Failure and Recommendations for Improvement in Perioperative Care. AORN J 2019; 111:e1-e15. [PMID: 31886544 DOI: 10.1002/aorn.12899] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Perioperative communication failures endanger patient safety and may reduce efficiency. The objective of our phenomenological research study was to determine the reasons for and consequences of perioperative communication failures and to seek recommendations for improvement. Fourteen perioperative nurses participated in this study. We conducted in-depth interviews with a semi-structured questionnaire following Colaizzi's seven-step methodology to extract themes. We organized the themes into categories: causes, consequences, and recommendations for preventing communication failure. Some themes for causes were inadequate time for preoperative preparation, lack of personnel, and disruptive behaviors of physicians. Consequences of communication failure were decreased staff retention, avoidance of colleagues, threats to patient safety, and intra-team violence. Two recommendations included enforcing institutional regulations and creating team spirit. The study revealed that nurses believe that institutional regulations should not only be present but enforced. Further, nurses believe that strengthening employees' interpersonal skills is essential to preventing communication issues.
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Abstract
Background: Glove perforation is common during surgery. Surgical gloves are used as personal protective equipment to reduce infection risks from bloodborne pathogens for both the surgical team and patients. This research was conducted to determine the perforation rates of gloves worn in open abdominal surgery performed in a general surgery department and the risk factors affecting perforation. Methods: This research was designed as an observational prospective cohort study including 70 open abdominal operations. There were four members of the surgical team (surgeon, first assistant, second assistant, and scrub nurse). A total of 280 (70 × 4) pairs of gloves in 70 consecutive open abdominal procedures were included in this study. A total of 140 unused gloves were tested as control group to assess perforations and pre-existing leaks. After the operation, all gloves were checked for water impermeability using the EN455-1 method and the presence or absence of a puncture hole was recorded. Results: Glove perforation was detected in 54.3% of operations. The rate of perforation in all gloves was 10.7%, of which 78% unnoticed by the surgical team during surgical procedure. It was determined that the puncture in the gloves was mostly on the non-dominant hand (left). For the left-hand glove, the highest number of holes was observed on the index finger (21.1%) and palm/dorsum of the hand (21.1%). The risk of glove perforation was 5.8 times greater for surgeons compared with the other team members, and operation time of 61 minutes or longer increased the risk of perforation by 12.77 times. Conclusions: Glove perforation rates are high in open abdominal surgery. The highest number of perforations occurred in the non-dominant hand (left) has a high rate of perforation in surgeons and long operations. It may be beneficial for surgical team members to change gloves at certain intervals during surgery or use indicator glove systems.
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Affiliation(s)
- Selma Sayın
- 1 Institute of Health Science, Department of Surgical Nursing, Manisa Celal Bayar University, Manisa, Turkey
| | - Emel Yılmaz
- 2 Faculty of Health Science, Department of Surgical Nursing, Manisa Celal Bayar University, Manisa, Turkey
| | - Hakan Baydur
- 3 Faculty of Health Science, Department of Social Work, Manisa Celal Bayar University, Manisa, Turkey
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Baldini A, Blevins K, Del Gaizo D, Enke O, Goswami K, Griffin W, Indelli PF, Jennison T, Kenanidis E, Manner P, Patel R, Puhto T, Sancheti P, Sharma R, Sharma R, Shetty R, Sorial R, Talati N, Tarity TD, Tetsworth K, Topalis C, Tsiridis E, W-Dahl A, Wilson M. General Assembly, Prevention, Operating Room - Personnel: Proceedings of International Consensus on Orthopedic Infections. J Arthroplasty 2019; 34:S97-S104. [PMID: 30360975 PMCID: PMC7111314 DOI: 10.1016/j.arth.2018.09.059] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
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Nilsson U, Göras C, Wallentin FY, Ehrenberg A, Unbeck M. The Swedish Safety Attitudes Questionnaire-Operating Room Version: Psychometric Properties in the Surgical Team. J Perianesth Nurs 2018; 33:935-945. [PMID: 30449442 DOI: 10.1016/j.jopan.2017.09.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Revised: 08/31/2017] [Accepted: 09/22/2017] [Indexed: 11/18/2022]
Abstract
PURPOSE To validate the Swedish Safety Attitudes Questionnaire-operating room (SAQ-OR) version by re-evaluating its psychometric properties for the surgical team. DESIGN Cross-sectional questionnaire study. METHODS 541 surgical team members including perioperative nurses, physicians, and licensed practical nurses at three Swedish hospitals were included. FINDINGS For the total sample, the Cronbach's α for the six factors ranged from 0.51 to 0.76. Goodness-of-fit analyses indicated that the six-factor model was acceptable and the factor loadings were statistically significant. The test of the hypothesized relationships among the factors showed a correlation from 0.936 to 0.042. CONCLUSIONS The refined Swedish version of the SAQ-OR is a reasonably reliable and acceptably valid instrument for the measurement of patient safety climate in the surgical team. However, the results related to the different analyses varied among the different professionals and further research, using larger samples, is needed to explore these differences, especially among the physicians.
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Fukushima S, Uemura M, Gotoh K, Ujike T, Wada H, Miyagawa S, Toda K, Sawa Y. Xeno-pericardial patch repair of the inferior vena cava for radical resection of renal cell carcinoma with tumor thrombus. J Surg Oncol 2017; 116:775-782. [PMID: 28608432 PMCID: PMC5724493 DOI: 10.1002/jso.24709] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Accepted: 05/13/2017] [Indexed: 01/24/2023]
Abstract
Background and Objectives For tumor thrombus in the inferior vena cava (IVC) complicated with kidney cancer, we built a surgical team to achieve (1) en bloc tumor resection; (2) xeno‐pericardial patch IVC repair; and (3) minimum organ damages. We reviewed outcome of the case series to verify rationale of this approach. Methods A consecutive series of 12 patients having the IVC tumor thrombus by renal cell carcinoma in the last 3 years was enrolled. Minimum kidney ischemia was induced in five cases (Procedure I), whereas liver and kidney ischemia was induced in five cases (Procedure II). Mild hypothermic extracorporeal circulation was used in two cases (Procedure III). Results There was no mortality or severe morbidities related to the surgery. Postoperative recovery was most prompt by the Procedure I. Liver and kidney ischemic time was longer in the Procedure III than the Procedure II, whereas organ function was not substantially impaired in either series. The resected IVC margin was free from the cancer in all cases, while local recurrence was not seen in any cases. Conclusions En bloc resection with xeno‐pericardial patch repair of the IVC was successfully performed in the tumor thrombus complicated with kidney cancer with minimum organ damage.
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Affiliation(s)
- Satsuki Fukushima
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Motohide Uemura
- Department of Urology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Kunihito Gotoh
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Takeshi Ujike
- Department of Urology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Hiroshi Wada
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Shigeru Miyagawa
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Koichi Toda
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Yoshiki Sawa
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
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13
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Abstract
BACKGROUND Communication and teamwork failures have frequently been identified as the root cause of adverse events and complications in surgery. Few studies have examined contextual factors that influence teams' non-technical skills (NTS) in surgery. The purpose of this prospective study was to identify and describe correlates of NTS. METHODS We assessed NTS of teams and professional role at 2 hospitals using the revised 23-item Non-TECHnical Skills (NOTECHS) and its subscales (communication, situational awareness, team skills, leadership and decision-making). Over 6 months, 2 trained observers evaluated teams' NTS using a structured form. Interobserver agreement across hospitals ranged from 86% to 95%. Multiple regression models were developed to describe associations between operative time, team membership, miscommunications, interruptions, and total NOTECHS and subscale scores. RESULTS We observed 161 surgical procedures across 8 teams. The total amount of explained variance in NOTECHS and its 5 subscales ranged from 14% (adjusted R2 0.12, p<0.001) to 24% (adjusted R2 0.22, p<0.001). In all models, inverse relationships between the total number of miscommunications and total number of interruptions and teams' NTS were observed. CONCLUSIONS Miscommunications and interruptions impact on team NTS performance.
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Affiliation(s)
- Brigid M Gillespie
- School of Nursing and Midwifery, Griffith University, Gold Coast, Queensland, Australia
- Gold Coast University Hospital, Gold Coast Hospital and Health Service, Gold Coast, Queensland, Australia
- National Centre for Research Excellence in Nursing (NCREN), Menzies Health Institute Qld (MHIQ), Griffith University, Gold Coast, Queensland, Australia
| | - Emma Harbeck
- School of Applied Psychology, Griffith University, Gold Coast, Queensland, Australia
| | - Evelyn Kang
- School of Nursing and Midwifery, Griffith University, Gold Coast, Queensland, Australia
| | - Catherine Steel
- Division of Surgery, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
| | - Nicole Fairweather
- Division of Surgery, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
| | - Wendy Chaboyer
- National Centre for Research Excellence in Nursing (NCREN), Menzies Health Institute Qld (MHIQ), Griffith University, Gold Coast, Queensland, Australia
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