title: Assessment of stress and teamwork in the operating room: an exploratory study.
abstract: BACKGROUND
  although effective teamwork is fundamental to patient safety in the operating room (OR), acute stress increasingly is recognized as detrimental for teamwork. This study concurrently assessed teamwork and stress levels experienced by OR team members.
  
  
  METHODS
  data were collected in real time in 20 elective surgical cases. The validated Observational Teamwork Assessment for Surgery was used to assess teamwork, whereas stress was assessed using the validated State-Trait Anxiety Inventory.
  
  
  RESULTS
  teamwork was overall above the scale midpoint, with higher scores preoperatively than in subsequent phases of the procedure, and also higher ratings for anesthetic subteams compared with surgical and nursing subteams (all P < .01). Overall stress levels were low. Qualitative analyses revealed differences across team members: circulating staff preoperatively and assistant surgeons intraoperatively and postoperatively were most likely to be stressed.
  
  
  CONCLUSIONS
  the study offers a feasible method for concurrently assessing stress and teamwork in the OR and reveals differences across team members' stress levels as surgery unfolds. This methodology can be used to increase understanding of the impact of stress on team performance in the OR.
authors.affiliation: Department of Surgery and Cancer, Imperial College London, 5th Floor, Wright Fleming Building, Norfolk Place, London, W2 1PG, UK. l.hull@imperial.ac.uk
authors.forename: Louise
authors.initials: L
authors.lastname: Hull
authors.forename: Sonal
authors.initials: S
authors.lastname: Arora
authors.forename: Eva
authors.initials: E
authors.lastname: Kassab
authors.forename: Roger
authors.initials: R
authors.lastname: Kneebone
authors.forename: Nick
authors.initials: N
authors.lastname: Sevdalis
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D003299:Cooperative Behavior; D003430:Cross-Sectional Studies; D006785:Hospitals, University; D006801:Humans; D008875:Middle Aged; D009873:Operating Rooms; D005791:Patient Care / Q000523:psychology; D010348:Patient Care Team; D011446:Prospective Studies; D012449:Safety; D013315:Stress, Psychological