title: Assessment of teamwork during structured interdisciplinary rounds on medical units.
abstract: BACKGROUND
  Interdisciplinary rounds (IDR) provide a means to assemble hospital team members and improve collaboration. Little is known about teamwork during IDR.
  
  
  OBJECTIVE
  To evaluate and characterize teamwork during IDR.
  
  
  METHODS
  Cross-sectional observational study.
  
  
  METHODS
  Six medical units which had implemented structured interdisciplinary rounds (SIDR).
  
  
  METHODS
  We adapted the Observational Teamwork Assessment for Surgery (OTAS) tool, a behaviorally anchored rating scale shown to be reliable and valid in surgical settings. OTAS provides scores ranging from 0 to 6 (0 = problematic behavior; 6 = exemplary behavior) across 5 domains (communication, coordination, cooperation/backup behavior, leadership, and monitoring/situational awareness) and for prespecified subteams. Two researchers conducted direct observations using the adapted OTAS tool.
  
  
  RESULTS
  We conducted 7-8 independent observations for each unit (total = 44) and 20 joint observations. Inter-rater reliability was excellent at the unit level (Spearman's rho = 0.75), and good across domains (rho = 0.53-0.68) and subteams (rho = 0.53-0.76) with the exception of the physician subteam, for which it was poor (rho = 0.35). Though teamwork scores were generally high, we found differences across units, with a median (interquartile range [IQR]) 4.5 (3.9-4.9) for the lowest and 5.4 (5.3-5.5) for the highest performing unit (P < 0.01). Domain scores differed, with leadership receiving the lowest (median [IQR] = 5.0 [4.6-5.3]), and cooperation/backup behavior and monitoring/situational awareness receiving highest scores (median [IQR] = 5.4 [5.0-5.5] and 5.4 [5.0-5.7]). Differences across subteams were of borderline significance (P = 0.05).
  
  
  CONCLUSIONS
  The adapted OTAS instrument demonstrated acceptable reliability for assessing teamwork during SIDR across units, domains, and most subteams. Variation in performance suggests a need to improve consistency of teamwork and emphasizes the importance of leadership.
authors.affiliation: Division of Hospital Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA. keoleary@nmh.org
authors.forename: Kevin J
authors.initials: KJ
authors.lastname: O'Leary
authors.forename: Yvonne N
authors.initials: YN
authors.lastname: Boudreau
authors.forename: Amanda J
authors.initials: AJ
authors.lastname: Creden
authors.forename: Maureen E
authors.initials: ME
authors.lastname: Slade
authors.forename: Mark V
authors.initials: MV
authors.lastname: Williams
mesh_terms: D003299:Cooperative Behavior; D006126:Group Processes; D006801:Humans; D007400:Interprofessional Relations; D015588:Observer Variation; D010348:Patient Care Team / Q000458:organization & administration*; D015203:Reproducibility of Results; D056164:Teaching Rounds / Q000458:organization & administration*