title: Assessing distractors and teamwork during surgery: developing an event-based method for direct observation.
abstract: OBJECTIVE
  To develop a behavioural observation method to simultaneously assess distractors and communication/teamwork during surgical procedures through direct, on-site observations; to establish the reliability of the method for long (>3 h) procedures.
  
  
  METHODS
  Observational categories for an event-based coding system were developed based on expert interviews, observations and a literature review. Using Cohen's κ and the intraclass correlation coefficient, interobserver agreement was assessed for 29 procedures. Agreement was calculated for the entire surgery, and for the 1st hour. In addition, interobserver agreement was assessed between two tired observers and between a tired and a non-tired observer after 3 h of surgery.
  
  
  RESULTS
  The observational system has five codes for distractors (door openings, noise distractors, technical distractors, side conversations and interruptions), eight codes for communication/teamwork (case-relevant communication, teaching, leadership, problem solving, case-irrelevant communication, laughter, tension and communication with external visitors) and five contextual codes (incision, last stitch, personnel changes in the sterile team, location changes around the table and incidents). Based on 5-min intervals, Cohen's κ was good to excellent for distractors (0.74-0.98) and for communication/teamwork (0.70-1). Based on frequency counts, intraclass correlation coefficient was excellent for distractors (0.86-0.99) and good to excellent for communication/teamwork (0.45-0.99). After 3 h of surgery, Cohen's κ was 0.78-0.93 for distractors, and 0.79-1 for communication/teamwork.
  
  
  CONCLUSIONS
  The observational method developed allows a single observer to simultaneously assess distractors and communication/teamwork. Even for long procedures, high interobserver agreement can be achieved. Data collected with this method allow for investigating separate or combined effects of distractions and communication/teamwork on surgical performance and patient outcomes.
authors.affiliation: University of Neuchâtel, Institute for Work and Organizational Psychology, Neuchâtel, Switzerland.
authors.forename: Julia C
authors.initials: JC
authors.lastname: Seelandt
authors.affiliation: University of Neuchâtel, Institute for Work and Organizational Psychology, Neuchâtel, Switzerland.
authors.forename: Franziska
authors.initials: F
authors.lastname: Tschan
authors.affiliation: University of Neuchâtel, Institute for Work and Organizational Psychology, Neuchâtel, Switzerland.
authors.forename: Sandra
authors.initials: S
authors.lastname: Keller
authors.affiliation: Department of Visceral Surgery and Medicine, University Hospital of Bern, Bern, Switzerland.
authors.forename: Guido
authors.initials: G
authors.lastname: Beldi
authors.affiliation: University of Neuchâtel, Institute for Work and Organizational Psychology, Neuchâtel, Switzerland.
authors.forename: Nadja
authors.initials: N
authors.lastname: Jenni
authors.affiliation: Department of Visceral Surgery and Medicine, University Hospital of Bern, Bern, Switzerland.
authors.forename: Anita
authors.initials: A
authors.lastname: Kurmann
authors.affiliation: Department of Visceral Surgery and Medicine, University Hospital of Bern, Bern, Switzerland.
authors.forename: Daniel
authors.initials: D
authors.lastname: Candinas
authors.affiliation: University of Bern, Institute for Psychology, Bern, Switzerland.
authors.forename: Norbert K
authors.initials: NK
authors.lastname: Semmer
mesh_terms: D001288:Attention; D003142:Communication; D005260:Female; D013502:General Surgery; D006801:Humans; D007400:Interprofessional Relations; D007407:Interviews as Topic; D008297:Male; D019370:Observation; D010348:Patient Care Team / Q000458:organization & administration*; D061214:Patient Safety; D013647:Task Performance and Analysis
keywords: Communication; Human Factors; Surgery; Teamwork