title: The relationship between intraoperative teamwork and management skills in patient care.
abstract: BACKGROUND
  Optimal team performance in the operating room (OR) requires a combination of interactions among OR professionals and adherence to clinical guidelines. Theoretically, it is possible that OR teams could communicate very well but fail to follow acceptable standards of patient care and vice versa. OR simulations offer an ideal research environment to study this relationship. The goal of this study was to determine the relationship between ratings of OR teamwork and communication with adherence to patient care guidelines in a simulated scenarios of malignant hyperthermia (MH).
  
  
  METHODS
  An interprofessional research team (2 anesthesiologists, 1 surgeon, an OR nurse, and a social scientist) reviewed videos of 5 intraoperative teams managing a simulated patient who manifested MH while undergoing general anesthesia for an epigastric herniorraphy in a high-fidelity, in situ OR. Participant teams consisted of 2 residents from anesthesiology, 1 from surgery, 1 OR nurse, and 1 certified surgical technician. Teamwork and communication were assessed with 4 published tools: Anesthesiologists' Non-Technical Skills (ANTS), Scrub Practitioners List of Intra-operative Non-Technical Skills (SPLINTS), Non-Technical Skills for Surgeons (NOTSS), and Objective Teamwork Assessment System (OTAS). We developed an evidence-based MH checklist to assess overall patient care.
  
  
  RESULTS
  Interrater agreement for teamwork tools was moderate. Average rater agreement was 0.51 For ANTS, 0.67 for SPLINTS, 0.51 for NOTSS, and 0.70 for OTAS. Observer agreement for the MH checklist was high (0.88). Correlations between teamwork and MH checklist were not significant. Teams were different in percent of the MH actions taken (range, 50-91%; P = .006).
  
  
  CONCLUSIONS
  In this pilot study, intraoperative teamwork and communication were not related to overall patient care management. Separating nontechnical and technical skills when teaching OR teamwork is artificial and may even be damaging, because such an approach could produce teams with excellent communication skills as they unsuccessfully manage the patient. OR simulations offer a unique opportunity to research how to best integrate both of these domains to improve patient care.
authors.affiliation: Department of Surgery, The Massachusetts General Hospital, Harvard Medical School, Boston, MA; MGH Learning Laboratory, The Massachusetts General Hospital, Harvard Medical School, Boston, MA. Electronic address: rphitayakorn@mgh.harvard.edu.
authors.forename: Roy
authors.initials: R
authors.lastname: Phitayakorn
authors.affiliation: MGH Learning Laboratory, The Massachusetts General Hospital, Harvard Medical School, Boston, MA; Department of Anesthesia, Critical Care, and Pain Medicine, The Massachusetts General Hospital, Harvard Medical School, Boston, MA.
authors.forename: Rebecca D
authors.initials: RD
authors.lastname: Minehart
authors.affiliation: MGH Learning Laboratory, The Massachusetts General Hospital, Harvard Medical School, Boston, MA; Department of Perioperative Services, The Massachusetts General Hospital, Harvard Medical School, Boston, MA.
authors.forename: Maureen W
authors.initials: MW
authors.lastname: Hemingway
authors.affiliation: MGH Learning Laboratory, The Massachusetts General Hospital, Harvard Medical School, Boston, MA; Department of Anesthesia, Critical Care, and Pain Medicine, The Massachusetts General Hospital, Harvard Medical School, Boston, MA.
authors.forename: May C M
authors.initials: MC
authors.lastname: Pian-Smith
authors.affiliation: Department of Surgery, The Massachusetts General Hospital, Harvard Medical School, Boston, MA; MGH Learning Laboratory, The Massachusetts General Hospital, Harvard Medical School, Boston, MA.
authors.forename: Emil
authors.initials: E
authors.lastname: Petrusa
mesh_terms: D057189:Checklist; D003299:Cooperative Behavior; D019983:Guideline Adherence; D059685:Herniorrhaphy / Q000193:education*; D006801:Humans; D007400:Interprofessional Relations; D008305:Malignant Hyperthermia; D010348:Patient Care Team; D010865:Pilot Projects; D011361:Professional Competence; D000066908:Simulation Training