Suchergebnisse

Der adäquate Umgang mit Komplexität stellt mit Blick auf die Sicherheit und Qualität medizinischer Patientenversorgung eine der zentralen Anforderungen in der Anästhesie dar. Die Frage, wie dieser unterstützt und gestaltet werden kann eröffnet eine Reihe von Themenfeldern für die arbeitswissenschaftliche - im günstigen Fall interdisziplinäre - Forschung. Dieses Buch liefert aus der Perspektive unterschiedlicher Disziplinen heraus einen Einblick in die wissenschaftliche Auseinandersetzung mit Komplexität in der Anästhesie. Zu den hier vorgestellten sowohl forschungs- als auch gestaltungsorientierten Ansätzen zählen: - die differenzierte Analyse anästhesiologischen Handelns, - die systematische Analyse kritischer Ereignisse, - die Entwicklung und Evaluation von Simulatortrainings sowie - die ergonomische Gestaltung der Rahmenbedingungen anästhesiologischen Handelns. Das Buch richtet sich an Forschende sowie an Praktiker, die an einer multidisziplinären Auseinandersetzung mit Komplexität in der Anästhesie interessiert sind. Dieses Interesse verlangt keine vertieften Kenntnisse des medizinischen Feldes, zumal die vorgetragenen Konzepte und Ergebnisse für verschiedene Forschungs- und Anwendungskontexte Relevanz besitzen

Since the end of the 1980s, so-called patient simulators have increasingly been used in anaesthesiology for training and research. The concrete design of simulator settings for teaching, learning or research-oriented use has many levels of freedom. Also due to this complexity, many (functional) relationships are still unclear when using the simulator. Until this project was carried out (2001-2003), there were no systematic studies in anaesthesiology with a comparison of the simulator with the simulated work area (operating room, intensive care unit, emergency room, etc.) in terms of fundamental research. This project was initiated in order to systematically explore the field of action of simulator setting for occupational and organizational psychological research.
The aim was therefore to check whether an analytical concept developed in preliminary studies to describe anesthesiological courses of action in the operating room (OR) is also suitable for the analysis of courses of action in the simulator and whether the two settings can be compared on the basis of the collected data. The activity structure should be described in particular, taking into account the handling of unexpected events. From the comparative analysis of both settings, the ecological validity of simulator settings was to be analysed by means of various data sources - observation and interviews. In addition to the fundamental research-oriented comparison of the two settings, design recommendations for simulator settings should also be deduced.
For the observations, the observation system developed was used to describe the anesthesiological activity and enabled differentiated observations of courses of action in the operating room and in the simulator in comparable laparoscopic operations. The comparison was based on the analysis of the structural composition of the course of action from seven partial actions (communication, observation, measures, documentation, additional activities, miscellaneous, anaesthetist leaves surgery) differentiated according to the anaesthetic phase (initiation of the anaesthetic, middle phase, recovery from the anaesthetic), the setting or type of case (surgical case, routine simulator case, simulator incident) and finally the expertise of the persons involved (interns; assistant doctors).
For the analysis of the ecological validity, in addition to the assessment of the "behavioral realsim" on the basis of the observation data, the experience of the situation by the study participants through semi-structured interviews was collected and the current practice of the use of the simulator through semi-structured interviews with simulator operators was collected.
Beyond the comparison of the views and actions of the participants in relation to simulator setting, it is important for an ecologically valid design of training and research conditions to maintain the close relationship between the simulated work area and simulation. In this project, this was done by means of socio-technical system analyses in a Swiss hospital. The results could be compared with the results of previous examinations in a German hospital.
The research project presented here therefore deals with the possibilities of describing anesthesiological courses of action, both in the operating room and in simulator setting, as well as the comparison of simulator and simulated work area against the background of work practice in the simulated work area. The analyses are used to develop design proposals for simulator setting.

Since the end of the 1980s, so-called patient simulators have increasingly been used in anaesthesiology for training and research. The concrete design of simulator settings for teaching, learning or research-oriented use has many levels of freedom. Also due to this complexity, many (functional) relationships are still unclear when using the simulator. Until this project was carried out (2001-2003), there were no systematic studies in anaesthesiology with a comparison of the simulator with the simulated work area (operating room, intensive care unit, emergency room, etc.) in terms of fundamental research. This project was initiated in order to systematically explore the field of action of simulator setting for occupational and organizational psychological research.
The aim was therefore to check whether an analytical concept developed in preliminary studies to describe anesthesiological courses of action in the operating room (OR) is also suitable for the analysis of courses of action in the simulator and whether the two settings can be compared on the basis of the collected data. The activity structure should be described in particular, taking into account the handling of unexpected events. From the comparative analysis of both settings, the ecological validity of simulator settings was to be analysed by means of various data sources - observation and interviews. In addition to the fundamental research-oriented comparison of the two settings, design recommendations for simulator settings should also be deduced.
For the observations, the observation system developed was used to describe the anesthesiological activity and enabled differentiated observations of courses of action in the operating room and in the simulator in comparable laparoscopic operations. The comparison was based on the analysis of the structural composition of the course of action from seven partial actions (communication, observation, measures, documentation, additional activities, miscellaneous, anaesthetist leaves surgery) differentiated according to the anaesthetic phase (initiation of the anaesthetic, middle phase, recovery from the anaesthetic), the setting or type of case (surgical case, routine simulator case, simulator incident) and finally the expertise of the persons involved (interns; assistant doctors).
For the analysis of the ecological validity, in addition to the assessment of the "behavioral realsim" on the basis of the observation data, the experience of the situation by the study participants through semi-structured interviews was collected and the current practice of the use of the simulator through semi-structured interviews with simulator operators was collected.
Beyond the comparison of the views and actions of the participants in relation to simulator setting, it is important for an ecologically valid design of training and research conditions to maintain the close relationship between the simulated work area and simulation. In this project, this was done by means of socio-technical system analyses in a Swiss hospital. The results could be compared with the results of previous examinations in a German hospital.
The research project presented here therefore deals with the possibilities of describing anesthesiological courses of action, both in the operating room and in simulator setting, as well as the comparison of simulator and simulated work area against the background of work practice in the simulated work area. The analyses are used to develop design proposals for simulator setting.

A team's ability to coordinate and adapt their performance to meet situational demands is critical to excellent patient care. The goal of this article is to identify common coordination characteristics that enable health care action teams to ensure effective patient care and to discuss specific examples of adaptive coordination within the health care setting. Task analyses were conducted to identify situational demands, in three different clinical settings: cardiac anesthesia, pediatric sepsis simulation, and trauma resuscitation. Each task analysis identified specific coordination requirements for pertinent tasks. The research team compared these task analyses, identified emerging themes, and agreed on core coordination characteristics common across all three environments by consensus through iterative abductive analysis. Findings across these diverse clinical settings showed that expert action teams (a) continually appraise their dynamic environment, (b) identify and define points of coordination, and (c) respond to the demands of nonroutine events by making coordination highly explicit. Specific examples of adaptive coordination within the health care setting are discussed, and implications for training are articulated. Findings are also pertinent outside of health care and may contribute to the understanding of coordination behaviors within action teams across multiple settings.

Objective: This study was aimed at examining team communication during postoperative handover and its relationship to clinicians' self-ratings of handover quality. Background: Adverse events can often be traced back to inadequate communication during patient handover. Research and improvement efforts have mostly focused on the information transfer function of patient handover. However, the specific mechanisms between handover communication processes among teams of transferring and receiving clinicians and handover quality are poorly understood. Method: We conducted a prospective, cross-sectional observation study using a taxonomy for handover behaviors developed on the basis of established approaches for analyzing teamwork in health care. Immediately after the observation, transferring and receiving clinicians rated the quality of the handover using a structured tool for handover quality assessment. Handover communication during 117 handovers in three postoperative settings and its relationship to clinicians' self-ratings of handover quality were analyzed with the use of correlation analyses and analyses of variance. Results: We identified significantly different patterns of handover communication between clinical settings and across handover roles. Assessments provided during handover were related to higher ratings of handover quality overall and to all four dimensions of handover quality identified in this study. If assessment was lacking, we observed compensatory information seeking by the receiving team. Conclusion: Handover quality is more than the correct, complete transmission of patient information. Assessments, including predictions or anticipated problems, are critical to the quality of postoperative handover. Application: The identification of communication behaviors related to high-quality handovers is necessary to effectively support the design and evaluation of handover improvement efforts.

Objective: This field study aimed at examining the role of anesthesia teams' adaptive coordination in managing changing situational demands, such as in nonroutine events (NREs). Background: Medical teams' ability to adapt their teamwork (e.g., their coordination activities) to changing situational demands is crucial to team performance and, thus, to patient safety. Whereas the majority of previous studies on the matter have focused on critical but rare events, it has recently been pointed out that the effective management of NREs is a key challenge to medical teams. Hence this study investigated the relationship between coordination activities, NRE occurrence, and team performance. Method: We videotaped 22 anesthesia teams during standard anesthesia induction and recorded data from the vital signs monitor and the ventilator. Coordination was coded by a trained observer using a structured observation system. NREs were recorded by an experienced staff anesthesiologist using all three video streams. Checklist-based team performance assessment was also performed by an experienced staff anesthesiologist. Results: We found that anesthesia teams adapt their coordination activities to changing situational demands. In particular, the increased occurrence of NREs caused an increase in the time the teams spent on task management. A stronger increase in the teams' task management (i.e., more adaptive coordination) was related to their performance. Conclusion: Our results emphasize the importance of adaptive coordination in managing NREs effectively. Application: This study provides valuable information for developing novel team training programs in health care that focus on adaptation to changing task requirements, for example, when faced with NREs.

Objective We examine whether surgical teams can handle changes in task requirements better when their formal leader and strategic core role holder—that is, the main surgeon—is central to team coordination. Background Evidence regarding the benefits of shared leadership for managing complex tasks is divided. We tested whether a strategic core role holder's centrality in team coordination helps teams to handle different types of task complexity. Method We observed coordination as specific leadership behavior in 30 surgical teams during real-life operations. To assess the strategic core role holder's coordination centrality, we conducted social network analyses. Task complexity (i.e., surgical difficulty and unexpected events) and surgical goal attainment were rated in a questionnaire. Results In the critical operation phase, surgical difficulty impaired goal attainment when the strategic core role holder's coordination centrality was low, while this effect was nonsignificant when his/her coordination centrality was high. Unexpected events had a negative effect on surgical goal attainment. However, coordination centrality of the strategic core role holder could not help manage unexpected events. Conclusion The results indicate that shared leadership is not beneficial when teams face surgical difficulty during the critical operation phase. In this situation, team coordination should rather be centralized around the strategic core role holder. Contrarily, when unexpected events occur, centralizing team coordination around a single leader does not seem to be beneficial for goal attainment. Application Leaders and team members should be aware of the importance of distributing leadership differently when it comes to managing different types of task complexity.

Background: Since the report "To err is human" was published by the Institute of Medicine in the year 2000, topics regarding patient safety and error management are in the focal point of interest of science and politics. Despite international attention, a structured and comprehensive medical education regarding these topics remains to be missing.