Trabajo en equipo como factor contribuyente en la ocurrencia de errores médicos o eventos adversos / Team work as a contributing factor on the incidence of medical errors or adverse events

Objetivo. El objetivo de esta revisión fue evaluar el trabajo en equipo como variable contribuyente a errores médicos o eventos adversos en salas de cirugía. Método. Se revisaron las bases de datos: Cochrane Library, Medline/PubMed, Embase, Ovid y Lilacs. Se incluyeron: revisiones sistemáticas, ensayos clínicos de asignación aleatoria, estudios controlados de antes y después o estudios de cohortes, donde se hubiera medido el trabajo en equipo y su relación con errores médicos o eventos adversos. Dos autores aplicaron de forma independiente los criterios de inclusión y exclusión a la revisión de títulos y resúmenes, y las discrepancias se resolvieron por consenso. Se revisaron los textos completos de los artículos seleccionados y se aplicaron estrategias para evaluar la calidad de la información. Resultados. De 917 estudios identificados en la búsqueda, se seleccionaron 32; además, se incluyeron cuatro investigaciones sugeridas por expertos. Ocho estudios cumplieron con los criterios de inclusión. Los estudios presentaron baja calidad, subjetividad en las mediciones, ausencia de grupos de control, problemas en el cegamiento, ocultamiento o posible efecto Hawthorne. Conclusiones. La información (evidence) sobre el impacto del trabajo en equipo en la seguridad del paciente es deficiente. Algunos resultados sugieren que los pacientes intervenidos por grupos de cirugía que habían presentado dificultades en el trabajo en equipo, tuvieron mayor riesgo de sufrir eventos adversos. Son necesarios estudios con mejor información y mayor calidad, que permitan determinar el impacto positivo en los resultados en salud de un adecuado trabajo en equipo en las salas de cirugía.

Background: The aim of this review was to assess team work as a contributing variable to the occurrence of medical errors or adverse events in the operating room. Data Sources: The Cochrane library, MEDLINE, Embase, OVID and LILACS databases were searched for studies measuring team work or its components, and their associations with medical errors or adverse events. Two authors worked independently to the review abstracts, disagreements were solved by consensus. The selected articles were reviewed and evidence quality rating was performed. Conclusions: Information on the impact of team work on patient safety is deficient. Some studies suggest that patients undergoing intervention by a surgical group that has had difficulties with team work exhibited a higher risk of adverse effects. There is need of further studies with better information and of superior quality so as to determine the positive impact on the health results by the adequate work of the surgical team in the operating room.

Building global capacity for patient safety: a training program for surgical safety research in developing and transitional countries.

BACKGROUND: Recent studies show a significant rate of adverse events in hospitalized patients in developing/transitional countries--with approximately 18% of them related to surgical procedures. Understanding and preventing these errors requires adequate training in patient safety research methods--however, relevant training programs are currently lacking. We developed, delivered and evaluated a training program to address this gap. METHODS: A one-day training program was developed based on the recently published WHO core competencies for patient safety research. The focus was on surgical patient safety research - including human factors, operating room (OR) teamwork, the OR environment, and safety culture. Feasibility, relevance and preliminary evaluation of the program ('proof of concept' testing) was conducted in Bogotá, Colombia in July 2011. A validated evaluation framework was utilized, assessing participants' objective knowledge, attitudes, and observational skills. RESULTS: 30 postgraduate students from a range of clinical/non-clinical disciplines signed up and 17 attended the program. Participants' knowledge of surgical patient safety significantly improved upon program completion (Mean pre-course=55% vs. Mean post-course=68%, P<0.01), as did their confidence and understanding of problems and methodologies to assess OR patient safety, and teamwork issues (P<0.05). Observational skills in recognizing safety-related behaviors using OTAS (i.e., quality of teamwork) improved on qualitative evaluation. CONCLUSIONS: We have developed a viable, WHO-driven training program that can be delivered to clinical and non-clinical researchers to develop their competencies and thereby build capacity in developing/transitional countries to carry out surgical safety research. All program materials are available in English and Spanish for research, training and dissemination.