Safer Surgery part 25. There have been few research investigations into how highly trained doctors and nurses work together to achieve safe and efficient anaesthesia and surgery. While there have been major advances in surgical and anaesthetic procedures, there are still significant risks for patients during operations and adverse events are not unknown. Due to rising concern about patient safety, surgeons and anaesthetists have looked for ways of minimising adverse events. | 214 Safer Surgery Table Concluded Category Definition Example Considering external conditions Includes considerations of conditions outside the team and their consequences. They re already waiting for us. Others Authoritarian behaviour Includes behaviours which are aimed at underlining power and status. Grabbing an instrument out of the hand of a team member without explanation. Silence and action Includes situations where team members work silently and independently. Silence and no action Coded if a person is obviously doing nothing at all - not even observing. A team member stands around without paying attention to the process. Chatting Includes non-task-relevant talk. Team member talks about the weather. Technical alarm Includes technical acoustic warning signals from one of the machines. An alarm goes off. Talking to patient Includes communicating with the patient beyond garnering or imparting clinical information. You will start to feel very sleepy. Incomprehensible communication Serves as a category for anything that is acoustically incomprehensible. In an ongoing research project we investigate the relationship between adaptive coordination processes non-technical skills ratings Fletcher et al. 2003 and clinical performance of anaesthesia teams in both simulated and live settings during routine situations as well as when confronted with non-routine events. Within this project we tested the taxonomy of explicit and implicit team coordination and heedful interrelating behaviour presented in Figure for interrater reliability. This required that two coders independently coded two out of 15 simulated inductions of general anaesthesia. Analyses of Cohen s Kappa values showed fair to substantial reliability for Explicit coordination of information exchange k .67 for Explicit coordination of actions k .63 for Implicit coordination of information exchange k .32 for Implicit coordination of actions k .76 heedful interrelating k .60 Landis and Koch 1977 .
