磁共振成像环境中麻醉危机管理的团队关系和角色认知：混合方法探索。

IF 2.3 Q2 HEALTH CARE SCIENCES & SERVICES

Joint Commission journal on quality and patient safety Pub Date : 2024-01-18 DOI:10.1016/j.jcjq.2024.01.007

Hedwig Schroeck MD (is Associate Professor of Anesthesiology, Geisel School of Medicine at Dartmouth College, and Anesthesiologist, Department of Anesthesiology and Perioperative Medicine, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire.), Michaela A. Whitty MPH (is Manager of Perioperative Inventory and Logistics, Dartmouth Health, Lebanon, New Hampshire.), Bridget Hatton MPH (formerly with the Dartmouth Institute of Health Policy, Hanover, New Hampshire, is DrPH Student, Johns Hopkins Bloomberg School of Public Health, Baltimore.), Pablo Martinez-Camblor PhD (is Assistant Professor of Anesthesiology, and Biomedical Data Science, Geisel School of Medicine at Dartmouth College.), Louise Wen MD (is Clinical Assistant Professor, Geisel School of Medicine at Dartmouth College, and Anesthesiologist, Department of Anesthesiology and Perioperative Medicine, Dartmouth Hitchcock Medical Center.), Andreas H. Taenzer MD (is Professor of Anesthesiology, and Pediatrics, Geisel School of Medicine at Dartmouth College. Please address correspondence to Hedwig Schroeck)

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引用次数: 0

摘要

背景越来越多的手术在非手术室麻醉（NORA）环境下进行，包括磁共振成像（MRI）室。非手术室麻醉中的患者护理由跨专业特设团队（麻醉临床医生、成像技师和其他人员）完成，而这些人并不经常一起工作。作者旨在探讨在核磁共振成像环境中危机情况下此类特设团队的团队关系和角色认知：这项混合方法研究采用了聚合平行设计：对在核磁共振成像环境中工作的麻醉和非麻醉人员进行了关系协调指数（RCI）和角色认知调查，并对特定样本进行了半结构化访谈。在进行了描述性统计和主题分析后，作者综合了定量和定性研究结果，确定并描述了两组人员之间重叠和不匹配的认知。RCI 评分显示，麻醉组和非麻醉组之间的关系协调性适中。麻醉组和非麻醉组的受访者一致认为，在危机处理过程中，麻醉临床医生起领导作用，而非麻醉人员则提供协助。对于非麻醉人员在呼救、了解特定设备需求和执行患者护理行动方面的作用，他们的期望值存在细微差别。许多麻醉临床医生对其非麻醉同事的危机相关技能感到不确定。磁共振成像技术人员强调注意磁力安全是他们不可或缺的角色，而麻醉人员却很少提及这一点。

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Team Relations and Role Perceptions During Anesthesia Crisis Management in Magnetic-Resonance Imaging Settings: A Mixed Methods Exploration

Background

An increasing number of procedures are performed in non-operating room anesthesia (NORA) settings, including magnetic resonance imaging (MRI) suites. Patient care in NORA is accomplished by interprofessional ad hoc teams (anesthesia clinicians, imaging technologists, and others), who do not regularly work together otherwise. The authors aimed to explore team relations and role perceptions during crisis situations in MRI settings among such ad hoc teams.

Methods

This mixed methods study used a convergent parallel design: The Relational Coordination Index (RCI) and a survey about role perceptions were administered to anesthesia and non-anesthesia personnel working in MRI settings, and semistructured interviews were conducted among a purposive sample. After descriptive statistics and thematic analysis, the authors integrated quantitative and qualitative findings to identify and describe overlapping and mismatched perceptions between the two groups.

Results

A total of 67 surveys (response rate 74.4%) and 17 interviews were analyzed. RCI ratings revealed moderate relational coordination between the anesthesia and non-anesthesia groups. Anesthesia and non-anesthesia respondents agreed that the anesthesia clinician assumes leadership during crisis management while non-anesthesia personnel assist. There were nuanced differences in expectations about the role of non-anesthesia personnel in calling for help, understanding specific equipment needs, and performing patient care actions. Many anesthesia clinicians felt unsure about crisis-relevant skills of their non-anesthesia colleagues. MRI technologists emphasized attention to magnetic safety as integral to their role, which was infrequently mentioned by anesthesia personnel.