ABSTRACT
Two studies are presented that investigated coordination in anesthesia teams. In the first study, 15 teams were observed while performing a simulated induction of general anesthesia with a cardiac arrest occurring during intubation. In the second study, 27 teams were observed during real anesthesia inductions. In both cases behavior was coded based on a taxonomy of coordination behaviors which distinguishes action and information coordination and within each of these categories explicit versus implicit coordination. In the simlutor study, coordination behavior of residents and nurses were compared and it was found that good teams were characterized by more explicit action coordination by residents, more implicit action coordination by nurses, and less explicit information coordination by both residents and nurses. During real inductions, team coordination patterns were compared for good and bad teams. In particular, effects of team monitoring and talking to the room were analyzed. In the good teams, team monitoring led to speaking up and unsolicited assistenace, while talking to the room seemed to be effective in reducing requirements for explicit coordination. Overall, the results
demonstrate the intricate nature of effective coordination in anesthesia teams. They also indicate the importance of detailed behavioral analyses in order to provide substantiated recommendations for team training.
