Objective: To test the construct validity of the Observational Teamwork Assessment for Surgery (OTAS) tool. Summary Background Data: Poor teamwork in surgical teams has been implicated in adverse events to patients. The OTAS is a tool that assesses teamwork in real time for the entire surgical team. Existing empirical research on OTAS has yet to explore how expert versus novice tool users use the tool to assess teamwork in the operating room. Methods: Data were collected in 12 elective procedures by an expert/expert (N = 6) and an expert/novice (N = 6) pair of raters. Five teamwork behaviors (communication, coordination, leadership, monitoring, and cooperation) were scored via observation pre, intra, and postoperatively by blind raters. Results: Significant and sizeable correlations were obtained in 12 of 15 behaviors in the expert/expert pair, but only in 3 of 15 behaviors in the expert/novice pair. Significant differences in mean scores were obtained in 3 of 15 behaviors in the expert/expert pair, but in 11 of 15 behaviors in the expert/novice pair. Total OTAS scores exhibited strong correlations and no significant differences in ratings in the expert/expert pair. In the expert/novice pair no correlations were obtained and there were significant differences in mean scores. The overall size of inconsistency in the scoring was 2% for expert/expert versus 15% for expert/novice. Conclusions: OTAS exhibits adequate construct validity as assessed by consistency in the scoring by expert versus novices—ie, expert raters produce significantly more consistent scoring than novice raters. Further validation should assess the learning curve for novices in OTAS. Relationships between OTAS, measures of technical skill, and behavioral responses to surgical crises should also be quantified.

The benefits of nature for our health have been an increasing research focus in recent years. In the context of a global increase in mental health diagnoses, the potential health benefits of nature have attracted attention. One practical nature treatment is to walk in nature. However, evidence for this practice on mental health has not been comprehensively appraised to date. This systematic review synthesized the effects of nature walks for depression and anxiety, and evaluated the methodological rigor of studies. Academic databases including ProQuest, PsycINFO, Science Direct, and Google Scholar were utilized to identify eligible articles, which were examined using the Newcastle–Ottawa Scale. Of 385 articles initially retrieved, 12 studies met all the eligibility criteria (nine pre-post within-subject studies, two quasi-experimental studies, and one experimental between-subjects study). These studies demonstrated that nature walks were effective for state anxiety but not generalized anxiety and the effects for depression were inconsistent. Findings indicate that nature walks may be effective for mental health, especially for reducing state anxiety. However, the quality of the included studies varied, and sample sizes were small, suggesting a need for more rigorous and large-scale research.

However, based on experience of safety in other industries, it could be argued that relying on this type of patient participation should not be a solution worthy of long-term investment at the governmental level, but should rather be an unexpected source of help in its sporadic occurrence.

Objective: To use observational methods to objectively evaluate the organisation of triage and what issues may affect the effectiveness of the process. Design: A two-phase study comprising observation of 16 h of triage in a London hospital emergency department and interviews with the triage staff to build a qualitative task analysis and study protocol for phase 2; observation and timing in triage for 1870 min including 257 patients and for 16 different members of the triage staff. Results: No significant difference was found between grades of staff for the average triage time or the fraction of time absent from triage. In all, 67% of the time spent absent from triage was due to escorting patients into the department. The average time a patient waited in the reception before triage was 13 min 34 s; the average length of time to triage for a patient was 4 min 17 s. A significant increase in triage time was found when patients were triaged to a specialty, expected by a specialty, or were actively “seen and treated” in triage. Protocols to prioritise patients with potentially serious conditions to the front of the queue had a significantly positive effect on their waiting time. Supplementary tasks and distractions had varying effects on the timely assessment and triage of patients. Conclusions: The human factors method is applicable to the triage process and can identify key factors that affect the throughput at triage. Referring a patient to a specialty at triage affects significantly the triage workload; hence, alternative methods or management should be suggested. The decision to offer active treatment at triage increases the time taken, and should be based on clinical criteria and the workload determined by staffing levels. The proportion of time absent from triage could be markedly improved by support from porters or other non-qualified staff, as well as by proceduralised handovers from triage to the main clinical area. Triage productivity could be improved by all staff by becoming aware of the effect of the number of interruptions on the throughput of patients.

Background Clinical handover is a necessary process for the continuation of safe patient care; however, deficiencies in the handover process can introduce error. While the number of handover studies increases, few have validated implemented improvements with repeated audit. Objective To improve the morning handover round on a busy critical care unit and assess sustainability of improvement through repeated audit. Design/Methods A quality improvement process based on prospective observational assessment of the doctor's shift-change handover was carried out, assessing the content of clinical information and effects of distractions, location and timing. The effect of a training session for the junior doctors with the introduction of a standardised handover protocol was assessed. Results The content of clinical information improved after the training session with introduction of a standardised protocol, but returned to baseline with a new cohort of untrained doctors. Distractions were associated with increased handover times for individual patients and for total handover time. Overall, handover time was shortest in the coffee room compared with ward and lecture theatre handovers. Individual patient handover time was positively correlated with clinical content scores. Four indices of critical illness all positively correlated with increased handover time. Conclusions Early specific training is vital for quality clinical handover. Distractions during handover cause inefficiency and can adversely affect information transfer. Changing handover location according to local environment can yield improved efficiency, structure and ease of management. Adequate time must be allocated for clinical handover especially when dealing with very sick and complex patients.