Trabajo en equipo: ¿es posible formar equipos médicos expertos a partir de profesionales expertos?
Palabras clave:
GRUPO DE ATENCIÓN AL PACIENTE, COMUNICACIÓN INTERDISCIPLINARIA, CAPACITACIÓN
Resumen
El trabajo en equipo multidisciplinario aumenta la seguridad de los pacientes, minimiza los errores médicos, mejora la satisfacción y el rendimiento del personal de salud y posiblemente evita gastos generados por mala praxis y complicaciones. Sin embargo, la implementación del trabajo médico en equipos es compleja y parecería ser una utopía principalmente en países con escasos recursos dedicados a la salud. A pesar de los esfuerzos por cambiar el paradigma de la asistencia médica, este aún se basa en la adquisición de conocimientos individuales más que en la interacción colectiva. El desarrollo de las habilidades necesarias para trabajar en equipo no forma parte del programa curricular en medicina en nuestro país. En este artículo, nos hemos apoyado en literatura indexada (PUBMED-MEDLINE Y LATININDEX) para explicar los pilares y las ventajas del trabajo en equipo. Nuestro objetivo es generar conciencia para iniciar el difícil camino hacia esa forma de trabajo en Uruguay.
Citas
(1) Salas E, Burke CS, Bowers CA, Wilson KA. Team training in the skies: does crew resource management (CRM) training work? Hum Factors 2001; 43(4):641-74.
(2) Flin R, Maran N. Identifying and training non-technical skills for teams in acute medicine. Qual Saf Health Care 2004; 13(Suppl 1):i80-4.
(3) Weaver SJ, Rosen MA, DiazGranados D, Lazzara EH, Lyons R, Salas E, et al. Does teamwork improve performance in the operating room? A multilevel evaluation. Jt Comm J Qual Patient Saf 2010; 36(3):133-42.
(4) West P, Sculli G, Fore A, Okam N, Dunlap C, Neily J, et al. Improving patient safety and optimizing nursing teamwork using crew resource management techniques. J Nurs Adm 2012; 42(1):15-20.
(5) Weaver SJ, Dy SM, Rosen MA. Team-training in healthcare: a narrative synthesis of the literature. BMJ Qual Saf 2014; 23(5):359-72.
(6) Mitchell I, Schuster A, Smith K, Pronovost P, Wu A. Patient safety incident reporting: a qualitative study of thoughts and perceptions of experts 15 years after ‘To Err is Human’. BMJ Qual Saf 2016; 25(2):92-9.
(7) Rutherford JS, Flin R, Irwin A. The non-technical skills used by anaesthetic technicians in critical incidents reported to the Australian Incident Monitoring System between 2002 and 2008. Anaesth Intensive Care 2015; 43(4):512-7.
(8) Thomas EJ, Studdert DM, Burstin HR, Orav EJ, Zeena T, Williams EJ, et al. Incidence and types of adverse events and negligent care in Utah and Colorado. Med Care 2000; 38(3):261-71.
(9) Manser T, Harrison TK, Gaba DM, Howard SK. Coordination patterns related to high clinical performance in a simulated anesthetic crisis. Anesth Analg 2009; 108(5):1606-15.
(10) King HB, Battles J, Baker DP, Alonso A, Salas E, Webster J, et al. TeamSTEPPS: Team Strategies and Tools to Enhance Performance and Patient Safety. En: Henriksen K, Battles JB, Keyes MA, Grady ML, eds. Advances in Patient Safety: new directions and alternative approaches ( Vol. 3: performance and tools). Rockville MD: Agency for Healthcare Research and Quality, 2008. Disponible en: http://www.ncbi.nlm.nih.gov/books/NBK43686/. Consulta: 2015.
(11) Weller J, Boyd M, Cumin D. Teams, tribes and patient safety: overcoming barriers to effective teamwork in healthcare. Postgrad Med J 2014; 90(1061):149-54.
(12) Weller JM, Torrie J, Boyd M, Frengley R, Garden A, Ng WL, et al. Improving team information sharing with a structured call-out in anaesthetic emergencies: a randomized controlled trial. Br J Anaesth 2014; 112(6):1042-9.
(13) Rando K, Niemann CU, Taura P, Klinck J. Optimizing cost-effectiveness in perioperative care for liver transplantation: a model for low- to medium-income countries. Liver Transpl 2011; 17(11):1247-78.
(14) Leykum LK, Lanham HJ, Provost SM, McDaniel RR, Pugh J. Improving outcomes of hospitalized patients: the Physician Relationships, Improvising, and Sensemaking intervention protocol. Implement Sci 2014; 9:171.
(15) Aritzeta A, Balluerka N. Cooperation, competition and goal interdependence in work teams: a multilevel approach. Psicothema 2006; 18(4):757-65.
(16) McComb S, Hebdon M. Enhancing patient outcomes in healthcare systems through multidisciplinary teamwork. Clin J Oncol Nurs 2013; 17(6):669-72.
(17) Muller-Juge V, Cullati S, Blondon KS, Hudelson P, Maître F, Vu NV, et al. Interprofessional collaboration between residents and nurses in general internal medicine: a qualitative study on behaviours enhancing teamwork quality. PLoS One 2014; 9(4):e96160.
(18) Leasure EL, Jones RR, Meade LB, Sanger MI, Thomas KG, Tilden VP, et al. There is no “i” in teamwork in the patient-centered medical home: defining teamwork competencies for academic practice. Acad Med 2013; 88(5):585-92.
(19) Hindmarsh J, Pilnick A. The Tacit Order of Teamwork: collaboration and embodied conduct in anesthesia. Sociol Q 2002; 43(2):139-64.
(20) Thomas EJ, Sexton JB, Helmreich RL. Translating teamwork behaviours from aviation to healthcare: development of behavioural markers for neonatal resuscitation. Qual Saf Health Care 2004; 13(Suppl 1):i57-64.
(21) Gramling R, Gajary-Coots E, Stanek S, Dougoud N, Pyke H, Thomas M, et al. Design of, and enrollment in, the palliative care communication research initiative: a direct-observation cohort study. BMC Palliat Care 2015; 14:40.
(22) Mathieu JE, Heffner TS, Goodwin GF, Salas E, Cannon-Bowers JA. The influence of shared mental models on team process and performance. J Appl Psychol 2000; 85(2):273-83.
(23) Silva P, Garganta J, Araújo D, Davids K, Aguiar P. Shared knowledge or shared affordances? Insights from an ecological dynamics approach to team coordination in sports. Sports Med 2013; 43(9):765-72.
(24) Healey AN, Undre S, Vincent CA. Developing observational measures of performance in surgical teams. Qual Saf Health Care 2004; 13(Suppl 1):i33-40.
(25) Rutherford JS, Flin R, Mitchell L. Non-technical skills of anaesthetic assistants in the perioperative period: a literature review. Br J Anaesth 2012; 109(1):27-31.
(26) Sorensen A, Poehlman J, Bollenbacher J, Riggan S, Davis S, Miller K, et al. Training for teamwork through in situ simulations. BMJ Innov 2015; 1(3):144.
(27) Sexton JB, Thomas EJ, Helmreich RL. Error, stress, and teamwork in medicine and aviation: cross sectional surveys. BMJ 2000; 320(7237):745-9.
(28) Nicksa GA, Anderson C, Fidler R, Stewart L. Innovative approach using interprofessional simulation to educate surgical residents in technical and nontechnical skills in high-risk clinical scenarios. JAMA Surg 2015; 150(3):201-7.
(29) Jacobs JP, Wernovsky G, Cooper DS, Karl TR. Principles of shared decision-making within teams. Cardiol Young 2015; 25(8):1631-6.
(30) Rando K, Harguindeguy M, Leites A, Ettlin A, González S, Scalone P, et al. Indicadores de calidad en cirugía hepática: influencia del trabajo en equipo multidisciplinario y del “efecto centro”. Acta Gastroenterol Latinoam 2010; 40(1):10-21.
(2) Flin R, Maran N. Identifying and training non-technical skills for teams in acute medicine. Qual Saf Health Care 2004; 13(Suppl 1):i80-4.
(3) Weaver SJ, Rosen MA, DiazGranados D, Lazzara EH, Lyons R, Salas E, et al. Does teamwork improve performance in the operating room? A multilevel evaluation. Jt Comm J Qual Patient Saf 2010; 36(3):133-42.
(4) West P, Sculli G, Fore A, Okam N, Dunlap C, Neily J, et al. Improving patient safety and optimizing nursing teamwork using crew resource management techniques. J Nurs Adm 2012; 42(1):15-20.
(5) Weaver SJ, Dy SM, Rosen MA. Team-training in healthcare: a narrative synthesis of the literature. BMJ Qual Saf 2014; 23(5):359-72.
(6) Mitchell I, Schuster A, Smith K, Pronovost P, Wu A. Patient safety incident reporting: a qualitative study of thoughts and perceptions of experts 15 years after ‘To Err is Human’. BMJ Qual Saf 2016; 25(2):92-9.
(7) Rutherford JS, Flin R, Irwin A. The non-technical skills used by anaesthetic technicians in critical incidents reported to the Australian Incident Monitoring System between 2002 and 2008. Anaesth Intensive Care 2015; 43(4):512-7.
(8) Thomas EJ, Studdert DM, Burstin HR, Orav EJ, Zeena T, Williams EJ, et al. Incidence and types of adverse events and negligent care in Utah and Colorado. Med Care 2000; 38(3):261-71.
(9) Manser T, Harrison TK, Gaba DM, Howard SK. Coordination patterns related to high clinical performance in a simulated anesthetic crisis. Anesth Analg 2009; 108(5):1606-15.
(10) King HB, Battles J, Baker DP, Alonso A, Salas E, Webster J, et al. TeamSTEPPS: Team Strategies and Tools to Enhance Performance and Patient Safety. En: Henriksen K, Battles JB, Keyes MA, Grady ML, eds. Advances in Patient Safety: new directions and alternative approaches ( Vol. 3: performance and tools). Rockville MD: Agency for Healthcare Research and Quality, 2008. Disponible en: http://www.ncbi.nlm.nih.gov/books/NBK43686/. Consulta: 2015.
(11) Weller J, Boyd M, Cumin D. Teams, tribes and patient safety: overcoming barriers to effective teamwork in healthcare. Postgrad Med J 2014; 90(1061):149-54.
(12) Weller JM, Torrie J, Boyd M, Frengley R, Garden A, Ng WL, et al. Improving team information sharing with a structured call-out in anaesthetic emergencies: a randomized controlled trial. Br J Anaesth 2014; 112(6):1042-9.
(13) Rando K, Niemann CU, Taura P, Klinck J. Optimizing cost-effectiveness in perioperative care for liver transplantation: a model for low- to medium-income countries. Liver Transpl 2011; 17(11):1247-78.
(14) Leykum LK, Lanham HJ, Provost SM, McDaniel RR, Pugh J. Improving outcomes of hospitalized patients: the Physician Relationships, Improvising, and Sensemaking intervention protocol. Implement Sci 2014; 9:171.
(15) Aritzeta A, Balluerka N. Cooperation, competition and goal interdependence in work teams: a multilevel approach. Psicothema 2006; 18(4):757-65.
(16) McComb S, Hebdon M. Enhancing patient outcomes in healthcare systems through multidisciplinary teamwork. Clin J Oncol Nurs 2013; 17(6):669-72.
(17) Muller-Juge V, Cullati S, Blondon KS, Hudelson P, Maître F, Vu NV, et al. Interprofessional collaboration between residents and nurses in general internal medicine: a qualitative study on behaviours enhancing teamwork quality. PLoS One 2014; 9(4):e96160.
(18) Leasure EL, Jones RR, Meade LB, Sanger MI, Thomas KG, Tilden VP, et al. There is no “i” in teamwork in the patient-centered medical home: defining teamwork competencies for academic practice. Acad Med 2013; 88(5):585-92.
(19) Hindmarsh J, Pilnick A. The Tacit Order of Teamwork: collaboration and embodied conduct in anesthesia. Sociol Q 2002; 43(2):139-64.
(20) Thomas EJ, Sexton JB, Helmreich RL. Translating teamwork behaviours from aviation to healthcare: development of behavioural markers for neonatal resuscitation. Qual Saf Health Care 2004; 13(Suppl 1):i57-64.
(21) Gramling R, Gajary-Coots E, Stanek S, Dougoud N, Pyke H, Thomas M, et al. Design of, and enrollment in, the palliative care communication research initiative: a direct-observation cohort study. BMC Palliat Care 2015; 14:40.
(22) Mathieu JE, Heffner TS, Goodwin GF, Salas E, Cannon-Bowers JA. The influence of shared mental models on team process and performance. J Appl Psychol 2000; 85(2):273-83.
(23) Silva P, Garganta J, Araújo D, Davids K, Aguiar P. Shared knowledge or shared affordances? Insights from an ecological dynamics approach to team coordination in sports. Sports Med 2013; 43(9):765-72.
(24) Healey AN, Undre S, Vincent CA. Developing observational measures of performance in surgical teams. Qual Saf Health Care 2004; 13(Suppl 1):i33-40.
(25) Rutherford JS, Flin R, Mitchell L. Non-technical skills of anaesthetic assistants in the perioperative period: a literature review. Br J Anaesth 2012; 109(1):27-31.
(26) Sorensen A, Poehlman J, Bollenbacher J, Riggan S, Davis S, Miller K, et al. Training for teamwork through in situ simulations. BMJ Innov 2015; 1(3):144.
(27) Sexton JB, Thomas EJ, Helmreich RL. Error, stress, and teamwork in medicine and aviation: cross sectional surveys. BMJ 2000; 320(7237):745-9.
(28) Nicksa GA, Anderson C, Fidler R, Stewart L. Innovative approach using interprofessional simulation to educate surgical residents in technical and nontechnical skills in high-risk clinical scenarios. JAMA Surg 2015; 150(3):201-7.
(29) Jacobs JP, Wernovsky G, Cooper DS, Karl TR. Principles of shared decision-making within teams. Cardiol Young 2015; 25(8):1631-6.
(30) Rando K, Harguindeguy M, Leites A, Ettlin A, González S, Scalone P, et al. Indicadores de calidad en cirugía hepática: influencia del trabajo en equipo multidisciplinario y del “efecto centro”. Acta Gastroenterol Latinoam 2010; 40(1):10-21.
Publicado
2016-03-31
Cómo citar
1.
Rando Huluk AEK. Trabajo en equipo: ¿es posible formar equipos médicos expertos a partir de profesionales expertos?. Rev. Méd. Urug. [Internet]. 31 de marzo de 2016 [citado 8 de noviembre de 2024];32(1):59-7. Disponible en: http://www2.rmu.org.uy/ojsrmu311/index.php/rmu/article/view/187
Sección
Artículos de opinión
