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BACKGROUND: Although effective teamwork is fundamental to patient safety in the operating room (OR), acute stress increasingly is recognized as detrimental for teamwork. This study concurrently assessed teamwork and stress levels experienced by OR team members.

METHODS: Data were collected in real time in 20 elective surgical cases. The validated Observational Teamwork Assessment for Surgery was used to assess teamwork, whereas stress was assessed using the validated State-Trait Anxiety Inventory.

RESULTS: Teamwork was overall above the scale midpoint, with higher scores preoperatively than in subsequent phases of the procedure, and also higher ratings for anesthetic subteams compared with surgical and nursing subteams (all P < .01). Overall stress levels were low. Qualitative analyses revealed differences across team members: circulating staff preoperatively and assistant surgeons intraoperatively and postoperatively were most likely to be stressed.

CONCLUSIONS: The study offers a feasible method for concurrently assessing stress and teamwork in the OR and reveals differences across team members' stress levels as surgery unfolds. This methodology can be used to increase understanding of the impact of stress on team performance in the OR.