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Background Briefing of the trauma team prior to patient arrival is unstructured in many centers. We surveyed trauma teams regarding agreement on patient care priorities, and evaluated the impact of a structured, physician-led briefing on concordance during simulated resuscitations. Methods Trauma nurses at our Level II center were surveyed, and participated in four resuscitation scenarios, randomized to “Briefed” or “Non-briefed.” For Non-briefed scenarios, nurses independently reviewed triage sheets with written information. Briefed scenarios had a structured, four-minute physician-led briefing reviewing triage sheets identical to Non-briefed scenarios. Teams included 3–4 nurses (subjects) and 2–4 confederates (physicians, respiratory therapists). Each team served as their own control group. Confederates were blinded to nurses’ Briefed or Non-briefed status. Immediately before, and at the midpoint of each scenario, nurses estimated patient morbidity and mortality and ranked the top 3 of 16 designated immediate care priorities. Briefed and Non-briefed groups’ responses were compared for: (1) Agreement using intraclass correlation coefficient (ICC), (2) Concordance with physicians’ responses using Fisher’s exact test, (3) Teamwork via T-NOTECHS ratings by nurses and physicians using t-test, (4) Time to complete clinical tasks using t-test. Results 38 nurses participated. 97% “agreed/strongly agreed” briefing is important, but only 46% agreed briefing was done well. Comparing Briefed versus Non-briefed scenarios, nurses’ estimation of morbidity and mortality in Briefed scenarios showed significantly greater agreement with each other and with physicians’ answers (p<0.01). Rank lists also better agreed with each other (ICC 0.64 vs 0.59) and with physicians’ answers in Briefed scenarios. T-NOTECHS Leadership ratings were significantly higher in Briefed scenarios (3.70 versus 3.39, p<.01). Time to completion of key clinical tasks was significantly faster for one of the Briefed scenarios. Conclusions Discordant perceptions of patient care goals was frequently observed. Structured, physician-led briefing appeared to improve interprofessional team concordance, leadership and task completion in simulated trauma resuscitations. Level of Evidence Level 3, Therapeutic / Care management

Background Trauma care requires coordinating an interprofessional team, with formative feedback on teamwork skills. We hypothesized nurses and surgeons have different perceptions regarding roles during resuscitation; that nurses’ teamwork self-assessment differs from experts’, and that video debriefing might improve accuracy of self-assessment. Methods Trauma nurses and surgeons were surveyed regarding resuscitation responsibilities. Subsequently, nurses joined interprofessional teams in simulated trauma resuscitations. Following each resuscitation, nurses and teamwork experts independently scored teamwork (T-NOTECHS). After video debriefing, nurses repeated T-NOTECHS self-assessment. Results Nurses and surgeons assumed significantly more responsibility by their own profession for 71% of resuscitation tasks. Nurses’ overall T-NOTECHS ratings were slightly higher than experts’. This was evident in all T-NOTECHS subdomains except “leadership,” but despite statistical significance the difference was small and clinically irrelevant. Video debriefing did not improve the accuracy of self-assessment. Conclusions Nurses and physicians demonstrated discordant perceptions of responsibilities. Nurses’ self-assessment of teamwork was statistically, but not clinically significantly, higher than experts’ in all domains except physician leadership.