BackgroundIn order to enhance patient safety during resuscitation of critically ill patients, we need to optimize team communication and enhance team situational awareness but little is known about resuscitation team communication patterns. The objective of this study is to understand how teams communicate during resuscitation; specifically to assess for a shared mental model (organized understanding of a team’s relationships) and information needs.MethodsWe triangulated 3 methods to evaluate resuscitation team communication at a tertiary care academic trauma center: (1) interviews; (2) simulated resuscitation observations; (3) live resuscitation observations. We interviewed 18 resuscitation team members about shared mental models, roles and goals of team members and procedural expectations. We observed 30 simulated resuscitation video recordings and documented the timing, source and destination of communication and the information category. We observed 12 live resuscitations in the emergency department and recorded baseline characteristics of the type of resuscitations, nature of teams present and type and content of information exchanges. The data were analyzed using a qualitative communication analysis method.ResultsWe found that resuscitation team members described a shared mental model. Respondents understood the roles and goals of each team member in order to provide rapid, efficient and life-saving care with an overall need for situational awareness. The information flow described in the interviews was reflected during the simulated and live resuscitations with the most responsible physician and charting nurse being central to team communication. We consolidated communicated information into six categories: (1) time; (2) patient status; (3) patient history; (4) interventions; (5) assistance and consultations; 6) team members present.ConclusionsResuscitation team members expressed a shared mental model and prioritized situational awareness. Our findings support a need for cognitive aids to enhance team communication during resuscitations.Electronic supplementary materialThe online version of this article (doi:10.1186/s12245-017-0149-4) contains supplementary material, which is available to authorized users.

Trauma-informed interventions have recently received more attention in the field of refugee resettlement and mental health. Although these interventions can be helpful to all trauma survivors, our model offers enhanced and cultural-based practice benefiting war-related trauma survivors, especially those from Post-Colonial nations. This model is based on needs identified by participants and collaboratively developed with the research team and the community. Our community-based participatory research (CBPR) began with three objectives. The first was to explore the current use of culturally-based, trauma-informed interventions and to assess service users’ (SUs) and service providers (SPs) experiences. This was accopmlished by collaborating with a local community agency. The second objective was to identify service needs and gaps. The third objective involved working with the project’s steering community members to develop a more effective model of interventions that can be used by resettlement and mental health agencies supporting refugees. During analysis, we examined the unique challenges identified by SUs and SPs to create a trauma-informed culturally-based intervention model (TICBI).We used a mixed-method study involving focus groups, individual interviews, and surveys with 23 service users (SUs) and 20 service providers (SPs). The barriers identified by the SUs included lack of access to needs-based assistance, cultural and linguistic misunderstandings, and marginalization. The barriers identified by the SPs included lack of structural/organizational support, lack of funding, large caseloads, and burnout risk.

Transactive Memory Systems (TMS) is one of the theoretical constructs used to account for how team members in high stress, high pressure emergency department (ED) distribute their cognitive and work load for more effective team performance. This study investigated the nature of TMS in ED teams by observing resuscitation team simulations and analyzing behaviours and communications reflecting this construct. The credibility of team members was pre-established based on the team members' titles. There was an overwhelming propagation and distribution of unsolicited information between members which indicated the efficiency of TMS in these educational settings. However, it also raised some concerns. This study has implications for training and the design of programs, tools, and electronic interfaces to help improve the efficiency of TMS and ultimately ensure the care and safety of patients. Acknowledgement I would like to thank Dr. Avi Parush, my supervisor, for his invaluable guidance and support, especially in the past few months. I would also like to thank my family, particularly, my husband for his support and amazing programming skills, my sister for helping me with going through rows and rows of data, and my son for his encouragement and support. Furthermore, I would like to thank Dr. Lisa Calder and Dr. George Mastoras for their inputs and suggestions, and acknowledge the generous financial support of the Academic Health Science Centre Alternate Fund Plan (AHSC AFP) Innovation Fund from The Ottawa Hospital. I would also like to thank all the emergency department healthcare workers and professionals who participated in the interviews or consented to having their resuscitation simulations to be viewed and transcribed for this study. Finally, I would like to thank my committee members, Dr. Mantler, Dr. MacLeod, and a special thank to Dr. Logan for providing invaluable input for my thesis. TRANSACTIVE MEMORY SYSTEMS IN EMERGENCY MEDICINE iii TABLE OF CONTENTS