Can teamwork and situational awareness (SA) in ED resuscitations be improved with a technological cognitive aid? Design and a pilot study of a team situation display

Parush, Avi; Mastoras, George; Bhandari, Abhi; Momtahan, Kathryn; Day, Kathleen; Weitzman, Brian; Sohmer, Benjamin; Cwinn, A. Adam; Hamstra, Stanley J.; Calder, Lisa A.

doi:10.1016/j.jbi.2017.10.009

Cited by 39 publications

(63 citation statements)

References 38 publications

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“…One of two subject matter experts (J-MG and MH) experienced in using the Clinical Teamwork Scale (CTS) directly observed simulations in real time and measured teamwork using the CTS, a validated instrument that measures overall teamwork and 15 specific elements in five overarching domains in addition to overall teamwork: communication, decision-making, role responsibility (leadership and followership), situational awareness/resource management and patient-friendliness 19. CTS was selected because the authors were skilled in its use having developed it over a decade ago with a diverse team (that included one of the founders of crew resource management), it was designed specifically to allow quick assessments of teamwork during rapidly moving clinical emergencies, it is free, and has been successfully used by us and numerous others to measure teamwork in emergent clinical scenarios similar to our intended purpose: paediatric resuscitations, obstetrics, trauma, advanced cardiac life support and emergency medical services 20–27. Evaluators rate the performance of the care team using a Likert scale of zero (unacceptable) to 10 (perfect) and are given space to insert narrative comments.…”

Section: Methodsmentioning

confidence: 99%

Association between measured teamwork and medical errors: an observational study of prehospital care in the USA

et al. 2019

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ObjectivesThe goal of this study was to examine the relationship between measured teamwork and adverse safety events in the prehospital emergency care of children using high-fidelity simulation. We posit that non-technical skills such as leadership, teamwork, situation awareness and decision-making are associated with the clinical success of teams.DesignObservational study.SettingEmergency medical services (EMS) responders were recruited from public fire and private transport agencies in Oregon State to participate in four simulations of paediatric emergencies using high-fidelity patient simulators, scene design, and professional actors playing parents and bystanders.ParticipantsForty-four fire/transport teams consisting of 259 EMS professionals consented to participate and completed simulations.Primary and secondary outcome measuresTeams were assessed using the Clinical Teamwork Scale (CTS), a validated instrument that measures overall teamwork and 15 specific elements in five overarching domains: communication, decision-making, role responsibility (leadership and followership), situational awareness/resource management and patient-friendliness. We used generalised estimating equations to estimate the odds of error with increasing overall CTS teamwork score while adjusting for clinical scenario and potential clustering by team.ResultsAcross 176 simulations, the mean overall score on the CTS was 6.04 (SD 2.10; range 1=poor to 10=perfect) and was normally distributed. The distribution of scores was similar across the four clinical scenarios. At least one error was observed in 82% of the simulations. In simulations with at least one observed error, the mean CTS score was 5.76 (SD 2.04) compared with 7.16 (SD 1.95) in scenarios with no observed error. Logistic regression analysis accounting for clustering at the team level revealed that the odds of an error decreased 28% with each unit increase in CTS (OR 0.72, 95% CI 0.59 to 0.88).ConclusionsThis study found that overall teamwork among care delivery teams was strongly associated with the risk of serious adverse events in simulated scenarios of caring for critically ill and injured children.

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Section: Methodsmentioning

confidence: 99%

Association between measured teamwork and medical errors: an observational study of prehospital care in the USA

et al. 2019

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“…A couple of research projects focus on the application of human factors engineering to design health IT for teams. Two research teams in Ottawa, Canada 48 , 50 – 52 and at the University of Illinois 53 used various human factors methods that provided input to build shared team displays for supporting cognitive work and communication during resuscitations. In Canada, Parush et al, designed a smart display to support cognitive work and team communication during ED resuscitation 48 , 50 – 52 .…”

Section: Human-centered Design Of Health Itmentioning

confidence: 99%

“…Two research teams in Ottawa, Canada 48 , 50 – 52 and at the University of Illinois 53 used various human factors methods that provided input to build shared team displays for supporting cognitive work and communication during resuscitations. In Canada, Parush et al, designed a smart display to support cognitive work and team communication during ED resuscitation 48 , 50 – 52 . Using multiple methods (e.g., interview of ED clinicians, observation of live resuscitations), they identified key information needs, and then implemented an iterative human-centered design process to develop a prototype for the shared situation display 48 , 52 .…”

Section: Human-centered Design Of Health Itmentioning

confidence: 99%

Human Factors and Usability for Health Information Technology: Old and New Challenges

2019

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Objectives: Despite national mandates, incentives, and other programs, the design of health information technology (IT) remains problematic and usability problems continue to be reported. This paper reviews recent literature on human factors and usability of health IT, with a specific focus on research aimed at applying human factors methods and principles to improve the actual design of health IT, its use, and associated patient and clinician outcomes. Methods: We reviewed recent literature on human factors and usability problems of health IT and research on human-centered design of health IT for clinicians and patients. Results: Studies continue to show usability problems of health IT experienced by multiple groups of health care professionals (e.g., physicians and nurses) as well as patients. Recent research shows that usability is influenced by both designers (e.g., IT vendors) and implementers in health care organizations, and that the application of human-centered design practices needs to be further improved and extended. We welcome emerging research on the design of health IT for teams as team-based care is increasingly implemented throughout health care. Conclusions: Progress in the application of human factors methods and principles to the design of health IT is occurring, with important information provided on their actual impact on care processes and patient outcomes. Future research should examine the work of health IT designers and implementers, which would help to develop strategies for further embedding human factors engineering in IT design processes.

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“…In the chaotic environment of a cardiac arrest, identification of error and other human factors is an important challenge [30]. There is an increasing body of literature to support the use of simulation to assess performance, and studies surrounding the use of decision support tools and systems in simulated critical situations are now emerging [38,39,24,27]. However, we have demonstrated that self-reporting of performance is misleading and should be avoided when studying such phenomenon.…”

Section: Resultsmentioning

confidence: 96%

“…Failures within teams and poor communication are among the most common reasons for adverse medical events [27,28]. Previous decision support tools were designed solely to support the team leader, failing to recognise the importance of effective communication and team cohesion, whereby team situational awareness could then be lost.…”

Section: Discussionmentioning

confidence: 99%

Does electronic decision support influence advanced life support in simulated cardiac arrest?

Jones

Hayes

Williams

et al. 2019

British Journal of Cardiac Nursing

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In-hospital Cardiac arrest is common but despite mandatory resuscitation training for staff, the survival rates vary considerably. The reason for such variation is unclear but may relate to a number of human factors. Decision support systems and tools have been suggested as a means of reducing human errors and improve patient outcome. In this proof of concept study, we tested the use of such a device in a simulated environment Methods The aims of this study were firstly, to investigate if the introduction of an electronic decision support system (eDSS) influenced the delivery of advanced life support in a simulated cardiac arrest scenario and secondly, to explore the users' views on their performance both with and without the eDSS.

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Can teamwork and situational awareness (SA) in ED resuscitations be improved with a technological cognitive aid? Design and a pilot study of a team situation display

Abstract: Overall, this pilot study implies that a situation display could facilitate better teamwork and team communication in the resuscitation event.

Cited by 39 publications

References 38 publications

Association between measured teamwork and medical errors: an observational study of prehospital care in the USA

Association between measured teamwork and medical errors: an observational study of prehospital care in the USA

Human Factors and Usability for Health Information Technology: Old and New Challenges

Does electronic decision support influence advanced life support in simulated cardiac arrest?

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