Collaborative practices in unscheduled emergency care: role and impact of the emergency care practitioner quantitative findings

Abstract

Objective: To identify collaborative instances and hindrances and to produce a model of collaborative practice. Methods: A 12 month (2005-6) mixed methods clinical case study in a large UK ambulance trust. Collaboration was measured through direct observational ratings of communication skills, teamwork and leadership with 24 multiprofessional emergency care practitioners (ECPs); interviews with 45 ECPs and stakeholders; and an audit of 611 patients. Results: Quantitative observational ratings indicated that the higher the leadership rating the greater the communication ability (p(0.001) and teamwork (p(0.001), and the higher grade ECPs were rated more highly on their leadership performance. From the patient audit, influences and outputs of collaborative practice are revealed: mean time on scene was 47 mins; 62% were not conveyed; 38% were referred, mainly to accident and emergency; ECPs claimed to make the referral decision in 87% of cases with a successful referral in 96% of cases; and in 66% of cases ECPs claimed that their intervention prevented an acute trust admission. The qualitative interview findings, final collaborative model and recommendations are reported in another paper. Conclusions: The collaborative performance of ECPs varies, but the ECPs' role does appear to have an impact on collaborative practices and patient care. Final recommendations are reported with the qualitative results elsewhere.

Communication and leadership in emergency situations: Systematic literature review and recommendations for practice

“…[4,5,11,13,16,18,22,[24][25][26]29] Simulation-based training is an important pedagogical tool to consolidate knowledge, [30,31] develop acute care skills, maintain proficiency, [30,[32][33][34] and produce leaders. [35][36][37][38][39] Communication and leadership are two closely related concepts, [13] to the extent that effective leadership requires effective communication [4,10,11,19,24,26] at different levels: to collect and process data; [14] to make quick [13,22] and correct decisions; [16,19,22] to achieve a more effective teamwork; [13,17,23,25] to motivate the team; [14] to improve the overall quality of the response; [4,14,15,20,24,29] and to improve patient safety. [4, 13-15, 18, 19, 22, 24] Lead...…”

Evaluation of TEAM dynamics before and after remote simulation training utilizing CERTAIN platform

“…Team performance is dependent on technical and nontechnical skills: teamwork, leadership, and task management [1–4]. Clinical experience alone has not been associated with improved team performance [5]; therefore, training programs are focusing on team dynamics during medical crises as a point of improvement.…”

“…To objectively assess team effectiveness in emergency situations, several assessment tools have been validated: Mayo High Performance Teamwork Scale [10], Emergency Team Dynamics Scale [1], and Team Emergency Assessment Measure (TEAM) [11]. All three scales have demonstrated reliability and validity [1,10,11]; however, only TEAM focuses on teamwork and leadership in the specific context of medical emergencies.…”

“…All three scales have demonstrated reliability and validity [1,10,11]; however, only TEAM focuses on teamwork and leadership in the specific context of medical emergencies. The TEAM tool evaluates team performance on a 0–4 Likert scale in three domains: leadership, team work, and task management [11].…”

“…Since interprofessional teamwork has been linked with patient outcomes [1] and team dynamics can be improved with simulation [6,7], we set out to determine if team dynamics can be improved via remote simulation in resource-limited areas. The original purpose of the simulations was to assess the effectiveness of CERTAIN-ELITE training; however, we wanted to utilize this pre-existing platform to assess the effects of remote simulation on team dynamics.…”