Error Reduction and Performance Improvement in the Emergency Department through Formal Teamwork Training: Evaluation Results of the MedTeams Project

Abstract

Objective. To evaluate the effectiveness of training and institutionalizing teamwork behaviors, drawn from aviation crew resource management (CRM) programs, on emergency department (ED) staff organized into caregiver teams. Study Setting. Nine teaching and community hospital EDs. Study Design. A prospective multicenter evaluation using a quasi-experimental, untreated control group design with one pretest and two posttests of the Emergency Team Coordination Course TM (ETCC). The experimental group, comprised of 684 physicians, nurses, and technicians, received the ETCC and implemented formal teamwork structures and processes. Assessments occurred prior to training, and at intervals of four and eight months after training. Three outcome constructs were evaluated: team behavior, ED performance, and attitudes and opinions. Trained observers rated ED staff team behaviors and made observations of clinical errors, a measure of ED performance. Staff and patients in the EDs completed surveys measuring attitudes and opinions. Data Collection. Hospital EDs were the units of analysis for the seven outcome measures. Prior to aggregating data at the hospital level, scale properties of surveys and event-related observations were evaluated at the respondent or case level. Principal Findings. A statistically significant improvement in quality of team behaviors was shown between the experimental and control groups following training ( p 5 .012). Subjective workload was not affected by the intervention ( p 5 .668). The clinical error rate significantly decreased from 30.9 percent to 4.4 percent in the experimental group ( p 5 .039). In the experimental group, the ED staffs' attitudes toward teamwork increased ( p 5 .047) and staff assessments of institutional support showed a significant increase ( p 5 .040). Conclusion. Our findings point to the effectiveness of formal teamwork training for improving team behaviors, reducing errors, and improving staff attitudes among the ETCC-trained hospitals.

Development of Crisis Resource Management Skills: A Literature Review

“…The HSRT is considered to be a valid measure of critical thinking with correlations to the Student Aptitude Test (SAT) and the American College Test (ACT) are .40 and.55 respectively (Goodstone et al, 2013)7-point Likert scale designed to assess performance in all five CRM skills as well as provide an overall performance score Content and construct validity established through expert panel and demonstrated acceptable interrater reliability through intraclass correlation coefficient by Uses five 7-point behaviorally anchored rating scales High internal consistency reliabilities previously calculated with a Cronbach's alpha value of .94 (Morey, et al, (2002). the point biserial correlation coefficient (PBCC) for each item was determined, and the mean PBCC for the ECG SimTest was 0.22, established by the test publisher on the basis of national scores on 21 of the 30 items (Brown and Chronister, 2009) 60 Multiple-choice question exam testing critical thinking skills ATI proficiency levels compared to NCLEX scores and based on custom reports 42-item measure evaluating clinical performance Interrater reliability tested across 3 raters with 30 videos of simulation performances.…”

A Multidisciplinary Teamwork Training Program: The Triad for Optimal Patient Safety (TOPS) Experience

“…committed to multidisciplinary education and had strong interest, knowledge, or experience in the content matter. After reviewing available literature on existing programs and curricula, the planning team developed several overarching goals 9,[29][30][31] .…”

“…Current literature discussing health-care team training has largely focused on closed environments such as emergency departments, intensive care units, labor and delivery suites, or operating rooms [7][8][9][10][11][12][13] . In these settings, all providers identify with a "unit-based" environment.…”

Teaching teamwork during the Neonatal Resuscitation Program: a randomized trial

“…For example, team behaviors are correlated with the quality of neonatal resuscitation, 3 communication breakdowns are root cause of 72% of perinatal deaths and injuries, 6 perceptions of effective teamwork are correlated with less burnout and fewer delays in labor and delivery, 7 and there is broad consensus from expert groups and researchers that measuring and improving teamwork will help improve the quality of health care. [8][9][10] However, none of the nine lessons in the NRP textbook 1 includes instruction about teamwork, in part because no studies have shown that team training can improve either teamwork or the quality of health care. 11,12 Therefore, we conducted a study with two specific aims: (1) to incorporate teamwork skills and information about human error into the 1-day NRP training program for interns and (2) to randomize interns to this new version of NRP or the standard NRP and measure the effects on teamwork during the simulated resuscitations at the end of the day.…”