Evaluation of Communication and Safety Behaviors During Hospital-Wide Code Response Simulation

Abstract

Introduction: To understand the baseline quality of team communication behaviors at our organization, we implemented institution-wide simulation training and measured the performance of safety behaviors of ad hoc teams in emergent situations. Methods: Clinicians participated in 2 interprofessional video-recorded simulation scenarios, each followed by debriefing. Using a standardized evaluation instrument, 2 reviewers independently evaluated the presence or absence of desired team safety behaviors, including escalating care, sharing a mental model, establishing leadership, thinking out loud, and identifying roles and responsibilities. We also scored the quality of sharing the mental model, closed-loop communication, and overall team performance on a 7-point scale. Discordant reviews were resolved with scoring by an additional reviewer. Results: A total of 1404 clinicians participated in 398 simulation scenarios, resulting in 257 usable videos. Overall, teams exhibited desired behaviors at the following frequencies: escalating care, 85%; sharing mental models, 66%; verbally establishing leadership, 6%; thinking out loud, 87%; and identifying roles and responsibilities, 27%. Across all reviews, the quality of the graded behaviors (of 7 points) was 2.8 for shared mental models, 3.3 for closed-loop communication, and 3.2 for overall team performance. Conclusions: In a simulation setting with ad hoc teams, there was variable performance on completing safety behaviors and only a fair quality of graded communication behaviors. These results establish a baseline assessment of communication and teamwork behaviors and will guide future quality improvement interventions.

Capability to identify and manage critical conditions: effects of an interprofessional training intervention

“…This perception is supported by Smith et al [ 38 ], who proved that staffing level influenced the rate of failure to adequately respond to deranged vital signs. Altogether, the findings confirmed the previously identified issues and need for improvements in the care of patients in general hospital wards [ 1 , 3 , 5 , 21 , 39 ].…”

“…Applying CRM creates a climate that encourages an open attitude with the opportunity for everyone on the team, regardless of profession or title, to speak-up for patient safety if something feels wrong [ 20 ]. However, in practice, there is a variable performance on completing the safety behaviors prescribed in CRM [ 21 ].…”

Closed-Loop Communication in Interprofessional Emergency Teams: A Cross-Sectional Observation Study on the Use of Closed-Loop Communication Among Anesthesia Personnel

“…Several studies found that adverse events decreased when team members used CLC, 14,16,17 whereas others reported that tasks were completed significantly faster with CLC, compared with nonstructured communication 12,16 . Most studies examining CLC were based on simulated emergencies 15,17–26 ; however, few have investigated the use of CLC in clinical practice 12,14,27 . The aim of this study was therefore to explore the use of CLC among anesthesia personnel in real-life interprofessional emergency teams.…”