Speaking Up and Sharing Information Improves Trainee Neonatal Resuscitations

Abstract

Objectives To identify teamwork behaviors associated with improving efficiency and quality of simulated resuscitation training. Methods Secondary analysis of a randomized controlled trial of trainees undergoing neonatal resuscitation training was performed. Trainees at a large academic center (n=100) were randomized to receive standard curriculum (n=36) versus supplemental team training curriculum (n=62). A two-hour team training session focused on communication skills and team behaviors served as the intervention. Outcomes of interest included resuscitation duration, time required to complete a simulated newborn resuscitation, and performance score, determined by evaluation of each of the team’s steps during simulated resuscitation scenarios. Results The teamwork behaviors assertion and sharing information were associated with shorter resuscitation duration and higher performance scores. Each additional use of assertion (per minute) was associated with a duration reduction of 41 s (95%CI: −71.5 to −10.2) and an increase in performance score of 1.6% (95%CI: 0.4 to 2.7). Each additional use of sharing information (per minute) was associated with a 14 s reduction in duration (95%CI: −30.4 to 2.9) and a 0.8% increase in performance score (95%CI: 0.05 to 1.5). Conclusions Teamwork behaviors of assertion and sharing information are two important mediators of efficiency and quality of resuscitations.

Factors relating to the perceived management of emergency situations: A survey of former Advanced Life Support course participants’ clinical experiences

“…Moreover, the issue of prejudice in this study seemingly did not show differences between situations managed well and not well. However, this survey may not have elicited these aspects, which may be tacit to the responder 18 . These findings suggest that educational initiatives should be directed towards the individual and team factors.…”

“…Likewise were the inclusion of suggestions made by co-workers in the decision making. Clear inter-personal communication has been emphasized in the resuscitation literature [18][19][20] , but mostly in the form of training the individual to give clear and direct commands and application of closed-loop communication whereas issues of including coworkers' perspectives and contributions are not emphasised. Our results correspond well with a recent study indicating that educators should turn their attention to include not only the individual team members' knowledge and skills, but also their awareness of team members' abilities and the tacit and explicit shared mental models and shared expectations 21 .…”

Team talk and team activity in simulated medical emergencies: a discourse analytical approach

“…This mutual understanding can be viewed as a pattern that arose from common goals and methods [44]. The flow of the team talk shows the teamwork dynamics and how the team members had the flexibility and adaptability they needed to accomplish the expected tasks, which is important for high-level team performance [33, 34, 45]. Although the team talk appeared to be unstructured, which could have some risks, the team members managed to manoeuvre safely within this complex situation by communicating with each other.…”

“…Online commentaries describe or evaluate what the physician is observing at that exact moment, and they both reassure the patient and contribute to the physician’s evaluation of the patient’s problems [30]. In the context of team communication, online commentaries are the way that team members share information of their real-time observations and assessments of observations based on relevant cues in the clinical situation [31–33]. Online commentaries are thus elements in team coordination and team adaption, which is associated with better team performance and which can impact patient safety [34–36].…”

Developing the NeoReadyTM: a systems approach to supporting teams during neonatal resuscitation

“…The specific communication skills of assertion and information sharing have emerged as key predictors of better team performance. 26 Vigilance (the sustained attention of individuals) is also associated with fewer procedural errors. 27 However, these findings reinforce the person-focused approach to minimizing error, and place the responsibility of preventing error back on the individual.…”