Team-focused Cardiopulmonary Resuscitation: Prehospital Principles Adapted for Emergency Department Cardiac Arrest Resuscitation

Johnson, Blake D.; Runyon, Michael S.; Weekes, Anthony J.; Pearson, David

doi:10.1016/j.jemermed.2017.08.065

Cited by 9 publications

(8 citation statements)

References 64 publications

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“…In prior CSCW work, Pine [63] explained how nurses in labor and delivery units choreograph multiple streams of work as they move from one task to another [7]. In our study, participants envisioned employing choreography for interprofessional team coordination within a code (or an OR), which aligns with findings in healthcare literature [34]. Four out of seven participants implicitly and explicitly envision employing RoboTSS as a choreography generation system.…”

Section: Choreography Generationsupporting

confidence: 67%

“…Pine defined choreography as "the embodied work of balancing and maintaining multiple simultaneous streams of work and bringing them together into a single coherent stream of actions" [63]. In clinical literature, Johnson et al [34] discussed how choreography increase team efficiency in resuscitation situations as team members can allocated to best perform their work.…”

Section: Choreographymentioning

confidence: 99%

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Coordinating Clinical Teams

Taylor

Lee

Kubota

et al. 2019

Proc. ACM Hum.-Comput. Interact.

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Patient safety errors account for over 400,000 preventable deaths annually in US in hospitals alone, 70% of which are caused by team communication breakdowns, stemming from hierarchical structures and asymmetrical power dynamics between physicians, nurses, patients, and others. Nurses are uniquely positioned to identify and prevent these errors, but they are often penalized for speaking up, particularly when physicians are responsible. Nevertheless, empowering nurses and building strong interdisciplinary teams can lead to improved patient safety and outcomes. Thus, our group has been developing a series of intelligent systems that support teaming in safety critical settings, Robot-Centric Team Support System (RoboTSS), and recently developed a group detection and tracking system for collaborative robots. In this paper, we explore how RoboTSS can be used to empower nurses in interprofessional team settings, through a three month long, collaborative design process with nurses across five US-based hospitals. The main findings and contributions of this paper are as follows. First, we found that participants envisioned using a robotic crash cart to guide resuscitation procedures to improve efficiency and reduce errors. Second, nurses discussed how RoboTSS can generate choreography for efficient spatial reconfigurations in co-located clinical teams, which is particularly important in time-sensitive situations such as resuscitation. Third, we found that nurses want to use RoboTSS to "stop the line", and disrupt power dynamics by policing unsafe physician behavior, such as avoiding safety protocols using a robotic crash cart. Fourth, nurses envisioned using our system to support real-time error identification, such as breaking the sterile field, and then communicating those errors to physicians, to relieve them of responsibility. Finally, based on our findings, we propose robot design implications that capture how nurses envision utilizing RoboTSS. We hope this work promotes further exploration in how to design technology to challenge authority in asymmetrical power relationships, particularly in healthcare, as strong teams save lives.

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Section: Choreography Generationsupporting

confidence: 67%

Section: Choreographymentioning

confidence: 99%

Coordinating Clinical Teams

Taylor

Lee

Kubota

et al. 2019

Proc. ACM Hum.-Comput. Interact.

View full text Add to dashboard Cite

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“…In these situations, adequate leadership and teamfocused resuscitation should play a beneficial role. 31 For example, team leader verbalisation makes EMTs aware of errors or encourages them to keep up the good work, reinforcing positive performance outcomes. 32 33 During MCPR deployment, EMT-Ps had subjective and objective median no-flow time of 8 and 13.5 s, respectively.…”

Section: Discussionmentioning

confidence: 99%

“…We posit that recognition of interruption time is not accurate while EMTs concentrate on specific emergency medical techniques, particularly during urgent OHCA resuscitations. In these situations, adequate leadership and team-focused resuscitation should play a beneficial role 31. For example, team leader verbalisation makes EMTs aware of errors or encourages them to keep up the good work, reinforcing positive performance outcomes 32 33…”

Section: Discussionmentioning

confidence: 99%

Objective performance of emergency medical technicians in the use of mechanical cardiopulmonary resuscitation compared with subjective self-evaluation: a cross-sectional, simulation-based study

et al. 2022

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ObjectiveTo evaluate the subjective and objective resuscitation performance of emergency medical technicians (EMTs) using mechanical cardiopulmonary resuscitation (MCPR) devices.Design and settingThis was a cross-sectional simulation-based study where participants installed the MCPR device on a training manikin.ParticipantsWe assessed EMT-Intermediates (EMT-Is) and EMT-Paramedics (EMT-Ps) of the Emergency Medical Services (Ambulance) Division of the Taipei City Fire Department.Primary and secondary outcome measuresThe primary outcome was the gap between self-perceived (subjective) and actual (objective) no-flow time during resuscitation, which we hypothesised as statistically insignificant. The secondary outcome was the association between resuscitation performance and personal attributes like knowledge, attitude and self-confidence.ResultsAmong 210 participants between 21 and 45 years old, only six were female. There were 144 EMT-Is and 66 EMT-Ps. During a simulated resuscitation lasting between four and a half and 5 min, EMTs had longer actual no-flow time compared with self-perceived no-flow time (subjective, 38 s; objective, 57.5 s; p value<0.001). This discrepancy could cause a 6.5% drop of the chest compression fraction in a resuscitation period of 5 min. Among the EMT personal factors, self-confidence was negatively associated with objective MCPR deployment performance (adjusted OR (aOR) 0.66, 95% CI 0.45 to 0.97, p=0.033) and objective teamwork performance (aOR 0.57, 95% CI 0.34 to 0.97, p=0.037) for EMT-Ps, whereas knowledge was positively associated with objective MCPR deployment performance (aOR 2.15, 95% CI 1.31 to 3.52, p=0.002) and objective teamwork performance (aOR 1.77, 95% CI 1.02 to 3.08, p=0.043) for EMT-Is. Moreover, regarding the self-evaluation of no-flow time, both self-satisfaction and self-abasement were associated with objectively poor teamwork performance.ConclusionsEMTs’ subjective and objective performance was inconsistent during the MCPR simulation. Self-confidence and knowledge were personal factors associated with MCPR deployment and teamwork performance. Both self-satisfaction and self-abasement were detrimental to teamwork during resuscitation.

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“…Increasing the complexity and number of tasks, without increasing available resources, can decrease the likelihood of all procedures being performed correctly (34). Recent advances in OHCA have been made using a team focussed, or 'pit-crew', approach to resuscitation (35).…”

Section: Discussionmentioning

confidence: 99%

Goldilocks in Cardiac Arrest: A Scoping Review of Invasive Hemodynamic Monitoring in the Pre-Hospital Setting for Getting Adrenaline Dosing Just Right

Wijland

2021

Australasian Journal of Paramedicine

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Introduction A one-size-fits-all approach to adrenaline dosing is likely to be sub-optimal for out-of-hospital cardiac arrest given the diverse nature of patient age, bodyweight, frailty and intra-arrest coronary perfusion pressure. An individualised adrenaline dosing approach to cardiac arrest using invasive blood pressure monitoring has been shown to increase rates of return of spontaneous circulation in the hospital setting, but evidence for this approach has not yet been reviewed in the pre-hospital setting. Methods A scoping review was undertaken using Science Direct, ProQuest, PubMed, CINAHL Complete and GALE Health and Wellness databases with the search terms ‘arterial line’, ‘pre-hospital’, ‘cardiac arrest’ and similar derivatives. Subject matter experts and authors of articles meeting inclusion criteria were also consulted to help identify further relevant studies. Articles were included if they pertained to the use of arterial lines in cardiac arrest in the pre-hospital field, and excluded if they related to traumatic cardiac arrest, in a language other than English, Dutch or French, or not retrievable as a full text. Results A total of 1408 articles were identified using the search method, of which three remained after de-duplication, use of inclusion and exclusion criteria, and full text appraisal. The current pre-hospital literature is lacking and avenues for further research to improve the evidence for hemodynamic guided resuscitation were identified. Conclusion Paramedic-initiated invasive arterial monitoring presents a new, but as yet unproven, intervention for improving cardiac arrest outcomes.

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Team-focused Cardiopulmonary Resuscitation: Prehospital Principles Adapted for Emergency Department Cardiac Arrest Resuscitation

Cited by 9 publications

References 64 publications

Coordinating Clinical Teams

Coordinating Clinical Teams

Objective performance of emergency medical technicians in the use of mechanical cardiopulmonary resuscitation compared with subjective self-evaluation: a cross-sectional, simulation-based study

Goldilocks in Cardiac Arrest: A Scoping Review of Invasive Hemodynamic Monitoring in the Pre-Hospital Setting for Getting Adrenaline Dosing Just Right

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