Team planning discussion and clinical performance: a prospective, randomised, controlled simulation trial

Abstract

Planning held before emergency management of a critical situation might be an invaluable asset for optimising team preparation. The purpose of this study was to investigate whether a brief planning discussion improved team performance in a simulated critical care situation. Forty-four pairs of trainees in anaesthesia and intensive care were randomly allocated to either an intervention or control group before participating in a standardised simulated scenario. Twelve different scenarios were utilised. Groups were stratified by postgraduate year and simulated scenario, and a facilitator was embedded in the scenario. In the intervention group, the pairs had an oral briefing followed by a 4-min planning discussion before starting the simulation. The primary end-point was clinical performance, as rated by two independent blinded assessors on a score of 0-100 using video records and pre-established scenario-specific checklists. Crisis resource management and stress response (cognitive appraisal ratio) were also assessed. Two pairs were excluded for technical reasons. Clinical performance scores were higher in the intervention group; mean (SD) 51 (9) points vs. 46 (9) in the control group, p = 0.039. The planning discussion was also associated with higher crisis resource management scores and lower cognitive appraisal ratios, reflecting a positive response. A 4-min planning discussion before a simulated critical care situation improved clinical team performance and cognitive appraisal ratios. Team planning should be integrated into medical education and clinical practice.

Cognitive appraisals and team performance under stress: A simulation study

“…In a recent study, in which medical teams were randomised to pre‐event planning versus no planning before a high‐stakes medical simulation, although there were no differences in the perceived level of anxiety between the two groups, cognitive appraisal ratios shifted from threat towards challenge for those who were allowed a period of pre‐event planning. The authors concluded that this shift may have influenced clinical performance in the simulated scenarios …”

“…, DRES ratio (scores of >1 reflect threat and scores of <1 reflect challenge); RM, repeated measures. Bold values represent statistically significant values.concluded that this shift may have influenced clinical performance in the simulated scenarios 36. Historically, team performance has been investigated with respect to two aspects of performance: team perspective, and centrality of authority.…”

Systematic review of the characteristics of brief team interventions to clarify roles and improve functioning in healthcare teams

“…The retained studies were published between 2009 and 2020 (see Table 1). Studies were conducted in Australia [39], Belgium [55], France [56], Germany [40,57], New Zealand [41], United States [42][43][44][45][46][47][48][49][50][51][52]54], Singapore [58], and Taiwan [53]. Key study characteristics are presented in Table 1 and outlined below.…”

“…Studies were conducted in acute care in-patient settings including the operating room/postanesthesia care unit [40-42, 44, 51], emergency department [52,54], intensive care unit transport team [53], medical/surgical units [39,58], labour and delivery [48], and crisis/cardiac arrest [43,45,49,50,[55][56][57] The overall quantity of the nontechnical skills were different between the groups (p = 0.02).…”

“…Three studies [41,44,45] included a prepost design and only reported the total number of participants in the study. Researchers reported on studies with physicians only [40,41,52], medical residents/students/interns only [39,42,49,50,54,56], nursing and medical students [43], nurses only [44,48], nursing students only [55], and a mix of care providers [45,47,51,53,57,58]. Only one study reported on a mix of care providers and patients [46].…”