Trauma resuscitation: can team behaviours in the prearrival period predict resuscitation performance?

Abstract

BackgroundOptimising team performance is critical in paediatric trauma resuscitation. Previous studies in aviation and surgery link performance to behaviours in the prearrival period.ObjectiveTo determine if patterns of human behaviour in the prearrival period of a simulated trauma resuscitation is predictive of resuscitation performance.DesignTwelve volunteer trauma teams performed in four simulation scenarios in a paediatric hospital. The scenarios were video recorded, transcribed and analysed in 10-second intervals. Variation in the amount of utterances per team member in the prearrival period was compared with team performance and implicit coordination during the resuscitation.Key resultsCoders analysed 18 962 s of video. They coded 5204 team member utterances into one of eight communication behaviour categories. Inter-rater reliability was excellent (an average of 83.1% across all four scenarios). The average number of communications occurring during the prearrival period was 18.84 utterances, with a range of 2–42 and a SD of 9.55. The average length of this period was almost 2 minutes (mean =117.30 s, SD=39.20). Lower variance in team member communication during the prearrival better was associated with better implicit coordination (p=0.011) but not team performance (p=0.054) during the resuscitation.ConclusionPatterns of communication in the prearrival trauma resuscitation period predicted implicit coordination and a trend towards significance for team performance which suggests further studies in such patterns are warranted.

Differences in talking-to-the-room behaviour between novice and expert teams during simulated paediatric resuscitation: a quasi-experimental study

“…Third, the finding that coordination patterns discriminate between teams with less versus more experienced members, which is in line with current teamwork research highlighting the importance of patterns,30 has implications for teamwork training as well. Although teamwork is in the focus of most SBT, they typically focus on the quantity and quality of certain behaviours of individual team members.…”

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

“…A planned approach has also been shown to improve crisis resource management . The present study found a positive impact of the planning discussion on crisis resource management scores.…”

“…For critical incidents occurring in a medical context there is often a brief period available for planning, for instance immediately before the admission of a known incoming patient. The importance of a free and constructive exchange during this time has been emphasised in a recent non‐randomised paediatric simulation study ; balanced communication structured around pertinent information was associated with better team coordination and a trend towards improved performance. In the present study, planning discussions with a highly situation‐specific content (scenarios with predictable crisis) were associated with an increase of over 11 points (5 + 6) in clinical performance score.…”

Information sharing and decision‐making in multidisciplinary crisis management teams

“…In sum, in complex and ambiguous environments, team information processing cannot be represented merely by the amount of information shared within the team; instead, it is strongly dependent on the extent to which a team collectively engages in higher level processing of the available information. Supported by work on the positive effects of reciprocal communication in hospital trauma teams (Su et al, 2017), we suggest that team processes in which team members engage in an exchange of their interpretations about the situation will lead to positive team outcomes for teams facing a complex, dynamic, and time pressured situation. Therefore, we pose the following research question:…”