Trauma team discord and the role of briefing

Abstract

Background Briefing of the trauma team prior to patient arrival is unstructured in many centers. We surveyed trauma teams regarding agreement on patient care priorities, and evaluated the impact of a structured, physician-led briefing on concordance during simulated resuscitations. Methods Trauma nurses at our Level II center were surveyed, and participated in four resuscitation scenarios, randomized to “Briefed” or “Non-briefed.” For Non-briefed scenarios, nurses independently reviewed triage sheets with written information. Briefed scenarios had a structured, four-minute physician-led briefing reviewing triage sheets identical to Non-briefed scenarios. Teams included 3–4 nurses (subjects) and 2–4 confederates (physicians, respiratory therapists). Each team served as their own control group. Confederates were blinded to nurses’ Briefed or Non-briefed status. Immediately before, and at the midpoint of each scenario, nurses estimated patient morbidity and mortality and ranked the top 3 of 16 designated immediate care priorities. Briefed and Non-briefed groups’ responses were compared for: (1) Agreement using intraclass correlation coefficient (ICC), (2) Concordance with physicians’ responses using Fisher’s exact test, (3) Teamwork via T-NOTECHS ratings by nurses and physicians using t-test, (4) Time to complete clinical tasks using t-test. Results 38 nurses participated. 97% “agreed/strongly agreed” briefing is important, but only 46% agreed briefing was done well. Comparing Briefed versus Non-briefed scenarios, nurses’ estimation of morbidity and mortality in Briefed scenarios showed significantly greater agreement with each other and with physicians’ answers (p<0.01). Rank lists also better agreed with each other (ICC 0.64 vs 0.59) and with physicians’ answers in Briefed scenarios. T-NOTECHS Leadership ratings were significantly higher in Briefed scenarios (3.70 versus 3.39, p<.01). Time to completion of key clinical tasks was significantly faster for one of the Briefed scenarios. Conclusions Discordant perceptions of patient care goals was frequently observed. Structured, physician-led briefing appeared to improve interprofessional team concordance, leadership and task completion in simulated trauma resuscitations. Level of Evidence Level 3, Therapeutic / Care management

The team briefing: setting up relational coordination for your resuscitation

“…The concept of briefing resuscitation teams is not novel, but there has been renewed energy towards improving those briefings as better understanding of team behaviours and non-clinical resuscitation skills have emerged. [1][2][3][4] Effective briefings have reduced mortality in surgical patients and have been shown to reduce the time to critical team tasks within a simulated resuscitation environment. 5,6 One proposed mechanism for benefit is the construction of a "shared mental model" amongst team members.…”

“…5,6 One proposed mechanism for benefit is the construction of a "shared mental model" amongst team members. 2,4 In a recent publication in Clinical and Experimental Emergency Medicine, Reid et al advocated for the incorporation of the "zero-point survey" (ZPS) as an antecedent to the longstanding and familiar primary survey. The ZPS includes consideration of personal and environmental factors as well as a critical team component, the briefing.…”

Examining non-technical skills for ad hoc resuscitation teams: a scoping review and taxonomy of team-related concepts

“…2. Leader performing technical interventions resulting in task fixation/loss of situational awareness [ 4 – 6 , 10 , 20 , 24 , 28 , 32 , 34 , 41 , 44 , 45 , 51 , 58 , 65 , 66 ] Communication Verbal and non-verbal exchange of information. May occur within the team and between team and environment (e.g., patient, bystanders).…”

Simulação clínica: construção e validação de roteiro para o Suporte Básico de Vida no adulto

“…Esse roteiro é voltado ao processo de ensino e aprendizagem de profissionais enfermeiros e estudantes de graduação em enfermagem e estabelece um roll de objetivos de aprendizagem que devem ser embasados na taxonomia de Bloom e nas diretrizes da American Heart Association (AHA). 6 Pesquisa experimental randomizada 24 realizada com 38 enfermeiros norte-americanos verificou se o pré-briefing/briefing é capaz de desenvolver competência clínica para a ressuscitação cardiopulmonar e identificou que o estabelecimento rigoroso dos objetivos de aprendizagem do SBV, durante a etapa de preparação, possibitou o rastreamento dos resultados de aprendizagem, melhorou o trabalho em equipe, a liderança dos indivíduos e a qualidade e rapidez na ressuscitação cardiopulmonar. 24 Os materiais, instrumentos e as ações que viabilizam a etapa de preparação também foram valorizados pelo roteiro, e, nesta perspectiva, estudos de revisão sistemática 4-5 fundamentaram a importância de se estabelecerem, principalmente, as ações pertinentes à pré-simulação e ao prébriefing/briefing, no âmbito da educação, visto que a ausência desse elemento pode comprometer os resultados de aprendizagem dos indivíduos submetidos a essa estratégia de ensino.…”