Rating teams’ non-technical skills in the emergency department: A qualitative study of nurses’ experience

The red hat - designating leadership using visual and verbal cues: a mixed-methods study

BACKGROUND

During a critical event in the labor and delivery operating room, it is crucial for team members responding to the situation to be aware of the designated leaders. Visual and verbal cues have been utilized to designate leadership in various healthcare settings; however, previous research has indicated mixed results using visual cues for role designation.

METHODS

The purpose of this study was to explore the use of the red surgical hat as a visual cue of leadership during obstetric emergency simulation training. We used a mixed-methods design to analyze simulation-based education video and debriefing transcripts.

RESULTS

There was a statistically significant difference in the proportion of participants who declared leadership vs. those who donned the red hat. Participants were more likely to visually declare leadership utilizing a red surgical bouffant hat than to verbally declare leadership. Most participants indicated that observing the red hat to detect leadership in the operating room was more effective than when leaders used a verbal declaration to inform others who was leading.

CONCLUSIONS

Our findings suggest that utilizing a visual cue of leadership with the red surgical bouffant hat improves participant perceptions of communication of the surgical team during an obstetrical critical event in a simulation environment.

Leadership factors for cardiopulmonary resuscitation for clinicians in-hospital; behaviours, skills and strategies: A systematic review and synthesis without meta-analysis

AIM

To identify leadership factors for clinicians during in-hospital cardiopulmonary resuscitation.

DESIGN

Systematic review with synthesis without meta-analysis.

METHODS

The review was guided by SWiM, assessed for quality using CASP and reported with PRISMA.

DATA SOURCES

Cochrane, EMBASE, PubMed, Medline, Scopus and CINAHL (years of 2013-2023) and a manual reference list search of all included studies.

RESULTS

A total of 60 papers were identified with three major themes of useful resuscitation leadership; 'social skills', 'cognitive skills and behaviour' and 'leadership development skills' were identified. Main factors included delegating effectively, while being situationally aware of team members' ability and progress during resuscitation, and being empathetic and supportive, yet 'controlling the room' using a hands-off style. Shared decision-making to reduce cognitive load for one leader was shown to improve effective teamwork. Findings were limited by heterogeneity of studies and inconsistently applied tools to measure leadership.

CONCLUSION

Traditional authoritarian leadership styles are not wanted by team members with preference for shared leadership and collaboration. Balancing this with the need for team members to see leaders in 'control of the room' brings new challenges for leaders and trainers of resuscitation.

IMPLICATIONS FOR NURSING PROFESSION

All clinicians need effective leadership skills for cardiopulmonary resuscitation in-hospital. Nurses provide first response and ongoing leadership for cardiopulmonary resuscitation. Nurses typically display suitable skills that align with useful resuscitation leader factors.

IMPACT

What were the main findings? Collaboration rather than an authoritarian approach to leadership is preferred by team members. Nurses are suitable to 'control the room'. Restricting resuscitation team size will manage disruptive behaviour of team members.

TRIAL REGISTRATION

PROSPERO Registration: CRD42022385630.

PATIENT OF PUBLIC CONTRIBUTION

No patient of public contribution.

Assessing team behaviours and time to defibrillation during simulated cardiac arrest: a pilot study of internal medicine trainees

Understanding team behaviours leading to successful outcomes in resuscitation could help guide future training. Guidelines recommend defibrillation for shockable rhythm cardiac arrests within 2 minutes. This observational pilot study aimed to determine whether teamwork behaviours among medical trainees differed when time to defibrillation (TTD) was less than 2 minutes, versus 2 minutes or more.

Following ethical approval, groups of six internal medicine trainee (IMT) doctors in Scotland formed an

Twenty-three videos involving 138 trainees were scored using the TEAM tool. Scores ranged from 19–39.5/44 (mean 28.2). Mean TTD was 86.2 seconds (range 24–224), with 17/23 teams achieving defibrillation in under 2 minutes. Those achieving fast TTD achieved higher TEAM scores, and the result was statistically significant (30.1 ± 5.0 vs 22.9 ± 3.3,

This observational pilot study found that improved team performance, as measured by the TEAM tool, was associated with faster defibrillation by IMT doctors in simulated cardiac arrest. It highlighted the importance of adaptability as a team behaviour associated with successful performance, which is of interest to those involved in training high stakes emergency teams.

An Evaluation of Pre-Hospital Emergency Care Personnel Knowledge About Crisis Resource Management and Perspectives of Educators About Inclusion of Crisis Resource Management in the Pre-Hospital Emergency Care Curriculum

PURPOSE

To evaluate the knowledge of pre-hospital emergency care personnel (PECP) in South Africa on the principles, practice of crisis resource management (CRM), and obtain emergency medical care (EMC) educators' views on the teaching and learning of CRM skills in the pre-hospital EMC curriculum.

METHODS

This research was designed as an exploratory study that used a semi-structured questionnaire administered to 2000 PECP and focus group discussion (FGD) with 19 emergency care educators. Chi-squared test and Cramér's V were used to examine the existence and the strength of an association between cross-tabulated variables. Responses to open-ended questions, as well as the data generated by the FGD, were analysed qualitatively using iterative inductive coding to identify themes.

RESULTS

A response rate of 76% was obtained for the survey. Findings are that the majority (64.5%) of the PECP were not familiar with CRM, though familiarity varied significantly across cadres of PECP (p <0.001). EMC educators reported that the concept of CRM must be thoroughly researched and developed in the emergency medical service (EMS) context before it is included in the EMC curriculum. The educators reported that early introduction of CRM in the EMC curriculum will have a positive effect on students' professional development. Difficulties with assessment, knowing what to teach, and lack of universally accepted guidelines or teaching modalities are some of the challenges identified by EMC educators in relation to teaching CRM in the EMC curriculum.

CONCLUSION

The findings of this study provide new insights into PECP's knowledge and EMC educators' views on the teaching and learning of CRM in the EMC curriculum. This study highlights that more research is needed to develop an EMS CRM curriculum. Investigation into the development of a teaching and learning framework for CRM in EMC education could be the focus of future studies.

Measuring non-technical skills during prehospital advanced cardiac life support: A pilot study

Aim

To analyse non-technical skills of mobile medical teams during out-of-hospital cardiac arrests (OHCA) using the validated Team Emergency Assessment Measure (TEAM) tool. To research the correlation between non-technical skills and patient outcome.

Methods

Adult patients who experienced an out-of-hospital cardiac arrest between July 2016, and June 2018, and were treated by a mobile medical team from the University Hospital Leuven, were eligible for the study. Resuscitations were video recorded from the team leader’s perspective. Video recordings were reviewed and scored by emergency physicians, using the TEAM evaluation form.

Results

In total 114 OHCAs were analysed. The mean TEAM score was 34.4/44 (SD = 5.5). The mean item score was 3.1/4 (SD = 0.8). On average, ‘effective team communication’ had the lowest score (2.4), while ‘acting with composure and control’ and ‘following of approved standards/guidelines’ scored the highest (3.4). The average non-technical skills theme scores were 2.9 (SD = 0.9) for ‘Leadership’, 3.1 (SD = 0.8) for ‘Teamwork’ and 3.3 (SD = 0.7) for ‘Task management’. ‘Leadership’ was rated significantly lower than ‘Teamwork’ (p = 0.004) and ‘Task management’ (p < 0.001). No significant correlation was found between TEAM and return of spontaneous circulation (p = 0.574) or one month survival (p = 0.225).

Conclusion

The mean overall TEAM score was categorized as good. Task management scored high, while leadership and team communication received lower scores. Future training programs should thus focus on improving leadership and communication. In this pilot study no correlation was found between non-technical skills and survival.

The Effect of Teaching Nontechnical Skills in Advanced Life Support: A Systematic Review

OBJECTIVES

The objective of this study was to evaluate the effect of nontechnical skills (NTS) training on performance in advanced life support (ALS) simulation. Furthermore, we aimed to determine the ideal frequency of training sessions for an optimal retention and the value of debriefing.

METHODS

A systematic search was performed using PubMed, EMBASE, WoS, ERIC, CINAHL, and the Cochrane Library conducted through August 1, 2018. All primary studies mentioning NTS in ALS education were included. Three reviewers independently extracted data on study design and outcome. The MERSQI approach was used to evaluate the overall quality of evidence.

RESULTS

Of the 10,723 identified articles, 40 studies were included with a combined total of 3,041 participants, ranging from students to experts. Depending on the focus of the study, articles were categorized in NTS (n = 25), retention (n = 8), and feedback (n = 10). Incorporating NTS during ALS simulation showed significant improvements in timing for performing critical first steps. Furthermore, good leadership skills had a favorable effect on overall technical performance and teamwork during simulation improved team dynamics and performance. Finally, debriefing also had a beneficial effect on team performance. One particular type of debriefing does not appear to be superior to other types of debriefing.

CONCLUSION

Team simulation training resulted in improved NTS and a reduction in the time required to complete a simulated cardiac arrest. Therefore, a formal NTS program should be introduced into ALS courses. Feedback and repetitive practice are key factors to train NTS. The impact of training on team behaviors can persist for at least 3 to 6 months. In conclusion, understanding and improving NTS may help to create more effective teams. The effect on patient outcome requires further investigation.

Emergencies within hospital wards: An observational study of the non-technical skills of medical emergency teams

BACKGROUND

Medical emergency teams are essential in responding to acute deterioration of patients in hospitals, requiring both clinical and non-technical skills. This study aims to assess the non-technical skills of medical emergency teams during hospital ward emergencies and explore team members perceptions and experiences of the use non-technical skills during medical emergencies.

METHODS

A multi-methods study was conducted in two phases. During phase one observation and assessment of non-technical skills used in medical emergencies using the Team Emergency Assessment Measure (TEAM™) was conducted; and in the phase two in-depth interviews were undertaken with medical emergency team members.

RESULTS

Based on 20 observations, mean TEAM™ ratings for non-technical skill domains were: 'leadership' 5.0 out of 8 (±2.0); 'teamwork' 21.6 out of 28 (±3.6); and 'task management' 6.5 out of 8 (±1.4). The mean 'global' score was 7.5 out of 10 (±1.5). The qualitative findings identified three areas, 'individual', 'team' and 'other' contributing factors, which impacted upon the non-technical skills of medical emergency teams.

CONCLUSION

Non-technical skills of hospital medical emergency teams differ, and the impact of the skill mix on resuscitation outcomes was recognised by team members. These findings emphasize the importance non-technical skills in resuscitation training and well-developed processes for medical emergency teams.

An observational study of ad-hoc anaesthesia teams

BACKGROUND

Anaesthesia teams are temporarily assembled to cooperate with teams in emergency departments in the immediate management of events compromising patients’ airway, ventilation and circulation.

PURPOSE

The aim was to describe a temporary ad-hoc anaesthesia team’s performance.

DESIGN

An observational study was conducted.

METHODS

Data, collected with 12 non-participatory observations, were analysed using both an thematic method, and a validated assessment tool, the Team Emergency Assessment Measure.

RESULTS

Three themes were identified: (1) flexibility in assuming varying roles, (2) expertise in verbal and non-verbal communication and (3) skills dealing with the challenges of working in unfamiliar dynamic environments. Ninety per cent of anaesthesia teams scored 7.6 (0–10) on the overall assessment according to the Team Emergency Assessment Measure rating.

CONCLUSION

Ad-hoc anaesthesia team members communicated in various ways and the anaesthesia team adapted well to the unpredictable environment in the emergency department.

Nontechnical Competency Framework for Health Professionals in All-Hazard Emergency Environment: A Systematic Review

OBJECTIVES

To summarize characteristics and commonalities of non-technical competency frameworks for health professionals in emergency and disaster.

METHODS

An electronic literature search was conducted in PubMed, MEDLINE, ERIC, Scopus, Cochrane database, and Google Scholar to identify original English-language articles related to development, evaluation or application of the nontechnical competency frameworks. Reviewers assessed identified articles for exclusion/inclusion criteria and abstracted data on study design, framework characteristics, and reliability/validity evidence.

RESULTS

Of the 9627 abstracts screened, 65 frameworks were identified from 94 studies that were eligible for result extraction. Sixty (63.8%) studies concentrated on clinical settings. Common scenarios of the studies were acute critical events in hospitals (44;46.8%) and nonspecified disasters (39;41.5%). Most of the participants (76; 80.9%) were clinical practitioners, and participants in 36 (38.3%) studies were multispecialty. Thirty-three (50.8%) and 42 (64.6%) frameworks had not reported evidence on reliability and validity, respectively. Fourteen of the most commonly involved domains were identified from the frameworks.

CONCLUSIONS

Nontechnical competency frameworks applied to multidisciplinary emergency health professionals are heterogeneous in construct and application. A fundamental framework with standardized terminology for the articulation of competency should be developed and validated so as to be accepted and adapted universally by health professionals in all-hazard emergency environment.