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L’Her E, Geeraerts T, Desclefs JP, Benhamou D, Blanie A, Cerf C, Delmas V, Jourdain M, Lecomte F, Ouanes I, Garnier M, Mossadegh C. Recommandations de pratiques professionnelles : Intérêts de l’apprentissage par simulation en soins critiques. ANNALES FRANCAISES DE MEDECINE D URGENCE 2022. [DOI: 10.3166/afmu-2022-0411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Ehrler F, Sahyoun C, Manzano S, Sanchez O, Gervaix A, Lovis C, Courvoisier DS, Lacroix L, Siebert JN. Impact of a shared decision-making mHealth tool on caregivers' team situational awareness, communication effectiveness, and performance during pediatric cardiopulmonary resuscitation: study protocol of a cluster randomized controlled trial. Trials 2021; 22:277. [PMID: 33849611 PMCID: PMC8042906 DOI: 10.1186/s13063-021-05170-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 03/05/2021] [Indexed: 01/10/2023] Open
Abstract
Background Effective team communication, coordination, and situational awareness (SA) by team members are critical components to deliver optimal cardiopulmonary resuscitation (CPR). Complexity of care during CPR, involvement of numerous providers, miscommunication, and other exogenous factors can all contribute to negatively influencing patient care, thus jeopardizing survival. We aim to investigate whether an mHealth supportive tool (the Interconnected and Focused Mobile Apps on patient Care Environment [InterFACE]) developed as a collaborative platform to support CPR providers in real-time and share patient-centered information would increase SA during pediatric CPR. Methods We will conduct a prospective, cluster randomized controlled trial by groups of 6 participants in a tertiary pediatric emergency department (33,000 consultations/year) with pediatric physicians and nurses. We will compare the impact of the InterFACE tool with conventional communication methods on SA and effective team communication during a standardized pediatric in-hospital cardiac arrest and a polytrauma high-fidelity simulations. Forty-eight participants will be randomized (1:1) to consecutively perform two 20-min video-recorded scenarios using either the mHealth tool or conventional methods. The primary endpoint is the SA score, measured with the Situation Awareness Global Assessment Technique (SAGAT) instrument. Enrollment will start in late 2020 and data analysis in early 2021. We anticipate that the intervention will be completed by early 2021 and study results will be submitted in mid 2021 for publication. Discussion This clinical trial will assess the impact of a collaborative mHealth tool on increasing situational awareness and effective team communication during in-hospital pediatric resuscitation. As research in this area is scarce, the results generated by this study may become of paramount importance in improving the care of children receiving in-hospital CPR, in the era of increasing communication technology. Trial registration ClinicalTrials.gov NCT04464603. Registered on 9 July 2020. Supplementary Information The online version contains supplementary material available at 10.1186/s13063-021-05170-3.
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Affiliation(s)
- Frédéric Ehrler
- Department of Diagnostic, Geneva University Hospitals, Geneva, Switzerland
| | - Cyril Sahyoun
- Department of Pediatric Emergency Medicine, Children's Hospital, Geneva University Hospitals, 47 Avenue de la Roseraie, 1211, Geneva 14, Switzerland
| | - Sergio Manzano
- Department of Pediatric Emergency Medicine, Children's Hospital, Geneva University Hospitals, 47 Avenue de la Roseraie, 1211, Geneva 14, Switzerland
| | - Oliver Sanchez
- Division of Pediatric Surgery, University Center of Pediatric Surgery of Western Switzerland, Geneva University Hospitals, Geneva, Switzerland
| | - Alain Gervaix
- Department of Pediatric Emergency Medicine, Children's Hospital, Geneva University Hospitals, 47 Avenue de la Roseraie, 1211, Geneva 14, Switzerland
| | - Christian Lovis
- Department of Radiology and Medical Informatics, Division of Medical Information Sciences, Geneva University Hospitals, Geneva, Switzerland
| | | | - Laurence Lacroix
- Department of Pediatric Emergency Medicine, Children's Hospital, Geneva University Hospitals, 47 Avenue de la Roseraie, 1211, Geneva 14, Switzerland
| | - Johan N Siebert
- Department of Pediatric Emergency Medicine, Children's Hospital, Geneva University Hospitals, 47 Avenue de la Roseraie, 1211, Geneva 14, Switzerland. .,University of Geneva, Geneva, Switzerland.
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Arriaga AF, Szyld D, Pian-Smith MCM. Real-Time Debriefing After Critical Events: Exploring the Gap Between Principle and Reality. Anesthesiol Clin 2020; 38:801-820. [PMID: 33127029 PMCID: PMC7552980 DOI: 10.1016/j.anclin.2020.08.003] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Alexander F Arriaga
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA; Ariadne Labs, Boston, MA, USA; Center for Surgery and Public Health, Boston, MA, USA.
| | - Demian Szyld
- Department of Emergency Medicine, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA; Center for Medical Simulation, Boston, MA, USA. https://twitter.com/debriefmentor
| | - May C M Pian-Smith
- Center for Medical Simulation, Boston, MA, USA; Department of Anesthesia, Critical Care & Pain Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
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Sweeney RE, Clapp JT, Arriaga AF, Muralidharan M, Burson RC, Gordon EKB, Falk SA, Baranov DY, Fleisher LA. Understanding Debriefing: A Qualitative Study of Event Reconstruction at an Academic Medical Center. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2020; 95:1089-1097. [PMID: 31567173 DOI: 10.1097/acm.0000000000002999] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
PURPOSE This qualitative study sought to characterize the role of debriefing after real critical events among anesthesia residents at the Hospital of the University of Pennsylvania. METHOD From October 2016 to June 2017 and February to April 2018, the authors conducted 25 semistructured interviews with 24 anesthesia residents after they were involved in 25 unique critical events. Interviews focused on the experience of the event and the interactions that occurred thereafter. A codebook was generated through annotation, then used by 3 researchers in an iterative process to code interview transcripts. An explanatory model was developed using an abductive approach. RESULTS In the aftermath of events, residents underwent a multistage process by which the nature of critical events and the role of residents in them were continuously reconstructed. Debriefing-if it occurred-was 1 stage in this process, which also included stages of internal dialogue, event documentation, and lessons learned. Negotiated in each stage were residents' culpability, reputation, and the appropriateness of their affective response to events. CONCLUSIONS Debriefing is one of several stages of interaction that occur after a critical event; all stages play a role in shaping how the event is interpreted and remembered. Because of its dynamic role in constituting the nature of events and residents' role in them, debriefing can be a high-stakes interaction for residents, which can contribute to their reluctance to engage in it. The function and quality of debriefing can be assessed in more insightful fashion by understanding its relation to the other stages of event reconstruction.
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Affiliation(s)
- Rachel E Sweeney
- R.E. Sweeney is a medical student, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania. J.T. Clapp is assistant professor, Department of Anesthesiology and Critical Care, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania. A.F. Arriaga is assistant professor of anesthesia, Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts. M. Muralidharan is research assistant, Department of Anesthesiology and Critical Care, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania. R.C. Burson II is a medical student, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania. E.K.B. Gordon is assistant professor, Department of Anesthesiology and Critical Care, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania. S.A. Falk is associate professor, Department of Anesthesiology and Critical Care, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania. D.Y. Baranov is associate professor, Department of Anesthesiology and Critical Care, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania. L.A. Fleisher is chair and Robert Dunning Dripps Professor of Anesthesia, Department of Anesthesiology and Critical Care, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
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Monteiro S, Camões J, Carvalho D, Araújo R, Gomes E. Improving medical emergency system: Results of a multi-professional questionnaire. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2020; 67:301-315. [PMID: 32448739 DOI: 10.1016/j.redar.2020.01.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Accepted: 01/12/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE This study aimed to identify ways to improve the Medical Emergency System (MES) in its different components and infer Medical Emergency Team (MET) activation failure causes. METHODS A questionnaire regarding opinions and attitudes towards the MES was conducted, targeting all professionals at the hospital, which has an implemented MES with Basic Life Support (BLS) since 1998. RESULTS Thirty two percent (n=585) of hospital professionals answered, from these 37.8% were neither doctors nor nurses. In mean six years passed since the BLS certification, yet 102 professionals (17.4%) had not done it. A relevant percentage admitted to not being familiarized with the different components of the MES (activation criteria 16.4%, telephone number 4.1%, content of the resuscitation trolleys 42.4% and defibrillator-monitor 47.4%), percentages lessened among those had taken the BLS course. The majority highly valued MET, however 83 (23%) could not confirm that debriefingand 17 (4.4%) that allocation of tasks happened after and during activation, respectively. When activating MET 52 (18.1%) admitted fear of criticism and 38 (13.3%) agreed that they needed validation by another professional, factors not influenced by BLS course completion. Excessive workload as a barrier to recognize ill patients was pointed by 127 (45.7%) of the respondents. CONCLUSION Despite educational and auditing efforts, the MES is not fully integrated into hospital culture. BLS certification for all professionals and non-technical skills of MET were identified has major areas for MES improvement. Unfamiliarity with activation criteria, fear of criticism and excessive workload were identified as failure of activation causes.
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Affiliation(s)
- S Monteiro
- Medicina Interna, Departamento de Medicina, Hospital Pedro Hispano, Unidad Local de Salud Matosinhos, Matosinhos, Portugal.
| | - J Camões
- Medicina Intensiva, Departamento de Urgencias y Medicina Intensiva, Hospital Pedro Hispano, Unidad Local de Salud Matosinhos , Matosinhos, Portugal
| | - D Carvalho
- Medicina Intensiva, Departamento de Urgencias y Medicina Intensiva, Hospital Pedro Hispano, Unidad Local de Salud Matosinhos , Matosinhos, Portugal
| | - R Araújo
- Medicina Intensiva, Departamento de Urgencias y Medicina Intensiva, Hospital Pedro Hispano, Unidad Local de Salud Matosinhos , Matosinhos, Portugal
| | - E Gomes
- Medicina Intensiva, Departamento de Urgencias y Medicina Intensiva, Hospital Pedro Hispano, Unidad Local de Salud Matosinhos , Matosinhos, Portugal
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L'Her E, Geeraerts T, Desclefs JP, Benhamou D, Blanié A, Cerf C, Delmas V, Jourdain M, Lecomte F, Ouanes I, Garnier M, Mossadegh C. Simulation-based teaching in critical care, anaesthesia and emergency medicine. Anaesth Crit Care Pain Med 2020; 39:311-326. [PMID: 32223994 DOI: 10.1016/j.accpm.2020.03.010] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Erwan L'Her
- Centre Hospitalier Régional Universitaire de Brest, La Cavale-Blanche, Médecine Intensive et Réanimation, LATIM, INSERM, UMR 1101, boulevard Tanguy-Prigent, 29609 Brest cedex, France.
| | - Thomas Geeraerts
- Anesthésie-Réanimation, CHU de Toulouse, Hôpital Pierre-Paul-Riquet, Institut Toulousain de Simulation en Santé (ItSimS), Université Toulouse 3-Paul-Sabatier, place du Docteur-Baylac, TSA 40031, 31059 Toulouse cedex 9, France
| | - Jean-Philippe Desclefs
- Samu 91, Smur de Corbeil-Essonnes, Centre Hospitalier Sud-Francilien, 91100 Corbeil-Essonnes, France
| | - Dan Benhamou
- Service d'Anesthésie-Réanimation, Hôpitaux Universitaires Paris-Sud, AP-HP, Hôpital Bicêtre, 78, rue du Général-Leclerc, 94275 Le Kremlin-Bicêtre, France
| | - Antonia Blanié
- Département d'anesthésie-réanimation-médecine périopératoire, groupe hospitalo-universitaire, Paris-Saclay, AP-HP, Paris, France; Centre de simulation LabForSIMS, faculté de médecine Paris-Sud, unité de recherche CIAMS, EA4532, UFR STAPS Paris-Sud, Orsay, France
| | - Charles Cerf
- Réanimation Polyvalente, Hôpital Foch, 40, rue Worth, 92150 Suresnes, France
| | - Véronique Delmas
- Urgences, CHU Le Mans, 194, avenue Rubillard, 72000 Le Mans, France
| | - Mercedes Jourdain
- Réanimation médicale, Hôpital Salengro, rue Émile-Laine, 59037 Lille, France
| | - François Lecomte
- Urgences, Hôpital Cochin, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France
| | - Islem Ouanes
- Réanimation Médicale, Hôpital Fattouma-Bourguiba, avenue Farhat-Hached, Monastir, Tunisia
| | - Marc Garnier
- Département d'anesthésie et réanimation, Pôle Thorax-Voies Aériennes-Anesthésie-Réanimation, Hôpital Tenon, 4, rue de la Chine, 75020 Paris, France; INSERM, UMR1152, Faculté de médecine X.-Bichat, 16, rue Henri-Huchard, 75018 Paris, France
| | - Chirine Mossadegh
- Hôpital Universitaire La Pitié-Salpêtrière, Service de Réanimation Médicale, 47-83, boulevard de l'Hôpital, 75651 Paris cedex 13, France
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Spencer SA, Nolan JP, Osborn M, Georgiou A. The presence of psychological trauma symptoms in resuscitation providers and an exploration of debriefing practices. Resuscitation 2019; 142:175-181. [PMID: 31251894 DOI: 10.1016/j.resuscitation.2019.06.280] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Revised: 06/03/2019] [Accepted: 06/19/2019] [Indexed: 10/26/2022]
Abstract
INTRODUCTION Witnessing traumatic experiences can cause post-traumatic stress disorder (PTSD). The true impact on healthcare staff of attending in-hospital cardiac arrests (IHCAs) has not been studied. This cross-sectional study examined cardiac arrest debriefing practices and the burden of attending IHCAs on nursing and medical staff. METHODS A 33-item questionnaire-survey was sent to 517 doctors (of all grades), nurses and health-care assistants (HCAs) working in the emergency department, the acute medical unit and the intensive care unit of a district general hospital between April and August 2018. There were three sections: demographics; cardiac arrest and debriefing practices; trauma-screening questionnaire (TSQ). RESULTS The response rate was 414/517 (80.1%); 312/414 (75.4%) were involved with IHCAs. Out of 1463 arrests, 258 (17.6%) were debriefed. Twenty-nine of 302 (9.6%) staff screened positively for PTSD. Healthcare assistants and Foundation Year 1 doctors had higher TSQ scores than nurses or more senior doctors (p = 0.02, p = 0.02, respectively). Debriefing was not associated with PTSD risk (p = 0.98). Only 8/67 (11.9%) of resuscitation leaders had prior debriefing training. CONCLUSIONS Nearly 10% of acute care staff screened positively for PTSD as a result of attending an IHCA, with junior staff being most at risk of developing trauma symptoms. Very few debriefs occurred, possibly because of a lack of debrief training amongst cardiac arrest team leaders. More support is required for acute care nursing and medical staff following an IHCA.
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Affiliation(s)
| | - Jerry P Nolan
- Royal United Hospital, Bath, United Kingdom; Warwick Clinical Trials Unit, University of Warwick, Coventry, United Kingdom
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Lauridsen KG, Schmidt AS, Caap P, Aagaard R, Løfgren B. Clinical experience and skills of physicians in hospital cardiac arrest teams in Denmark: a nationwide study. Open Access Emerg Med 2017; 9:37-41. [PMID: 28331374 PMCID: PMC5349502 DOI: 10.2147/oaem.s124149] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background The quality of in-hospital resuscitation is poor and may be affected by the clinical experience and cardiopulmonary resuscitation (CPR) training. This study aimed to investigate the clinical experience, self-perceived skills, CPR training and knowledge of the guidelines on when to abandon resuscitation among physicians of cardiac arrest teams. Methods We performed a nationwide cross-sectional study in Denmark. Telephone interviews were conducted with physicians in the cardiac arrest teams in public somatic hospitals using a structured questionnaire. Results In total, 93 physicians (53% male) from 45 hospitals participated in the study. Median age was 34 (interquartile range: 30–39) years. Respondents were medical students working as locum physicians (5%), physicians in training (79%) and consultants (16%), and the median postgraduate clinical experience was 48 (19–87) months. Most respondents (92%) felt confident in treating a cardiac arrest, while fewer respondents felt confident in performing intubation (41%) and focused cardiac ultrasound (39%) during cardiac arrest. Median time since last CPR training was 4 (2–10) months, and 48% had attended a European Resuscitation Council (ERC) Advanced Life Support course. The majority (84%) felt confident in terminating resuscitation; however, only 9% were able to state the ERC guidelines on when to abandon resuscitation. Conclusion Physicians of Danish cardiac arrest teams are often inexperienced and do not feel competent performing important clinical skills during resuscitation. Less than half have attended an ERC Advanced Life Support course, and only very few physicians know the ERC guidelines on when to abandon resuscitation.
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Affiliation(s)
- Kasper G Lauridsen
- Department of Internal Medicine; Clinical Research Unit, Regional Hospital of Randers, Randers; Research Center for Emergency Medicine, Aarhus University Hospital
| | - Anders S Schmidt
- Department of Internal Medicine; Clinical Research Unit, Regional Hospital of Randers, Randers; Research Center for Emergency Medicine, Aarhus University Hospital
| | - Philip Caap
- Research Center for Emergency Medicine, Aarhus University Hospital; Institute of Clinical Medicine, Aarhus University, Aarhus
| | - Rasmus Aagaard
- Clinical Research Unit, Regional Hospital of Randers, Randers; Research Center for Emergency Medicine, Aarhus University Hospital; Department of Anesthesiology, Randers Regional Hospital, Denmark
| | - Bo Løfgren
- Department of Internal Medicine; Research Center for Emergency Medicine, Aarhus University Hospital; Institute of Clinical Medicine, Aarhus University, Aarhus
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Renna TD, Crooks S, Pigford AA, Clarkin C, Fraser AB, Bunting AC, Bould MD, Boet S. Cognitive Aids for Role Definition (CARD) to improve interprofessional team crisis resource management: An exploratory study. J Interprof Care 2016; 30:582-90. [PMID: 27294389 DOI: 10.1080/13561820.2016.1179271] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
This study aimed to assess the perceived value of the Cognitive Aids for Role Definition (CARD) protocol for simulated intraoperative cardiac arrests. Sixteen interprofessional operating room teams completed three consecutive simulated intraoperative cardiac arrest scenarios: current standard, no CARD; CARD, no CARD teaching; and CARD, didactic teaching. Each team participated in a focus group interview immediately following the third scenario; data were transcribed verbatim and qualitatively analysed. After 6 months, participants formed eight new teams randomised to two groups (CARD or no CARD) and completed a retention intraoperative cardiac arrest simulation scenario. All simulation sessions were video recorded and expert raters assessed team performance. Qualitative analysis of the 16 focus group interviews revealed 3 thematic dimensions: role definition in crisis management; logistical issues; and the "real life" applicability of CARD. Members of the interprofessional team perceived CARD very positively. Exploratory quantitative analysis found no significant differences in team performance with or without CARD (p > 0.05). In conclusion, qualitative data suggest that the CARD protocol clarifies roles and team coordination during interprofessional crisis management and has the potential to improve the team performance. The concept of a self-organising team with defined roles is promising for patient safety.
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Affiliation(s)
- Tania Di Renna
- a Department of Anesthesiology , The Ottawa Hospital , Ottawa , Ontario , Canada
| | - Simone Crooks
- a Department of Anesthesiology , The Ottawa Hospital , Ottawa , Ontario , Canada
| | - Ashlee-Ann Pigford
- b Department of Anesthesiology , The Ottawa Hospital Research Institute , Ottawa , Ontario , Canada
| | - Chantalle Clarkin
- c The Children's Hospital of Eastern Ontario Research Institute , Ottawa , Ontario , Canada
| | - Amy B Fraser
- a Department of Anesthesiology , The Ottawa Hospital , Ottawa , Ontario , Canada
| | | | - M Dylan Bould
- e Department of Anesthesiology and Department of Innovation in Medical Education , Children's Hospital of Eastern Ontario , Ottawa , Ontario , Canada
| | - Sylvain Boet
- f Department of Anesthesiology and Department of Innovation in Medical Education , The Ottawa Hospital , Ottawa , Ontario , Canada
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Robinson PS, Shall E, Rakhit R. Cardiac arrest leadership: in need of resuscitation? Postgrad Med J 2016; 92:715-720. [PMID: 27281816 DOI: 10.1136/postgradmedj-2015-133738] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Revised: 03/22/2016] [Accepted: 04/17/2016] [Indexed: 11/04/2022]
Abstract
BACKGROUND Leadership skills directly correlate with the quality of technical performance of cardiopulmonary resuscitation (CPR) and clinical outcomes. Despite an improved focus on non-technical skills in CPR training, the leadership of cardiac arrests is often variable. AIMS To assess the perceptions of leadership and team working among members of a cardiac arrest team and to evaluate future training needs. METHODS Cross-sectional survey of 102 members of a cardiac arrest team at an Acute Hospital Trust in the UK with 892 inpatient beds. Responses sought from doctors, nurses and healthcare assistants to 12 rated statements and 4 dichotomous questions. RESULTS Of 102 responses, 81 (79%) were from doctors and 21 (21%) from nurses. Among specialist registrars 90% agreed or strongly agreed that there was clear leadership at all arrests compared with between 28% and 49% of nurses and junior doctors respectively. Routine omission of key leadership tasks was reported by as many as 80% of junior doctors and 50% of nurses. Almost half of respondents reported non-adherence with Advanced Life Support (ALS) guidelines. Among junior members of the team, 36% felt confident to lead an arrest and 75% would welcome further dedicated cardiac arrest leadership training. CONCLUSIONS Leadership training is integrated into the ALS (Resus Council, UK) qualification. However, this paper found that in spite of this training; standards of leadership are variable. The findings suggest a pressing need for further dedicated cardiac arrest leadership training with a focus on improving key leadership tasks such as role assignment, team briefing and debriefing.
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Affiliation(s)
| | - Emma Shall
- Royal Free London NHS Foundation Trust, London, UK
| | - Roby Rakhit
- Royal Free London NHS Foundation Trust, London, UK
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Zinns LE, O'Connell KJ, Mullan PC, Ryan LM, Wratney AT. National Survey of Pediatric Emergency Medicine Fellows on Debriefing After Medical Resuscitations. Pediatr Emerg Care 2015; 31:551-4. [PMID: 25198763 DOI: 10.1097/pec.0000000000000196] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Medical resuscitations of critically ill children in the emergency department are stressful events requiring a coordinated team effort. Current guidelines recommend debriefing after such events to improve future performance. Debriefing practices within pediatric emergency departments by pediatric emergency medicine (PEM) fellows in the United States has not been studied. OBJECTIVE The aim of this study was to describe the current debriefing experience of PEM fellows in the United States. METHODS A 10-item, anonymous questionnaire regarding debriefing characteristics was distributed to fellows in US Accreditation Council for Graduate Medical Education-accredited PEM programs via e-mail and paper format from December 2011 to March 2012. Results were summarized using descriptive statistics. RESULTS Of 393 eligible PEM fellows, 201 (51.1%) completed the survey. The 201 respondents included 82 first-year fellows (40.8%), 71 second-year fellows (35.3%), and 48 third-year fellows (23.9%). Ninety-nine percent had participated in medical resuscitations during their fellowship training, yet 88.0% reported no formal teaching on how to debrief. There was wide variability in the format and timing of debriefings. The majority of debriefings were led by PEM attending physicians (65.5%) and PEM fellows (19.6%). Most (91.5%) of the fellows indicated they would like further education about debriefing. CONCLUSIONS The majority of PEM fellows do not receive formal training on how to debrief after a critical event and may have limited experience in leading debriefings. Debriefing training should be considered part of the educational curriculum during PEM fellowship.
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Affiliation(s)
- Lauren E Zinns
- From the *Division of Emergency Medicine, Children's National Medical Center, Washington, DC; †Division of Emergency Medicine, Johns Hopkins Hospital, Baltimore, MD; and ‡Division of Critical Care Medicine, Children's National Medical Center, Washington, DC
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Lauridsen KG, Schmidt AS, Adelborg K, Løfgren B. Organisation of in-hospital cardiac arrest teams – A nationwide study. Resuscitation 2015; 89:123-8. [DOI: 10.1016/j.resuscitation.2015.01.014] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Revised: 01/13/2015] [Accepted: 01/15/2015] [Indexed: 11/29/2022]
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Parker-Raley J, Mottet TP, Lawson KA, Duzinski SV, Cerroni A, Mercado M. Investigating pediatric trauma team communication effectiveness phase one: the development of the assessment of pediatric resuscitation communication. ACTA ACUST UNITED AC 2013. [DOI: 10.1179/1753807612y.0000000007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Implementation of an In Situ Qualitative Debriefing Tool for Resuscitations. Resuscitation 2013; 84:946-51. [DOI: 10.1016/j.resuscitation.2012.12.005] [Citation(s) in RCA: 86] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2012] [Revised: 10/26/2012] [Accepted: 12/03/2012] [Indexed: 11/24/2022]
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Fernandez Castelao E, Russo SG, Riethmüller M, Boos M. Effects of team coordination during cardiopulmonary resuscitation: a systematic review of the literature. J Crit Care 2013; 28:504-21. [PMID: 23602030 DOI: 10.1016/j.jcrc.2013.01.005] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2012] [Revised: 12/28/2012] [Accepted: 01/01/2013] [Indexed: 01/01/2023]
Abstract
PURPOSE The purpose of this study is to identify and evaluate to what extent the literature on team coordination during cardiopulmonary resuscitation (CPR) empirically confirms its positive effect on clinically relevant medical outcome. MATERIAL AND METHODS A systematic literature search in PubMed, MEDLINE, PsycINFO and CENTRAL databases was performed for articles published in the last 30 years. RESULTS A total of 63 articles were included in the review. Planning, leadership, and communication as the three main interlinked coordination mechanisms were found to have effect on several CPR performance markers. A psychological theory-based integrative model was expanded upon to explain linkages between the three coordination mechanisms. CONCLUSIONS Planning is an essential element of leadership behavior and is primarily accomplished by a designated team leader. Communication affects medical performance, serving as the vehicle for the transmission of information and directions between team members. Our findings also suggest teams providing CPR must continuously verbalize their coordination plan in order to effectively structure allocation of subtasks and optimize success.
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Factors affecting team leadership skills and their relationship with quality of cardiopulmonary resuscitation*. Crit Care Med 2012; 40:2617-21. [DOI: 10.1097/ccm.0b013e3182591fda] [Citation(s) in RCA: 107] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Fein AB. Leadership and resuscitation. Crit Care Med 2012; 40:2719-20. [DOI: 10.1097/ccm.0b013e31825ce8cf] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Integrated in-situ simulation using redirected faculty educational time to minimize costs: a feasibility study. Simul Healthc 2012; 6:337-44. [PMID: 21937963 DOI: 10.1097/sih.0b013e318224bdde] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Simulation is an effective teaching tool, but many hospitals do not possess the space or finances to support traditional simulation centers. Our objective is to describe the feasibility of an in situ simulation program model that uses minimal permanent space and "redirected" cost-neutral faculty educational time to address these issues. METHODS Two pediatric simulators and audiovisual equipment were purchased. Course faculty were derived from a group of physicians and nurses with a percentage work assignment apportioned to education. A portion of this was subsequently redirected toward simulation. After 2 years of operation, faculty were surveyed regarding time devoted to the program. Program growth and quality statistics were examined descriptively. RESULTS The program supported 786 learner encounters in 166 sessions over 2 years. Simulation hours per month increased over sixfold during that period (P < 0.001). Program initiation cost was $128920.89, with subsequent yearly costs of $11,695. Mean program ratings ranged between 4.5/5 for Crisis Resource Management and 4.4/5 for communication skills training. Resident (2.6 h/y increase, P value <0.001) and nursing (2.2 h/y increase, P < 0.001) simulation hours increased significantly. Faculty involvement averaged between 3% and 32% of total work hours. CONCLUSION This report demonstrates the feasibility of implementing an in situ simulation program using minimal permanent institutional space and cost-neutral redirected faculty time. This type of programmatic structure is conducive to short- and medium-term growth, is well received by participants, and allows for substantial cost savings. Future work will be needed to determine what growth limitations are inherent in this staffing and structural model.
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Riethmüller M, Fernandez Castelao E, Eberhardt I, Timmermann A, Boos M. Adaptive coordination development in student anaesthesia teams: a longitudinal study. ERGONOMICS 2012; 55:55-68. [PMID: 22176484 DOI: 10.1080/00140139.2011.636455] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
UNLABELLED Although adaptive coordination has been highlighted by several studies, research dealing with how adaptive coordination develops is still rare. Thus, the aim of this study was to investigate the development of coordination mechanisms and their task-related adaptation in a longitudinal observation of medical simulation-based training of final year students. We recorded six anaesthesia teams during a sequence of four task scenarios, and each scenario comprised of a routine and a complication phase. After trained observers rated sub-tasks within each scenario for explicit and implicit coordination, statistical analysis revealed a statistically significant effect of previous scenarios on coordination development in the routine phases. While the amount of explicit coordination decreased, implicit coordination increased, revealing adaptive coordination as a skill developed through repeated group interaction. We conclude that anaesthesia training should consider cost- and patient safety-benefits of implicit and explicit coordination and focus on adaptive coordination. PRACTITIONER SUMMARY Group coordination is crucial to anaesthesia team performance. Results of this longitudinal observation of six anaesthesia teams during four medical simulation-based training scenarios document that teams develop adaptive patterns of coordination. This study also demonstrates that adaptive coordination is a trainable skill within crisis resource management training.
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Affiliation(s)
- M Riethmüller
- Department of Social and Communication Psychology , Georg-August-University, Göttingen, Germany.
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Rousek JB, Hallbeck MS. The ergonomics of “Code Blue” medical emergencies: a literature review. ACTA ACUST UNITED AC 2011. [DOI: 10.1080/19488300.2011.628556] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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22
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European Resuscitation Council Guidelines for Resuscitation 2010 Section 9. Principles of education in resuscitation. Resuscitation 2010; 81:1434-44. [DOI: 10.1016/j.resuscitation.2010.08.014] [Citation(s) in RCA: 128] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Preusch MR, Bea F, Roggenbach J, Katus HA, Jünger J, Nikendei C. Resuscitation Guidelines 2005: does experienced nursing staff need training and how effective is it? Am J Emerg Med 2010; 28:477-84. [PMID: 20466229 DOI: 10.1016/j.ajem.2009.01.040] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2008] [Revised: 01/28/2009] [Accepted: 01/29/2009] [Indexed: 10/19/2022] Open
Abstract
INTRODUCTION Even among health care professionals, resuscitation performance has been shown to be poor. So far, it remains unclear whether cardiac arrest staff with frequent practice in resuscitation requires training to adapt to the new International Liaison Committee on Resuscitation (ILCOR) guidelines of 2005. This study evaluated the need for basic life support training in nurses with emergency experience. METHODS AND RESULTS Nurses (N = 24) recruited from an intensive care unit self-assessed their resuscitation skills and performed a cardiac arrest scenario using a manikin. After a theoretical instruction and hands-on training followed by feedback, participants once again performed a resuscitation scenario in addition to completing posttraining self-assessments. Participating nurses considered resuscitation skills training--in particular in adapting to the new ILCOR guidelines of 2005--to be important. Pretraining data revealed performance deficits even in this sample of emergency-experienced nursing staff. Training resulted in significant improvement in ventilation volume (P < .001), rate of compressions with correct depth (P < .031) and full release (P < .001), and a reduction in total hands-off time (P < .050). Objective data were mirrored in participants' self-assessed competencies. CONCLUSION Results suggest that basic life support training based on the ILCOR guidelines of 2005 is necessary even in nurses with emergency experience. Training followed by the application of a feedback algorithm seems to improve short-term resuscitation performance and is well accepted by experienced nurses who work on an intensive care unit and who also comprise the inner-hospital cardiac arrest team.
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Affiliation(s)
- Michael R Preusch
- Department of Cardiology, Angiology, Pneumology, University Hospital, University of Heidelberg, 69120 Heidelberg, Germany.
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Manser T. Teamwork and patient safety in dynamic domains of healthcare: a review of the literature. Acta Anaesthesiol Scand 2009; 53:143-51. [PMID: 19032571 DOI: 10.1111/j.1399-6576.2008.01717.x] [Citation(s) in RCA: 669] [Impact Index Per Article: 44.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIMS/BACKGROUND This review examines current research on teamwork in highly dynamic domains of healthcare such as operating rooms, intensive care, emergency medicine, or trauma and resuscitation teams with a focus on aspects relevant to the quality and safety of patient care. RESULTS Evidence from three main areas of research supports the relationship between teamwork and patient safety: (1) Studies investigating the factors contributing to critical incidents and adverse events have shown that teamwork plays an important role in the causation and prevention of adverse events. (2) Research focusing on healthcare providers' perceptions of teamwork demonstrated that (a) staff's perceptions of teamwork and attitudes toward safety-relevant team behavior were related to the quality and safety of patient care and (b) perceptions of teamwork and leadership style are associated with staff well-being, which may impact clinician' ability to provide safe patient care. (3) Observational studies on teamwork behaviors related to high clinical performance have identified patterns of communication, coordination, and leadership that support effective teamwork. CONCLUSION In recent years, research using diverse methodological approaches has led to significant progress in team research in healthcare. The challenge for future research is to further develop and validate instruments for team performance assessment and to develop sound theoretical models of team performance in dynamic medical domains integrating evidence from all three areas of team research identified in this review. This will help to improve team training efforts and aid the design of clinical work systems supporting effective teamwork and safe patient care.
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Affiliation(s)
- T Manser
- ETH Zurich, Center for Organizational and Occupational Sciences, Zurich, Switzerland.
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Abella BS, Kim S, Edelson DP, Huang KN, Merchant RM, Myklebust H, Vanden Hoek TL, Becker LB. Difficulty of cardiac arrest rhythm identification does not correlate with length of chest compression pause before defibrillation. Crit Care Med 2006; 34:S427-31. [PMID: 17114972 DOI: 10.1097/01.ccm.0000246757.15898.13] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Performing high-quality cardiopulmonary resuscitation immediately before electrical defibrillation serves as an important predictor of shock success. Long preshock pauses in cardiopulmonary resuscitation frequently occur, as noted by recent clinical investigations. We sought to determine whether these long pauses were due to difficulties in identifying shockable rhythms or rather due to local factors during resuscitation attempts. DESIGN Prospective in-hospital study of cardiac arrest resuscitation attempts coupled with a retrospective review of preshock pause rhythms by 12 trained providers. Reviewers scored rhythms by ease of identification using a discrete Likert scale from 1 (most difficult to identify) to 5 (easiest to identify). The resuscitation cohort was organized into preshock pause-duration quartiles for statistical analysis. Resident physicians were then surveyed regarding human factors affecting preshock pauses. RESULTS A total of 118 preshock pauses from 45 resuscitation episodes were collected. When evaluated by quartiles of preshock pause duration, difficulty of rhythm identification did not correlate with increasing pause time. In fact, the opposite was found (longest preshock pause quartile of 23.8-60.2 secs vs. shortest pause quartile of 1.1-7.9 secs; rhythm difficulty scores, 3.2 vs. 3.0; p = .20). When 29 resident physicians who recently served on resuscitation teams were surveyed, 18 of 29 (62.1%) attributed long pauses to lack of time sense during resuscitation, and 16 of 29 (55.2%) thought that room crowding prevented rapid defibrillation. CONCLUSIONS Long cardiopulmonary resuscitation pauses before defibrillation are likely due to human factors during the resuscitation and not due to inherent difficulties with rhythm identification. This preliminary work highlights the need for more research and training in the area of team performance and human factors during resuscitation.
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Affiliation(s)
- Benjamin S Abella
- Department of Emergency Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Tschan F, Semmer NK, Gautschi D, Hunziker P, Spychiger M, Marsch SU. Leading to Recovery: Group Performance and Coordinative Activities in Medical Emergency Driven Groups. HUMAN PERFORMANCE 2006. [DOI: 10.1207/s15327043hup1903_5] [Citation(s) in RCA: 101] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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DeVita MA, Schaefer J, Lutz J, Wang H, Dongilli T. Improving medical emergency team (MET) performance using a novel curriculum and a computerized human patient simulator. Qual Saf Health Care 2006; 14:326-31. [PMID: 16195564 PMCID: PMC1744065 DOI: 10.1136/qshc.2004.011148] [Citation(s) in RCA: 207] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
PROBLEM Advance cardiac life support (ACLS) training does not address coordination of team resources to improve the ability of teams to deliver needed treatments reliably and rapidly. Our objective was to use a human simulation training educational environment to develop multidisciplinary team skills and improve medical emergency team (MET) performance. We report findings of a crisis team training course that is focused on organization. SETTING Large center for human simulation training at a university affiliated tertiary care hospital. PARTICIPANTS Ten courses were delivered and 138 clinically experienced individuals were trained (69 critical care nurses, 48 physicians, and 21 respiratory therapists). All participants were ACLS trained and experienced in responding to cardiac arrest situations. COURSE DESIGN: Each course had four components: (1) a web based presentation and pretest before the course; (2) a brief reinforcing didactic session on the day of the course; (3) three of five different simulated scenarios; each followed by (4) debriefing and analysis with the team. Three of five simulator scenarios were used; scenario selection and order was random. Trainees did not repeat any scenario or role during the training. Participants were video recorded to assist debriefing. Debriefing focused on reinforcing organizational aspects of team performance: assuming designated roles independently, completing goals (tasks) assigned to each role, and directed communication. MEASURES FOR IMPROVEMENT: Participants graded their performance of specific organizational and treatment tasks within specified time intervals by consensus. Simulator "survival" depended on supporting oxygenation, ventilation, circulation within 60 seconds, and delivering the definitive treatment within 3 minutes. EFFECTS OF CHANGE Simulated survival (following predetermined criteria for death) increased from 0% to 89%. The initial team task completion rate was 10-45% and rose to 80-95% during the third session. LESSONS LEARNT Training multidisciplinary teams to organize using simulation technology is feasible. This preliminary report warrants more detailed inquiry.
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Affiliation(s)
- M A DeVita
- Department of Critical Care Medicine, University of Pittsburgh School of Medicine and UPMC Health System, Pittsburgh, PA 15212, USA.
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Marsch SCU, Müller C, Marquardt K, Conrad G, Tschan F, Hunziker PR. Human factors affect the quality of cardiopulmonary resuscitation in simulated cardiac arrests. Resuscitation 2004; 60:51-6. [PMID: 14987784 DOI: 10.1016/j.resuscitation.2003.08.004] [Citation(s) in RCA: 210] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2003] [Revised: 07/01/2003] [Accepted: 08/14/2003] [Indexed: 11/27/2022]
Abstract
AIM Cardiopulmonary resuscitation is a team endeavour. There are only limited data on whether team performance during cardiopulmonary resuscitation is influenced by behavioural issues. The aim of the study was to determine whether and how human factors affect the quality of cardiopulmonary resuscitation. METHODS 16 teams, each consisting of three health-care workers, were studied in a patient simulator. A scenario of witnessed cardiac arrest due to ventricular fibrillation was used. Ventricular fibrillation could be converted into sinus rhythm by two countershocks administered during the first 2 min or by two countershocks administered during the first 5 min provided that uninterrupted basic life support was started in under 60 s. Teams were rated to be successful if ventricular fibrillation was converted into sinus rhythm. Behavioural rating included leadership, task distribution, information transfer, and conflicts. RESULTS Only six out of 16 teams were successful. Compared with successful teams, teams that failed exhibited significantly less leadership behaviour (P=0.033) and explicit task distribution (P=0.035). All teams shared among them sufficient theoretical knowledge to successfully treat the simulated cardiac arrest. CONCLUSIONS In a scenario of simulated witnessed cardiac arrest almost two thirds of teams composed of qualified health-care workers failed to provide basic life support and/or defibrillation within an appropriate time window. Absence of leadership behaviour and absence of explicit task distribution were associated with poor team performance. Failure to translate theoretical knowledge into effective team activity appears to be a major problem.
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Affiliation(s)
- Stephan C U Marsch
- Medical Intensive Care Unit, University of Basel, Kantonsspital, 4031 Basel, Switzerland.
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