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Steinbach TC, Jennerich AL, Çoruh B. Effective Behaviors of Leaders During Clinical Emergencies: A Qualitative Study of Followers' Perspectives. Chest 2024:S0012-3692(24)00685-8. [PMID: 38838955 DOI: 10.1016/j.chest.2024.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 04/29/2024] [Accepted: 05/04/2024] [Indexed: 06/07/2024] Open
Abstract
BACKGROUND To manage a clinical emergency effectively, physicians need well-developed leadership skills, yet limited structured leadership training is available for critical care trainees. To develop an effective curriculum, leadership competencies must first be defined. RESEARCH QUESTION During clinical emergencies, what leadership behaviors do followers value? STUDY DESIGN AND METHODS We conducted qualitative interviews with members of multidisciplinary critical care teams at a large academic health system, with participants including resident physicians, nurses, and respiratory therapists (N = 15). Thematic analysis was used to categorize leadership behaviors that followers perceived to be effective. RESULTS We identified three themes related to leadership during clinical emergencies: control, collaboration, and common understanding. Participants described behaviors they believed resulted in both effective and ineffective leadership. For effective leaders, control, the most dominant theme, included behaviors that clearly established roles for the leader and followers, allowing the leader to guide care during a clinical emergency. Collaboration referenced the ability of a leader to maintain a collegial environment. Finally, common understanding reflected a leader's ability to manage communication in a way that fostered a shared mental model across team members. INTERPRETATION During clinical emergencies, followers value leaders who assert themselves while also maintaining positive team interaction and encouraging an organized flow of information. Our findings provide a potential framework to develop a leadership curriculum for critical care trainees.
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Affiliation(s)
- Trevor C Steinbach
- Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO.
| | - Ann L Jennerich
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington, Seattle, WA
| | - Başak Çoruh
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington, Seattle, WA
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Botelho F, Gerk A, Harley JM, Poenaru D. Improving Pediatric Trauma Education by Teaching Non-technical Skills: A Randomized Controlled Trial. J Pediatr Surg 2024; 59:874-888. [PMID: 38369400 DOI: 10.1016/j.jpedsurg.2024.01.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Accepted: 01/16/2024] [Indexed: 02/20/2024]
Abstract
BACKGROUND Pediatric trauma is a significant cause of child mortality, and the absence of non-technical skills (NTS) among health providers is linked with errors in patients' care. In this study, we evaluate the effectiveness of a structured debriefing protocol in enhancing NTS during pediatric trauma simulation. METHODS A total of 45 medical students were successfully recruited from two medical schools, one in Brazil and one in Canada. Medical students were assigned to a control (N = 20) or intervention group (N = 25) in a randomized control trial. Following simulated scenarios, participants in the intervention group underwent NTS debriefing, while the control received standard debriefing based on the Advanced Trauma Life Support (ATLS) protocol. Students' confidence, NTS level, and performance were measured through self-assessment surveys, the Non-Technical Skills for Surgeons (NOTSS) score, and adherence to the trauma protocol, respectively. Baseline characteristics and outcomes were compared using t-tests, Mann-Whitney, Wilcoxon signed-rank Kruskal-Wallis, ANOVA, and a repeated-measures ANCOVA. A significance level was set at p < 0.05. RESULTS The workshop increased students' confidence in leading trauma resuscitation regardless of their assignment to condition. While controlling for covariates, students in the intervention group significantly improved their overall NOTSS compared to those in the control and in all categories: situational awareness, decision-making, communication and teamwork, and leadership. The intervention teams also demonstrated a significant increase in completing trauma protocol steps. CONCLUSION Implementing structured debriefing focusing on NTS enhanced these skills and improved adherence to protocol among medical students managing pediatric trauma-simulated scenarios. These findings support integrating NTS training in pediatric trauma education. LEVEL OF EVIDENCE I.
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Affiliation(s)
- Fabio Botelho
- Department of Surgery, McGill University, Montreal General Hospital, Montreal, Canada; Harvey E. Beardmore Division of Pediatric Surgery, Montreal Children's Hospital, Montreal, Canada.
| | - Ayla Gerk
- Department of Surgery, McGill University, Montreal General Hospital, Montreal, Canada
| | - Jason M Harley
- Department of Surgery, McGill University, Montreal General Hospital, Montreal, Canada; Steinberg Centre for Simulation and Interactive Learning, McGill University, Montreal, Canada; Institute of Health Sciences Education, McGill University, Montreal, Canada; Research Institute of the McGill University Health Centre, Montreal, Canada
| | - Dan Poenaru
- Department of Surgery, McGill University, Montreal General Hospital, Montreal, Canada; Harvey E. Beardmore Division of Pediatric Surgery, Montreal Children's Hospital, Montreal, Canada; Institute of Health Sciences Education, McGill University, Montreal, Canada; Research Institute of the McGill University Health Centre, Montreal, Canada
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Carenzo L, Mercalli C, Reitano E, Tartaglione M, Ceolin M, Cimbanassi S, Del Fabbro D, Sammartano F, Cecconi M, Coniglio C, Chiara O, Gamberini L. State of the art of trauma teams in Italy: A nationwide study. Injury 2024; 55:111388. [PMID: 38316572 DOI: 10.1016/j.injury.2024.111388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 01/05/2024] [Accepted: 01/24/2024] [Indexed: 02/07/2024]
Abstract
Trauma teams play a vital role in providing prompt and specialized care to trauma patients. This study aims to provide a comprehensive description of the presence and organization of trauma teams in Italy. A nationwide cross-sectional epidemiological study was conducted between July and October 2022, involving interviews with 137 designated trauma centers. Centers were stratified based on level: higher specialized trauma centers (CTS), intermediate level trauma centers (CTZ + N) and district general hospital with trauma capacity (CTZ). A standardized structured interview questionnaire was used to gather information on hospital characteristics, trauma team prevalence, activation pathways, structure, components, leadership, education, and governance. Descriptive statistics were used for analysis. Results showed that 53 % of the centers had a formally defined trauma team, with higher percentages in CTS (73 %) compared to CTZ + N (49 %) and CTZ (39 %). The trauma team activation pathway varied among centers, with pre-alerts predominantly received from emergency medical services. The study also highlighted the lack of formally defined massive transfusion protocols in many centers. The composition of trauma teams typically included airway and procedure doctors, nurses, and healthcare assistants. Trauma team leadership was predetermined in 59 % of the centers, with anesthesiologists/intensive care physicians often assuming this role. The study revealed gaps in trauma team education and governance, with a lack of specific training for trauma team leaders and low utilization of simulation-based training. These findings emphasize the need for improvements in trauma management education, governance, and the formalization of trauma teams. This study provides valuable insights that can guide discussions and interventions aimed at enhancing trauma care at both local and national levels in Italy.
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Affiliation(s)
- Luca Carenzo
- Department of Anesthesia and Intensive Care Medicine, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano (MI), Italy.
| | - Cesare Mercalli
- Humanitas University, Department of Biomedical Sciences, Via Rita Levi Montalcini 4, 20090, Pieve Emanuele, Milan, Italy
| | - Elisa Reitano
- Department of Translational Medicine, University of Eastern Piedmont, Via Solaroli 17, 28100, Novara, Italy
| | - Marco Tartaglione
- Department of Anesthesia, Intensive Care and Prehospital Emergency, Maggiore Hospital Carlo Alberto Pizzardi, Bologna, Italy
| | - Martina Ceolin
- Department of Trauma and Acute Care Surgery, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano (MI), Italy
| | - Stefania Cimbanassi
- Trauma Team, ASST GOM Niguarda, Piazza Ospedale Maggiore 3, 20162, Milan, Italy; Department of Pathophysiology and Transplants, Università degli Studi di Milano, Via Festa del Perdono 7, 20122, Milan, Italy
| | - Daniele Del Fabbro
- Department of Trauma and Acute Care Surgery, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano (MI), Italy
| | - Fabrizio Sammartano
- Department of Trauma Surgery, San Carlo Borromeo Hospital, ASST Santi Paolo e Carlo, 20162, Milan, Italy
| | - Maurizio Cecconi
- Department of Anesthesia and Intensive Care Medicine, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano (MI), Italy; Humanitas University, Department of Biomedical Sciences, Via Rita Levi Montalcini 4, 20090, Pieve Emanuele, Milan, Italy
| | - Carlo Coniglio
- Department of Anesthesia, Intensive Care and Prehospital Emergency, Maggiore Hospital Carlo Alberto Pizzardi, Bologna, Italy
| | - Osvaldo Chiara
- Trauma Team, ASST GOM Niguarda, Piazza Ospedale Maggiore 3, 20162, Milan, Italy; Department of Pathophysiology and Transplants, Università degli Studi di Milano, Via Festa del Perdono 7, 20122, Milan, Italy
| | - Lorenzo Gamberini
- Department of Anesthesia, Intensive Care and Prehospital Emergency, Maggiore Hospital Carlo Alberto Pizzardi, Bologna, Italy
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Berkeveld E, Azijli K, Bloemers FW, Giannakópoulos GF. The effect of a clock's presence on trauma resuscitation times in a Dutch level-1 trauma center: a pre-post cohort analysis. Eur J Trauma Emerg Surg 2024; 50:489-496. [PMID: 37794254 PMCID: PMC11035447 DOI: 10.1007/s00068-023-02371-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 09/12/2023] [Indexed: 10/06/2023]
Abstract
PURPOSE Interventions performed within the first hour after trauma increase survival rates. Literature showed that measuring times can optimize the trauma resuscitation process as time awareness potentially reduces acute care time. This study examined the effect of a digital clock placement on trauma resuscitation times in an academic level-1 trauma center. METHODS A prospective observational pre-post cohort analysis was conducted for six months before and after implementing a visible clock in the trauma resuscitation room, indicating the time passed since starting the in-hospital resuscitation process. Trauma patients (age ≥ 16) presented during weekdays between 9.00 AM and 9.00 PM were included. Time until diagnostics (X-Ray, FAST, or CT scan), time until therapeutic intervention, and total resuscitation time were measured manually with a stopwatch by a researcher in the trauma resuscitation room. Patient characteristics and information regarding trauma- and injury type were collected. Times before and after clock implementation were compared. RESULTS In total, 100 patients were included, 50 patients in each cohort. The median total resuscitation time (including CT scan) was 40.3 min (IQR 23.3) in the cohort without a clock compared to 44.3 (IQR 26.1) minutes in the cohort with a clock. The mean time until the first diagnostic and until the CT scan was 8.3 min (SD 3.1) and 25.5 min (SD 7.1) without a clock compared to 8.6 min (SD 6.5) and 26.6 min (SD 11.5) with a clock. Severely injured patients (Injury Severity Score (ISS) ≥ 16) showed a median resuscitation time in the cohort without a clock (n = 9) of 54.6 min (IQR 50.5) compared to 46.0 min (IQR 21.6) in the cohort with a clock (n = 8). CONCLUSION This study found no significant reduction in trauma resuscitation time after clock placement. Nonetheless, the data represent a heterogeneous population, not excluding specific patient categories for whom literature has shown that a short time is essential, such as severely injured patients, might benefit from the presence of a trauma clock. Future research is recommended into resuscitation times of specific patient categories and practices to investigate time awareness.
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Affiliation(s)
- Eva Berkeveld
- Department of Trauma Surgery, Amsterdam UMC Location Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands.
| | - Kaoutar Azijli
- Department of Emergency Medicine, Amsterdam UMC Location Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands
| | - Frank W Bloemers
- Department of Trauma Surgery, Amsterdam UMC Location Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands
- Department of Trauma Surgery, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - Georgios F Giannakópoulos
- Department of Trauma Surgery, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
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Bäckström D, Alvinius A. Physicians' challenges when working in the prehospital environment - a qualitative study using grounded theory. Int J Emerg Med 2024; 17:28. [PMID: 38413854 PMCID: PMC10900586 DOI: 10.1186/s12245-024-00599-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Accepted: 02/19/2024] [Indexed: 02/29/2024] Open
Abstract
BACKGROUND In the rapid development in prehospital medicine the awareness of the many challenges in prehospital care is important as it highlights which areas need improvement and where special attention during education and training should be focused. The purpose of this study is to identify challenges that physicians face when working in the prehospital environment. The research question is thus; what challenges do physicians face when working in prehospital care? METHOD This is a qualitative study with an inductive approach and is based on individual interviews. The interviews were analyzed using the Classic Grounded Theory (GT) method as an approach. The interviews were conducted as semi-structured interviews via the digital platform Zoom during winter / early spring 2022. RESULTS Challenges for prehospital physicians can be understood as a process that involves a balancing act between different factors linked to the extreme environment in which they operate. This environment creates unique challenges not usually encountered in routine hospital practice, which results in trade-offs that they would not otherwise be faced with. Their individual situation needs to be balanced against organizational conditions, which means, among other things, that their medical decisions must be made based on limited information as a result of the constraints that exist in the prehospital environment. They must, both as individuals and as part of a team, manoeuvre in time and space for decision-making and practical tasks. This theory of balancing different entities is based on four themes; thus the theory is the relation between the four themes: leadership, environment, emotion management and organization. CONCLUSIONS With the help of previous studies and what we have found, it is reasonable to review what training is needed before starting to work prehospital as a physician. This should include components of the themes we have described: organization, environment, leadership and emotional management.
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Affiliation(s)
- Denise Bäckström
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, 581 83, Sweden.
| | - Aida Alvinius
- Department of Leadership and Command & Control, Swedish Defence University, Våxnäsgatan 10, Karlstad, 651 80, Sweden
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Maiga AW, Vella MA, Appelbaum RD, Irlmeier R, Ye F, Holena DN, Dumas RP. Getting out of the bay faster: Assessing trauma team performance using trauma video review. J Trauma Acute Care Surg 2024; 96:76-84. [PMID: 37880840 DOI: 10.1097/ta.0000000000004168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2023]
Abstract
BACKGROUND Minutes matter for trauma patients in hemorrhagic shock. How trauma team function impacts time to the next phase of care has not been rigorously evaluated. We hypothesized better team performance scores to be associated with decreased time to the next phase of trauma care. METHODS This retrospective secondary analysis of a prospective multicenter observational study included hypotensive trauma patients at 19 centers. Using trauma video review, we analyzed team performance with the validated Non-Technical Skills for Trauma scale: leadership, cooperation and resource management, communication, assessment/decision making, and situational awareness. The primary outcome was minutes from patient arrival to next phase of care; deaths in the bay were excluded. Secondary outcomes included time to initiation and completion of first unit of blood and inpatient mortality. Associations between team dynamics and outcomes were assessed with a linear mixed-effects model adjusting for Injury Severity Score, mechanism, initial blood pressure and heart rate, number of team members, and trauma team lead training level and sex. RESULTS A total of 441 patients were included. The median Injury Severity Score was 22 (interquartile range, 10-34), and most (61%) sustained blunt trauma. The median time to next phase of care was 23.5 minutes (interquartile range, 17-35 minutes). Better leadership, communication, assessment/decision making, and situational awareness scores were associated with faster times to next phase of care (all p < 0.05). Each 1-point worsening in the Non-Technical Skills for Trauma scale score (scale, 5-15) was associated with 1.6 minutes more in the bay. The median resuscitation team size was 12 (interquartile range, 10-15), and larger teams were slower ( p < 0.05). Better situational awareness was associated with faster completion of first unit of blood by 4 to 5 minutes ( p < 0.05). CONCLUSION Better team performance is associated with faster transitions to next phase of care in hypotensive trauma patients, and larger teams are slower. Trauma team training should focus on optimizing team performance to facilitate faster hemorrhage control. LEVEL OF EVIDENCE Therapeutic/Care Management; Level III.
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Affiliation(s)
- Amelia W Maiga
- From the Division of Acute Care Surgery, Department of Surgery (A.W.M., R.D.A.), Section of Surgical Sciences, Vanderbilt University Medical Center, Nashville, Tennessee; Critical Illness, Brain dysfunction, and Survivorship Center (A.W.M.), Vanderbilt University Medical Center, Nashville, Tennessee; Division of Acute Care Surgery and Trauma (M.A.V.), University of Rochester Medical Center, Rochester, New York; Department of Biostatistics (R.I.), Vanderbilt University Medical Center, Nashville, Tennessee; Department of Medicine (F.Y.), Vanderbilt University Medical Center, Nashville, Tennessee; Division of Trauma and Acute Care Surgery (D.N.H.), Medical College of Wisconsin, Milwaukee, Wisconin; and Division of Burn Trauma Acute and Critical Care Surgery (R.P.D.), UT Southwestern Medical Center, Dallas, Texas
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Janssens S, Clipperton S, Simon R, Lowe B, Griffin A, Beckmann M, Marshall S. Coleadership in Maternity Teams, a Randomized, Counterbalanced, Crossover Trial in Simulation. Simul Healthc 2023; 18:299-304. [PMID: 35940597 DOI: 10.1097/sih.0000000000000680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE This study aimed to measure the effect of a coleadership model on team performance compared with singular leadership model in simulated maternity emergencies. METHODS A randomized, counterbalanced, crossover trial was performed at 2 tertiary maternity hospitals. Teams of obstetric physicians and nurse/midwives responded to 2 simulated maternity emergencies in either a singular or coleadership model. The primary outcome measure was teamwork rated with the Auckland Team Behavior tool. Secondary outcome measures included clinical performance (completion of critical tasks, time to critical intervention, documentation), self-rated teamwork (TEAM tool) and workload. Participants also answered a survey assessing their views on the coleadership model. Paired t tests and mixed-effects linear regression considering team as a random effect were used to estimate the unadjusted and adjusted associations between leadership model and the outcomes of interest. RESULTS There was no difference between leadership models for the primary outcome of teamwork (5.3 vs. 5.3, P = 0.91). Clinical outcome measures and self-rated teamwork scores were also similar. Team leaders reported higher workload than other team members, but these were not different between the leadership models. Participants viewed coleadership positively despite no measured objective evidence of benefit. CONCLUSIONS A coleadership model did not lead to a difference in team performance within simulated maternity emergencies. Despite this, participants viewed coleadership positively.
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Affiliation(s)
- Sarah Janssens
- From the Mater Misericordiae Ltd (S.J., M.B.), Australia; Monash University, Department of Anaesthesia and Perioperative Medicine (S.J., S.M.), Melbourne, Australia; University of Queensland, School of Medicine (S.J.), Brisbane, Australia; Mater Education Ltd. (S.C.), Australia; Massachusetts General Hospital and Harvard Medical School (retired) (R.S.); Gold Coast University Hospital (B.L.), Southport, Australia; Bond University (B.L.), Southport, Australia; QIMR Berghofer Medical Research Institute (A.G.), Brisbane, Australia; Mater Research (M.B.), University of Queensland, Brisbane Australia; and University of Melbourne, Department of Critical Care (S.M.), Melbourne, Australia
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van Maarseveen OEC, Ham WHW, Leenen LPH. Future perspectives of higher standards for trauma teams' organization, support, and evaluation. Eur J Trauma Emerg Surg 2023; 49:1661-1664. [PMID: 36542110 PMCID: PMC10449656 DOI: 10.1007/s00068-022-02196-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 12/01/2022] [Indexed: 12/24/2022]
Affiliation(s)
- Oscar E C van Maarseveen
- Department of Trauma Surgery, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands.
| | - Wietske H W Ham
- Department of Trauma Surgery, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Luke P H Leenen
- Department of Trauma Surgery, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
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Bento A, Ferreira L, Yánez Benitez C, Koleda P, Fraga GP, Kozera P, Baptista S, Mesquita C, Alexandrino H. Worldwide snapshot of trauma team structure and training: an international survey. Eur J Trauma Emerg Surg 2023; 49:1771-1781. [PMID: 36414695 DOI: 10.1007/s00068-022-02166-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 11/04/2022] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Trauma teams (TTs) are a key tool in trauma care, as they bring a multidisciplinary approach to the trauma patient, improving outcomes. Excellent teamwork (TW) requires not only individual skills but also training at non-technical skills (NTS). Although there is evidence supporting TTs, there is little information regarding how they are organized and trained. With this study, we intend to assess the reality of TTs all over the world, focusing on how they are organized and trained. MATERIALS AND METHODS We composed a 42-question sheet on Google Forms, in four different languages (English, Polish, Portuguese, and Spanish). The questions regarded the respondents' background, and their respective hospitals' trauma patient management, TT features and its training, NTS and TW. The survey was shared on social media, through the International Assessment Group of Online Surgical & Trauma Education community, and the European Society of Trauma and Emergency Surgery. Statistical analysis was performed on Statistical Package for the Social Sciences (SPSS®) version 27. RESULTS We obtained 296 answers from 52 different countries, with 6 having at least 10 answers (Brazil, Portugal, Poland, Spain, Italy, and USA). While the majority of the respondents (97%) agreed that TTs can improve outcomes, only 61% have a TT in their hospital, with 69% of these being dedicated TTs. General surgery (76%), trauma surgery (68%), and anesthesia (66%) were the three most common specialties in the teams. Teams performed briefings and debriefings with a frequency of, at least, "often" in only 49% and 38%, respectively. Only 50% and 33% of the respondents stated that their hospital provided trauma management courses focusing on individual technical skills, and TT training courses, respectively. The Advanced Trauma Life Support (85%), the Definitive Surgical and Anesthetic Trauma Care (38%), and the European Trauma Course (31%) were the three trauma management courses of choice. Regarding TT training courses, the European Trauma Course (52%) and local/in-house (42%) courses were the most common ones. Most participants (93%) stated that NTS were highly important in trauma care. However, only 60% of the respondents had postgraduate training on NTS and TW, and only 24% had this type of training on an undergraduate level. CONCLUSION The number of TTs worldwide does not match their relevance in trauma care. Institutions are not providing enough trauma courses, particularly TT training courses and NTS teaching. Implementing TT should include promotion of team courses, as well as team briefings and debriefings.
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Affiliation(s)
- André Bento
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal.
| | - Luís Ferreira
- Department of General Surgery, Hospital Central do Funchal, SESARAM, Funchal, Portugal
| | - Carlos Yánez Benitez
- General and Gastrointestinal Surgery, Royo Villanova Hospital, SALUD, Zaragoza, Spain
| | - Piotr Koleda
- Department of Medical Simulation, Faculty of Medicine, Wroclaw Medical University, Wroclaw, Poland
| | - Gustavo P Fraga
- Division of Trauma Surgery, School of Medical Sciences (SMS), University of Campinas (Unicamp), Campinas, SP, Brazil
| | - Piotr Kozera
- Faculty of Medicine, Collegium Medicum, University of Warmia and Mazury, Olsztyn, Poland
| | - Sérgio Baptista
- Department of Anesthesiology, Centro Hospitalar do Médio Tejo, EPE, Tomar, Portugal
| | - Carlos Mesquita
- Head of Clinic (Consultancy in General and Emergency Surgery and Trauma), Private Practice Coimbra, Coimbra, Portugal
| | - Henrique Alexandrino
- Department of General Surgery, Faculty of Medicine, Coimbra University Hospital Center, University of Coimbra, Praceta Mota Pinto, 3000-045, Coimbra, Portugal
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Abahuje E, Reddy S, Rosu C, Lin KA, Mack L, Valukas C, Shapiro M, Alam HB, Halverson A, Bilimoria K, Coleman J, Stey AM. Relationship Between Residents' Physiological Stress and Faculty Leadership Skills in a Department of Surgery. JOURNAL OF SURGICAL EDUCATION 2023; 80:1129-1138. [PMID: 37336667 DOI: 10.1016/j.jsurg.2023.05.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 04/21/2023] [Accepted: 05/21/2023] [Indexed: 06/21/2023]
Abstract
BACKGROUND Leadership skills of team leaders can impact the functioning of their teams. It is unknown whether attending surgeons' leadership skills impact residents' physiological stress. This study sought to (1) assess the relationship between attending surgeons' leadership skills and residents' physiological stress and (2) to characterize lifestyle behaviors associated with resident physiological stress. We hypothesized that strong attending leadership skills would be associated with low resident physiological stress. STUDY DESIGN This prospective observational cohort study was conducted at a single urban, academic medical center in the US, over 12 months. Residents were enrolled during their rotation of 1 to 2 months on the Trauma and ICU services. The primary predictor was the attending surgeons' leadership skills that were measured using a weekly survey filled out by residents, using the Surgeons' Leadership Inventory (SLI). The SLI uses a 4-point Likert scale to measure surgeons' leadership skills across eight domains. The primary outcome was residents' physiological stress, which was measured by their Heart Rate Variability (HRV). We recorded the residents' HRV with a WHOOP strap that was continuously worn on the wrist or the bicep. We used multivariate repeated measures gamma regression to assess the relationship between attending leadership skills and residents' physiological stress, adjusting for hours of sleep, age, and service. RESULTS Sixteen residents were enrolled over 12 months. The median attending surgeons' leadership score was 3.8 (IQR: 3.2-4.0). The median residents' percent of maximal HRV was 70.8% (IQR: 56.7-83.7). Repeated measure gamma regression model demonstrated a minimal nonsignificant increase of 1.6 % (95% CI: -5.6, 8.9; p-value = 0.65) in the percent of maximal HRV (less resident physiological stress) for every unit increase in leadership score. There was an increase of 2.9% (95% CI= 1.6, 4.2; p-value < 0.001) in the percent of maximal HRV per hour increase in sleep and a significant decrease of 10.9% (95% CI= -16.8, -5.2; < 0.001) in the percent of HRV when working in the ICU compared to the Trauma service. CONCLUSION This study revealed that more residents' sleep was associated with lower physiological stress. Attending surgeons' leadership skills were not associated with residents' physiological stress.
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Affiliation(s)
- Egide Abahuje
- Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois; Massachusetts General Hospital, Institute of Health Professions, Boston, Massachusetts.
| | - Susheel Reddy
- Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Claudia Rosu
- Massachusetts General Hospital, Institute of Health Professions, Boston, Massachusetts
| | - Katherine A Lin
- Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Lara Mack
- Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Catherine Valukas
- Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Michael Shapiro
- Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Hasan B Alam
- Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Amy Halverson
- Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Karl Bilimoria
- Department of Surgery, School of Medicine, Indian University, Indianapolis, Indiana
| | - Jamie Coleman
- Department of Surgery, School of Medicine, University of Louisville, Louisville, Kentucky
| | - Anne M Stey
- Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
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van Maarseveen OEC, Ham WHW, Leenen LPH. The effect of an on-site trauma surgeon during resuscitations of severely injured patients. BMC Emerg Med 2022; 22:163. [PMID: 36171543 PMCID: PMC9520822 DOI: 10.1186/s12873-022-00724-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 09/21/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Although the timely involvement of trauma surgeons is widely accepted as standard care in a trauma center, there is an ongoing debate regarding the value of an on-site attending trauma surgeon compared to an on-call trauma surgeon. The aim of this study was to evaluate the effect of introducing an on-site trauma surgeons and the effect of their presence on the adherence to Advanced Trauma Life Support (ATLS) related tasks and resuscitation pace in the trauma bay. METHODS The resuscitations of severely injured (ISS > 15) trauma patients 1 month before and 1 month after the introduction of an on-site trauma surgeon were assessed using video analysis. The primary outcome was total resuscitation time. Second, time from trauma bay admission until tasks were performed, and ATLS adherence were assessed. RESULTS Fifty-eight videos of resuscitations have been analyzed. After the introduction of an on-site trauma surgeon, the mean total resuscitation time was 259 seconds shorter (p = 0.03) and seven ATLS related tasks (breathing assessment, first and second IV access, EKG monitoring and abdominal, pelvic, and long bone examination; were performed significantly earlier during trauma resuscitation (p ≤ 0.05). Further, we found a significant enhancement to the adherence of six ATLS related tasks (Airway assessment, application of a rigid collar, IV access; EKG monitoring, log roll, and pronouncing results of arterial blood gas analysis; p-value ≤0.05). CONCLUSION Having a trauma surgeon on-site during trauma resuscitations of severely injured patients resulted in improved processes in the trauma bay. This demonstrates the need of direct involvement of trauma surgeons in institutions treating severely injured patients.
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Affiliation(s)
- Oscar E C van Maarseveen
- Department of Trauma Surgery, University Medical Center Utrecht, Heidelberglaan 100, 3584, CX, Utrecht, The Netherlands.
| | - Wietske H W Ham
- Emergency Department, University Medical Center Utrecht, Heidelberglaan 100, 3584, CX, Utrecht, The Netherlands.,University of Applied Science Utrecht, Institute of Nursing Studies, Utrecht, The Netherlands
| | - Loek P H Leenen
- Department of Trauma Surgery, University Medical Center Utrecht, Heidelberglaan 100, 3584, CX, Utrecht, The Netherlands
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Maarseveen OECV, Ham WHW, Huijsmans RLN, Leenen LPH. The pace of a trauma resuscitation: experience matters. Eur J Trauma Emerg Surg 2022; 48:2503-2510. [PMID: 35141771 PMCID: PMC9192480 DOI: 10.1007/s00068-021-01838-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 11/08/2021] [Indexed: 11/26/2022]
Abstract
Purpose Resuscitation quality and pace depend on effective team coordination, which can be facilitated by adequate leadership. Our primary aim was to assess the influence of trauma team leader experience on resuscitation pace. Second, we investigated the influence of injury severity on resuscitation pace. Methods The trauma team leaders were identified (Staff trauma surgeon vs Fellow trauma surgeon) and classified from video analysis during a 1-week period. Resuscitations were assessed for time to the treatment plan, total resuscitation time, and procedure time. Furthermore, patient and resuscitation characteristics were assessed and compared: age, gender, Injury Severity Score, Glasgow Coma Scale < 9, and the number (and duration) of surgical procedures during initial resuscitation. Correlations between total resuscitation time, Injury Severity Score, and time to treatment plan were calculated. Results After adjustment for the time needed for procedures, the time to treatment plan and total resuscitation time was significantly shorter in resuscitations led by a Staff trauma surgeon compared to a Fellow trauma surgeon (median 648 s (IQR 472–813) vs 852 s (IQR 694–1256); p 0.01 resp. median 1280 s (IQR 979–1494) vs 1535 s (IQR 1247–1864), p 0.04). Surgical procedures were only performed during resuscitations led by Staff trauma surgeons (4 thorax drains, 1 endotracheal intubation, 1 closed fracture reduction). Moreover, a significant negative correlation (r: – 0.698, p < 0.01) between Injury Severity Score and resuscitation time was found. Conclusion Experienced trauma team leaders may positively influence the pace of the resuscitation. Moreover, we found that the resuscitation pace increases when the patient is more severely injured.
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Affiliation(s)
- Oscar E C van Maarseveen
- Department of Trauma Surgery, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands.
| | - Wietske H W Ham
- Emergency Department, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
- Institute of Nursing Studies, University of Applied Science, Heidelberglaan 7, 3584 CS, Utrecht, The Netherlands
| | - Roel L N Huijsmans
- Department of Trauma Surgery, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Luke P H Leenen
- Department of Trauma Surgery, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
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Leenstra NF, Jung OC, Cnossen F, Jaarsma ADC, Tulleken JE. Development and Evaluation of the Taxonomy of Trauma Leadership Skills-Shortened for Observation and Reflection in Training: A Practical Tool for Observing and Reflecting on Trauma Leadership Performance. Simul Healthc 2021; 16:37-45. [PMID: 32732816 PMCID: PMC7850591 DOI: 10.1097/sih.0000000000000474] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
INTRODUCTION Trauma leadership skills are increasingly being addressed in trauma courses, but few resources are available to systematically observe and debrief trainees' performances. The authors therefore translated their previously developed, extensive Taxonomy of Trauma Leadership Skills (TTLS) into a practical observation tool that is tailored to the vocabulary of clinician instructors and their workflow and workload during simulation-based training. METHODS In 2016 to 2018, the TTLS was subjected to practical evaluation in an iterative process of 2 stages. In the first stage, testing panels of trauma specialists observed excerpts from videotaped simulations and indicated from the list of elements which behaviors they felt were being shown. Any ambiguities or redundancy were addressed by rephrasing or combining elements. In the second stage, iterations were used in actual scenario training to observe and debrief trainees' performances. The instructors' recommendations resulted in further improvements of clarity, ease of use, and usefulness, until no new suggestions were raised. RESULTS The resultant "TTLS-Shortened for Observation and Reflection in Training" was given a simpler structure and more concrete and self-explanatory benchmarks. It contains 6 skill categories for evaluation, each with 4 to 6 benchmark behaviors. CONCLUSIONS The TTLS-Shortened for Observation and Reflection in Training is an important addition to other trauma assessment tools because of its specific focus on leadership skills. It helps set concrete performance expectations, simplify note taking, and target observations and debriefings. One central challenge was striking a balance between its conciseness and specificity. The authors reflected on how the decisions for the resultant structure ease and leverage the conduct of observations and performance debriefing.
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Andersen SK, Hustveit R, Frøland E, Uleberg O, Krüger A, Klepstad P, Nordseth T. Improper monitoring and deviations from physiologic treatment goals in patients with brain injury in the early phases of emergency care. J Clin Monit Comput 2021; 35:147-153. [PMID: 31938998 PMCID: PMC7889683 DOI: 10.1007/s10877-019-00455-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Accepted: 12/28/2019] [Indexed: 12/05/2022]
Abstract
Severe traumatic brain injury (TBI), out-of-hospital cardiac arrest (OHCA) and intracerebral- and subarachnoid hemorrhage (ICH/SAH) are conditions associated with high mortality and morbidity. The aim of this study was to investigate the feasibility of obtaining continuous physiologic data and to identify possible harmful physiological deviations in these patients, in the early phases of emergency care. Patients with ICH/SAH, OHCA and severe TBI treated by the Physician-staffed Emergency Medical Service (P-EMS) between September and December 2016 were included. Physiological data were obtained from site of injury/illness, during transport, in the emergency department (ED) and until 3 h after admittance to the intensive care unit. Physiological deviations were based on predefined target values within each 5-min interval. 13 patients were included in the study, of which 38% survived. All patients experienced one or more episodes of hypoxia, 38% experienced episodes of hypercapnia and 46% experienced episodes of hypotension. The mean proportion of time without any monitoring in the pre-hospital phase was 29%, 47% and 56% for SpO2, end-tidal CO2 and systolic blood pressure, respectively. For the ED these proportions were 57%, 71% and 56%, respectively. Continuous physiological data was not possible to obtain in this study of critically ill and injured patients with brain injury. The patients had frequent deviations in blood pressure, SpO2 and end tidal CO2-levels, and measurements were frequently missing. There is a potential for improved monitoring as a tool for quality improvement in pre-hospital critical care.
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Affiliation(s)
- Siri Kojen Andersen
- Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, P.O. box 3250, Sluppen, 7006, Trondheim, Norway
| | - Ragnhild Hustveit
- Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, P.O. box 3250, Sluppen, 7006, Trondheim, Norway
| | - Erlend Frøland
- Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, P.O. box 3250, Sluppen, 7006, Trondheim, Norway
| | - Oddvar Uleberg
- Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, P.O. box 3250, Sluppen, 7006, Trondheim, Norway
- Department of Emergency Medicine and Pre-hospital Services, St. Olav`s University Hospital, 7006, Trondheim, Norway
- Department of Research and Development, Norwegian Air Ambulance Foundation, P.O.Box 6770, 0130, Oslo, Norway
| | - Andreas Krüger
- Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, P.O. box 3250, Sluppen, 7006, Trondheim, Norway
- Department of Emergency Medicine and Pre-hospital Services, St. Olav`s University Hospital, 7006, Trondheim, Norway
- Department of Research and Development, Norwegian Air Ambulance Foundation, P.O.Box 6770, 0130, Oslo, Norway
| | - Pål Klepstad
- Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, P.O. box 3250, Sluppen, 7006, Trondheim, Norway
- Department of Anaesthesia and Intensive Care Medicine, St. Olav University Hospital, 7006, Trondheim, Norway
| | - Trond Nordseth
- Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, P.O. box 3250, Sluppen, 7006, Trondheim, Norway.
- Department of Emergency Medicine and Pre-hospital Services, St. Olav`s University Hospital, 7006, Trondheim, Norway.
- Regional Centre for Health Care Research, St. Olav University Hospital, 7006, Trondheim, Norway.
- Department of Anesthesia Molde Hospital, Møre og Romsdal Hospital Trust, 6412, Molde, Norway.
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Ong ZH, Tan LHE, Ghazali HZB, Ong YT, Koh JWH, Ang RZE, Bok C, Chiam M, Lee ASI, Chin AMC, Zhou JX, Chan GWH, Nadarajan GD, Krishna LKR. A Systematic Scoping Review on Pedagogical Strategies of Interprofessional Communication for Physicians in Emergency Medicine. JOURNAL OF MEDICAL EDUCATION AND CURRICULAR DEVELOPMENT 2021; 8:23821205211041794. [PMID: 34671703 PMCID: PMC8521417 DOI: 10.1177/23821205211041794] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
BACKGROUND Interprofessional communication (IPC) is integral to interprofessional teams working in the emergency medicine (EM) setting. Yet, the coronavirus disease 2019 pandemic has laid bare gaps in IPC knowledge, skills and attitudes. These experiences underscore the need to review how IPC is taught in EM. PURPOSE A systematic scoping review is proposed to scrutinize accounts of IPC programs in EM. METHODS Krishna's Systematic Evidence-Based Approach (SEBA) is adopted to guide this systematic scoping review. Independent searches of ninedatabases (PubMed, Embase, CINAHL, Scopus, PsycINFO, ERIC, JSTOR, Google Scholar and OpenGrey) and "negotiated consensual validation" were used to identify articles published between January 1, 2000 and December 31, 2020. Three research teams reviewed the data using concurrent content and thematic analysis and independently summarized the included articles. The findings were scrutinized using SEBA's jigsaw perspective and funneling approach to provide a more holistic picture of the data. RESULTS IN TOTAL 18,809 titles and abstracts were identified after removal of duplicates, 76 full-text articles reviewed, and 19 full-text articles were analyzed. In total, four themes and categories were identified, namely: (a) indications and outcomes, (2) curriculum and assessment methods, (3) barriers, and (4) enablers. CONCLUSION IPC training in EM should be longitudinal, competency- and stage-based, underlining the need for effective oversight by the host organization. It also suggests a role for portfolios and the importance of continuing support for physicians in EM as they hone their IPC skills. HIGHLIGHTS • IPC training in EM is competency-based and organized around stages.• IPC competencies build on prevailing knowledge and skills.• Longitudinal support and holistic oversight necessitates a central role for the host organization.• Longitudinal, robust, and adaptable assessment tools in the EM setting are necessary and may be supplemented by portfolio use.
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Affiliation(s)
- Zhi H. Ong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore
| | - Lorraine H. E. Tan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore
| | | | - Yun T. Ong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore
| | - Jeffrey W. H. Koh
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore
- National University of Singapore, Singapore
| | - Rachel Z. E. Ang
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore
- Alice Lee Centre for Nursing Studies, National University of Singapore, Singapore
| | - Chermaine Bok
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore
| | - Min Chiam
- Division of Cancer Education, National Cancer Centre Singapore, Singapore
| | - Alexia S. I. Lee
- Division of Cancer Education, National Cancer Centre Singapore, Singapore
| | | | - Jamie X. Zhou
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore
- Lien Centre for Palliative Care, Duke-NUS Medical School, Singapore
- Duke-NUS Medical School, Singapore
| | - Gene W. H. Chan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- National University Hospital, National University Health System, Singapore
| | | | - Lalit K. R. Krishna
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore
- Division of Cancer Education, National Cancer Centre Singapore, Singapore
- Duke-NUS Medical School, Singapore
- Palliative Care Institute Liverpool, Academic Palliative & End of Life Care Centre, UK
- Centre for Biomedical Ethics, National University of Singapore, Singapore
- PalC, The Palliative Care Centre for Excellence in Research and Education, Singapore
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16
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Khudadad U, Aftab W, Ali A, Khan NU, Razzak J, Siddiqi S. Perception of the healthcare professionals towards the current trauma and emergency care system in Kabul, Afghanistan: a mixed method study. BMC Health Serv Res 2020; 20:991. [PMID: 33121505 PMCID: PMC7596957 DOI: 10.1186/s12913-020-05845-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 10/21/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Trauma and injury contribute to 11% of the all-cause mortality in Afghanistan. The study aimed to explore the perceptions of the healthcare providers (pre and in-hospital), hospital managers and policy makers of the public and private health sectors to identify the challenges in the provision of an effective trauma care in Kabul, Afghanistan. METHODS A concurrent mixed method design was used, including key-informant interviews (healthcare providers, hospital managers and policy makers) of the trauma care system (N = 18) and simultaneous structured emergency care system assessment questionnaire (N = 35) from July 15 to September 25, 2019. Interviews were analyzed using content analysis approach and structured questionnaire data were descriptively analyzed. RESULTS Four themes were identified that describe the challenges: 1) pre-hospital care, 2) cohesive trauma management system, 3) physical and human resources and 4) stewardship. Some key challenges were found related to scene and transportation care, in-hospital care and emergency preparedness within the wider trauma care system. Less than 25% of the population is covered by the pre-hospital ambulance system (n = 23, 65.7%) and there is no communication process between health care facilities to facilitate transfer (n = 28, 80%). Less than 25% of patients with an injury requiring emergent surgery have access to surgical care in a staffed operating theatre within 2 h of injury (n = 19, 54.2%) and there is no regular assessment of the ability of the emergency care system to mobilize resources (human and physical) to respond to disasters, and other large-scale emergencies (n = 28, 80%). CONCLUSION This study highlighted major challenges in the delivery of trauma care services across Kabul, Afghanistan. Systematic improvement in the workforce training, structural organization of the trauma care system and implementing externally validated clinical guidelines for trauma management could possibly enhance the functions of the existing trauma care services. However, an integrated state-run trauma care system will address the current burden of traumatic injury more effectively within the wider healthcare system of Afghanistan.
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Affiliation(s)
- Umerdad Khudadad
- Department of Emergency Medicine, Aga Khan University, Karachi, Pakistan
| | - Wafa Aftab
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Asrar Ali
- Department of Emergency Medicine, Aga Khan University, Karachi, Pakistan
| | - Nadeem Ullah Khan
- Department of Emergency Medicine, Aga Khan University, Karachi, Pakistan
| | - Junaid Razzak
- Department of Emergency Medicine, Johns Hopkins School of Medicine, Baltimore, USA
| | - Sameen Siddiqi
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
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Dumas RP, Vella MA, Chreiman KC, Smith BP, Subramanian M, Maher Z, Seamon MJ, Holena DN. Team Assessment and Decision Making Is Associated With Outcomes: A Trauma Video Review Analysis. J Surg Res 2019; 246:544-549. [PMID: 31635832 DOI: 10.1016/j.jss.2019.09.033] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 07/24/2019] [Accepted: 09/18/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Teamwork is a critical element of trauma resuscitation. Assessment tools such as T-NOTECHS (Trauma NOn-TECHnical Skills) exist, but correlation with patient outcomes is unclear. Using emergency department thoracotomy (EDT), we sought to describe T-NOTECHS scores during resuscitations. We hypothesized that patients undergoing EDT whose resuscitations had better scores would be more likely to have return of spontaneous circulation (ROSC). METHODS Continuously recording video was used to review all captured EDTs over a 24-mo period. We used a modification of the validated T-NOTECHS instrument to measure five domains on a 3-point scale (1 = best, 2 = average, 3 = worst). A total T-NOTECHS score was calculated by one of three reviewers. The primary outcome was ROSC. ROSC was defined as an organized rhythm no longer requiring internal cardiac compressions. Associations between variables and ROSC were examined using univariate regression. RESULTS Sixty-one EDTs were captured. Nineteen patients had ROSC (31%) and 42 (69%) did not. The median T-NOTECHS score for all resuscitations was 8 [IQR 6-10]. As demographic and injury data (age, gender, mechanism, signs of life) were not associated with ROSC in univariate analysis, they were not considered for inclusion in a multivariable regression model. The association between overall T-NOTECHS score and ROSC did not reach statistical significance, but examination of the individual components of the T-NOTECHS score demonstrated that, compared to resuscitations that had "average" (2) or "worst" (3) scores on "Assessment and Decision Making," resuscitations with a "best" score were 5 times more likely to lead to ROSC. CONCLUSIONS Although the association between overall T-NOTECHS scores and ROSC did not reach statistical significance, better scores in the domain of assessment and decision making are associated with improved rates of ROSC in patients arriving in cardiac arrest who undergo EDT. LEVEL OF EVIDENCE Level IV Therapeutic/Care Management.
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Affiliation(s)
- Ryan P Dumas
- Division of General and Acute Care Surgery, University of Texas Southwestern Medical Center, Dallas, Texas.
| | - Michael A Vella
- Division of Traumatology, Surgical Critical Care and Emergency Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Kristen C Chreiman
- Division of Traumatology, Surgical Critical Care and Emergency Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Brian P Smith
- Division of Traumatology, Surgical Critical Care and Emergency Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Madhu Subramanian
- Division of Traumatology, Surgical Critical Care and Emergency Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Zoe Maher
- Division of Trauma and Surgical Critical Care, Temple University, Philadelphia, Pennsylvania
| | - Mark J Seamon
- Division of Traumatology, Surgical Critical Care and Emergency Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Daniel N Holena
- Division of Traumatology, Surgical Critical Care and Emergency Surgery, University of Pennsylvania, Philadelphia, Pennsylvania; Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, Pennsylvania
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Bharwani A, Kline T, Patterson M. Perceptions of effective leadership in a medical school context. CANADIAN MEDICAL EDUCATION JOURNAL 2019; 10:e101-e106. [PMID: 31388383 PMCID: PMC6681927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND There have been calls for the development of leadership attributes in healthcare practitioners through leadership development programs. However, understanding how leadership is conceptualized is needed to assure effective participant-centred leadership development programs. The purpose of this study was to elucidate how the construct of leadership is conceptualized by multiple stakeholder groups associated with medical school leadership programs. METHODS We conducted a total of 77 semi-structured interviews with six major demographic groups: Trainees (n = 16), Mid-Level University Leaders (n = 10), Clinician Leaders (n = 17), Senior University Leaders (n = 10), Medical Scientists (n = 12), and Senior Leaders, external to the University (n = 12) to address the research question. RESULTS Content analyses revealed that the leaders were expected to create a compelling vision and a foster a motivating culture within the organization. Integrity and a sense of passion about leading were viewed as being principal characteristics of a leader. The twin skills of technical competence and communication were endorsed as most important for a leader. Finally, leaders are expected to be accountable for outcomes. CONCLUSION Medical school leadership training programs should strive to incorporate these characteristics, given their broad appeal to diverse interest groups.
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Affiliation(s)
- Aleem Bharwani
- Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - Theresa Kline
- Department of Psychology, University of Calgary, Alberta, Canada
| | - Margaret Patterson
- Cumming School of Medicine, University of Calgary, Alberta, Canada
- Department of Psychology, University of Calgary, Alberta, Canada
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Mortality in trauma patients admitted during, before, and after national academic emergency medicine and trauma surgery meeting dates in Japan. PLoS One 2019; 14:e0207049. [PMID: 30695039 PMCID: PMC6350962 DOI: 10.1371/journal.pone.0207049] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Accepted: 01/16/2019] [Indexed: 02/07/2023] Open
Abstract
Annually, many physicians attend national academic meetings. While participating in these meetings can have a positive impact on daily medical practice, attendance may result in reduced medical staffing during the meeting dates. We sought to examine whether there were differences in mortality after trauma among patients admitted to the hospital during, before, and after meeting dates. Using the Japan Trauma Data Bank, we analyzed in-hospital mortality in patients with traumatic injury admitted to the hospital from 2004 to 2015 during the dates of two national academic meetings-the Japanese Association for Acute Medicine (JAAM) and the Japanese Association for the Surgery of Trauma (JAST). We compared the data with that of patients admitted with trauma during identical weekdays in the weeks before and after the meetings, respectively. We used multiple logistic regression analysis to compare outcomes among the three groups. A total of 7,491 patients were included in our analyses, with 2,481, 2,492, and 2,518 patients in the during, before, and after meeting dates groups, respectively; their mortality rates were 7.3%, 8.0%, and 8.5%, respectively. After adjusting for covariates, no significant differences in in-hospital mortality were found among the three groups (adjusted odds ratio [95% CI] of the before meeting dates and after meeting dates groups; 1.18 [0.89-1.56] and 1.23 [0.93-1.63], respectively, with the during meeting dates group as the reference category). No significant differences in in-hospital mortality were found among trauma patients admitted during, before, and after the JAAM and JAST meeting dates.
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Mo D, O'Hara NN, Hengel R, Cheong AR, Singhal A. The Preferred Attributes of a Trauma Team Leader: Evidence From a Discrete Choice Experiment. JOURNAL OF SURGICAL EDUCATION 2019; 76:120-126. [PMID: 30241992 DOI: 10.1016/j.jsurg.2018.06.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 05/18/2018] [Accepted: 06/26/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE Leaders of a pediatric trauma team are tasked with managing rapidly changing diagnostic and treatment challenges, while ensuring the entire team functions effectively to produce optimal patient outcomes. An effective trauma team leader is often thought to be self-evident, and there is little formal literature identifying the leadership characteristics and attributes associated with optimal trauma team performance. The purpose of this study was to elicit the trauma team leader traits and characteristics deemed of greatest utility by members of the pediatric trauma team. DESIGN, SETTING, PARTICIPANTS Members of the pediatric trauma team at British Columbia Children's Hospital were asked to participate in a semistructured interview to identify trauma team leader attributes associated with maximal team performance. Using the attributes, we constructed a discrete choice experiment (DCE). DCEs, developed in the economics and market research setting, allow participants to express preferences among finite alternatives, with subsequent statistical analysis that allows quantitative comparison of the utility of selected attributes. RESULTS After interviewing 21 trauma team practitioners, 6 themes were identified as being most important for trauma team leadership. The developed DCE was administered to 64 members of the trauma team. Analysis of the DCE revealed the most important attributes were collaboration, strong communication, and decisiveness. The attribute of least utility was experience. The specific leadership qualities that provided the most utility to the trauma team included "actively involves input for team" (mean utility [MU]: 0.70; standard error [SE]: 0.11) and "concise communication, at times closed-loop" (MU: 0.52; SE: 0.09). "Hesitant and unclear communication" (MU: -0.88; SE: 0.09) and "often indecisive" (MU: -0.68; SE: 0.10) were deemed most detrimental (negative utility) to the team's function. CONCLUSIONS This study is novel in applying a strategy to identify and quantify the relative value of trauma team leader attributes. When designing education initiatives for pediatric trauma care teams, defining trauma team quality metrics, and providing continuing medical education for the team leader, it is essential to incorporate preferred leadership characteristics. Crisis resource management skills benefit greatly from an understanding of the preferred attributes, as defined and evaluated by other trauma team members.
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Affiliation(s)
- David Mo
- Division of Pediatric Neurosurgery, Department of Surgery, University of British Columbia and BC Children's Hospital, Vancouver, British Columbia, Canada
| | - Nathan N O'Hara
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland
| | - Ross Hengel
- Division of Pediatric Neurosurgery, Department of Surgery, University of British Columbia and BC Children's Hospital, Vancouver, British Columbia, Canada
| | - Alexander R Cheong
- Division of Pediatric Neurosurgery, Department of Surgery, University of British Columbia and BC Children's Hospital, Vancouver, British Columbia, Canada
| | - Ash Singhal
- Division of Pediatric Neurosurgery, Department of Surgery, University of British Columbia and BC Children's Hospital, Vancouver, British Columbia, Canada.
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van der Vliet QMJ, van Maarseveen OEC, Smeeing DPJ, Houwert RM, van Wessem KJP, Simmermacher RKJ, Govaert GAM, de Jong MB, de Bruin IGJ, Leenen LPH, Hietbrink F. Severely injured patients benefit from in-house attending trauma surgeons. Injury 2019; 50:20-26. [PMID: 30119939 DOI: 10.1016/j.injury.2018.08.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Revised: 07/26/2018] [Accepted: 08/10/2018] [Indexed: 02/02/2023]
Abstract
INTRODUCTION There is continuous drive to optimize healthcare for the most severely injured patients. Although still under debate, a possible measure is to provide 24/7 in-house (IH) coverage by trauma surgeons. The aim of this study was to compare process-related outcomes for severely injured patients before and after transition of attendance policy from an out-of-hospital (OH) on-call attending trauma surgeon to an in-house attending trauma surgeon. METHODS Retrospective before-and-after study using prospectively gathered data in a Level 1 Trauma Center in the Netherlands. All trauma patients with an Injury Severity Score (ISS) >24 presenting to the emergency department for trauma before (2011-2012) and after (2014-2016) introduction of IH attendings were included. Primary outcome measures were the process-related outcomes Emergency Department length of stay (ED-LOS) and time to first intervention. RESULTS After implementation of IH trauma surgeons, ED-LOS decreased (p = 0.009). Time from the ED to the intensive care unit (ICU) for patients directly transferred to the ICU was significantly shorter with more than doubling of the percentage of patients that reached the ICU within an hour. The percentage of patients undergoing emergency surgery within 30 min nearly doubled as well, with a larger amount of patients undergoing CT imaging before emergency surgery. CONCLUSIONS Introduction of a 24/7 in-house attending trauma surgeon led to improved process-related outcomes for the most severely injured patients. There is clear benefit of continuous presence of physicians with sufficient experience in trauma care in hospitals treating large numbers of severely injured patients.
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Affiliation(s)
| | | | - Diederik P J Smeeing
- University Medical Center Utrecht, Department of Surgery, Utrecht, The Netherlands.
| | - Roderick M Houwert
- University Medical Center Utrecht, Department of Surgery, Utrecht, The Netherlands.
| | | | | | - Geertje A M Govaert
- University Medical Center Utrecht, Department of Surgery, Utrecht, The Netherlands.
| | - Mirjam B de Jong
- University Medical Center Utrecht, Department of Surgery, Utrecht, The Netherlands.
| | - Ivar G J de Bruin
- University Medical Center Utrecht, Department of Surgery, Utrecht, The Netherlands.
| | - Luke P H Leenen
- University Medical Center Utrecht, Department of Surgery, Utrecht, The Netherlands.
| | - Falco Hietbrink
- University Medical Center Utrecht, Department of Surgery, Utrecht, The Netherlands.
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Larsen T, Beier-Holgersen R, Østergaard D, Dieckmann P. Training residents to lead emergency teams: A qualitative review of barriers, challenges and learning goals. Heliyon 2018; 4:e01037. [PMID: 30603684 PMCID: PMC6304469 DOI: 10.1016/j.heliyon.2018.e01037] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 09/14/2018] [Accepted: 12/07/2018] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE An investigation to determine any consensus in opinions and views in the literature about challenges or barriers in training leadership for emergencies. SUMMARY OF BACKGROUND DATA Leadership in emergencies is reported as being very important for patient outcome. A systematic review failed in 2016 to find any focused leadership training. In the literature, the research has described and focused on developing tools to evaluate leadership. METHOD Articles identified in the systematic review combined with other reviews and opinions were included to incorporate experiences, perceptions and emotions connected with leadership training in emergency situations. Two qualitative content analyses were conducted. The first analysis searched for opinions about leadership and leadership training in emergencies. The method was abductive - inductive qualitative content analysis. The second analysis searched, on the basis of an article written in 1986, statements about challenges regarding leadership training in all articles. This method was directed qualitative content analysis. FINDINGS In total 40 articles covering the years 1986-2016 were analysed. An explicit need for workable leadership training of team leaders in emergencies was identified. The importance of the teamleader in emergencies was repeatedly stressed by 31/40 articles, leadership training is needed or required was stated by 30/40 articles, 27/40 articles described the emergency situation as stressful, complex, chaotic or unpredictable, 17/40 described the importance of self-confidence by the teamleader, and 8/40 described that the situation was perceived as creating concern, anxiety or panic. CONCLUSIONS The literature recommends finding a solution to teach residents to gain courage and confidence in stressful surroundings. The literature recommends finding a way to work with body language, non-verbal communication, attitude and appearance in order to radiate credibility in a setting separated from medical knowledge.
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Affiliation(s)
- Ture Larsen
- Simulation Unit (SimNord), Department of Administration, Nordsjællands Hospital, Denmark
| | | | - Doris Østergaard
- Copenhagen Academy for Medical Education and Simulation (CAMES), Capital Region of Denmark and University of Copenhagen, Copenhagen, Denmark
| | - Peter Dieckmann
- Copenhagen Academy for Medical Education and Simulation (CAMES), Capital Region of Denmark and University of Copenhagen, Copenhagen, Denmark
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A search for training of practising leadership in emergency medicine: A systematic review. Heliyon 2018; 4:e00968. [PMID: 30761367 PMCID: PMC6286301 DOI: 10.1016/j.heliyon.2018.e00968] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Revised: 09/11/2018] [Accepted: 11/20/2018] [Indexed: 11/23/2022] Open
Abstract
Objective This systematic review examines the medical, psychological and educational literature for training in practising leadership of a team leader in emergencies. The objectives of this paper are (1) describe how literature addresses operational training in practising leadership for the emergency medical team-leader (2) enhance understanding of leadership training in the medical environment. Background Worldwide, medical supervisors find it difficult to get students to rise to the occasion as leaders of emergency teams. It appears that many residents feel unprepared to adopt the role as a leader in emergencies. Method A systematic review was conducted (May-December 2016) in accordance with the PRISMA 2009 Checklist. A literature search was conducted against a set of inclusion criteria. Databases searched included PubMed, Psycinfo (via Ovid), and ERIC. Results 27 articles covering the period 1986-2016 were analysed. Four sources of data were identified: Intervention studies practising leadership, intervention studies on simulation and leadership assessment, observation studies assessing leadership, interview/survey studies about the need for leadership training. No workable training in practising leadership in emergencies for doctors was found. The majority of the research projects focused on various different types of taxonomies. Conclusions No consistent and workable leadership training for the emergency medical teamleader was identified. One study for paramedics succeeded in training empowering leadership skills. For many years multiple taxonomies and leadership assessment tools have been developed but failed to come to terms with workable leadership training. The literature describes lack of leadership as highly detrimental to performance during a critical, clinical situation.
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Hong ZJ, Chen CJ, Chan DC, Chen TW, Yu JC, Hsu SD. Experienced trauma team leaders save the lives of multiple-trauma patients with severe head injuries. Surg Today 2018; 49:261-267. [PMID: 30302552 DOI: 10.1007/s00595-018-1723-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2018] [Accepted: 09/29/2018] [Indexed: 11/25/2022]
Abstract
The trauma team leader is a professional who receives and treats trauma patients. We aimed to evaluate whether or not the seniority of a qualified trauma team leader was a prognostic factor for multiple-trauma patients managed by a trauma team. This was a retrospective cohort study conducted at a Level I Trauma Center in North Taiwan. From January 2009 to December 2013, 284 patients were randomly assigned to one of two trauma team leaders (junior and senior leaders) on duty, irrespective of the seniority of the qualified trauma team leader. All parameters were collected and compared between these two groups. In the subgroup of multiple-trauma patients with Glasgow Coma Scale (GCS) ≤ 8, there were significant differences in the injury severity score, revised trauma score, and seniority of the leader between the alive and dead groups. A multivariate logistic regression analysis showed that the seniority of the trauma team leader was an important mortality risk factor [odds ratio (OR): 14.529, 95% confidence interval (CI) 1.683-125.429, p = 0.015] in patients with GCS ≤ 8. However, in patients with GCS > 8, age was the only independent risk factor [OR: 1.055, 95% CI 1.023-1.087, p = 0.001]. The seniority of the qualified trauma leader is important for teamwork, organization, and efficiency, all of which play an important role in improving the survival outcome of patients with GCS ≤ 8.
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Affiliation(s)
- Zhi-Jie Hong
- Division of General Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC.,Division of Trauma Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC.,Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Cheng-Jueng Chen
- Division of General Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC.,Division of Trauma Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC
| | - De-Chuan Chan
- Division of General Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Teng-Wei Chen
- Division of General Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Jyh-Cherng Yu
- Division of General Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Sheng-Der Hsu
- Division of General Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC. .,Division of Trauma Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC. .,Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, 325, Sec 2, Chen-Kung Rd, Neihu 114, Taipei, Taiwan, ROC.
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Dunn JA, Schroeppel TJ, Metzler M, Cribari C, Corey K, Boyd DR. History and significance of the trauma resuscitation flow sheet. Trauma Surg Acute Care Open 2018; 3:e000145. [PMID: 30402554 PMCID: PMC6203133 DOI: 10.1136/tsaco-2017-000145] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Revised: 07/25/2018] [Accepted: 08/08/2018] [Indexed: 11/08/2022] Open
Abstract
There is little to no written information in the literature regarding the origin of the trauma flow sheet. This vital document allows programs to evaluate initial processes of trauma care. This information populates the trauma registry and is reviewed in nearly every Trauma Process Improvement and Patient Safety conference when discerning the course of patient care. It is so vital, a scribe is assigned to complete this documentation task for all trauma resuscitations, and there are continual process improvement efforts in trauma centers across the nation to ensure complete and accurate data collection. Indeed, it is the single most important document reviewed by the verification committee when evaluating processes of care at site visits. Trauma surgeons often overlook its importance during resuscitation, as recording remains the domain of the trauma scribe. Yet it is the first document scrutinized when the outcome is less than what is expected. The development of the flow sheet is not a result of any consensus statement, expert work group, or mandate, but a result of organic evolution due to the need for relevant and better data. The purpose of this review is to outline the origin, importance, and critical utility of the trauma flow sheet.
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Affiliation(s)
- Julie A Dunn
- Trauma and Acute Care Surgery, UC Health Medical Center of the Rockies, Loveland, Colorado, USA
| | - Thomas J Schroeppel
- Trauma and Acute Care Surgery, UC Health Memorial Hospital, Colorado Springs, Colorado, USA
| | - Michael Metzler
- Trauma and Acute Care Surgery, UC Health Medical Center of the Rockies, Loveland, Colorado, USA
| | - Chris Cribari
- Trauma and Acute Care Surgery, UC Health Medical Center of the Rockies, Loveland, Colorado, USA
- Trauma and Acute Care Surgery, UC Health Memorial Hospital, Colorado Springs, Colorado, USA
| | - Katherine Corey
- Trauma and Acute Care Surgery, UC Health Medical Center of the Rockies, Loveland, Colorado, USA
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Quick JA. Simulation Training in Trauma. MISSOURI MEDICINE 2018; 115:447-450. [PMID: 30385994 PMCID: PMC6205286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Trauma care is the classic high-acuity event for which simulation training has the potential to greatly improve outcomes. While not a new concept, the variability and availability of training modalities in trauma continues to rapidly multiply. Spanning the continuum of fidelity, simulation extends from simple trauma scenario discussion, to advanced virtual reality experiences. The choice of simulation is largely dependent upon the desired outcome, which is broadly divided into either task-oriented or non-technical skill acquisition.
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Affiliation(s)
- Jacob A Quick
- Jacob A. Quick, MD, FACS, is Assistant Professor of Surgery, Division of Acute Care Surgery, Department of Surgery, University of Missouri School of Medicine, Columbia, Missouri
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27
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Larsen T, Beier-Holgersen R, Dieckmann P, Østergaard D. Conducting the emergency team: A novel way to train the team-leader for emergencies. Heliyon 2018; 4:e00791. [PMID: 30263972 PMCID: PMC6156909 DOI: 10.1016/j.heliyon.2018.e00791] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Revised: 06/27/2018] [Accepted: 09/11/2018] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Worldwide, medical supervisors find it difficult to get students to rise to the occasion when called upon to act as leaders of emergency teams: many residents/rescuers feel unprepared to adopt the leadership role. The challenge is to address the residents very strong emotions caused by the extremely stressful context. No systematic leadership training takes this aspect into account. AIM The overall aim of the course is to investigate whether, in an emergency, a clinical team leader could apply a conductor's leadership skills. BACKGROUND An orchestral conductor is a specialist in practicing leadership focusing on non-verbal communication. The conductor works with highly trained specialists and must lead them to cooperate and put his interpretation into effect. The conductor works purposefully in order to appear calm, genuine and gain authority. METHOD A conductor and a consultant prepared a course for residents, medical students and nurses, n = 61. Ten × two course days were completed. The exercises were musical and thus safe for the students as there were no clinical skills at stake. The programme aimed to create stress and anxiety in a safe learning environment. CONCLUSION The transfer of a conductor's skills improved and profoundly changed the participating students', nurses' and residents' behaviour and introduced a method to handle anxiety and show calmness and authority. PERSPECTIVES If this course in leadership is to be introduced as a compulsory part of the educating of doctors, the ideal time would be after clinical skills have been acquired, experience gained and routines understood in the clinic.
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Affiliation(s)
- Ture Larsen
- Simulation Unit (SimNord), Department of Administration, Kvalitetsafdelingen, Nordsjællands Hospital, Dyrehavevej 29, 3400 Hillerød, Denmark
| | - Randi Beier-Holgersen
- Department of Gastrointestinal Surgery, Nordsjællands Hospital, Dyrehavevej 29, 3400 Hillerød, Denmark
| | - Peter Dieckmann
- Copenhagen Academy for Medical Education and Simulation (CAMES), Capital Region of Denmark and University of Copenhagen, Herlev Hospital, Herlev Ringvej 75, 25 etage, 2730 Herlev, Copenhagen, Denmark
| | - Doris Østergaard
- Copenhagen Academy for Medical Education and Simulation (CAMES), Capital Region of Denmark and University of Copenhagen, Herlev Hospital, Herlev Ringvej 75, 25 etage, 2730 Herlev, Copenhagen, Denmark
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Jakobsen RB, Gran SF, Grimsmo B, Arntzen K, Fosse E, Frich JC, Hjortdahl P. Examining participant perceptions of an interprofessional simulation-based trauma team training for medical and nursing students. J Interprof Care 2017; 32:80-88. [DOI: 10.1080/13561820.2017.1376625] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Rune Bruhn Jakobsen
- Department of Health Management and Health Economics, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of Orthopedic Surgery, Akershus University Hospital, University of Oslo, Oslo, Norway
| | - Sarah Frandsen Gran
- Department of Health Management and Health Economics, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of General Practice, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Bergsvein Grimsmo
- Department of Nursing, Faculty of Health Sciences, Oslo and Akershus University College of Applied Sciences, Oslo, Norway
| | - Kari Arntzen
- Department of Nursing, Faculty of Health Sciences, Oslo and Akershus University College of Applied Sciences, Oslo, Norway
| | - Erik Fosse
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
- The Intervention Centre, Oslo University Hospital, Oslo, Norway
| | - Jan C. Frich
- Department of Health Management and Health Economics, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Per Hjortdahl
- Department of General Practice, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
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Lapierre A, Gauvin-Lepage J, Lefebvre H. La collaboration interprofessionnelle lors de la prise en charge d’un polytraumatisé aux urgences : une revue de la littérature. Rech Soins Infirm 2017:73-88. [DOI: 10.3917/rsi.129.0073] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Braun M, Schmidt WU, Möckel M, Römer M, Ploner CJ, Lindner T. Coma of unknown origin in the emergency department: implementation of an in-house management routine. Scand J Trauma Resusc Emerg Med 2016; 24:61. [PMID: 27121376 PMCID: PMC4848793 DOI: 10.1186/s13049-016-0250-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2015] [Accepted: 04/20/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Coma of unknown origin is an emergency caused by a variety of possibly life-threatening pathologies. Although lethality is high, there are currently no generally accepted management guidelines. METHODS We implemented a new interdisciplinary standard operating procedure (SOP) for patients presenting with non-traumatic coma of unknown origin. It includes a new in-house triage process, a new alert call, a new composition of the clinical response team and a new management algorithm (altogether termed "coma alarm"). It is triggered by two simple criteria to be checked with out-of-hospital emergency response teams before the patient arrives. A neurologist in collaboration with an internal specialist leads the in-hospital team. Collaboration with anaesthesiology, trauma surgery and neurosurgery is organised along structured pathways that include standardised laboratory tests and imaging. Patients were prospectively enrolled. We calculated response times as well as sensitivity and false positive rates, thus proportions of over- and undertriaged patients, as quality measures for the implementation in the SOP. RESULTS During 24 months after implementation, we identified 325 eligible patients. Sensitivity was 60 % initially (months 1-4), then fluctuated between 84 and 94 % (months 5-24). Overtriage never exceeded 15 % and undertriage could be kept low at a maximum of 11 % after a learning period. We achieved a median door-to-CT time of 20 minutes. 85 % of patients needed subsequent ICU treatment, 40 % of which required specialised neuro-ICUs. DISCUSSION Our results indicate that our new simple in-house triage criteria may be sufficient to identify eligible patients before arrival. We aimed at ensuring the fastest possible proceedings given high portions of underlying time-sensitive neurological and medical pathologies while using all available resources as purposefully as possible. CONCLUSIONS Our SOP may provide an appropriate tool for efficient management of patients with non-traumatic coma. Our results justify the assignment of the initial diagnostic workup to neurologists and internal specialists in collaboration with anaesthesiologists.
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Affiliation(s)
- Mischa Braun
- Department of Neurology, Charité-Universitätsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany.,Center for Stroke Research, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Wolf Ulrich Schmidt
- Department of Neurology, Charité-Universitätsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany. .,Center for Stroke Research, Charité-Universitätsmedizin Berlin, Berlin, Germany.
| | - Martin Möckel
- Department of Emergency Medicine, Charité-Universitätsmedizin Berlin, Campus Virchow-Klinikum, Berlin, Germany
| | - Michael Römer
- Department of Anaesthesiology and Intensive Care Medicine, Charité-Universitätsmedizin Berlin, Campus Virchow-Klinikum, Berlin, Germany
| | - Christoph J Ploner
- Department of Neurology, Charité-Universitätsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Tobias Lindner
- Department of Emergency Medicine, Charité-Universitätsmedizin Berlin, Campus Virchow-Klinikum, Berlin, Germany
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Härgestam M, Hultin M, Brulin C, Jacobsson M. Trauma team leaders' non-verbal communication: video registration during trauma team training. Scand J Trauma Resusc Emerg Med 2016; 24:37. [PMID: 27015914 PMCID: PMC4807541 DOI: 10.1186/s13049-016-0230-7] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2015] [Accepted: 03/17/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There is widespread consensus on the importance of safe and secure communication in healthcare, especially in trauma care where time is a limiting factor. Although non-verbal communication has an impact on communication between individuals, there is only limited knowledge of how trauma team leaders communicate. The purpose of this study was to investigate how trauma team members are positioned in the emergency room, and how leaders communicate in terms of gaze direction, vocal nuances, and gestures during trauma team training. METHODS Eighteen trauma teams were audio and video recorded during trauma team training in the emergency department of a hospital in northern Sweden. Quantitative content analysis was used to categorize the team members' positions and the leaders' non-verbal communication: gaze direction, vocal nuances, and gestures. The quantitative data were interpreted in relation to the specific context. Time sequences of the leaders' gaze direction, speech time, and gestures were identified separately and registered as time (seconds) and proportions (%) of the total training time. RESULTS The team leaders who gained control over the most important area in the emergency room, the "inner circle", positioned themselves as heads over the team, using gaze direction, gestures, vocal nuances, and verbal commands that solidified their verbal message. Changes in position required both attention and collaboration. Leaders who spoke in a hesitant voice, or were silent, expressed ambiguity in their non-verbal communication: and other team members took over the leader's tasks. DISCUSSION In teams where the leader had control over the inner circle, the members seemed to have an awareness of each other's roles and tasks, knowing when in time and where in space these tasks needed to be executed. Deviations in the leaders' communication increased the ambiguity in the communication, which had consequences for the teamwork. Communication cannot be taken for granted; it needs to be practiced regularly just as technical skills need to be trained. Simulation training provides healthcare professionals the opportunity to put both verbal and non-verbal communication in focus, in order to improve patient safety. CONCLUSIONS Non-verbal communication plays a decisive role in the interaction between the trauma team members, and so both verbal and non-verbal communication should be in focus in trauma team training. This is even more important for inexperienced leaders, since vague non-verbal communication reinforces ambiguity and can lead to errors.
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Affiliation(s)
- Maria Härgestam
- Department of Nursing, Umeå University, S-90187, Umeå, Sweden. .,Department of Surgical and Perioperative Sciences, Umeå University, S-90185, Umeå, Sweden.
| | - Magnus Hultin
- Department of Surgical and Perioperative Sciences, Umeå University, S-90185, Umeå, Sweden
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Härgestam M, Lindkvist M, Jacobsson M, Brulin C, Hultin M. Trauma teams and time to early management during in situ trauma team training. BMJ Open 2016; 6:e009911. [PMID: 26826152 PMCID: PMC4735161 DOI: 10.1136/bmjopen-2015-009911] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVES To investigate the association between the time taken to make a decision to go to surgery and gender, ethnicity, years in profession, experience of trauma team training, experience of structured trauma courses and trauma in the trauma team, as well as use of closed-loop communication and leadership styles during trauma team training. DESIGN In situ trauma team training. The patient simulator was preprogrammed to represent a severely injured patient (injury severity score: 25) suffering from hypovolemia due to external trauma. SETTING An emergency room in an urban Scandinavian level one trauma centre. PARTICIPANTS A total of 96 participants were divided into 16 trauma teams. Each team consisted of six team members: one surgeon/emergency physician (designated team leader), one anaesthesiologist, one registered nurse anaesthetist, one registered nurse from the emergency department, one enrolled nurse from the emergency department and one enrolled nurse from the operating theatre. PRIMARY OUTCOME HRs with CIs (95% CI) for the time taken to make a decision to go to surgery was computed from a Cox proportional hazards model. RESULTS Three variables remained significant in the final model. Closed-loop communication initiated by the team leader increased the chance of a decision to go to surgery (HR: 3.88; CI 1.02 to 14.69). Only 8 of the 16 teams made the decision to go to surgery within the timeframe of the trauma team training. Conversely, call-outs and closed-loop communication initiated by the team members significantly decreased the chance of a decision to go to surgery, (HR: 0.82; CI 0.71 to 0.96, and HR: 0.23; CI 0.08 to 0.71, respectively). CONCLUSIONS Closed-loop communication initiated by the leader appears to be beneficial for teamwork. In contrast, a high number of call-outs and closed-loop communication initiated by team members might lead to a communication overload.
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Affiliation(s)
- Maria Härgestam
- Department of Nursing, Umeå University, Umeå, Sweden
- Department of Surgical and Perioperative Sciences, Anaesthesiology and Intensive Care, Umeå University, Umeå, Sweden
| | - Marie Lindkvist
- Department of Statistics, Umeå School of Business and Economics, Umeå International School of Public Health, Umeå University, Umeå, Sweden
- Department of Public Health and Clinical Medicine, Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | | | | | - Magnus Hultin
- Department of Surgical and Perioperative Sciences, Anaesthesiology and Intensive Care, Umeå University, Umeå, Sweden
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Zimmermann K, Holzinger IB, Ganassi L, Esslinger P, Pilgrim S, Allen M, Burmester M, Stocker M. Inter-professional in-situ simulated team and resuscitation training for patient safety: Description and impact of a programmatic approach. BMC MEDICAL EDUCATION 2015; 15:189. [PMID: 26511721 PMCID: PMC4625566 DOI: 10.1186/s12909-015-0472-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Accepted: 10/22/2015] [Indexed: 05/21/2023]
Abstract
BACKGROUND Inter-professional teamwork is key for patient safety and team training is an effective strategy to improve patient outcome. In-situ simulation is a relatively new strategy with emerging efficacy, but best practices for the design, delivery and implementation have yet to be evaluated. Our aim is to describe and evaluate the implementation of an inter-professional in-situ simulated team and resuscitation training in a teaching hospital with a programmatic approach. METHODS We designed and implemented a team and resuscitation training program according to Kern's six steps approach for curriculum development. General and specific needs assessments were conducted as independent cross-sectional surveys. Teamwork, technical skills and detection of latent safety threats were defined as specific objectives. Inter-professional in-situ simulation was used as educational strategy. The training was embedded within the workdays of participants and implemented in our highest acuity wards (emergency department, intensive care unit, intermediate care unit). Self-perceived impact and self-efficacy were sampled with an anonymous evaluation questionnaire after every simulated training session. Assessment of team performance was done with the team-based self-assessment tool TeamMonitor applying Van der Vleuten's conceptual framework of longitudinal evaluation after experienced real events. Latent safety threats were reported during training sessions and after experienced real events. RESULTS The general and specific needs assessments clearly identified the problems, revealed specific training needs and assisted with stakeholder engagement. Ninety-five interdisciplinary staff members of the Children's Hospital participated in 20 in-situ simulated training sessions within 2 years. Participant feedback showed a high effect and acceptance of training with reference to self-perceived impact and self-efficacy. Thirty-five team members experiencing 8 real critical events assessed team performance with TeamMonitor. Team performance assessment with TeamMonitor was feasible and identified specific areas to target future team training sessions. Training sessions as well as experienced real events revealed important latent safety threats that directed system changes. CONCLUSIONS The programmatic approach of Kern's six steps for curriculum development helped to overcome barriers of design, implementation and assessment of an in-situ team and resuscitation training program. This approach may help improve effectiveness and impact of an in-situ simulated training program.
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Affiliation(s)
- Katja Zimmermann
- Department of Paediatrics, Children's Hospital Lucerne, CH-6000, Lucerne 16, Switzerland.
| | | | - Lorena Ganassi
- Department of Paediatrics, Children's Hospital Lucerne, CH-6000, Lucerne 16, Switzerland.
| | - Peter Esslinger
- Department of Paediatrics, Children's Hospital Lucerne, CH-6000, Lucerne 16, Switzerland.
| | - Sina Pilgrim
- University Children's Hospital Berne, Inselspital, CH-3000, Bern, Switzerland.
| | - Meredith Allen
- The Royal Children's Hospital, Flemington Road, Parkville, VIC, 3052, Australia.
| | | | - Martin Stocker
- Department of Paediatrics, Children's Hospital Lucerne, CH-6000, Lucerne 16, Switzerland.
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Surgeons' Leadership Styles and Team Behavior in the Operating Room. J Am Coll Surg 2015; 222:41-51. [PMID: 26481409 DOI: 10.1016/j.jamcollsurg.2015.09.013] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Revised: 09/16/2015] [Accepted: 09/21/2015] [Indexed: 11/22/2022]
Abstract
BACKGROUND The importance of leadership is recognized in surgery, but the specific impact of leadership style on team behavior is not well understood. In other industries, leadership is a well-characterized construct. One dominant theory proposes that transactional (task-focused) leaders achieve minimum standards and transformational (team-oriented) leaders inspire performance beyond expectations. STUDY DESIGN We videorecorded 5 surgeons performing complex operations. Each surgeon was scored on the Multifactor Leadership Questionnaire, a validated method for scoring transformational and transactional leadership style, by an organizational psychologist and a surgeon researcher. Independent coders assessed surgeons' leadership behaviors according to the Surgical Leadership Inventory and team behaviors (information sharing, cooperative, and voice behaviors). All coders were blinded. Leadership style (Multifactor Leadership Questionnaire) was correlated with surgeon behavior (Surgical Leadership Inventory) and team behavior using Poisson regression, controlling for time and the total number of behaviors, respectively. RESULTS All surgeons scored similarly on transactional leadership (range 2.38 to 2.69), but varied more widely on transformational leadership (range 1.98 to 3.60). Each 1-point increase in transformational score corresponded to 3 times more information-sharing behaviors (p < 0.0001) and 5.4 times more voice behaviors (p = 0.0005) among the team. With each 1-point increase in transformational score, leaders displayed 10 times more supportive behaviors (p < 0.0001) and displayed poor behaviors 12.5 times less frequently (p < 0.0001). Excerpts of representative dialogue are included for illustration. CONCLUSIONS We provide a framework for evaluating surgeons' leadership and its impact on team performance in the operating room. As in other fields, our data suggest that transformational leadership is associated with improved team behavior. Surgeon leadership development, therefore, has the potential to improve the efficiency and safety of operative care.
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Hanche-Olsen TP, Alemu L, Viste A, Wisborg T, Hansen KS. Evaluation of training program for surgical trauma teams in Botswana. World J Surg 2015; 39:658-68. [PMID: 25413178 DOI: 10.1007/s00268-014-2873-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Trauma represents a challenge to healthcare systems worldwide, particularly in low-and middle-income countries. Positive effects can be achieved by improving trauma care at the scene of the accident and throughout hospitalization and rehabilitation. Therefore, we assessed the long-term effects of national implementation of a training program for multidisciplinary trauma teams in a southern African country. METHODS From 2007 to 2009, an educational program for trauma, "Better and Systematic Team Training," (BEST) was implemented at all government hospitals in Botswana. The effects were assessed through interviews, a structured questionnaire, and physical inspections using the World Health Organization's "Guidelines for Essential Trauma Care." Data on human and physical resources, infrastructure, trauma administrative functions, and quality-improvement activities before and at 2-year follow-up were compared for all 27 government hospitals. RESULTS A majority of hospitals had formed local trauma organizations; half were performing multidisciplinary trauma simulations and some had organized multidisciplinary trauma teams with alarm criteria. A number of hospitals had developed local trauma guidelines and local trauma registries. More equipment for advanced airway management and stiff cervical collars were available after 2 years. There were also improvements in the skills necessary for airway and breathing management. The most changes were seen in the northern region of Botswana. CONCLUSIONS Implementation of BEST in Botswana hospitals was associated with several positive changes at 2-year follow-up, particularly for trauma administrative functions and quality-improvement activities. The effects on obtaining technical equipment and skills were moderate and related mostly to airway and breathing management.
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Abstract
This article considers the role of the clinical leader as a team member and leader and explores how an understanding of the purpose and functions of teams can help doctors work more effectively in the various teams with which they are involved.
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Affiliation(s)
- Helen O'Sullivan
- Professor of Medical Education, School of Medicine, University of Liverpool, Liverpool L69 3BX
| | - Michael J Moneypenny
- Director of Scottish Clinical Simulation Centre, Forth Valley Royal Hospital, Larbert
| | - Judy McKimm
- Director of Strategic Educational Development, College of Medicine, Swansea University, Swansea
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MacKinnon RJ, Kennedy C, Doherty C, Shepherd M, Cole J, Stenfors-Hayes T. Fitness for purpose study of the Field Assessment Conditioning Tool (FACT): a research protocol. BMJ Open 2015; 5:e006386. [PMID: 25869682 PMCID: PMC4401849 DOI: 10.1136/bmjopen-2014-006386] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
INTRODUCTION As part of a programme of research aiming to improve the outcomes of traumatically injured children, a multisource healthcare advocacy tool has been developed to allow trauma team members and hospital governance administrators to reflect and to act on complex trauma team-hospital systems interactions. We have termed this tool a Field Assessment Conditioning Tool (FACT). The FACT draws on quantitative data including clinical care points in addition to self-reflective qualitative data. The FACT is designed to provide feedback on this assessment data both horizontally across fellow potential team members and vertically to the hospital/organisation governance structure, enabling process gap identification and allowing an agenda of improvements to be realised. The aim of the study described in this paper is to explore the perceived fitness for purpose of the FACT to provide an opportunity for healthcare advocacy by healthcare professionals caring for traumatically injured children. METHODS AND ANALYSIS The FACT will be implemented and studied in three district hospitals, each around a major trauma centre in the UK, USA and New Zealand. Using a qualitative approach with standardised semi-structured interviews and thematic analysis we will explore the following question: Is the FACT fit for purpose in terms of providing a framework to evaluate, reflect and act on the individual hospital's own performance (trauma team-hospital interactions) in terms of readiness to receive traumatically injured children? ETHICS AND DISSEMINATION Ethics opinion was sought for each research host organisation participating and deemed not required. The results will be disseminated to participating sites, networks and published in high-impact journals.
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Affiliation(s)
- Ralph James MacKinnon
- Department of Paediatric Anaesthesia, Royal Manchester Children's Hospital, Manchester, UK
| | - Chris Kennedy
- Emergency & Urgent Care, Children's Mercy Hospital, Kansas City, Kansas, USA
| | - Catherine Doherty
- Department of Paediatric Anaesthesia, Royal Manchester Children's Hospital, Manchester, UK
| | - Michael Shepherd
- Children's Emergency Department, Starship Children's Hospital, Auckland, New Zealand
| | - Joanne Cole
- Children's Emergency Department, Starship Children's Hospital, Auckland, New Zealand
| | - Terese Stenfors-Hayes
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
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McCullough AL, Haycock JC, Forward DP, Moran CG. Early management of the severely injured major trauma patient. Br J Anaesth 2014; 113:234-41. [PMID: 25038155 DOI: 10.1093/bja/aeu235] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
The major trauma team relies on an efficient, communicative team to ensure patients receive the best quality care. This requires a comprehensive handover, rapid systematic review, and early management of life- and limb-threatening injuries. These multiple injured patients often present with complex conditions in a dynamic situation. The importance of team work, communication, senior decision-making, and documentation cannot be underestimated.
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Affiliation(s)
| | - J C Haycock
- Nottingham University Hospital, Nottingham, UK
| | - D P Forward
- Nottingham University Hospital, Nottingham, UK
| | - C G Moran
- Nottingham University Hospital, Nottingham, UK
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Hjortdahl M, Zakariassen E, Wisborg T. The role of general practitioners in the pre hospital setting, as experienced by emergency medicine technicians: a qualitative study. Scand J Trauma Resusc Emerg Med 2014; 22:47. [PMID: 25145390 PMCID: PMC4237950 DOI: 10.1186/s13049-014-0047-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2014] [Accepted: 08/05/2014] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Together with the ambulances staffed with emergency medical technicians (EMTs), general practitioners (GPs) on call are the primary resources for handling emergencies outside hospitals in Norway. The benefit of the GP accompanying the ambulance to pre-hospital calls is a matter of controversy in Norway. The purpose of the present study was to gain better insight into the EMT's experiences with the role of the GPs in the care for critically ill patients in the pre-hospital setting. METHODS We conducted four focus group interviews with EMTs at four different ambulance stations in Norway. Three of the stations were located at least 2 hours driving distance from the nearest hospital. The interviews were transcribed and analyzed using systematic text condensation. RESULTS The EMTs described increasing confidence in emergency medicine during the last few years. However, they felt the need for GP participation in the ambulance when responding to a critically ill patient. The presence of GPs made the EMTs feel more confident, especially in unclear and difficult cases that did not fit into EMT guidelines. The main contributions of the GPs were described as diagnosis and decision-making. Bringing the physician to the patient shortened transportation time to the hospital and important medication could be started earlier. Several examples of sub-optimal treatment in the absence of the GP were given. The EMTs described discomfort with GPs not responding to the calls. They also experienced GPs responding to calls that did not function in the pre-hospital emergency setting. The EMTs reported a need for professional requirements for GPs taking part in out-of-hours work and mandatory interdisciplinary training on a regular basis. CONCLUSIONS EMTs want GPs to be present in challenging pre-hospital emergency settings. The presence of GPs is perceived as improving patient care. However, professional requirements are needed for GPs taking part in out-of-hours work, and the informants suggested a formalized area for training between EMTs and GPs on call.
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Affiliation(s)
- Magnus Hjortdahl
- National Centre for Emergency Primary Health Care, Uni Research Health, Bergen, Norway
| | - Erik Zakariassen
- National Centre for Emergency Primary Health Care, Uni Research Health, Bergen, Norway
- Department of Research, Norwegian Air Ambulance Foundation, Drøbak, 1441, Norway
- Department of Global Public Health and Primary Care University of Bergen, Bergen, 5020, Norway
| | - Torben Wisborg
- Norwegian National Advisory Unit on Trauma, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway
- Anaesthesia and Critical Care Research Group, Faculty of Health Sciences, University of Tromsø, Tromsø, Norway
- Department of Acute Care, Hammerfest hospital, Finnmark Hospital Trust, Hammerfest, Norway
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Frank CB, Wölfl CG, Hogan A, Suda AJ, Gühring T, Gliwitzky B, Münzberg M. PHTLS ® (Prehospital Trauma Life Support) provider courses in Germany - who takes part and what do participants think about prehospital trauma care training? J Trauma Manag Outcomes 2014; 8:7. [PMID: 25050135 PMCID: PMC4104731 DOI: 10.1186/1752-2897-8-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2014] [Accepted: 06/20/2014] [Indexed: 12/01/2022]
Abstract
Background The goal of this study was to examine PHTLS Provider courses in Germany and to proof the assumption that formation of physicians and paramedics in prehospital trauma care can be optimized. Methods PHTLS participants were asked to fill out standardized questionnaires during their course preparation and directly after the course. There were some open questions regarding their professional background and closed questions concerning PHTLS itself. Further questions were to be answered on an analog scale in order to quantify subjective impressions of confidence, knowledge and also to describe individual levels of education and training. Results 247 questionnaires could be analyzed. Physicians noted significant (p < 0.001) more deficits in their professional training than paramedics. 80% of the paramedics affirmed to have had adequate training with respect to prehospital trauma care, all physicians claimed not to have had sufficient training for prehospital trauma care situations at Medical School. Physicians were statistically most significant dissatisfied then paramedics (p < 0.001). While most participants gave positive feedback, anesthetists were less convinced of PHTLS (p = 0.005), didn’t benefit as much as the rest (p = 0.004) and stated more often, that the course was of less value for their daily work (p = 0.03). After the course confidence increased remarkably and reached higher rates than before the course (p < 0.001). After PHTLS both groups showed similar ratings concerning the course concept indicating that PHTLS could equalize some training deficits and help to gain confidence and assurance in prehospital trauma situations. 90% of the paramedics and 100% of the physicians would recommend PHTLS. Physicians and especially anesthetists revised their opinions with regard to providing PHTLS at Medical School after having taken part in a PHTLS course. Conclusion The evaluation of PHTLS courses in Germany indicates the necessity for special prehospital trauma care training. Paramedics and physicians criticize deficits in their professional training, which can be compensated by PHTLS. With respect to relevant items like confidence and knowledge PHTLS leads to a statistically significant increase in ratings on a visual analogue scale. PHTLS should be integrated into the curriculum at Medical School.
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Affiliation(s)
- Christian B Frank
- Department of Orthopedic and Trauma Surgery - Clinic Mittelbaden, Dr. Rumpf Weg 7D 76530 Baden Baden, Germany ; PHTLS Research Group Europe (PERG), Im Schlangengarten 52, D 76877 Offenbach/Queich, Germany
| | - Christoph G Wölfl
- Department of Trauma and Orthopedic Surgery - BG Trauma Center Ludwigshafen, Ludwig-Guttmann-Straße 13, D 67071 Ludwigshafen am Rhein, Germany ; PHTLS Research Group Europe (PERG), Im Schlangengarten 52, D 76877 Offenbach/Queich, Germany
| | - Aidan Hogan
- Department of Trauma and Orthopedic Surgery - BG Trauma Center Ludwigshafen, Ludwig-Guttmann-Straße 13, D 67071 Ludwigshafen am Rhein, Germany
| | - Arnold J Suda
- Department of Trauma and Orthopedic Surgery - BG Trauma Center Ludwigshafen, Ludwig-Guttmann-Straße 13, D 67071 Ludwigshafen am Rhein, Germany
| | - Thorsten Gühring
- Department of Trauma and Orthopedic Surgery - BG Trauma Center Ludwigshafen, Ludwig-Guttmann-Straße 13, D 67071 Ludwigshafen am Rhein, Germany
| | - Bernhard Gliwitzky
- German Association of Emergency Medical Technician (DBRD), Im Schlangengarten 52, D 76877 Offenbach/Queich, Germany ; PHTLS Research Group Europe (PERG), Im Schlangengarten 52, D 76877 Offenbach/Queich, Germany
| | - Matthias Münzberg
- Department of Trauma and Orthopedic Surgery - BG Trauma Center Ludwigshafen, Ludwig-Guttmann-Straße 13, D 67071 Ludwigshafen am Rhein, Germany ; PHTLS Research Group Europe (PERG), Im Schlangengarten 52, D 76877 Offenbach/Queich, Germany
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Team training – The BEST approach to continuing education in resuscitation. TRENDS IN ANAESTHESIA AND CRITICAL CARE 2013. [DOI: 10.1016/j.tacc.2013.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Krueger A, Frink M, Kiessling A, Ruchholtz S, Kühne C. [Emergency room management : in the era of the White Paper, S3 guidelines, Advanced Trauma Life Support® and TraumaNetwork DGU® of the German Society of Trauma Surgery]. Chirurg 2013; 84:437-50. [PMID: 23553150 PMCID: PMC7096044 DOI: 10.1007/s00104-012-2384-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The treatment of the severely injured is, just as the injury severity and combinations, often highly complex and leaves little leeway for delay, dissent or even error. In order to reduce this to a minimum, trained emergency room teams in addition to optimal technical and structural prerequisites are necessary. This must function in an interdisciplinary fashion according to fixed consensus algorithms which are known to all team members and have been agreed by all participants. The White Paper on treatment of the severely injured of the German Society of Trauma Surgery (DGU) and the recently published S3 guidelines offer evidence-based recommendations on the structural, technical, organizational and personnel prerequisites.
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Affiliation(s)
- A. Krueger
- Klinik für Unfall-, Hand- und Wiederherstellungschirurgie, Universitätsklinika Gießen und Marburg GmbH, Standort Marburg, 35043 Marburg, Deutschland
| | - M. Frink
- Klinik für Unfall-, Hand- und Wiederherstellungschirurgie, Universitätsklinika Gießen und Marburg GmbH, Standort Marburg, 35043 Marburg, Deutschland
| | - A. Kiessling
- Klinik für Unfall-, Hand- und Wiederherstellungschirurgie, Universitätsklinika Gießen und Marburg GmbH, Standort Marburg, 35043 Marburg, Deutschland
| | - S. Ruchholtz
- Klinik für Unfall-, Hand- und Wiederherstellungschirurgie, Universitätsklinika Gießen und Marburg GmbH, Standort Marburg, 35043 Marburg, Deutschland
| | - C.A. Kühne
- Klinik für Unfall-, Hand- und Wiederherstellungschirurgie, Universitätsklinika Gießen und Marburg GmbH, Standort Marburg, 35043 Marburg, Deutschland
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Khademian Z, Sharif F, Tabei SZ, Bolandparvaz S, Abbaszadeh A, Abbasi HR. Teamwork improvement in emergency trauma departments. IRANIAN JOURNAL OF NURSING AND MIDWIFERY RESEARCH 2013; 18:333-9. [PMID: 24403932 PMCID: PMC3872871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Interprofessional teamwork is considered as the key to improve the quality of patient management in critical settings such as trauma emergency departments, but it is not fully conceptualized in these areas to guide practice. The aim of this article is to explore interprofessional teamwork and its improvement strategies in trauma emergency departments. MATERIALS AND METHODS Participants of this qualitative study consisted of 11 nurses and 6 supervisors recruited from the emergency departments of a newly established trauma center using purposive sampling. Data were generated using two focus group and six in-depth individual interviews, and analyzed using qualitative content analysis. RESULTS Interprofessional teamwork attributes and improvement strategies were emerged in three main themes related to team, context, and goal. These were categorized as the effective presence of team members, role definition in team framework, managerial and physical context, effective patient management, and overcoming competing goals. CONCLUSIONS Interprofessional teamwork in trauma emergency departments is explained as interdependence of team, context, and goal; so, it may be improved by strengthening these themes. The findings also provide a basis to evaluate, teach, and do research on teamwork.
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Affiliation(s)
- Zahra Khademian
- Department of Nursing, Student Research Center, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Farkhondeh Sharif
- Department of Nursing, Community based Psychiatric Care Research Center, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran,Address for correspondence: Dr. Farkhondeh Sharif, Community based Psychiatric Care Research Center, Department of Nursing, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran. E-mail:
| | - Seyed Ziaadin Tabei
- Medical Ethics Department, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Abbas Abbaszadeh
- Department of Medical-Surgical Nursing, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hamid Reza Abbasi
- Trauma Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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Jacobsson M, Hargestam M, Hultin M, Brulin C. Flexible knowledge repertoires: communication by leaders in trauma teams. Scand J Trauma Resusc Emerg Med 2012; 20:44. [PMID: 22747848 PMCID: PMC3494569 DOI: 10.1186/1757-7241-20-44] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2012] [Accepted: 05/01/2012] [Indexed: 12/02/2022] Open
Abstract
Background In emergency situations, it is important for the trauma team to efficiently communicate their observations and assessments. One common communication strategy is “closed-loop communication”, which can be described as a transmission model in which feedback is of great importance. The role of the leader is to create a shared goal in order to achieve consensus in the work for the safety of the patient. The purpose of this study was to analyze how formal leaders communicate knowledge, create consensus, and position themselves in relation to others in the team. Methods Sixteen trauma teams were audio- and video-recorded during high fidelity training in an emergency department. Each team consisted of six members: one surgeon or emergency physician (the designated team leader), one anaesthesiologist, one nurse anaesthetist, one enrolled nurse from the theatre ward, one registered nurse and one enrolled nurse from the emergency department (ED). The communication was transcribed and analyzed, inspired by discourse psychology and Strauss’ concept of “negotiated order”. The data were organized and coded in NVivo 9. Results The findings suggest that leaders use coercive, educational, discussing and negotiating strategies to work things through. The leaders in this study used different repertoires to convey their knowledge to the team, in order to create a common goal of the priorities of the work. Changes in repertoires were dependent on the urgency of the situation and the interaction between team members. When using these repertoires, the leaders positioned themselves in different ways, either on an authoritarian or a more egalitarian level. Conclusion This study indicates that communication in trauma teams is complex and consists of more than just transferring messages quickly. It also concerns what the leaders express, and even more importantly, how they speak to and involve other team members.
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Moran CG, Forward DP. The early management of patients with multiple injuries: an evidence-based, practical guide for the orthopaedic surgeon. ACTA ACUST UNITED AC 2012; 94:446-53. [PMID: 22434457 DOI: 10.1302/0301-620x.94b4.27786] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
There have been many advances in the resuscitation and early management of patients with severe injuries during the last decade. These have come about as a result of the reorganisation of civilian trauma services in countries such as Germany, Australia and the United States, where the development of trauma systems has allowed a concentration of expertise and research. The continuing conflicts in the Middle East have also generated a significant increase in expertise in the management of severe injuries, and soldiers now survive injuries that would have been fatal in previous wars. This military experience is being translated into civilian practice. The aim of this paper is to give orthopaedic surgeons a practical, evidence-based guide to the current management of patients with severe, multiple injuries. It must be emphasised that this depends upon the expertise, experience and facilities available within the local health-care system, and that the proposed guidelines will inevitably have to be adapted to suit the local resources.
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Affiliation(s)
- C G Moran
- Department of Trauma and Orthopaedics, Queens Medical Centre Campus, Nottingham University Hospitals, Derby Road, Nottingham NG7 2UH, UK.
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Paltved C, Musaeus P. Qualitative Research on Emergency Medicine Physicians: A Literature Review. ACTA ACUST UNITED AC 2012. [DOI: 10.4236/ijcm.2012.37a136] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Abstract
In England, trauma is the leading cause of death across all age groups, with over 16,000 deaths per year. Major trauma implies the presence of multiple, serious injuries that could result in death or serious disability. Successive reports have documented the fact that the current ad hoc unstructured management of this patient group is associated with considerable avoidable death and disability. The reform of trauma care in England, especially of the severely injured patient, has already begun. Strong clinical leadership is embraced as the way forward. The present article summarises the steps that have been made over the last decade that led to the recent decision to move towards a long anticipated restructure of the National Health Service (NHS) trauma services with the introduction of Regional Trauma Networks (RTNs). While, for the first time, a genuine political will and support exists, the changes required to maintain the momentum for the implementation of the RTNs needs to be marshalled against arguments, myths and perceptions from the past. Such an approach may reverse the disinterest attitude of many, and will gradually evolve into a cultural shift of the public, clinicians and policymakers in the fullness of time.
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Affiliation(s)
- Nikolaos K Kanakaris
- Academic Department of Trauma and Orthopaedics, Leeds General Infirmary, Clarendon Wing, Level A, Great George Street, LS13EX, Leeds, UK
| | - Peter V Giannoudis
- Academic Department of Trauma and Orthopaedics, Leeds General Infirmary, Clarendon Wing, Level A, Great George Street, LS13EX, Leeds, UK
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Ringen AH, Hjortdahl M, Wisborg T. Norwegian trauma team leaders--training and experience: a national point prevalence study. Scand J Trauma Resusc Emerg Med 2011; 19:54. [PMID: 21975088 PMCID: PMC3197515 DOI: 10.1186/1757-7241-19-54] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2011] [Accepted: 10/05/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The treatment of trauma victims is a complex multi-professional task in a stressful environment. We previously found that trauma team members perceive leadership as the most important human factor. The aim of the present study was to assess the experience and education of Norwegian trauma team leaders, and allow them to describe their perceived educational needs. METHODS We conducted an anonymous descriptive study using a point prevalence methodology based on written questionnaires. All 45 hospitals in Norway receiving severely injured trauma victims were contacted on a randomly selected weeknight during November 2009. Team leaders were asked to specify what trauma related training programs they had participated in, how much experience they had, and what further training they wished, if any. RESULTS Response rate was 82%. Slightly more than half of the team leaders were residents. The median working experience as a surgeon among team leaders was 7.5 years. Sixty-eight percent had participated in multi-professional training in non-technical skills, while 54% had passed the advanced trauma life support(ATLS) course. Fifty-one percent were trained in damage control surgery. A median of one course per team leader was needed to comply with the new proposed national standards. Team leaders considered training in damage control surgery the most needed educational objective. CONCLUSIONS Level of experience among team leaders was highly variable and their educational background insufficient according to international and proposed national standards. Proposed national standards should be urgently implemented to ensure equal access to high quality trauma care.
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Affiliation(s)
- Amund Hovengen Ringen
- The BEST Foundation: Better & Systematic Team Training, Hammerfest Hospital, Department of Anaesthesiology and Intensive Care, Finnmark Health Trust, Hammerfest, Norway.
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