Variation of in-hospital trauma team staffing: new resuscitation, new team

Team member familiarity and team effectiveness in the operating room: The mediating effect of mutual trust and shared mental models

BACKGROUND

Teamwork in the operating room is of paramount importance to provide high-quality patient care. It has been shown that increased team member familiarity predicts improved teamwork. A complicating factor is the often-changing composition of the operating room teams. Team member familiarity is associated with shared mental models and mutual trust, which are in turn important factors for team effectiveness. However, it remains unclear how this interplay takes place and can be influenced (eg, through team training). Our aim was to investigate the relationship between team member familiarity and perceived team effectiveness in operating room teams. We hypothesized that shared mental models and mutual trust mediate this relationship.

METHODS

We performed a prospective, correlational study in 2 hospitals in the Netherlands. A questionnaire was used to assess team member familiarity, mutual trust, shared mental models (perceived and content-related), and perceived team effectiveness. Data were analyzed using a random intercept multilevel model.

RESULTS

Team member familiarity significantly predicted perceived team effectiveness, both through a direct effect, as well as mediated by perceived shared mental models. Mutual trust also significantly predicted team effectiveness. Variance is determined mostly at an individual level, but also partly (12%) at the operating room level.

CONCLUSION

Greater team member familiarity predicts greater team effectiveness, and this relationship is mediated by shared mental models. Training should be aimed at these aspects of team functioning to optimize team performance in the operating room.

Non-technical skills and teamwork in trauma: from the emergency department to the operating room

Management of a trauma patient is a challenging process. Swift and accurate clinical assessment is required and time-sensitive decisions and life-saving procedures must be performed in an unstable patient. This requires a coordinated response by both the emergency room (ER) and operating room (OR) teams. However, a team of experts does not necessarily make an expert team. Root cause analysis of adverse events in surgery has shown that failures in coordination, planning, task management and particularly communication are the main causes for medical errors. While most research is focused on the ER trauma team, the trauma OR team also deserves attention. In fact, OR team dynamics may resemble more the ER team than the elective OR team. ER and OR trauma teams assemble on short notice, and their members, who are from different specialties and backgrounds, may not train regularly together or even know each other beforehand. And yet, they have to perform high-risk procedures and make high stake decisions, in a time-sensitive manner. The airline industry has long recognized the role of team training and non-technical skills (NTS) in reducing hazards. The implementation of the so called crew resource management or crisis resource management (CRM) has significantly made airline travel safer and the transposition to the medical context, with specific training in non-technical skills, has also brought great benefits. In fact, it is clear that adoption of non-technical skills (NTS) in healthcare has led to an increase in patient safety. In this narrative review we recapitulate some of the key non-technical skills and their relevance in trauma, with a focus on both the emergency department (ER) and the operating room (OR) teams, as well as on the transition of care from one to the other. Also, we explore the use of debriefing the team, as well as the roles of NTS training in both undergraduate and postgraduate settings. We review some of the existing trauma training courses and their roles in developing NTS. Finally, we briefly address the challenges posed by the development of trauma hybrid operating rooms.

On the edge of decision-making in trauma care: A focus group study on radiographers' experiences of interprofessional collaboration

INTRODUCTION

The temporary trauma teams in trauma alerts consist of a diverse group of unique professionals requiring interprofessional collaboration and coordination to achieve efficient, high-quality care. The uncertain situation and complex care environment impose high demands on team dynamics such as individual attitudes and team behaviours. Within interprofessional teams, interaction and coordination reflect the collective success of collaboration and the achievement of goals. Interactions with radiographers have increased in trauma teams given computed tomography's prominent role in providing crucial knowledge for decision-making in trauma care. This study aimed to explore radiographers' experiences of interprofessional collaboration during trauma alerts.

METHOD

The study was designed with focus group methodology, including 17 radiographers participating in five focus groups, analysed with an inductive focus group analysis.

RESULTS

An overarching theme, "On the edge of decision-making", emerged along with three sub-themes: "Feeling included requires acknowledgement", "Exclusion precludes shared knowledge", and "Experience and mutual awareness facilitate team interaction".

CONCLUSIONS

Interprofessional collaboration from the radiographer's perspective within trauma teams requires a sense of inclusion and the ability to interact with the team. Exclusion from vital decision-making obstructs radiographers' comprehension of situations and thereby the interdependence in interprofessional collaboration.

IMPLICATIONS FOR PRACTICE

Common platforms are needed for knowledge sharing and team practices, including radiographers' areas of responsibility and relational coordination to foster interprofessional relationships. Through these means interdependence through awareness and shared knowledge can be facilitated on trauma teams.