Team communication patterns during real and simulated trauma resuscitation-a social network analysis

In trauma teams, coordination can be established through a centralised leader. The team can also use a decentralised strategy. In this descriptive study of video-recorded trauma resuscitations, using quantification of qualitative data, Social Network analysis of all real-time communications of eight in-real-life (IRL) and simulated trauma teams explained team social structure. The communication network structures in the simulated scenarios were more centralised using individually directed speech and had a high proportion of communication to update all team members. Such a structure might be the result of work performed in a complexity-stripped simulation environment where simplified task-executions required less interactions, or from work revolving around a deteriorating patient, imposing high demands on rapid decision-making and taskwork. Communication IRL was mostly decentralised, with more variability between cases, possibly due to unpredictability of the IRL case. The flexibility to act in a decentralised manner potentiates adaptability and seems beneficial in rapidly changing situations.Practitioner summary: Efficient collaboration in trauma teams is essential. Communication in in-real-life and simulated trauma teams was analysed using social network analysis. The simulation teams were overall more centralised compared to the IRL teams. The flexibility to act decentralised seems beneficial for emergency teams as it enables adaptability in unpredictable situations.

Development of trauma team cognition can be explained by "split vision": A grounded theory study

The aim of this study was to explore interaction of interprofessional hospital trauma teams. A theory about how team cognition is developed through a dynamical process was established using grounded theory methodology. Video recordings of in-real-life resuscitations performed in the emergency ward of a Scandinavian mid-size urban hospital were collected and eligible for inclusion using theoretical sampling. By analyzing interactions during seven trauma resuscitations, the theory that trauma teams perform patient assessment and resuscitation by alternating between two process modes, the two main categories "team positioning" and "sensitivity to the patient," was generated. The core category "working with split vision" explicates how the teams interplay between the two modes to coordinate team focus with an emergent mental model of the specific situation. Split vision ensures that deeper aspects of the team, such as culture, knowledge, empathy, and patient needs are absorbed to continuously adapt team positioning and create precision in care for the specific patient.

An analysis of trauma team communication using the verbal response mode taxonomy

BACKGROUND

Although 40 years has passed since the Institute of Medicine released its report "To Err Is Human," error counts are still high in healthcare. The understanding and training of nontechnical skills and teamwork thus remains a pertinent area for improvement. Most evaluation of nontechnical skills of trauma teams takes place in simulation rooms. The aim of this study was to determine if real trauma resuscitation communication could be analyzed using the speech classification system of verbal response modes, otherwise known as the verbal response mode taxonomy and, if so, if there is a predominant approach of verbally delivering messages.

METHODS

Video and audio recordings of 5 trauma team resuscitations were transcribed. Communication was coded using the verbal response mode taxonomy for both form and intent. The rate of mixed-mode communication (unmatched form and intent) and pure-mode communication were calculated and compared between the participants roles. Comparisons were made with simulated material published in other research.

RESULTS

The most frequent mixed-mode communication was acknowledgment in service of confirmation. Question in service of a question was the most used pure-mode communication. Six predominant roles were seen, which matched well with the roles in the simulations.

CONCLUSION

The verbal response mode taxonomy can be used to study communication during real trauma resuscitation, and it was found that pure-mode communication was predominant, meaning that the grammatical form matches the intent. Verbal response mode methodology is time consuming and requires analysts with domain knowledge. Comparisons show some differences between simulations and our material indicating that verbal response modes can be used to evaluate differences in communication.

Magnesium in drinking water in relation to morbidity and mortality from acute myocardial infarction

We investigated the importance of magnesium and calcium in drinking water in relation to morbidity and mortality from acute myocardial infarction. Cases were men and women 50-74 years of age living in 18 Swedish municipalities who had suffered an acute myocardial infarction some time between October 1, 1994, and June 30, 1996. Controls were randomly selected from the same study base. We interviewed the surviving cases (N = 823) and controls (N = 853), focusing on risk factors for acute myocardial infarction. We collected individual data on drinking water levels of magnesium and calcium. We classified subjects by quartile of water magnesium or calcium levels. The total number of cases was similar in the four quartiles. The risk of death was 7.6% (95% confidence interval = 2.1-13.1) lower in the quartile with high magnesium levels (> or = 8.3 mg/liter). The odds ratio for death from acute myocardial infarction in relation to water magnesium was 0.64 (95% confidence interval = 0.42-0.97) for the highest quartile relative to the three lower ones. Multivariate analyses showed that other risk factors were not important confounders. For calcium, this study was inconclusive. The data suggest that magnesium in drinking water is associated with lower mortality from acute myocardial infarction, but not with the total incidence.

[Prevalence of anti-HAV antibodies in selected groups of children]

Hepatitis A is a significant endemic and epidemic disease of global importance. There are few studies on the epidemiology of hepatitis A in Poland. The aim of this study was to investigate the prevalence of the antibodies to HAV (anti-HAV IgG) in children and adolescents living in urban and rural areas. Sera from 377 children were collected: 195 lived in Warsaw and 182 in rural area (voyevodship opolskie). The prevalence of anti-HAV was very low--9.3% and 3.8% respectively. This finding suggest that epidemiological shift from intermediate to low endemicity is possible in Poland and a new policy of prophylaxis hepatitis A may be necessary.

High prevalence of antibodies to hepatitis C virus in three haemodialysis centres in south-western Poland

We assessed the prevalence of anti-hepatitis C virus (anti-HCV) antibodies and markers of hepatitis B virus (HBV) infection in patients of three haemodialysis centres before initiating anti-HBV vaccinations. Of the 94 patients, 39 (41.5%) were anti-HCV positive (+) and 81 (86.2%) were anti-hepatitis B core antigen (HBc) positive. There was a high rate of anti-HBc positivity among anti-HCV (+) patients (92.3%), although the presence of anti-HCV and anti-HBc antibodies were not significantly related to each other. Multiple blood transfusions (> 5 units) was a risk factor for development of HCV infection (P < 0.02), while none of our patients admitted intravenous drug abuse. Although 53.8% of anti-HCV (+) patients have had moderate serum alanine aminotransferase (ALT) elevations during the study period, none has had considerable liver disease, nor did the increased ALT correlate with the presence of anti-HCV. Only two of 17 staff members participating in the survey were anti-HCV (+), though almost every one gave a history of accidental needlestick exposure. All the study subjects were human immunodeficiency virus (HIV) negative. Our results, obtained with the second-generation, highly specific enzyme immunoassay and verified by the immunoblot assay for anti-HCV antibodies, support a recent suggestion that earlier reports might have underestimated the true prevalence of anti-HCV antibodies in haemodialysis patients.

[Evaluation of incidence of biological markers for A and B hepatitis]

Fifty employees of the hospital laboratories were examined for the markers of non-A, non-B hepatitis infection. Immunoenzymatic tests of Abbott Diagnostic Division were used for this purpose. Anti-HAV antibodies were diagnosed in 68% of the examined persons, i.e. with an incidence similar to that in the general population. HBV markers were found in 50% of the examined persons, i.e. a few times more often than in the Polish general population. HBsAg carriers constituted 2% of this group. In the remaining persons with anti-HBV antibodies various combinations were found. Most frequent were anti-HBe+, anti-HBc+ and anti-HBs+.

Outcome of pregnancy in relation to irregular and inconvenient work schedules

The relation between irregular and inconvenient working hours and the outcome of pregnancy was studied among women employed at a hospital in Sweden some time between 1980 and 1984. A questionnaire was distributed to 807 women; 81% replied. The pregnancies were divided into six groups with respect to work schedules during pregnancy. A slightly, but not significantly, increased risk of miscarriage was found in women who worked irregular hours or rotating shifts compared with women who worked only during the day (RR = 1.44, 95% confidence interval 0.83-2.51). Infants of non-smoking mothers who worked irregular hours had significantly lower birth weights than infants of non-smoking women working day time only. This difference was largest at birth order 2+. Similar results were found for infants of this birth order whose non-smoking mothers worked evenings or rotating shift.

Outcome of pregnancy among women living near petrochemical industries in Sweden

The association between exposure to emissions from petrochemical industries and outcome of pregnancy was examined in a small area of Sweden. The study was based largely, but not entirely, on questionnaire data and evaluated the pregnancies which occurred between the end of 1963 and 30 June 1981 for a sample of 1400 women born between 1935 and 1960. In addition to the questionnaire study, information on all infants born between 1973 and 1981 in this area was obtained from central registers. The miscarriage rate was slightly elevated in the exposed area (OR = 1.15, 0.75-1.76, 95% confidence interval). While a statistically significant increase in miscarriages was found for a small subset of women who worked for one of the petrochemical companies during pregnancy (OR = 6.6, 2.3-19.2), the overall results did not support the hypothesis that ambient community exposures were associated with an increased risk of unfavourable pregnancy outcome.