Effectiveness of interprofessional manikin-based simulation training on teamwork among real teams during trauma resuscitation in adult emergency departments : a systematic review

This systematic review synthesizes the relevant evidence about the effectiveness of interprofessional manikin-based simulation training on teamwork among real teams during trauma resuscitation in adult civilian emergency departments. A systematic literature search was conducted in MEDLINE, CINAHL, EMBASE, EBM reviews, PsycINFO, and Web of Science with no time limit. Only experimental and quasi-experimental studies were included. Effects of the simulation intervention on teamwork were categorized according to a modified version of the Kirkpatrick's model. From the 1120 studies found, 11 studies were included for synthesis. All studies showed immediate improvement in teamwork after training, but divergent results were found regarding skills retention. Although this review focused on interprofessional manikin-based simulations in real trauma teams, the results are similar to previous systematic reviews including different types of simulation. This raises significant questions regarding the importance of simulation design characteristics to improve teamwork in trauma care

Role of Adaptive Team Coordination during Cardiopulmonary Resuscitation

Plus de 200 000 patients en Amérique du Nord subissent un arrêt cardiaque à l’hôpital chaque année, mais moins de 25 % des patients survivent jusqu’à leur congé de l’hôpital. Lorsque le coeur aux battements arythmiques d’un patient ne parvient pas à faire circuler efficacement le sang, une équipe de secouristes procèdent à des interventions vitales définies en fonction d’algorithmes de réanimation cardiorespiratoire (RCR). Depuis l’adoption des lignes directrices de l’American Heart Association (AHA) il y a plus de 30 ans, les travaux de recherche ont principalement porté sur l’amélioration des taux de survie grâce à l’efficacité des tâches techniques de RCR. Au cours de la dernière décennie, une plus grande importance a été accordée aux facteurs associés à la performance d’équipe. Outre les facteurs propres au patient, les chances de survie dépendent du délai de traitement et de la qualité de la RCR que vient compliquer l’interaction de multiples intervenants qui tentent d’orchestrer des mesures de secours concurrentes. Ainsi, la coordination et le travail d’équipe inefficaces font partir des plus grands obstacles à une réanimation réussie en équipe. Dans le cadre de la présente thèse, la relation entre les différents mécanismes de coordination et le résultat technique de la RCR, mesurée en temps passif dans deux contextes de recherche empirique de réanimation simulée, a été mise à l’essai. Les résultats laissent croire que si l’action explicite constitue la caractéristique déterminante des mécanismes de coordination utilisés en réanimation cardiaque en équipe, les équipes qui performent le mieux coordonnent leurs activités de manière différente de celles qui performent le moins bien, et qu’il existe un lien important entre les tendances en matière de mécanismes de coordination et la réussite de la RCR, qui change en fonction des exigences de la tâche. Ces résultats combinés permettent d’établir un cadre de coordination proposé pour les soins de réanimation actifs et de proposer des aspects pratiques pour la formation en RCR et une contribution méthodologique aux futurs travaux de recherche.In-hospital cardiac arrest affects over 200,000 patients in North America each year, but less than 25% of patients survive to hospital discharge. When a patient’s arrhythmic heart is unable to effectively circulate blood, a team of rescuers provide lifesaving interventions according to Cardiopulmonary Resuscitation (CPR) rescue algorithms. Since the inception of the American Heart Association (AHA) CPR guidelines over 30 years ago, research pursuits to improve survival rates have primarily focused on the technical tasks such as CPR technique. Over the past decade, there has been increased focus on team performance related to treatment delays and CPR quality, touting ineffective coordination and teamwork as some of the largest obstacles to successful team resuscitation. The objective of this work was to validate a proposed framework outlining the relationship among explicit and implicit coordination mechanisms required for successful CPR performance: minimal interruptions (hands-off ratio), rapid initiation of chest compressions and defibrillation. The framework was tested in two independent studies of simulated adult and pediatric resuscitation of in-hospital cardiac arrest. The results showed that while team performance improved over time, the main Explicit and Implicit coordination type patterns were stable. Instead, small shifts occurred within the Information and Action coordination sub-types. Explicit coordination was dominant throughout all resuscitation scenarios, but only Implicit coordination was associated with better hands-off ratio performance. In both studies, higher performing teams coordinated differently than lower performing teams and there was a significant relationship between the patterns of coordination mechanisms and CPR performance. The combined results are used to refine a proposed coordination framework for acute resuscitation care and propose practical implications for CPR training and methodological contribution for future research

Transacting Expertise in Emergency Management and Response

In this paper we extend transactive memory systems (TMS) theory to develop an understanding of the distributed coordination of expertise in high-reliability organizations. We illustrate our conceptual developments in a study of emergency management and response in Greece. We focus on the interaction between operators/dispatchers, ambulance crew, and specialist doctors, including the information and communication technologies (ICT) they use to respond to emergency incidents. Our case contributes to an in-depth understanding of the ways in which high-reliability organizations can sustain a distributed coordination of expertise over the duration of emergency incidents. This is achieved through the cultivation of TMS during a socialization and training period, the dynamic development of trust in emergent actions, and a commitment to shared protocols, which allow for improvisation and bricolage during unexpected incidents. Our findings also explore the role of ICTs in inscribing TMS in computerized protocols, while mediating the development of trust across the team, as well as mediating the construction of running narratives, which enable leaders to coordinate expertise in unexpected incidents

A MULTILEVEL INVESTIGATION OF LEADER EMPOWERING BEHAVIORS: INTEGRATING THE JOB DEMANDS-CONTROL MODEL AND TRANSACTIVE MEMORY SYSTEM THEORY

Empowering leader behaviors have been generally suggested to motivate employees and facilitate their goal achievement, but they can also be challenging and demanding. Yet questions regarding why employees may feel challenged and even concerned when empowered and how leaders can reduce such unfavorable reactions have been largely ignored in the literature. To examine the multifaceted impacts of empowering leadership and, at the same time, consider how the empowerment climate created by the leader at the team level may help facilitate the individual-level leadership processes, this research integrates the job demands-control (JD-C) model and the transactive memory system (TMS) literature to advance and test a model of the impacts of leader empowering behaviors on individuals and teams, as well as interrelationships of the multilevel dynamics. Applying the JD-C model, I propose that empowering leadership can provide team members with learning opportunities but also generate perceptions of role overload, which then influence, in opposite directions, their engagement and performance. Further incorporating the TMS literature, I propose that by creating an empowerment climate, leaders can help foster the development of TMS within the team. TMS will, in turn, benefit team performance as well as produce a positive cross-level influence on individual team members. Using survey data from 74 research and development teams in 14 high-technology companies in China, hierarchical linear modeling and hierarchical regression analyses provided overall support for the model. Theoretical and practical implications are also discussed in this dissertation

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

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

Pre-hospital Information Use during Trauma Resuscitation

Information about incoming patients received from the ambulance crews and pre-hospital staff is critical in assisting emergency medical teams prepare for the patient care. Yet few studies have focused on the importance of this pre-hospital information in the care of critically ill patients. In this study, we examine the use of pre-hospital information during trauma resuscitations. Our analysis of communication during seven actual resuscitation events revealed several challenges in sharing and recalling pre-hospital information. Using these findings, we discuss design opportunities for improving the use of pre-hospital information during resuscitations.ye

Teamwork on Patrol: Investigating Teamwork Processes and Underlaying Coordinating Mechanisms in a Police Training Program

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Occupational Therapy in the Intensive Care Unit: A Quick Reference Guide

Purpose: The purpose of this project was to create a quick reference guide for occupational therapists treating clients in the intensive care unit (ICU) in order to increase quality of care, decrease medical errors, and improve confidence. Methods: A literature review was conducted to determine the needs of occupational therapists and other health professionals working in the ICU environment. It was discovered that occupational therapists do not receive specific education on treating clients in the ICU and that there are no specific resources for occupational therapists currently available. Rehabilitation is beginning sooner within the ICU in order to decrease client length of stay and hospital costs, which will in turn bring more occupational therapists to work in this area of practice. The increasing number of therapists working in this area, establishes a need for this product. Results: Through the literature review and consultation with the University of North Dakota Simulation Center, a quick reference guide to occupational therapy within the ICU was created to provide occupational therapists with technical information about the person, the environment, and occupations within the ICU. The quick reference guide was designed through the guidance of Person-Environment-Occupation model. Conclusions: In order to provide quality and client centered care within the ICU; it is pertinent for health professionals to have specialized knowledge and skills specific to this area of practice. Through research and personal experience, it was evident that occupational therapists and many health professionals do not feel confident treating clients in the ICU. The limitations of this project include: the quick reference guide has not been piloted, the equipment is constantly advancing requiring the update of equipment in the guide frequently, and that it is not comprehensive and only provides the most relevant pieces of equipment to occupational therapy. Further recommendations for the quick reference guide include: implementing it into the University of North Dakota Occupational Therapy curriculum, use by fieldwork students, utilization by other health care professionals, and the adaptation of the guide for use by families

Do team processes really have an effect on clinical performance? A systematic literature review

Summary There is a growing literature on the relationship between team processes and clinical performance. The purpose of this review is to summarize these articles and examine the impact of team process behaviours on clinical performance. We conducted a literature search in five major databases. Inclusion criteria were: English peer-reviewed papers published between January 2001 and May 2012, which showed or tried to show (i) a statistical relationship of a team process variable and clinical performance or (ii) an improvement of a performance variable through a team process intervention. Study quality was assessed using predefined quality indicators. For every study, we calculated the relevant effect sizes. We included 28 studies in the review, seven of which were intervention studies. Every study reported at least one significant relationship between team processes or an intervention and performance. Also, some non-significant effects were reported. Most of the reported effect sizes were large or medium. The study quality ranged from medium to high. The studies are highly diverse regarding the specific team process behaviours investigated and also regarding the methods used. However, they suggest that team process behaviours do influence clinical performance and that training results in increased performance. Future research should rely on existing theoretical frameworks, valid, and reliable methods to assess processes such as teamwork or coordination and focus on the development of adequate tools to assess process performance, linking them with outcomes in the clinical settin

Do team processes really have an effect on clinical performance? A systematic literature review

There is a growing literature on the relationship between team processes and clinical performance. The purpose of this review is to summarize these articles and examine the impact of team process behaviours on clinical performance. We conducted a literature search in five major databases. Inclusion criteria were: English peer-reviewed papers published between January 2001 and May 2012, which showed or tried to show (i) a statistical relationship of a team process variable and clinical performance or (ii) an improvement of a performance variable through a team process intervention. Study quality was assessed using predefined quality indicators. For every study, we calculated the relevant effect sizes. We included 28 studies in the review, seven of which were intervention studies. Every study reported at least one significant relationship between team processes or an intervention and performance. Also, some non-significant effects were reported. Most of the reported effect sizes were large or medium. The study quality ranged from medium to high. The studies are highly diverse regarding the specific team process behaviours investigated and also regarding the methods used. However, they suggest that team process behaviours do influence clinical performance and that training results in increased performance. Future research should rely on existing theoretical frameworks, valid, and reliable methods to assess processes such as teamwork or coordination and focus on the development of adequate tools to assess process performance, linking them with outcomes in the clinical setting