Hands-on time during cardiopulmonary resuscitation is affected by the process of teambuilding: a prospective randomised simulator-based trial

BACKGROUND: Cardiac arrests are handled by teams rather than by individual health-care workers. Recent investigations demonstrate that adherence to CPR guidelines can be less than optimal, that deviations from treatment algorithms are associated with lower survival rates, and that deficits in performance are associated with shortcomings in the process of team-building. The aim of this study was to explore and quantify the effects of ad-hoc team-building on the adherence to the algorithms of CPR among two types of physicians that play an important role as first responders during CPR: general practitioners and hospital physicians. METHODS: To unmask team-building this prospective randomised study compared the performance of preformed teams, i.e. teams that had undergone their process of team-building prior to the onset of a cardiac arrest, with that of teams that had to form ad-hoc during the cardiac arrest. 50 teams consisting of three general practitioners each and 50 teams consisting of three hospital physicians each, were randomised to two different versions of a simulated witnessed cardiac arrest: the arrest occurred either in the presence of only one physician while the remaining two physicians were summoned to help ("ad-hoc"), or it occurred in the presence of all three physicians ("preformed"). All scenarios were videotaped and performance was analysed post-hoc by two independent observers. RESULTS: Compared to preformed teams, ad-hoc forming teams had less hands-on time during the first 180 seconds of the arrest (93 +/- 37 vs. 124 +/- 33 sec, P > 0.0001), delayed their first defibrillation (67 +/- 42 vs. 107 +/- 46 sec, P > 0.0001), and made less leadership statements (15 +/- 5 vs. 21 +/- 6, P > 0.0001). CONCLUSION: Hands-on time and time to defibrillation, two performance markers of CPR with a proven relevance for medical outcome, are negatively affected by shortcomings in the process of ad-hoc team-building and particularly deficits in leadership. Team-building has thus to be regarded as an additional task imposed on teams forming ad-hoc during CPR. All physicians should be aware that early structuring of the own team is a prerequisite for timely and effective execution of CPR

Lake Wobegon for anesthesia... where everyone is above average except those who aren't: variability in the management of simulated intraoperative critical incidents (editorial)

The May 2008 edition of American Vogue magazine carried the cover headline, “When Good work goes bad... undoing medical mistakes.” Inside was a story on cosmetic surgery with several tips including, “Board certification is a key indication of skill.” There was no mention of the importance of the anesthesiologist despite entertainer Joan Rivers’ claim that the key is “to get a really good anesthesiologist...” The public perceives that board certification, or international equivalents like Fellow of the Australian and New Zealand College of Anesthetists, is the “gold standard” and, if a clinician possesses this credential, he or she has the knowledge and skills required to be competent. However, evidence is mixed as to whether successfully attaining these qualifications actually results in safe and competent practice. In this issue of Anesthesia & Analgesia, a research group, who have been working for many years towards a validated simulation-based test of performance ability of anesthesia providers, report that a group of board-certified anesthesiologists performed with variable, and overall mediocre, degrees of success during a mannequin-based assessment of management of simulated intra operative emergencies. These results are consistent with the findings of the last 20 yr of simulation-based research into the evaluation of human performance in anesthesia. In their study, the researchers included a comparison group of certified registered nurse anesthetists (CRNAs) who also performed with variable, and overall mediocre, degrees of success, and with only modestly (but statistically significantly) lower overall scores