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NCBI: db=pubmed; Term=teamwork emergency medicine
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Why saying what you mean matters: An analysis of trauma team communication.

tir, 21/11/2017 - 15:21

Why saying what you mean matters: An analysis of trauma team communication.

Am J Surg. 2017 Nov 08;:

Authors: Jung HS, Warner-Hillard C, Thompson R, Haines K, Moungey B, LeGare A, Shaffer DW, Pugh C, Agarwal S, Sullivan S

Abstract
BACKGROUND: We hypothesized that team communication with unmatched grammatical form and communicative intent (mixed mode communication) would correlate with worse trauma teamwork.
METHODS: Interdisciplinary trauma simulations were conducted. Team performance was rated using the TEAM tool. Team communication was coded for grammatical form and communicative intent. The rate of mixed mode communication (MMC) was calculated. MMC rates were compared to overall TEAM scores. Statements with advisement intent (attempts to guide behavior) and edification intent (objective information) were specifically examined. The rates of MMC with advisement intent (aMMC) and edification intent (eMMC) were also compared to TEAM scores.
RESULTS: TEAM scores did not correlate with MMC or eMMC. However, aMMC rates negatively correlated with total TEAM scores (r = -0.556, p = 0.025) and with the TEAM task management component scores (r = -0.513, p = 0.042).
CONCLUSIONS: Trauma teams with lower rates of mixed mode communication with advisement intent had better non-technical skills as measured by TEAM.

PMID: 29153980 [PubMed - as supplied by publisher]

Should they stay or should they go now? Exploring the impact of team familiarity on interprofessional team training outcomes.

tor, 16/11/2017 - 00:07
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Should they stay or should they go now? Exploring the impact of team familiarity on interprofessional team training outcomes.

Am J Surg. 2017 Nov 04;:

Authors: Joshi K, Hernandez J, Martinez J, AbdelFattah K, Gardner AK

Abstract
INTRODUCTION: Although simulation is an effective method for enhancing team competencies, it is unclear how team familiarity impacts this process. We examined how team familiarity impacted team competencies.
METHODS: Trainees were assigned to stable or dynamic teams to participate in three simulated cases. Situation awareness (SA) data was collected through in-scenario freezes. The recorded performances were assessed for clinical effectiveness (ClinEff) and teamwork. All data are reported on a 1-100% (100% = perfect performance) scale.
RESULTS: Forty-six trainees (23 General Surgery; 23 Emergency Medicine) were randomized by specialty into stable (N = 8) or dynamic (N = 7) groups. Overall changes from Sim 1 to Sim3 were 12.2% (p < 0.01), -1.1% (ns), and 7.1% (p < 0.01) for SA, ClinEff, and Teamwork, respectively. However, improvements differed by condition, with stable teams reflecting improvements in ClinEff (15.2%; p < 0.05), whereas dynamic team ClinEff improvement (8.7%) was not significant. Both groups demonstrated improvements in teamwork (stable = 9%, p < 0.05; dynamic = 4.9%, p < 0.05).
CONCLUSIONS: Teams who continued to work together demonstrated increased improvements in clinical effectiveness and teamwork, while dynamic teams only demonstrated improvements in teamwork.

PMID: 29132646 [PubMed - as supplied by publisher]

Integration of in-hospital cardiac arrest contextual curriculum into a basic life support course: a randomized, controlled simulation study.

fre, 10/11/2017 - 21:26
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Integration of in-hospital cardiac arrest contextual curriculum into a basic life support course: a randomized, controlled simulation study.

Resuscitation. 2017 May;114:127-132

Authors: Hunt EA, Duval-Arnould JM, Chime NO, Jones K, Rosen M, Hollingsworth M, Aksamit D, Twilley M, Camacho C, Nogee DP, Jung J, Nelson-McMillan K, Shilkofski N, Perretta JS

Abstract
OBJECTIVE: The objective was to compare resuscitation performance on simulated in-hospital cardiac arrests after traditional American Heart Association (AHA) Healthcare Provider Basic Life Support course (TradBLS) versus revised course including in-hospital skills (HospBLS).
DESIGN: This study is a prospective, randomized, controlled curriculum evaluation.
SETTING: Johns Hopkins Medicine Simulation Center.
SUBJECTS: One hundred twenty-two first year medical students were divided into fifty-nine teams.
INTERVENTION: HospBLS course of identical length, containing additional content contextual to hospital environments, taught utilizing Rapid Cycle Deliberate Practice (RCDP).
MEASUREMENTS: The primary outcome measure during simulated cardiac arrest scenarios was chest compression fraction (CCF) and secondary outcome measures included metrics of high quality resuscitation.
MAIN RESULTS: Out-of-hospital cardiac arrest HospBLS teams had larger CCF: [69% (65-74) vs. 58% (53-62), p<0.001] and were faster than TradBLS at initiating compressions: [median (IQR): 9s (7-12) vs. 22s (17.5-30.5), p<0.001]. In-hospital cardiac arrest HospBLS teams had larger CCF: [73% (68-75) vs. 50% (43-54), p<0.001] and were faster to initiate compressions: [10s (6-11) vs. 36s (27-63), p<0.001]. All teams utilized the hospital AED to defibrillate within 180s per AHA guidelines [HospBLS: 122s (103-149) vs. TradBLS: 139s (117-172), p=0.09]. HospBLS teams performed more hospital-specific maneuvers to optimize compressions, i.e. utilized: CPR button to flatten bed: [7/30 (23%) vs. 0/29 (0%), p=0.006], backboard: [21/30 (70%) vs. 5/29 (17%), p<0.001], stepstool: [28/30 (93%) vs. 8/29 (28%), p<0.001], lowered bedrails: [28/30 (93%) vs. 10/29 (34%), p<0.001], connected oxygen appropriately: [26/30 (87%) vs. 1/29 (3%), p<0.001] and used oral airway and/or two-person bagging when traditional bag-mask-ventilation unsuccessful: [30/30 (100%) vs. 0/29 (0%), p<0.001].
CONCLUSION: A hospital focused BLS course utilizing RCDP was associated with improved performance on hospital-specific quality measures compared with the traditional AHA course.

PMID: 28323084 [PubMed - indexed for MEDLINE]

Simulation in Interprofessional Clinical Education: Exploring Validated Nontechnical Skills Measurement Tools.

tor, 09/11/2017 - 18:59
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Simulation in Interprofessional Clinical Education: Exploring Validated Nontechnical Skills Measurement Tools.

Simul Healthc. 2017 Nov 08;:

Authors: von Wendt CEA, Niemi-Murola L

Abstract
The research literature regarding interprofessional simulation-based medical education has grown substantially and continues to explore new aspects of this educational modality. The aim of this study was to explore the validation evidence of tools used to assess teamwork and nontechnical skills in interprofessional simulation-based clinical education. This systematic review included original studies that assessed participants' teamwork and nontechnical skills, using a measurement tool, in an interprofessional simulated setting. We assessed the validity of each assessment tool using Kane's framework. Medical Education Research Study Quality Instrument scores for the studies ranged from 8.5 to 17.0. Across the 22 different studies, there were 20 different assessment strategies, in which Team Emergency Assessment Measure, Anesthetist's Nontechnical Skills, and Nontechnical Skills for Surgeons were used more than once. Most assessment tools have been validated for scoring and generalization inference. Fewer tools have been validated for extrapolation inference, such as expert-novice analysis or factor analysis.

PMID: 29117089 [PubMed - as supplied by publisher]

Association Between Physician Teamwork and Health System Outcomes After Coronary Artery Bypass Grafting.

ons, 08/11/2017 - 17:47
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Association Between Physician Teamwork and Health System Outcomes After Coronary Artery Bypass Grafting.

Circ Cardiovasc Qual Outcomes. 2016 Nov;9(6):641-648

Authors: Hollingsworth JM, Funk RJ, Garrison SA, Owen-Smith J, Kaufman SA, Pagani FD, Nallamothu BK

Abstract
BACKGROUND: Patients undergoing coronary artery bypass grafting (CABG) must often see multiple providers dispersed across many care locations. To test whether teamwork (assessed with the bipartite clustering coefficient) among these physicians is a determinant of surgical outcomes, we examined national Medicare data from patients undergoing CABG.
METHODS AND RESULTS: Among Medicare beneficiaries who underwent CABG between 2008 and 2011, we mapped relationships between all physicians who treated them during their surgical episodes, including both surgeons and nonsurgeons. After aggregating across CABG episodes in a year to construct the physician social networks serving each health system, we then assessed the level of physician teamwork in these networks with the bipartite clustering coefficient. Finally, we fit a series of multivariable regression models to evaluate associations between a health system's teamwork level and its 60-day surgical outcomes. We observed substantial variation in the level of teamwork between health systems performing CABG (SD for the bipartite clustering coefficient was 0.09). Although health systems with high and low teamwork levels treated beneficiaries with comparable comorbidity scores, these health systems differed over several sociocultural and healthcare capacity factors (eg, physician staff size and surgical caseload). After controlling for these differences, health systems with higher teamwork levels had significantly lower 60-day rates of emergency department visit, readmission, and mortality.
CONCLUSIONS: Health systems with physicians who tend to work together in tightly-knit groups during CABG episodes realize better surgical outcomes. As such, delivery system reforms focused on building teamwork may have positive effects on surgical care.

PMID: 28263939 [PubMed - indexed for MEDLINE]

Characterizing Teamwork in Cardiovascular Care Outcomes: A Network Analytics Approach.

ons, 08/11/2017 - 17:47
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Characterizing Teamwork in Cardiovascular Care Outcomes: A Network Analytics Approach.

Circ Cardiovasc Qual Outcomes. 2016 Nov;9(6):670-678

Authors: Carson MB, Scholtens DM, Frailey CN, Gravenor SJ, Powell ES, Wang AY, Kricke GS, Ahmad FS, Mutharasan RK, Soulakis ND

Abstract
BACKGROUND: The nature of teamwork in healthcare is complex and interdisciplinary, and provider collaboration based on shared patient encounters is crucial to its success. Characterizing the intensity of working relationships with risk-adjusted patient outcomes supplies insight into provider interactions in a hospital environment.
METHODS AND RESULTS: We extracted 4 years of patient, provider, and activity data for encounters in an inpatient cardiology unit from Northwestern Medicine's Enterprise Data Warehouse. We then created a provider-patient network to identify healthcare providers who jointly participated in patient encounters and calculated satisfaction rates for provider-provider pairs. We demonstrated the application of a novel parameter, the shared positive outcome ratio, a measure that assesses the strength of a patient-sharing relationship between 2 providers based on risk-adjusted encounter outcomes. We compared an observed collaboration network of 334 providers and 3453 relationships to 1000 networks with shared positive outcome ratio scores based on randomized outcomes and found 188 collaborative relationships between pairs of providers that showed significantly higher than expected patient satisfaction ratings. A group of 22 providers performed exceptionally in terms of patient satisfaction. Our results indicate high variability in collaboration scores across the network and highlight our ability to identify relationships with both higher and lower than expected scores across a set of shared patient encounters.
CONCLUSIONS: Satisfaction rates seem to vary across different teams of providers. Team collaboration can be quantified using a composite measure of collaboration across provider pairs. Tracking provider pair outcomes over a sufficient set of shared encounters may inform quality improvement strategies such as optimizing team staffing, identifying characteristics and practices of high-performing teams, developing evidence-based team guidelines, and redesigning inpatient care processes.

PMID: 28051772 [PubMed - indexed for MEDLINE]

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