Trauma resuscitation: can team behaviours in the prearrival period predict resuscitation performance?

Su et al. · Team Learning, Safety & Error, Power & Equity · BMJ Simulation and Technology Enhanced Learning · 2017 · Open access

By its authors' account the first study of prearrival communication as a predictor of later coordination in healthcare, this simulation study, with Mary Waller and Seth Kaplan among its co-authors, asks whether how a trauma team talks before the patient arrives predicts how it coordinates and performs afterwards. Twelve volunteer teams at a children's hospital each ran four in situ scenarios, in a secondary analysis of a checklist study that yielded 47 usable videos coded in ten-second intervals. Balance was measured as the variance in utterances per team member during the prearrival period, which averaged almost two minutes; implicit coordination as the ratio of information provided to information requested; performance as time to the second life-saving intervention.

More evenly shared talk was associated with more implicit coordination (p = 0.011, one-tailed), but its association with performance fell short of significance (p = 0.054, also one-tailed), and Su and colleagues say further studies are needed to establish whether there is any association at all. The lead physician spoke more than half of the prearrival utterances, and in exploratory analyses more utterances by the lead physician went with lower implicit coordination and a longer time to the second intervention. Su and colleagues offer two readings: that the leader intimidated the team, lowering psychological safety, or that the leader sensed a need to take a more vocal, dominant role, perhaps judging the team inexperienced or hesitant. Psychological safety, familiarity and cohesion were not measured, nor were experience or other demographics; each team included three confederates; and as a simulation it could not assess real patient outcomes.

Su, L., Kaplan, S., Burd, R., Winslow, C., Hargrove, A. and Waller, M. (2017) 'Trauma resuscitation: Can team behaviours in the prearrival period predict resuscitation performance?', BMJ Simulation and Technology Enhanced Learning, 3(3), pp. 106-110.

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