Association between measured teamwork and medical errors: an observational study of prehospital care in the USA

Abstract

ObjectivesThe goal of this study was to examine the relationship between measured teamwork and adverse safety events in the prehospital emergency care of children using high-fidelity simulation. We posit that non-technical skills such as leadership, teamwork, situation awareness and decision-making are associated with the clinical success of teams.DesignObservational study.SettingEmergency medical services (EMS) responders were recruited from public fire and private transport agencies in Oregon State to participate in four simulations of paediatric emergencies using high-fidelity patient simulators, scene design, and professional actors playing parents and bystanders.ParticipantsForty-four fire/transport teams consisting of 259 EMS professionals consented to participate and completed simulations.Primary and secondary outcome measuresTeams were assessed using the Clinical Teamwork Scale (CTS), a validated instrument that measures overall teamwork and 15 specific elements in five overarching domains: communication, decision-making, role responsibility (leadership and followership), situational awareness/resource management and patient-friendliness. We used generalised estimating equations to estimate the odds of error with increasing overall CTS teamwork score while adjusting for clinical scenario and potential clustering by team.ResultsAcross 176 simulations, the mean overall score on the CTS was 6.04 (SD 2.10; range 1=poor to 10=perfect) and was normally distributed. The distribution of scores was similar across the four clinical scenarios. At least one error was observed in 82% of the simulations. In simulations with at least one observed error, the mean CTS score was 5.76 (SD 2.04) compared with 7.16 (SD 1.95) in scenarios with no observed error. Logistic regression analysis accounting for clustering at the team level revealed that the odds of an error decreased 28% with each unit increase in CTS (OR 0.72, 95% CI 0.59 to 0.88).ConclusionsThis study found that overall teamwork among care delivery teams was strongly associated with the risk of serious adverse events in simulated scenarios of caring for critically ill and injured children.

Nurses' perception of teamwork and its relationship with the occurrence and reporting of adverse events: A questionnaire survey in teaching hospitals

“…Previous studies also demonstrated that nursing teamwork significantly impacted missed nursing care (Chapman, Rahman, Courtney, & Chalmers, 2017, Kalisch and Lee, 2010). A data‐based investigation of pre‐hospital care in the USA reported that general teamwork among care delivery teams had a strong association with the risk of severe AEs in the simulation of scenarios in caring for youngsters with critical illnesses and injuries (Herzberg et al, 2019). A study conducted in Iraq found significantly decreased rates of communication‐related errors, medication and transfusion errors, and needle stick incidents following teamwork training (Deering et al, 2011).…”

“…Non‐technical skills (e.g. good communication and teamwork) play a crucial role in preventing AEs and in ensuring patient safety (Herzberg et al, 2019). In the past decade, the growing complexity of health care systems has led to an emphasis on the need for teamwork in health care practice to improve quality care and it has been understood to be a key factor that contributes to reductions in AEs (Manser, 2009, Hwang and Park, 2017).…”

Psychometric properties of the Chinese version of the TeamSTEPPS teamwork perceptions questionnaire to measure teamwork perceptions of Chinese residents: a cross-sectional study

“…Effective teamwork in healthcare not only augments patient's satisfaction but also decreases burnout among the health professionals. [1][2][3][4] The Agency for Healthcare Research and Quality (AHRQ), the Joint Commission and other institutions ranked teamwork as a dominant factor for enhancing the healthcare quality. 5 6 Furthermore, teamwork has been classified as an important competency to help optimise the healthcare services and poor teamwork could increase the medical errors and reduce patient safety.…”

Medical Error in Psychiatry - Brazilian Analysis and Proposal For A Doctor's Protection Protocol

“…Materializing, in a study that examined the relationship between medical team work and adverse safety events in pre-hospital emergency care for children using high-fidelity simulation, at least one error was found in 82% of the simulations [18]. Distinguishing the physician's guilt is an arduous task and by way of example Campo et al [19] found that a patient in an intensive care unit receives an average of 178 interventions per day and the risk of error or adverse event increases by 6% each day of hospitalization. If a medical error occurs, who is directly responsible?…”