Improving medical crisis team performance

DeVita, Michael A.; Schaefer, John J.; Lutz, John; Dongilli, Thomas; Wang, Henry E.

doi:10.1097/01.ccm.0000110872.86812.1c

Cited by 97 publications

(44 citation statements)

References 11 publications

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“…Only recently has medicine started to recognize this fact, and started teaching physicians to be effective team leaders (Howard et al 1992;Reznek et al 2003;Marsch et al 2004). It has been shown that teams who function with an effective team leader adhere more closely to established protocols, sustain fewer medical errors, and as a result, have a more favourable outcome for their patients, both simulated and real (Hoff et al 1997;Cooper & Wakelam 1999;Morey et al 2002;Devita et al 2004Devita et al , 2005Marsch et al 2004).…”

Section: Introductionmentioning

confidence: 99%

Development of a leadership skills workshop in paediatric advanced resuscitation

2007

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Background: Paediatric residency programs rarely prepare trainees to assume resuscitation team leadership roles despite the recognized need for these skills by specialty accreditation organizations. We conducted a needs-assessment survey of all residents in the McGill Pediatric Residency Program, which demonstrated that most residents had minimal or no experience at leading resuscitation events and felt unprepared to assume this role in the future. Aims: We developed an educational intervention (workshop) and evaluated immediate and long term learning outcomes in order to determine whether residents could acquire and retain team leadership skills in pediatric advanced resuscitation. Methods: Fifteen paediatric residents participated in a workshop that we developed to fulfill the learning needs highlighted with the needs assessment, as well as the Objectives of Training in Pediatrics from the Royal College of Physicians and Surgeons of Canada. It consisted of a plenary session followed by 2 simulated resuscitation scenarios. Team performance was evaluated by checklist. Residents were evaluated again 6 months later without prior interactive lecture. Learning was also assessed by self-reported retrospective pre/post questionnaire. Conclusions: Residents acquired resuscitation team leadership skills following an educational intervention as shown by both observational checklist scores and self-reported survey. The six-month follow-up evaluation demonstrated skill retention beyond the initial intervention. A control group suggested that these results were due to completion of the first workshop.

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Section: Introductionmentioning

confidence: 99%

Development of a leadership skills workshop in paediatric advanced resuscitation

2007

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“…Uluslar arası verilerde ortalama bu oran %6.4 olarak bildirilmektedir (16 Gelişmiş ülkelerde bile KPR sırasında yapılan yanlışların büyük bir kısmının önlenebilir insan hatalarına bağlı olduğu görülmektedir (17). Temel yaşam desteği ve ileri yaşam desteği eğitimi verilen doktorların bile bir arrest karşısında yeterli olmadıkları, takım lideri rolü üstlenemedikleri saptanmıştır (18). Sağ kalımda ilk halka olarak kabul edilen acil tıp servislerin aranması için geçen zaman arrest ile gelen hastanın uzun dönem prognozunu doğrudan etkilemektedir.…”

Section: Introductionunclassified

Basic and advanced life support practices in out-of-hospital cardiopulmonary arrest developing patients: analysis of 27 months

Al¹,

Zengin²,

Kabul³

et al. 2013

Gaziantep Med J

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ÖzetBu çalışmada acil servisimize 112 acil servis aracılığı ile getirilen hastane dışı kardiyopulmoner arrest hastalarda temel ve ileri yaşam destek müdahalelerinin değerlendirilmesi amaçlanmıştır. 30 Ocak 2009 ve 15 Mart 2011 tarihleri arasında Gaziantep Üniversitesi Tıp Fakültesi Hastanesi Acil Tıp Anabilim Dalına 112 Acil Servis ekibi tarafından kardiyopulmoner arrest olarak getirilen 61 hasta çalışmaya dâhil edildi. Hastaların cinsiyeti, yaşı, tanısı; doktor eşliğinde olup olmadığı, endotrakeal entübasyon ve kardiyopulmoner resusitasyon gibi temel ve ileri yaşam desteğinin yapılıp yapılmadığı değerlendirildi ve sonuçlar prospektif olarak kayıt edildi. Hastaların %60.7'si (n=37) erkek, %39.3'ü (n=24) kadın idi ve ortalama yaşları 65.5 (yaş aralığı 18-90) idi. En fazla hasta grubu (n=23) koroner arter haslığı olanlar oluşturuyordu. Hastaların %34.4'ü doktor eşliğinde, %65.6'sı paramedik eşliğinde acil servise getirildi. Temel yaşam desteği olarak sadece hastaların damar yolu açılmış ve oksijen verilmişti. Kardiyopulmoner arrest olup endotrakeal entübasyon yapılmadan getirilen hastaların oranı %86.9 idi (n=53). Tamamı paramedikler tarafından olmak üzere sadece 8 (%13.1) hastaya endotrakeal entübasyon yapılmıştı (p=0.028). Hiçbir hastaya kardiyopulmoner resusitasyon ve defibrilasyon uygulanmamıştı. Acil servise girişte hiçbir hastada nabız, tansiyon, kardiyak tepe atımı alınamamıştır. Acil serviste tüm hastalara kardiyopulmoner resusitasyon yapılmış; sadece birisinden olumlu cevap alınmış; o da yoğun bakımda 20 gün takipten sonra kayıp edilmiştir. 112 Acil Servis hizmetlerinde çalışan sağlık ekipleri temel ve ileri yaşam desteği sağlamada yeterli deneyime ve bilgi birikimine sahip değillerdir. Paramedikler hastane dışında kardiyopulmoner arrest olmuş hastaya endotrakeal entübasyon yapma konusunda doktorlara göre istatistiksel olarak daha başarılı bulunmuştur. Anahtar kelimeler: Doktor; endotrakeal entübasyon; hastane dışı kardiyopulmoner arrest; paramedik; temel ve ileri yaşam desteği. AbstractOur aim is evaluating of basic and advanced life support interventions at the cardiopulmonary arrest patients that brought to our emergency department by 112 emergency services. Sixty-one cardiopulmonary arrest patients who brought to Emergency Department of Medicine School in Gaziantep University by 112 emergency services between 30 January 2009 and 15 March 2011 were included in the study. Gender, age and diagnosis of patients; accompanied by person, basic and advanced life support such as endotracheal intubation and cardiopulmonary resuscitation status were evaluated, and the results were recorded prospectively. Of patients, 60.7% (n=37) were male and 39.3% (n=24) were female. The mean age was 65.5 (18-90). The majority patient group (n=23) was coronary artery disease. Of patients, 34.4% were accompanies by doctor, and 65.6% were accompanied by paramedics. As basic life support, just only intravenous access and supplemental oxygen were performed. The ratio of patients who had experienced cardiopulmonary arrest and not i...

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“…The process for cardiac arrest resuscitation is highly protocolised with a limited number of interventions that can be applied (A-B-C), with little latitude for deviation, after which there is a dichotomous outcome (dead or alive). Comparison of a resuscitation team with a NASCAR pit crew [14] is therefore valid because each element of both processes can be finely choreographed to achieve a predictably effective performance. However, the same cannot be said for the acutely ill septic patient who needs a customised team performance each time, which requires flexibility, adaptation and innovation.…”

Section: Why Should We Assess Team Performance?mentioning

confidence: 99%

Assessing team performance – Markers and methods

Marriage

Kinnear

2016

Trends in Anaesthesia and Critical Care

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Optimal team performance in healthcare is vital to avoid error. Assessing teams improves their performance by providing accurate feedback to team members. To construct an assessment tool that is both valid and reliable, it is necessary to understand what should be measured, when it should be measured and the context of the team performance. Current assessment methods include observation of behavioural markers, self-assessment by team members, event-based coding, and narrative field notes. Future assessment tools should incorporate best practice elements such as having a theoretical or empirical basis for teamwork competencies, measuring process rather than outcomes, analysing rather than describing performance, capturing non-observable cognitions, distinguishing individual from collective team behaviours, using trained raters, and linking assessment to learning objectives.

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Improving medical crisis team performance

Cited by 97 publications

References 11 publications

Development of a leadership skills workshop in paediatric advanced resuscitation

Development of a leadership skills workshop in paediatric advanced resuscitation

Basic and advanced life support practices in out-of-hospital cardiopulmonary arrest developing patients: analysis of 27 months

Assessing team performance – Markers and methods

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