Improving the position of resuscitation team leader with simulation (IMPORTS); a pilot cross-sectional randomized intervention study

Abstract

Background: Leadership and teamwork are important contributory factors in determining cardiac resuscitation performance and clinical outcome. We aimed to determine whether fixed positioning of the resuscitation team leader (RTL) relative to the patient influences leadership qualities during cardiac resuscitation using simulation. Methods: A cross-sectional randomized intervention study over 12 months’ duration was conducted in university hospital simulation lab. ACLS-certified medical doctors were assigned to run 2 standardized simulated resuscitation code as RTL from a head-end position (HEP) and leg-end position (LEP). They were evaluated on leadership qualities including situational attentiveness (SA), errors detection (ED), and decision making (DM) using a standardized validated resuscitation-code-checklist (RCC). Performance was assessed live by 2 independent raters and was simultaneously recorded. RTL self-perceived performance was compared to measured performance. Results: Thirty-four participants completed the study. Mean marks for SA were 3.74 (SD ± 0.96) at HEP and 3.54 (SD ± 0.92) at LEP, P = .48. Mean marks for ED were 2.43 (SD ± 1.24) at HEP and 2.21 (SD ± 1.14) at LEP, P = .40. Mean marks for DM were 4.53 (SD ± 0.98) at HEP and 4.47 (SD ± 0.73) at LEP, P = .70. The mean total marks were 10.69 (SD ± 1.82) versus 10.22 (SD ± 1.93) at HEP and LEP respectively, P = .29 which shows no significance difference in all parameters. Twenty-four participants (71%) preferred LEP for the following reasons, better visualization (75% of participants); more room for movement (12.5% of participants); and better communication (12.5% of participants). RTL's perceived performance did not correlate with actual performance Conclusion: The physical position either HEP or LEP appears to have no influence on performance of RTL in simulated cardiac resuscitation. RTL should be aware of the advantages and limitations of each position.

Effects of team leaders’ position in cardiopulmonary resuscitation teams on leadership behavior and team performance: A prospective randomized interventional cross-over simulation-based trial

“…However, regardless of the leaders’ positioning, active leadership of team leaders, in terms of the total number of leadership statements, was associated with better CPR performance in regards of hands-on times. These results converge with those of Saiboon and colleagues [31] who also reported that the physical positioning of the leader had no effect on situational attentiveness, error detection and decision making. It may be due to the plausibility for the hands-off leader that team leader positioning during resuscitation has hardly been investigated.…”

“…[25,27] Behavioral markers in secondary outcomes were leaders' task violation, defined as the time spent with any task deferring from their allocated role in the hands-off or head position respectively (e.g., operating defibrillator in hands-off position); utterances leading to deviation from resuscitation guideline algorithms; Decision Making; Error Detection; and Situational Awareness, following Saiboon and colleagues. [31,32] We adapted and analyzed these parameters as follows:…”

“…Moreover, all non-leading team members in their study were confederates, so that many important aspects of teamwork as well as performance were not assessable. [31] The current study is one of very few investigating physical positioning of team leaders, which may be particularly important in teams in which task execution is tied to specific physical positions. In spite of the findings by Cooper and Wakelam [6] and the recommendations by the International Consensus on Cardiopulmonary Resuscitation [23] and their apparent plausibility, we did not find performance differences associated with physical positioning of the leader.…”

“…Moreover, all non-leading team members in their study were confederates, so that many important aspects of teamwork as well as performance were not assessable. [31]…”

Knowledge and Confidence Level Among Emergency Healthcare Workers in Airway Management and Resuscitation of Suspected COVID-19 Patients: A Cross Sectional Study in Malaysia

“…A survey instrument was designed based on guidelines, reports, course materials on resuscitation and respiratory disease including COVID-19. 8,[18][19][20] The questionnaire was divided into two parts. Part A was related to the demography of the respondents, comprising age, gender, EHCW designation categories and length of service (LOS) which was defined as the number of years of working as a healthcare provider.…”