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Abstract

Introduction: Code teams respond to cardiopulmonary arrest (CPA) events and must be able to act immediately as a team to effectively manage these emergencies. Teamwork amongst the code team during these responses are critical for efficient and effective resuscitation actions. Code team members are trained and skilled to respond to CPA events, but are often deficient in teamwork skills during resuscitation. Findings from previous research at the study organization to assess teamwork perception by code team members showed deficits in perception of teamwork related to leadership, communication, and mutual team support. The purpose of this study was to determine the effect of a two-hour training program using simulation, debriefing, and review of Crew Resource Management principles related to CPA events on perception of teamwork of code team members. Methods: The study was conducted in one large tertiary teaching hospital. Code team members who routinely respond to CPA events were invited to participate in a two-hour teamwork training program. A pre-test, post-test design was used for the study. A sample of resident physicians (MDs), nurses (RNs), and respiratory therapists (RTs) participated in a two-hour teamwork training program for CPA events. After informed consent, subjects participated in a mock CPA event in a simulation lab while being evaluated for teamwork skills by trained observers. After the simulation, subjects and observers rated teamwork performance during the simulation using the Team Emergency Assessment Measure (TEAM) tool on a 1–4 scale, including a global rating (1–10 scale). Next, a debriefing of the event was done, followed by a didactic presentation with group discussion on teamwork skills during CPA emergencies, using Crew Resource Management and TeamSTEPPS principles. Key areas of emphasis were on leadership, communication, and mutual support during CPA events. Subjects then participated in a second simulation of a different CPA event and were encouraged to use principles they had just learned in the program. Immediately following, subjects and observers again rated teamwork performance using the TEAM tool and completed evaluations on the program. Results: Seventy-three code team members participated in the study: 18 MDs (25%), 23 RNs (32%), and 30 RTs (41%) in small groups over a 12 week period. Significant improvement in the average TEAM score was noted by both participants and observers after the teamwork training program. Participants’ mean TEAM pre-test score was 3.3 and post-test score was 3.7 (p<.001) on a 1–4 scale. Observers’ mean scores improved from 3.0 to 3.7 (p<.001). Participants’ global rating score (1–10 scale) increased from 7.7 to 8.8 (p<.001) and observers’ global rating scores increased from 7.3–9.0 (p<.001). While observers rated the TEAM scores significantly lower than those of participants on the 1st simulated event, no differences were found after the 2nd simulation evaluation or on either of the global ratings (p<.05) Participants rated the simulation and training program as being beneficial, effective, enjoyed interprofessional team learning, and supported incorporating team training in future CPA training. Conclusions: A two-hour teamwork training program incorporating simulation and teamwork principles improves perceptions of teamwork from both trained observers and code team members. It was possible to incorporate teamwork principles into a two-hour training session versus a longer workshop program on team training. The program was effective in conveying key concepts relating to teamwork during CPA events in an interprofessional learning environment and participants were able to learn from each other, respecting contributions and roles from members of the code team. While long term retention of concepts and sustainability was not assessed in this study, a potential area for study on how team training for CPA events translates into behaviors during actual CPA emergencies may enhance knowledge in this area of practice.