Assessing team behaviours and time to defibrillation during simulated cardiac arrest: a pilot study of internal medicine trainees

Abstract

Abstract Introduction Understanding team behaviours leading to successful outcomes in resuscitation could help guide future training. Guidelines recommend defibrillation for shockable rhythm cardiac arrests within 2 minutes. This observational pilot study aimed to determine whether teamwork behaviours among medical trainees differed when time to defibrillation (TTD) was less than 2 minutes, versus 2 minutes or more. Methods Following ethical approval, groups of six internal medicine trainee (IMT) doctors in Scotland formed an ad hoc team in high-fidelity immersive simulation (shockable rhythm cardiac arrest). TTD was recorded. Video-recordings were scored by two researchers independently using the Team Emergency Assessment Measure (TEAM) tool. Differences between TEAM scores in the fast TTD versus slow TTD groups were compared using Student’s t-test. Results Twenty-three videos involving 138 trainees were scored using the TEAM tool. Scores ranged from 19–39.5/44 (mean 28.2). Mean TTD was 86.2 seconds (range 24–224), with 17/23 teams achieving defibrillation in under 2 minutes. Those achieving fast TTD achieved higher TEAM scores, and the result was statistically significant (30.1 ± 5.0 vs 22.9 ± 3.3, p = 0.004). When analysing the statistical significance of the differences in individual TEAM items, there was a statistically significant difference in the fast TTD and slow TTD groups for item 7 (adaptability). Discussion This observational pilot study found that improved team performance, as measured by the TEAM tool, was associated with faster defibrillation by IMT doctors in simulated cardiac arrest. It highlighted the importance of adaptability as a team behaviour associated with successful performance, which is of interest to those involved in training high stakes emergency teams.