Critical Outcomes: Clinical and Team Performance Across Acute Illness Scenarios in Emergency Departments of Critical Access Hospitals

Abstract

In their provision of acute care services, emergency department (ED) providers in critical access hospitals (CAHs) are uniquely challenged by limitations in personnel, facility resources, and available expertise. We sought to define the impact of team behaviors among ED staff in CAHs on clinical performance by studying the relationship between team and clinical performance scores across 100 simulated scenarios. Team and clinical performance scores were calculated for each scenario using standardized checklists to quantify goal achievement and aggregated across teams and scenario types. These scores were compared using bivariate analysis and correlated with clinical and team performance outcomes using Pearson's correlation (r coefficient). There was a positive correlation between team and clinical performance across all scenarios; the relationship was statistically significant (p<.05) in 3 scenarios: acute coronary syndrome (r=.69; p=.027); abdominal aortic aneurysm (r=.77; p=.009); and nonaccidental trauma (r=.75; p=.013). The wide correlation between clinical and team performance may be a function of the critical care event itself or the unique characteristics of CAHs that make them more vulnerable when faced with high acuity, complex, and infrequently encountered clinical scenarios.