Abstract
BackgroundIn order to enhance patient safety during resuscitation of critically ill patients, we need to optimize team communication and enhance team situational awareness but little is known about resuscitation team communication patterns. The objective of this study is to understand how teams communicate during resuscitation; specifically to assess for a shared mental model (organized understanding of a team’s relationships) and information needs.MethodsWe triangulated 3 methods to evaluate resuscitation team communication at a tertiary care academic trauma center: (1) interviews; (2) simulated resuscitation observations; (3) live resuscitation observations. We interviewed 18 resuscitation team members about shared mental models, roles and goals of team members and procedural expectations. We observed 30 simulated resuscitation video recordings and documented the timing, source and destination of communication and the information category. We observed 12 live resuscitations in the emergency department and recorded baseline characteristics of the type of resuscitations, nature of teams present and type and content of information exchanges. The data were analyzed using a qualitative communication analysis method.ResultsWe found that resuscitation team members described a shared mental model. Respondents understood the roles and goals of each team member in order to provide rapid, efficient and life-saving care with an overall need for situational awareness. The information flow described in the interviews was reflected during the simulated and live resuscitations with the most responsible physician and charting nurse being central to team communication. We consolidated communicated information into six categories: (1) time; (2) patient status; (3) patient history; (4) interventions; (5) assistance and consultations; 6) team members present.ConclusionsResuscitation team members expressed a shared mental model and prioritized situational awareness. Our findings support a need for cognitive aids to enhance team communication during resuscitations.
Highlights
In order to enhance patient safety during resuscitation of critically ill patients, we need to optimize team communication and enhance team situational awareness but little is known about resuscitation team communication patterns
We found that interviewees described potential resuscitation scenarios which clustered into 6 types: trauma, cardiac, overdose, major hemorrhage, sepsis and respiratory failure
Key findings We found that resuscitation team members have a shared mental model which involved understanding each other’s roles and goals in the resuscitation in terms of providing rapid, efficient, life-saving care with a need for overall situational awareness
Summary
In order to enhance patient safety during resuscitation of critically ill patients, we need to optimize team communication and enhance team situational awareness but little is known about resuscitation team communication patterns. Many efforts have been devoted to enhancing healthcare team performance via programs such as TeamSTEPPS, MedTEAMS and the practicing of non-technical skills via hi-fidelity simulation [5,6,7,8,9,10]. These efforts largely arose from a recommendation by the Institute of Medicine to use simulation focusing on teamwork with a view to enhancing patient safety [11]. This has yet to be fully described in the literature
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