Clinical efficiency in a simulated emergency and relationship to team behaviours: a multisite cross‐sectional study

Please cite this paper as: Siassakos D, Bristowe K, Draycott T, Angouri J, Hambly H, Winter C, Crofts J, Hunt L, Fox R. Clinical efficiency in a simulated emergency and relationship to team behaviours: a multisite cross‐sectional study. BJOG 2011;118:596–607. Objective  To identify specific aspects...

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Published in:BJOG : an international journal of obstetrics and gynaecology 2011-04, Vol.118 (5), p.596-607
Main Authors: Siassakos, D, Bristowe, K, Draycott, TJ, Angouri, J, Hambly, H, Winter, C, Crofts, JF, Hunt, LP, Fox, R
Format: Article
Language:English
Subjects:
Biological and medical sciences
Calcium Channel Blockers - therapeutic use
Clinical Competence - standards
Clinical trials
Closed loop
Communication
Cross-Sectional Studies
Decision Making
eclampsia
education
Emergencies
Emergency Treatment - standards
Female
Gynecology. Andrology. Obstetrics
handoff
handover
Humans
Interprofessional Relations
leadership
magnesium sulfate
Magnesium Sulfate - therapeutic use
Medical sciences
mnemonics
obstetric labour complications
Obstetrics
patient care team
Patient Care Team - standards
Pre-Eclampsia - drug therapy
Pregnancy
Pregnancy Outcome
Prenatal Care - standards
pre‐eclampsia
SBAR
Simulation
teaching
Teamwork
Time Factors
training
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Summary:Please cite this paper as: Siassakos D, Bristowe K, Draycott T, Angouri J, Hambly H, Winter C, Crofts J, Hunt L, Fox R. Clinical efficiency in a simulated emergency and relationship to team behaviours: a multisite cross‐sectional study. BJOG 2011;118:596–607. Objective  To identify specific aspects of teamworking associated with greater clinical efficiency in simulated obstetric emergencies. Design  Cross‐sectional secondary analysis of video recordings from the Simulation & Fire‐drill Evaluation (SaFE) randomised controlled trial. Setting  Six secondary and tertiary maternity units. Sample  A total of 114 randomly selected healthcare professionals, in 19 teams of six members. Methods  Two independent assessors, a clinician and a language communication specialist identified specific teamwork behaviours using a grid derived from the safety literature. Main outcome measures  Relationship between teamwork behaviours and the time to administration of magnesium sulfate, a validated measure of clinical efficiency, was calculated. Results  More efficient teams were likely to (1) have stated (recognised and verbally declared) the emergency (eclampsia) earlier (Kendall’s rank correlation coefficient τb = −0.53, 95% CI from −0.74 to −0.32, P = 0.004); and (2) have managed the critical task using closed‐loop communication (task clearly and loudly delegated, accepted, executed and completion acknowledged) (τb = 0.46, 95% CI 0.17–0.74, P = 0.022). Teams that administered magnesium sulfate within the allocated time (10 minutes) had significantly fewer exits from the labour room compared with teams who did not: a median of three (IQR 2–5) versus six exits (IQR 5–6) (P = 0.03, Mann–Whitney U‐test). Conclusions  Using administration of an essential drug as a valid surrogate of team efficiency and patient outcome after a simulated emergency, we found that more efficient teams were more likely to exhibit certain team behaviours relating to better handover and task allocation.
ISSN:1470-0328
1471-0528
DOI:10.1111/j.1471-0528.2010.02843.x