Teaching teamwork during the Neonatal Resuscitation Program: A randomized trial

Article (PDF Available)inJournal of Perinatology 27(7):409-14 · July 2007with127 Reads
DOI: 10.1038/sj.jp.7211771 · Source: PubMed
Abstract
To add a team training and human error curriculum to the Neonatal Resuscitation Program (NRP) and measure its effect on teamwork. We hypothesized that teams that received the new course would exhibit more teamwork behaviors than those in the standard NRP course. Interns were randomized to receive NRP with team training or standard NRP, then video recorded when they performed simulated resuscitations at the end of the day-long course. Outcomes were assessed by observers blinded to study arm allocation and included the frequency or duration of six team behaviors: inquiry, information sharing, assertion, evaluation of plans, workload management and vigilance. The interns in the NRP with team training group exhibited more frequent team behaviors (number of episodes per minute (95% CI)) than interns in the control group: information sharing 1.06 (0.24, 1.17) vs 0.13 (0.00, 0.43); inquiry 0.35 (0.11, 0.42) vs 0.09 (0.00, 0.10); assertion 1.80 (1.21, 2.25) vs 0.64 (0.26, 0.91); and any team behavior 3.34 (2.26, 4.11) vs 1.03 (0.48, 1.30) (P-values <0.008 for all comparisons). Vigilance and workload management were practiced throughout the entire simulated code by nearly all the teams in the NRP with team training group (100% for vigilance and 88% for workload management) vs only 53 and 20% of the teams in the standard NRP. No difference was detected in the frequency of evaluation of plans. Compared with the standard NRP, NRP with a teamwork and human error curriculum led interns to exhibit more team behaviors during simulated resuscitations.

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ORIGINAL ARTICLE
Teaching teamwork during the Neonatal Resuscitation Program:
a randomized trial
EJ Thomas
1,2
, B Taggart
1,3
, S Crandell
1,4
, RE Lasky
1,4
, AL Williams
4
, LJ Love
4
, JB Sexton
1,5,6
, JE Tyson
1,4
and
RL Helmreich
1,3
1
The University of Texas Center of Excellence for Patient Safety Research and Practice (Agency for Healthcare Research and Quality grant
#1PO1HS1154401), Houston, TX, USA;
2
Division of General Medicine, Department of Medicine, The University of Texas Houston Medical
School, Houston, TX, USA;
3
Department of Psychology, The University of Texas at Austin, Human Factors Research Project, Austin, TX,
USA;
4
Department of Pediatrics, The University of Texas Houston Medical School, Austin, TX, USA;
5
Department of Anesthesiology and
Critical Care, The Johns Hopkins University Schools of Medicine and Public Health, Baltimore, MD, USA and
6
Department of Health
Policy and Management, The Johns Hopkins University Schools of Medicine and Public Health, Baltimare, MD, USA
Objective: To add a team training and human error curriculum to the
Neonatal Resuscitation Program (NRP) and measure its effect on
teamwork. We hypothesized that teams that received the new course would
exhibit more teamwork behaviors than those in the standard NRP course.
Study design: Interns were randomized to receive NRP with team
training or standard NRP, then video recorded when they performed
simulated resuscitations at the end of the day-long course. Outcomes were
assessed by observers blinded to study arm allocation and included the
frequency or duration of six team behaviors: inquiry, information sharing,
assertion, evaluation of plans, workload management and vigilance.
Result: The interns in the NRP with team training group exhibited
more frequent team behaviors (number of episodes per minute (95% CI))
than interns in the control group: information sharing 1.06 (0.24, 1.17)
vs 0.13 (0.00, 0.43); inquiry 0.35 (0.11, 0.42) vs 0.09 (0.00, 0.10);
assertion 1.80 (1.21, 2.25) vs 0.64 (0.26, 0.91); and any team behavior
3.34 (2.26, 4.11) vs 1.03 (0.48, 1.30) (P-values <0.008 for all
comparisons). Vigilance and workload management were practiced
throughout the entire simulated code by nearly all the teams in the NRP
with team training group (100% for vigilance and 88% for workload
management) vs only 53 and 20% of the teams in the standard NRP. No
difference was detected in the frequency of evaluation of plans.
Conclusion: Compared with the standard NRP, NRP with a teamwork
and human error curriculum led interns to exhibit more team behaviors
during simulated resuscitations.
Journal of Perinatology (2007) 27, 409414. doi:10.1038/sj.jp.7211771;
published online 7 June 2007
Keywords: teamwork; neonatal resuscitation; patient safety; team training
Introduction
The Neonatal Resuscitation Program (NRP) is the standard
curriculum used to teach caregivers how to treat newborns
in the delivery room. Worldwide, the NRP could improve outcomes
of thousands of newborns per year.
1
However, approximately
30% of NRP steps are not performed or performed
incorrectly,
2,3
and pediatric residents often fail to intubate
infants correctly.
4
Neonatal resuscitation should be a team activity that
involves at least two people who work together to achieve a
shared goal.
5
Breakdowns in teamwork may contribute to the
quality problems noted above. For example, team behaviors
are correlated with the quality of neonatal resuscitation,
3
communication breakdowns are root cause of 72% of perinatal
deaths and injuries,
6
perceptions of effective teamwork are
correlated with less burnout and fewer delays in labor and
delivery,
7
and there is broad consensus from expert groups
and researchers that measuring and improving teamwork will
help improve the quality of health care.
8–10
However, none
of the nine lessons in the NRP textbook
1
includes instruction
about teamwork, in part because no studies have shown that
team training can improve either teamwork or the quality of
health care.
11,12
Therefore, we conducted a study with two specific aims: (1) to
incorporate teamwork skills and information about human error
into the 1-day NRP training program for interns and (2) to
randomize interns to this new version of NRP or the standard NRP
and measure the effects on teamwork during the simulated
resuscitations at the end of the day. We hypothesized that it would
be feasible to add the teamwork training to the 1-day NRP course,
and that interns who were randomized to the NRP course with
team training would exhibit more teamwork behaviors during the
simulated resuscitation than would the interns in the standard
NRP course.
Received 12 January 2007; revised 9 April 2007; accepted 8 May 2007; published online 7 June 2007
Correspondence: Dr EJ Thomas, Department of Internal Medicine, Houston Medical School,
The University of Texas, 6431 Fannin MSB 1.122, Houston TX 77030, USA.
E-mail: Eric.Thomas@uth.tmc.edu
Journal of Perinatology (2007) 27, 409414
r
2007 Nature Publishing Group All rights reserved. 0743-8346/07 $30
www.nature.com/jp
Materials and methods
All interns in pediatrics, combined internal medicine and
pediatrics, family medicine, and obstetrics and gynecology
who began training in June 2005 were eligible for the study.
The study was approved by the IRB, and consenting subjects
were randomly assigned (generated using a random number
generator by ALW) to attend the standard NRP course or the
NRP course with additional instruction in teamwork skills
and human error. The course was conducted during their
orientationinJune.
Intervention
The teamwork and human error component was delivered
during the first 2 1/2 h of the day. The curriculum’s major
topics were as follows: (1) frequency and types of errors during
neonatal resuscitation; (2) the nature and causes of human
error (limits of human performance, role of systems in causing
human error, situational awareness, flawed communication);
(3) commercial aviation’s approach to team training; (4) role
plays and video clips to illustrate concepts and skills; and (5)
description of teamwork skills relevant to neonatal resuscitation.
Methods used to convey these topics included lecture, low-fidelity
simulations (role play), short video clips to illustrate points and
a question and answer period. Subsequently, the interns then
received the complete standard NRP course lectures. These
lectures were delivered in modules that addressed specific skills.
After each module, the interns went to skill stations to practice
the skill (for example, intubation) on low-fidelity mannequins.
During these skills stations, the interns in the intervention arm
were prompted by instructors to practice the team behaviors.
Otherwise, the curriculum followed the standard NRP course and
was identical to the control group curriculum in all aspects
other than the teamwork and human error instruction that
occurred at the beginning of the day and during the skills
stations. All the instructors had experience in teaching NRP and
were the usual group of instructors used at the study site. Those
who volunteered were taught the teamwork and human error
curriculum the day before the study so that they would be
prepared to help teach the interns at the skills stations.
Instructors who interacted with the control group did not receive
the curriculum.
The following team behaviors were taught: inquiry, information
sharing, assertion, evaluation of plans, workload management and
vigilance (Figure 1). These behaviors were chosen and defined
based upon focus groups with neonatal physicians and nurses,
observations of actual neonatal resuscitations
3,13,14
and behaviors
found to prevent and manage error in commercial aviation.
9,15
The
behaviors were defined during the lecture, they were illustrated
during the role play and video clips, discussed during question and
answer sessions, and instructors reminded students to use them
during the skills stations.
Data collection
Each intern led a team comprising of one or two other subjects
(the other interns) in a mock resuscitation at the end of the day.
Each subject took turns being the leader. These were conducted
using a low-fidelity mannequin on a table. The intervention and
control groups were on different floors. An instructor
communicated the clinical situation to the team (for example, the
infant’s heart rate, color and tone), then asked the team to begin
the resuscitation. The resuscitations were video recorded and
randomly divided among two trained, blinded observers.
Observer training and reliability testing occurred in three steps
over a 5-month period using video recordings from an earlier
study.
3
First, observers were oriented by an investigator (EJT) and
they viewed a training video that demonstrated examples of
teamwork behaviors during neonatal resuscitations. Second, the
investigator and two observers independently viewed two
resuscitations and then met to discuss differences in their
observations of teamwork behaviors and to clarify definitions.
Third, a total of 28 resuscitations were scored, divided among five
phases. At the end of each phase, we calculated a Cohen’s k for
each teamwork behavior, and the raters and investigator discussed
ways to clarify the definitions of team behaviors and to improve
reliability. ks for the final phase of training ranged from moderate
to excellent (workload management (k ¼ 0.54), evaluation of
plans (k ¼ 0.57), vigilance (k ¼ 0.59), information sharing
(k ¼ 0.66), inquiry (k ¼ 0.82) and assertion (k ¼ 0.87)).
When viewing a video recording, the observers indicated the
number of times each behavior was exhibited. Episodes of inquiry,
resuscitation.
b. Information sharing- Interns verbalized information to other team members
status.
a. Inquiry –Interns asked questions of each other about anything related to the
about the infant’s status. For example, verbalization of heart rate, color, tone,
vocal cord visualization, statements of opinion, advocating of views in non-
critical moments, and other relevant observations or impressions about the baby’s
c. Assertion– An intern asserted an opinion about the resuscitation process
(through questions or statements) during critical times. Assertion did not include
routine statements or questions about a baby’s heart rate, tone, color, and
respirations.
d. Evaluation of plans - An explicit and detailed discussion about the status of the
baby and the decisions made to get to the current situation.
e. Workload management – Tasks were prioritized and distributed among the
team members.
f. Vigilance - Interns remained alert and focused on the resuscitation. Lack of
vigilance was coded when any of the team members lost focus on the
resuscitation for at least 3 seconds.
Figure 1 Definitions of teamwork behaviors.
Teamwork during the Neonatal Resuscitation Program
EJ Thomas et al
410
Journal of Perinatology
information sharing, assertion or evaluation of plans were noted
based upon verbalizations of team members. Vigilance and
workload management were measured as percent time in that
particular state. Teams were considered to be non-vigilant when
any team member stopped watching the resuscitation for more
than 3 s. Workload management assessed the appropriate
distribution of tasks during the procedure. Teams were without
workload management if any team member did not offer to assist
with the resuscitation when the leader was handling two or more
tasks simultaneously (for example, if the leader was performing
bag-mask ventilation and trying to measure heart rate
simultaneously).
Data analysis
Because there were no previous studies addressing this topic, we
had no a priori sample size calculations. The teamwork behaviors
exhibited during the simulated resuscitations were compared for
interns who received the standard NRP training and those who
received NRP with team training. The data were recorded with
Noldus Observer (version 5.0; October 2003; Noldus Information
Technology, The Netherlands). Information sharing, inquiry,
assertion, intentions shared and evaluation of plans were recorded
as rates (number of behaviors per minute). Vigilance and workload
management were measured as percentages of the simulation time
that interns remained in that state. Teamwork behavior frequencies
from the two groups of interns were compared using
nonparametric MannWhitney rank sum tests in STATA (version
9.0; May 2005; StataCorp., College Station, TX 77845, USA). STATA
was also used to calculate CI about the medians using the
binomial method.
Results
Of the 51 eligible subjects, 29 were from pediatrics and combined
pediatrics-internal medicine, 12 from family medicine and 10 from
obstetrics and gynecology. Fifty were asked to participate (one was
not in town when consent was obtained) and there were five non-
consenters from pediatrics and five from obstetrics and gynecology,
so 40 interns were randomized. There were no differences in the
distribution of types of interns in the two groups. The intervention
group had 11 pediatric interns, 6 family medicine and 2 obstetrics
and gynecology; the control group had 12, 6 and 3, respectively.
Seven interns from the control group had an incomplete video
recording because the camera ran out of tape or the camera was
started after the event began (there was only one person responsible
for monitoring six cameras). One intern from the intervention
group did not take a turn as a team leader. This left 17
intervention and 15 control interns in the final analysis (Figure 2).
The interns in the NRP with team training group exhibited
more frequent information sharing, inquiry and assertion than the
interns in the control group (Figure 3). Evaluation of plans was
observed once in the NRP with team training group. It was not
observed in the standard NRP group. Vigilance and workload
management were practiced throughout the entire simulated code
by nearly all the teams in the NRP with team training group
(100% for vigilance and 88% for workload management). In
contrast, only 53 and 20% of the teams in the standard NRP group
were vigilant and managed their workload throughout the entire
simulated code session.
Discussion
Interns who were randomized to an NRP course with a teamwork
and human error curriculum exhibited more team behaviors
during the simulated resuscitation at the end of the course than
interns in the standard NRP course. This is the first study to
document that team training for neonatal resuscitation, and
perhaps any health-care process, can result in more frequent
utilization of team behaviors. Other strengths include random
allocation of subjects to the intervention and control groups; use of
trained, blinded observers to rate the frequency of team behaviors;
teaching and measurement of team behaviors that were developed
based upon research in commercial aviation and neonatal
resuscitation;
3,9,1315
and incorporating the teamwork and human
error curriculum into an existing and widely used training
program. The latter increases the likelihood that the team training
would be widely disseminated if future research confirms and
expands our findings. A final strength is that we used low-fidelity
instead of high-fidelity simulation. Resuscitation dolls are
substantially less expensive and more widely available than
computer-driven mannequins in simulated delivery room. However,
we have no data to comment on whether low- or high-fidelity
simulation is more effective for team training.
Limitations included having only physicians (interns) as
subjects, so our results may not generalize to more experienced
51 Eligible Subjects
1 Not available to consent
10 Refused
40 Randomized
18 Assigned and received
NRP with team training
1 did not lead a simulated
resuscitation
17 Included in analysis
22 Assigned and received
Standard NRP
7 Had an incomplete
video recording
15 Included in analysis
Figure 2 Progress of patients throughout the trial.
Teamwork during the Neonatal Resuscitation Program
EJ Thomas et al
411
Journal of Perinatology
physicians. Seven resuscitations in the control arm (vs only one in
the intervention arm) were excluded owing to technical issues with
the recordings. We believe that the technical difficulties were
random occurrences, but if the excluded subjects exhibited high
frequencies of team behaviors, then we might have found a smaller
effect size for this intervention. It is also notable that neither the
intervention nor the control group used the behavior called
evaluation of plans. This may indicate a weakness in the training
program, or perhaps that novices are not comfortable using this
behavior which conceptually and empirically tends to be a
leadership behavior.
3
We have not studied how long the team
behaviors persist after training and we did not assess whether the
intervention improved teamwork or quality during actual patient
care.
There is a rapidly growing interest in improving teamwork and
using simulation in health care. This is due in part to expert
groups such as the Institute of Medicine and regulators like the
Joint Commission for Accreditation of Health-care Organizations
who advocate some type of team training. In addition, research
suggests the need for improved teamwork and communication in
neonatal intensive care,
2,3,16
emergency departments,
10
the
operating room,
17,18
trauma resuscitation
1921
and among
residents of all disciplines.
22
Despite this interest and research, two
recent reviews concluded that no studies have shown that team
training can improve teamwork and the quality of care,
11,12
and a
cluster randomized trial of team training for labor and delivery
teams did not find significant changes in the process of care or
outcome measures.
23
Thus, knowledge about how to improve team
behavior appears to be in its infancy.
The most progress has been made in the emergency room
setting where studies have been carried out to evaluate the
effectiveness of team training on actual patient care.
10,24
Morey
reported improved measures of teamwork, but their participants
were not randomized and their observers were not blinded. Shapiro
did not find statistically significant improvements in team
behavior. An important difference between both of these studies and
ours is that we measured the frequency and duration of specific
behaviors whereas they used five seven-point behaviorally anchored
rating scales to rate the quality of certain dimensions of teamwork
(maintain team structure and climate, apply problem-solving
strategies, support team with information, execute plans and
manage workload, and improve team skills). It is possible that our
more focused frequency and duration-based team outcome
measures are more sensitive. Our teamwork measures may also be
more sensitive because they were developed and defined based upon
observations of actual neonatal resuscitations. Similarly, our
training curriculum was firmly grounded in the context and
processes of neonatal resuscitation. It included data on the types
and causes of errors during neonatal resuscitation and used
examples of good and bad teamwork from neonatal resuscitation.
Our results support the belief that generic team training principles
and skills will only be effective if grounded in specific health-care
processes.
25,26
Another important difference is that we observed
video recordings of simulated patient care instead of direct
observation of actual patient care. The latter method is much more
challenging for observers.
The current NRP student textbook does not mention teamwork,
but the leader guide lists 10 behavioral skills for effective
Figure 3 Rates of teamwork behaviors in the standard NRP and NRP with team training groups. Evaluation of plans was observed once in the NRP
with team training group. It was not observed in the standard NRP group.
Teamwork during the Neonatal Resuscitation Program
EJ Thomas et al
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Journal of Perinatology
resuscitation teams, and has half a page of accompanying text. The
behaviors we measured and those in the NRP leader guide are
similar, but our behaviors are more explicit and discreet. This
should make them easier to measure and teach. For example, the
leader guide suggests communicate clearly, efficiently and directly
with other team members. In previous research, we found that two
specific behaviors, information sharing and inquiry, group together
in a domain we called communication (the other domains were
leadership and management, each composed of specific, observable
behaviors).
3
Thus, future editions of the NRP might note that
information sharing and inquiry, as we defined them, are
examples of communicating clearly, efficiently and directly. Our
study may also have implications for the content of the NRP
student textbook, lectures and practicing team behaviors during the
skills stations.
A relatively brief teamwork and human error curriculum can
affect the team behavior of pediatric, family medicine and
obstetrics/gynecology interns. Our study should encourage more
research on incorporating similar curricula into the NRP and
perhaps other resuscitation programs such as Advanced Cardiac
Life Support. It will be important to assess whether the training
effects persist and how they affect quality of care and patient
outcomes. Clinicians are not provided teamwork training in
medical and nursing schools, so future research can expand on
our study to provide caregivers the care coordination skills that are
increasingly important for modern medicine.
Acknowledgments
Funding for this study was provided by Agency for Health-care Research and
Quality (#1PO1HS1154401). Financial disclosures: Bill Taggart works as a team
training consultant. The remaining authors have no conflicts of interest.
References
1 Kattwinkel J (Ed.) Textbook of Neonatal Resuscitation. American Academy
of Pediatrics and American Heart Association, 2006.
2 Carbine DN, Finer NN, Knodel E, Rich W. Video recording as a means
of evaluating neonatal resuscitation performance. Pediatrics 2000; 106:
654658.
3 Thomas EJ, Sexton JB, Lasky RE, Helmreich RL, Crandell S, Tyson J.
Teamwork and quality during neonatal care in the delivery room.
J Perinatol 2006; 26: 163169.
4 Falck AJ, Escobedo MB, Baillargeon JG, Villard LG, Gunkel JH. Proficiency of
pediatric residents in performing neonatal endotracheal intubation.
Pediatrics 2003; 112: 12421247.
5 Brannick MT, Prince C. An overview of team performance measurement. In:
Brannick MT, Salas E, Prince C (eds). Team Performance Assessment and
Measurement. Theory, Methods, and Applications. Lawrence Erlbaum:
Mahwah, NJ, 1997.
6 Joint Commission. Sentinal Event Alert. Issue 30, July 21, 2004 http://
www.jointcommission.org/SentinelEvents/SentinelEventAlert/sea_30.htm
accessed September 2006.
7 Sexton JB, Holzmueller CG, Pronovost PJ, Thomas EJ, McFerran S, Nunes J
et al. Variation in caregiver perceptions of teamwork climate in labor and
delivery units. J Perinatol 2006; 26(8): 463470.
8 Kohn LT, Corrigan JM, Donaldson MS Eds). To Err is Human. Building a
Safer Health System. National Academy Press: Washington, DC, 1999.
9 Helmreich RL, Schaefer HG. Team performance in the operating room. In:
Bogner MS (Ed)., Human Error in Medicine. Erlbaum: Hillsdale, NJ, 1994,
pp 225253.
10 Morey JC, Simon R, Jay GD et al. Error reduction and performance
improvement in the emergency department through formal teamwork
training: evaluation results of the MedTeams project. Health Services Res
2002; 37: 15531581.
11 Baker DP, Gustafson S, Beaubien JM, Salas E, Barach P. Medical team
Training Programs in Health Care. In: Henriksen K, Battles JB, Marks ES,
Lewin DI (eds). Advances in Patient Safety: from Research to
Implementation. Vol 4. AHRQ: Rockville MD Feb 2005. Programs, tools and
concepts. AHRQ Publication No. 05-0021-2.
12 Salas E, Wilson KA, Burke CS, Wightman DC. Does crew resource
management training work? An update, an extension, and some critical
needs. Hum Factors 2006; 48: 392412.
13 Thomas EJ, Sherwood GD, Mulhollem JL, Sexton JB, Helmreich RL.
Working together in the neonatal intensive care unit: provider perspectives.
J Perinatol 2004; 24(9): 552559.
14 Thomas EJ, Sexton JB, Helmreich RL. Translating teamwork behaviors from
aviation to healthcare: development of behavioral markers for neonatal
resuscitation. Qual Saf Healthcare 2004; 13(Suppl 1): i57i64.
15 Helmreich RL, Foushee HC. Why crew resource management: empirical and
theoretical bases of human factors training in aviation. In: Wiener EL, Kanki
BG, Helmreich RL (eds). Cockpit Resource Management. Academic Press:
San Diego, CA, 1993.
16 Halamek LP, Kaegi DM, Gaba DM, Sowb YA, Smith BC, Smith BE et al. Time for
a new paradigm in pediatric medical education: teaching neonatal resuscitation
in a simulated delivery room environment. Pediatrics 2000; 106: E45.
17 Makary MA, Sexton JB, Freischlag JA, Holzmueller CG, Millman EA, Rowen L
et al. Operating room teamwork among physicians and nurses: teamwork in
the eye of the beholder. J Am Coll Surg 2006; 202(5): 746752.
18 Carthey J, de Leval MR, Wright DJ, Farewell VT, Reason JT. Behavioural
markers of surgical excellence. Safety Sci 2003; 41: 409425.
19 Santora TA, Trooskin SZ, Blank CA, Clarke JR, Schinco MA. Video assessment
of trauma response: adherence to ATLS protocols. Am J Emerg Med 1996;
14(6): 564569.
20 Sugrue M, Seger M, Kerridge R, Sloane D, Deane S. A prospective study of the
performance of the trauma team leader. J Trauma 1995; 38(1): 7982.
21 Xiao Y, Hunter WA, Mackenzie CF, Jefferies NJ, Horst RL. Task complexity in
emergency medical care and its implications for team coordination. LOTAS
Group. Level one trauma anesthesia simulation. Hum Factors 1996; 38(4):
636645.
22 Sutcliffe KM, Lewton E, Rosenthal MM. Communication failures: an
insidious contributor to medical mishaps. Acad Med 2004; 79: 186194.
23 Nielsen PE, Goldman MB, Mann S, Shapiro DE, Marcus RG, Pratt SD et al.
Effects of teamwork training on adverse outcomes and process of care in labor
and delivery: a randomized controlled trial. Obstet Gynecol 2007; 109: 4855.
Teamwork during the Neonatal Resuscitation Program
EJ Thomas et al
413
Journal of Perinatology
24 Shapiro MJ, Morey JC, Small SD, Langford V, Kaylor CJ, Jagminas L et al.
Simulation based teamwork training for emergency department staff:
does it improve clinical team performance when added to an existing
didactic teamwork curriculum? Qual Saf Health Care 2004; 13:
417421.
25 Healy AN, Undre S, Vincent CA. Defining the technical skills of teamwork in
surgery. Qual Saf Health Care 2006; 15: 231234.
26 Yule S, Flin R, Paterson-Brown S, Maran N, Rowley D. Development of a
rating system for surgeons’ non-technical skills. Med Edu 2006; 40(11):
10981104.
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    • "All the studies found refered to NTS improvement after its training courses (Brunckhorst et al., 2015; Capella et al., 2010; Garbee et al., 2013; Hull et al., 2012; Lindamood et al., 2011; Lyk-Jensen et al., 2014; Martinou et al., 2015; Nguyen, Elliott, Watson, & Dominguez, 2015; Paige et al., 2014; Riley et al., 2011; Robertson et al., 2009; Thomas et al., 2007; Ziesmann et al., 2013). In resuscitation teams, Thomas et al. (2007) aimed to integrate a team training and human error curriculum to the Neonatal Resuscitation Program and measure its effect on teamwork, hypothesizing and then concluding that teams that received the new course exhibited more teamwork behaviors during simulated resuscitations than others. On the other hand, Capella et al. (2010) demonstrated that strucutured simulation-based trauma resuscitation team (surgery residents, faculty, and nurses) training improves team performance, resulting in improved efficiency of patient care, proposing that formal teamwork training should be included in surgery residency training. "
    Conference Paper · Nov 2016 · BMC Medical Education
    • "Thomas and colleagues identified optimal teamwork behaviors for neonatal resuscitation including sharing information, evaluating plans, and prioritizing and distributing the workload among team members [11]. Teaching team behaviors in conjunction with a skills-based curriculum such as the Neonatal Resuscitation Program (NRP; [12]) can significantly improve teamwork131415161718 and quality of care [13,15]. To facilitate effective teamwork, the 2010 International Consensus Guidelines on Neonatal Resuscitation recommend briefing and debriefing, the process of reviewing and communicating pertinent facts about the resuscitation before and after events [19]. "
    [Show abstract] [Hide abstract] ABSTRACT: Stabilization and resuscitation of a newborn infant is a complex activity that involves multiple team members. Neonatal intensive care units (NICU) participating in the Vermont Oxford Network (VON) iNICQ 2012 quality improvement collaborative reported on delivery room care policies and guidelines and submitted information on up to 10 consecutive deliveries attended by NICU team members. Teams received immediate feedback on their local performance and a summary of results from all participating units for use in quality improvement planning. Most of the 84 NICU teams that participated in the audit had policies or guidelines about which deliveries required NICU team attendance (83%), personnel who should attend (81%), and their required training (79%). Fewer had policies about briefing prior to the delivery (8%), debriefing after delivery (6%), or communicating with family members (10%). Eighty-one percent of NICUs reported using simulation-based resuscitation training, 14% used a safety checklist, and 2% videotaped deliveries for review. Of the 609 audited deliveries, 88% had team member attendance that conformed to unit policy, 66% had a briefing before delivery, 19% had a debriefing after delivery, and 92% had family communication occur within 30 minutes. NICU teams can improve the quality and safety of delivery room care by implementing formal tools designed to facilitate teamwork such as briefings, debriefings, checklists, and videotape reviews. Rapid online audits are effective methods for helping teams identify opportunities for improvement.
    Full-text · Article · Dec 2015
    • "Moreover, both the European Resuscitation Council (ERC) and the American Heart Association (AHA) strongly recommend integrating teamwork training, including leadership as a key skill, into advanced life support (ALS) education [10, 11]. Regarding the implemented teaching methods, some training approaches combine patient simulation with debriefings on team and leadership behavior [7, 9,121314. Other approaches are less extensive (i.e., no debriefings) and some comprise more invasive teaching elements such as brief instructions [8, 15, 16]. "
    [Show abstract] [Hide abstract] ABSTRACT: Effective team leadership in cardiopulmonary resuscitation (CPR) is well recognized as a crucial factor influencing performance. Generally, leadership training focuses on task requirements for leading as well as non-leading team members. We provided crisis resource management (CRM) training only for designated team leaders of advanced life support (ALS) trained teams. This study assessed the impact of the CRM team leader training on CPR performance and team leader verbalization. Forty-five teams of four members each were randomly assigned to one of two study groups: CRM team leader training (CRM-TL) and additional ALS-training (ALS add-on). After an initial lecture and three ALS skill training tutorials (basic life support, airway management and rhythm recognition/defibrillation) of 90-min each, one member of each team was randomly assigned to act as the team leader in the upcoming CPR simulation. Team leaders of the CRM-TL groups attended a 90-min CRM-TL training. All other participants received an additional 90-min ALS skill training. A simulated CPR scenario was videotaped and analyzed regarding no-flow time (NFT) percentage, adherence to the European Resuscitation Council 2010 ALS algorithm (ADH), and type and rate of team leader verbalizations (TLV). CRM-TL teams showed shorter, albeit statistically insignificant, NFT rates compared to ALS-Add teams (mean difference 1.34 (95 % CI -2.5, 5.2), p = 0.48). ADH scores in the CRM-TL group were significantly higher (difference -6.4 (95 % CI -10.3, -2.4), p = 0.002). Significantly higher TLV proportions were found for the CRM-TL group: direct orders (difference -1.82 (95 % CI -2.4, -1.2), p < 0.001); undirected orders (difference -1.82 (95 % CI -2.8, -0.9), p < 0.001); planning (difference -0.27 (95 % CI -0.5, -0.05) p = 0.018) and task assignments (difference -0.09 (95 % CI -0.2, -0.01), p = 0.023). Training only the designated team leaders in CRM improves performance of the entire team, in particular guideline adherence and team leader behavior. Emphasis on training of team leader behavior appears to be beneficial in resuscitation and emergency medical course performance.
    Full-text · Article · Jul 2015
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