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

Siassakos, D.; Bristowe, K.; Draycott, T. J.; Angouri, J.; Hambly, H.; Winter, C.; Crofts, J. F.; Hunt, L. P.; Fox, R.

Abstract

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 τ b = )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) (τ b = 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. © 2011 The Authors BJOG An International Journal of Obstetrics and Gynaecology © 2011 RCOG.

Citation

Siassakos, D., Bristowe, K., Draycott, T. J., Angouri, J., Hambly, H., Winter, C., …Fox, R. (2011). Clinical efficiency in a simulated emergency and relationship to team behaviours: A multisite cross-sectional study. BJOG: An International Journal of Obstetrics and Gynaecology, 118(5), 596-607. https://doi.org/10.1111/j.1471-0528.2010.02843.x

• Journal Article Type: Article
• Publication Date: Apr 1, 2011
• Journal: BJOG: An International Journal of Obstetrics and Gynaecology
• Print ISSN: 1470-0328
• Electronic ISSN: 1471-0528
• Publisher: Wiley
• Peer Reviewed: Peer Reviewed
• Volume: 118
• Issue: 5
• Pages: 596-607
• DOI: https://doi.org/10.1111/j.1471-0528.2010.02843.x
• Keywords: closed loop, communication, eclampsia, education, emergencies, handoff, handover, leadership, magnesium sulfate, mnemonics, obstetric labour complications, ; patient care team, pre-eclampsia, SBAR, simulation, teaching; teamwork, training
• Public URL: https://uwe-repository.worktribe.com/output/964053
• Publisher URL: http://dx.doi.org/10.1111/j.1471-0528.2010.02843.x