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Clinical efficiency in a simulated emergency and relationship to team behaviours: a multisite cross‐sectional study
Author(s) -
Siassakos D,
Bristowe K,
Draycott TJ,
Angouri J,
Hambly H,
Winter C,
Crofts JF,
Hunt LP,
Fox R
Publication year - 2011
Publication title -
bjog: an international journal of obstetrics and gynaecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.157
H-Index - 164
eISSN - 1471-0528
pISSN - 1470-0328
DOI - 10.1111/j.1471-0528.2010.02843.x
Subject(s) - teamwork , medicine , patient safety , cross sectional study , randomized controlled trial , task (project management) , medical emergency , health care , surgery , pathology , political science , law , economics , economic growth , management
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 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.