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

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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.

Keywords: Closed loop; SBAR; communication; eclampsia; education; emergencies; handoff; handover; leadership; magnesium sulfate; mnemonics; obstetric labour complications; patient care team; pre-eclampsia; simulation; teaching; teamwork; training

Document Type: Research Article


Affiliations: 1: Department of Linguistics and Social Studies, University of the West of England (UWE), Bristol, UK 2: Speech and Language Research Unit, Frenchay Hospital, Bristol, UK 3: NIHR Western Comprehensive Local Research Network, Women’s Health, Southmead Hospital, Westbury on Trym, Bristol, UK 4: Bristol North Academy, University of Bristol, Bristol, UK 5: University of Bristol School of Clinical Sciences, UBHT Education Centre, Bristol, UK 6: Taunton and Somerset Hospital, Taunton, UK

Publication date: 2011-04-01

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