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

• 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
• ISSN: 1470-0328; 1471-0528
• DOI: 10.1111/j.1471-0528.2010.02843.x

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.