Journal
BJOG-AN INTERNATIONAL JOURNAL OF OBSTETRICS AND GYNAECOLOGY
Volume 118, Issue 5, Pages 596-607Publisher
WILEY
DOI: 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
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Funding
- Department of Health
- North Bristol Research and Development Small Grant
- National Institute for Health Research [CL-2010-25-004] Funding Source: researchfish
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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 tau(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) (tau(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.
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