Table 1.
Targets for training and video analysis
| Targets for training | Method | Analysis | Note |
|---|---|---|---|
| Behaviour (1–5): | |||
| 1. Take a team member role 2. Gather information and communicate 3. Contribute to a shared understanding of the situation 4. Make collaborative decisions 5. Coordinate and execute tasks |
The A-TEAM programme, not yet validated, was used. Separate videos were used for calibration of rating. Active participants’ behaviours were analysed blind by two raters. They observed the study videos individually at random in 3 min sequences. |
Each active participant was individually graded on a four-level scale (poor, in need of improvement, good, proficient). Team members were categorised as either leader or follower, by applying the behavioural elements for ‘Leader’ and ‘Follower’, respectively, from the category ‘Takes a team member role’ in the A-TEAM programme. For instance, a leader takes the initiative to provide structure and direct teamwork and task work, while a follower challenges constructively and assumes assigned responsibilities. |
Annotation 1 |
| Clinical performance (6–7): | |||
| 6. Time to call for help, in seconds (s) | A standardised measure of call for help was calculated as a ratio by dividing 60 s with the team's measured time in seconds. | The time from the entrance of the first active participant into the scenario until the team called for help was measured. | Annotations 1 and 2 |
| 7a. Frequency of top-to-toe examinations (n×h−1) | The average frequency was calculated as the number of examinations divided by the length of the scenario. A standardised measure was calculated as the ratio between the team's measured frequency and the specialist team's reference frequency. | The number of top-to-toe physical examinations the team completed in a scenario was counted. | Annotations 1 and 2 |
| 7b. Frequency of team sum-ups (n×h−1) | The average frequency was calculated as the number of sum-ups divided by the length of the scenario. A standardised measure was calculated as the ratio between the team's measured frequency and the specialist team's reference frequency. | A sum-up includes the patient's present problem, clinical background, vital functions and further plan. The number of team sum-ups performed during a scenario was calculated. | Annotations 1 and 2 |
| Medical management (8): | |||
| 8. Stabilise the vital functions of the patient | Time in seconds. | The time from the entrance of the first active participant in a scenario until stabilisation of the vital functions of the patient was measured. | Not used (see Results) |
Annotations:
(1) Two observers, one specialist in anaesthesia and intensive care (LM), and one senior research psychologist (LH), neither of whom were involved in the training process, analysed individual teamwork behaviours (Targets 1–5) using the A-TEAM programme, not yet validated.27 LM observed clinical performance and medical management.
(2) As the nine scenarios were of different complexity and, as such, not comparable, standardised measures for clinical performance were calculated for each separate scenario. A reference emergency team, including a senior consultant, a specialist nurse and a nurse assistant, carried out each of the nine scenarios, generating reference measures for Targets 6 and 7.