RESUMEN
Background: Performance of interdisciplinary teams and their leaders is crucial in acute medical care and can be monitored by observing specific events. Standardised operational procedures (SOP) are easily observable, whereas the unpredictability of medical emergencies makes performance monitoring in these situations difficult. The aim of this study was therefore to assess whether performance in emergency situations can be predicted by performance observed during an SOP. Methods: 30 intensive care unit teams composed of one staff physician (leader), one resident and three nurses performed a simulated scenario of an elective electrical cardioversion (SOP) followed by a cardiac arrest (emergency). Video recordings obtained during simulations were used for data analysis. The primary outcome was the correlation between performance scores of electrical cardioversion and performance during cardiopulmonary resuscitation (hands-on time, time to first defibrillation). Results: None of the cardioversion performance scores significantly correlated with resuscitation performance. Leadership scores during electrical cardioversion correlated positively with leadership scores during cardiopulmonary resuscitation (r=0.365, p=0.047). Moreover, there was a positive correlation of leaders being hands-off during both electrical cardioversion and cardiopulmonary resuscitation (r=0.645, p<0.0001). Conclusions: Team performance in SOP carried no predictive value for emergency situations. Observing teams in easily observable SOP is therefore no suitable substitute for monitoring the performance in medical emergencies. There was a between-situation consistency for specific elements of leadership.
RESUMEN
OBJECTIVE: Studies investigating the quality of cardiopulmonary resuscitation (CPR) have revealed frequent unnecessary interruptions of life support. The primary objective of the study is to analyze what happens during interruptions. We investigated (a) whether interruptions are filled with "secondary activities", i.e., activities only indirectly related to the primary task of providing life support (e.g., preparatory and diagnostic activities), and (b) whether all group members focus on the same secondary activity during interruptions, thus impeding group coordination, and detracting from the primary task of providing life support. DESIGN: Prospective observational study. SETTING: Twenty teams of general practitioners were videotaped during a simulated cardiac arrest. OUTCOME MEASURES: Resuscitation performance was assessed as hands-on time according to resuscitation guidelines. Unnecessary interruptions were defined as periods the patient received no hands-on support. RESULTS: Teams of general practitioners achieved hands-on time in accordance with the resuscitation guidelines (chest compression/ventilation/defibrillation) during 62% of the time the patient had no pulse. Unnecessary interruptions consumed 32% of the available time. During most of the unnecessary interruption time, team members engaged in secondary medical activities, particularly observing the monitor (47%) and dealing with the defibrillator (47%). During 56% of the unnecessary interruption time, all team members focussed their attention on the same secondary activity, thus neglecting the need for task distribution among team members. CONCLUSIONS: Unnecessary interruptions of CPR occur frequently and consume approximately one-third of the time patients should receive continuous life support. Unnecessary interruptions are mainly characterized by secondary medical activities that may be perceived as meaningful. During the majority of unnecessary interruptions, all team members focus on the same secondary activity, indicating shortcomings in task distribution in the resuscitation team. The findings emphasize the importance of team training with particular emphasis on situational awareness and task distribution.