Teamwork Training Improves the Clinical Care of Trauma Patients

doi:10.1016/j.jsurg.2010.06.006

Journal of Surgical Education

Volume 67, Issue 6, November–December 2010, Pages 439-443

https://doi.org/10.1016/j.jsurg.2010.06.006 Get rights and content

Objectives

We investigated these questions: Does formal team training improve team behaviors in the trauma resuscitation bay? If yes, then does improved teamwork lead to more efficiency in the trauma bay and/or improved clinical outcomes?

Design

This intervention study used a pretraining/posttraining design. The intervention was TeamSTEPPS augmented by simulation. The evaluation instrument, which was the Trauma Team Performance Observation Tool (TPOT), was used by trained evaluators to assess teams' performance during trauma resuscitations. From November 2008 to February 2009, a convenience sample (n = 33) of trauma resuscitations was evaluated. From February to April 2009, team training was conducted. From May to July 2009, another sample (n = 40) of resuscitations were evaluated. Clinical data were gathered from our trauma registry. The clinical parameters included time from arrival to computed tomography (CT) scanner, arrival to intubation, arrival to operating room, arrival to Focused Assessment Sonography in Trauma (FAST) examination, time in emergency department (ED), hospital length of stay (LOS), intensive care unit LOS, complications, and mortality. Comparing pretraining and posttraining resuscitations, we calculated means, standard deviations, and p values for teamwork ratings and clinical parameters, and we determined significance using the independent samples t-test.

Setting

Level I Trauma Center.

Participants

The trauma team included surgery residents, faculty, and nurses.

Results

Our trauma team showed significant improvement in all teamwork domain ratings and overall ratings from pretraining to posttraining—leadership (2.87-3.46, p = 0.003), situation monitoring (3.30-3.91, p = 0.009), mutual support (3.40-3.96, p = 0.004), communication (2.90-3.46, p = 0.001), and overall (3.12-3.70, p < 0.001). The times from arrival to the CT scanner (26.4-22.1 minutes, p = 0.005), endotracheal intubation (10.1-6.6 minutes, p = 0.49) and the operating room (130.1-94.5 minutes, p = 0.021) were decreased significantly after the training.

Conclusions

Structured trauma resuscitation team training augmented by simulation improves team performance, resulting in improved efficiency of patient care in the trauma bay. We propose that formal teamwork training augmented by simulation be included in surgery residency training as well as Advanced Trauma Life Support (ATLS).

Section snippets

Objectives

In the book titled, To err is human: building a safer health system, Kohn et al.¹ pointed out that poor communication is one of the leading root causes of medical error in the United States. Baker et al.,² in The Canadian Adverse Events Study: The incidence of adverse events among hospital patients in Canada had similar findings in 2004. From this study, it has been postulated that improved communication and teamwork would result in improved outcomes in health care.

Several authors have

Design

After review by the Institutional Review Board of Carilion Clinic, this project was classified as a performance improvement project. The Trauma Team Performance Observation Tool (TPOT) was used to assess teams, not individuals. Clinical data were gleaned from the trauma registry.

This study was a pre/posttraining intervention design. The Trauma TPOT, the development and preliminary validation of which has been described previously,⁶ was used by trained evaluators to assess the performance of

Setting

The study was conducted in a level I trauma center.

Participants

The trauma teams consisted of surgery residents (n = 28), faculty surgeons (n = 6), and ED nurses (n = 80). All the residents and faculty surgeons, and more than 80% of the ED nurses, had participated in the training by May 1, 2009.

Nearly all resuscitations are attended by a faculty trauma surgeon unless they are in the operating room or managing a critically ill patient elsewhere. All resuscitations have at least 2 residents and 1 nurse, as well as an ED physician, a recorder, and a

Results

As shown in Table 1, team performance improved significantly across all domains of teamwork as described in TeamSTEPPS.

As shown in Table 2, the pretraining and posttraining groups were essentially the same with regard to age and gender. The Injury Severity Scores (ISSs) were somewhat less for the posttraining group. The times from arrival to CT scanner, endotracheal intubation, and operating room were decreased significantly after the training. Intensive care unit LOS, hospital LOS,

Discussion

Before now, there have been little data published indicating that team specific training does result in better teamwork and that better teamwork results in improvement in clinical care depending on the setting.3, 4, 5 Furthermore, while several surgery programs are introducing team training, no data have been published to show that team training results in better patient care in the trauma room. This study shows that team training improves team performance in the trauma room setting as it does

Conclusions

Trauma team training improves team performance in the trauma room, which results in improved efficiency of patient care. Larger studies may show an improvement in global clinical outcomes as well as efficiency. Our results are encouraging and support the continued devotion of resources to the design and implementation of standardized team training in surgical programs. We recommend that formal trauma team training augmented by simulation be included in surgery residency training and in ATLS

References (6)

D.C. Strasser et al.
Team training and stroke rehabilitation outcomes: a cluster randomized trial
Arch Phys Med Rehabil
(2008)
G.R. Baker et al.
The Canadian Adverse Events Study: the incidence of adverse events among hospital patients in Canada
CMAJ
(2004)

There are more references available in the full text version of this article.

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2010 APDS spring meetingTeamwork Training Improves the Clinical Care of Trauma Patients

Objectives

Design

Setting

Participants

Results

Conclusions

Section snippets

Objectives

Design

Setting

Participants

Results

Discussion

Conclusions

Arch Phys Med Rehabil

The Canadian Adverse Events Study: the incidence of adverse events among hospital patients in Canada

CMAJ

2010 APDS spring meeting
Teamwork Training Improves the Clinical Care of Trauma Patients