Morey John C, Simon Robert, Jay Gregory D, Wears Robert L, Salisbury Mary, Dukes Kimberly A, Berns Scott D
Crew Performance Group, Dynamics Research Corporation, Andover, MA 01810, USA.
Health Serv Res. 2002 Dec;37(6):1553-81. doi: 10.1111/1475-6773.01104.
To evaluate the effectiveness of training and institutionalizing teamwork behaviors, drawn from aviation crew resource management (CRM) programs, on emergency department (ED) staff organized into caregiver teams.
Nine teaching and community hospital EDs.
A prospective multicenter evaluation using a quasi-experimental, untreated control group design with one pretest and two posttests of the Emergency Team Coordination Course (ETCC). The experimental group, comprised of 684 physicians, nurses, and technicians, received the ETCC and implemented formal teamwork structures and processes. Assessments occurred prior to training, and at intervals of four and eight months after training. Three outcome constructs were evaluated: team behavior, ED performance, and attitudes and opinions. Trained observers rated ED staff team behaviors and made observations of clinical errors, a measure of ED performance. Staff and patients in the EDs completed surveys measuring attitudes and opinions.
Hospital EDs were the units of analysis for the seven outcome measures. Prior to aggregating data at the hospital level, scale properties of surveys and event-related observations were evaluated at the respondent or case level.
A statistically significant improvement in quality of team behaviors was shown between the experimental and control groups following training (p = .012). Subjective workload was not affected by the intervention (p = .668). The clinical error rate significantly decreased from 30.9 percent to 4.4 percent in the experimental group (p = .039). In the experimental group, the ED staffs' attitudes toward teamwork increased (p = .047) and staff assessments of institutional support showed a significant increase (p = .040).
Our findings point to the effectiveness of formal teamwork training for improving team behaviors, reducing errors, and improving staff attitudes among the ETCC-trained hospitals.
评估借鉴航空机组资源管理（CRM）项目中的团队协作行为培训及将其制度化，对组建为照护团队的急诊科（ED）工作人员的效果。
9家教学医院和社区医院的急诊科。
采用准实验、无处理对照组设计对急诊团队协作课程（ETCC）进行前瞻性多中心评估，进行一次预测试和两次后测试。实验组由684名医生、护士和技术人员组成，接受ETCC培训并实施正式的团队协作结构和流程。在培训前以及培训后4个月和8个月时进行评估。评估了三个结果指标：团队行为、急诊科绩效以及态度和意见。经过培训的观察员对急诊科工作人员的团队行为进行评分，并观察临床失误情况（作为急诊科绩效的一项指标）。急诊科的工作人员和患者完成了测量态度和意见的调查。
医院急诊科是7项结果指标的分析单位。在将数据汇总到医院层面之前，在受访者或病例层面评估了调查的量表特性以及与事件相关的观察结果。
培训后，实验组与对照组相比，团队行为质量有统计学意义上的显著改善（p = 0.012）。主观工作量未受干预影响（p = 0.668）。实验组的临床失误率从30.9%显著降至4.4%（p = 0.039）。在实验组中，急诊科工作人员对团队协作的态度有所提升（p = 0.047），且工作人员对机构支持的评估有显著提高（p = 0.040）。
我们的研究结果表明，对于接受ETCC培训的医院，正式的团队协作培训在改善团队行为、减少失误以及提升工作人员态度方面是有效的。
