School of Communication and Information, Rutgers University, 4 Huntington Street, New Brunswick, NJ 08901, USA.
Int J Med Inform. 2011 Apr;80(4):227-38. doi: 10.1016/j.ijmedinf.2011.01.004.
Trauma resuscitation involves multidisciplinary teams under surgical leadership in most US trauma centers. Because many trauma centers have also incorporated emergency department (ED) physicians, shared and cross-disciplinary leadership structures often occur. Our study identifies leadership structures and examines the effects of cross-disciplinary leadership on trauma teamwork.
We conducted an ethnographic study at two US Level-1 trauma centers, one of which is a dedicated pediatric trauma center. We used observation, videotaping and interviews to contextualize and classify leadership structures in trauma resuscitation. Leadership structures were evaluated based on three dimensions of team performance: defined leadership, likelihood of conflict in decision making, and appropriate care.
We identified five common leadership structures, grouped under two broad leadership categories: solo decision-making and intervening models within intra-disciplinary leadership; intervening, parallel, and collaborative models within cross-disciplinary leadership.
Most important weaknesses of different leadership structures are manifested in inefficient teamwork or inappropriate patient care. These inefficiencies are particularly problematic when leadership is shared between physicians from different disciplines with different levels of experience, which often leads to conflict, reduces teamwork efficiency and lowers the quality of care. We discuss practical implications for technology design.
在美国大多数创伤中心，创伤复苏涉及多学科团队，由外科医生领导。由于许多创伤中心还纳入了急诊部（ED）医生，因此经常出现共享和跨学科的领导结构。我们的研究确定了领导结构，并研究了跨学科领导对创伤团队合作的影响。
我们在美国的两个一级创伤中心进行了一项民族志研究，其中一个是专门的儿科创伤中心。我们使用观察、录像和访谈来使创伤复苏中的领导结构背景化和分类。根据团队绩效的三个维度评估领导结构：明确的领导、决策中冲突的可能性以及适当的护理。
我们确定了五种常见的领导结构，分为两类：在单学科领导内的单独决策和干预模型；在跨学科领导内的干预、并行和协作模型。
不同领导结构的最重要弱点表现为团队合作效率低下或患者护理不当。当领导权由具有不同经验水平的不同学科的医生共享时，这些效率低下的问题尤其严重，这往往会导致冲突，降低团队合作效率，并降低护理质量。我们讨论了技术设计的实际意义。
