Trauma Center at Penn, University of Pennsylvania, Philadelphia, PA, USA.
J Surg Educ. 2012 Mar-Apr;69(2):236-40. doi: 10.1016/j.jsurg.2011.09.004. Epub 2011 Nov 15.
Leadership plays a key role in trauma team management and might affect the efficiency of patient care. Our hypothesis was that a positive relationship exists between the trauma team members' perception of leadership and the efficiency of the injured patient's initial evaluation.
We conducted a prospective observational study evaluating trauma attending leadership (TAL) over 5 months at a level 1 trauma center. After the completion of patient care, trauma team members evaluated the TAL's ability using a modified Campbell Leadership Descriptor Survey tool. Scores ranged from 18 (ineffective leader) to 72 (perfect score). Clinical efficiency was measured prospectively by recording the time needed to complete an advanced trauma life support (ATLS)-directed resuscitation. Assessment times across Leadership score groups were compared using Kruskal-Wallis and Mann-Whitney tests (p < 0.05, statistically significant).
Seven attending physicians were included with a postfellowship experience ranging from ≤1 to 11 years. The average leadership score was 59.8 (range, 27-72). Leadership scores were divided into 3 groups post facto: low (18-45), medium (46-67), and high (68-72). The teams directed by surgeons with low scores took significantly longer than teams directed by surgeons with high scores to complete the secondary survey (14 ± 4 minutes in contrast to 11 ± 2 minutes, p < 0.009) and to transport the patient for CT evaluation (19 ± 5 minutes in contrast to 14 ± 4 minutes; p < 0.001). Attending surgeon experience also affected clinical efficiency with teams directed by less experienced surgeons taking significantly longer to complete the primary survey (p < 0.05).
The trauma team's perception of leadership is associated positively with clinical efficiency. As such, more formal leadership training could potentially improve patient care and should be included in surgical education.
领导力在创伤团队管理中起着关键作用，可能会影响患者护理的效率。我们的假设是，创伤团队成员对领导力的看法与受伤患者初始评估的效率之间存在正相关关系。
我们在一家一级创伤中心进行了一项前瞻性观察研究，评估了创伤主治医生（TAL）在 5 个月内的领导能力。在完成患者治疗后，创伤团队成员使用改良的坎贝尔领导力描述符调查工具评估 TAL 的能力。评分范围从 18（无效领导者）到 72（完美得分）。临床效率通过记录完成高级创伤生命支持（ATLS）指导复苏所需的时间来前瞻性地测量。使用 Kruskal-Wallis 和 Mann-Whitney 检验比较领导评分组之间的评估时间（p < 0.05，具有统计学意义）。
纳入了 7 名主治医生，他们的住院医师后经验从 1 年到 11 年不等。平均领导得分为 59.8（范围，27-72）。事后将领导得分分为 3 组：低（18-45）、中（46-67）和高（68-72）。得分较低的外科医生指导的团队完成二次检查所需的时间明显长于得分较高的外科医生指导的团队（14 ± 4 分钟与 11 ± 2 分钟，p < 0.009），将患者送往 CT 评估的时间也明显更长（19 ± 5 分钟与 14 ± 4 分钟；p < 0.001）。主治医生的经验也会影响临床效率，经验较少的外科医生指导的团队完成初步检查所需的时间明显更长（p < 0.05）。
创伤团队对领导力的看法与临床效率呈正相关。因此，更正式的领导力培训可能会提高患者护理质量，应纳入外科教育。
