Tschan Franziska, Semmer Norbert K, Vetterli Maria, Hunziker Patrick R, Marsch Stephan C
Department of Psychology, University of Neuchâtel, Neuchâtel, Switzerland.
Department of Psychology, University of Berne, Berne, Switzerland.
BMJ Simul Technol Enhanc Learn. 2018 Jul 11;5(2):102-107. doi: 10.1136/bmjstel-2018-000342. eCollection 2019.
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.
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).
None of the cardioversion performance scores significantly correlated with resuscitation performance. Leadership scores during electrical cardioversion correlated positively with leadership scores during cardiopulmonary resuscitation (=0.365, p=0.047). Moreover, there was a positive correlation of leaders being hands-off during both electrical cardioversion and cardiopulmonary resuscitation (=0.645, p<0.0001).
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.
跨学科团队及其领导者在急性医疗护理中的表现至关重要，可通过观察特定事件进行监测。标准化操作程序（SOP）易于观察，而医疗紧急情况的不可预测性使得在这些情况下进行绩效监测变得困难。因此，本研究的目的是评估在SOP期间观察到的绩效是否可以预测紧急情况下的绩效。
由一名主治医师（领导者）、一名住院医师和三名护士组成的30个重症监护病房团队进行了择期电复律模拟场景（SOP），随后进行心脏骤停（紧急情况）。模拟过程中获得的视频记录用于数据分析。主要结果是电复律绩效得分与心肺复苏期间的绩效（实际操作时间、首次除颤时间）之间的相关性。
电复律绩效得分与复苏绩效均无显著相关性。电复律期间的领导能力得分与心肺复苏期间的领导能力得分呈正相关（=0.365，p=0.047）。此外，在电复律和心肺复苏期间领导者放手操作之间存在正相关（=0.645，p<0.0001）。
SOP中的团队绩效对紧急情况没有预测价值。因此，在易于观察的SOP中观察团队并不能替代监测医疗紧急情况中的绩效。领导能力的特定要素在不同情境之间存在一致性。
