心肺复苏团队中团队领导的职位对领导行为和团队表现的影响：一项前瞻性随机干预交叉模拟试验。

Effects of team leaders' position in cardiopulmonary resuscitation teams on leadership behavior and team performance: A prospective randomized interventional cross-over simulation-based trial.

机构信息

Department of Intensive Care, University Hospital Basel, Basel, Switzerland.

Department of Psychology, University of Neuchâtel, Fribourg, Switzerland.

出版信息

Medicine (Baltimore). 2023 Jul 7;102(27):e34235. doi: 10.1097/MD.0000000000034235.

DOI:10.1097/MD.0000000000034235

PMID:37417598

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10328606/

Abstract

BACKGROUND

Leadership is an important performance factor in resuscitation teams. Medical guidelines for cardiopulmonary resuscitation (CPR) advise team leaders to keep hands off patients. There is little evidence for this recommendation that is based purely on observational data. Accordingly, the aim of this trial was to investigate the effect of leaders' position during CPR on leadership behavior and team performance.

METHOD

This is a prospective randomized interventional crossover simulation-based single center trial. Teams of 3 to 4 physicians each, representing a rapid response team, were confronted with a simulated cardiac arrest. Team leaders were randomly assigned and assigned team leaders were 1:1 randomized to 2 leadership positions: position at the patient's head; and hands-off position. Data analysis was performed from video-recordings. All utterances during the first 4 minutes of CPR were transcribed and coded based on a modified "Leadership Description Questionnaire." The primary endpoint was the number of leadership statements. Secondary outcomes included CPR related performance markers like hands-on time and chest compression rate, and the behavioral related endpoints Decision Making, Error Detection, and Situational Awareness.

RESULTS

Data from 40 teams (143 participants) was analyzed. Leaders in hands-off position made more leadership statements (28 ± 8 vs 23 ± 8; P <.01) and contributed more to their team's leadership (59 ± 13% vs 50 ± 17%; P = .01) than leaders in the head position. Leaders' position had no significant effect on their teams' CPR performance, Decision Making, and Error Detection. Increased numbers of leadership statements lead to improved hands-on time ( R = 0.28; 95% confidence interval 0.05-0.48; P = .02).

CONCLUSIONS

Team leaders in a hands-off position made more leadership statements and contributed more to their teams' leadership during CPR than team leaders actively involved in the head position. However, team leaders' position had no effect on their teams' CPR performance.

摘要

背景

领导力是复苏团队的重要表现因素。心肺复苏（CPR）的医学指南建议团队领导者不要接触患者。这一建议纯粹基于观察数据，几乎没有证据支持。因此，本试验旨在研究领导者在 CPR 期间的位置对领导行为和团队绩效的影响。

方法

这是一项前瞻性随机干预交叉模拟单中心试验。每组由 3 至 4 名医生组成，代表快速反应团队，面对模拟心脏骤停。随机分配团队领导者，并将团队领导者 1:1 随机分配到 2 个领导位置：患者头部位置和非接触式位置。数据分析来自视频记录。CPR 前 4 分钟的所有话语均被转录并根据修改后的“领导描述问卷”进行编码。主要终点是领导陈述的数量。次要结果包括与 CPR 相关的表现指标，如上手时间和胸外按压率，以及与行为相关的决策制定、错误检测和态势感知终点。

结果

对 40 个团队（143 名参与者）的数据进行了分析。处于非接触式位置的领导者发表了更多的领导言论（28±8 与 23±8；P<.01），并对其团队的领导做出了更多贡献（59±13%与 50±17%；P=.01），而处于头部位置的领导者则没有。领导者的位置对他们团队的 CPR 表现、决策制定和错误检测没有显著影响。领导言论的数量增加导致上手时间的增加（R=0.28；95%置信区间 0.05-0.48；P=.02）。