Stanford University, Department of Emergency Medicine, Palo Alto, California.
Royal College of Surgeons, Dublin, Ireland.
West J Emerg Med. 2024 Jul;25(4):557-564. doi: 10.5811/westjem.18012.
Optimizing the performance of emergency department (ED) teams impacts patient care, but the utility of current, team-based performance assessment tools to comprehensively measure this impact is underexplored. In this study we aimed to 1) evaluate ED team performance using current team-based assessment tools during an interprofessional in situ simulation and 2) identify characteristics of effective ED teams.
This mixed-methods study employed case study methodology based on a constructivist paradigm. Sixty-three eligible nurses, technicians, pharmacists, and postgraduate year 2-4 emergency medicine residents at a tertiary academic ED participated in a 10-minute in situ simulation of a critically ill patient. Participants self-rated performance using the (TPOT) 2.0 and completed a brief demographic form. Two raters independently reviewed simulation videos and rated performance using the TPOT 2.0, (TEAM), and (Ottawa GRS). Following simulations, we conducted semi-structured interviews and focus groups with in situ participants. Transcripts were analyzed using thematic analysis.
Eighteen team-based simulations took place between January-April 2021. Raters' scores were on the upper end of the tools for the TPOT 2.0 (R1 4.90, SD 0.17; R2 4.53, SD 0.27, IRR [inter-rater reliability] 0.47), TEAM (R1 3.89, SD 0.19; R2 3.58, SD 0.39, IRR 0.73), and Ottawa GRS (R1 6.6, SD 0.56; R2 6.2, SD 0.54, IRR 0.68). We identified six themes from our interview data: team member entrustment; interdependent energy; leadership tone; optimal communication; strategic staffing; and simulation empowering team performance.
Current team performance assessment tools insufficiently discriminate among high performing teams in the ED. Emergency department-specific assessments that capture features of entrustability, interdependent energy, and leadership tone may offer a more comprehensive way to assess an individual's contribution to a team's performance.
优化急诊科（ED）团队的绩效会影响患者的护理，但目前基于团队的绩效评估工具在全面衡量这一影响方面的作用尚未得到充分探索。本研究旨在 1）在一项跨专业现场模拟中使用当前基于团队的评估工具评估 ED 团队的绩效，2）确定有效的 ED 团队的特征。
这项混合方法研究采用基于建构主义范式的案例研究方法。一家三级学术 ED 的 63 名合格护士、技师、药剂师和住院医师 2-4 年级参加了一项危重病患者的 10 分钟现场模拟。参与者使用 （TPOT）2.0 自我评估绩效，并填写简短的人口统计学表格。两名评估员独立查看模拟视频，并使用 TPOT 2.0、 （TEAM）和 （Ottawa GRS）进行绩效评估。模拟后，我们对现场参与者进行了半结构化访谈和焦点小组讨论。使用主题分析对转录本进行分析。
2021 年 1 月至 4 月期间进行了 18 次基于团队的模拟。评分者的分数在 TPOT 2.0 的工具上限范围内（R1 4.90，SD 0.17；R2 4.53，SD 0.27，IRR [互信度] 0.47）、TEAM（R1 3.89，SD 0.19；R2 3.58，SD 0.39，IRR 0.73）和 Ottawa GRS（R1 6.6，SD 0.56；R2 6.2，SD 0.54，IRR 0.68）。我们从访谈数据中确定了六个主题：团队成员的委托；相互依存的能量；领导基调；最佳沟通；战略人员配备；以及模拟赋予团队绩效的能力。
目前的团队绩效评估工具在急诊科无法区分高绩效团队。针对可委托性、相互依存能量和领导基调等特征的特定于急诊科的评估方法可能提供一种更全面的方法来评估个人对团队绩效的贡献。
