Elsevier

Resuscitation

Volume 49, Issue 1, April 2001, Pages 39-46
Resuscitation

Team performance in the emergency room: assessment of inter-disciplinary attitudes

https://doi.org/10.1016/S0300-9572(00)00304-XGet rights and content

Abstract

In-hospital emergency medicine in central Europe relies on inter-disciplinary co-operation. To improve team performance in the emergency room (ER), a questionnaire for assessment of attitudes and judgements in resuscitation procedures was developed. A total of 43 items were evaluated according to a five-point Likert scale. With a response rate of 81%, 143 questionnaires were evaluated. Assessment of data was performed with regard to professional speciality and level in the medical hierarchy. Factorial analysis identified four main factors: Assessment of ‘quality of performance’ (F1), ‘importance of structure’ (F2), ‘quality of team culture’ (F3), and ‘importance of hierarchy’ (F4). Influences from the categories ‘speciality’ and ‘hierarchy’ and from the covariate ‘gender’ on these main factors were evaluated by two-factorial analysis of variance. For all four factors, ‘speciality’ produced significant differences. Surgeons accorded high values to F1 and low values to F2, whereas anaesthesiologists accorded low values to F1 and high values to F2. F3 showed a low ranking from within the ER nursing staff and the residents in internal medicine, whereas F4 received high scores by medical residents and staff members. For F1 and F3, there was a tendency towards hierarchy dependency, whereas no factor was influenced by gender. In conclusion, team performance in the ER is mainly influenced by different perceptions and attitudes of the different disciplines involved in the resuscitation process.

Zusammenfassung

A medicina de emergência intra-hospitalar na Europa central baseia-se na colaboração interdisciplinar. Para melhorar a qualidade da equipa na sala de emergência (SE) foi realizado um questionário par avaliar atitudes em situações de reanimação. Foram avaliados 43 itens de acordo com a escala de Likert. A taxa de resposta foi de 81% (143 questionários). A avaliação dos resultados foi feita tendo em consideração a especialidade e o nı́vel na hierarquia médica. A análise multifactorial identificou 4 factores principais: Qualidade das intervenções (F1), Importância da estrutura (F2), Qualidade da “cultura de equipe” (F3) e Importância da hierarquia (F4). Nestes 4 factores a especialidade produziu diferenças significativas. Os cirurgiões tiveram valores altos em F1 e baixos em F2 enquanto os anestesiologistas tiveram valores altos em F2 e baixos em F1. Os enfermeiros e internos de Medicina Interna tiveram de um modo geral pontuação baixa em F3. Os Internos e Especialistas de Medicina tiveram valores altos em F4. Em relação a F1 e F2 houve uma tendência a estarem dependentes da hierarquia, não tendo havido nenhum factor relacionado com o sexo. Em conclusão a actuação da equipa na SE é influenciada pelas diferenças de atitude e postura das várias especialidades envolvidas.

Introduction

Effective treatment of life-threatened patients in the emergency room (ER) requires inter-disciplinary knowledge, skills in resuscitation techniques, communication, knowledge of priorities, and decision making. In the United States and in the United Kingdom the medical specialities ‘Emergency Medicine’ or ‘Accident and Emergency Medicine’, exist to deal with the immediate needs of a severely ill or traumatized patient, many countries in continental Europe rely on in-hospital co-operation between several different specialities such as surgery, medicine, anesthesiology, and radiology.

One of the outstanding problems encountered in the emergency admitting area is the need for teamwork by physicians who are accustomed to working as individuals [1], and who have a great deal of difficulty in dealing with human error when it occurs [2]. The study of human factors is an evolving discipline that originally dealt with the inter-face between the human being and the machine, but soon included the discovery and application of knowledge about individual and team interactions with technology. Research into workplace culture, as reflected by the attitudes of personnel, is essential for an understanding of the dynamics of this environment. Sexton et al. demonstrated different perspectives on teamwork among medical staff in a cross sectional survey of operating theatre and intensive care unit team members [3]. Helmreich and Schaefer adapted a flight management attitudes questionnaire to measure goals in the environment of the operating room [4]. They initiated surveys such as the operating room management attitudes questionnaire (ORMAQ) investigating the attitudes of people toward stress, hierarchy, teamwork, and error. Attitudes regarding the recognition of stressor effects indicate the degree to which individuals will place themselves in error inducing conditions, and items regarding hierarchy and teamwork indicate the abilities of team members to manage both threats and errors in a team environment [3].

As part of the quality improvement program in the emergency admitting area, we used a similar Emergency Room Management Attitudes Questionnaire (ERMAQ) to identify attitudes based on items such as negotiation, communication, team-member responsibilities, recognition of stressors, and leadership. Furthermore, group-specific (surgeons, physicians, anaesthesiologists, emergency room personnel) and hierarchy-specific (staff, residents, nurses) responses were investigated.

Section snippets

Methods

The ‘Operating Room Management Attitudes Questionnaire’ (ORMAQ) [5] contains questions that deal with team communication and co-ordination, leadership, work motivation, organizational climate, and recognition of the effects of stressors on personal capabilities [4].

Comparable with the ORMAQ, but specifically adapted to the needs and problems encountered in the ER, we developed a questionnaire (see Table 1, Table 2, Table 3, Table 4) containing 43 items answered on five-point Likert scale with

Results

For data analysis, results of the single items were also evaluated, but were not included within Table 1, Table 2, Table 3, Table 4.

Discussion

The results of this survey showed that the assessment of group and individual performance at in-hospital resuscitation of emergency patients differs strongly between members of different specialities, but not significantly between different hierarchical levels.

This is in contrast with the common belief that the personnel hierarchical structure is a principal impediment to teamwork in medicine. Sexton et al. demonstrated that there were large differences in the intensive care unit between the

Conclusion

In the ER, several medical specialists or substitute teams are expected to co-operate effectively and, hopefully, ‘error free’, under stressful and time-limited conditions. The results of our survey showed, however, that individual and team performance, structure of the processes, team culture, and importance of hierarchy were assessed differently by members of the various specialities involved. Organizational, environmental, and individual factors set the stage for group processes that in turn

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