Team performance in the emergency room: assessment of inter-disciplinary attitudes
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
References (10)
- et al.
Human error in emergency medicine
Ann. Emerg. Med.
(1999) - et al.
The potential for improved teamwork to reduce medical errors in the emergency department
Ann. Emerg. Med.
(1999) - et al.
Leadership of resuscitation teams: ‘Lighthouse Leadership’
Resuscitation
(1999) - et al.
Videotaping in the admitting area: a most useful tool for quality improvement of the trauma care
Eur. J. Emerg. Med.
(1997) Error in medicine
JAMA
(1994)
Cited by (29)
The organizational culture of emergency departments and the effect on care of older adults: A modified scoping study
2015, International Emergency NursingCitation Excerpt :Assumptions “(d)etermine behaviour, perception, thought, and feeling” (p. 24). Sixteen articles address ED values and beliefs, or underlying assumptions (Adams and Gerson, 2003; Eisenberg et al., 2006; Fry, 2012; Fry and Stainton, 2005; Hwang and Morrison, 2007; Kelly et al., 2011; Khokher et al., 2009; Kihlgren et al., 2005; Liu et al., 2012; Moss et al., 2008; Muntlin et al., 2010; Nugus and Braithwaite, 2010; Nyström et al., 2003; Sbaih, 2001; Seltzer et al., 2012; Ummenhofer et al., 2001). Five main values and beliefs were identified along with corresponding assumptions embedded in the ED culture that impact geriatric care.
Rating medical emergency teamwork performance: Development of the Team Emergency Assessment Measure (TEAM)
2010, ResuscitationCitation Excerpt :The quality of cardiopulmonary resuscitation (CPR) and medical emergency team performance has been questioned given that survival from in-hospital resuscitation is low.1,2 The determinants of effective team performance include technical and nontechnical skills such as leadership and teamwork,3–5,6 decision making and situation awareness.7 First developed for aircraft cockpit crews, situation awareness (SA) has been measured in anaesthesia and acute medicine8–10 to ascertain awareness and understanding of environmental elements.11
Multiple-trauma management: Standardized evaluation of the subjective experience of involved team members
2005, European Journal of AnaesthesiologyWhat factors affect team members’ evaluation of collaboration in medical teams?
2023, Frontiers in PsychologyTraining and assessment of non-technical skills in Norwegian helicopter emergency services: A cross-sectional and longitudinal study
2019, Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine