title: Hands-on time during cardiopulmonary resuscitation is affected by the process of teambuilding: a prospective randomised simulator-based trial.
abstract: BACKGROUND
  Cardiac arrests are handled by teams rather than by individual health-care workers. Recent investigations demonstrate that adherence to CPR guidelines can be less than optimal, that deviations from treatment algorithms are associated with lower survival rates, and that deficits in performance are associated with shortcomings in the process of team-building. The aim of this study was to explore and quantify the effects of ad-hoc team-building on the adherence to the algorithms of CPR among two types of physicians that play an important role as first responders during CPR: general practitioners and hospital physicians.
  
  
  METHODS
  To unmask team-building this prospective randomised study compared the performance of preformed teams, i.e. teams that had undergone their process of team-building prior to the onset of a cardiac arrest, with that of teams that had to form ad-hoc during the cardiac arrest. 50 teams consisting of three general practitioners each and 50 teams consisting of three hospital physicians each, were randomised to two different versions of a simulated witnessed cardiac arrest: the arrest occurred either in the presence of only one physician while the remaining two physicians were summoned to help ("ad-hoc"), or it occurred in the presence of all three physicians ("preformed"). All scenarios were videotaped and performance was analysed post-hoc by two independent observers.
  
  
  RESULTS
  Compared to preformed teams, ad-hoc forming teams had less hands-on time during the first 180 seconds of the arrest (93 +/- 37 vs. 124 +/- 33 sec, P < 0.0001), delayed their first defibrillation (67 +/- 42 vs. 107 +/- 46 sec, P < 0.0001), and made less leadership statements (15 +/- 5 vs. 21 +/- 6, P < 0.0001).
  
  
  CONCLUSIONS
  Hands-on time and time to defibrillation, two performance markers of CPR with a proven relevance for medical outcome, are negatively affected by shortcomings in the process of ad-hoc team-building and particularly deficits in leadership. Team-building has thus to be regarded as an additional task imposed on teams forming ad-hoc during CPR. All physicians should be aware that early structuring of the own team is a prerequisite for timely and effective execution of CPR.
authors.affiliation: Medical Intensive Care Unit, University of Basel, 4031 Basel, Switzerland. shunziker@uhbs.ch
authors.forename: Sabina
authors.initials: S
authors.lastname: Hunziker
authors.forename: Franziska
authors.initials: F
authors.lastname: Tschan
authors.forename: Norbert K
authors.initials: NK
authors.lastname: Semmer
authors.forename: Roger
authors.initials: R
authors.lastname: Zobrist
authors.forename: Martin
authors.initials: M
authors.lastname: Spychiger
authors.forename: Marc
authors.initials: M
authors.lastname: Breuer
authors.forename: Patrick R
authors.initials: PR
authors.lastname: Hunziker
authors.forename: Stephan C
authors.initials: SC
authors.lastname: Marsch
mesh_terms: D000328:Adult; D000465:Algorithms; D016887:Cardiopulmonary Resuscitation / Q000379:methods*; D003142:Communication; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D008297:Male; D008875:Middle Aged; D010348:Patient Care Team / Q000458:organization & administration*; D016544:Patient Simulation; D011446:Prospective Studies; D011795:Surveys and Questionnaires; D013997:Time Factors; D014743:Videotape Recording