Teamwork behaviours and errors during neonatal resuscitation.
OBJECTIVE
To describe relationships between teamwork behaviours and errors during neonatal resuscitation.


METHODS
Trained observers viewed video recordings of neonatal resuscitations (n = 12) for the occurrence of teamwork behaviours and errors. Teamwork state behaviours (such as vigilance and workload management, which extend for some duration) were assessed as the percentage of each resuscitation that the behaviour was observed and correlated with the percentage of observed errors. Teamwork event behaviours (such as information sharing, inquiry and assertion, which occur at specific times) were counted in 20-s intervals before and after resuscitation steps, and a generalised linear mixed model was calculated to evaluate relationships between these behaviours and errors.


RESULTS
Resuscitation teams who were more vigilant committed fewer errors (Spearman's rho for vigilance and errors = -0.62, 95% CI -0.07 to -0.87, p = 0.031). Assertions were more likely to occur before errors than correct steps (OR = 1.44, 95% CI 1.10 to 1.89, p = 0.008) and teaching/advising occurred less frequently after errors (OR = 0.59, 95% CI 0.37 to 0.94, p = 0.028). Though not statistically significant, there was less information sharing before errors (OR = 0.90, 95% CI 0.77 to 1.05, p = 0.172).


CONCLUSIONS
Vigilance is an important behaviour for error management. Assertion may have caused errors, or perhaps was an indicator for some other factor that caused errors. Teams may have preferred to resolve errors directly, rather than using errors as opportunities to teach their teammates. These observations raise important questions about the appropriate use of some teamwork behaviours and how to include them in team training programmes.
Williams
A L
AL
Center for Clinical Research and Evidence-Based Medicine, University of Texas Medical School at Houston, Houston, Texas, USA.
Lasky
R E
RE
Dannemiller
J L
JL
Andrei
A M
AM
Thomas
E J
EJ
D003299:Cooperative Behavior; D006801:Humans; D007231:Infant, Newborn; D015931:Intensive Care, Neonatal / Q000458:organization & administration*; D019300:Medical Errors / Q000517:prevention & control* / Q000706:statistics & numerical data; D010348:Patient Care Team / Q000592:standards*; D011785:Quality Assurance, Health Care / Q000379:methods*; D012151:Resuscitation / Q000592:standards*