title: Clinical efficiency in a simulated emergency and relationship to team behaviours: a multisite cross-sectional study.
abstract: OBJECTIVE
  To identify specific aspects of teamworking associated with greater clinical efficiency in simulated obstetric emergencies.
  
  
  METHODS
  Cross-sectional secondary analysis of video recordings from the Simulation & Fire-drill Evaluation (SaFE) randomised controlled trial.
  
  
  METHODS
  Six secondary and tertiary maternity units.
  
  
  METHODS
  A total of 114 randomly selected healthcare professionals, in 19 teams of six members.
  
  
  METHODS
  Two independent assessors, a clinician and a language communication specialist identified specific teamwork behaviours using a grid derived from the safety literature.
  
  
  METHODS
  Relationship between teamwork behaviours and the time to administration of magnesium sulfate, a validated measure of clinical efficiency, was calculated.
  
  
  RESULTS
  More efficient teams were likely to (1) have stated (recognised and verbally declared) the emergency (eclampsia) earlier (Kendall's rank correlation coefficient τ(b) = -0.53, 95% CI from -0.74 to -0.32, P=0.004); and (2) have managed the critical task using closed-loop communication (task clearly and loudly delegated, accepted, executed and completion acknowledged) (τ(b) = 0.46, 95% CI 0.17-0.74, P=0.022). Teams that administered magnesium sulfate within the allocated time (10 minutes) had significantly fewer exits from the labour room compared with teams who did not: a median of three (IQR 2-5) versus six exits (IQR 5-6) (P=0.03, Mann-Whitney U-test).
  
  
  CONCLUSIONS
  Using administration of an essential drug as a valid surrogate of team efficiency and patient outcome after a simulated emergency, we found that more efficient teams were more likely to exhibit certain team behaviours relating to better handover and task allocation.
authors.affiliation: Department of Obstetrics and Gynaecology, Southmead Hospital, Westbury on Trym, Bristol, UK. jsiasakos@googlemail.com
authors.forename: D
authors.initials: D
authors.lastname: Siassakos
authors.forename: K
authors.initials: K
authors.lastname: Bristowe
authors.forename: T J
authors.initials: TJ
authors.lastname: Draycott
authors.forename: J
authors.initials: J
authors.lastname: Angouri
authors.forename: H
authors.initials: H
authors.lastname: Hambly
authors.forename: C
authors.initials: C
authors.lastname: Winter
authors.forename: J F
authors.initials: JF
authors.lastname: Crofts
authors.forename: L P
authors.initials: LP
authors.lastname: Hunt
authors.forename: R
authors.initials: R
authors.lastname: Fox
mesh_terms: D002121:Calcium Channel Blockers / Q000627:therapeutic use; D002983:Clinical Competence / Q000592:standards*; D003142:Communication; D003430:Cross-Sectional Studies; D003657:Decision Making; D004630:Emergencies; D004638:Emergency Treatment / Q000592:standards*; D005260:Female; D006801:Humans; D007400:Interprofessional Relations; D008278:Magnesium Sulfate / Q000627:therapeutic use; D010348:Patient Care Team / Q000592:standards*; D011225:Pre-Eclampsia / Q000188:drug therapy*; D011247:Pregnancy; D011256:Pregnancy Outcome; D011295:Prenatal Care / Q000592:standards*; D013997:Time Factors
chemical_list: D002121:Calcium Channel Blockers; D008278:Magnesium Sulfate