title: Improving team information sharing with a structured call-out in anaesthetic emergencies: a randomized controlled trial.
abstract: BACKGROUND
  Sharing information with the team is critical in developing a shared mental model in an emergency, and fundamental to effective teamwork. We developed a structured call-out tool, encapsulated in the acronym 'SNAPPI': Stop; Notify; Assessment; Plan; Priorities; Invite ideas. We explored whether a video-based intervention could improve structured call-outs during simulated crises and if this would improve information sharing and medical management.
  
  
  METHODS
  In a simulation-based randomized, blinded study, we evaluated the effect of the video-intervention teaching SNAPPI on scores for SNAPPI, information sharing, and medical management using baseline and follow-up crisis simulations. We assessed information sharing using a probe technique where nurses and technicians received unique, clinically relevant information probes before the simulation. Shared knowledge of probes was measured in a written, post-simulation test. We also scored sharing of diagnostic options with the team and medical management.
  
  
  RESULTS
  Anaesthetists' scores for SNAPPI were significantly improved, as was the number of diagnostic options they shared. We found a non-significant trend to improve information-probe sharing and medical management in the intervention group, and across all simulations, a significant correlation between SNAPPI and information-probe sharing. Of note, only 27% of the clinically relevant information about the patient provided to the nurse and technician in the pre-simulation information probes was subsequently learnt by the anaesthetist.
  
  
  CONCLUSIONS
  We developed a structured communication tool, SNAPPI, to improve information sharing between anaesthetists and their team, taught it using a video-based intervention, and provide initial evidence to support its value for improving communication in a crisis.
authors.affiliation: Centre for Medical and Health Sciences Education, University of Auckland, Private Bag 92019, Auckland 1142, New Zealand Department of Anaesthesia, Auckland City Hospital, Auckland, New Zealand j.weller@auckland.ac.nz.
authors.forename: J M
authors.initials: JM
authors.lastname: Weller
authors.affiliation: Department of Anaesthesia, Auckland City Hospital, Auckland, New Zealand Simulation Centre for Patient Safety, University of Auckland, Auckland, New Zealand.
authors.forename: J
authors.initials: J
authors.lastname: Torrie
authors.affiliation: Centre for Medical and Health Sciences Education, University of Auckland, Private Bag 92019, Auckland 1142, New Zealand.
authors.forename: M
authors.initials: M
authors.lastname: Boyd
authors.affiliation: Department of Intensive Care, Waikato Hospital, New Zealand.
authors.forename: R
authors.initials: R
authors.lastname: Frengley
authors.affiliation: Department of Anaesthesia, Wellington Hospital,New Zealand.
authors.forename: A
authors.initials: A
authors.lastname: Garden
authors.affiliation: Department of Anaesthesia, Middlemore Hospital,New Zealand.
authors.forename: W L
authors.initials: WL
authors.lastname: Ng
authors.affiliation: Department of Medicine, University of Otago, Christchurch, New Zealand.
authors.forename: C
authors.initials: C
authors.lastname: Frampton
mesh_terms: D000776:Anesthesiology / Q000379:methods*; D002983:Clinical Competence; D004630:Emergencies; D006801:Humans; D033181:Information Dissemination / Q000379:methods*; D033183:Interdisciplinary Communication; D010348:Patient Care Team / Q000458:organization & administration*; D016544:Patient Simulation; D016037:Single-Blind Method
keywords: communication; education, medical, continuing; leadership; patient safety