title: Factors affecting team size and task performance in pediatric trauma resuscitation.
abstract: OBJECTIVE
  Varying team size based on anticipated injury acuity is a common method for limiting personnel during trauma resuscitation. While missing personnel may delay treatment, large teams may worsen care through role confusion and interference. This study investigates factors associated with varying team size and task completion during trauma resuscitation.
  
  
  METHODS
  Video-recorded resuscitations of pediatric trauma patients (n = 201) were reviewed for team size (bedside and total) and completion of 24 resuscitation tasks. Additional patient characteristics were abstracted from our trauma registry. Linear regression was used to assess which characteristics were associated with varying team size and task completion. Task completion was then analyzed in relation to team size using best-fit curves.
  
  
  RESULTS
  The average bedside team ranged from 2.7 to 10.0 members (mean, 6.5 [SD, 1.7]), with 4.3 to 17.7 (mean, 11.0 [SD, 2.8]) people total. More people were present during high-acuity activations (+4.9, P < 0.001) and for patients with a penetrating injury (+2.3, P = 0.002). Fewer people were present during activations without prearrival notification (-4.77, P < 0.001) and at night (-1.25, P = 0.002). Task completion in the first 2 minutes ranged from 4 to 19 (mean, 11.7 [SD, 3.8]). The maximum number of tasks was performed at our hospital by teams with 7 people at the bedside (13 total).
  
  
  CONCLUSIONS
  Resuscitation task completion varies by team size, with a nonlinear association between number of team members and completed tasks. Management of team size during high-acuity activations, those without prior notification, and those in which the patient has a penetrating injury may help optimize performance.
authors.affiliation: From the Division of Trauma and Burn Surgery, Children's National Medical Center, Washington, DC.
authors.forename: Deirdre C
authors.initials: DC
authors.lastname: Kelleher
authors.forename: Mark L
authors.initials: ML
authors.lastname: Kovler
authors.forename: Lauren J
authors.initials: LJ
authors.lastname: Waterhouse
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Carter
authors.forename: Randall S
authors.initials: RS
authors.lastname: Burd
mesh_terms: D002648:Child; D004219:District of Columbia; D005260:Female; D006801:Humans; D008297:Male; D010348:Patient Care Team / Q000458:organization & administration*; D010372:Pediatrics / Q000458:organization & administration; D012044:Regression Analysis; D012151:Resuscitation / Q000379:methods* / Q000706:statistics & numerical data; D013647:Task Performance and Analysis; D014193:Trauma Centers / Q000458:organization & administration; D014194:Traumatology; D000078329:Workforce