title: Measuring teamwork performance: Validity testing of the Team Emergency Assessment Measure (TEAM) with clinical resuscitation teams.
abstract: OBJECTIVE
  To test the resuscitation non-technical Team Emergency Assessment Measure (TEAM) for feasibility, validity and reliability, in two Australian Emergency Departments (ED).
  
  
  BACKGROUND
  Non-technical (teamwork) skills have been identified as inadequate and as such have a significant impact on patient safety. Valid and reliable teamwork assessment tools are an important element of performance assessment and debriefing processes.
  
  
  METHODS
  A quasi experimental design based on observational ratings of resuscitation non-technical skills in two metropolitan ED. Senior nursing staff rated 106 adult resuscitation team events over a ten month period where three or more resuscitation team members attended. Resuscitation events, team performance and validity and reliability data was collected for the TEAM.
  
  
  RESULTS
  Most rated events were for full cardiac resuscitation (43%) with 3-15 team members present for an average of 45 min. The TEAM was found to be feasible and quickly completed with minimal or no training. Discriminant validity was good as was internal consistency with a Cronbach alpha of 0.94. Uni-dimensional and concurrent validity also reached acceptable standards, 0.94 and >0.63 (p=<0.001), respectively, and a single 'teamwork' construct was identified. Non-technical skills overall were good but leadership was rated notably lower than task and teamwork performance indicating a need for leadership training.
  
  
  CONCLUSIONS
  The TEAM is a feasible, valid and reliable non-technical assessment measure in simulated and real clinical settings. Emergency teams need to develop leadership skills through training and reflective debriefing.
authors.affiliation: School of Nursing and Midwifery, Federation University, Gippsland Campus, Northways Road, Churchill 3842, Australia; School of Nursing and Midwifery, University of Brighton, Sussex, United Kingdom; School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China. Electronic address: s.cooper@federation.edu.au.
authors.forename: Simon
authors.initials: S
authors.lastname: Cooper
authors.affiliation: School of Nursing and Midwifery, Monash University, PO Box 1071, Narre Warren 3805, VIC, Australia. Electronic address: robyn.cant@monash.edu.
authors.forename: Robyn
authors.initials: R
authors.lastname: Cant
authors.affiliation: School of Nursing and Midwifery, Monash University, PO Box 1071, Narre Warren 3805, VIC, Australia. Electronic address: clifford.connell@monash.edu.
authors.forename: Cliff
authors.initials: C
authors.lastname: Connell
authors.affiliation: School of Nursing and Midwifery, Monash University, PO Box 1071, Narre Warren 3805, VIC, Australia. Electronic address: lasim5@student.monash.edu.
authors.forename: Lyndall
authors.initials: L
authors.lastname: Sims
authors.affiliation: School of Nursing and Midwifery, Federation University, Gippsland Campus, Northways Road, Churchill 3842, Australia. Electronic address: joanne.porter@federation.edu.au.
authors.forename: Joanne E
authors.initials: JE
authors.lastname: Porter
authors.affiliation: School of Nursing and Midwifery, Monash University, PO Box 1071, Narre Warren 3805, VIC, Australia. Electronic address: mark.symmons@monash.edu.
authors.forename: Mark
authors.initials: M
authors.lastname: Symmons
authors.affiliation: School of Rural Health, Faculty of Medicine, Nursing & Health Sciences, Monash University, Wellington Road, Clayton 3800, Australia. Electronic address: debra.nestel@monash.edu.
authors.forename: Debra
authors.initials: D
authors.lastname: Nestel
authors.affiliation: Alice Lee Centre for Nursing Studies, National University of Singapore, Singapore, Singapore. Electronic address: nurliaw@nus.edu.sg.
authors.forename: Sok Ying
authors.initials: SY
authors.lastname: Liaw
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002983:Clinical Competence; D005260:Female; D057209:Hospital Rapid Response Team / Q000592:standards*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D012151:Resuscitation; D055815:Young Adult
keywords: Medical emergency teams; Non-technical skills; Patient safety; Teamwork