title: Trauma team size and task performance in adult trauma resuscitations.
abstract: The initial evaluation of a trauma patient involves multiple personnel from various disciplines. Whereas this approach can expedite care, an increasing number of personnel can also create chaos and hinder efficiency. We sought to determine the optimal number of persons associated with an expedient primary survey.
  
  
  
  Audio and/or video recordings of all consecutive adult trauma evaluations at a level 1 trauma center were reviewed for a 1-month period. A 20-task checklist was developed based on Advanced Trauma Life Support principles. The number of practitioners present (TeamN) and tasks completed at 2 and 5 min (Task2, Task5) were recorded. The association between TeamN, demographics, presence of attending surgeon, and team leader engagement and Task2/Task5 was measured the using chi square test and Spearman correlation. A multivariate regression model was developed.
  
  
  
  A total of 170 cases were reviewed, 44 of which were top-tier activations. Average TeamN was 6 ± 2 persons. Task2 and Task5 were significantly positively correlated with TeamN (r = 0.34, P < 0.0001; r = 0.22, P = 0.004, respectively) and leader engagement (r = 0.27, P < 0.01; r = 0.16, P < 0.05, respectively). There was a significant positive correlation between TeamN and Task2 and Task5. Only TeamN had a significant, independent association with Task2 and Task5 (P = 0.005). We did not find a size that was negatively associated with task completion. Only assessment of breath sounds was negatively associated with increasing team size.
  
  
  
  TeamN is significantly associated with efficiency of trauma evaluation. Studies evaluating reasons for this and the effect of maximal team size are needed to determine optimal trauma team staffing.
authors.affiliation: Center for Trauma and Critical Care, Department of Surgery, The George Washington University, Washington, DC.
authors.forename: Patrick
authors.initials: P
authors.lastname: Maluso
authors.affiliation: Center for Trauma and Critical Care, Department of Surgery, The George Washington University, Washington, DC.
authors.forename: Madelyn
authors.initials: M
authors.lastname: Hernandez
authors.affiliation: Center for Trauma and Critical Care, Department of Surgery, The George Washington University, Washington, DC.
authors.forename: Richard L
authors.initials: RL
authors.lastname: Amdur
authors.affiliation: Department of Nursing, The George Washington University Hospital, Washington, DC.
authors.forename: Lois
authors.initials: L
authors.lastname: Collins
authors.affiliation: Center for Trauma and Critical Care, Department of Surgery, The George Washington University, Washington, DC.
authors.forename: Mary E
authors.initials: ME
authors.lastname: Schroeder
authors.affiliation: Center for Trauma and Critical Care, Department of Surgery, The George Washington University, Washington, DC. Electronic address: bsarani@mfa.gwu.edu.
authors.forename: Babak
authors.initials: B
authors.lastname: Sarani
mesh_terms: D000328:Adult; D057189:Checklist; D004219:District of Columbia; D017598:Efficiency, Organizational; D006801:Humans; D007857:Leadership; D015999:Multivariate Analysis; D010348:Patient Care Team / Q000458:organization & administration*; D017064:Process Assessment, Health Care; D012151:Resuscitation / Q000379:methods / Q000592:standards; D013637:Tape Recording; D013647:Task Performance and Analysis; D014193:Trauma Centers / Q000458:organization & administration*; D014741:Video Recording; D014947:Wounds and Injuries / Q000175:diagnosis / Q000628:therapy*
keywords: Efficiency; Resuscitation; Teamwork; Trauma