title: Improving the non-technical skills of hospital medical emergency teams: The Team Emergency Assessment Measure (TEAM™).
abstract: OBJECTIVE
  This prospective descriptive study aimed to test the validity and feasibility of the Team Emergency Assessment Measure (TEAM™) for assessing real-world medical emergency teams' non-technical skills. Second, the present study aimed to explore the instrument's contribution to practice regarding teamwork and learning outcomes.
  
  
  METHODS
  Registered nurses (RNs) and medical staff (n = 104) in two hospital EDs in rural Victoria, Australia, participated. Over a 10 month period, the (TEAM™) instrument was completed by multiple clinicians at medical emergency episodes.
  
  
  RESULTS
  In 80 real-world medical emergency team resuscitation episodes (283 clinician assessments), non-technical skills ratings averaged 89% per episode (39 of a possible 44 points). Twenty-one episodes were rated in the lowest quartile (i.e. ≤37 points out of 44). Ratings differed by discipline, with significantly higher scores given by medical raters (mean: 41.1 ± 4.4) than RNs (38.7 ± 5.4) (P = 0.001). This difference occurred in the Leadership domain. The tool was reliable with Cronbach's alpha 0.78, high uni-dimensional validity and mean inter-item correlation of 0.45. Concurrent validity was confirmed by strong correlation between TEAM™ score and the awarded Global Rating (P < 0.001), with 38.4% of shared variance. RNs praised the instrument as it initiated staff reflection and debriefing discussions around performance improvement.
  
  
  CONCLUSIONS
  Non-technical skills of medical emergency teams are known to often be suboptimal; however, average ratings of 89% were achieved in this real-world study. TEAM™ is a valid, reliable and easy to use tool, for both training and clinical settings, with benefits for team performance when used as an assessment and/or debriefing tool.
authors.affiliation: School of Nursing and Midwifery, Monash University, Narre Warren, Victoria, Australia.
authors.forename: Robyn P
authors.initials: RP
authors.lastname: Cant
authors.affiliation: School of Nursing, Midwifery and Healthcare, Federation University Australia, Churchill, Victoria, Australia.
authors.forename: Joanne E
authors.initials: JE
authors.lastname: Porter
authors.affiliation: School of Nursing, Midwifery and Healthcare, Federation University Australia, Churchill, Victoria, Australia.
authors.forename: Simon J
authors.initials: SJ
authors.lastname: Cooper
authors.affiliation: Emergency Department, Central Gippsland Health Service, Sale, Victoria, Australia.
authors.forename: Kate
authors.initials: K
authors.lastname: Roberts
authors.affiliation: Emergency Department, Northeast Health (Wangaratta), Wangaratta, Victoria, Australia.
authors.forename: Ian
authors.initials: I
authors.lastname: Wilson
authors.affiliation: Emergency Department, Northeast Health (Wangaratta), Wangaratta, Victoria, Australia.
authors.forename: Christopher
authors.initials: C
authors.lastname: Gartside
mesh_terms: D000328:Adult; D002983:Clinical Competence; D005260:Female; D057209:Hospital Rapid Response Team / Q000458:organization & administration / Q000592:standards*; D006780:Hospitals, Rural; D006801:Humans; D033183:Interdisciplinary Communication; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D015203:Reproducibility of Results; D012151:Resuscitation / Q000592:standards*; D014739:Victoria
keywords: advanced life support; medical emergency team; non-technical skills; team leadership; teamwork