Measuring non-technical skills in medical emergency care: a review of assessment measures.
- Authors: Cooper, Simon J. , Endacott, Ruth , Cant, Robyn
- Date: 2010
- Type: Text , Journal article
- Relation: Open Access Emergency Medicine Vol. 2, no. (2010), p. 7-16
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- Description: Aim: To review the literature on non-technical skills and assessment methods relevant to emergency care. Background: Non-technical skills (NTS) include leadership, teamwork, decision making and situation awareness, all of which have an impact on healthcare outcomes. Significant concerns have been raised about the rates of adverse medical events, many of which are attributed to NTS failures. Methods: Ovid, Medline, ProQUEST, PsycINFO and specialty websites were searched for NTS measures using applicable access strategies, inclusion and exclusion criteria. Publications identified were assessed for relevance. Results: A range of non-technical skill measures relevant to emergency care was identified: leadership (n = 5), teamwork (n = 7), personality/behavior (n = 3) and situation awareness tools (n = 1). Of these, 9 have been used with emergency care populations/clinicians. All had varying degrees of reliability and validity. In the last decade there has been some development of teamwork measures specific to emergency care with a predominantly global and collective rating of broad skills. Conclusion: A variety of non-technical skill measures are available; only a few have been used in the emergency care arena. There is a need for an increase in the focused assessment of teamwork skills for a greater understanding of team performance to enhance patient safety in medical emergency care.
Managing deteriorating patients: Registered nurses' performance in a simulated setting
- Authors: Cooper, Simon J. , McConnell-Henry, Tracy , Cant, Robyn , Porter, Joanne , Missen, Karen , Kinsman, Leigh , Endacott, Ruth , Scholes, Julie
- Date: 2011
- Type: Text , Journal article
- Relation: The Open Nursing Journal Vol. 5, no. (2011), p. 120-126
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- Description: Aim: To examine, in a simulated environment, rural nurses’ ability to assess and manage patient deterioration using measures of knowledge, situation awareness and skill performance. Background: Nurses’ ability to manage deterioration and ‘failure to rescue’ are of significant concern with questions over knowledge and clinical skills. Simulated emergencies may help to identify and develop core skills. Methods: An exploratory quantitative performance review. Thirty five nurses from a single ward completed a knowledge questionnaire and two video recorded simulated scenarios in a rural hospital setting. Patient actors simulated deteriorating patients with an Acute Myocardial Infarction (AMI) and Chronic Obstructive Pulmonary Disease (COPD) as the primary diagnosis. How aware individuals were of the situation (levels of situation awareness) were measured at the end of each scenario. Results: Knowledge of deterioration management varied considerably (range: 27%-91%) with a mean score of 67%. Average situation awareness scores and skill scores across the two scenarios (AMI and COPD) were low (50%) with many important observations and actions missed. Participants did identify that ‘patients’ were deteriorating but as each patient deteriorated staff performance declined with a reduction in all observational records and actions. In many cases, performance decrements appeared to be related to high anxiety levels. Participants tended to focus on single signs and symptoms and failed to use a systematic approach to patient assessment. Conclusion: Knowledge and skills were generally low in this rural hospital sample with notable performance decrements as patients acutely declined. Educational models that incorporate high fidelity simulation and feedback techniques are likely to have a significant positive impact on performance.
Can eye-tracking technology improve situational awareness in paramedic clinical education?
- Authors: Williams, Brett , Quested, Andrew , Cooper, Simon J.
- Date: 2013
- Type: Text , Journal article
- Relation: Open Access Emergency Medicine Vol. 5, no. (2013), p. 23-28
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- Description: Human factors play a significant part in clinical error. Situational awareness (SA) means being aware of one's surroundings, comprehending the present situation, and being able to predict outcomes. It is a key human skill that, when properly applied, is associated with reducing medical error: eye-tracking technology can be used to provide an objective and qualitative measure of the initial perception component of SA. Feedback from eye-tracking technology can be used to improve the understanding and teaching of SA in clinical contexts, and consequently, has potential for reducing clinician error and the concomitant adverse events.
Measuring situation awareness in emergency settings: a systematic review of tools and outcomes
- Authors: Cooper, Simon J. , Porter, Joanne , Peach, Linda
- Date: 2013
- Type: Text , Journal article
- Relation: Open Access Emergency Medicine Vol. 6, no. (2013), p. 1-7
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- Description: Background: Nontechnical skills have an impact on health care outcomes and improve patient safety. Situation awareness is core with the view that an understanding of the environment will influence decision-making and performance. This paper reviews and describes indirect and direct measures of situation awareness applicable for emergency settings. Methods: Electronic databases and search engines were searched from 1980 to 2010, including CINAHL, Ovid Medline, Pro-Quest, Cochrane, and the search engine, Google Scholar. Access strategies included keyword, author, and journal searches. Publications identified were assessed for relevance, and analyzed and synthesized using Oxford evidence levels and the Critical Appraisal Skills Programme guidelines in order to assess their quality and rigor. Results: One hundred and thirteen papers were initially identified, and reduced to 55 following title and abstract review. The final selection included 14 papers drawn from the fields of emergency medicine, intensive care, anesthetics, and surgery. Ten of these discussed four general nontechnical skill measures (including situation awareness) and four incorporated the Situation Awareness Global Assessment Technique. Conclusion: A range of direct and indirect techniques for measuring situation awareness is available. In the medical literature, indirect approaches are the most common, with situation awareness measured as part of a nontechnical skills assessment. In simulation-based studies, situation awareness in emergencies tends to be suboptimal, indicating the need for improved training techniques to enhance awareness and improve decision-making.
The TEAM instrument for measuring emergency team performance: validation of the Swedish version at two emergency departments
- Authors: Karlgren, Klas , Dahlström, Anders , Birkestam, Anderz , Norling, Annelie , Forss, Gustav , Cooper, Simon J.
- Date: 2021
- Type: Text , Journal article
- Relation: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine Vol. 29, no. 1 (2021), p.
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- Description: Background: The Team Emergency Assessment Measure (TEAM) questionnaire is designed for rating the non-technical performance of emergency medical teams during emergencies, e.g., resuscitation or trauma management. Originally developed in Australia it has today been translated and validated into eleven languages, but a Swedish version is lacking. The aim was therefore to cross-culturally translate and evaluate the reliability and validity of the TEAM questionnaire in a Swedish health care setting. Methods: The instrument was forward and backward translated and adapted into a Swedish context according to established guidelines for cross-cultural adaptation of survey-based measures. The translated version was tested through 78 pairwise assessments of 39 high-priority codes at the emergency departments of two major hospitals. The raters observed the teams at work in real time and filled in the questionnaires immediately afterwards independently of each other. Psychometric properties of the instrument were evaluated. Results: The original instrument was translated by pairs of translators independently of each other and reviewed by an expert committee of researchers, nurses and physicians from different specialties, a linguist and one of the original developers of the tool. A few adaptations were needed for the Swedish context. A principal component factor analysis confirmed a single ‘teamwork’ construct in line with the original instrument. The Swedish version showed excellent reliability with a Cronbach’s alpha of 0.955 and a mean inter-item correlation of 0.691. The mean item-scale correlation of 0.82 indicated high internal consistency reliability. Inter-rater reliability was measured by intraclass correlation and was 0.74 for the global score indicating good reliability. Individual items ranged between 0.52 and 0.88. No floor effects but ceiling effects were noted. Finally, teams displaying clear closed-loop communication had higher TEAM scores than teams with less clear communication. Conclusions: Real time observations of authentic, high priority cases at two emergency departments show that the Swedish version of the TEAM instrument has good psychometric properties for evaluating team performance. The TEAM instrument is thus a welcome tool for assessing non-technical skills of emergency medical teams. © 2021, The Author(s). **Please note that there are multiple authors for this article therefore only the name of the first 5 including Federation University Australia affiliate “Simon Cooper" is provided in this record**