EMERGENCY DEPARTMENT TEAMWORK

SUMMARY A major facet of New Look error-correction technology has been adapted for the Emergency Room as The Teamwork System. Teamwork intrinsically and systematically detects and corrects various types of error before they cause adverse patient outcome. Membership of The Team is ad hoc, resulting from adoption of a component role during that particular shift.

Most hospital risk managers are well aware of the finding of the large and controversial Harvard Medical Practice Study^1,2,³ ^[full-text] that 4% of hospital inpatients experience adverse events causing injury. It has been proposed elsewhere^[full-text] that, in the Emergency Room (E-R), over 90% of such adverse events are preventable.

In a related study⁵, 54 E-R incidents judged mitigable or preventable were analysed on a system model. The researchers identified an average of 8.8 teamwork failures per incident.

A major facet of New Look error-correction technology has been adapted for the Emergency Room as The Teamwork System.

Team membership comprises 3-10 (average 6) clinically skilled caregivers who work together during a shift and have been trained to use specific teamwork behaviors to tightly coordinate and manage their clinical actions.

Practical Pointer

Team Functions

Maintain team structure and climate

Apply problem-solving strategies

Communicate with the team

Execute plans and manage workload

Improve team skill

Maintain team structure and climate

Main behaviours include establishing leadership, organising the team, cultivating the team climate and resolving conflicts constructively.

Apply problem-solving strategies

Principal components: situational planning, decision-making methods, error-correction actions

Communicate with the team

Standards of effective communication, offer and request supporting information

Execute plans and manage workload

Implement plan, primary and secondary triage, priorise, manage resources and workload, cross-monitor team member actions, maintain situation awareness

Improve team skill

Informal and formal team improvement strategies

Teamworkintrinsically and systematically detects and corrects various types of error before they cause adverse patient outcome

Slips (adjustment failures)
well-practiced tasks

require little conscious attention

causes - lack of attention to detail.
Lapses (memory failures)

tasks omitted

causes - task overload or distraction.

Mistakes (misclassification failures)

a) analytic processing activities are

disturbed,

disrupted,

missing key information

b) common causes

personal stress,

fatigue,

task overload,

environmental distractions

lack of clinical knowledge.

c) = perfect execution of poor or inaccurate care plans.

Membership of The Team is ad hoc, resulting from adoption of a component role during that particular shift. Since all players are trained in The Teamwork System, no reorganisation of staffing is required: behaviours for error-detection and incident-prevention are intrinsic to the job.

Practical Pointer

Individual teamwork behaviours

Identify a protocol or develop a plan

Advocate/ assert a position or corrective action

Prioritise tasks for a patient

Cross-monitor actions of team members

Teamwork Activity is of two types:

Team Meetings (2-5 minutes)

Individual Teamwork Actions

Common Individual Teamwork Actions

Caregiver A helps caregiver B with a task, clinical or non-clinical.

Caregiver A cross-monitors caregiver B’s actions and either

notes nothing unusual, so no direct interaction occurs, or

notes an unexpected care action by B, and acts/communicates as necessary to

aid or adjust B’s actions or understanding, or

to adjust A’s own understanding

Practical Pointer

Contribution of each team member

maintain own situation awareness

maintain situation awareness of teammates

catch simple errors made by teammates

(Rarely), identify true best practice conflicts that require significant clinical discussion for resolution