Evaluating trauma team performance in a Level I trauma center: Validation of the trauma team communication assessment (TTCA-24).

BACKGROUND: Nontechnical skills (NTS), such as team communication, are well-recognized determinants of trauma team performance and good patient care. Measuring these competencies during trauma resuscitations is essential, yet few valid and reliable tools are available. We aimed to demonstrate that the Trauma Team Communication Assessment (TTCA-24) is a valid and reliable instrument that measures communication effectiveness during activations. METHODS: Two tools with adequate psychometric strength (Trauma Nontechnical Skills Scale [T-NOTECHS], Team Emergency Assessment Measure [TEAM]) were identified during a systematic review of medical literature and compared with TTCA-24. Three coders used each tool to evaluate 35 stable and 35 unstable patient activations (defined according to Advanced Trauma Life Support criteria). Interrater reliability was calculated between coders using the intraclass correlation coefficient. Spearman rank correlation coefficient was used to establish concurrent validity between TTCA-24 and the other two validated tools. RESULTS: Coders achieved an intraclass correlation coefficient of 0.87 for stable patient activations and 0.78 for unstable activations scoring excellent on the interrater agreement guidelines. The median score for each assessment showed good team communication for all 70 videos (TEAM, 39.8 of 54; T-NOTECHS, 17.4 of 25; and TTCA-24, 87.4 of 96). A significant correlation between TTTC-24 and T-NOTECHS was revealed (p = 0.029), but no significant correlation between TTCA-24 and TEAM (p = 0.77). Team communication was rated slightly better across all assessments for stable versus unstable patient activations, but not statistically significant. CONCLUSION: TTCA-24 correlated with T-NOTECHS, an instrument measuring nontechnical skills for trauma teams, but not TEAM, a tool that assesses communication in generic emergency settings. TTCA-24 is a reliable and valid assessment that can be a useful adjunct when evaluating interpersonal and team communication during trauma activations. LEVEL OF EVIDENCE: Diagnostic tests or criteria, level II.

Tools for Assessment of Communication Skills of Hospital Action Teams: A Systematic Review.

BACKGROUND: Hospital action teams comprise interdisciplinary health care providers working simultaneously to treat critically ill patients. Assessments designed to evaluate communication effectiveness or "nontechnical" performance of these teams are essential to minimize medical errors and improve team productivity. Although multiple communication tools are available, the characteristics and psychometric validity of these instruments have yet to be systematically compared. OBJECTIVE: To identify assessments used to evaluate the communication or "nontechnical" performance of hospital action teams and summarize evidence to develop and validate these instruments. METHOD: A literature search was conducted using MEDLINE/PubMed database to identify original articles related to assessment of communication skills in teams working in acute care medicine not exclusive to emergency room, operating room, prehospital air and ground transport, or code blue/rapid response resuscitations. RESULTS: Ten communication assessment tools were identified. Six tools (60%) were designed to measure communication performance of the whole team, whereas 4 tools (40%) were created to assess individual team member's communication skills. Regardless of the type of analysis, the most commonly assessed behavior domains were Leadership, Teamwork, Communication, and Situation awareness. Only 1 of 16 articles describing a particular communication assessment tool reported all the validation criteria, other authors underreported efforts to validate their instruments. CONCLUSION: A number of tools designed to measure the communication or "nontechnical" performance of hospital action teams are available. Unfortunately, limited reported validity evidence may hamper the utility of these tools in actual clinical practice until further validation studies are performed.