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.

Understanding health care professionals' views of family presence during pediatric resuscitation.

OBJECTIVE: To examine the conflicting perceptions that health care professionals hold regarding family presence during pediatric resuscitation. METHODS: In phase 1, 137 health care professionals completed a 23-item questionnaire about their views on family presence and their perceptions of their opponents' views on family presence. In phase 2, 12 phase 1 respondents were interviewed about the effects that family presence may have on patients' families and on trauma teams. RESULTS: All respondents indicated that legal concerns and risks were important factors during family presence; however, respondents in favor of family presence believed that legal concerns and risks were minimized when patients' families were present whereas respondents who were opposed believed the opposite. Respondents who were opposed assumed that respondents who were in favor of family presence were less sympathetic and concerned about families, trauma teams, and health care providers; respondents in favor of family presence assumed that respondents who were opposed were overly preoccupied with legal concerns and potential risks involved with family presence during pediatric resuscitations. All respondents believed that patients' families and trauma teams are affected by family presence. Specifically, respondents in favor of family presence believed that families and trauma team members are positively affected whereas opponents believed the opposite. CONCLUSIONS: These findings provide a deeper understanding of the views of health care professionals and how these views might affect the delivery of family-centered care.

Adolescent cancer survivors: identity paradox and the need to belong.

Adolescent cancer survivors face psychological effects that can include isolation, poor peer relations, anxiety, depression, and fear of recurrence, which can increase their risk for psychological late effects and poor health posttreatment. The purpose of this exploratory analysis was to understand the experiences of adolescent cancer survivors, with a particular focus on identity, health promotion, and meaning making. In-depth interviews were conducted with 12 adolescent cancer survivors. Constant comparative analysis was used to identify core themes from the data. Findings revealed that adolescent survivors might experience an identity paradox when making the transition to "survivor," which can contribute to their sense of isolation and risk of health-detracting behaviors. Health promotion, prevention, and supportive programs need to be developed for health care professionals to address the isolation and identity transition needs of adolescent cancer survivors.

Communicating the death of a child in the emergency department: managing dialectical tensions.

This study highlighted the tensions that physicians face when communicating the death of a child to parents. Ten pediatric physicians participated in interviews in which they were asked to provide specific details about end-of-life discussions they have had with families in pediatric emergency rooms. From these findings, it is evident that physicians are required to balance multiple external and internal tensions embedded in these difficult conversations.

Finding the right words: using the terms allow natural death (AND) and do not resuscitate (DNR) in pediatric palliative care.

When children are dying in a hospital setting, healthcare providers need to help families make important end-of-life care decisions. Most providers use the term do not resuscitate (DNR) when suggesting a course of action that involves not using extraordinary lifesaving measures. Some healthcare providers use the term allow natural death (AND) to discuss this same approach. This study investigated pediatric healthcare providers' beliefs about using AND as opposed to DNR. Results revealed that providers believe the term AND is somewhat ambiguous but may be more family centered.