Team performance during postsurgical patient handovers in paediatric care.

Postsurgical handover of paediatric patients from operating rooms to intensive care units is a critical moment. This process is susceptible to errors and inefficiencies particularly if poor teamwork in this multidisciplinary and ad hoc collaboration occurs. Through combining provider- and observer-rated team performance, we aimed to determine agreement levels on team performance and associations with mental demands, disruptions, and stress. An observational and multisource study of provider and concomitant expert-observer ratings was established. In an Academic Paediatric Hospital, we conducted standardized observations of postsurgical handovers to PICU. We applied established observational and self-reported teamwork tools. Nested fixed and mixed models were established to estimate agreement within teams, between providers' and observer's ratings, as well as for estimations between team performance and mental demands, disruptions, and stress outcomes. Thirty-one postsurgical patient handovers were included with overall 109 ratings of involved providers. Provider-perceived team performance was rated high. Within the receiving sub-team, situation awareness was perceived lower compared to the handoff sub-team [F(df = 1) = 4.41, p = .04]. Inter-provider agreement on handover team performance was low for the overall team yet higher within handover sub-teams. We observed that high level of distractions during the handover was associated with inferior team performance rated by observers (B = - 0.72, 95% CI = - 1.44, - 0.01).Conclusion: We observed substantial disagreements on how involved professionals as well as observers rated teamwork during patient transfers. Investigations into paediatric teamwork and particular team-based handovers should carefully consider if concurrent provider and observer assessments are a valid and reliable way to evaluate teamwork in paediatric care. Common handover language should be established and mandatory before jointly evaluating this process. Our findings advocate also that handovers should be performed under low levels of distractions.What is Known:• Efficient teamwork during transfers of critically ill children is fundamental to quality and safety of handover practice.• Postoperative handovers are often performed by ad hoc teams of caregivers with multiple backgrounds and are prone to suboptimal team performance, communication, and information transfer.What is New:• Our provider and expert evaluations of team performance during OR-PICU handovers showed poor agreement for team performance. Our findings challenge previous results drawing upon single source assessments and inform future studies to carefully consider what approach of team performance assessments is required.• We further demonstrate that high levels of disruptions are associated with poor team performance during patient handovers and that efforts to ensure undisrupted handover practices in clinical care are necessary.

Structured performance assessment in three pediatric emergency scenarios: a validation study.

OBJECTIVE: To develop and validate 3 performance evaluation checklists (PECs) for systematic performance assessment in 3 clinical scenarios: cardiopulmonary arrest, dyspnea with oxygen desaturation after intubation, and respiratory syncytial virus (RSV). STUDY DESIGN: The 3 PECs were developed using an integrative approach and used to rate 50 training sessions in a simulator environment by different raters. Construct validity was tested by correlating the checklist scores with external constructs (ie, global rating, team experience level, and time to action). Further interrater reliability was tested for all 3 PECs. RESULTS: The PECs for the desaturation and cardiopulmonary arrest scenarios were valid and reliable, whereas the PEC for RSV had limited validity and reliability. CONCLUSION: For 2 pediatric emergencies, the PEC is a valid and reliable tool for systematic performance assessment. The unsatisfactory results for the PEC for RSV may be related to limitations of the simulation setting and require further investigation. Structured assessment of clinical performance can augment feedback on technical performance aspects and is essential for training purposes as well as for research. Only reliable and valid performance measures will allow medical educators to accurately evaluate the behavioral effects of training interventions and further enhance the quality of patient care.