The impact of critical event checklists on medical management and teamwork during simulated crises in a surgical daycare facility.

Although the incidence of major adverse events in surgical daycare centres is low, these critical events may not be managed optimally due to the absence of resources that exist in larger hospitals. We aimed to study the impact of operating theatre critical event checklists on medical management and teamwork during whole-team operating theatre crisis simulations staged in a surgical daycare facility. We studied 56 simulation encounters (without and with a checklist available) divided between an initial session and then a retention session several months later. Medical management and teamwork were quantified via percentage adherence to key processes and the Team Emergency Assessment Measure, respectively. In the initial session, medical management was not improved by the presence of a checklist (56% without checklist vs. 62% with checklist; p = 0.50). In the retention session, teams performed significantly worse without the checklists (36% without checklist vs. 60% with checklist; p = 0.04). We did not observe a change in non-technical skills in the presence of a checklist in either the initial or retention sessions (68% without checklist vs. 69% with checklist (p = 0.94) and 69% without checklist vs. 65% with checklist (p = 0.36), respectively). Critical events checklists do not improve medical management or teamwork during simulated operating theatre crises in an ambulatory surgical daycare setting.

Development and usability of a behavioural marking system for performance assessment of obstetrical teams.

BACKGROUND: Teamwork and communication have been identified as root causes of sentinel events involving infant death and injury during delivery. However, despite the emphasis on team training as a way to improve maternal and fetal safety outcomes, valid and reliable markers of obstetrical team performance are not available to assess curricular efficacy. OBJECTIVES: The objective of this study was to develop and assess the usability of two obstetrical behavioural marking systems for use with simulation entitled Assessment of Obstetrical Team Performance (AOTP) and Global Assessment of Obstetrical Team Performance (GAOTP). METHODS: In a previous study, obstetrical teams were videotaped managing simulated emergency obstetrical scenarios. In the current study, 13 reviewers reviewed these videotapes and generated a list of behaviours judged to negatively or positively affect the teams' performances. Qualitative analysis using research team consensus and NVivo generated themes and subthemes. Research team members developed descriptors for poor and excellent team performance for each of the behaviours. Subsequently, the usability of the prototypes was assessed by an additional 14 reviewers. RESULTS: In total, the reviewers identified 1294 items, which were sorted into 6 themes and 18 subthemes of obstetrical team performance. In terms of usability, the median amount of time that participants spent completing the AOTP was 7.5 min (range 1.5 to 50 min) and 75% thought the time requirement was moderate and manageable. CONCLUSION: Feedback regarding usability suggests that the AOTP allows for an accurate reflection of raters' assessments of the performance of the team, and as a whole, it is comprehensive, quick and easy to use. Studies are underway to establish the validity and reliability of the AOTP and GAOTP.