The accuracy of clinical assessments made by neonatal resuscitation team leaders in simulated scenarios

Nadler, Izhak, Sanderson, P. and Liley, Helen G. (2010). The accuracy of clinical assessments made by neonatal resuscitation team leaders in simulated scenarios. In: SimTecT Health 2010, Melbourne, VIC, Australia, (). 30 August - 2 September 2010.

Author Nadler, Izhak
Sanderson, P.
Liley, Helen G.
Title of paper The accuracy of clinical assessments made by neonatal resuscitation team leaders in simulated scenarios
Conference name SimTecT Health 2010
Conference location Melbourne, VIC, Australia
Conference dates 30 August - 2 September 2010
Publication Year 2010
Sub-type Oral presentation
Language eng
Formatted Abstract/Summary
Aims: We tested whether the accuracy of clinical assessments made by Neonatal Resuscitation (NR) team leaders differs from the accuracy of team members. We used a novel approach for measuring the effectiveness of team interaction that we had developed previously.

Background: Accurate clinical assessments are necessary for initiating correct medical interventions1 2. During NR such assessments should be made every 30 seconds3. Although NR is a team effort, there is no formal teamwork training for it4. There is no guidance about who performs the clinical assessments and how assessments are discussed and shared among team members. Moreover, it is not clear who leads the intervention, how a leader carries out his/her role and what support is provided from other team members. Nonetheless, the Joint Commission5 recommends team training to make NR safer. There are no reliable measures of team training6 7. In previous research, however, we showed that clinicians make more accurate clinical assessments after hands-on team training.

Methods: The experiment took place in xxx (a simulation centre). Seventeen NR clinicians (nine doctors and eight nurses) from (a hospital) participated. In the base-line phase, clinicians reviewed 40 recordings showing simulated resuscitations of the SimNewBTM (Laerdal Inc.) manikin. After each recording, each clinician individually assigned an Apgar score8. In the second phase, teams of three clinicians resuscitated the mannequin in 51 scenarios and after every scenario each clinician individually assigned an Apgar score. At each phase, we calculated an Accuracy Score9 (AS) to measure how closely each clinician's Apgar scores matched the actual Apgar score for the manikin (perfect match would be 1.0). Team leaders were identified as the person in charge of airway management. The AS for a leader was calculated only from scenarios that he or she led. The AS for a team member was calculated only from all the scenarios in which he or she participated.

Results: In the base-line phase the mean AS for the leaders was 0.90 (SD=0.04) and for team members it was 0.89 (SD=0.03). The two phases were significantly different (p<0.001) with a lower AS overall in the second, hands-on, phase. A post-hoc unequal-N Tukey test showed that the AS of the team members did not deteriorate significantly in the hands-on phase (0.79, SD=0.07, p=0.21), but it did for the leaders (0.72, SD=0.17, p<0.01). There was wide variability between leaders.

Conclusions: There is a trend for NR team leaders to find it more difficult to monitor the clinical condition of a manikin in a hands-on simulated NR than do the members of their teams. For leadership to be effective, leaders must be supported by the team members. Indeed, Apgar herself indicated that "It is preferred that the assessment will be made by an observer..."10. The AS is an objective measure presented on absolute scale and calculated algorithmically. Accordingly, researchers in future team training studies may find the AS to be useful for measuring and testing different aspects of trainees' performance.
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Document type: Conference Paper
Collection: Faculty of Humanities and Social Sciences - Publications
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Created: Fri, 25 Mar 2011, 04:01:56 EST by Cheryl Byrnes on behalf of Faculty of Social & Behavioural Sciences