The Potential for Improved Teamwork to Reduce Medical Errors in the Emergency Department☆,☆☆,★,★★,♢
Section snippets
INTRODUCTION
Over a decade of aviation research has shown that effective teamwork is essential to flight safety. 1, 2, 3, 4 Both military and commercial aviation organizations have standardized teamwork training systems in place because experience has shown that effective teamwork does not arise spontaneously but rather requires specific skill development and practice. The objective of the training is to reduce the risk that crews will make a fatal error or permit a fatal chain of errors to unfold because
THE TEAMWORK SYSTEM
The teamwork model presented here is an overview of the system created by the MedTeams Project,*a large applied translational research project that has developed an emergency care teamwork system based on a successful aviation model. The system is currently undergoing field evaluation in 10 US EDs.
The teamwork system is designed to improve care delivery performance and reduce the number of clinical
TEAM DIMENSIONS AND TEAMWORK BEHAVIORS
Studies on aircrew coordination 2, 3, 5 have led to an integrating framework composed of 5 behavioral team dimensions. The emergency care–specific teamwork actions described here resulted from tailoring aviation teamwork behaviors to the emergency care setting through systematic observations by behavioral scientists, data collection and analysis, and a series of expert panel meetings of emergency physicians, emergency nurses, and behavioral scientists over a 2-year period (Table). Specific
DAILY TEAM MEMBER ACTIVITIES
Team members coordinate directly and repeatedly with each other to ensure proper and timely clinical task execution and to assist overloaded teammates. Each team member works to maintain a clear and accurate understanding (a common situation awareness) of the care status and care plan for each patient assigned to the team and the workload status of each team member. The team oversees and directly manages the use of all other care resources needed by the patients assigned to the team. Figure 2
TEAMWORK FAILURES AND THEIR CONSEQUENCES
To better understand the nature of teamwork failures in the ED, a retrospective review of claim files was conducted by the MedTeams project. 15, 16, 18 The cases examined were a convenience sample drawn from 8 participating hospitals. The hospitals included large teaching hospitals, as well as medium-sized and small community hospitals from both military and civilian environments. Fifty-four cases, 25 risk cases (open claims) from a total population of unknown size and 29 closed malpractice
Acknowledgements
MedTeams Research Consortium: Gary Adamowicz, BS; Steven L Banks, DO; MAJ Tammie Chang, RN, MSN, CEN; MAJ James Cleveland, RN; CPT Robin Cody, RN, EMT-B, CEN; Teresa Czaplinski, RN, BSN; Amy Guilfoil-Dumont, RN; James Evangelista, RN, RPh,CEN; COL Daniel Fitzpatrick, DO, MPH; Nancy Gates; Marjorie Geist, RN, MSN, MHA, PhD; Lori A Hughes, RN, MS, CEN; Bruce Janiak, MD; Jorie Klein, RN; Vinette Langford, RN-CS, MSN, CEN; MAJ Constance Lavieri-Reynolds, MD; LTC Thomas Lenz, MD; Ann Locke, RN-CS,
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Cited by (0)
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From Dynamics Research Corporation, * Andover, MA; Departments of Medicine ∥ and Pediatrics, ‡ Brown University School of Medicine, Providence, RI; Section of Emergency Medicine, Madigan Army Medical Center, Department of Emergency Medicine, § Fort Lewis, WA.
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Supported by Army Research Laboratory Contract #DAAL01-96-C-0091.
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Address for reprints: Daniel T Risser, PhD, Crew Performance Group, Dynamics Research Corp, 60 Frontage Road, Andover, MA 01810; 978-475-9090, fax 978-474-9059; E-mail [email protected].
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0196-0644/99/$8.00 + 0
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