TEAMWORK, COMMUNICATION AND DECISION-MAKING: AN ASSESSMENT PROGRAM USING SIMULATI

描述(申请人提供)：团队合作，沟通和决策：使用模拟危机事件的评估计划医疗中心通常由一个专家团队管理，团队成员同步他们的努力，以确保最佳的患者护理。成功的结果不仅取决于团队成员的技能，还取决于他们彼此沟通和集体达成诊断和治疗计划的能力。到目前为止，很少有研究系统地考虑危机事件团队的沟通模式，也很少考虑他们的决策过程，据我们所知，没有人将这两者联系起来。我们建议使用模拟来比较和对比两个在危机中做出反应的团队：儿科快速反应团队和创伤复苏团队的沟通模式和决策过程。每个团队都将遇到遵循公认模式的模拟，以及需要团队重新评估和重新评估非典型且不遵循常规启发式的条件的场景。我们的目标是确定那些构成有效沟通的行为，以及那些导致有效决策的认知和沟通行为。我们还将考虑沟通和决策如何相互关联，以及医疗队如何识别和纠正启发式驱动的诊断错误。30个儿科团队和30个创伤团队将参加9个模拟情景，这些情景将代表一系列危机事件。每个小组将由三名驻地医生和一名专职护士(即一名照本宣科的南部邦联成员)组成。将使用对话分析中的定性技术和使用名为DYALOGUE的计算机软件包的定量技术来研究每个团队的沟通模式。决策的敏锐性和团队合作的质量将通过专家小组完成的核对表进行评估。我们预测，无论团队的类型如何，成功的团队都会进行类似的沟通和决策行为。这项调查汇集了麻醉学、外科、护理、听觉康复和心理测量学领域的专家，将为美国各地医疗中心制定培训团队沟通和决策的教学和评估战略提供必要的数据和方法。 公共卫生相关性：项目描述-两种类型的危机医疗团队将参与模拟情景，以确定什么构成有效的沟通和决策过程，并确定团队如何避免启发式驱动的诊断错误。结果将在全国范围内带来更好的患者护理，因为我们的目标是为未来的医疗团队成员开发数据驱动的评估和培训程序。

DESCRIPTION (provided by applicant): Teamwork, Communication and Decision-Making: An Assessment Program Using Simulation Crises events in medical centers are typically managed by a team of experts, with team members synchronizing their efforts to ensure optimal patient care. Successful outcomes hinge not only upon the skills of the team members, but also upon their abilities to communicate with one another and to collectively reach a diagnosis and treatment plan. To date, few investigations have systematically considered the communication patterns of crisis event teams and few have considered their decision-making processes, and none that we know of have related the two. We propose to use simulation to compare and contrast the communication patterns and decision-making processes of two teams that respond in crisis: pediatric rapid response teams and trauma resuscitation teams. Each team will encounter simulations that follow recognized patterns as well as scenarios that require teams to reassess and reevaluate a condition that is atypical and does not follow usual heuristics. Our goal is to identify those behaviors that comprise effective communication, and those cognitive and communicative actions that lead to effective decision-making. We will also consider how communication and decision-making inter-relate, and how medical teams recognize and correct heuristics-driven diagnostic mistakes. Thirty pediatric teams and thirty trauma teams will participate in nine simulation scenarios, scenarios that will represent a range of crises events. Each team will consist of three resident physicians and one staff nurse (i.e., a scripted confederate). Each team's communication patterns will be studied using qualitative techniques from Conversational Analysis and quantitative techniques using a computer software package called DYALOGUE. Decision-making acumen and quality of teamwork will be assessed with checklists completed by panels of experts. We predict that successful teams engage in comparable communication and decision- making behaviors, regardless of the type of team. This investigation, which brings together experts in the fields of anesthesiology, surgery, nursing, aural rehabilitation, and psychometrics, will yield data and methodology necessary for developing teaching and assessment strategies for training team communication and decision making in medical centers throughout the United States. PUBLIC HEALTH RELEVANCE: Project Description - Two types of crisis medical teams will engage in simulation scenarios to determine what constitutes effective communication and decision-making processes and to determine how teams may avoid heuristics-driven diagnostic mistakes. Results will lead to better patient care nation-wide, as we aim to develop data-driven assessment and training procedures for future medical team members.