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

团队合作、沟通与决策：一个使用模拟的评估程序 医疗中心的危机事件通常由专家团队管理，团队成员同步 他们努力确保最佳的病人护理。成功的结果不仅取决于团队的技能 成员，但也对他们的能力，以相互沟通，并共同达成诊断 和治疗计划。到目前为止，很少有调查系统地考虑了 危机事件团队，很少有人考虑过他们的决策过程，我们所知道的没有一个 这两个相关。我们建议使用模拟来比较和对比通信模式， 在危机中做出反应的两个团队的决策过程：儿科快速反应团队和创伤 复苏队每个小组都将遇到模拟，这些模拟遵循公认的模式和场景 这需要团队重新评估和重新评估一个非典型的情况，不遵循通常的治疗方法。 我们的目标是确定那些构成有效沟通的行为，以及那些认知和 沟通行动，导致有效的决策。我们还将考虑如何沟通和 决策相互关联，以及医疗团队如何识别和纠正药物驱动的诊断 错误30个儿科团队和30个创伤团队将参加9个模拟场景， 这将代表一系列危机事件。每个小组将由三名住院医生和一名工作人员组成 护士（即，一个脚本的同盟者）。每个团队的沟通模式将使用定性研究 技术从会话分析和定量技术使用计算机软件包称为 对话。决策的敏锐性和团队合作的质量将通过完成检查表进行评估 由专家小组。我们预测，成功的团队参与可比的沟通和决策- 不管是什么类型的团队，这项调查汇集了该领域的专家 麻醉学、外科学、护理学、听力康复学和心理测量学的综合研究，将产生数据和方法 为培训团队沟通和决策制定教学和评估策略 在美国各地的医疗中心。

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.