Team situation awareness and the anticipation of patient progress during ICU rounds

Tom W. Reader, Rhona Flin, Kathryn Mearns, Brian H. Cuthbertson

Research output: Contribution to journalArticle

32 Citations (Scopus)

Abstract

Background: The ability of medical teams to develop and maintain team situation awareness (team SA) is crucial for patient safety. Limited research has investigated team SA within clinical environments. This study reports the development of a method for investigating team SA during the intensive care unit (ICU) round and describes the results.

Methods: In one ICU, a sample of doctors and nurses (n=44, who combined to form 37 different teams) were observed during 34 morning ward rounds. Following the clinical review of each patient (n=105), team members individually recorded their anticipations for expected patient developments over 48 h. Patient-outcome data were collected to determine the accuracy of anticipations. Anticipations were compared among ICU team members, and the degree of consensus was used as a proxy measure of team SA. Self-report and observational data measured team-member involvement and communication during patient reviews.

Results: For over half of 105 patients, ICU team members formed conflicting anticipations as to whether patients would deteriorate within 48 h. Senior doctors were most accurate in their predictions. Exploratory analysis found that team processes did not predict team SA. However, the involvement of junior and senior trainee doctors in the patient decision-making process predicted the extent to which those team members formed team SA with senior doctors.

Conclusions: A new method for measuring team SA during the ICU round was successfully employed. A number of areas for future research were identified, including refinement of the situation awareness and teamwork measures.

Original languageEnglish
Pages (from-to)1035-1042
Number of pages8
JournalBMJ Quality & Safety
Volume20
Issue number12
DOIs
Publication statusPublished - Dec 2011

Keywords

  • safety
  • communication
  • cardiac-surgery
  • survival
  • organ failure
  • cognition
  • predictions
  • intensive-care-unit
  • stay

Cite this

Team situation awareness and the anticipation of patient progress during ICU rounds. / Reader, Tom W.; Flin, Rhona; Mearns, Kathryn; Cuthbertson, Brian H.

In: BMJ Quality & Safety, Vol. 20, No. 12, 12.2011, p. 1035-1042.

Research output: Contribution to journalArticle

Reader, Tom W. ; Flin, Rhona ; Mearns, Kathryn ; Cuthbertson, Brian H. / Team situation awareness and the anticipation of patient progress during ICU rounds. In: BMJ Quality & Safety. 2011 ; Vol. 20, No. 12. pp. 1035-1042.
@article{b19002d1c01a4a7cb09bb26474068cbd,
title = "Team situation awareness and the anticipation of patient progress during ICU rounds",
abstract = "Background: The ability of medical teams to develop and maintain team situation awareness (team SA) is crucial for patient safety. Limited research has investigated team SA within clinical environments. This study reports the development of a method for investigating team SA during the intensive care unit (ICU) round and describes the results.Methods: In one ICU, a sample of doctors and nurses (n=44, who combined to form 37 different teams) were observed during 34 morning ward rounds. Following the clinical review of each patient (n=105), team members individually recorded their anticipations for expected patient developments over 48 h. Patient-outcome data were collected to determine the accuracy of anticipations. Anticipations were compared among ICU team members, and the degree of consensus was used as a proxy measure of team SA. Self-report and observational data measured team-member involvement and communication during patient reviews.Results: For over half of 105 patients, ICU team members formed conflicting anticipations as to whether patients would deteriorate within 48 h. Senior doctors were most accurate in their predictions. Exploratory analysis found that team processes did not predict team SA. However, the involvement of junior and senior trainee doctors in the patient decision-making process predicted the extent to which those team members formed team SA with senior doctors.Conclusions: A new method for measuring team SA during the ICU round was successfully employed. A number of areas for future research were identified, including refinement of the situation awareness and teamwork measures.",
keywords = "safety, communication, cardiac-surgery, survival, organ failure, cognition, predictions, intensive-care-unit, stay",
author = "Reader, {Tom W.} and Rhona Flin and Kathryn Mearns and Cuthbertson, {Brian H.}",
year = "2011",
month = "12",
doi = "10.1136/bmjqs.2010.048561",
language = "English",
volume = "20",
pages = "1035--1042",
journal = "BMJ Quality & Safety",
issn = "2044-5415",
publisher = "BMJ Publishing Group",
number = "12",

}

TY - JOUR

T1 - Team situation awareness and the anticipation of patient progress during ICU rounds

AU - Reader, Tom W.

AU - Flin, Rhona

AU - Mearns, Kathryn

AU - Cuthbertson, Brian H.

PY - 2011/12

Y1 - 2011/12

N2 - Background: The ability of medical teams to develop and maintain team situation awareness (team SA) is crucial for patient safety. Limited research has investigated team SA within clinical environments. This study reports the development of a method for investigating team SA during the intensive care unit (ICU) round and describes the results.Methods: In one ICU, a sample of doctors and nurses (n=44, who combined to form 37 different teams) were observed during 34 morning ward rounds. Following the clinical review of each patient (n=105), team members individually recorded their anticipations for expected patient developments over 48 h. Patient-outcome data were collected to determine the accuracy of anticipations. Anticipations were compared among ICU team members, and the degree of consensus was used as a proxy measure of team SA. Self-report and observational data measured team-member involvement and communication during patient reviews.Results: For over half of 105 patients, ICU team members formed conflicting anticipations as to whether patients would deteriorate within 48 h. Senior doctors were most accurate in their predictions. Exploratory analysis found that team processes did not predict team SA. However, the involvement of junior and senior trainee doctors in the patient decision-making process predicted the extent to which those team members formed team SA with senior doctors.Conclusions: A new method for measuring team SA during the ICU round was successfully employed. A number of areas for future research were identified, including refinement of the situation awareness and teamwork measures.

AB - Background: The ability of medical teams to develop and maintain team situation awareness (team SA) is crucial for patient safety. Limited research has investigated team SA within clinical environments. This study reports the development of a method for investigating team SA during the intensive care unit (ICU) round and describes the results.Methods: In one ICU, a sample of doctors and nurses (n=44, who combined to form 37 different teams) were observed during 34 morning ward rounds. Following the clinical review of each patient (n=105), team members individually recorded their anticipations for expected patient developments over 48 h. Patient-outcome data were collected to determine the accuracy of anticipations. Anticipations were compared among ICU team members, and the degree of consensus was used as a proxy measure of team SA. Self-report and observational data measured team-member involvement and communication during patient reviews.Results: For over half of 105 patients, ICU team members formed conflicting anticipations as to whether patients would deteriorate within 48 h. Senior doctors were most accurate in their predictions. Exploratory analysis found that team processes did not predict team SA. However, the involvement of junior and senior trainee doctors in the patient decision-making process predicted the extent to which those team members formed team SA with senior doctors.Conclusions: A new method for measuring team SA during the ICU round was successfully employed. A number of areas for future research were identified, including refinement of the situation awareness and teamwork measures.

KW - safety

KW - communication

KW - cardiac-surgery

KW - survival

KW - organ failure

KW - cognition

KW - predictions

KW - intensive-care-unit

KW - stay

U2 - 10.1136/bmjqs.2010.048561

DO - 10.1136/bmjqs.2010.048561

M3 - Article

VL - 20

SP - 1035

EP - 1042

JO - BMJ Quality & Safety

JF - BMJ Quality & Safety

SN - 2044-5415

IS - 12

ER -