Why saying what you mean matters: An analysis of trauma team communication.

BACKGROUND: We hypothesized that team communication with unmatched grammatical form and communicative intent (mixed mode communication) would correlate with worse trauma teamwork. METHODS: Interdisciplinary trauma simulations were conducted. Team performance was rated using the TEAM tool. Team communication was coded for grammatical form and communicative intent. The rate of mixed mode communication (MMC) was calculated. MMC rates were compared to overall TEAM scores. Statements with advisement intent (attempts to guide behavior) and edification intent (objective information) were specifically examined. The rates of MMC with advisement intent (aMMC) and edification intent (eMMC) were also compared to TEAM scores. RESULTS: TEAM scores did not correlate with MMC or eMMC. However, aMMC rates negatively correlated with total TEAM scores (r = -0.556, p = 0.025) and with the TEAM task management component scores (r = -0.513, p = 0.042). CONCLUSIONS: Trauma teams with lower rates of mixed mode communication with advisement intent had better non-technical skills as measured by TEAM.

Identifying Nontechnical Skill Deficits in Trainees Through Interdisciplinary Trauma Simulation.

OBJECTIVE: The goal of this study was to investigate nontechnical skills in a simulated trauma setting both before and after a debriefing session in order to better understand areas to target for the development of educational interventions. DESIGN: Wilcoxon signed rank tests were used to compare scores on the 5 domains of the T-NOTECHS pre- and postdebriefings. A qualitative analysis using the PEARLS debriefing framework was performed to provide a rich description of the strategies used by the debriefing facilitators. SETTING: The Joint Trauma Simulation Program is an interdisciplinary project designed to improve the quality of trauma care through simulation exercises emphasizing nontechnical skills development. PARTICIPANTS: Thirteen teams of 5 trauma trainees participated in trauma resuscitation simulations: a surgical chief resident, a surgical junior resident, an emergency medicine resident, and 2 emergency medicine nurses. RESULTS: Teams significantly improved on communication and interaction skills in the simulation scenarios from pre- to postdebriefing. The debrief facilitators spent most of their time engaged in Directive Performance Feedback (56.13%). CONCLUSIONS: Interprofessional team simulation in trauma resuscitation scenarios followed by debriefing differently affected individual nontechnical skills domains. Additional facilitation strategies, such as focused facilitation and encouraging learner self-assessment, may target other nontechnical skills in different ways.

The Impact of a Flexible Care Area on Throughput Measures in an Academic Emergency Department.

INTRODUCTION: Crowding in emergency departments is a multifaceted problem. We hypothesized that implementing an on-call "Flexible Care Area" (FCA), utilizing multiple front-end throughput solutions, would reduce ED length of stay (LOS). METHODS: This retrospective study evaluates the impact of an FCA on ED throughput at one hospital over a 2-year period (2011-2012). The average arrival-to-room time, arrival-to-physician time, LOS, number of inpatient admissions, and number of discharges during FCA hours were collected, and days with and without FCA functionality were compared. RESULTS: The FCA was open 165 days in 2011 and 252 days in 2012. The mean daily ED census, as well as the number of ED visits and inpatient admissions during FCA hours, were higher on days with FCA functionality than on days without FCA functionality. Total ED LOS was shorter for Emergency Severity Index (ESI) level 3 patients on days with FCA than on days without it in 2011, but this finding was not repeated in 2012. ESI level 4 patients had shorter LOS on FCA days in both years. The arrival-to-room and arrival-to-physician times showed variable improvement for ESI level 3 and 4 patients over the study period. No statistically significant difference for these measures was found when evaluating ESI levels 2 and 5. DISCUSSION: Implementing upfront throughput solutions through use of the FCA correlated with reduced ED LOS for all ESI level 3 and 4 patients, not just those who were seen in the FCA.

Fabrication and characterization of nonplanar microelectrode array circuits for use in arthroscopic diagnosis of cartilage diseases.

A process to fabricate nonplanar microelectrode array circuits was developed and the microelectrodes were characterized. These platinum microelectrode arrays are for recording streaming potential signals generated during indentation of articular cartilage. The nonplanar substrate was produced by permanent deformation of a 7-in-diameter circular stainless-steel wafer to form 32 semi-spherical caps (radius of curvature = 4.65 mm and height = 250 microm) at the periphery. The wafer was covered with a 2.5-microm-thick layer of insulating polyimide. Standard microelectronic processes were applied to produce 32 circuits (60 mm long x 4 mm wide) with 37 exposed circular microelectrodes (diameter = 100 microm) centered over each semi-spherical cap. A 2.5-microm-thick photodefinable polyimide layer encapsulated the conducting lines. Capacitances between one microelectrode and either another microelectrode or the metallic substrate were 14.6 +/- 2.0 and 34.4 +/- 3.3 pF, respectively, at 100 Hz. The impedance of the microelectrodes in a 0.15 M saline bath (PBS) was 0.25 +/- 0.08 Mohms while the crosstalk (Vinduced/Vapplied) between two microelectrodes was 0.20 +/- 0.11%, at 100 Hz. Indentation measurements were performed on articular cartilage in vitro showing,streaming potentials that indicate electrode-tissue contact times and generation of streaming potentials.