Development of a formative assessment tool for measurement of performance in multi-professional resuscitation teams.

BACKGROUND: Treating cardiac arrest is linked to the mutual performance of several health-care individuals' task coordination. Non-technical skills, including communication, leadership and team interaction, could improve sequencing the tasks in the cardiac arrest algorithm. Non-technical skills have been a part of crew resource management training, created to improve safety in aviation. This study aimed, first, to establish crew resource management and non-technical skill-based learning objectives and behavioural markers for the performance of multi-professional resuscitation teams; second, to develop a checklist and to evaluate the validity and reliability of the checklist; and, finally, to develop a simulation-based course including the checklist on behavioural markers, as a tool for learning and assessment. METHOD: A seven-step procedure was used. Findings from interviews with Advanced Life Support instructors and analysis of critical incidents were used to create learning objectives, assessment tools and course curriculum. Reliability and validity were tested by assessing digital versatile disc (DVD)-recorded simulated cardiac arrests. RESULTS: A checklist with 22 behavioural markers based on nine learning objectives was developed and embedded in an 8-h full-scale simulation course. Inter-rater reliability of the checklist (intra-class correlation) was 0.9. Concurrent validity (intra-class correlation) was 0.93. Rate of agreement (0.58-0.91) and kappa values (0.03-0.82) on single items varied. CONCLUSION: A full-scale simulation course and a checklist with 22 behavioural markers were developed. Good inter-rater reliability and concurrent validity of the checklist were demonstrated. Single items on the checklist need refinement to improve accuracy.

Identifying non-technical skills and barriers for improvement of teamwork in cardiac arrest teams.

BACKGROUND: The application of non-technical skills (NTSs) in health care has previously been described in other health-care educational programmes. NTSs are behavioural principles such as leadership, task distribution and communication. The aim of this study was to identify NTSs suitable for improving team performance in multi-professional cardiac arrest teams, and to describe barriers to the use and implementation of such NTSs by using a qualitative method. METHODS: Individual semi-structured interviews were conducted with 11 Danish Advanced Life Support instructors during the period April 2006 to November 2006. Interviews were focussed on barriers and recommendations for teamwork in the cardiac arrest team, optimal policy for improvement of resuscitation training and clinical practice, use of cognitive aids and adoption of European Resuscitation Council (ERC) Guidelines 2005. Interviews and data analysis were supported by a template describing 25 NTSs derived from other educational programmes in health care. RESULTS: A framework with five categories relating to NTSs was identified: leadership, communication, mutual performance monitoring, maintenance of standards and guidelines and task management. Important barriers that were identified were inexperienced team leaders, task overload and hierarchic structure in the teams' inability to maintain focus on chest compressions. CONCLUSION: Interview participants pointed out that NTSs of teams could improve the treatment of cardiac arrest, but several barriers to this exist. Improving resuscitation training should include considerations regarding team leader experience, structured communication, mandatory use of cognitive aids, avoidance of task overload and mutual performance monitoring to avoid unnecessary interruptions in chest compressions.

Critical incidents related to cardiac arrests reported to the Danish Patient Safety Database.

BACKGROUND: Critical incident reports can identify areas for improvement in resuscitation practice. The Danish Patient Safety Database is a mandatory reporting system and receives critical incident reports submitted by hospital personnel. The aim of this study is to identify, analyse and categorize critical incidents related to cardiac arrests reported to the Danish Patient Safety Database. METHODS: The search terms "cardiac arrest" and "resuscitation" were used to identify reports in the Danish Patient Safety Database. Identified critical incidents were then classified into categories. RESULTS: One hundred and seven reports describing 122 separate incidents were identified and classified into incidents related to: alerting the resuscitation team (n=32; 26%), human performance (n=22; 18%), equipment failure (n=19; 16%), resuscitation equipment not available (n=13; 11%), physical environment (n=14; 11%), insufficient monitoring (n=14; 11%), and medication error (n=8; 7%). CONCLUSION: Critical incidents related to cardiac arrest occur due to logistical, technical, teamworking and knowledge problems. These findings should be considered when planning education and implementing resuscitation practice.

IT for advanced life support in hospitals.

In this study we analyzed how IT support can be established for the treatment and documentation of advanced life support (ALS) in a hospital. In close collaboration with clinical researchers, a running prototype of an IT solution to support the clinical decisions in ALS was developed and tried out in a full scale simulation environment. We have named this IT solution the CardioData Prototype.

[Ornithosis--an overlooked cause of atypical pneumonia]. / Ornitose--en overset årsag til atypisk pneumoni.

A case illustrating the potential severity of infection with Chlamydia psittaci (ornithosis) is reported. The importance of considering Chlamydia psittaci as an option in patients with severe respiratory failure is emphasized with a view to early PCR diagnosis of ornithosis.