Hacking teamwork in health care: Addressing adverse effects of ad hoc team composition in critical care medicine.

BACKGROUND: The continued need for improved teamwork in all areas of health care is widely recognized. The present article reports on the application of a hackathon to the teamwork problems specifically associated with ad hoc team formation in rapid response teams. PURPOSES: Hackathons-problem-solving events pioneered in computer science-are on the rise in health care management. The focus of these events tends to be on medical technologies, however, with calls for improvements in management practices as general recommendations. The hackathon reported here contributes to health care management practice by addressing improvements in teamwork as the focal problem. METHODOLOGY: The hackathon event took place over 2.5 days in conjunction with an academic conference focused on group research. Three teams comprised of practicing healthcare professionals, academic researchers and students developed solutions to problems of ad hoc team formation in rapid response teams. FINDINGS: The event fulfilled several goals. The teams produced three distinct, yet complementary solutions that were backed by both field-based experience and solid research evidence. The event provided the opportunity for two-way translation of research and practice through direct collaboration among key stakeholders. The hackathon produced long term effects through establishing or strengthening collaborations, dissemination of the ideas through presentations, workshops, and publications, and changes in participantsâ work practices. PRACTICE IMPLICATION: The event demonstrated that hackathons, classically focused on technology, can also offer a spur to innovation around organizational processes. The article provides advice for organizing other hackathons focused on similar topics. The solutions offered by the participants in the event yields the clear insight that multipronged solutions for emergency-oriented teamwork are needed. The hackathon highlighted the scaled of collaboration and effort needed to tackle the many complexities in health care that impact outcomes for providers, patients, and health organizations.

Cardiac resuscitation events: one eyewitness is not enough.

OBJECTIVE: To determine the accuracy of paper cardiopulmonary resuscitation records. DESIGN: Case series. SETTING: Twenty-six-bed video-monitored pediatric cardiac ICU. PATIENTS: All patients who had a resuscitation event with available video and electronically stored vital sign and waveform data from May 2012 to February 2013. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: There were 41 cardiopulmonary resuscitation events during the study period. Fifteen had complete and valid data from the paper cardiopulmonary resuscitation forms, the retrieved monitor data, and the continuous bedside video monitoring. These 15 events occurred in 12 individual patients, and there was 100% agreement of data in the documentation of interventions in place (ventilation, arterial catheter, pulse oximetry, and vascular access) and in the presence of a witness at the onset of the arrest. All events were witnessed. Of the 15 events, video and monitor review revealed that 14 used waveform and numeric capnometry to confirm endotracheal tube/tracheostomy placement, but this section was only completed on the paper cardiopulmonary resuscitation record in three of the 14 cases. All records showed no discrepancies in the time of return of spontaneous circulation. The video and monitor review revealed delay in initiating cardiopulmonary resuscitation (mode, 2 min; two cases ≥ 7 min) and shockable rhythms (ventricular arrhythmia) in two cases. A sign of pulseless state was discovered in seven cases classified on the paper record as "always with a pulse." Those include sudden loss of consciousness, flat arterial line tracing, and abrupt drop in the partial pressure of exhaled carbon dioxide tracing (< 10 mm Hg). CONCLUSIONS: Eyewitness accounts of cardiopulmonary resuscitation are often inaccurate and incomplete. Review of information from video and electronically stored vital sign and waveform data provides more accurate information than review of paper-based cardiopulmonary resuscitation records and may provide the insight necessary to improving cardiopulmonary resuscitation.

TIDES: examining the influence of temporal individual differences on multitasking in educational simulation.

BACKGROUND: The majority of tasks nurses complete in acute care settings are time-sensitive. Due to complex patient needs, nurses' multitasking behavior is of growing importance. Situations involving multitasking behavior typically require nurses to switch their attention among multiple tasks and patients in a rapid fashion. Research suggests temporal individual differences such as time urgency, polychronicity, and time perspective influence decision-making. The factors suggest that balanced time perspective may facilitate multitasking. Given novice nurses commit errors related to multitasking, we evaluated the relationship between temporal individual differences, cognitive workload, and multitasking behaviors in a simulation setting. METHODS: A one-group repeated measures design was used to evaluate the relationship between multitasking, demographic factors, cognitive workload, and temporal individual differences. One hundred sixty fourth-year, prelicensure nursing students independently completed two 45-min multiple patients simulations involving care of three interactive patient simulators. Participants completed the Multitasking Preference Inventory, Time Perspective Inventory, Experiences of Time survey, and Time Urgency Scale before simulation. A summary Creighton Simulation Evaluation Instrument score was used to represent multitasking. Participants completed the Task Load Index to represent cognitive workload. We calculated deviation from balanced time perspective and measured its correlation with multitasking. Regression models calculated how much variance deviation from balanced time perspective, demographic factors, and cognitive workload contributed to multitasking. RESULTS: Standardized test scores were more predictive of multitasking than deviation from balanced time perspective (ß = 0.19, t = 2.48, p = 0.0142). As deviation from balanced time perspective increased, multitasking behaviors decreased (r = - 0.17), participants reported a higher sense of urgency (r = 0.39), and they had more frustration after simulation (r = 0.22). Deviation from balanced time perspective did not influence cognitive workload. CONCLUSIONS: Nursing students who demonstrate multitasking behaviors tend to have a more balanced time perspective. Knowing students' deviation from balanced time perspective may help educators anticipate who will need more assistance with multitasking in simulation. Nursing students frequently wait until just before graduation to provide care for multiple patients; including mention of deviation from balanced time perspective in simulation preparation may help senior nursing students become more self-aware and ultimately improve behavioral performance.

The effect of pore size on permeability and cell attachment in collagen scaffolds for tissue engineering.

The permeability of scaffolds and other three-dimensional constructs used for tissue engineering applications is important as it controls the diffusion of nutrients in and waste out of the scaffold as well as influencing the pressure fields within the construct. The objective of this study was to characterize the permeability/fluid mobility of collagen-GAG scaffolds as a function of pore size and compressive strain using both experimental and mathematical modeling techniques. Scaffolds containing four distinct mean pore sizes (151, 121, 110, 96 microns) were fabricated using a freeze-drying process. An experimental device was constructed to measure the permeability of the scaffold variants at different levels of compressive strain (0, 14, 29 and 40% while a low-density open-cell foam cellular solids model utilizing a tetrakaidecahedral unit cell was used to accurately model the permeability of each scaffold variant at all level of applied strain. The results of both the experimental and the mathematical analysis revealed that scaffold permeability increases with increasing pore size and decreases with increasing compressive strain. The excellent comparison between experimentally measured and predicted scaffold permeability suggests that cellular solids modelling techniques can be utilized to predict scaffold permeability under a variety of physiological loading conditions as well as to predict the permeability of future scaffolds with a wide variety of pore microstructures.

Trauma resuscitation: can team behaviours in the prearrival period predict resuscitation performance?

Background: Optimising team performance is critical in paediatric trauma resuscitation. Previous studies in aviation and surgery link performance to behaviours in the prearrival period. Objective: To determine if patterns of human behaviour in the prearrival period of a simulated trauma resuscitation is predictive of resuscitation performance. Design: Twelve volunteer trauma teams performed in four simulation scenarios in a paediatric hospital. The scenarios were video recorded, transcribed and analysed in 10-second intervals. Variation in the amount of utterances per team member in the prearrival period was compared with team performance and implicit coordination during the resuscitation. Key results: Coders analysed 18 962 s of video. They coded 5204 team member utterances into one of eight communication behaviour categories. Inter-rater reliability was excellent (an average of 83.1% across all four scenarios). The average number of communications occurring during the prearrival period was 18.84 utterances, with a range of 2-42 and a SD of 9.55. The average length of this period was almost 2 minutes (mean =117.30 s, SD=39.20). Lower variance in team member communication during the prearrival better was associated with better implicit coordination (p=0.011) but not team performance (p=0.054) during the resuscitation. Conclusion: Patterns of communication in the prearrival trauma resuscitation period predicted implicit coordination and a trend towards significance for team performance which suggests further studies in such patterns are warranted.

Organizational Behavior: A Brief Overview and Safety Orientation.

Organizational Behavior (OB) is a discipline of social science that seeks explanations for human behavior in organizations. OB draws on core disciplines such as psychology, sociology, anthropology, economics, communication, and law to create and investigate multilevel explanations of why people engage in particular behaviors, and which behaviors under which circumstances lead to better outcomes in organizations. Created using an applied or pragmatic lens and tested with a wide range of both quantitative and qualitative methodologies, most OB theories and research have direct implications for managers and for other organizational participants. Not surprisingly, one focal area of OB research concerns safety in organizations, and a growing body of safety-oriented literature in OB is based on data collected during simulation training across a variety of organizations such as hospitals, airlines, nuclear power plants, and other high reliability organizations.

Monitoring and talking to the room: autochthonous coordination patterns in team interaction and performance.

This paper builds on and extends theory on team functioning in high-risk environments. We examined 2 implicit coordination behaviors that tend to emerge autochthonously within high-risk teams: team member monitoring and talking to the room. Focusing on nonrandom patterns of behavior, we examined sequential patterns of team member monitoring and talking to the room in higher- and lower-performing action teams working in a high-risk health care environment. Using behavior observation methods, we coded verbal and nonverbal behaviors of 27 anesthesia teams performing an induction of general anesthesia in a natural setting and assessed team performance with a Delphi-validated checklist-based performance measure. Lag sequential analyses revealed that higher-performing teams were characterized by patterns in which team member monitoring was followed by speaking up, providing assistance, and giving instructions and by patterns in which talking to the room was followed by further talking to the room and not followed by instructions. Higher- and lower-performing teams did not differ with respect to the frequency of team member monitoring and talking to the room occurrence. The results illustrate the importance of patterns of autochthonous coordination behaviors and demonstrate that the interaction patterns, as opposed to the behavior frequencies, discriminated higher- from lower-performing teams. Implications for future research and for team training are included. (PsycINFO Database Record (c) 2014 APA, all rights reserved).

The benefits of flexible team interaction during crises.

Organizations increasingly rely on teams to respond to crises. While research on team effectiveness during nonroutine events is growing, naturalistic studies examining team behaviors during crises are relatively scarce. Furthermore, the relevant literature offers competing theoretical rationales concerning effective team response to crises. In this article, the authors investigate whether high- versus average-performing teams can be distinguished on the basis of the number and complexity of their interaction patterns. Using behavioral observation methodology, the authors coded the discrete verbal and nonverbal behaviors of 14 nuclear power plant control room crews as they responded to a simulated crisis. Pattern detection software revealed systematic differences among crews in their patterns of interaction. Mean comparisons and discriminant function analysis indicated that higher performing crews exhibited fewer, shorter, and less complex interaction patterns. These results illustrate the limitations of standardized response patterns and highlight the importance of team adaptability. Implications for future research and for team training are included.