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.

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Project Description: Two types of crisis medical teams will engage in simulation scenarios to determine what constitutes effective communication and decision-making processes and to determine how teams may avoid heuristics-driven diagnostic mistakes. Results will lead to better patient care nation-wide, as we aim to develop data-driven assessment and training procedures for future medical team members.

National Institute of Health (NIH)
Agency for Healthcare Research and Quality (AHRQ)
Research Project (R01)
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Health Care Technology and Decision Science (HTDS)
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Chang, Christine Sutine
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Washington University
Schools of Medicine
Saint Louis
United States
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Murray, David J (2014) Progress in simulation education: developing an anesthesia curriculum. Curr Opin Anaesthesiol 27:610-5
Boulet, John R; Murray, David (2012) Review article: assessment in anesthesiology education. Can J Anaesth 59:182-92
Fehr, James J; Boulet, John R; Waldrop, William B et al. (2011) Simulation-based assessment of pediatric anesthesia skills. Anesthesiology 115:1308-15