The Nature, Characteristics and Patterns of Perinatal Critical Events Teams

The Institute of Medicine has released several important reports strongly recommending team training to improve patient safety. Most team theory assumes that teams are stable, and leadership is constant. However, there are numerous instances in health care where teams are not stable, and leadership is constantly changing. A growing body of evidence has documented the complexity of interdisciplinary health care teams, particularly in critical events. This study uses in situ simulation to better understand the nature, characteristics, and the communication patterns of health care teams. We conducted 35 obstetrics emergency simulations at six different hospitals, involving over 700 physicians, nurses, and support staff. These simulated emergencies were videotaped, and 16 were analyzed extensively by medical, human factors, and safety experts. Our findings indicate that during health care emergencies, critical events teams are not stable, and their leadership changes constantly. Important areas for team training and future study are identified. Background Within the last decade, interest in communication patterns and performance of health care teams has re-emerged. A growing body of evidence indicates that interprofessional team communication plays a significant role in ensuring patient safety during critical events. In the early 1990s, research on nurse-physician interactions on critical care units indicated that nursephysician communication and collaboration had an important effect on patient morbidity and mortality, establishing a link between critical care team performance and patient outcomes. 2, 3 Recent research, using the concepts of crisis resource management (CRM) (derived from crew resource management in aviation) and critical event team training (CETT) (primarily in health care), has refocused attention on the complexity of interprofessional health care team composition, leadership, communications, and performance. CRM and CETT have also provided a conceptual foundation for understanding team performance during critical events in health care. In its examination of medical errors and patient safety, the Institute of Medicine (IOM) 5, 6 concluded that although important, the nature, characteristics, and communications patterns of health care teams remain poorly understood. The IOM indicated that the quality of communication among health care team members varies significantly and that this variability has