Journal Club Article: Reader, T. W., & Cuthbertson, B. H. (2011). Teamwork and team training in the ICU: Where do the similarities with aviation end?. Critical care, 15(6), 313.
Background
Comparing the lessons learnt and development of team training approaches in the aviation industry to the complex needs of the Intensive Care Unit (ICU). The importance of teamwork and the coordination of behaviours in terms of patient care provided and subsequent outcomes. Higher levels of doctor-nurse collaboration improve safety and mortality rates. The recognised importance of poor communication which has been identified as a factor in medical error.
Team input and team processes = team output
- Teamwork
“Team skills are important for maintaining safety in both domains, as multidisciplinary teams must work effectively under highly complex, stressful, and uncertain conditions. ”
- Active & Latent Failures
“team-related ‘active failures’ (for example, failures to communicate the proximity of nearby aircraft) and ‘latent failures’ (for example, lack of team training, poor ergonomic design, and organizational culture) that influence behavior and error in the cockpit.”
- Decision Making Under Stress
“Techniques include exposing teams to high-stress situations, training pilots to facilitate team discussions before and after stressful team activities, and cross-training aircrew team members to understand the demands and needs of one another’s role. Teams are trained in a multidisciplinary environment…….”
- Hierarchical Team Structures
The ability to understand other roles, so in stressful events still work together as a team and negative behaviours and attitudes don’t effect performance.
- Environmental Factors
“Fatigue and stress are known to negatively influence performance in the ICU, and non-technical factors such as team communication, situation awareness, and decision making frequently underlie error.”
Developing a workplace culture based upon safety requires supporting and valuing staff in the high risk environment of ICU, with models of training and supervision that focuses not only on the norms of practice (normative) and educative training, but on restorative and supportive resources to improve stress and burnout, and aid personal development.
Keywords: Intensive Care Unit; Team Performance; Human Factors; Team Training; Aviation Industry; Cognitive Load; Situation Awareness.
Relevant additional resources around some of the themes identified in this articles to aid collaborative educational teamwork:
- Simulation and stress inoculation by EMCrit.com
- Deliberate Practice: Practice Like You Play
- Simulation resources: Simulcast
- Factors Nurses Leaving Critical Care