Elsevier

Annals of Emergency Medicine

Volume 34, Issue 3, September 1999, Pages 373-383
Annals of Emergency Medicine

The Potential for Improved Teamwork to Reduce Medical Errors in the Emergency Department,☆☆,,★★,

Presented at the annual meeting of the Society for Academic Emergency Medicine, Chicago, IL, May 1998, and the American College of Emergency Physicians Management Academy, New Orleans, LA, May 1998.
https://doi.org/10.1016/S0196-0644(99)70134-4Get rights and content

Abstract

This article describes emergency department care work teams designed to improve team communication and coordination and reduce error. The core of this teamwork system is the teaching of teamwork behaviors and skills, development of teamwork habits, and creation of small work teams, all of which are key teamwork concepts largely drawn from successful aviation programs. Arguments for enculturating teamwork into ED practice are drawn from a retrospective study of ED malpractice incidents. Fifty-four incidents (1985-1996), a sample of convenience drawn from 8 hospitals, were identified and judged mitigable or preventable by better teamwork. An average of 8.8 teamwork failures occurred per case. More than half of the deaths and permanent disabilities that occurred were judged avoidable. Better teamwork could save nearly $3.50 per ED patient visit. Caregivers must improve teamwork skills to reduce errors, improve care quality, and reduce litigation risks. [Risser DT, Rice MM, Salisbury ML, Simon R, Jay GD, Berns SD, The MedTeams Research Consortium: The potential for improved teamwork to reduce medical errors in the emergency department. Ann Emerg Med September 1999;34:373-383.]

Section snippets

INTRODUCTION

Over a decade of aviation research has shown that effective teamwork is essential to flight safety. 1, 2, 3, 4 Both military and commercial aviation organizations have standardized teamwork training systems in place because experience has shown that effective teamwork does not arise spontaneously but rather requires specific skill development and practice. The objective of the training is to reduce the risk that crews will make a fatal error or permit a fatal chain of errors to unfold because

THE TEAMWORK SYSTEM

The teamwork model presented here is an overview of the system created by the MedTeams Project,*a large applied translational research project that has developed an emergency care teamwork system based on a successful aviation model. The system is currently undergoing field evaluation in 10 US EDs.

The teamwork system is designed to improve care delivery performance and reduce the number of clinical

TEAM DIMENSIONS AND TEAMWORK BEHAVIORS

Studies on aircrew coordination 2, 3, 5 have led to an integrating framework composed of 5 behavioral team dimensions. The emergency care–specific teamwork actions described here resulted from tailoring aviation teamwork behaviors to the emergency care setting through systematic observations by behavioral scientists, data collection and analysis, and a series of expert panel meetings of emergency physicians, emergency nurses, and behavioral scientists over a 2-year period (Table). Specific

DAILY TEAM MEMBER ACTIVITIES

Team members coordinate directly and repeatedly with each other to ensure proper and timely clinical task execution and to assist overloaded teammates. Each team member works to maintain a clear and accurate understanding (a common situation awareness) of the care status and care plan for each patient assigned to the team and the workload status of each team member. The team oversees and directly manages the use of all other care resources needed by the patients assigned to the team. Figure 2

TEAMWORK FAILURES AND THEIR CONSEQUENCES

To better understand the nature of teamwork failures in the ED, a retrospective review of claim files was conducted by the MedTeams project. 15, 16, 18 The cases examined were a convenience sample drawn from 8 participating hospitals. The hospitals included large teaching hospitals, as well as medium-sized and small community hospitals from both military and civilian environments. Fifty-four cases, 25 risk cases (open claims) from a total population of unknown size and 29 closed malpractice

Acknowledgements

MedTeams Research Consortium: Gary Adamowicz, BS; Steven L Banks, DO; MAJ Tammie Chang, RN, MSN, CEN; MAJ James Cleveland, RN; CPT Robin Cody, RN, EMT-B, CEN; Teresa Czaplinski, RN, BSN; Amy Guilfoil-Dumont, RN; James Evangelista, RN, RPh,CEN; COL Daniel Fitzpatrick, DO, MPH; Nancy Gates; Marjorie Geist, RN, MSN, MHA, PhD; Lori A Hughes, RN, MS, CEN; Bruce Janiak, MD; Jorie Klein, RN; Vinette Langford, RN-CS, MSN, CEN; MAJ Constance Lavieri-Reynolds, MD; LTC Thomas Lenz, MD; Ann Locke, RN-CS,

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    From Dynamics Research Corporation, * Andover, MA; Departments of Medicine and Pediatrics, Brown University School of Medicine, Providence, RI; Section of Emergency Medicine, Madigan Army Medical Center, Department of Emergency Medicine, § Fort Lewis, WA.

    ☆☆

    Supported by Army Research Laboratory Contract #DAAL01-96-C-0091.

    Address for reprints: Daniel T Risser, PhD, Crew Performance Group, Dynamics Research Corp, 60 Frontage Road, Andover, MA 01810; 978-475-9090, fax 978-474-9059; E-mail [email protected].

    ★★

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