Emerg Med J 30:377-381 doi:10.1136/emermed-2012-201312
  • Original article

Managing patient deterioration: assessing teamwork and individual performance

  1. Ruth Endacott1,2
  1. 1School of Nursing and Midwifery, Monash University, Victoria, Australia
  2. 2School of Nursing and Midwifery, Plymouth University, Drake Circus, Plymouth, UK
  1. Correspondence to Simon Cooper, Monash University, School of Nursing and Midwifery, 100 Clyde Rd, Berwick, Victoria 3806, Australia; simon.j.cooper{at}
  1. Contributors SJC contributed to the study design, data collection, statistical analysis and wrote and edited the paper. RC contributed to the study design, statistical analysis and wrote and edited the paper. JP, KM, LS and TMC-H contributed to the study design, data collection and edited the paper. RE contributed to the study design and edited the paper.

  • Accepted 18 April 2012
  • Published Online First 19 May 2012


Objective To assess the ability of rural Australian nurse teams to manage deteriorating patients.

Methods This quasi-experimental design used pre- and post-intervention assessments and observation to evaluate nurses' simulated clinical performance. Registered nurses (n=44) from two hospital wards completed a formative knowledge assessment and three team-based video recorded scenarios (Objective Structured Clinical Examinations (OSCE)). Trained patient actors simulated deteriorating patients. Skill performance and situation awareness were measured and team performance was rated using the Team Emergency Assessment Measure.

Results Knowledge in relation to patient deterioration management varied (mean 63%, range 27–100%) with a median score of 64%. Younger nurses with a greater number of working hours scored the highest (p=0.001). OSCE performance was generally low with a mean performance of 54%, but performance was maintained despite the increasing complexity of the scenarios. Situation awareness was generally low (median 50%, mean 47%, range 17–83%, SD 14.03) with significantly higher levels in younger participants (r=−0.346, p=0.021). Teamwork ratings averaged 57% with significant associations between the subscales (Leadership, Teamwork and Task Management) (p<0.006), the global rating scale (p<0.001) and two of the OSCE measures (p<0.049). Feedback from participants following the programme indicated significant improvements in knowledge, confidence and competence (p<0.001).

Conclusion Despite a satisfactory knowledge base, the application of knowledge was low with notable performance deficits in these demanding and stressful situations. The identification and management of patient deterioration needs to be taught in professional development programmes incorporating high fidelity simulation techniques. The Team Emergency assessment tool proved to be a valid measure of team performance in patient deterioration scenarios.


  • Funding Contracted research: the funding body had no involvement in the study design or collection, analysis and interpretation of data.

  • Competing interests None.

  • Ethics approval Ethical approval was obtained from the hospital ethics committee and the Monash University Standing Committee on Ethical Research in Humans. Written consent was required after open disclosure regarding the elements of the study. The research teams' supportive role, debriefing and feedback elements were emphasised. No attendance incentives were offered.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No unpublished data will be made available. Details of the tools and instruments used for the study assessments can be provided on request.

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