Elsevier

Resuscitation

Volume 81, Issue 6, June 2010, Pages 695-702
Resuscitation

Simulation and education
Identifying non-technical skills and barriers for improvement of teamwork in cardiac arrest teams

https://doi.org/10.1016/j.resuscitation.2010.01.024Get rights and content

Abstract

Background

The application of non-technical skills (NTSs) in health care has previously been described in other health-care educational programmes. NTSs are behavioural principles such as leadership, task distribution and communication. The aim of this study was to identify NTSs suitable for improving team performance in multi-professional cardiac arrest teams, and to describe barriers to the use and implementation of such NTSs by using a qualitative method.

Methods

Individual semi-structured interviews were conducted with 11 Danish Advanced Life Support instructors during the period April 2006 to November 2006. Interviews were focussed on barriers and recommendations for teamwork in the cardiac arrest team, optimal policy for improvement of resuscitation training and clinical practice, use of cognitive aids and adoption of European Resuscitation Council (ERC) Guidelines 2005. Interviews and data analysis were supported by a template describing 25 NTSs derived from other educational programmes in health care.

Results

A framework with five categories relating to NTSs was identified: leadership, communication, mutual performance monitoring, maintenance of standards and guidelines and task management. Important barriers that were identified were inexperienced team leaders, task overload and hierarchic structure in the teams’ inability to maintain focus on chest compressions.

Conclusion

Interview participants pointed out that NTSs of teams could improve the treatment of cardiac arrest, but several barriers to this exist. Improving resuscitation training should include considerations regarding team leader experience, structured communication, mandatory use of cognitive aids, avoidance of task overload and mutual performance monitoring to avoid unnecessary interruptions in chest compressions.

Section snippets

Data collection and sampling

We conducted individual semi-structured interviews with 11 ALS instructors from April 2006 to November 2006. The participants were recruited by responding to an e-mail sent to Danish ALS instructors, asking for participants for this study.

The ALS instructors were nine doctors and two nurses from cardiology and anaesthesiology departments in six university hospitals. The ALS instructor group was chosen because of the clinical experience in the treatment of cardiac arrest and knowledge of the

Data analysis

We used a modified framework analysis approach for applied policy research.15, 16 This method is based on data analysis as a continuous process where data are categorised according to a thematic framework derived from the research question and finally the data are interpreted to develop strategies for change. The analysis was supported by an a priori designed NTS template with 25 topics (see Table 1) drawn from three models for CRM, NTSs and teamwork.11, 12, 17 All interviews were listened to

Results

We developed a framework with five categories (leadership, communication, mutual performance monitoring, maintenance of guidelines and task management), considered to be important when adding to existing recommendations for education in resuscitation with regard to NTS. In Table 2, the results from the interviews arranged by category, recommended behaviour, the barriers for recommended behaviour and selected citations are shown. Recommendations for improvement in resuscitation training based on

Discussion

Participants in the interview study generally recommended the use of NTSs during the treatment of cardiac arrest, but described many barriers to the use of such skills. We categorised five areas of NTSs (leadership, communication, mutual performance monitoring, maintenance of guidelines and task management), considered important to improve efficiency in cardiac arrest teams, and corresponding barriers that challenge the team interaction, communication and possible compliance with guidelines.

Conclusion

Participants in the interview pointed out that NTSs could improve teamwork and the treatment of clinical cardiac arrest, but several barriers to this exist. A framework with five categories relating to NTSs was identified – leadership, communication, mutual performance monitoring, maintenance of standards and guidelines and task management – during individual semi-structured interviews with 11 Danish ALS instructors.

Conflict of interest

None.

Acknowledgements

The authors would like to thank the ALS instructors participating in the study for their support and patience during the interviews. The work was supported by grants from the Copenhagen County.

References (24)

  • B.S. Abella et al.

    Chest compression rates during cardiopulmonary resuscitation are suboptimal: a prospective study during in-hospital cardiac arrest

    Circulation

    (2005)
  • G. Abbas et al.

    Advanced life support algorithm

  • Cited by (159)

    • Human factors in obstetrics

      2022, Anaesthesia and Intensive Care Medicine
    View all citing articles on Scopus

    “A Spanish translated version of the summary of this article appears as Appendix in the final online version at doi:10.1016/j.resuscitation.2010.01.024”.

    View full text