Simulation and educationIdentifying non-technical skills and barriers for improvement of teamwork in cardiac arrest teams☆
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.
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“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”.