Background:
Team dynamics have been a learning objective of AHA courses since 2005. Cardiopulmonary resuscitation (CPR) in a hospital setting involves a multidisciplinary team with multiple specific roles occurring simultaneously. Though evaluation of team performance in simulated resuscitation events has been studied, little information exists on the performance of teams in real CPR events. The development of a video-based resuscitation quality improvement (QI) program has allowed a route for the analysis of team performance during actual patient care.
Objective:
Demonstrate feasibility of team performance rating of real pediatric CPR events using video review.
Methods:
All pediatric resuscitations requiring cardiopulmonary resuscitation (CPR) in the emergency department of a tertiary children’s hospital are video-recorded for QI purposes. Following video review, team performance was rated by study personnel using the validated Behavioral Assessment Tool (BAT). The BAT scores 10 domains of team performance, each on a 0-4 Likert Scale (score range 0 – 40). Univariate comparison of BAT scores was done between patient age categories, event duration, location of arrest (in- vs. out-of-hospital), and chest compression fraction (CCF) below or above 80% using nonparametric methods.
Results:
13 events requiring CPR occurred during the study period. Mean BAT scores were 32 (+/- 6) points. Lowest rated domains were Attention allocation , Distribution of workload, and Utilization of information. Highest rated domains across all events were Recognition of Limitations and Professional behavior. BAT scores were significantly higher in infant CPR events than older children (39 vs. 28, p=0.005) and out-of-hospital events compared with in-hospital (37 vs 27, p=0.04). There were no significant differences in BAT scores based on event duration or CCF.
Conclusions:
Video-based review of pediatric CPR events is a feasible method for efficient evaluation of team performance using validated tools. Quantitative assessment of team performance allows for needs assessments to determine areas in which intervention should be focused for maximum impact on CPR quality. Future work should focus on interventions to address areas of suboptimal performance.
