Team dynamics in emergency surgery teams: results from a first international survey

Background Emergency surgery represents a unique context. Trauma teams are often multidisciplinary and need to operate under extreme stress and time constraints, sometimes with no awareness of the trauma’s causes or the patient’s personal and clinical information. In this perspective, the dynamics of how trauma teams function is fundamental to ensuring the best performance and outcomes. Methods An online survey was conducted among the World Society of Emergency Surgery members in early 2021. 402 fully filled questionnaires on the topics of knowledge translation dynamics and tools, non-technical skills, and difficulties in teamwork were collected. Data were analyzed using the software R, and reported following the Checklist for Reporting Results of Internet E-Surveys (CHERRIES). Results Findings highlight how several surgeons are still unsure about the meaning and potential of knowledge translation and its mechanisms. Tools like training, clinical guidelines, and non-technical skills are recognized and used in clinical practice. Others, like patients’ and stakeholders’ engagement, are hardly implemented, despite their increasing importance in the modern healthcare scenario. Several difficulties in working as a team are described, including the lack of time, communication, training, trust, and ego. Discussion Scientific societies should take the lead in offering training and support about the abovementioned topics. Dedicated educational initiatives, practical cases and experiences, workshops and symposia may allow mitigating the difficulties highlighted by the survey’s participants, boosting the performance of emergency teams. Additional investigation of the survey results and its characteristics may lead to more further specific suggestions and potential solutions.

Trauma, Teams, and Telemedicine: Evaluating Telemedicine and Teamwork in a Mass Casualty Simulation

Introduction Mass casualty events (MASCAL) are on the rise globally. Although natural disasters are often unavoidable, the preparation to respond to unique patient demands in MASCAL can be improved. Utilizing telemedicine can allow for a better response to such disasters by providing access to a virtual team member with necessary specialized expertise. The purpose of this study was to examine the positive and/or negative impacts of telemedicine on teamwork in teams responding to MASCAL events. Methods We introduced a telemedical device (DiMobile Care) to Forward Surgical Teams during a MASCAL simulated training event. We assessed teamwork-related attitudes, behaviors, and cognitions during the MASCAL scenario through pre-post surveys and observations of use. Analyses compare users and nonusers of telemedicine and pre-post training differences in teamwork. Results We received 50 complete responses to our surveys. Overall, clinicians have positive reactions toward the potential benefits of telemedicine; further, participants report a significant decrease in psychological safety after training, with users rating psychological safety as significantly higher than non-telemedicine users. Neither training nor telemedicine use produced significant changes in cognitive and behavioral-based teamwork. Nonetheless, participants reported perceiving that telemedicine improved leadership and adaptive care plans. Conclusions Telemedicine shows promise in connecting Forward Surgical Teams with nuanced surgical expertise without harming quality of care metrics (i.e., teamwork). However, we advise future iterations of DiMobile Care and other telemedical devices to consider contextual features of information flow to ensure favorable use by teams in time-intensive, high-stakes environments, such as MASCAL.

Locked In - Locked Out: Inflexibility in UK Training

Trainee doctors and surgeons involved in UK trauma teams work within inflexible training systems. Examples include prohibitively strict regional transfer rules which lock trainees in and rigid recruitment pathways by a National Selection process which can lock them out of training. The 2020 coronavirus pandemic required systems to adapt, exposing inflexibilities in training frameworks. Training inflexibility is identified as a major but addressable problem – the pressing question is which actions to take to give trainees the autonomy to excel.

Team trust and performance in pediatric trauma

Pediatric trauma cases involve multiple healthcare workers and a complicated coordination of care. The differing roles and changing hospital schedules means that trauma teams are constantly changing and each trauma case may involve a new team. Trust in these dynamic, high stakes environment is important for team performance. A survey on team trust, psychological safety, and team learning behavior was circulated by email to all roles that respond to the highest level trauma at a large, Midatlantic, level 1 pediatric trauma center. Seventy-seven participants responded and represented the emergency department, pediatric intensive care unit, surgery, respiratory therapy, pharmacy, technician, child life, social work, and spiritual care. The respondents generally scored high on measures of psychological safety; however, the majority (69%) did not agree that it was safe to take a risk on the team. Similarly, the respondents scored high on measures of team trust. Measures of team learning varied with the majority responding neither agree nor disagree on “In this team, someone always makes sure that we stop to reflect on the team's work process,” “People in this team often speak up to test assumptions about issues under discussion,” and “We invite people from outside the team to present information or have discussions with us”. The results show that these responses also vary by role and home department, but these differences were not statistically significant. Understanding current perceptions of team trust and learning will allow for targeted interventions to improve team communication and performance in pediatric trauma.

IRL relational dependence in Swedish trauma teams- a Social Network Analysis of communication

Functional teamwork in trauma resuscitation teams is essential for team performance and the quality of care. Challenging situations put strain on the teams, which can affect how coordination is achieved. Proposedly there is a relation between the adapted social structure of the team and the acquisition of a common mental model in the team, which facilitates task performance. From other studies it is proposed that the equality of reliance between team members and an open-structure of information sharing is coupled to the possibility of establishing shared goals and situational awareness within the team. This would correspond to low centralization in teams. This study assessed the social structure of IRL teams from trauma resuscitations through a Social Network Analysis (SNA) of communication. The analysis revealed that the examining physician was the most prominent communicator. However, the teams had over-all high degrees of centrality on more than one of its parts, making them high in centralization but not “star-like”. The study provides a snapshot of social relations IRL and hints about future possibilities of studying the dynamics of social interaction in emergency teams.

The Evolution of NIMHANS Neurotrauma Care

Neurotrauma services in NIMHANS, Bangalore, have been evolving since its inception in 1958. At present, it is a major referral center for Karnataka and surrounding districts of the southern states. It has many firsts to its credit, from having a separate building to having dedicated trauma teams to manage the service 24/7. It has made rapid strides in healthcare delivery based on data-driven evidence, improvisation with Lean sigma approach, and contribution through research and publications. This center has won best Neurotrauma center award in 2010.

Swedish emergency hospital surgical surge capacity to mass casualty incidents

Background In Sweden the surgical surge capacity for mass casualty incidents (MCI) is managed by county councils within their dedicated budget. It is unclear whether healthcare budget constraints have affected the regional MCI preparedness. This study was designed to investigate the current surgical MCI preparedness at Swedish emergency hospitals. Methods Surveys were distributed in 2015 to department heads of intensive care units (ICU) and surgery at 54 Swedish emergency hospitals. The survey contained quantitative measures as the number of (1) surgical trauma teams in hospital and available after activating the disaster plan, (2) surgical theatres suitable for multi-trauma care, and (3) surgical ICU beds. The survey was also distributed to the Armed Forces Centre for Defence Medicine. Results 53 hospitals responded to the survey (98%). Included were 10 university hospitals (19%), 42 county hospitals (79%), and 1 private hospital (2%). Within 8 h the surgical capacity could be increased from 105 to 399 surgical teams, while 433 surgical theatres and 480 ICU beds were made available. The surgical surge capacity differed between university hospitals and county hospitals, and regional differences were identified regarding the availability of surgical theatres and ICU beds. Conclusions The MCI preparedness of Swedish emergency care hospitals needs further attention. To improve Swedish surgical MCI preparedness a national strategy for trauma care in disaster management is necessary.

High-Energy Proximal Humerus Fractures in Geriatric Patients: A Review

High-energy proximal humerus fractures in elderly patients can occur through a variety of mechanisms, with falls and MVCs being common mechanisms of injury in this age group. Even classically low-energy mechanisms can result in elevated ISS scores, which are associated with higher mortality in both falls and MVCs. These injuries result in proximal humerus fractures which are commonly communicated via Neer’s classification scheme. There are many treatment options in the armamentarium of the treating surgeon. Nonoperative management is widely supported by systematic review as compared to almost all other treatment methods. ORIF is particularly useful for complex patterns and fracture dislocations in healthy patients. Hemiarthroplasty can be of utility in patients with fracture patterns with high risk of AVN and poor bone quality risking screw cut-out. Reverse total shoulder arthroplasty is a popular method of treatment for geriatric patients also, with literature now showing that even late conversion from nonoperative management or ORIF to rTSA can lead to good clinical outcomes. Prevention is possible and important for geriatric patients. Optimizing medical care including hearing, vision, strength, and bone quality, in coordination with primary care and geriatricians, is of great importance in preventing fractures and decreasing injury when falls do occur. Involving geriatricians on dedicated trauma teams will also likely be of benefit.