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- PublicationMétadonnées seulementPerformance of first responders in simulated cardiac arrests(2005)
;Marsch, Stephan ; ;Semmer, Norbert ;Spychiger, Martin ;Breuer, MarcHunziker, PatrickObjective. Survival of in-hospital cardiac arrests depends more on first responders than on cardiac arrest teams. The objective of this study was to determine the adherence to algorithms of cardiopulmonary resuscitation of first responders in simulated cardiac arrests in intensive care. A second objective was to assess the effect of the early vs. late availability of a physician on the performance of nurse-based teams acting as first responders. Design: Prospective study. Setting. Patient simulator in a tertiary level intensive care unit. Participants: A total of 20 teams consisting of three registered nurses and one resident each. Interventions: A simulated witnessed cardiac arrest due to ventricular fibrillation occurred in the presence of one nurse while the remaining two nurses could be called to help. Depending on the time of the residents' arrival, teams were classified as "early" (median arrival 50 secs after the onset of the arrest) or "late" (median arrival 150 secs after the onset of the arrest). Measurements and Main Results: In all teams, the recognition of the arrest and the calling for help occurred, in a timely fashion. However, a median of 85 secs (interquartile range , 130 secs) elapsed until the start of cardiac massage and 100 secs (IQ, 45 secs) to the first defibrillation. Once commenced, cardiac massage and mask ventilation were carried out during 61% (IQ, 33%) and 77% (IQ, 23%) of the possible time only. Delays and interruptions were generally not recalled by the participants. Compared with teams with late arriving residents, teams with early arriving residents administered more countershocks: 4.5 (IQ, 2) vs. 3.5 (IQ, 1.5; p =.026). Conclusions. First responders in intensive care often failed to build a team structure that ensured timely, effective, monitored, and ongoing team activity. The early availability of a physician increased the number of countershocks administered. Self-reporting is unsuitable to reliably assess the quality of cardiopulmonary resuscitation.
- PublicationMétadonnées seulementGetting groups to develop good strategies: Effects of reflexivity interventions on team process, team performance, and shared mental models(2007)
;Gurtner, Andrea ; ;Semmer, NorbertNägele, ChristofThis study examines the effect of guided reflection on team processes and performance, based on West's (1996, 2000) concept of reflexivity. Communicating via e-mail, 49 hierarchically structured teams (one commander and two specialists) performed seven 15 min shifts of a simulated team-based military air-surveillance task (TAST) in two meetings, a week apart. At the beginning of the second meeting, teams were assigned either to a reflexivity (individual or group) or to a control condition. Results show that reflexivity enhanced performance, the link between reflexivity and team performance being mediated by communication and implementation of strategies as well as by similarity of mental models. Contrary to expectations, individual reflexivity was superior to group reflexivity. Additional analyses suggested that group reflexivity decreased the commanders' active behavior and increased discussion of strategies that were too general to be helpful. Results point to the usefulness of reflexivity as a generic intervention but underscore the importance of focusing on strategies that are task-specific. (c) 2006 Elsevier Inc. All rights reserved.
- PublicationMétadonnées seulementExplicit Reasoning, Confirmation Bias, and Illusory Transactive Memory A Simulation Study of Group Medical Decision Making(2009)
; ;Semmer, Norbert ;Gurtner, Andrea ;Bizarri, Lara ;Spychiger, Martin ;Breuer, MarcMarsch, StephanTeamwork is important in medicine, and this includes team-based diagnoses. The influence of communication on diagnostic accuracy in an ambiguous situation was investigated in an emergency medical simulation. The situation was ambiguous in that some of the patient's symptoms suggested a wrong diagnosis. Of 20 groups of physicians, 6 diagnosed the patient, 8 diagnosed with help, and 6 missed the diagnosis. Based on models of decision making, we hypothesized that accurate diagnosis is more likely if groups (a) consider more information, (b) display more explicit reasoning, and (c) talk to the room. The latter two hypotheses were supported. Additional analyses revealed that physicians often failed to report pivotal information after reading in the patient chart. This behavior suggested to the group that the chart contained no critical information. Corresponding to a transactive memory process, this process results in what we call illusory transactive memory. The plausible but incorrect diagnosis implied that the two lungs should sound differently. Despite objectively identical sounds, some physicians did hear a difference, indicating confirmation bias. Training physicians in explicit reasoning could enhance diagnostic accuracy.