Trauma Team Performance

The role of effective teamwork in accomplishing complex tasks is accepted in many domains. Similarly, there is good evidence that the outcome in trauma care depends on effective trauma team performance. Teamwork during trauma care can be deficient in a number of ways (Table 1), and multiple deficiencies may interact to impair team success and patient outcomes. This chapter focuses on understanding, assessing, and improving trauma team performance. Resuscitation of trauma patients is a specialized domain in which critically ill patients are treated in a dedicated facility. The need to train and evaluate the performance of trauma teams has emerged as an important topic over the past decade (1,2). Institutions must establish and continuously validate their team-based trauma resuscitation procedures to assure high quality care. This iterative evaluation must include the review of secondary management, careful delineation of team structure, comprehensive team training, effective support structures, and continuous quality improvement. This chapter reviews the state-of-the-art methodology useful for the trauma team’s training, evaluation, and improvement. Emphasis is placed upon essential features and newer techniques, including computer simulation and video-assisted analysis and debriefing. Team training has a proven history in aviation and military organizations. Recently, these experiences and techniques have been utilized in medicine, including trauma resuscitation and critical care management. Studies of aviation teams revealed failures of coordination, communication, workload management, loss of group situational awareness, and inefficient resource utilization (3–6). Thorough investigation of adverse events occuring during trauma resuscitation revealed similarities to failures discovered in aviation-related mishaps, both tending to be multifactorial and complex (7–11). Much of health care is performed by interdisciplinary teams: individuals with diverse specialized skills focused upon a common task in a defined period of time and space, who must respond flexibly to contingencies and share responsibility for outcomes. This is particularly true of trauma care. Traditional specialty-centric clinical education programs are deficient in team training, because most assume that individuals acquire adequate competencies in teamwork passively without any formal training. Performance incentives in health care are targeted at individuals and not at teams, as are job and other selection and assessment processes (12). With a few exceptions, risk management and liability data, morbidity and mortality conferences, and even quality improvement projects have not systematically addressed systems factors or teamwork issues. Substantial evidence suggests that teams routinely outperform individuals and are required to succeed in today’s complex work arenas where information and resources are widely distributed, technology is becoming more complicated, and workload is increasing (13,14). Nevertheless, our understanding of how medical teams coordinate in real-life situations, especially during time-constrained and crisis situations, remains incomplete.