TEMPLATE DESIGN © 2008 www.PosterPresentations.com Rapid Assessment Tool for Team Communication during Obstetrical Emergencies Jean T. Baumgardner, 1 Susanna R. Cohen, 2 Julia C. Dettinger, 3 Dilys Walker, 4 Edgar Kestler, 5 John Cranmer 6 1 Family Nurse Practitioner Graduate Student, Seattle University, 2 Assistant Professor, Nurse Midwifery and Women’s Health, University of Utah College of Nursing, 3 PRONTO International Research Coordinator, University of Washington Department of Global Health, 4 PRONTO International, Associate Professor of Obstetrics-Gynecology and Global Health, University of Washington, 5 Epidemiological Research Center in Sexual and Reproductive Health (CIESAR), Guatemala City, Guatemala, 6 Senior Fogarty Fellow, University of Washington Department of Global Health Purpose Results Implications Extensions Acknowledgements The PFA method could be applied to the other four teamwork domains on the PACT-V to create a comprehensive short form for teamwork measurement. Findings from Guatemala could be applied to simulation-based team trainings in similar contexts • The Short-Form could be applied PRONTO SM trainings globally (Kenya, India, Mexico). Other contexts for the Short-Form may include: • Obstetrical Teams, observed births, obstetrical emergencies, or Low-Income Countries • Retrospective measurement of obstetrical simulations, observations Interdisciplinary simulation team training improves teamwork and patient outcomes. Assessing an obstetrical emergency training’s effectiveness in fostering teamwork skills requires a tool that is: psychometrically sound, contextually appropriate and user friendly. The PACT-Video (PACT-V) tool is a reliable tool for measuring teamwork behaviors and is based on the TeamSTEPPS model. In its current form, it allows raters to retrospectively measure teamwork and communication. However, in Low and Middle Income Countries where PRONTO SM provides on-site emergency obstetrical training, a tool is needed to rapidly and reliably measure teamwork and team communication in real-time. We applied the PACT-V tool to longitudinal videos of simulated emergency obstetrical training in Guatemala to measure teamwork development. Then, we took this obstetrical teamwork video data and used Principal Factor Analysis to design a "short- form" version of the PACT-V Communication Domain in order to rapidly measure obstetrical communication in real-time. Figure 1: TeamSTEPPS Model of Teamwork PFA identified salient communication techniques for effective team function during transitional and routine obstetric care. Specific surrogate communication behaviors were selected using multiple criteria. The PACT-V Communication Short Form provides a rapid assessment tool for measuring and describing team communication. Its potential uses include: • Rapidly and reliably quantify team communication behaviors • Allow trainers to systematically provide communication feedback • Enable trainees to self-evaluate or debrief with greater specificity • Measure communication improvements over time • Create a culture of team communication, self-evaluation at facilities Background Globally, poor communication and ineffective teamwork are root causes of adverse health outcomes. • Team-based obstetrical care simulation training in low and middle-income countries can reduce maternal and perinatal mortality. • PRONTO SM -Guatemala trains healthcare providers using simulated obstetric and neonatal emergencies and teamwork development activities based on TeamSTEPPS. TeamSTEPPS is a program for improving teamwork and communication in healthcare systems. • It emerged from the “Big Five Factors” theory of teamwork. • It improves patient safety by enhancing interprofessional communication and teamwork skills. The PACT-V tool measures teamwork (Figure 2). It has: • Five domains of teamwork based on the TeamSTEPPS model • High inter-rater reliability (ICC(1,k)=90.0%) • A cohesive communication scale (α=84.0%) Figure 2: PACT-V Tool Scoring Sheet Methods Principal Factor Analysis: All Communication Variables • 12 communication behaviors cluster on two factors (Table 3) • Clustering suggests communication behavior is situation-dependent and related to techniques needed for “Routine” or “Transition” teamwork. • Factors were selected by Kaiser Criterion, Scree Test and BIC (Table 1). • These 2 factors explained 77.1% of all communication behaviors. • Robust 2-factor model (Post-Model analysis) • KMO=72.9% (Kaiser-Meyer-Olkin) Variable Selection •Surrogate variables were extracted from 2 factors using defined criteria (Tables 2, 3) •Repeat-Back: Dropped based on strong overlap with Closed-Loop communication techniques (ρ=65.5%) •Clarify: Retained based on moderate loading, relationship to error prevention Table 3: Statistical Output of PFA including Surrogate Variable Selection Short-Form Creation •The “Short Form” (Figure 4) is based on 5 highlighted surrogate behavior variables (Table 3). • Robustness increased compared to 2-factor model (KMO=80.5% vs. 72.9) • Cohesion is similar to the original PACT-V tool (α=82.8% vs. 84.0) Figure 4: Team Communication Short Form We used a 4-step process to design a practical, theoretically-grounded tool for measuring team communication during obstetric care in low-resource countries: Step 1 - Video Coding 56 archived simulated obstetrical emergency videos were scored using the PACT-V tool •Two bilingual coders scored 76 videos (45% jointly coded). •Videos documented team behaviors during 9 distinct simulated emergencies at 6 sites. Total Composite Score (TCS) is based on 3 ordinal scales: •Frequency of behaviors (26) (0-2 rating) •Quality of behaviors (26) (0-3 rating) •Global impression of teamwork (5 domains) (0-3 rating) Step 2 - Exploratory Data Analysis • PACT-V measures communication behaviors (6) using frequency and quality scores. (Figure 3) • Exploratory Data Analysis was used to identify data patterns. • Factor Analysis focused on the communication domain. Figure 3: Communication Behaviors Measured by PACT-V Tool Step 3 - Principal Factor Analysis—All Communication Variables •Principal Factor Analysis (PFA) applied to all communication variables •Varimax Orthogonal rotation maximized the uniqueness of each factor •Identified factors and specific communication behaviors for a “Short-Form” •Data were analyzed in STATA 11.2 Step - 4 “Short-Form” Tool Creation Variable selection criteria: •Factors (clusters of communication behaviors) (Table 1) •Surrogate variables from within each factor (Table 2) Table 1: Inclusion Criteria for Selecting Factors Table 2: Inclusion Criteria for Selecting Surrogate Communication Variables Selected References The data collection for this project was supported by NIH Research Training Grant #R25 TW009345 awarded to the Northern Pacific Global Health Fellows Program by the Fogarty International Center, NIMH, and the Office of the Director. This study was nested within a cluster randomized trial in Guatemala approved by UW-IRB and CIESAR, Guatemala. Special thanks to Dr. Katherine Camacho-Carr and Dr. Benjamin Miller for their support and advice. Corresponding Author: Jean T. Baumgardner Family Nurse Practitioner Graduate Student, Seattle University baumgard@seattleu.edu Teamwork and Measurement Theory Henriksen, K., Battles, J. B., Keyes, M. A., Grady, M. L., King, H. B., Battles, J.,… & Salisbury, M. (2008). TeamSTEPPS™: Team strategies and tools to enhance performance and patient safety. Advances in patient safety: new directions and alternative approaches, Performance and tools, 3. Kohn, L. T., Corrigan, J. M., & Donaldson, M. S. (Eds.). (2000). To err is human: Building a safer health system (Vol. 627). National Academies Press. Salas, E., Sims, D. E., & Burke, C. S. (2005). Is there a “Big Five” in teamwork? Small group research, 36(5), 555-599. 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