Closed loop communication in the trauma bay: identifying opportunities for team performance improvement through a video review analysis

• Published in: Canadian journal of emergency medicine Vol. 24; no. 4; p. 419
• Main Authors: Bhangu, Avneesh, Notario, Lowyl, Pinto, Ruxandra L, Pannell, Dylan, Thomas-Boaz, Will, Freedman, Corey, Tien, Homer, Nathens, Avery B, da Luz, Luis
• Format: Journal Article
• Language: English
• Published: England 01-06-2022
• Subjects: Clinical Competence; Communication; Humans; Leadership; Patient Care Team; Resuscitation; Teach-Back Communication; Nontechnical skills; Callout; Team performance; T-NOTECHS; Closed loop communication; Communication
• ISSN: 1481-8043
• DOI: 10.1007/s43678-022-00295-z

Communication among trauma team members in the trauma bay is vulnerable to errors, which may impact patient outcomes. We used the previously validated trauma-non-technical skills (T-NOTECHS) tool to identify communication gaps during patient management in the trauma bay and to inform development strategies to improve team performance.
Two reviewers independently assessed non-technical skills of team members through video footage at Sunnybrook Health Sciences Centre. Team performance was measured using T-NOTECHS across five domains using a five-point Likert scale (lower score indicating worse performance): (1) leadership; (2) cooperation and resource management; (3) communication and interaction; (4) assessment and decision making; (5) situation awareness/coping with stress. Secondary outcomes assessed the number of callouts, closed loop communications and parallel conversations.
The study included 55 trauma activations. Injury severity score (ISS) was used as a measure of trauma severity. A case with an ISS score ≥ 16 was considered severe. ISS was ≥ 16 in 37% of cases. Communication and interaction scored significantly lower compared to all other domains (p < 0.0001). There were significantly more callouts and completed closed loop communications in more severe cases compared to less severe cases (p = 0.017 for both). Incomplete closed loop communications and parallel conversations were identified, irrespective of case severity.
A lower communication score was identified using T-NOTECHS, attributed to incomplete closed loop communications and parallel conversations. Through video review of trauma team activations, opportunities for improvement in communication can be identified by the T-NOTECHS tool, as well as specifically identifying callouts and closed loop communication. This process may be useful for trauma programs as part of a quality improvement program on communication skills and team performance.