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BJOG. 2011 Apr;118(5):596-607. doi: 10.1111/j.1471-0528.2010.02843.x. Epub 2011 Feb 4.

Clinical efficiency in a simulated emergency and relationship to team behaviours: a multisite cross-sectional study.

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Department of Obstetrics and Gynaecology, Southmead Hospital, Westbury on Trym, Bristol, UK.



To identify specific aspects of teamworking associated with greater clinical efficiency in simulated obstetric emergencies.


Cross-sectional secondary analysis of video recordings from the Simulation & Fire-drill Evaluation (SaFE) randomised controlled trial.


Six secondary and tertiary maternity units.


A total of 114 randomly selected healthcare professionals, in 19 teams of six members.


Two independent assessors, a clinician and a language communication specialist identified specific teamwork behaviours using a grid derived from the safety literature.


Relationship between teamwork behaviours and the time to administration of magnesium sulfate, a validated measure of clinical efficiency, was calculated.


More efficient teams were likely to (1) have stated (recognised and verbally declared) the emergency (eclampsia) earlier (Kendall's rank correlation coefficient τ(b) = -0.53, 95% CI from -0.74 to -0.32, P=0.004); and (2) have managed the critical task using closed-loop communication (task clearly and loudly delegated, accepted, executed and completion acknowledged) (τ(b) = 0.46, 95% CI 0.17-0.74, P=0.022). Teams that administered magnesium sulfate within the allocated time (10 minutes) had significantly fewer exits from the labour room compared with teams who did not: a median of three (IQR 2-5) versus six exits (IQR 5-6) (P=0.03, Mann-Whitney U-test).


Using administration of an essential drug as a valid surrogate of team efficiency and patient outcome after a simulated emergency, we found that more efficient teams were more likely to exhibit certain team behaviours relating to better handover and task allocation.

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