Teamwork And Communication In Emergency Department

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Teamwork And Communication In Emergency Department

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Discuss about the Teamwork And Communication In Emergency Department.

Answer:

Introduction:
Teamwork is a vital element to provide safe and effective care to patients in health care setting. The significance of team work is realized because of the complexity of care due to increase in prevalence of diseases and presence of multiple co-morbidities in patient. As multi-professional health care staffs like doctors, nurses, support staffs and other allied health care professionals work together for the safety of patient, effective communication between teams helped to coordinate care and reduce adverse events or any harm to patient (Gluyas, 2015). Many health care issues or conflicts have been seen in health care setting because of poor team work and ineffective communication process between team. Ineffective communication process leads to communication breakdown and poor coordination of care. This form of communication breakdown results in inaccurate diagnosis, medication errors, an increase in workload and poor satisfaction with care (Hohenstein et al., 2016). Problems related to conflict and bullying also act as a barrier in providing patient-focused care (O’connor et al., 2016). Hence, as effective team work and communication is regarded as a solution to address patient safety issues in health care, the main aim of this proposal is to conduct a rapid review of systematic reviews to understand the effectiveness of team work and communication between health care professional in promoting patient safety in health care setting.
Aim and objective:
The main aim of the proposal is to assess the impact of teamwork and communication in promote safety of patient in health care setting. By the use of rapid review of systematic review, the main objective of the proposal is:

To evaluate the impact of team work and communication on patient safety outcome
To identify strategies to improve team work and communication process
To analyse the impact of communication skill on team performance and quality of care
To analyse systematic reviews and prepare an understanding of the effectiveness of teamwork and communication outcome in less than 5 weeks

Significance of the project:
Effective team work and communication process is the main area of interest for the proposal because of gaps and limitations found in the performance of multi-professional health care team. The evidence related to adverse events and medication errors in hospital setting suggest that poor teamwork and communication as the main source of patient safety issues (Hohenstein et al., 2016). Hence, the significance of the rapid review of systematic reviews is that it can help to find wide range of studies that gives brief idea about the effectiveness of teamwork and communication intervention on quality of care. Review of various randomized controlled trials and cohort studies in systematic review may also help to identify most effective intervention to resolve the issue of poor team communication and reduce negative events in clinical setting.
Literature review:
The review of past research studies gives insight into the impact of poor teamwork and communication related issues in contributing to patient safety risk and adverse events in health care setting. Rabøl et al. (2012) revealed that poor communication and coordination between multi-professional health care team results is associated with adverse events and high morbidity and mortality rate. The communication between team is particularly compromised during patient handover process due to lack of standard communication process, interruptions and poor clarity regarding individual roles. The study by Frydenberg and Brekke (2012) gives the indication that poor communication related to drug use is most commonly seen among health care professionals and this is the reason behind majority of medication errors during hospital stay. Hence, teamwork and coordination between team is crucial to avoid medication errors and promote safety of patient.
Another research exploring about the impact of poor teamwork on patient outcome indicated that limitations in team communication skills increased risk for patients. Lack of coordination and poor leadership are the common causes of poor teamwork and half of these events have been found to have high impact on patient safety outcomes (Hohenstein et al., 2016). The evidence suggests the main rational behind identifying the effectiveness of team work and communication process on patient safety outcomes. The research question for rapid review is as follows:
How is good teamwork and communication (I) between health care professionals (P) effective reducing patient safety risk (O) in health care setting compared to poor teamwork and communication process (C)?

Project design and method:
To get answer to the research question, the plan is to undertake a rapid review of systematic review of research literature. The main rational for evaluating results of systematic review is that it mainly scrutinizes carefully designed research studies like randomized controlled trials and use of such high level evidence can help to get realistic data related to the effectiveness of health care interventions (Moher et al., 2015). The rapid review of research studies will be guided by the development of appropriate search strategies, selection of databases, development of inclusion and exclusion criteria and use of specific critical appraisal tool.
Search strategy:
To retrieve and extract research articles related to the research questions, the search will be conducted in databases like CINAHL, Medline and PubMed. These databases has been chosen because they are globally recognized databases that publishes variety of research from the field of health care and bioscience. During the search process, search filters will be applied by setting the language to English and selecting peer reviewed journal articles as type of sources or studies. Keywords for search process will be taken from the research question and the main keywords that will be used include patient safety, teamwork, inter-professional team, communication, health and care setting and adverse events. Boolean operators like ‘AND’ and ‘OR’ will also be used for conducting search in CINAHL databases. The detailed search strategy for one of the database is provided in appendix 1.
Inclusion and exclusion criteria
The inclusion and exclusion criteria for the rapid review of systematic reviews will be as follows:

Only those research studies will be included in the rapid review which has systematic review as the research design. Another specific inclusion criteria is that only those systematic review will be taken in literature review which used high level primary studies such randomized controlled trials, cohort studies and case controlled trial for analysis
Research published within the year 2008 to 2018 will be included
All selected research studies must have team work and communication as the main intervention
The main population of interest for the study includes inter-professional health care team
The research must be published in English language

The exclusion criteria for the study will be as follows:

Studies which are not systematic reviews will be excluded
Studies which are published before 2008 will be excluded
Studies published in language other than English will be excluded

Three relevant studies have been found that meets the inclusion and exclusion criteria. The first is the study by Miller et al. (2018) which investigated about team building interventions in acute health care setting. The second research articles retrieved in accordance with the inclusion and exclusion criteria includes study by McEwan et al. (2017) which used systematic review method to analyse the effect of team work training on team work behaviours and team performance. The third relevant article suitable for the rapid review is the study by Wen and Schulman (2014) which conducted a systematic review of randomized controlled trials to assess impact of team based care on patient satisfaction level. Kilner and Sheppard (2010) have given insight into role of team work and communication in the emergency department. Manser (2009) also revealed the effectiveness teamwork on patient safety outcomes by conducting a systematic review of research literatures.

Data analysis:
After entering search terms and enforcing search limits, screening for articles will be done in accordance with the research question and inclusion and exclusion criteria. Two reviewers assessed the articles for eligibility. The full-text articles will be analysed to ensure it has desired research design and research participants. Data will extracted for each study in a data extraction form and this will be presented in data extraction form given in appendix 3. The quality of studies will be done by assessment of risk of bias and by critical appraisal of the research methodology using the CASP tool.
Timeline:
It is planned to complete the project within 5 weeks time frame. The first week will involve development of research question, developing search strategy and choosing database for research. The second and third week will involve screening of data, extraction of data and critical appraisal of the evidence. The final week will comprise developing the detailed report for the outcomes of the rapid review. All formatting related needs and submission to journal will be done in the final week.

Expected outcomes:
By conducting the rapid review of systematic reviews on the research question, it is expected to gain an in-depth understanding regarding the effectiveness of teamwork and communication on patient safety outcome. By doing a critical review of systematic review, it is expected to retrieve and identify the best intervention that are effective in improving team work and communication skills and influence patient safety outcome for client in clinical setting. This will aid in implementing effective interventions to address teamwork and communication breakdown related issues in hospital setting. The completion of the proposal will play a crucial role in promote quality improvement in health care organization.

References:
Frydenberg, K., & Brekke, M. (2012). Poor communication on patients’ medication across health care levels leads to potentially harmful medication errors. Scandinavian Journal of Primary Health Care, 30(4), 234–240. https://doi.org/10.3109/02813432.2012.712021
Gluyas, H. (2015). Effective communication and teamwork promotes patient safety. Nursing Standard (2014+), 29(49), 50.
Hohenstein, C., Fleischmann, T., Rupp, P., Hempel, D., Wilk, S., & Winning, J. (2016). German critical incident reporting system database of prehospital emergency medicine: Analysis of reported communication and medication errors between 2005–2015. World journal of emergency medicine, 7(2), 90.
Kilner, E., & Sheppard, L. A. (2010). The role of teamwork and communication in the emergency department: a systematic review. International emergency nursing, 18(3), 127-137.
Manser, T., 2009. Teamwork and patient safety in dynamic domains of healthcare: a review of the literature. Acta Anaesthesiologica Scandinavica, 53(2), pp.143-151.
McEwan, D., Ruissen, G. R., Eys, M. A., Zumbo, B. D., & Beauchamp, M. R. (2017). The effectiveness of teamwork training on teamwork behaviors and team performance: a systematic review and meta-analysis of controlled interventions. PloS one, 12(1), e0169604.
Miller, C. J., Kim, B., Silverman, A., & Bauer, M. S. (2018). A systematic review of team-building interventions in non-acute healthcare settings. BMC Health Services Research, 18, 146. https://doi.org/10.1186/s12913-018-2961-9
Moher, D., Shamseer, L., Clarke, M., Ghersi, D., Liberati, A., Petticrew, M., … & Stewart, L. A. (2015). Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement. Systematic reviews, 4(1), 1.
O’connor, P., O’dea, A., Lydon, S., Offiah, G., Scott, J., Flannery, A., … & Byrne, D. (2016). A mixed-methods study of the causes and impact of poor teamwork between junior doctors and nurses. International journal for quality in health care, 28(3), 339-345.
Rabøl, L. I., McPhail, M. A., Østergaard, D., Andersen, H. B., & Mogensen, T. (2012). Promoters and barriers in hospital team communication. A focus group study. Journal of Communication in Healthcare, 5(2), 129-139.
Wen, J., & Schulman, K. A. (2014). Can team-based care improve patient satisfaction? A systematic review of randomized controlled trials. PloS one, 9(7), e100603.

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