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Measuring the teamwork performance of teams in crisis situations: a systematic review of assessment tools and their measurement properties

Quality and Safety in Health Care Journal -


Educational interventions to improve teamwork in crisis situations have proliferated in recent years with substantial variation in teamwork measurement. This systematic review aimed to synthesise available tools and their measurement properties in order to identify the most robust tool for measuring the teamwork performance of teams in crisis situations.


Searches were conducted in Embase (via OVID), PsycINFO, Cumulative Index to Nursing and Allied Health Literature, Education Resources Information Center, Medline and Medline In-Process (via OVID) (through 12 January 2017). Studies evaluating the measurement properties of teamwork assessment tools for teams in clinical or simulated crisis situations were included. Two independent reviewers screened studies based on predetermined criteria and completed data extraction. Risk of bias was assessed using the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) checklist.


The search yielded 1822 references. Twenty studies were included, representing 13 assessment tools. Tools were primarily assessed in simulated resuscitation scenarios for emergency department teams. The Team Emergency Assessment Measure (TEAM) had the most validation studies (n=5), which demonstrated three sources of validity (content, construct and concurrent) and three sources of reliability (internal consistency, inter-rater reliability and test–retest reliability). Most studies of TEAM’s measurement properties were at no risk of bias.


A number of tools are available for assessing teamwork performance of teams in crisis situations. Although selection will ultimately depend on the user’s context, TEAM may be the most promising tool given its measurement evidence. Currently, there is a lack of tools to assess teamwork performance during intraoperative crisis situations. Additional research is needed in this regard.

Xeljanz, Xeljanz XR (tofacitinib): Safety Communication - Safety Trial Finds Increased Risk of Blood Clots in the Lungs and Death with Higher Dose in Rheumatoid Arthritis Patients

FDA MedWatch -

FDA is alerting the public that a safety clinical trial found an increased risk of blood clots in the lungs and death when a 10 mg twice daily dose of tofacitinib (Xeljanz, Xeljanz XR) was used in patients with rheumatoid arthritis (RA). FDA has not approved this 10 mg twice daily dose for RA; this dose is only approved in the dosing regimen for patients with ulcerative colitis

From incident reporting to the analysis of the patient journey

Quality and Safety in Health Care Journal -

Patricia Trbovich and Charles Vincent

Incident reporting has been a mainstay of patient safety initiatives throughout the world, but its purpose and potential for stimulating safety improvements are still much debated. Record review studies of adverse events revealed the nature and scale of harm to patients, and it was initially hoped that incident reporting systems would capture these adverse events on an ongoing basis.1 2 This epidemiological dream was never realised; studies showed that incident reporting was actually very poor at identifying adverse events.3 Furthermore, incident reporting, record review and other systems such as pharmacy reports capture very different types of problems, which means that combining information sources can provide a more complete picture of safety issues.4 5

In this issue, de Vos and colleagues6 extend this argument to suggest that we should draw on a...

Every patient should be enabled to stop the line

Quality and Safety in Health Care Journal -

When Taiichi Ohno introduced ‘Stop the Line’ manufacturing, people were sceptical.1 2 Each assembly line worker was entrusted with the responsibility to push a red button to stop the line if she/he noticed something wrong. The idea was to catch problems early, before they got out of control. But the approach seemed at odds with production goals, namely keeping assembly lines running at full speed. Why not have managers, more trained in production, oversee the line and make fewer stops? Ohno’s idea seemed too risky to some managers, who resisted. Indeed, managers who implemented Stop the Line experienced a productivity drop. Investigating and fixing problems took time. But soon, things flipped. The teams using Stop the Line were faster and more reliable than those that did not and Stop the Line manufacturing became a standard Toyota approach.

When patients enter the hospital, they entrust clinicians...

Engaging with theory: from theoretically informed to theoretically informative improvement research

Quality and Safety in Health Care Journal -

Repeated calls have been made for the increased use of theory in designing and evaluating improvement and implementation interventions.1–4 The benefits are argued to include identifying contextual influences on quality improvement (QI), supporting the generalisability of findings and anticipating how future phenomena might unfold.2 5 Most importantly, the ability of theories to provide robust explanations is invaluable for understanding how, why and in what circumstances interventions work (or do not work),6 thus addressing crucial questions relating, for example, to variation in improvement outcomes.4 7

Although the use of theory in improvement and implementation research appears to be increasing over time,8 the emphasis largely remains on adopting a theoretically informed approach, that is, applying theory to design an intervention or to systematise and explain evaluation findings. Despite the recognised need...

Connecting perspectives on quality and safety: patient-level linkage of incident, adverse event and complaint data

Quality and Safety in Health Care Journal -

Background and objective

Incident, adverse event (AE) and complaint data are typically used separately, but may be related at the patient level with one event triggering a cascade of events, ultimately resulting in a complaint. This study examined relations between incidents, AEs and complaints that co-occurred in admissions.


Independently and routinely collected incident, AE and complaint data were retrospectively linked for surgical admissions in an academic centre (2008–2014). Two investigators reviewed whether incidents/AEs in admissions were clinically related and in what sequence (incident preceding vs following AE). Likelihood of occurrence of AEs and AE cascades (ie, ≥3 AEs) was studied using logistic regression analyses.


Complaints were filed for 33 (0.1%) of 26 383 admissions. Complaints filed by patients with incidents and/or AEs (n=13) mostly addressed quality/safety problems, whereas other complaints mostly addressed relationship problems. Incidents and AEs co-occurred in 730 (2.8%) admissions, which seemed clinically related in 34% of these cases. Incidents with related AEs preceded as well as followed AEs (56.6%/44.4%). Patients with incidents were at greater risk of AEs than patients without incidents, even for seemingly unrelated AEs (OR 1.4; 95% CI 1.3 to 1.6). Risk of AE cascades was greater when patients with AEs also had incidents, regardless of whether these seemed related (unrelated: OR 2.0; 95% CI 1.6 to 2.5; related: OR 5.7; 95% CI 4.3 to 7.4) or whether incidents preceded or followed AEs in these admissions (53% vs 52%, P>0.05).


Patient-level linkage of incident, AE and complaint data can reveal relations between events that otherwise remain obscured, such as incidents that trigger as well as follow AEs, introducing event cascades, regardless of whether clinical relations seem present.


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