N. Ho1, G. Kurosawa1, A. Wei1, E. Lim1, S. Steinemann1,2 1University Of Hawaii,John A. Burns School Of Medicine,Honolulu, HI, USA 2The Queen’s Medical Center,Honolulu, HI, USA
Introduction:
Efficient teamwork requires knowledge of members’ capabilities and task domains. In modern trauma teams, multiple levels of “physician” practitioners (medical students, residents, fellows, attendings and physicians’ assistants – “PAs”) may create confusion. We hypothesized that trauma nurses (TRNs) lack detailed knowledge of team members’ abilities, and that TRNs and surgeons may have discordant perceptions of responsibilities during resuscitations.
Methods:
A survey was conducted at a Level II Trauma Center which includes medical students, residents, surgical critical care fellows (Fellows) and PAs on the trauma team. TRNs enrolled in a trauma refresher course gave informed consent to participate and were asked their knowledge of the education, clinical training and need for supervision of team members. TRNs then ranked, on a 7-point Likert-type scale, their perception of responsibility for 17 resuscitation tasks. TRN perceptions were compared (via two sample t tests) to those of attending trauma surgeons.
Results:
42 TRNs (100%) and 9 surgeons (90%) participated. Only 4% of TRNs knew the minimum clinical years training of first-year residents (PGY1s), Fellows and PAs. 90% of TRNs underestimated the clinical experience of PAs by an average of 2-fold; 61% underestimated the experience of PGY1s and Fellows.
88% of TRNs correctly identified the need for medical student, PGY1 and PA supervision for specific procedures or patient conditions. However, 92% of TRNs thought mid-level residents should be supervised for tube thoracostomy, a procedure typically performed by mid-level residents without direct supervision.
TRNs and attending surgeons differed in perception of responsibility for most resuscitation tasks with both groups assigning significantly more responsibility to their own profession (Table).
Conclusion:
Our study demonstrates a gap in TRN understanding of the education and experience of surgical trainees and PAs, and a perceived need for additional procedural supervision of mid-level residents. Both TRNs and attending trauma surgeons maintained “ownership” of a number of trauma resuscitation tasks. This could conceivably result in inefficiency and duplication of diagnostic procedures or interventions. Further education regarding trauma team members’ training and ability, and attention to nontechnical “teamwork” skills (e.g. pre-briefing, role assignments, communication) may be warranted to reduce redundancy and confusion.
