The majority of hospital resuscitations occur in Emergency Department resus rooms. Except in the most organised institutions, the group that assembles in ED resus rooms does not fit the definition of a “team”. Use of the word “team” leads to false expectations, and feelings of failure when “teamwork” has not occurred.
Teams train & practice together, know each others names, skill-set, abilities, strengths & weaknesses, teams are coached, critiqued and drilled, so that on game day, they perform at an optimal level. Teams review their games and focus on improving on areas of weakness or mistakes. Teams analyse their competition, and seek out ways to maximise their chances of winning.
Photo courtesy of mirror.co.uk
None of these attributes apply to groups of individuals who perform Emergency Department resuscitation. Regarding just the ED medical staff, factors such as shift-work (meaning one rarely works with the same people), rotations of doctors through ED and out to other specialties, and having multiple mid to senior level doctors rostered on at the same time means a “team” can never form. Add to this the same factors which apply to different specialties who come to ED to assist with resuscitations (mainly Anaesthetics & ICU), and your chances of assembling the same group of people in a resus room are exceptionally slim. Then consider that another group – the nursing staff – will also vary with almost every resus, due to shiftwork, enforced meal-breaks, and skill-mix variations, and you are faced with the fact that a “team” cannot form in this setting.
Based on this, RRM aims to give the doctors in charge if running a resus (until now often called the “Team Leader” – ironic?), a skill set that allows them to manage a heterogenous group of individuals with varying skills and priorities and as well as managing the multiple simultaneous clinical events that occur in resus. RRM aims to give individuals who arrive to participate in a resus (ED medical and nursing staff, and non-ED medical staff) a clear set of expectations of how they will behave and perform while attending an ED resus, and skill set that they can use to work with the Resus Leader to achieve optimal outcomes.
Manchester United is a “team”.
The heterogenous group of strangers who arrive to run most ED resuscitations is not.
Tug-of-war photo courtesy of: milwaukeecountyfirst.com