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Predicting team-performance and leadership in emergency situations by observing standardised operational procedures: a prospective single-blind simulator-based trial
  1. Franziska Tschan1,
  2. Norbert K Semmer2,
  3. Maria Vetterli1,
  4. Patrick R Hunziker3,
  5. Stephan C Marsch3
  1. 1 Department of Psychology, University of Neuchâtel, Neuchâtel, Switzerland
  2. 2 Department of Psychology, University of Berne, Berne, Switzerland
  3. 3 Medical Intensive Care Unit, University of Basel Hospital, Basel, Switzerland
  1. Correspondence to Dr Stephan C Marsch, Department of Medical Intensive Care, University Hospital, Basel 4031, Switzerland; stephan.marsch{at}


Background Performance of interdisciplinary teams and their leaders is crucial in acute medical care and can be monitored by observing specific events. Standardised operational procedures (SOP) are easily observable, whereas the unpredictability of medical emergencies makes performance monitoring in these situations difficult. The aim of this study was therefore to assess whether performance in emergency situations can be predicted by performance observed during an SOP.

Methods 30 intensive care unit teams composed of one staff physician (leader), one resident and three nurses performed a simulated scenario of an elective electrical cardioversion (SOP) followed by a cardiac arrest (emergency). Video recordings obtained during simulations were used for data analysis. The primary outcome was the correlation between performance scores of electrical cardioversion and performance during cardiopulmonary resuscitation (hands-on time, time to first defibrillation).

Results None of the cardioversion performance scores significantly correlated with resuscitation performance. Leadership scores during electrical cardioversion correlated positively with leadership scores during cardiopulmonary resuscitation (r=0.365, p=0.047). Moreover, there was a positive correlation of leaders being hands-off during both electrical cardioversion and cardiopulmonary resuscitation (r=0.645, p<0.0001).

Conclusions Team performance in SOP carried no predictive value for emergency situations. Observing teams in easily observable SOP is therefore no suitable substitute for monitoring the performance in medical emergencies. There was a between-situation consistency for specific elements of leadership.

  • leadership
  • prediction of team performance
  • standardized operational procedure
  • simulation
  • interdisciplinary teams
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  • Contributors FT, NKS, MV and SCM contributed to the study concept, study design, data collection and analysis and writing of the article. PRH contributed substantially to planning of the study, data collection and revised the article critically for important intellectual content. All authors approved the final version of the article.

  • Funding This is an investigator-funded study partly supported by the Swiss National Foundation.

  • Competing interests None declared.

  • Ethics approval Ethikkommission Nordwestschweiz.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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