Effect of crowding on teamwork in the resuscitation room

Abstract

Abstract Background: Crowding, describing a state where patient demands exceed available emergency department (ED) resources, seems to be associated with patient outcomes but its effect on teamwork is unknown. Aim: To examine how crowding affects the teamwork of ED staff in the resuscitation room. Secondarily, to assess if teamwork correlates with patients’ length of stay (LOS) in ED. Materials and methods: Data was collected from 50 cases treated in resuscitation rooms over a 23-day period in the autumn of 2022, at the Karolinska University Hospital ED in Huddinge. The questionnaire Team Emergency Assessment Measure (TEAM) was used by staff to evaluate teamwork. The TEAM has three sub-categories and a total score, all evaluated on a 5-point Likert scale. Data was presented as median with interquartile range (IQR). Crowding was assessed binarily as a value over 1.0 for the ratio of number of patients present divided by number of beds. Results: The median scores on TEAM for total performance was 41 (IQR 38-44) for hours with non-crowding compared to 40 (34-43) for hours with crowding (p-value 0.61). Further, no differences were found on any of the sub-categories, i.e. leadership, teamwork, and task management 7 (6-8); 26 (25-28); and 8 (7-8) compared to 8 (6-8); 26 (22-28); and 8 (7-8), respectively (all p-values >0.05). No statistically significant correlations were found between team performances and patients’ LOS. Conclusion: Teamwork was often assessed as good or excellent by team members, during or not during crowding. However, the poorest scores on teamwork were during crowding.