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Background: Sharing information with the team is critical in developing a shared mental model in an emergency, and fundamental to effective teamwork. We developed a structured call-out tool, encapsulated in the acronym 'SNAPPI': Stop; Notify; Assessment; Plan; Priorities; Invite ideas. We explored whether a video-based intervention could improve structured call-outs during simulated crises and if this would improve information sharing and medical management., Methods: In a simulation-based randomized, blinded study, we evaluated the effect of the video-intervention teaching SNAPPI on scores for SNAPPI, information sharing, and medical management using baseline and follow-up crisis simulations. We assessed information sharing using a probe technique where nurses and technicians received unique, clinically relevant information probes before the simulation. Shared knowledge of probes was measured in a written, post-simulation test. We also scored sharing of diagnostic options with the team and medical management., Results: Anaesthetists' scores for SNAPPI were significantly improved, as was the number of diagnostic options they shared. We found a non-significant trend to improve information-probe sharing and medical management in the intervention group, and across all simulations, a significant correlation between SNAPPI and information-probe sharing. Of note, only 27% of the clinically relevant information about the patient provided to the nurse and technician in the pre-simulation information probes was subsequently learnt by the anaesthetist., Conclusions: We developed a structured communication tool, SNAPPI, to improve information sharing between anaesthetists and their team, taught it using a video-based intervention, and provide initial evidence to support its value for improving communication in a crisis., (© The Author [2014]. Published by Oxford University Press on behalf of the British Journal of Anaesthesia. All rights reserved. For Permissions, please email: journals.permissions@oup.com.)

Background: Teamwork is an important contributor to patient safety and a validated teamwork measurement tool could help healthcare teams identify areas for improvement and measure progress. We explored the psychometric properties of a teamwork measurement tool when used for self-assessment. We hypothesized that the tool had a valid factor structure and that scores from participants and external assessors would correlate., Methods: Forty intensive care teams (one doctor, three nurses) participated in four simulated emergencies, and each independently rated their team's performance at the end of each case using the teamwork measurement tool, without prior training in the use of the tool. We used exploratory factor analysis (EFA) and confirmatory factor analysis (CFA), and compared factor structure between participants and external assessors (using previously reported data). Scores from participants and external assessors were compared using Pearson's correlation coefficient., Results: EFA demonstrated items loaded onto three distinct factors which were supported by the CFA. We found significant correlations between external and participant scores for overall teamwork scores and the three factors. Participants agreed with external assessors on the ranking of overall team performance but scored themselves significantly higher than external assessors., Conclusions: The teamwork measurement tool has a valid structure when used for self-assessment. Participant and external assessor scores correlated significantly, suggesting that participants could discriminate between different levels of performance, although leniency in self-assessed scores indicated the need for calibration. This tool could help structure reflection on teamwork and potentially facilitate self-directed, workplace-based improvement in teamwork.

Introduction: Teamwork failures contribute to adverse events causing harm to patients. Establishing and maintaining a team and managing the tasks are active processes. Medical education largely ignores teamwork skills. However, lack of robust instruments to measure teamwork limits evaluation of interventions to improve it. The authors aimed to develop and validate an instrument to measure teamwork behaviours., Methods: From existing literature, the authors developed an instrument, gaining rater consensus that the final 23 items were comprehensive, comprehensible and observable. Data on the instrument were obtained from three expert raters who scored videotaped simulations of 40 critical care teams (one doctor, three nurses) participating in four simulated emergencies. Exploratory Factor Analysis, Generalisability Analysis and rater interviews on assessor performance provided information on the properties of the instrument., Results: Exploratory Factor Analysis found items clustered into three factors: Leadership and Team Coordination; Mutual Performance Monitoring; and Verbalising Situational Information. Internal consistencies (Cronbach's α) for these factors were 0.917, 0.915 and 0.893, respectively. The Generalisability coefficient for overall team behaviour was 0.78 and the G coefficients for the three factors were 0.85, 0.4 and 0.37, respectively. Variance Components and interview data provided insight into individual item performance. Significantly improved performance with time and seniority supported construct validity., Discussion: The instrument performed well as an overall measure of team behaviour and reflected three dimensions of teamwork. Triangulation of information on the instrument, the factors and individual items will allow a methodical and informed approach to further development of the instrument. The ultimate goal is an instrument that can robustly evaluate interventions to improve team function in healthcare.