Positive communication behaviour during handover and team-based clinical performance in critical situations: a simulation randomised controlled trial

Abstract

Background: Positive communication behaviour within anaesthesia teams may decrease stress response and improve clinical performance. We aimed to evaluate the effect of positive communication during medical handover on the subsequent team-based clinical performance in a simulated critical situation. We also assessed the effect of positive communication behaviour on stress response.

Methods: This single-centre RCT involved anaesthesia teams composed of a resident and a nurse in a high-fidelity scenario of anaesthesia-related paediatric laryngospasm after a standardised handover. During the handover, similar information was provided to all teams, but positive communication behaviour was adopted only for teams in the intervention group. Primary outcome was team-based clinical performance, assessed by an independent blinded observer, using video recordings and a 0-to 100-point scenario-specific scoring tool. Three categories of tasks were considered: safety checks before the incision, diagnosis/treatment of laryngospasm, and crisis resource management/non-technical skills. Individual stress response was monitored by perceived level of stress and HR variability.

Results: The clinical performance of 64 anaesthesia professionals (grouped into 32 teams) was analysed. The mean (standard deviation) team-based performance score in the intervention group was 44 (10) points vs 35 (12) in the control group (difference: +8.4; CI95% [0.4-16.4]; P=0.04). The effects were homogeneous over the three categories of tasks. Perceived level of stress and HR variability were not significantly different between groups.

Conclusions: Positive communication behaviour between healthcare professionals during medical handover improved team-based performance in a simulation-based critical situation.

Clinical trial registration: NCT03375073.

Keywords: clinical performance; communication behaviour; high-fidelity simulation; positive communication; stress response; teamwork.

Copyright © 2020 British Journal of Anaesthesia. Published by Elsevier Ltd. All rights reserved.

Figures

Fig 1

Timeline of conduct of the study and distribution of the measurements. D-15, 15 days before intervention; PSS, perceived stress scale; sdnn, standard deviation normal to normal; STAI-S, State-Trait Anxiety Inventory-State anxiety; STAI-T, State-Trait Anxiety Inventory-Trait anxiety.

Fig 2

Flow diagram. Based on Consolidated Standards of Reporting Trials guidelines.

Fig 3

(a) Overall and (b) category-specific team-based clinical performance scores. Box plots show, from bottom to top, minimum, 25th percentile (Q1), median, 75th percentile (Q3), and maximum values. Outliers (shown as points) are defined by values below Q1–1.5∗[Q1–Q3] or above Q3+1.5∗[Q1–Q3].

Fig 4

(a) Psychological and (b) physiological stress response over time. Data presented in difference from basal values; sdnn in milliseconds; VAS on a scale of 100 points. Each point is represented with 25th percentile, median, and 75th percentile. sdnn, standard deviation normal to normal.