Elsevier

Resuscitation

Volume 160, March 2021, Pages 126-139
Resuscitation

Review
The effect of team and leadership training of advanced life support providers on patient outcomes: A systematic review

https://doi.org/10.1016/j.resuscitation.2021.01.020Get rights and content

Abstract

Aim

To conduct a systematic review evaluating improvement in team and leadership performance and resuscitation outcomes after such a training of healthcare providers during advanced life support (ALS) courses.

Methods

This systematic review asked the question of whether students taking structured and standardised ALS courses in an educational setting which include specific leadership or team training, compared to no such specific training in these courses, improves patient survival, skill performance in actual resuscitations, skill performance at 3−15 months (patient tasks, teamwork, leadership), skill performance at course conclusion (patient tasks, teamwork, leadership), or cognitive knowledge PubMed, Embase and the Cochrane database were searched until April 2020. Screening of articles, analysis of risk of bias, outcomes and quality assessment were performed according to the Grading of Recommendations Assessment, Development and Evaluation methodology. Only studies with abstracts in English were included.

Results

14 non-randomised studies and 17 randomised controlled trials, both in adults and children, and seven studies involving patients were included in this systematic review. No randomised controlled trials but three observational studies of team and leadership training showed improvement in the critical outcome of “patient survival”. However, they suffered from risk of bias (indirectness and imprecision). The included studies reported many different methods to teach leadership skills and team behaviour.

Conclusion

This systematic review found very low certainty evidence that team and leadership training as part of ALS courses improved patient outcome. This supports the inclusion of team and leadership training in ALS courses for healthcare providers.

Introduction

Teamwork and leadership are increasingly recognised as important competencies for medical professionals; and as human factors that contribute to patient safety and outcomes.1 Resuscitation efforts are delivered as complex high-stake dynamic competencies and need effective interprofessional team coordination and collaboration to deliver safe and high-quality care. Teaching leadership and teamwork aims to create a highly performing team of healthcare professionals from a group of highly skilled individual clinicians so they can effectively deliver resuscitation to improve patient outcome. Team and leadership training is not only the teaching of better communication, it includes how to guide briefing and debriefing, clarify team roles, install situational awareness and promote effective decision-making. All these components of collaborative practice might promote and develop successful teamwork and leadership.

Providing Advanced Life Support (ALS) is fundamentally a team effort. Teamwork and leadership are therefore expected to make a significant contribution to cardiac arrest patients’ survival outcomes. As early as 1999, Cooper and Wakelam reported that leadership during resuscitation is associated with the team performance.2 They recommended that leadership training should be provided during resuscitation education.2 Therefore, teamwork was integrated in the European Resuscitation Council (ERC) ALS and Immediate Life Support (ILS) courses for healthcare providers. The 2015 ERC guidelines emphasised non-technical skills training (including teamwork, leadership, and structured communication skills training) as an essential adjunct to the technical skills training, especially for those who are expected to perform cardiopulmonary resuscitation (CPR) regularly.3

The International Liaison Committee on Resuscitation (ILCOR) Task Force on Education, Implementation, and Teams (EIT) prioritised the question of the effect of team and leadership training during ALS courses on patient and educational outcomes and was the underlying impetus for the conduct of this systematic review.

This systematic review is an update of the “Team and leadership training” systematic review undertaken in 2015 by the International Liaison Committee on Resuscitation (ILCOR), as part of the Consensus on Science and Treatment Recommendations (CoSTR), and published simultaneously in Resuscitation and Circulation.4, 5

Section snippets

Methods

The protocol for the current review was registered at the PROSPERO International Prospective Registry for Systematic Reviews (CRD42020164205) and was conducted in accordance with the Preferred Reporting Items for a Systematic Review and Meta-analysis (PRISMA) guidelines.6, 7

Results

After removal of duplicates, the search identified 31 studies (Fig. 1, Table 1a, Table 1b), 17 randomised and 14 non-randomised studies, which included both adults and children, 2 studies in trauma life support (1 RCT and 1 non-RCT) and one study in newborns. The key findings of the included studies are summarised in Table 2.

The risk of bias assessment for confounding ranged from low risk to high risk (Supplemental Tables 3 and 4). The overall certainty of evidence was rated low or very low for

Discussion

The current review provides evidence (albeit with low levels of certainty) to include team and leadership training in ALS education; and confirms the 2015 Consensus of Science and Treatment Recommendation (CoSTR) of the Education Implementation and Teams (EIT) Task Force.

In 2015 the ILCOR EIT Task Force issued a weak recommendation based on low-level quality of evidence to include team and leadership training in ALS courses.5 Although the current review identified many new studies since the

Conclusion

This systematic review identified very low certainty evidence for improved patient outcome if team and leadership training is included as part of a structured ALS course. Nonetheless, this evidence does support a recommendation that team and leadership training should be included as part of ALS courses for healthcare providers.

Funding

No.

Conflicts of interest

KGM and EG are members, and RG is chairperson of the ILCOR EIT Task Force. JF is a member of the ILCOR Scientific Advisory Committee. KGM is ERC Chair-elect; RG is ERC Director of Education and Training, AK is member of the ERC Science and Education Committee BLS.

CRediT authorship contribution statement

A. Kuzovlev: Conceptualization, Methodology, Investigation, Writing - original draft, Writing - review & editing, Visualization. K.G. Monsieurs: Conceptualization, Methodology, Investigation, Writing - original draft, Writing - review & editing, Visualization. E. Gilfoyle: Conceptualization, Methodology, Investigation, Writing - review & editing. J. Finn: Methodology, Writing - review & editing, Project administration. R. Greif: Conceptualization, Methodology, Writing - review & editing,

Acknowledgements

We would like to thank the AHA appointed information specialist for developing the ILCOR C2015 search strategy.

The following ILCOR EIT Taskforce Members are acknowledged as collaborators on this systematic review: Blair L. Bigham, Jan Breckwoldt, Adam Cheng, Jonathan P. Duff, Ming-Ju Hsieh, Taku Iwami, Andrew Lockey, Matthew Huei-Ming Ma, Joyce Yeung, Peter Morley Chair of the ILCOR Scientific Advisory Committee.

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