Available online 5 June 2023, 110851

Author links open overlay panel, , , , , ABSTRACTBackround

The CAST Grid has been developed to evaluate the use of closed-loop communication (CLC) in the trauma bay.

Methods

The CAST Grid and two validated non-technical team performance assessment tools (the TEAM and T-NOTECHS grids) were completed by 2 independent reviewers based on trauma care simulation videos from a French Level 1 trauma center. Intra- and inter-rater agreements were evaluated for CLC parameters and non-technical performance, and correlations between these parameters were analyzed.

Results

The study analyzed 11 videos. The intra- and inter-rater agreement for the number of CLC per minute (CLC/min) was moderate and good, respectively, based on Lin's concordance correlation coefficient [95%CI] (0.57 [-0.40;0.94] and 0.77 [0.33;0,94]). However, the agreement was poor for the percentage of CLC (0.37 [-0.58;0.89] and -0.36 [-0.71;0.14], respectively). The study found that a lower number of CLC/min was correlated with an increased duration of the simulation (r=-0.75 [-0.93; -0.25]).

Conclusion

The CAST Grid showed a relatively good inter-rater agreement to quantify the number of CLC/min which was inversely correlated with the duration of care. This tool opens up the possibility of quantifying CLC and allows for new analyses of team functioning and interactions.

Section snippetsINTRODUCTION

The management of severe trauma requires both medical and surgical skills which involves many people who must act and interact to stabilize and orient the patient as quickly as possible. This is complex and requires the establishment of many soft skills. [1] It has been shown that optimizing teamwork in the operating room, in particular by improving communication within a multidisciplinary team, can reduce surgical mortality. [2] One way to optimize interprofessional interactions is the use of

Study design

The CAST Grid was designed to record and report all verbal communications during trauma care, quickly and easily. The instructions for using the grid (Figure 1) are detailed in the Figure 2. The CAST Grid was evaluated through the retrospective analysis of videos from in situ simulations managed in a French Level 1 trauma at Lyon University Hospitals (Hospices Civils de Lyon, HCL, France). The CAST Grid was filled out by two reviewers, Reviewer 1 (PA) and Reviewer 2 (VS), watching the video

Descriptive data

Eleven trauma care simulation videos recorded during the year 2018 were analyzed (Table 1). In total, 406 minutes of simulation were viewed by the two reviewers (191 minutes for Reviewer 1 and 251 minutes for Reviewer 2). The median duration [IQR] of simulation was 16 minutes [12-24]. The median ISS [IQR] was 33 [29-34]. The median [IQR] T-NOTECHS and TEAM score were respectively 21 [17-22] and 43 [36-45] for Reviewer 1, and 21 [18-21] and 44 [41-50] for Reviewer 2 (Table 2). The simulations

DISCUSSION

The CAST Grid is the first standardized method for studying closed-loop communications. We demonstrated the CAST Grid can be used to quantify CLC with relatively good inter-rater reliability in the setting of trauma simulation sessions. Although we did not find any correlation between the use of CLC and non-technical performance scores, CLC-based communication could be associated with a faster management of patients in the trauma bay.

In the present study, three quantitative indices were

CONCLUSIONS

The CAST Grid demonstrates a good performance for the quantification of CLC during trauma simulation sessions and allowed to show that the number of CLC/min is correlated with a decrease in the duration of care. The CAST Grid therefore appears as a reliable tool to evaluate the impact of CLC use during care management. This tool opens up the possibility of quantifying CLC and allows for new analyses of team functioning and interactions.

FUNDINGS

None

Ethical approval

Ethical approval for this study was obtained from the ethics committee of the Lyon university hospitals (ID 20/118).

Authorship contributions

Conception and design of study: V. Schwindenhammer, T. Rimmelé, A. Duclos, J. Haesebaert, P. Abraham.

Acquisition of data: V. Schwindenhammer, P. Abraham.

Analysis and/or interpretation of data: V. Schwindenhammer, P. Abraham.

Drafting the manuscript: V. Schwindenhammer.

Revising the manuscript critically for important intellectual content: V. Schwindenhammer, T. Rimmelé, A. Duclos, J. Haesebaert, M. Lilot, P. Abraham.

Approval of the version of the manuscript to be published: V. Schwindenhammer, T.

Declaration of Competing Interest

None.

ACKNOWLEDGEMENTS

The authors would like to thank Philip Robinson (DRS, Hospices Civils de Lyon) for his substantial help in manuscript editing.

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