The teamwork structure, process, and context of a paediatric cardiac surgery team in Mongolia: A mixed-methods approach

Team communication patterns during real and simulated trauma resuscitation-a social network analysis

In trauma teams, coordination can be established through a centralised leader. The team can also use a decentralised strategy. In this descriptive study of video-recorded trauma resuscitations, using quantification of qualitative data, Social Network analysis of all real-time communications of eight in-real-life (IRL) and simulated trauma teams explained team social structure. The communication network structures in the simulated scenarios were more centralised using individually directed speech and had a high proportion of communication to update all team members. Such a structure might be the result of work performed in a complexity-stripped simulation environment where simplified task-executions required less interactions, or from work revolving around a deteriorating patient, imposing high demands on rapid decision-making and taskwork. Communication IRL was mostly decentralised, with more variability between cases, possibly due to unpredictability of the IRL case. The flexibility to act in a decentralised manner potentiates adaptability and seems beneficial in rapidly changing situations.Practitioner summary: Efficient collaboration in trauma teams is essential. Communication in in-real-life and simulated trauma teams was analysed using social network analysis. The simulation teams were overall more centralised compared to the IRL teams. The flexibility to act decentralised seems beneficial for emergency teams as it enables adaptability in unpredictable situations.

Enhancing Quality of Congenital Heart Care Within Resource-Limited Settings

Over 90% of the world's children with congenital heart disease (CHD) are born in the resources poor settings of low- to middle-income countries (LMICs). The shortfall in human and material resources and dysfunctional health systems leads to poor quality of care (QoC) which contributes substantially to suboptimal outcomes of patients with CHD in LMICs. Notwithstanding these challenges, it is possible to develop a quality improvement (QI) framework that can have a significant impact on outcomes and prevent a number of deaths. In this review, we examine the common barriers to implementing effective QI processes in LMICs. Using examples of successful QI initiatives in LMIC, we propose a broad framework that focuses on simple, yet effective measures involving cohesive efforts of all key participants guided and nurtured by a leadership that strongly values QoC.

Communication challenges: perioperative risks and care directives

PURPOSE OF REVIEW

Effective communication and shared decision-making is crucial in caring for children with congenital or acquired heart disease. Despite high mortality, complications related to interventions, and suffering in pediatric advanced heart disease, there is a disproportionate lack of research and advancements in communication and shared decision-making surrounding perioperative risks and advance care planning. We have comprehensively reviewed recent research on this multifaceted topic in the past 1.5 years to highlight major findings and propose priorities for future research.

RECENT FINDINGS

Research has focused on parental perception of clinician/team communication with a notable paucity of research investigating the clinician perception of barriers to effective communication. Although there are discrepancies between parental and clinician perception, lack of trust between the patient's family and provider was acknowledged as a barrier by both parents and clinicians. Insight into interprofessional needs and expansion of structured language for discussions around shared decision-making should be prioritized.

SUMMARY

Clinician discomfort with communication skills and conveying uncertainty in prognosis are two major areas for future research. On the basis of the literature to date, the focus should be placed on interprofessional needs and structured language for discussions around shared decision-making.