Abaya R, Delgado EM, Scarfone RJ, et al Improving efficiency of pediatric emergency asthma treatment by using metered dose inhaler J Asthma 2018:1–8 doi:10.1080/02770903.2018.1514629 Balamuth F, Alpern ER, Abbadessa MK, et al Improving recognition of pediatric severe sepsis in the emergency department: contributions of a vital sign–based electronic alert and bedside clinician identification Ann Emerg Med 2017;70(6):759–768.e2 Bloch SA, Bloch AJ Using video discharge instructions as an adjunct to standard written instructions improved caregivers’ understanding of their child’s emergency department visit, plan, and follow-up: a randomized controlled trial Pediatr Emerg Care 2013;29(6):699–704 Dandoy CE, Hariharan S, Weiss B, et al Sustained reductions in time to antibiotic delivery in febrile immunocompromised children: results of a quality improvement collaborative BMJ Qual Saf 2016;25:100–109 Sheehan B, Nigrovic LE, Dayan PS, et al Informing the design of clinical decision support services for evaluation of children with minor blunt head trauma in the emergency department: a sociotechnical analysis J Biomed Inform 2013;46(5):905–913 CHAPTER ■ MULTIDISCIPLINARY TEAMWORK JANE LAVELLE, DEBRA A POTTS, TRACY A WALKER, JAMES C WON, JACQUELINE T NOLL INTRODUCTION Emergency departments (EDs) must provide efficient, comprehensive care to patients with emergent and nonemergent conditions who arrive in an unpredictable manner 24 hours daily The environment of the ED is one of organized chaos; there is a high cognitive load, a high density of decision making and technical/diagnostic evaluations and reevaluations occurring in an atmosphere with constant interruptions The environment of the ED is composed of the physical space, the care processes, and the people; the people are the most important component With the explosion of medical knowledge and technology resulting in complex patients and care processes, the complexity of decision making and the execution of tasks have correspondingly increased Rather than placing this entire burden on individuals, there has been a shift in emphasis to teams and to the importance of performance in teams, with a focus on understanding effective coordination and collaboration facilitating this performance Teams offer the ability to achieve more than any single person can achieve—they offer a variety of knowledge to make decisions, solve problems, generate ideas, and complete tasks more effectively and efficiently Patients with growing medical complexity require a healthcare team to optimize their experience and outcome This is even more critical for the ED where teamwork occurs in uncertain, time-pressured situations Thus, the environment, care processes, and leadership must support a culture which allows for the development of strong interdisciplinary teams with shared awareness, goals, knowledge, and strong communication skills including the ability to resolve conflict in the moment WHY TEAMWORK IS IMPORTANT TO QUALITY AND SAFETY Preventable harm to patients in our healthcare system may exceed 250,000 deaths annually The fragmented nature of healthcare delivery is a common contributor to medical error Communication failures at shift change or patient transition are high-risk interactions which include important patient information and may lead to miscommunication, delays in care or even inappropriate treatment Hierarchy within the medical system can further inhibit open communication which could prevent error As stated above, no single individual can assure that a patient receives the highest quality of care possible nor can they protect that patient from potential harm associated with complex bedside care Currently, despite high need for strong teams, healthcare does not implement evidenced-based practices for supporting teams and coordinating care or provide the necessary resources There is a growing body of evidence that links teamwork to the quality (degree to which patients receive the treatment consistent with current guidelines and professional knowledge), safety of care (risk of preventable harm), and the patient’s experience (self-reported outcomes)—all of which are necessary for optimal clinical outcomes Patients receiving care with poor teamwork are almost five times more likely to die or experience a complication Patients receiving care from higher performing teams report being more satisfied Patients also report lower levels of postoperative pain with more rapid recovery and decreased hospital length of stay Teamwork creates a more positive, engaging, and resilient work environment Thus, effective, strong interdisciplinary teamwork offers an opportunity to increase quality, decrease harm significantly, and improve the experience of the patients and members of the healthcare team What Is a Team? A team is defined as a set of two or more people who interact dynamically and work toward a common, valued goal Team members have specific assigned roles or functions to perform In the ED, the team performs timesensitive tasks in a dynamic environment by coordinating their efforts to meet these common goals For example, care of the patient with suspected sepsis requires nurses with advanced IV skills, respiratory therapists to assist with respiratory support, pharmacists to assist with medications and infusions, etc.; importantly although each member has a specific role, all team members share the responsibility of monitoring the patient and raising concerns about response to treatment, delays in care or potential harm Who Is on a Team? Members of the large ED team include physicians, advanced practice nurses and physician assistants, nurses, physicians in training, nurse assistants, technicians, patient care associates, child life specialists, social workers, respiratory therapists, and numerous consultants It also includes representatives from services lines such as pharmacy, radiology, laboratory medicine, nutrition, supplies, and environmental services The patient and family are also important team members Including them in decision making leads to improved patient/family experiences as well as reported outcomes During an ED visit, the patient and family interact directly with at least seven members of the team If testing, consultation and admission are required, this number can easily grow to >50 individuals For example, patients with acute, severe headache interact with many ED team members and consultants; but they may require emergent MRI imaging This often requires transport of the patient to a location outside of the ED, preparation for safe MRI imaging, and interpretation by a neuroradiologist in a timely way Systems such as these must be organized and coordinated across areas and assure that focus remains on the patient experience aiming to minimize discomfort, delays, and errors Team Core Competencies Five important core components described by Salas et al include team leadership, mutual performance monitoring, backup behavior, adaptability, and team orientation Team members need competencies in cognition including clinical decision making and procedures; social behaviors are also required These social skills include communication and personal behavior skills that support high quality, safe, effective and efficient interprofessional care within the complex healthcare system Five core values of team members include honesty, discipline, creativity, humility, and curiosity Team Leadership ... TEAMWORK JANE LAVELLE, DEBRA A POTTS, TRACY A WALKER, JAMES C WON, JACQUELINE T NOLL INTRODUCTION Emergency departments (EDs) must provide efficient, comprehensive care to patients with emergent... consultants It also includes representatives from services lines such as pharmacy, radiology, laboratory medicine, nutrition, supplies, and environmental services The patient and family are also important