Team Emergency Assessment Measure (TEAM)

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Submitted by National Center... on Sep 6, 2016 - 11:12am CDT

Cooper, S.
Cant, R
Porter, J.
Somers, G
Kinsman, L
Nestel, D

This observational rating tool was designed to assess the nontechnical performance of team members during resuscitation events. Specifically, it focuses on team leadership, teamwork, and task management as performed by acute care specialists (e.g., physicians, nurses).  The tool includes ratings of 11 specific behaviors and also a global performance item.  A thorough investigation of content, construct, and concurrent validity of the tool was conducted.  In the latter investigations, analyses were performed on data collected from 56 previously recorded hospital resuscitations. The resulting data demonstrated a single underlying factor and high internal consistency for the instrument. The total TEAM score for teams was significantly related to global performance.  Inter-rater reliability statistics were computed on a random sample of six recordings.  In a related "real time" feasibility study, clinicians rated 15 medical and nursing students being trained on simulated events; similarly high internal consistency estimates were reported.  The results are intended to be used for learning and improvement, with the ultimate goal of improving patient safety.

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Descriptive Elements
Who is Being Assessed or Evaluated?: 
Instrument Type: 
Observer-based (e.g., rubric, rating tool, 360 degree feedback)
Notes for Type: 

The tool was designed to assess teamwork during resuscitation attempts, and could be used on videorecorded attempts in the hospital, or during "live," "real time" simulation-based training.  In the real-time feasibility study, students performed CPR in the simulation lab using high fidelity manikins (SimMan: Laerdal).  The scenarios were adapted from the Resuscitation Council (UK).

Source of Data: 
Health care providers, staff
Notes for Data Sources: 

In the real time feasibility study, raters were experienced clinicians who taught a one-day life support class and assessed students in final scenarios.

Instrument Content: 
Behaviors / skills
Notes for Content: 

Three categories of teamwork behaviors are represented:

  1. Leadership
  2. Teamwork
  3. Task Management

An additional final question is included on global team performance.

Instrument Length: 

12 questions; time would vary with the emergency resuscitation event

Item Format: 
Eleven 5-point Likert-type questions ranging from 0 (Never) to 4 (Always); a single 10-point global item ranging from 1 to 10.
In the real time feasibility study, students were assigned to one of three teams. Three experienced resuscitation trainers/clinicians (one per team) taught emergency life support skills to one team during the day and assessed a different team during the final five scenarios, recording the TEAM ratings immediately after each scenario.
Authors suggest summing the categories and/or summing the eleven item total.
None described.
Open access (available on this website)
Notes on Access: 

The instrument was copied from the journal article; contact the author to confirm permission to use.

Psychometric Elements: Evidence of Validity
Questions within the tool were based on 14 existing teamwork instruments. The items were then reviewed for content validity by an international panel of six resuscitation experts (physicians, nurses) with at least 15 years of acute care experience. All items had a content validity index of over 0.83.
Response Process: 
The practicality of the tool was tested in simulated resuscitation scenarios with eight medical students and seven nursing students (n=15). At the end of the day the three assessors completed a 24-item questionnaire adapted from Fletcher, et al., which aimed to evaluate the feasibility of the TEAM instrument. Based on the survey results, the instrument was found to be "complete," "acceptable," and "adequately designed." The assessor comments noted, however, that "teamwork morale" was hard to judge, and they also indicated that having sufficient content knowledge about resuscitation would be important for accurate scoring.
Internal Structure: 
Factor analysis was performed on ratings of 56 video recorded events finding a single factor explaining 80.3% of variance across items. Alpha reliability for the scale when rating the 56 video recorded events ranged from 0.89 - 0.98 across contexts. Inter-rater reliability, tested with Cohen’s kappa, for the 11 items on 6 event recordings completed by two independent raters was 0.55. Test-retest reliability on 6 event recordings completed by the same rater, also tested with Cohen’s kappa for the 11 items, was 0.53.
Relation to Other Variables: 
The rho correlations between the teamwork items and the global overall performance scale were all significant (p < .01).
None described.