Table 1 Examples of poor and good behaviors for each of the elements (categories and elements are adopted from the ANTS) [13]
Category | Element | Poor behavioral marker | Good behavioral marker |
|---|---|---|---|
Task Management | Planning and Preparing | Starting to intubate the patient, while the intubation materials are not prepared | Timely preparation of medication (e.g., Amiodarone) before needing to administer it |
Prioritizing | Actively attending to the patients family member during complicated tasks | Mentioning the order in which tasks need to be performed (i.e., after defibrillation, I would like to intubate the patient) | |
Providing and Maintaining Standards | Not checking whether anyone touches the bed while defibrillating | Double check of medication | |
Identifying and Utilizing Resources | Not checking the capabilities of the co-workers and therefore not making use of their skills | Call for the resuscitation team | |
Team Working | Coordinating Activities with Team | Not giving specific orders to one person, but giving several tasks to the whole team in general | Asking the team members who they are, e.g., are you the intern? |
Exchanging Information | Starting with tasks without explaining what s/he is doing and why s/he is doing the task | Mentioning the patients status, e.g., we need to resuscitate the patient | |
Using Authority and Assertiveness | Forgets to give team members tasks and tries to perform all the tasks him/herself | Clearly indicates the next steps and who needs to perform which tasks, e.g., if we still do not have a sinus rhythm after defibrillation, I want you to prepare 300 mg adrenaline. | |
Assessing Capabilities | Gives orders to the intern, without checking whether s/he has sufficient knowledge to perform the task correctly | Asking the intern whether s/he knows how to give basic life support? | |
Supporting Others | Negative or defensive tone when answering the team members’ questions | Complimenting team members | |
Situation Awareness | Gathering Information | Actively conducting tasks while not paying attention to the patient’s situation | Regularly checking the monitor, asking team members what they know about the patient |
Recognizing and Understanding | Not noticing that the patient is intubated incorrectly | Immediately recognizing that the patient needs to be resuscitated | |
Anticipating | Not preparing for potential problems or possible next steps | Mentioning the next steps, e.g., in 2 min, we will defibrillate again; until then, I would like you to call the on-call cardiologist. | |
Decision Making | Identifying Options | Not mentioning options when decisions need to be made | Considering reasons why the patient has a VT/VF |
Balancing Risks and Selecting Options | No verbal considerations about the options and risks of the options | Initiates discussion on what to do next | |
Re-evaluating | Does not show any verbal re-evaluation of the situation | Evaluates the situation and considers treatment options |