• Maria Härgestam, Marie Lindkvist, Christine Brulin, Maritha Jacobsson, and Magnus Hultin.
• Department of Nursing, Umeå University, Umeå, Sweden.
• BMJ Open. 2013 Jan 1;3(10):e003525.

ObjectivesInvestigate the use of call-out (CO) and closed-loop communication (CLC) during a simulated emergency situation, and its relation to profession, age, gender, ethnicity, years in profession, educational experience, work experience and leadership style.DesignExploratory study.SettingIn situ simulator-based interdisciplinary team training using trauma cases at an emergency department.ParticipantsThe result was based on 16 trauma teams with a total of 96 participants. Each team consisted of two physicians, two registered nurses and two enrolled nurses, identical to a standard trauma team.ResultsThe results in this study showed that the use of CO and CLC in trauma teams was limited, with an average of 20 CO and 2.8 CLC/team. Previous participation in trauma team training did not increase the frequency of use of CLC while ≥2 structured trauma courses correlated with increased use of CLC (risk ratio (RR) 3.17, CI 1.22 to 8.24). All professions in the trauma team were observed to initiate and terminate CLC (except for the enrolled nurse from the operation theatre). The frequency of team members' use of CLC increased significantly with an egalitarian leadership style (RR 1.14, CI 1.04 to 1.26).ConclusionsThis study showed that despite focus on the importance of communication in terms of CO and CLC, the difficulty in achieving safe and reliable verbal communication within the interdisciplinary team remained. This finding indicates the need for validated training models combined with further implementation studies.

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