Impact of teamwork and communication training interventions on safety culture and patient safety in emergency departments: a systematic review

Objectives: To narratively summaries literature reporting on the effect of teamwork and communication training interventions on culture and patient safety in emergency department (ED) settings.
Methods: We searched PubMed, EMBASE, Psych Info CINAHL, Cochrane, Science Citation Inc, Web of Science, and Educational Resources Information Centre for peer-reviewed journal articles published from January 1, 1988, until June 8, 2018 that assessed teamwork and communication interventions focusing on how they influence patient safety in the ED were selected. One additional search update was performed in July 2019.
Results: Sixteen studies were included from 8,700 screened publications. The studies’ design, interventions, and evaluation methods varied widely. The most impactful ED training interventions were End-of-Course Critique, TeamSTEPPS, and crisis resource management (CRM)-based training. CRM and TeamSTEPPS CRM-based training curriculum were used in most of the studies. Multiple tools, including the Kirkpatrick (KP) evaluation model, Agency for Healthcare Research and Quality Hospital Survey on Patient Safety Culture, TeamSTEPPS Teamwork Attitudes Questionnaire, the Safety Attitudes Questionnaire, and the Communication and Teamwork Skills Assessment were used to assess the impact of such interventions. Improvements in one of the domains of safety culture and related domains were found in all studies. Four empirical studies established improvements in patient health outcomes that occurred following simulation CRM training (KP4), but there was no effect on mortality.
Conclusion: Overall, teamwork and communication training interventions improve the safety culture in ED settings and may positively affect patient outcome. The implementation of safety culture programs may be considered to reduce incidence of medical errors and adverse events.