Trauma team discord and the role of briefing.

Background: Briefing of the trauma team prior to patient arrival is unstructured in many centers. We surveyed trauma teams regarding agreement on patient care priorities, and evaluated the impact of a structured, physician-led briefing on concordance during simulated resuscitations. Methods: Trauma nurses at our Level II center were surveyed, and participated in four resuscitation scenarios, randomized to "Briefed" or "Non-briefed." For Non-briefed scenarios, nurses independently reviewed triage sheets with written information. Briefed scenarios had a structured, four-minute physician-led briefing reviewing triage sheets identical to Non-briefed scenarios. Teams included 3-4 nurses (subjects) and 2-4 confederates (physicians, respiratory therapists). Each team served as their own control group. Confederates were blinded to nurses' Briefed or Non-briefed status. Immediately before, and at the midpoint of each scenario, nurses estimated patient morbidity and mortality and ranked the top 3 of 16 designated immediate care priorities. Briefed and Non-briefed groups' responses were compared for: (1) Agreement using intraclass correlation coefficient (ICC), (2) Concordance with physicians' responses using Fisher's exact test, (3) Teamwork via T-NOTECHS ratings by nurses and physicians using t-test, (4) Time to complete clinical tasks using t-test. Results: 38 nurses participated. 97% "agreed/strongly agreed" briefing is important, but only 46% agreed briefing was done well. Comparing Briefed versus Non-briefed scenarios, nurses' estimation of morbidity and mortality in Briefed scenarios showed significantly greater agreement with each other and with physicians' answers (p

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