• Jeremy David Pallas, John Paul Smiles, and Michael Zhang.
• Emergency Department, John Hunter Hospital, New Lambton Heights, New South Wales, Australia jeremy.pallas@health.nsw.gov.au.
• Emerg Med J. 2021 Aug 1; 38 (8): 572-578.

BackgroundMedical team leaders in cardiac arrest teams are routinely subjected to disproportionately high levels of cognitive burden. This simulation-based study explored whether the introduction of a dedicated 'nursing team leader' is an effective way of cognitively offloading medical team leaders of cardiac arrest teams. It was hypothesised that reduced cognitive load may allow medical team leaders to focus on high-level tasks resulting in improved team performance.MethodsThis randomised controlled trial used a series of in situ simulations performed in two Australian emergency departments in 2018-2019. Teams balanced on experience were randomised to either control (traditional roles) or intervention (designated nursing team leader) groups. No crossover between groups occurred with each participant taking part in a single simulation. Debriefing data were collected for thematic analysis and quantitative evaluation of self-reported cognitive load and task efficiency was evaluated using the NASA Task Load Index (NTLX) and a 'task time checklist' which was developed for this trial.ResultsTwenty adult cardiac arrest simulations (120 participants) were evaluated. Intervention group medical team leaders had significantly lower NTLX scores (238.4, 95% CI 192.0 to 284.7) than those in control groups (306.3, 95% CI 254.9 to 357.6; p=0.02). Intervention group medical team leaders working alongside a designated nursing leader role had significantly lower cognitive loads than their control group counterparts (206.4 vs 270.5, p=0.02). Teams with a designated nurse leader role had improved time to defibrillator application (23.5 s vs 59 s, p=0.004), faster correction of ineffective compressions (7.5 s vs 14 s, p=0.04), improved compression fraction (91.3 vs 89.9, p=0.048), and shorter time to address reversible causes (107.1 s vs 209.5 s, p=0.002).ConclusionDedicated nursing team leadership in simulation based cardiac arrest teams resulted in cognitive offload for medical leaders and improved team performance.© Author(s) (or their employer(s)) 2021. No commercial re-use. See rights and permissions. Published by BMJ.

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