Trauma leadership and ICU shift-handovers: Identification, observation and integration of key skills

Residents’ work in trauma and intensive care is centered on patients with complex and high-risk conditions and involves close collaboration and coordination within a multidisciplinary team. For two specific skills – trauma leadership and ICU shift-handovers –Nico Leenstra and his team identified the concrete behaviors by which they can be taught, observed and evaluated, and which factors affect their use in practice.

Trauma leadership
Through an interview study with trauma team members and leaders, Leenstra identified the key leadership behaviors of the trauma leader (i.e., information coordination, action coordination, decision making, communication management, and team development), and established the extensive Taxonomy of Trauma Leadership Skills (TTLS). It benefits the design of leadership training. Complementary, a second version (TTLS-SHORT) was developed and evaluated, specifically for its ability to benefit observations, note-taking and reflections on leadership performances.

ICU shift-handovers
Regarding shift-handovers, Leenstra explored two dimensions. First, he identified physicians’ perceptions regarding the various functions of shift-handovers and how handover conditions may alter the handover process. His findings add to the growing case for handovers in complex settings being educated as more than information transfers, but also revealed dilemmas for engaging in functions such as joint decision making or reflection.
Second, Leenstra analyzed the various strategies for structuring handover communication by residents, and evaluated how differing structures affected the reception of handover information. Foremost, he found that stating the working diagnosis early in the handover (as opposed to more towards the end) was associated with more critical reflections and information seeking by the receiver.