A Night With Red Eyes Reveals How Teamwork Unfolds in Out-Of-Hours Primary Care

Area of Science:

• Healthcare Management
• Primary Care Medicine
• Emergency Response

Background:

• An Out-of-Hours Primary Care (OOH-PC) team encountered an unusual surge of patients reporting "burning eyes."
• The team lacked a specific protocol to manage this unforeseen clinical event.

Purpose of the Study:

• To explore how a co-located OOH-PC triage team adapted to an unexpected clinical situation.
• To identify team processes and emergent states that facilitated coordination under uncertainty.

Main Methods:

• Case study methodology utilizing a semi-structured focus group interview.
• Thematic analysis of interviews with OOH-PC team members on duty during the incident.

Main Results:

• Identified three key themes: informal communication, managing situations without protocols, and physician-nurse dynamics.
• Physicians led planning and coordination, while nurses actively contributed due to mutual respect and communication.
• Pre-existing team characteristics were crucial for adaptive responses.

Conclusions:

• Flexible and dynamic teamwork is vital for triage teams managing unexpected events without established protocols.
• Effective informal communication and established team dynamics support coordination under uncertainty.
• Adaptive responses to critical events are facilitated by strong pre-existing team characteristics.