Sensemaking in the formation of basic life support teams - a proof-of-concept, qualitative study of simulated in-hospital cardiac arrests

Background: The formation of critical care teams is a complex process where team members need to get a shared understanding of a serious situation. No previous studies have focused on how this shared understanding is achieved during the formation of cardiac arrest teams. "Sensemaking" is a concept well known in organizational studies. It refers to the collaborative effort among members in a dialogue to create meaning in an ambiguous situation, often by using subtle variations in the sentences in the dialogue. Sentences with high degrees of "sensemaking" activity can be thematized as "co-orientation", "re-presentation" and/or "subordination" (among others). We sought to establish if elements of "sensemaking" occur in the formation of in-hospital cardiac arrest teams. Methods: Videos of ten simulations of unannounced in-hospital cardiac arrests treated by basic life support (BLS) providers. We transcribed all verbal communication from the moment the first responder stepped into the room until the moment external chest compression were initiated (verbatim transcription). Transcriptions were then analyzed with a focus on identifying three elements of sensemaking: Co-orientation, Re-presentation and Sub-ordination. Results: Sensemaking elements could be identified in seven of ten scenarios as part of team formation. Co-orientation was the element that was used most consistently, occurring in all of the eight scenarios that included sensemaking efforts. Conclusions: Sensemaking is an element in the communication in some cardiac arrest teams. It is possible that the active moderation of sensemaking should be considered a non-technical skill in cardiac arrest teams.