Abstract
BACKGROUND: Effective team communication is crucial for managing medical emergencies like malignant hyperthermia (MH), but current assessment methods fail to capture the dynamic and temporal nature of teamwork processes. The lack of reliable measures to inform feedback to teams is likely limiting the overall effectiveness of simulation training. This study demonstrates the application of ordered network analysis (ONA) to model communication sequences during the simulated MH scenario. METHODS: Twenty-two anesthesiologists participated in video-recorded MH simulations. Each scenario involved one participant as the primary anesthesiologist with confederates in supporting roles. Team communication was coded using the Team Reflection Behavioral Observation (TuRBO) framework, capturing behaviors related to information gathering, evaluation, planning, and implementation. ONA modeled the sequences of these coded behaviors as dynamic networks. Teams were classified as high- or low-performing based on timely dantrolene administration and appropriate MH treatment actions. Network visualizations and statistical tests compared communication patterns between groups. RESULTS: Five of 22 teams (23%) were high-performing. ONA revealed high-performers transitioned more effectively from situation assessment (information seeking/evaluation) to planning and implementation, while low-performers cycled between assessment behaviors without progressing (p = 0.04, Cohen's d = 1.72). High-performers demonstrated stronger associations between invited input, explicitly assessing the situation, stating plans, and implementation. CONCLUSIONS: Integrating video coding with ONA provides an innovative approach for examining team behaviors. Leveraging ONA can uncover patterns in communication timing and sequences, guiding targeted interventions to improve team coordination in various real-world clinical and simulated settings (e.g., operating room, EMS, ICU).