Modeling variation of clinical team processes with multiple sequence alignment

Nathan J. Bahr, S. Herzberg, W. Lambert, M. Hansen, J. J. McNulty, A. Cohen, P. N. Gorman, J. M. Guise

Research output: Contribution to journalArticlepeer-review


Our objective was to model process variation of Emergency Medical Service teams responding to simulated pediatric emergencies and determine if sequence alignment distinguishes performance quality. We performed a retrospective process analysis by watching and coding activities in videos from standardized simulations of 42 Emergency Medical Service teams. Teams were classified into high- or low-performing groups based on the Clinical Teamwork Scale™. Activities were coded according to resuscitation tasks, performer, and times. We used ClustalG to align task sequences within and between groups, and measured similarity. Teams within and between performance levels had an average sequence similarity of 52 ± 7% and 50 ± 7%. Teams performed clinically appropriate tasks that varied in prioritization, for example, performing compressions or connecting the EKG monitor early. There was no statistical difference in gross similarity between groups but specific differences in prioritization may have had clinically meaningful implications. Alignment could improve by accounting for task duration and concurrency.

Original languageEnglish (US)
JournalMethodological Innovations
Issue number1
StatePublished - 2019


  • Clinical practice patterns/guidelines/resource use/evidence-based practice
  • ambulatory/outpatient care
  • observational data/quasi-experiments
  • quality of care/patient safety (measurement)

ASJC Scopus subject areas

  • Sociology and Political Science
  • Social Sciences (miscellaneous)


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