Participants said VC made it possible to work more effectively and as one team.

However, cooperation between participants is different on VC than with telephones, and need to be learned [Appendix 1C]. Communication and team work had to be balanced with the need for working independently. Rules for communication had to Inhibitors,research,lifescience,medical be set. Most important, those at LYB wanted to work uninterrupted during the first minutes after patient arrival. UNN doctors noticed that discussions of 26s Proteasome structure diagnostics and treatment within their own group were disturbing the LYB teams, which at times made them mute their microphone. This option was agreed should be used more [Appendix 1D]. Team members at LYB said they relied on oral information, and did not need images of their colleagues at UNN. Inhibitors,research,lifescience,medical Still they found facial contact to ease communication, and VC beneficial for time-critical clinical decisions. Also, they believed visual information gives a better foundation for decision-making and had more confidence in

treatment advice given by specialists during VC [Appendix 2A]. The specialists said VC made it possible to use “the clinical eye” and that they sometimes observed matters that LYB doctors or nurses did not. They said it was valuable to monitor the effects of treatment, for example improved blood pressure after intravenous fluid or the reaction Inhibitors,research,lifescience,medical on light of a dilated pupil following intensive treatment efforts. Some specialists felt more psychological involvement and commitment to the patient during Inhibitors,research,lifescience,medical VC, important when prioritising between patients [Appendix 2B]. All believed good patient care were given during both communication modes, but several thought VC improved quality. The use of telephones may result in rumors, while VC improve the certainty and safety, and ensure quality of treatment, doctors said. Doctors at LYB said they might be more willing to do certain procedures with direct guidance and visual support via

VC, even given procedures they do not perform ordinarily. UNN specialists Inhibitors,research,lifescience,medical came together to discuss, which was believed to result in better decisions and improved treatment of patients regardless of communication technology [Appendix 3]. Prior to trials, most below members at LYB expressed uneasiness about the possibility of being “surveilled”. Following trials, they reported less stress than anticipated, and stated that stress decreased after each VC scenario. Nurses reported increased tension when the doctor left the patient room to make telephone calls, in particular when patient condition deteriorated, and argued that this made VC favorable [Appendix 4]. Discussion Virtual team building In this study, VC improved clinical work processes in virtual trauma teams when compared to telephone communication.