Improving Perinatal Team Communication to Decrease Patient Harm With Team Strategies and Tools to Enhance Performance and Patient Safety Training

During childbirth, multiple providers deliver care at the bedside that requires optimal teamwork and communication to prevent patient harm. The complexity of caring for obstetrical patient demands a well-coordinated team to relay information and respond to conditions that can change quickly during childbirth. A patient safety strategy to prevent perinatal harm is Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS) training. TeamSTEPPS is an evidence-based program based on crew resource management (CRM) principles developed in the aviation and military industries. This process improvement project used the Plan-Do-Study-Act framework and Kotter\u27s change theory to implement TeamSTEPPS training after an increase in patient safety events from 2014 to 2016. A convenience sample of 200 physicians, nurses, respiratory therapists, scrub techs, and patient care techs from perinatal units completed the training in a community hospital setting. The Teamwork Perceptions Questionnaire administered pre- and posttraining show a statistical improvement in teamwork, communication, and situational awareness among nursing staff that correlated with a decrease in safety events. Project limitations include lack of a control group for comparison and lack of physician involvement with training. The positive social impact of TeamSTEPPS training is the decrease in maternal and newborn adverse events surrounding childbirth due to perinatal teams using CRM principles. Over the long term, TeamSTEPPs training may become the standard team training method to improve birth outcomes and support the establishment of a patient safety culture, which may be replicated in perinatal centers around the world

Interventions to improve team effectiveness within health care

Background: A high variety of team interventions aims to improve team performance outcomes. In 2008, we conducted a systematic review to provide an overview of the scientific studies focused on these interventions. However, over the past decade, the literature on team interventions has rapidly evolved. An updated overview is therefore required, and it will focus on all possible team interventions without restrictions to a type of intervention, setting, or research design. Objectives: To review the literature from the past decade on interventions with the goal of improving team effectiveness within healthcare organizations and identify the "evidence base" levels of the research. Methods: Seven major databases were systematically searched for relevant articles published between 2008 and July 2018. Of the original search yield of 6025 studies, 297 studies met the inclusion criteria according to three independent authors and were subsequently included for analysis. The Grading of Recommendations, Assessment, Development, and Evaluation Scale was used to assess the level of empirical evidence. Results: Three types of interventions were distinguished: (1) Training, which is sub-divided into training that is based on predefined principles (i.e. CRM: crew resource management and TeamSTEPPS: Team Strategies and Tools to Enhance Performance and Patient Safety), on a specific method (i.e. simulation), or on general team training. (2) Tools covers tools that structure (i.e. SBAR: Situation, Background, Assessment, and Recommendation, (de)briefing checklists, and rounds), facilitate (through communication technology), or trigger (through monitoring and feedback) teamwork. (3) Organizational (re)design is about (re)designing structures to stimulate team processes and team functioning. (4) A programme is a combination of the previous types. The majority of studies evaluated a training focused on the (acute) hospital care setting. Most of the evaluated interventions focused on improving non-technical skills and provided evidence of improvements. Conclusion: Over the last decade, the number of studies on team interventions has increased exponentially. At the same time, research t

The Impact of Nursing Crew Resource Management Training on the Patient Safety Self-Efficacy of Nursing Students

Quality health care and optimal health outcomes begin by assuring patient safety. This is a shared responsibility of all health care providers. However, nurses have a fundamental obligation to assure patient safety, given their constant presence with patients requiring care. Patients who are cared for by nurses with insufficient or outdated patient safety education and knowledge can and often experience costly and catastrophic outcomes (Institute of Medicine (IOM), 2011). Medical errors now rank as the third leading cause of death in the United States and cost over 17.1 billion dollars/year (Makary & Daniel, 2016; Andel, Davidow, Hollander & Moreno, 2012). A shocking report issued in 2010 by the Society of Actuaries indicated that when years of lost productivity were calculated with the direct costs, the total costs were near one-trillion dollars per year (Shreve et al., 2010). National health organizations have been calling for improvements in patient safety practices and in patient safety education for years (IOM, 2011; QSEN, 2014; The Joint Commission, 2014). To date, no solid consensus on how to effectively accomplish this has been determined. This has prompted many in health care to look at what other industries are doing to assure employee and consumer safety. Years ago, the airline industry adopted the use of the Crew Resource Management (CRM) training program and noted improvements in several key safety categories (Sculli & Sine, 2011). More recently, CRM has been adapted as Nursing Crew Management (NCRM) training and it has shown promise with improving patient safety in some health care settings. However, its\u27 use with nursing students, who will soon be entering practice is lacking in the literature (Aebersold, Tschannen, & Sculli, 2013). The purpose of this quasi-experimental, two group, pre and post-test pilot study was to determine if NCRM training could make a significant improvement in patient safety self-efficacy in nursing students. The self-efficacy aspect of Bandura’s Social Learning Theory was used to inform the study. The sample consisted of 46, final semester baccalaureate nursing students. A four-hour, NCRM training was provided to the experimental group. The Health Professional Education in Patient Safety Survey (H-PEPSS) was used as a pre and posttest to gauge the self-efficacy related to patient safety of both groups. The H-PEPSS includes 7 categories related to safety including understanding humans and environments, communication, working in teams, clinical safety, managing safety risks, disclosing adverse events and maintaining a culture of safety. Data was analyzed using 2 x 2 factorial analysis of variances for each of the seven categories on the H-PEPSS. Significant differences were found between the control and experimental groups posttest scores on all of the H-PEPSS categories except clinical safety. Results of the study indicated that NCRM training can positively impact patient safety self-efficacy in nursing students. Recommendations include repetition of the study with larger groups using different educational delivery mechanisms. Nurse academic administrators and faculty are encouraged to consider if inclusion of the NCRM training would be helpful as part of a larger effort to develop student knowledge and skills related to working with health care teams to provide safe patient care

Interventions to improve team effectiveness within health care: a systematic review of the past decade

Background A high variety of team interventions aims to improve team performance outcomes. In 2008, we conducted a systematic review to provide an overview of the scientific studies focused on these interventions. However, over the past decade, the literature on team interventions has rapidly evolved. An updated overview is therefore required, and it will focus on all possible team interventions without restrictions to a type of intervention, setting, or research design. Objectives To review the literature from the past decade on interventions with the goal of improving team effectiveness within healthcare organizations and identify the “evidence base” levels of the research. Methods Seven major databases were systematically searched for relevant articles published between 2008 and July 2018. Of the original search yield of 6025 studies, 297 studies met the inclusion criteria according to three independent authors and were subsequently included for analysis. The Grading of Recommendations, Assessment, Development, and Evaluation Scale was used to assess the level of empirical evidence. Results Three types of interventions were distinguished: (1) Training, which is sub-divided into training that is based on predefined principles (i.e. CRM: crew resource management and TeamSTEPPS: Team Strategies and Tools to Enhance Performance and Patient Safety), on a specific method (i.e. simulation), or on general team training. (2) Tools covers tools that structure (i.e. SBAR: Situation, Background, Assessment, and Recommendation, (de)briefing checklists, and rounds), facilitate (through communication technology), or trigger (through monitoring and feedback) teamwork. (3) Organizational (re)design is about (re)designing structures to stimulate team processes and team functioning. (4) A programme is a combination of the previous types. The majority of studies evaluated a training focused on the (acute) hospital care setting. Most of the evaluated interventions focused on improving non-technical skills and provided evidence of improvements. Conclusion Over the last decade, the number of studies on team interventions has increased exponentially. At the same time, research tends to focu

Empowering medical personnel to challenge through simulation-based training

The rigid structure of medical hierarchies within UK hospitals can become the source of dissatisfaction and conflict for medical personnel, the repercussions of which can be disastrous for patients and staff. The research reported herein presents the results of an investigation into the use of Virtual Reality (VR) simulation and conventional story-boarded techniques to empower medical personnel to challenge decisions they feel are inappropriate. Prototype applications were crafted from a selection of transcribed ‘challenge events’ acquired from an opportunistic sample of clinical staff. Data obtained from an initial investigation were used to establish attitudes toward challenging and evaluate the findings of the literature to generate research questions and objectives. Medical personnel who engaged with both media as part of an experimental phase assessed their viability as potential training resources to help foster the ability to challenge. Analysis of this experiment suggested that both techniques are viable tools in the delivery of decision-making training and could potentially deliver impact into other applications within healthcare. To increase the realism of the training material, the technologies should be presented in a format appropriate for those with limited ‘gaming’ experience and allow a credible level of interaction with the environment and characters