Inter-professional in-situ simulated team and resuscitation training for patient safety: Description and impact of a programmatic approach

© 2015 Zimmermann et al.Background: Inter-professional teamwork is key for patient safety and team training is an effective strategy to improve patient outcome. In-situ simulation is a relatively new strategy with emerging efficacy, but best practices for the design, delivery and implementation have yet to be evaluated. Our aim is to describe and evaluate the implementation of an inter-professional in-situ simulated team and resuscitation training in a teaching hospital with a programmatic approach. Methods: We designed and implemented a team and resuscitation training program according to Kerns six steps approach for curriculum development. General and specific needs assessments were conducted as independent cross-sectional surveys. Teamwork, technical skills and detection of latent safety threats were defined as specific objectives. Inter-professional in-situ simulation was used as educational strategy. The training was embedded within the workdays of participants and implemented in our highest acuity wards (emergency department, intensive care unit, intermediate care unit). Self-perceived impact and self-efficacy were sampled with an anonymous evaluation questionnaire after every simulated training session. Assessment of team performance was done with the team-based self-assessment tool TeamMonitor applying Van der Vleutens conceptual framework of longitudinal evaluation after experienced real events. Latent safety threats were reported during training sessions and after experienced real events. Results: The general and specific needs assessments clearly identified the problems, revealed specific training needs and assisted with stakeholder engagement. Ninety-five interdisciplinary staff members of the Childrens Hospital participated in 20 in-situ simulated training sessions within 2 years. Participant feedback showed a high effect and acceptance of training with reference to self-perceived impact and self-efficacy. Thirty-five team members experiencing 8 real critical events assessed team performance with TeamMonitor. Team performance assessment with TeamMonitor was feasible and identified specific areas to target future team training sessions. Training sessions as well as experienced real events revealed important latent safety threats that directed system changes. Conclusions: The programmatic approach of Kerns six steps for curriculum development helped to overcome barriers of design, implementation and assessment of an in-situ team and resuscitation training program. This approach may help improve effectiveness and impact of an in-situ simulated training program

Implementation of TeamSTEPPS

This scholarly project focused on implementing Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS) in an emergency room (ER). The aim of TeamSTEPPS is to improve patient outcomes by educating healthcare professionals on communication and teamwork skills. TeamSTEPPS teaches healthcare professionals leadership skills, shared mental models, mutual trust, and closed loop communication. The purpose of the scholarly project was to improve teamwork and communication. The study method was descriptive analysis of 51 pre and posttest questionnaires, specifically looking for increased knowledge of TeamSTEPPS tools. The participants included: ER physicians, ER nurses, ER certified nursing assistants/health unit coordinators, a pharmacy technician, public safety officers, and patient revenue management organization (PRMO). Further research is needed to evaluate how to significantly increase staff knowledge on TeamSTEPPS tools in a class setting

In-situ simulation: A different approach to patient safety through immersive training

Simulation is becoming more and more popular in the field of healthcare education. The main concern for some faculty is knowing how to organise simulation training sessions when there is no simulation centre as they are not yet widely available and their cost is often prohibitive. In medical education, the pedagogic objectives are mainly aimed at improving the quality of care as well as patient safety. To that effect, a mobile training approach whereby simulation-based education is done at the point of care, outside simulation centres, is particularly appropriate. It is usually called “in-situ simulation”. This is an approach that allows training of care providers as a team in their normal working environment. It is particularly useful to observe human factors and train team members in a context that is their real working environment. This immersive training approach can be relatively low cost and enables to identify strengths and weaknesses of a healthcare system. This article reminds readers of the principle of « context specific learning » that is needed for the good implementation of simulation-based education in healthcare while highlighting the advantages, obstacles, and challenges to the development of in-situ simulation in hospitals. The objective is to make clinical simulation accessible to all clinicians for the best interests of the patient.Peer reviewe

Leadership and Teamwork in Trauma and Resuscitation.

Leadership skills are described by the American College of Surgeons' Advanced Trauma Life Support (ATLS) course as necessary to provide care for patients during resuscitations. However, leadership is a complex concept, and the tools used to assess the quality of leadership are poorly described, inadequately validated, and infrequently used. Despite its importance, dedicated leadership education is rarely part of physician training programs. The goals of this investigation were the following: 1. Describe how leadership and leadership style affect patient care; 2. Describe how effective leadership is measured; and 3. Describe how to train future physician leaders. We searched the PubMed database using the keywords "leadership" and then either "trauma" or "resuscitation" as title search terms, and an expert in emergency medicine and trauma then identified prospective observational and randomized controlled studies measuring leadership and teamwork quality. Study results were categorized as follows: 1) how leadership affects patient care; 2) which tools are available to measure leadership; and 3) methods to train physicians to become better leaders. We included 16 relevant studies in this review. Overall, these studies showed that strong leadership improves processes of care in trauma resuscitation including speed and completion of the primary and secondary surveys. The optimal style and structure of leadership are influenced by patient characteristics and team composition. Directive leadership is most effective when Injury Severity Score (ISS) is high or teams are inexperienced, while empowering leadership is most effective when ISS is low or teams more experienced. Many scales were employed to measure leadership. The Leader Behavior Description Questionnaire (LBDQ) was the only scale used in more than one study. Seven studies described methods for training leaders. Leadership training programs included didactic teaching followed by simulations. Although programs differed in length, intensity, and training level of participants, all programs demonstrated improved team performance. Despite the relative paucity of literature on leadership in resuscitations, this review found leadership improves processes of care in trauma and can be enhanced through dedicated training. Future research is needed to validate leadership assessment scales, develop optimal training mechanisms, and demonstrate leadership's effect on patient-level outcome

Assessing the interrater reliability of the Assessment of Pediatric Resuscitation Communication (APRC)

The purpose of this study was to further validate the Assessment of Pediatric Resuscitation Communication (APRC), by establishing the interrater reliability of the instrument. The aim was to determine if the APRC instrument can be used by trained coders from a range of disciplines to assess the communication effectiveness of trauma team members and leaders during pediatric trauma resuscitations. These scores will be used to determine if team and leader communication is correlated with medical performance during trauma resuscitations. The sample included 8 participants from diverse backgrounds. A calculation of the Percentage of Agreement (1996) of 4 pediatric resuscitations was used to test the hypothesis and research question which proposed coders will be able to achieve interrater reliability at .80 or above after APRC training had been completed. Findings revealed that interrater reliability scores significantly improved after APRC training was conducted

A Prospective Investigation to Develop Data-Driven Interventions and Improve Process Efficiency at a Level II Trauma Center

INTRODUCTION: The purpose of this investigation was to better understand process inefficiencies in a Level II trauma center through the identification and classification of flow disruptions. Data-driven interventions were systematically developed and introduced in an effort to reduce disruptions threatening the optimal delivery of trauma care. METHOD: Medical human factors researchers observed disruptions during resuscitation and imaging in 117 trauma cases. Data was classified using the human factors taxonomy Realizing Improved Patient Care through Human-centered Operating Room Design for Threat Window Analysis (RIPCHORD-TWA). Interdisciplinary subject matter experts (SMEs) utilized a human factors intervention matrix (HFIX) to generate targeted interventions designed to address the most detrimental disruptions. A multiple-baseline interrupted time-series (ITS) design was used to gauge the effectiveness of the interventions introduced. RESULTS: Significant differences were found in the frequency of disruptions between the pre-intervention (n=65 cases, 1137 disruptions) and post-intervention phases (n=52 cases, 939 disruptions). Results revealed significant improvements related to ineffective communication (x2 (1, n=2076) = 24.412, p=0.00, x2 (1, n=1031) = 9.504, p=0.002, x2 (1, n=1045) = 12.197, p=0.000); however, similar levels of improvement were not observed in the other targeted areas. CONCLUSION: This study provided a foundation for a data-driven approach to investigating precursor events and process inefficiencies in trauma care. Further, this approach allowed individuals on the front lines to generate specific interventions aimed at mitigating systemic weaknesses and inefficiencies frequently encountered in their work environment

Competências não-instrumentais na prestação de cuidados em saúde

The literature shows that healthcare errors are due to a lack of non-technical skills. Non-technical skills are interpersonal and cognitive skills, whose training in high-fidelity simulation environment, contributes to a safe and effective performance in the solution of diverse and adverse clinical situations. Although the literature reinforces the importance of non-technical skills training in the prevention of errors and consequently in the improvement of patient care delivery, there is not yet an effective and structured curricular integration that allows to develop, in a systematic way, these competences in healthcare education. In order to respond to World Health Organization concerns, particularly those related to patient safety issues, the promotion and implementation of nontechnical skills training programs is paramount. In this sense, the objective of this quasi-experimental investigation is to promote knowledge and training of acting strategies in clinical nursing practice, through the development and implementation of a non-technical skills training course in high-fidelity simulation context with nursing students. In order to evaluate the effectiveness of the developed course, some instruments were constructed, namely the Non-Technical Skills Assessment Scale in Nursing. Thus, according to the results obtained, the present investigation contributes to scientific evidence, reinforcing the importance of non-technical skills training in increasing knowledge, performance and confidence in patient care delivery in the experimental group after the implementation of the course, in comparison with the control group. The main implication for clinical practice is the promotion of patient safety. Based on the present investigation, future work may focus on the implementation of this course not only to nursing students but also to professionals in healthcare teams. On the other hand, it would be important to integrate these competences into structured and specialized curricular modules in nursing education, and in other healthcare areas, as high-quality clinical performance involves not only technical, but mainly non-technical skills.A literatura demonstra que a maioria dos erros em saúde se deve à falta de competências não-instrumentais. Estas, são competências interpessoais e cognitivas que, treinadas em ambiente de simulação de alta-fidelidade, contribuem para potenciar um desempenho seguro e eficaz na resolução de situações clínicas diversas e adversas. Apesar de a literatura reforçar a importância do seu treino na prevenção de erros e consequentemente na melhoria da prestação de cuidados ao doente, não existe ainda uma integração curricular efetiva e estruturada, que permita desenvolver, de forma sistemática, estas competências no ensino em saúde. Procurando dar resposta às normativas e preocupações da Organização Mundial de Saúde, nomeadamente às questões ligadas à segurança do doente, será premente a promoção e implementação de programas de formação em competências não-instrumentais. Neste sentido, o objetivo da presente investigação, do tipo quase-experimental, é o de promover o conhecimento e treino de estratégias de atuação na prática clínica em enfermagem através do desenvolvimento e implementação de uma ação de formação em competências não-instrumentais em contexto de simulação de alta-fidelidade a estudantes de enfermagem. Com o intuito de avaliarmos a sua eficácia foram construídos alguns instrumentos, dos quais destacamos o Questionário de Competências Não-Instrumentais. Desta forma, de acordo com os resultados obtidos, a presente investigação constitui um contributo para a evidência científica, reforçando a importância do treino de competências não-instrumentais no aumento do conhecimento, do desempenho e da confiança na prestação de cuidados, do grupo experimental após a implementação da formação, em comparação com o grupo de controlo, tendo como principal implicação para a prática clínica a promoção da segurança do doente. Com base na presente investigação, futuros trabalhos poderão focar-se na implementação desta formação não só a estudantes como a profissionais de saúde, nomeadamente a equipas de trabalho constituídas. Por outro lado, seria importante a integração desta temática em módulos curriculares estruturados e especializados em competências não-instrumentais no ensino de estudantes de enfermagem, e de outras áreas da saúde, na medida em que o desempenho clínico de alta qualidade envolve não só competências instrumentais, mas sobretudo competências não-instrumentais.Programa Doutoral em Psicologi