Improving safety using HFMEA and insitu simulation prior to initiating contrast MRI studies in an ambulatory setting

The objective of this event was to test a new system for emergency response to MRI contrast reactions by ensuring staff familiarity with emergency equipment and a newly drafted emergency response protocols, and to mitigate any LST identified.https://knowledgeconnection.mainehealth.org/lambrew-retreat-2021/1020/thumbnail.jp

Is sepsis hiding in plain sight? Implementation of an interprofessional (IP) sepsis simulation to detect early sepsis

Early detection of hospital-acquired sepsis can be challenging. With highly effective IP teams and efficient healthcare systems, sepsis treated quickly can influence morbidity and mortality. This project is aimed at training IP teams in early recognition of sepsis using simulation. Nurses and providers rarely have opportunities to learn together. Simulation followed by an IP debrief is an excellent tool to collaborate for safe patient care.https://knowledgeconnection.mainehealth.org/lambrew-retreat-2023/1000/thumbnail.jp

The Maine Obstetric Medical Simulation (MOMSim) Program Identifies and Categorizes Latent Safety Threats Across Rural Hospitals

Objective: Combine in-situ simulation with an HFMEA framework to identify and categorize common system wide LST and opportunities to improve patient safetyhttps://knowledgeconnection.mainehealth.org/lambrew-retreat-2023/1003/thumbnail.jp

Development of Maine Ongoing Outreach Simulation Education (MOOSE), a Novel Telesimulation Program, to Improve Neonatal Resuscitation in a Rural Community Hospital

Objective- To implement monthly neonatal resuscitation telesimulation team training sessions in a rural community hospital delivery room that is feasible, sustainable, and replicable at other sites.https://knowledgeconnection.mainehealth.org/lambrew-retreat-2021/1010/thumbnail.jp

A Simulation-Based Outreach Program Improves Delivery Room Team Confidence in Neonatal Resuscitation at Rural Community Hospitals

Objective- Our goal is to pilot the use of an onsite Neonatal Community Outreach Education Program to improve provider confidence with procedural skills and neonatal resuscitation in the delivery room.https://knowledgeconnection.mainehealth.org/lambrew-retreat-2021/1008/thumbnail.jp

Can hospital adult code-teams and individual members perform high-quality CPR? A multicenter simulation-based study incorporating an educational intervention with CPR feedback

AIMS: A multicenter simulation-based research study to assess the ability of interprofessional code-teams and individual members to perform high-quality CPR (HQ-CPR) at baseline and following an educational intervention with a CPR feedback device. METHODS: Five centers recruited ten interprofessional teams of AHA-certified adult code-team members with a goal of 200 participants. Baseline testing of chest compression (CC) quality was measured for all individuals. Teams participated in a baseline simulated cardiac arrest (SCA) where CC quality, chest compression fraction (CCF), and peri-shock pauses were recorded. Teams participated in a standardized HQ-CPR and abbreviated TeamSTEPPS® didactic, then engaged in deliberate practice with a CPR feedback device. Individuals were assessed to determine if they could achieve ≥80% combined rate and depth within 2020 AHA guidelines. Teams completed a second SCA and CPR metrics were recorded. Feedback was disabled for assessments except at one site where real-time CPR feedback was the institutional standard. Linear regression models were used to test for site effect and paired -tests to evaluate significant score changes. Logistic univariate regression models were used to explore characteristics associated with the individual achieving competency. RESULTS: Data from 184 individuals and 45 teams were analyzed. Baseline HQ-CPR mean score across all sites was 18.5% for individuals and 13.8% for teams. Post-intervention HQ-CPR mean score was 59.8% for individuals and 37.0% for teams. There was a statistically significant improvement in HQ-CPR mean scores of 41.3% (36.1, 46.5) for individuals and 23.2% (17.1, 29.3) for teams ( \u3c 0.0001). CCF increased at 3 out of 5 sites and there was a mean 5-s reduction in peri-shock pauses ( \u3c 0.0001). Characteristics with a statistically significant association were height ( = 0.01) and number of times performed CPR ( = 0.01). CONCLUSION: Code-teams and individuals struggle to perform HQ-CPR but show improvement after deliberate practice with feedback as part of an educational intervention. Only one site that incorporated real-time CPR feedback devices routinely achieved ≥80% HQ-CPR

Simulation-Based Outreach Program Improves Rural Hospitals\u27 Team Confidence in Neonatal Resuscitation

INTRODUCTION: Neonatal resuscitation is a high acuity, low occurrence event (HALO), and in rural community hospitals, low birth rates prevent providers from regular opportunities to maintain essential resuscitation skills. Simulation is an effective training modality for medical education, although resources for simulation are often limited in rural hospitals. Our primary objective was to test the hypothesis that in situ neonatal resuscitation simulation training improves rural hospitals\u27 delivery room team confidence in performing key Neonatal Resuscitation Program (NRP) skills. Our secondary objective was to compare confidence to performance as measured by adherence to NRP® guidelines. METHODS: We conducted a quasi-experimental pre-training survey and post-training survey of delivery room team confidence in NRP skills at five level one delivery hospitals before and after an in situ simulation training program. Participants included rural hospitals\u27 usual delivery room team members. Participants rated their confidence on a five-point Likert scale. Simulations were analyzed using an adapted version of a validated scoring tool for NRP adherence and presented as overall percentage scores. RESULTS: Our data demonstrate a significant improvement in self-assessed confidence levels pre- and post-simulation training in key areas of neonatal resuscitation. Participants reported higher confidence in airway management (4 vs. 3, p=0.003), emergency intravenous access (3 vs. 2, p=0.007), and the ability to manage a code in the delivery room (4 vs. 3, p=0.013) and the operating room (4 vs. 3, p=0.028). Improvements were also noted in their team member\u27s knowledge and skills to perform neonatal resuscitation. While improvements were appreciated in confidence, the performance of skills (NRP adherence scores) was often in the sub-optimal performance range. CONCLUSIONS: An in situ-based neonatal resuscitation outreach simulation program improves self-confidence among rural delivery room teams. Additional research is needed to understand how to translate improved confidence into actual improved performance

Can hospital adult code-teams and individual members perform high-quality CPR? A multicenter simulation-based study incorporating an educational intervention with CPR feedback

Aims: A multicenter simulation-based research study to assess the ability of interprofessional code-teams and individual members to perform high-quality CPR (HQ-CPR) at baseline and following an educational intervention with a CPR feedback device. Methods: Five centers recruited ten interprofessional teams of AHA-certified adult code-team members with a goal of 200 participants. Baseline testing of chest compression (CC) quality was measured for all individuals. Teams participated in a baseline simulated cardiac arrest (SCA) where CC quality, chest compression fraction (CCF), and peri-shock pauses were recorded. Teams participated in a standardized HQ-CPR and abbreviated TeamSTEPPS® didactic, then engaged in deliberate practice with a CPR feedback device. Individuals were assessed to determine if they could achieve ≥80% combined rate and depth within 2020 AHA guidelines. Teams completed a second SCA and CPR metrics were recorded. Feedback was disabled for assessments except at one site where real-time CPR feedback was the institutional standard. Linear regression models were used to test for site effect and paired t-tests to evaluate significant score changes. Logistic univariate regression models were used to explore characteristics associated with the individual achieving competency. Results: Data from 184 individuals and 45 teams were analyzed. Baseline HQ-CPR mean score across all sites was 18.5% for individuals and 13.8% for teams. Post-intervention HQ-CPR mean score was 59.8% for individuals and 37.0% for teams. There was a statistically significant improvement in HQ-CPR mean scores of 41.3% (36.1, 46.5) for individuals and 23.2% (17.1, 29.3) for teams (p < 0.0001). CCF increased at 3 out of 5 sites and there was a mean 5-s reduction in peri-shock pauses (p < 0.0001). Characteristics with a statistically significant association were height (p = 0.01) and number of times performed CPR (p = 0.01). Conclusion: Code-teams and individuals struggle to perform HQ-CPR but show improvement after deliberate practice with feedback as part of an educational intervention. Only one site that incorporated real-time CPR feedback devices routinely achieved ≥80% HQ-CPR

Engagement Across Professions: A Mixed Methods Study of Debriefing After Interprofessional Team Training

INTRODUCTION: Simulation is an ideal tool for interprofessional (IP) team training. Debriefing after simulation is key to IP learning, although engagement and participation may be adversely influenced by cultural and hierarchical barriers. This mixed-methods study explored factors influencing learner engagement and participation in IP debriefing and the experience of silent but apparently engaged participants. METHODS: Semistructured profession-specific focus groups were conducted with participants from a weekly IP pediatric simulation program. Focus groups were recorded, transcribed, and thematically analyzed. Eligible participants were assigned to silent or verbal groups according to observed behavior and received a questionnaire. Participants\u27 self-rated engagement scores were compared using a t test. RESULTS: Thirty-six of 81 eligible participants were included, 13 completed a questionnaire, and 23 (8 physicians, 10 nursing staff, 4 pharmacists, 1 respiratory therapist) participated in 13 focus groups. Twenty-two subthemes were grouped into 6 themes: psychological safety, realism, distractors, stress, group characteristics, and facilitator behavior, with differences in perspective according to profession. Of the 36 respondents, 18 were silent and 18 verbal. Self-rated engagement scores differed between groups (3.65 vs. 4.17, P = 0.06); however, silent participants described themselves as engaged. CONCLUSIONS: Themes identified that influenced learner engagement in debriefing included aspects of prebriefing and the simulation. Some aligned with general simulation best practices, such as psychological safety, prebriefing, and facilitator behavior. Findings unique to IP simulation included importance of realism to nonphysician professions, protecting time for training, group composition, and direct probing by cofacilitators to decrease physician bias and emphasize IP contributions. Silent participants reported engagement

Factors correlating with interprofessional engagement in debriefing following pediatric simulation-based team training.

Peter W. Bates Award for Excellence in Health Professions Education Research- Trainee 1st Place Award - Scientific Talk Richard Byrnes, Student, Tufts University School of Medicine-MMC Maine Track Program, Medical Education, Maine Medical Center: Factors correlating with interprofessional engagement in debriefing following pediatric simulation-based team training (video presentation by Leah Mallory, Medical Director, The Hannaford Simulation Center, Maine Medical Center). Background: Interprofessional (IP) teamwork is key to patient safety. Simulation provides a low risk, high fidelity tool to train and study IP collaboration. Debriefing following simulation is a critical component of simulation-based education. In debriefing following IP team training, underlying cultural and hierarchical barriers may prohibit balanced participation. Little data exist to suggest which factors or strategies contribute to robust IP engagement in debriefing. Objective: To analyze IP debriefing events and identify factors correlated with increased learner engagement Design/Methods: This retrospective pilot study used 20 pre-recorded IP pediatric high fidelity simulation-based team training debriefings beween 5/25/18 and 6/28/19. Two or more reviewers observed each video using a modified STROBE tool (Fig 1) (1,2) to assess learner engagement and learner: facilitator (L:F) question ratios. Data related to the scenario, debriefing, learners and facilitators was entered into a RedCap database. Chi square or Fisher\u27s exact test were used to compare number of utterances by learner profession and L: F question ratios. Spearman’s correlation was used to analyze association between factors of interest and average learner engagement scores (ALES) for each debrief. Results: Our analysis included 20 educational events with a total of 175 learners. The mean learners per event were 11.8 (range 6-20). Physician learners comprised (38.3%), nurses (24.6%) other professionals (18.9%, mainly RT and Pharmacy), and students (18.2%). ALES was 3.19 (1-5 STROBE scale) and varied significantly between professions (Fig 2). There was a significant negative correlation between ALES and group size (Fig 3). Physicians spoke significantly more than any other group and physician facilitators spoke more than nurse co-facilitators. ALES was significantly correlated with higher L:F question ratios (Fig 4). Conclusion(s): In our single center IP Team Training program physicians were most represented and spoke more than other professionals. Students of all kind were less engaged and least apt orally contribute, supporting that student level IP team training might be necessary to optimally engage this group. An inverse trend between ALES and facilitator utterances, and the significant relationship between ALES and higher L:F question ratio, suggest that inquiry-based probing by facilitators, allowing learners to orally contribute more may lead to optimal IP engagement. References: 1. O\u27Malley, K. J., et al. (2003). \u27Validation of an observation instrument for measuring student engagement in health professions settings.\u27 Eval Health Prof 26(1): 86-103. 2. Alimoglu, M. K., et al. (2014). \u27An observation tool for instructor and student behaviors to measure in-class learner engagement: a validation study.\u27 Med Educ Online 19: 24037