In-situ simulation-based intervention for enhancing teamwork in the emergency department Short report (original) (raw)
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In-situ simulation-based intervention for enhancing teamwork in the emergency department
BMJ Simulation and Technology Enhanced Learning, 2019
Simulation-based learning activities in the emergency department (ED) improve communication and teamwork and familiarise personnel with existing protocols. The authors’ objective was to develop standardised in-situ simulations and to assess their effects on team performance during simulated patient care. The study was a prospective, single-centre pre-in-situ and post-in-situ simulation-based intervention in the ED of an academic hospital between March 2017 and February 2018. Teams of three to five participants (n=46) were in two simulation interventions 2 weeks apart; each simulation was followed by debriefing with good judgement. The adapted Simulation Team Assessment Tool (STAT) Score was the primary measure for team performance. Skills are measured on a scale of 2–0 based on the complete and timely performance of tasks for a total (adapted) score of 171. Overall STAT scores improved significantly between simulations I (60.5 (28.3)) and II (81.1 (24.6)), p=029; notably in airway a...
Background: In hospital emergencies require a structured team approach to facilitate simultaneous input into immediate resuscitation, stabilisation and prioritisation of care. Efforts to improve teamwork in the health care context include multidisciplinary simulation-based resuscitation team training, yet there is limited evidence demonstrating the value of these programmes. 1 We aimed to determine the current state of knowledge about the key components and impacts of multidisciplinary simulation-based resuscitation team training by conducting an integrative review of the literature. Methods: A systematic search using electronic (three databases) and hand searching methods for primary research published between 1980 and 2014 was undertaken; followed by a rigorous screening and quality appraisal process. The included articles were assessed for similarities and differences; the content was grouped and synthesised to form three main categories of findings. Results: Eleven primary research articles representing a variety of simulation-based resuscitation team training were included. Five studies involved trauma teams; two described resuscitation teams in the context of intensive care and operating theatres and one focused on the anaesthetic team. Simulation is an effective method to train resuscitation teams in the management of crisis scenarios and has the potential to improve team performance in the areas of communication, teamwork and leadership.
Journal of Surgical Simulation, 2022
Background: Teamwork plays an essential role in providing quality health care and ensuring good outcomes and safe practices in any health care system. This has been demonstrated in several studies in emergency care where resuscitation teams perform at a high level to achieve desired outcomes in life-threatening situations. Simulation has been identified as an effective way of improving team performance skills, especially in acute care settings where team dynamics change rapidly and require good collaboration. In addition to clinical competence, the members of the team need to be conversant with non-technical skills such as team leadership and communication. Methods: The MEDLINE, EMBASE and Cochrane Library databases were searched for original articles from the last 20 years investigating team performance in multidisciplinary team-based simulation training in acute care settings. The research questions were developed using the participants, intervention, comparisons, outcome (PICO) framework. The review was designed and reported in accordance with PRISMA guidelines. The articles were then assessed by independent reviewers using the Critical Appraisal Skills Program (CASP) to standardize the assessment process. Results: Of the 1260 articles identified, 12 primary research articles representing a variety of team-based simulation training in various acute care settings were included. The studies were published between 2002 and 2020 and included 679 participants 418 years of age. All articles were original research papers with a combination of pre-/post-test, observational, randomized, and prospective designs; 11 were single-site studies and one was a multi-site study. Six studies used a pre-/post-test interventional method, four used a post-interventional method and one was an observational study. One study used a prospective blinded controlled observational method. Most of the articles reviewed did not provide high-level evidence and the control aspect of PICO was not applied because the review focused mainly on the intervention and outcome with no comparator. This study shows that 72.2% of the reviewed articles demonstrated a positive impact of team-based simulation training on team performance. Discussion: This review has demonstrated some evidence that team-based simulation training used in various emergency and acute care clinical settings does improve team performance. However, how that translates to improvement in patient safety and clinical outcomes was not fully addressed by most of the articles reviewed and other previous studies. Simulation enhances team training; the evidence to support multidisciplinary team training is positive although limited and will require further research to fully develop and validate simulation-based team training programmes.
Academic Emergency Medicine, 2008
Across health care, teamwork is a critical element for effective patient care. Yet, numerous well-intentioned training programs may fail to achieve the desired outcomes in team performance. Hope for the improvement of teamwork in health care is provided by the success of the aviation and military communities in utilizing simulation-based training (SBT) for training and evaluating teams. This consensus paper 1) proposes a scientifically based methodology for SBT design and evaluation, 2) reviews existing team performance metrics in health care along with recommendations, and 3) focuses on leadership as a target for SBT because it has a high likelihood to improve many team processes and ultimately performance. It is hoped that this discussion will assist those in emergency medicine (EM) and the larger health care field in the design and delivery of SBT for training and evaluating teamwork.
Quality and Safety in Health Care, 2004
Objective. To evaluate the effectiveness of training and institutionalizing teamwork behaviors, drawn from aviation crew resource management (CRM) programs, on emergency department (ED) staff organized into caregiver teams. Study Setting. Nine teaching and community hospital EDs. Study Design. A prospective multicenter evaluation using a quasi-experimental, untreated control group design with one pretest and two posttests of the Emergency Team Coordination Course TM (ETCC). The experimental group, comprised of 684 physicians, nurses, and technicians, received the ETCC and implemented formal teamwork structures and processes. Assessments occurred prior to training, and at intervals of four and eight months after training. Three outcome constructs were evaluated: team behavior, ED performance, and attitudes and opinions. Trained observers rated ED staff team behaviors and made observations of clinical errors, a measure of ED performance. Staff and patients in the EDs completed surveys measuring attitudes and opinions. Data Collection. Hospital EDs were the units of analysis for the seven outcome measures. Prior to aggregating data at the hospital level, scale properties of surveys and event-related observations were evaluated at the respondent or case level. Principal Findings. A statistically significant improvement in quality of team behaviors was shown between the experimental and control groups following training (p 5 .012). Subjective workload was not affected by the intervention (p 5 .668). The clinical error rate significantly decreased from 30.9 percent to 4.4 percent in the experimental group (p 5 .039). In the experimental group, the ED staffs' attitudes toward teamwork increased (p 5 .047) and staff assessments of institutional support showed a significant increase (p 5 .040). Conclusion. Our findings point to the effectiveness of formal teamwork training for improving team behaviors, reducing errors, and improving staff attitudes among the ETCC-trained hospitals.
Simulation-Based Team Training Improves Team Performance among Pediatric Intensive Care Unit Staff
Journal of Pediatric Intensive Care, 2018
Simulation training fosters collaborative learning and improves communication among interdisciplinary teams. In this prospective observational cohort study, we evaluated the impact of interdisciplinary simulation-based team training (SBTT) on immediate learning of team performance behaviors. In a 3-month period, 30 simulation sessions were conducted and 165 staff members, including physicians, nurses, and respiratory therapists, were trained. Regression analysis showed a statistically significant improvement in team performance (p < 0.0001). Study results demonstrate that SBTT is effective in immediate acquisition of optimal team performance behaviors by multidisciplinary pediatric intensive care unit staff, including physicians with higher level subspecialty training in the simulation environment.
… , Trauma and Shock, 2010
This article provides a qualitative review of the published literature dealing with the design, implementation, and evaluation of simulation-based team training (SBTT) in healthcare with the purpose of providing synthesis of the present state of the science to guide practice and future research. A systematic literature review was conducted and produced 27 articles meeting the inclusion criteria. These articles were coded using a low-inference content analysis coding scheme designed to extract important information about the training program. Results are summarized in 10 themes describing important considerations for what occurs before, during, and after a training event. Both across disciplines and within Emergency Medicine (EM), SBTT has been shown to be an effective method for increasing teamwork skills. However, the literature to date has underspecified some of the fundamental features of the training programs, impeding the dissemination of lessons learned. Implications of this s...
Demonstration of High‐fidelity Simulation Team Training for Emergency Medicine
Academic Emergency Medicine, 1999
Emergency medicine (EM) presents many cognitive, social, and systems challenges to practitioners. Coordination and communication under stress between and among individuals and teams representing a number of disciplines are critical for optimal care of the patient. The specialty is characterized by uncertainty, complexity, rapidly shifting priorities, a dependence on teamwork, and elements common to other risky domains such as perioperative medicine and aviation. High-fidelity simulators have had a long tradition in aviation, and in the past few years have begun to have a significant impact in anesthesiology. A national, multicenter research program to document the costs of teamwork failures in EM and provide a remedy in the form of an Emergency Team Coordination Course has developed to the point that high-fidelity medical simulators will be added to the hands-on training portion of the course. This paper describes an evolving collaborative effort by members of the Center for Medical Simulation, the Harvard Emergency Medicine Division, and the MedTeams program to design, demonstrate, and refine a high-fidelity EM simulation course to improve EM clinician performance, increase patient safety, and decrease liability. The main objectives of the paper are: 1) to present detailed specifications of tools and techniques for high-fidelity medical simulation; 2) to share the results of a proof-of-concept EM simulation workshop introducing multiple mannequin/ three-patient scenarios; and 3) to focus on teamwork applications. The authors hope to engage the EM community in a wide-ranging discussion and handson exploration of these methods.
Multidisciplinary Simulation-based Team Training Course to Improve Patient Safety
2010
OBJECTIVE: Simulation-based training as an educational intervention for healthcare providers has increased in use over the past 2 decades. The simulation community has called for standardized reporting of methodologies and outcomes. The purpose of this review was to (1) summarize existing data on the use of simulation-based team training for acute trauma resuscitation, and (2) describe differences in training methodologies, outcomes reporting, and gaps in the literature to inform research priorities. DESIGN: We performed a scoping review of Ovid Medline, Embase, Cochrane Library, CINAHL, Web of Science, ERIC, and Google Scholar for studies evaluating simulation-based team training for acute trauma resuscitation. Full-text review was performed by 2 reviewers and variables related to study design, training methodology, outcomes reported, and impact of training were abstracted. RESULTS: Forty-seven out of 3,911 screened studies met criteria for inclusion. Only 2 studies were randomized. The most frequent design was a pre-post study (64%). Eleven studies did not report their simulated scenario design. Interventions occurred most frequently in a laboratory-based setting (45%). Simulation-based training was associated with greater knowledge (n = 5/6), higher nontechnical skills (n = 12/13), greater number of resuscitation tasks completed (n = 10/13), and faster time to resuscitation task completion (n = 11/11). No differences in patient outcomes were found (n = 3/3). CONCLUSIONS: Simulation-based training for trauma resuscitation is associated with improved measures of teamwork, task performance and speed, knowledge, and provider satisfaction. Type of reported outcomes and training methodologies are variable. Standardized reporting of training methodology and outcomes is needed to address the impact of this intervention. (J Surg Ed 000:1À12.
Simulation-based team training in paediatric units
2017
Background: Medically justifiable practice of health care requires collaboration between the health professionals involved, who must have excellent professional knowledge and practical training in teamwork. In recent decades, healthcare providers have undergone simulation training in realistic patient situations demanding complex decision-making and teamwork. The training was based on experiences with “Crew Resource Management” (CRM) used in civil aviation.