TeamSTEPPS®: The Patient Safety Tool That Needs to Be Implemented

Cross-Cultural Validation of the TeamSTEPPS Teamwork Perceptions Questionnaire-Spanish in Colombia

BACKGROUND

Teamwork influences health care quality and patient safety. Yet, validated instruments for assessing teamwork in Colombia are lacking.

PURPOSE

The purpose of this study was to validate the Spanish version of the TeamSTEPPS-Teamwork Perceptions Questionnaire (T-TPQ-S) for the Colombian health care context.

METHODS

The T-TPQ-S underwent translation, cultural adaptation, and comprehensive psychometric testing, including reliability and confirmatory factor analyses and item difficulty and discrimination analyses.

RESULTS

The T-TPQ-S demonstrated high internal consistency and excellent fit to the theoretical model. Item discrimination was within expected ranges, with response thresholds displaying an ascending order. The tool better differentiated subjects with low and high teamwork perceptions.

CONCLUSIONS

The T-TPQ-S is an effective, reliable, and valid instrument for assessing teamwork perception among Colombian health care workers.

A new practical approach using TeamSTEPPS strategies and tools: - an educational design

BACKGROUND

Teamwork has played a critical role in ensuring patients' safety and preventing human errors in surgery. With advancements in educational technologies, including virtual reality, it is necessary to develop new teaching methods for interpersonal teamwork based on local needs assessments in countries with indigenous cultures. This study aimed to design and develop a new method of teaching teamwork in cesarean section surgery using virtual reality; we further evaluated the effects of this method on healthcare professionals' knowledge and attitudes about teamwork.

METHODS

This study was designed using the ADDIE instructional design model. The TeamSTEPPS Learning Benchmarks questionnaire was used to assess the educational needs of 85 participants who were members of the cesarean section surgery team. A specialized panel analyzed the extracted needs, and the scenario was compiled during the design stage. Finally, four virtual reality contents were created using 360-video H.265 format, which were prepared from specified scenarios in the development of the educational program. The TeamSTEPPS Learning Benchmarks questionnaire was used to measure knowledge, and the T-TAQ was used to measure the participants' attitudes.

RESULTS

Six micro- skills were identified as training needs, including briefing, debriefing, cross-monitoring, I'M SAFE checklist, call-out and check-back, and two-challenge rule. Intervention results showed that the virtual reality content improved teamwork competencies in an interprofessional team performing cesarean section surgery. A significant increase was observed in the mean score of knowledge and attitude after the intervention.

CONCLUSION

Through addressing the need for teamwork training, utilizing the TeamSTEPPS strategy, and incorporating new educational technologies like virtual reality, the collaboration among surgical team members can be enhanced.

TeamSTEPPS®-based clinical simulation training program for critical care professionals: A mixed-methodology study

INTRODUCTION

The Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS®) programme has been shown to improve interprofessional work among healthcare professionals by enhancing teamwork. Intensive care professionals were trained in this methodology through the course "Simulation Trainer: Improving Teamwork through TeamSTEPPS®".

OBJECTIVES

To analyse the teamwork performance and good practice in simulation of the intensive care professionals attending the course and to explore their perceptions of the training experience carried out during the course.

METHODS

A cross-sectional descriptive and phenomenological study was carried out using a mixed methodology. The 18 course participants were administered the questionnaires "TeamSTEPPS™ 2.0 Team Performance Observation Tool" to evaluate teamwork performance and "Educational Practices Questionnaire" for good practices in simulation after the simulated scenarios. Subsequently, a group interview was conducted through a focus group with 8 attendees using the Zoom™ videoconferencing platform. A thematic and content analysis of the discourses was carried out using the interpretative paradigm. Quantitative and qualitative data were analysed using IBM SPSS Statistics™ 27.0 and MAXQDA Analytics Pro™ respectively.

RESULTS

Both the level of teamwork performance (mean = 96.25; SD = 8.257) and good practice in simulation (mean = 75; SD = 1.632) following the simulated scenarios were adequate. The following main themes were identified: satisfaction with the TeamSTEPPS® methodology, usefulness of the methodology, barriers to methodology implementation and non-technical skills improved through TeamSTEPPS®.

CONCLUSIONS

TeamSTEPPS® methodology can be a good interprofessional education strategy for the improvement of communication and teamwork in intensive care professionals, both at the care level (through on-site simulation strategies) and at the teaching level (through its inclusion in the students' curriculum).

Incorporating TeamSTEPPS training to improve staff collaboration in an academic level I emergency and trauma center

BACKGROUND

Seamless communication and coordinated teamwork is paramount in high stakes clinical practice settings, such as the emergency department (ED), to prevent medical errors and ensure high quality patient care delivery. Ineffective communication in this fast-paced environment can be detrimental for patient outcomes and staff collaboration.

PURPOSE

The purpose of this project was to evaluate the effect of TeamSTEPPS® training (Team strategies and Tools to Enhance Performance and Patient Safety), an evidenced based communication-training toolkit, on staff perception of teamwork and communication in an academic Level I Emergency and Trauma Center.

METHODS

A prospective, single group, pre-post design with a convenience sample was employed. The sample consisted of thirty-five clinical staff members, including registered nurses (RNs) and patient care technicians (PCTs), recruited from an academic Level I Emergency and Trauma Center. A pre-intervention T-TPQ (TeamSTEPPS® teamwork and Perceptions Questionnaire) measuring staff perception of teamwork and collaboration was administered followed by a one-hour TeamSTEPPS® education session from freely-available published materials. Three weeks later, a post-intervention T-TPQ was administered. A paired samples t-test and Wilcoxon signed-rank test was used to analyze changes in scores from pre-post-test for outcome measures.

RESULTS

23 females and 12 males with a mean age of 30 years and 9 years of experience participated. T-TPQ scores showed a mean of 121.4 pre-training and mean of 128.2 after training. Paired t-test demonstrated overall pre-intervention (mean = 3.52, SD ± 0.5) and post-intervention (mean = 3.78, SD = 0.4) scores were significantly improved overall (-0.29 to -0.13, p < 0.001).

CONCLUSION

TeamSTEPPS® was an effective communication collaboration program to improve teamwork and communication perceptions in the ED suggesting that an evidence-based multifaceted, multimedia instructional toolkit may promote a collaborative culture of effective communication and teamwork. Long term effects of TeamSTEPPS® training in the ED requires further study.

Effectiveness of a training intervention to improve communication between/awareness of team roles: A randomized clinical trial

BACKGROUND

Interprofessional teamwork training of nursing undergraduates is essential to improving healthcare. The absence of clear role definitions and poor interprofessional communications have been listed as the main reasons behind abandonment of the profession by recently graduated nurses.

PURPOSE

The aim of this parallel randomized clinical trial was to evaluate the impact of Situation-Background-Assessment-Recommendation (SBAR) role-play training on interprofessional teamwork skills (role-related and communication-related) and non-technical skills (patient assessment, patient intervention, patient safety, and critical thinking).

METHOD

The intervention group were taught teamwork skills, role and task assignment skills, and use of the SBAR worksheet in a 1-hour role-play training session, while the control group received conventional lecture-based training. Teamwork and non-technical skills were then assessed in high-fidelity simulation scenarios using the KidSIM Team Performance Scale (teamwork skills) and the Clinical Simulation Evaluation Tool (non-technical skills). Cohen's d (d) was used to examine effect size differences.

RESULTS

Compared to the control group, the intervention group improved in 4 teamwork items - 'verbalize out loud' (p < 0.001, d = 0.99), 'paraphrase' (p < 0.001, d = 0.77), 'cross-monitoring' (p < 0.001, d = 0.72), and 'role clarity' (p = 0.002, d = 0.66) - and in a single non-technical skill (patient intervention: p = 0.004, d = 0.66), while also reporting greater confidence in performing patient assessments (p = 0.02, d = 0.56).

CONCLUSIONS

Role-play and SBAR training for undergraduate nurses improved patient intervention, enhanced information sharing in an interprofessional team, and raised awareness of their own and other team members' roles.

Objective Measures of Communication Behavior Predict Clinical Performance

OBJECTIVE

Effective teamwork and communication are critical to patient outcomes, and subjective assessment tools have been studied in predicting team performances. However, inherent biases remain while using subjective assessment tools. This study hypothesizes that objective communication features can assess and predict clinical performance.

DESIGN

Forty 3rd-year medical students participated in the Acute Care Trauma Simulation as the role of doctor, teaming up with a nurse confederate and a simulated patient. Participants conducted postoperative patient management, patient care diagnoses, and treatment. Audio from all team members were recorded, speech variables (e.g., speech duration, number of conversations, etc.) were extracted, and statistical analyses were performed to associate communication with clinical performance.

SETTING

This study was performed at the simulation center located at Fairbanks Hall, Indiana University School of Medicine.

PARTICIPANTS

Data from forty 3rd-year medical students were collected and analyzed.

RESULTS

Majority (67%) of the communications were initiated by student. Speech ratio, intensity, and frequency of communications differed when students communicate with nurse than with patient (e.g., student communication to patient had higher intensity than nurse). Increasing frequency of check-backs between student and nurse (p < 0.05) and speech duration from student to patient (p = 0.001) positively associated with student's clinical performance score.

CONCLUSION

Objective communication features can predict medical trainee's clinical performance and provide an objective approach for simulation-based trauma care training.

TeamSTEPPS® : An evidence-based approach to reduce clinical errors threatening safety in outpatient settings: An integrative review

OBJECTIVE

The objective of this integrative review of literature was to investigate and evaluate feasibility and potential for success of TeamSTEPPS® implementation, the influence of TeamSTEPPS for Office-Based Care on the clinical error rate in a private outpatient clinic, and influence of TeamSTEPPS for Office-Based Care on patient satisfaction.

BACKGROUND

Patient safety remains a top priority for all health care providers in all clinical settings. Despite multiple varied efforts, clinical errors directly attributed to communication are consistently at the top of the list of root causes, although improvement strategies such as Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS) have been implemented, there is insufficient data reported measuring the influence of this intervention on patient safety, clinical errors related to communication, and patient satisfaction.

SEARCH STRATEGY

A systematic search of the electronic databases MEDLINE Complete, CINAHL Complete, Embase, and Science Direct was conducted to seek literature that reported the effectiveness of the TeamSTEPPS tool to reduce clinical errors, improve communication, and increase patient satisfaction. Nineteen studies met inclusion criteria. Levels of evidence for each study was determined using the 2009 American Association of Critical Care Nursing (AACN) levels.

CONCLUSIONS

The present review is consistent with marked improvement in communication, decrease in clinical error rates, and improvement in patient satisfaction. There is a significant need for evaluation of the impact of this validated toolkit from the Agency for Healthcare Research and Quality to maintain a sustainable health care environment for all stakeholders. As a result of this integrative review, a quality improvement project related to both the primary and secondary end points is in progress.

A Saturated Approach to the Four-Phase, Brain-Based Simulation Framework for TeamSTEPPS® in a Pediatric Medicine Unit

Introduction

Although many organizations have reported successful outcomes as a result of Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS), implementation can be challenging, with its share of administrative obstacles and lack of research that shows observable change in practice.

Methods

This quantitative, pretest/posttest design pilot research used a combination of classroom simulation-based instruction and in situ simulation in a Pediatrics department in an urban academic center. All personnel with direct patient care responsibilities (n = 547) were trained in TeamSTEPPS in an 8-week period. TeamSTEPPS course knowledge scores were compared pretraining to posttraining using the Wilcoxon rank-sum test. The performance of two-day and overnight shift teams, pre- and postintervention was assessed using the TeamSTEPPS Team Performance Observation Tool.

Results

TeamSTEPPS course knowledge improved from the beginning of the course to completion with median scores of 16 and 19, respectively (P < 0.001). Both day and evening postintervention groups demonstrated greater team performance scores than their control counterparts. Specifically, postintervention day shift team showed the greatest improvement and demonstrated more TeamSTEPPS behaviors.

Conclusion

This pilot study involving 1 department in an urban hospital showed that TeamSTEPPS knowledge and performance could be improved to increase patient safety and reduce medical errors. However, teams need to be trained within a shorter period so they can apply a shared-model of teamwork and communication. Leaders and educators throughout the department must also reinforce the behaviors and include them in every education intervention.

Relationships Among Nurse Manager Leadership Skills, Conflict Management, and Unit Teamwork

OBJECTIVE

The aim of this study is to examine the relationships among staff nurse perceptions of their nurse manager (NM) leadership ability, conflict management, and team backup on medical-surgical units.

BACKGROUND

Team backup, an important component of teamwork, is crucial to patient safety and outcomes. A threat to successful teamwork is ineffective conflict management. There is scant knowledge, however, about NM conflict management skills and unit teamwork through the concept of team backup.

METHODS

Secondary analyses were conducted utilizing data previously collected from a sample of 257 staff nurses. A series of multiple regressions, including a mediation model, were estimated to determine relationships among variables.

RESULTS

Positive relationships were substantiated among the variables of NM leadership ability, conflict management, and team backup. Staff nurse perceptions of NM leadership ability were a significant predictor of conflict management and team backup.

CONCLUSION

Findings support the importance of the NM demonstrating skilled leadership and the ability to manage conflicts and to develop team backup. This study further highlights the importance of conflict management as a leadership competency.

In search of a resident-centered handoff tool: Discovering the complexity of transitions of care

INTRODUCTION

Transfer of a patient's care between providers is a significant potential for medical errors. Given the potential for patient safety breeches we sought to investigate residents' perceptions of handoffs at our institution.

METHODS

Residents completed an online survey assessing the effectiveness of handoffs and what they thought was necessary for safe and informative transition communication. Thematic analysis was used to identify critical themes.

RESULTS

78% of residents reported formal training in handoff delivery. 90% stated they were effective in delivering handoffs; however they scored 41% of handoffs they received as less than effective. 11 themes emerged, the most commonly described requirement was "important events" from the previous shift. Only 16% of residents used an established formal handoff tool.

CONCLUSIONS

In a survey of surgical residents they view themselves as very effective at delivering handoffs, but judge nearly half of handoffs they receive as ineffective. Multiple handoff tools exist but residents rarely use them. In an era of increasing transitions of care, efforts targeting improvement of handoff effectiveness will require education beyond checklists and mnemonics.

Emergency medicine staff’s perception of SimWars: A Singapore view

Background:

SimWars is an onstage competition among teams of health care providers in front of an audience. Participants demonstrate communication, teamwork, clinical management, and problem-solving skills. Upon completion, judges debrief participants’ clinical actions and team dynamics.

Purpose:

The Society for Emergency Medicine in Singapore hosted the inaugural SimWars in 2014. This study investigated whether SimWars was effective in teaching emergency medicine staff, explored how the competitive nature of SimWars affected the performance and learning of participants, and identified strategies to implement SimWars effectively in Singapore.

Methods:

A descriptive qualitative design was selected owing to the exploratory nature of the questions. Thirteen SimWars participants, six audiences, and three judges participated in the study.

Results:

(1) Twenty-one out of 22 considered SimWars useful for learning; (2) 14 out of 19 agreed that SimWars closely resemble clinical practice compared to clinical practice; (3) 16 out of 19 agreed that competition induced stress from participants and enhanced performance; (4) 16 out of 22 said SimWars was psychologically safe; (5) 18 said the team worked well together; (6) 19 said that debriefing helped them to improve through clarification, discussion, and reflection; debriefing should be personalized, longer, more structured, more detailed, and in a more private manner; (7) 13 said their knowledge and skills on the content areas will change; 21 said what they learned will be transferred to clinical practice; (8) the useful parts of SimWars included practicing under stress, debriefing, teamwork, and critical thinking; and (9) future improvements included avoiding technical problems and providing clear guidelines.

Conclusion:

Our responders perceived SimWars to be effective for professional development.