Training teams and leaders to reduce resuscitation errors and improve patient outcome

The human factor and ergonomics in Patient Safety

The human condition is linked to error in any activity that is performed, and the healthcare world is no exception. The origin of human error does not lie within the perversity of human nature, instead, it has its origins in latent failures in the healthcare environment and is a consequence of the processes and procedures applied. The science of the Human Factor deals with the application of knowledge to people (capabilities, characteristics and limitations), with the design and the management of the equipment they use and with the environments in which they work and the activities they carry out. Part of the Human Factor are the non-technical skills. These skills greatly influence people's behavior and, therefore, their performance and the quality of healthcare in a very complex socio-technical system.

Interprofessional simulation of acute care for nursing and medical students: interprofessional competencies and transfer to the workplace

BACKGROUND

Teamwork and communication are essential tools for doctors, nurses and other team members in the management of critically ill patients. Early interprofessional education during study, using acute care simulation, may improve teamwork and communication between interprofessional team members on the long run.

METHODS

A comparative sequential quantitative-qualitative study was used to understand interprofessional learning outcomes in nursing and medical students after simulation of acute care. Students were assigned to a uni- or interprofessional training. Questionnaires were used to measure short and long term differences in interprofessional collaboration and communication between the intervention and control group for nursing and medical students respectively. Semi-structured focus groups were conducted to gain a better understanding of IPE in acute simulation.

RESULTS

One hundred and ninety-one students participated in this study (131 medical, 60 nursing students). No differences were found between the intervention and control group in overall ICCAS scores for both medical and nursing students (p = 0.181 and p = 0.441). There were no differences in ICS scores between the intervention and control group. Focus groups revealed growing competence in interprofessional communication and collaboration for both medical and nursing students.

CONCLUSIONS

Interprofessional simulation training did show measurable growth of interprofessional competencies, but so did uniprofessional training. Both medical and nursing students reported increased awareness of perspective and expertise of own and other profession. Furthermore, they reported growing competence in interprofessional communication and collaboration in transfer to their workplace.

Professionalism of Admitting and Consulting Services and Trauma Patient Outcomes

OBJECTIVE

To determine whether trauma patients managed by an admitting or consulting service with a high proportion of physicians exhibiting patterns of unprofessional behaviors are at greater risk of complications or death.

SUMMARY BACKGROUND DATA

Trauma care requires high-functioning interdisciplinary teams where professionalism, particularly modeling respect and communicating effectively, is essential.

METHODS

This retrospective cohort study used data from nine level I trauma centers that participated in a national trauma registry linked with data from a national database of unsolicited patient complaints. The cohort included trauma patients admitted January 1, 2012 through December 31, 2017. The exposure of interest was care by one or more high-risk services, defined as teams with a greater proportion of physicians with high numbers of patient complaints. The study outcome was death or complications within 30 days.

RESULTS

Among the 71,046 patients in the cohort, 9,553 (13.4%) experienced the primary outcome of complications or death, including 1,875 of 16,107 patients (11.6%) with 0 high-risk services, 3,788 of 28,085 patients (13.5%) with one high-risk service, and 3,890 of 26,854 patients (14.5%) with 2+ high-risk services (p < .001). In logistic regression models adjusting for relevant patient, injury, and site characteristics, patients who received care from one or more high-risk services were at 24.1% (95% CI 17.2% to 31.3%; P < 0.001) greater risk of experiencing the primary study outcome.

CONCLUSIONS

Trauma patients who received care from at least one service with a high proportion of physicians modeling unprofessional behavior were at an increased risk of death or complications.

Professional Assessment Tool for Team Improvement: An assessment tool for paediatric intensive care unit nurses' technical and nontechnical skills

BACKGROUND

Cardiorespiratory arrests are rare in paediatric intensive care units, yet intensive care nurses must be able to initiate resuscitation before medical assistance is available. For resuscitation to be successful, instant decision-making, team communication, and the coordinating role of the first responsible nurse are crucial. In-house resuscitation training for nurses includes technical and nontechnical skills.

OBJECTIVES

The aim of this study was to develop a valid, reliable, and feasible assessment instrument, called the Professional Assessment Tool for Team Improvement, for the first responsible nurse's technical and nontechnical skills.

METHODS

Instrument development followed the COnsensus-based Standards for the selection of health Measurement Instruments guidelines and professionals' expertise. To establish content validity, experts reached consensus via group discussions about the content and the operationalisation of this team role. The instrument was tested using two resuscitation assessment scenarios. Inter-rater reliability was established by assessing 71 nurses in live scenario sessions and videotaped sessions, using intraclass correlation coefficients and Cohen's kappa. Internal consistency for the total instrument was established using Cronbach's alpha. Construct validity was assessed by examining the associations between raters' assessments and nurses' self-assessment scores.

RESULTS

The final instrument included 12 items, divided into four categories: Team role, Teamwork and communication, Technical skills, and Reporting. Intraclass correlation coefficients were good in both live and videotaped sessions (0.78-0.87). Cronbach's alpha was stable around 0.84. Feasibility was approved (assessment time reduced by >30%).

CONCLUSIONS

The Professional Assessment Tool for Team Improvement appears to be a promising valid and reliable instrument to assess both technical and nontechnical skills of the first responsible paediatric intensive care unit nurse. The ability of the instrument to detect change over time (i.e., improvement of skills after training) needs to be established.

Integration of In Situ Simulation Into an Emergency Department Code Orange Exercise in a Tertiary Care Trauma Referral Center

OBJECTIVES

Disaster-preparedness and response are a commonly overlooked aspect of hospital policy and can frequently be outdated and undertested. Simulation-based education has become a core education modality within Canadian medical training programs. We hypothesized that integrating in situ simulation (ISS) into a hospital-wide, mass-casualty response exercise would enhance realism and our ability to identify latent safety threats (LSTs).

METHODS

Using ISS we created a simulated mass shooting scenario with 20 patients, played by actors in full moulage, presenting to a large tertiary care hospital over a 50-minute period.

RESULTS

Integrating ISS into our exercise created a realistic experience for the participants involved and improved participant education, while imparting enough systemic stress to expose LSTs associated within patient care and hospital policy.

CONCLUSION

Overall, ISS was successfully used and enhanced a large-scale test of our hospital's mass-casualty response plan.

Stress Testing the Resuscitation Room: Latent Threats to Patient Safety Identified During Interprofessional In Situ Simulation in a Canadian Academic Emergency Department

OBJECTIVES

Emergency department (ED) resuscitation is a complex, high-stakes procedure where positive outcomes depend on effective interactions between the health care team, the patient, and the environment. Resuscitation teams work in dynamic environments and strive to ensure the timely delivery of necessary treatments, equipment, and skill sets when required. However, systemic failures in this environment cannot always be adequately anticipated, which exposes patients to opportunities for harm.

METHODS

As part of a new interprofessional education and quality improvement initiative, this prospective, observational study sought to characterize latent safety threats (LSTs) identified during the delivery of in situ, simulated resuscitations in our ED. In situ simulation (ISS) sessions were delivered on a monthly basis in the EDs at each campus of a large tertiary care academic hospital system, during which a variety of scenarios were run with teams of ED health care professionals. LSTs were identified by simulation facilitators and participants during the case and debriefing and then grouped thematically for analysis.

RESULTS

During the study period, 22 ISS sessions were delivered, involving 58 cases and reaching 383 ED health care professionals. 196 latent safety threats were identified through these sessions (mean = 3.4 LSTs per case) of which 110 were determined to be "actionable" at a system level. LSTs identified included system/environmental design flaws, equipment problems, failures in department processes, and knowledge/skill gaps. Corrective mechanisms were initiated in 85% of actionable cases.

CONCLUSIONS

Effective quality improvement and continuing education programs are essential to translate these findings into more resilient patient care. ISS, beyond its role as a training tool for developing intrinsic and crisis resource management skills, can be effectively used to identify system issues in the ED that could expose critically ill patients to harm.

Facilitators and barriers to the clinical application of teamwork skills taught in multidisciplinary simulated Trauma Team Training

BACKGROUND

Efforts to improve teamwork in trauma include simulation-based team training with a non-technical skills (NTS) focus. However, there is a lack of evidence to inform the development of team training programs for maximum uptake of NTS in clinical practice. This descriptive paper aims to evaluate the extent NTS were practiced by the trauma team in a Level 1 trauma hospital after NTS training and to identify facilitators and barriers to use of NTS in clinical practice.

METHOD

A 38-item questionnaire targeting clinicians who attended a simulation based multidisciplinary Trauma Team Training program was developed. The questionnaire was developed using the Theoretical Domains Framework, a validated tool to identify what practices need to change. It included questions on the current practice of NTS in real life trauma resuscitation.

RESULTS

Eighty six of 235 eligible participants (rate 37%) responded to the questionnaire. All relevant professions and clinical services were represented. There were 15 facilitators and 12 barriers identified. Barriers and facilitators were allocated to categories of factors known to influence trauma team practices. These were: (1) organisational factors that influence the trauma team, (2) team factors that influence teamwork and (3) cognitive factors that influence team decision making.

CONCLUSION

NTS were being used by frontline clinicians in real world trauma resuscitations to varying degrees, depending on organisational, team and cognitive facilitators and barriers. Facilitators to the implementation of NTS skills during trauma emergencies included team composition, roles and responsibilities, procedural compliance and leadership. Barriers included decision making and communication. This study described team members experience of using NTS in 'real world trauma resuscitation' to inform future team training interventions.

Using theories of behaviour change to transition multidisciplinary trauma team training from the training environment to clinical practice

Background

Major trauma patients—such as patients who have experienced road injury, high-impact falls or violence—require complex, intense and rapid resuscitation from a multidisciplinary team of clinicians. These ‘flash teams’ must form quickly and function effectively, often having never met before. There is evidence that multidisciplinary teamwork training improves the performance of the trauma team in simulation. However, the translation of learnt resuscitation teamwork skills from simulation into clinical practice has had modest and variable effects. This paper outlines a method for developing an intervention designed to translate the teaching from a simulated training environment into clinical practice using the theoretical domains framework, behaviour change wheel and behaviour change techniques as the theoretical and empirical basis for the process.

Methods

The data used to inform the intervention development process were collected during an implementation evaluation study of the trauma team training programme at the busiest level 1 trauma centre in Sydney, Australia. A detailed barrier and enabler assessment were conducted using qualitative and quantitative data. The theoretical domains framework was used to integrate the results. Implementation interventions were selected using the behaviour change wheel.

Results

Twenty-three facilitators and 19 barriers were identified to influence the implementation of trauma team training in the clinical setting. The facilitators and barriers corresponded to all 14 domains of the theoretical domains framework. Seven intervention functions and four policy categories of the behavioural change wheel were selected to address the target behaviours, and a multimodal relaunch of the revised trauma team training programme was developed.

Conclusions

This study offers a framework for deductively employing the theoretical domains framework, behaviour change wheel and behaviour change techniques to assess and develop intervention strategies to improve the functioning of trauma resuscitation teams.

The impact of SimMan on resident training in emergency skills

The purpose of this study was to analyze the role of SimMan in resident training of emergency skills.Forty-five 1st year medical residents were selected for this study. All participants were divided into groups and each participant performed different roles during training. Clinical cases were selected using the tutor mode/auto mode in the SimMan computer system in order to train and assess each group. A pre-test was administered to the 45 residents before emergency medical technician (EMT) skill training. Finally, a post-test was conducted with SimMan after training. Tutors scored the student's performance and recorded the overall time for the procedure.Before training, the overall qualification rate was 44.44%. The average score of the 9 groups was 62.78 ± 8.84 and the average 1st aid duration was 519.22 ± 34.35 seconds. After the training, the overall qualification rate was 100%. The average score of the 9 groups was 80.89 ± 7.39. The average 1st aid duration was 453.56 ± 24.40 seconds. The P values in comparing pre- and post-training data were .009, <.001 and <.001.An integrated learning approach using SimMan as a tool for training and examination can help training residents develop emergency skills, teamwork, and communication.

Maternal out-of-hospital cardiac arrest: A retrospective observational study

AIM

Out-of-hospital cardiac arrests (OHCAs) in pregnant women are rare events. In this study, we aimed to describe a cohort of pregnant women who experienced OHCAs in a large urban area, and received treatment by the prehospital teams in a two-tiered emergency response system.

METHODS

This retrospective study included pregnant women over 18 years of age who experienced OHCAs. The analysed variables included maternal age, gestational age, variables specific to the rescue system, number of shocks delivered by an automatic external defibrillator, and rates of maternal and neonatal survival.

RESULTS

Over the 5-year study period, 19,515 OHCAs occurred, 16 of which were in pregnant women. These 16 patients had a median age of 31 years [interquartile range (IQR): 28-35] and a median gestational age of 20 weeks [IQR: 10-33]. Three patients (18.8%) had an initial rhythm of ventricular fibrillation. Only one patient underwent thrombolysis. Of the 16 patients, 6 (38%) died after resuscitation on the scene. The remaining 10 were transported to the hospital, of whom 5 achieved circulation through a mechanical CPR device. Only 2 patients were alive 30days after OHCA.

CONCLUSIONS

Over half of the pregnant women who experienced OHCA were at least 20 weeks pregnant. Analysis of the prehospital medical data suggests that the current recommendations are difficult to apply in an out-of-hospital environment. Specific recommendations for this situation must be developed.

Effects of interprofessional education for medical and nursing students: enablers, barriers and expectations for optimizing future interprofessional collaboration - a qualitative study

Background

To ensure high quality patient care an effective interprofessional collaboration between healthcare professionals is required. Interprofessional education (IPE) has a positive impact on team work in daily health care practice. Nevertheless, there are various challenges for sustainable implementation of IPE. To identify enablers and barriers of IPE for medical and nursing students as well as to specify impacts of IPE for both professions, the 'Cooperative academical regional evidence-based Nursing Study in Mecklenburg-Western Pomerania' (Care-N Study M-V) was conducted. The aim is to explore, how IPE has to be designed and implemented in medical and nursing training programs to optimize students' impact for IPC.

Methods

A qualitative study was conducted using the Delphi method and included 25 experts. Experts were selected by following inclusion criteria: (a) ability to answer every research question, one question particularly competent, (b) interdisciplinarity, (c) sustainability and (d) status. They were purposely sampled. Recruitment was based on existing collaborations and a web based search.

Results

The experts find more enablers than barriers for IPE between medical and nursing students. Four primary arguments for IPE were mentioned: (1) development and promotion of interprofessional thinking and acting, (2) acquirement of shared knowledge, (3) promotion of beneficial information and knowledge exchange, and (4) promotion of mutual understanding. Major barriers of IPE are the coordination and harmonization of the curricula of the two professions. With respect to the effects of IPE for IPC, experts mentioned possible improvements on (a) patient level and (b) professional level. Experts expect an improved patient-centered care based on better mutual understanding and coordinated cooperation in interprofessional health care teams. To sustainably implement IPE for medical and nursing students, IPE needs endorsement by both, medical and nursing faculties.

Conclusion

In conclusion, IPE promotes interprofessional cooperation between the medical and the nursing profession. Skills in interprofessional communication and roles understanding will be primary preconditions to improve collaborative patient-centered care. The impact of IPE for patients and caregivers as well as for both professions now needs to be more specifically analysed in prospective intervention studies.

The use of interprofessional learning and simulation in undergraduate nursing programs to address interprofessional communication and collaboration: An integrative review of the literature

OBJECTIVE

To identify how simulation and interprofessional learning are used together in undergraduate nursing programs and undertaken in schools of nursing to address interprofessional communication and collaboration.

DESIGN

An integrative literature review.

DATA SOURCES

The databases CINAHL, ProQuest, PubMed, Scopus, PsycInfo and Science Direct were searched to identify articles from 2006 to 2016 that reported on the use of IPL and simulation together in undergraduate nursing education.

REVIEW METHOD

Whittemore and Knafl's five step process was used to guide the integrative review of quantitative and qualitative literature. Only peer reviewed articles written in English that addressed undergraduate nursing studies, were included in the review. Articles that did not aim to improve communication and collaboration were excluded. All articles selected were examined to determine their contribution to interprofessional learning and simulation in undergraduate nursing knowledge.

RESULTS

The faculties of nursing used interprofessional learning and simulation in undergraduate nursing programs that in some cases were connected to a specific course. A total of nine articles, eight research papers and one narrative report, that focused on collaboration and communication were selected for this review. Studies predominantly used nursing and medical student participants. None of the included studies identified prior student experience with interprofessional learning and simulation. Four key themes were identified: communication, collaboration/teamwork, learning in practice and understanding of roles, and communication.

CONCLUSION

This review highlights the identified research relating to the combined teaching strategy of interprofessional learning and simulation that addressed communication and collaboration in undergraduate nursing programs. Further research into the implementation of interprofessional learning and simulation may benefit the emergent challenges. Information drawn from this review can be used in informing education and educational development in the future.

Perimortem caesarean deliveries

Although cardiac arrest in pregnancy is rare, it is important that all individuals involved in the acute care of pregnant women are suitably trained, because the outcome for both mother and fetus can be affected by the management of the arrest. Perimortem caesarean delivery was first described in 715 BC. Initially the procedure was performed principally for religious or political reasons. Although the potential for fetal survival was proposed, it was rarely successful, probably because the delivery was delayed until maternal death was established. However, in recent decades, case reports have suggested improved maternal as well as fetal survival if perimortem caesarean section was performed rapidly once maternal arrest has occurred. While evidence for this is largely based on case reports, the physiological advantages including removing inferior caval obstruction, and hence improving venous return to the heart, reducing oxygen requirement and improving chest compliance appear compelling. Factors that reduce errors and minimise the delay in performance of caesarean delivery are discussed, in particular the importance of training, organizational factors within a hospital and the use of prompts during an arrest. While evidence is limited, it is probable that both maternal and fetal survival are improved with early delivery by perimortem caesarean delivery. More importantly, no evidence was found from case report reviews that either maternal or fetal survival was worsened. Perimortem caesarean delivery therefore remains a key consideration in the management of maternal arrest from the mid second trimester.

Educational technology "Anatomy and Vital Signs": Evaluation study of content, appearance and usability

BACKGROUND

The use of new technology has recently grown considerably as an increasing number of college students using Internet. In nursing education, the personal computer and the Internet facilitate teaching theoretical and practical knowledge.

OBJECTIVES

Evaluate an educational technology known as "Anatomy and Vital Signs" with respect to content, appearance and usability.

METHOD

This was a first stage evaluation-by specialists to verify content and functioning, prior to a second validation as to learning by students. A methodological study in which instructional technologists (11 participants) and nursing specialists (17 participants) used the technology in an unguided manner and completed three questionnaires. The evaluation was measured by the difference between disagreement and agreement for each statement in the questionnaires.

RESULTS

Most of the items were positively evaluated at a level higher than 70% by most of the evaluators except for the following usability criteria: grouping by shape, minimum actions and user control, which did not attain the 70% agreement level among instructional technologists.

CONCLUSION

The evaluation was useful to improve the technology and guarantee suitable product for nursing education. It may be a reliable educational tool for nursing education that applies technological resources.

Effect of CRM team leader training on team performance and leadership behavior in simulated cardiac arrest scenarios: a prospective, randomized, controlled study

BACKGROUND

Effective team leadership in cardiopulmonary resuscitation (CPR) is well recognized as a crucial factor influencing performance. Generally, leadership training focuses on task requirements for leading as well as non-leading team members. We provided crisis resource management (CRM) training only for designated team leaders of advanced life support (ALS) trained teams. This study assessed the impact of the CRM team leader training on CPR performance and team leader verbalization.

METHODS

Forty-five teams of four members each were randomly assigned to one of two study groups: CRM team leader training (CRM-TL) and additional ALS-training (ALS add-on). After an initial lecture and three ALS skill training tutorials (basic life support, airway management and rhythm recognition/defibrillation) of 90-min each, one member of each team was randomly assigned to act as the team leader in the upcoming CPR simulation. Team leaders of the CRM-TL groups attended a 90-min CRM-TL training. All other participants received an additional 90-min ALS skill training. A simulated CPR scenario was videotaped and analyzed regarding no-flow time (NFT) percentage, adherence to the European Resuscitation Council 2010 ALS algorithm (ADH), and type and rate of team leader verbalizations (TLV).

RESULTS

CRM-TL teams showed shorter, albeit statistically insignificant, NFT rates compared to ALS-Add teams (mean difference 1.34 (95% CI -2.5, 5.2), p = 0.48). ADH scores in the CRM-TL group were significantly higher (difference -6.4 (95% CI -10.3, -2.4), p = 0.002). Significantly higher TLV proportions were found for the CRM-TL group: direct orders (difference -1.82 (95% CI -2.4, -1.2), p < 0.001); undirected orders (difference -1.82 (95% CI -2.8, -0.9), p < 0.001); planning (difference -0.27 (95% CI -0.5, -0.05) p = 0.018) and task assignments (difference -0.09 (95% CI -0.2, -0.01), p = 0.023).

CONCLUSION

Training only the designated team leaders in CRM improves performance of the entire team, in particular guideline adherence and team leader behavior. Emphasis on training of team leader behavior appears to be beneficial in resuscitation and emergency medical course performance.

Team training for safer birth

Effective and coordinated teamworking is key to achieving safe birth for mothers and babies. Confidential enquiries have repeatedly identified deficiencies in teamwork as factors contributing to poor maternal and neonatal outcomes. The ingredients of a successful multi-professional team are varied, but research has identified some fundamental teamwork behaviours, with good communication, proficient leadership and situational awareness at the heart. Simple, evidence-based methods in teamwork training can be seamlessly integrated into a core, mandatory obstetric emergency training. Training should be an enjoyable, inclusive and beneficial experience for members of staff. Training in teamwork can lead to improved clinical outcomes and better birth experience for women.

Efficacy of simulation-based trauma team training of non-technical skills. A systematic review

Trauma resuscitation is a complex situation, and most organisations have multi-professional trauma teams. Non-technical skills are challenged during trauma resuscitation, and they play an important role in the prevention of critical incidents. Simulation-based training of these is recommended. Our research question was: Does simulation-based trauma team training of non-technical skills have effect on reaction, learning, behaviour or patient outcome? The authors searched PubMed, EMBASE and the Cochrane Library and found 13 studies eligible for analysis. We described and compared the educational interventions and the evaluations of effect according to the four Kirkpatrick levels: reaction, learning (knowledge, skills, attitudes), behaviour (in a clinical setting) and patient outcome. No studies were randomised, controlled and blinded, resulting in a moderate to high risk of bias. The multi-professional trauma teams had positive reactions to simulation-based training of non-technical skills. Knowledge and skills improved in all studies evaluating the effect on learning. Three studies found improvements in team performance (behaviour) in the clinical setting. One of these found difficulties in maintaining these skills. Two studies evaluated on patient outcome, of which none showed improvements in mortality, complication rate or duration of hospitalisation. A significant effect on learning was found after simulation-based training of the multi-professional trauma team in non-technical skills. Three studies demonstrated significantly increased clinical team performance. No effect on patient outcome was found. All studies had a moderate to high risk of bias. More comprehensive randomised studies are needed to evaluate the effect on patient outcome.

An interprofessional communication training using simulation to enhance safe care for a deteriorating patient

BACKGROUND

Communication and teamwork between doctors and nurses are critical for optimal patient care. Simulation and interprofessional team learning are emerging as significant learning strategies to promote teamwork and communication between different health professionals.

AIM

The aim of the study is to describe the development, implementation and evaluation of a simulation-based interprofessional educational (Sim-IPE) program, using a presage-process-product (3P) model, for improving medical and nursing students' communication skills in caring of a patient with physiological deterioration.

METHOD

The program was conducted using full-scale simulation and communication strategies adapted from Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS). 127 medical and nursing students participated in a 3-hour small group interprofessional learning that incorporated simulation scenarios of deteriorating patients. Pre and post-tests were conducted to assess the students' self-confidence in interprofessional communication and perception in interprofessional learning. After the training, the students completed a satisfaction questionnaire.

RESULTS

Both medicine and nursing groups demonstrated a significant improvement on post-test score from pre-test score for self-confidence (p<.0001) and perception (p<.0001) with no significant differences detected between the two groups. The participants were highly satisfied with their simulation learning.

CONCLUSION

The Sim-IPE has better prepared the medical and nursing students in communicating with one another in providing safe care for deteriorating patient. In addition, it has improved their perception towards interprofessional learning. This pre-registration interprofessional education could prepare them for more comprehensive interprofessional team learning at post-registration level.

Reducing risk in maternity by optimising teamwork and leadership: an evidence-based approach to save mothers and babies

Poor teamwork results in preventable morbidity and mortality for mothers and babies. Suboptimal communication and lack of leadership cost not only lives but also money that is diverted from clinical care to insurance and litigation. Avoidable harm is usually not the result of staff failing their duty of care, it is the result of poor training failing hard-worked staff. A few simple teamwork and leadership behaviours can make a huge difference to outcome and experience for women and their companions, yet they are often missing from maternity care. Recent research has identified the problems and solutions, including the best way to train maternity teams to make a palpable difference. We describe simple yet evidence-based methods to improve teams and leaders.

Effects of pre-training using serious game technology on CPR performance--an exploratory quasi-experimental transfer study

BACKGROUND

Multiplayer virtual world (MVW) technology creates opportunities to practice medical procedures and team interactions using serious game software. This study aims to explore medical students' retention of knowledge and skills as well as their proficiency gain after pre-training using a MVW with avatars for cardio-pulmonary resuscitation (CPR) team training.

METHODS

Three groups of pre-clinical medical students, n = 30, were assessed and further trained using a high fidelity full-scale medical simulator: Two groups were pre-trained 6 and 18 months before assessment. A reference control group consisting of matched peers had no MVW pre-training. The groups consisted of 8, 12 and 10 subjects, respectively. The session started and ended with assessment scenarios, with 3 training scenarios in between. All scenarios were video-recorded for analysis of CPR performance.

RESULTS

The 6 months group displayed greater CPR-related knowledge than the control group, 93 (±11)% compared to 65 (±28)% (p < 0.05), the 18 months group scored in between (73 (±23)%).At start the pre-trained groups adhered better to guidelines than the control group; mean violations 0.2 (±0.5), 1.5 (±1.0) and 4.5 (±1.0) for the 6 months, 18 months and control group respectively. Likewise, in the 6 months group no chest compression cycles were delivered at incorrect frequencies whereas 54 (±44)% in the control group (p < 0.05) and 44 (±49)% in 18 months group where incorrectly paced; differences that disappeared during training.

CONCLUSIONS

This study supports the beneficial effects of MVW-CPR team training with avatars as a method for pre-training, or repetitive training, on CPR-skills among medical students.

Team performance in resuscitation teams: comparison and critique of two recently developed scoring tools

Background and aim

Following high profile errors resulting in patient harm and attracting negative publicity, the healthcare sector has begun to focus on training non-technical teamworking skills as one way of reducing the rate of adverse events. Within the area of resuscitation, two tools have been developed recently aiming to assess these skills – TEAM and OSCAR. The aims of the study reported here were:1.

To determine the inter-rater reliability of the tools in assessing performance within the context of resuscitation.

2.

To correlate scores of the same resuscitation teams episodes using both tools, thereby determining their concurrent validity within the context of resuscitation.

3.

To carry out a critique of both tools and establish how best each one may be utilised.

Methods

The study consisted of two phases – reliability assessment; and content comparison, and correlation. Assessments were made by two resuscitation experts, who watched 24 pre-recorded resuscitation simulations, and independently rated team behaviours using both tools. The tools were critically appraised, and correlation between overall score surrogates was assessed.

Results

Both OSCAR and TEAM achieved high levels of inter-rater reliability (in the form of adequate intra-class coefficients) and minor significant differences between Wilcoxon tests. Comparison of the scores from both tools demonstrated a high degree of correlation (and hence concurrent validity). Finally, critique of each tool highlighted differences in length and complexity.

Conclusion

Both OSCAR and TEAM can be used to assess resuscitation teams in a simulated environment, with the tools correlating well with one another. We envisage a role for both tools – with TEAM giving a quick, global assessment of the team, but OSCAR enabling more detailed breakdown of the assessment, facilitating feedback, and identifying areas of weakness for future training.