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Rider AC, Williams SR, Jones V, Rebagliati D, Schertzer K, Gisondi MA, Sebok-Syer SS. Assessing Team Performance: A Mixed-Methods Analysis Using Interprofessional in situ Simulation. West J Emerg Med 2024; 25:557-564. [PMID: 39028241 PMCID: PMC11254157 DOI: 10.5811/westjem.18012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 01/21/2024] [Accepted: 03/01/2024] [Indexed: 07/20/2024] Open
Abstract
Introduction Optimizing the performance of emergency department (ED) teams impacts patient care, but the utility of current, team-based performance assessment tools to comprehensively measure this impact is underexplored. In this study we aimed to 1) evaluate ED team performance using current team-based assessment tools during an interprofessional in situ simulation and 2) identify characteristics of effective ED teams. Methods This mixed-methods study employed case study methodology based on a constructivist paradigm. Sixty-three eligible nurses, technicians, pharmacists, and postgraduate year 2-4 emergency medicine residents at a tertiary academic ED participated in a 10-minute in situ simulation of a critically ill patient. Participants self-rated performance using the Team Performance Observation Tool (TPOT) 2.0 and completed a brief demographic form. Two raters independently reviewed simulation videos and rated performance using the TPOT 2.0, Team Emergency Assessment Measure (TEAM), and Ottawa Crisis Resource Management Global Rating Scale (Ottawa GRS). Following simulations, we conducted semi-structured interviews and focus groups with in situ participants. Transcripts were analyzed using thematic analysis. Results Eighteen team-based simulations took place between January-April 2021. Raters' scores were on the upper end of the tools for the TPOT 2.0 (R1 4.90, SD 0.17; R2 4.53, SD 0.27, IRR [inter-rater reliability] 0.47), TEAM (R1 3.89, SD 0.19; R2 3.58, SD 0.39, IRR 0.73), and Ottawa GRS (R1 6.6, SD 0.56; R2 6.2, SD 0.54, IRR 0.68). We identified six themes from our interview data: team member entrustment; interdependent energy; leadership tone; optimal communication; strategic staffing; and simulation empowering team performance. Conclusion Current team performance assessment tools insufficiently discriminate among high performing teams in the ED. Emergency department-specific assessments that capture features of entrustability, interdependent energy, and leadership tone may offer a more comprehensive way to assess an individual's contribution to a team's performance.
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Affiliation(s)
- Ashley C. Rider
- Stanford University, Department of Emergency Medicine, Palo Alto, California
| | - Sarah R. Williams
- Stanford University, Department of Emergency Medicine, Palo Alto, California
| | | | | | - Kimberly Schertzer
- Stanford University, Department of Emergency Medicine, Palo Alto, California
| | - Michael A. Gisondi
- Stanford University, Department of Emergency Medicine, Palo Alto, California
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Hooper GA, Butler AM, Guidry D, Kumar N, Brown K, Beninati W, Brown SM, Peltan ID. Relationship Between Resuscitation Team Members' Self-Efficacy and Team Competence During In-Hospital Cardiac Arrest. Crit Care Explor 2024; 6:e1029. [PMID: 38259865 PMCID: PMC10803034 DOI: 10.1097/cce.0000000000001029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2024] Open
Abstract
OBJECTIVES Inadequate self-efficacy of resuscitation team members may impair team performance, but high self-efficacy does not guarantee competence. We evaluated the relationship between individual self-efficacy and resuscitation team competence. DESIGN Secondary analysis of a randomized controlled trial. SETTING High-fidelity in situ in-hospital cardiac arrest simulations at seven hospitals in Utah. SUBJECTS Multidisciplinary cardiac arrest resuscitation team members. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Resuscitation team members completed surveys evaluating resuscitation self-efficacy (confidence in resuscitation role, difficulty thinking clearly, and concerns about committing errors) after each simulation. The primary outcome was event-level chest compression hands-on fraction greater than 75%. Secondary outcomes included other measures of resuscitation quality, advanced cardiac life support protocol adherence, and nontechnical team performance. Analyses employed the Datta-Satten rank-sum method to account for response clustering within simulation events. Of 923 participants in 76 analyzable simulations, 612 (66%) submitted complete surveys and 33 (43%) resuscitation teams achieved hands-on fraction greater than 75%. Event-level chest compression hands-on fraction greater than 75% versus less than or equal to 75% was not associated with the percentage of resuscitation team members reporting confidence in their team role (n = 213 [74%] vs. n = 251 [77%], respectively, p = 0.18), lack of difficulty thinking clearly (n = 186 [65%] vs. n = 214 [66%], p = 0.92), or lack of worry about making errors (n = 155 [54%] vs. n = 180 [55%], p = 0.41). Team members' confidence was also not associated with secondary outcomes, except that teams with confident members had better values for composite (3.55 [interquartile range, IQR 3.00-3.82] vs. 3.18 [IQR 2.57-3.64], p = 0.024) and global (8 [7-9] vs. 8 [6-8], p = 0.029) scales measuring nontechnical team performance. CONCLUSIONS Team members' self-efficacy was not associated with most team-level competence metrics during simulated cardiac arrest resuscitation. These data suggest that self-efficacy should have a limited role for evaluation of resuscitation training programs and for initial certification and monitoring of individual resuscitation team members' competence.
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Affiliation(s)
| | | | - David Guidry
- Department of Pulmonary and Critical Care Medicine, Intermountain Medical Center, Murray, UT
- Telecritical Care Program, Intermountain Health, Salt Lake City, UT
| | - Naresh Kumar
- Department of Pulmonary and Critical Care Medicine, Intermountain Medical Center, Murray, UT
| | - Katie Brown
- Department of Pulmonary and Critical Care Medicine, Intermountain Medical Center, Murray, UT
| | - William Beninati
- Telehealth Program, Intermountain Health, Salt Lake City, UT
- Department of Medicine, Stanford University School of Medicine, Stanford, CA
| | - Samuel M Brown
- Department of Pulmonary and Critical Care Medicine, Intermountain Medical Center, Murray, UT
- Telecritical Care Program, Intermountain Health, Salt Lake City, UT
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Utah School of Medicine, Salt Lake City, UT
| | - Ithan D Peltan
- Department of Pulmonary and Critical Care Medicine, Intermountain Medical Center, Murray, UT
- Telecritical Care Program, Intermountain Health, Salt Lake City, UT
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Utah School of Medicine, Salt Lake City, UT
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Armijo-Rivera S, Ferrada-Rivera S, Aliaga-Toledo M, Pérez LA. Application of the Team Emergency Assessment Measure Scale in undergraduate medical students and interprofessional clinical teams: validity evidence of a Spanish version applied in Chile. Front Med (Lausanne) 2023; 10:1256982. [PMID: 37771978 PMCID: PMC10525305 DOI: 10.3389/fmed.2023.1256982] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 08/23/2023] [Indexed: 09/30/2023] Open
Abstract
Background Teamwork is one of the competencies necessary for physicians to work effectively in health systems and is a competency that can be developed with simulation in professionals and medicine students. The Team Emergency Assessment Measurement (TEAM) was created to evaluate the non-technical performance of team members during resuscitation events in real teams. The TEAM scale includes items to assess leadership, teamwork, situational awareness, and task management. An objective evaluation tool in Spanish is valuable for training health professionals at all undergraduate and continuing education levels. This study aimed to generate evidence of the validity of the Team Emergency Assessment Measure (TEAM) in Spanish to measure the performance of medical students and adult, pediatric, and obstetric emergency clinical teams in simulated emergencies as a self-assessment tool. Methods To develop the Spanish version of the instrument, a forward and backward translation process was followed by independent translators, native and fluent in English and Spanish, and a review by a panel of Chilean experts comprising three trained simulation instructors to verify semantics and cultural equivalence. High-fidelity simulations with debriefing were conducted with 5th-year medical students, in which students and instructors applied the Spanish version of the TEAM scale. In the second stage, adult, pediatric, and obstetric emergency management simulations were conducted using the TEAM scale for real clinical teams as a self-assessment tool. Findings By applying the overall TEAM scale to medicine students and clinical teams, Cronbach's alpha was 0.921. For medical students' self-assessment, we obtained Cronbach's alpha of 0.869. No significant differences were found between the overall scores and the scores by dimensions evaluated by instructors and students (p > 0.05). In the case of clinical team training, Cronbach's alpha was 0.755 for adult emergency teams, 0.797 for pediatric emergency teams, and 0.853 for obstetric emergency teams. Conclusion The validated instrument is adequate for evaluating teamwork in medical student simulations by instructors and peers and for self-assessment in adult, pediatric, and obstetric emergency clinical teams.
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Affiliation(s)
- Soledad Armijo-Rivera
- Escuela de Medicina, Facultad de Medicina Clínica Alemana Universidad del Desarrollo, Santiago, Chile
| | - Sandra Ferrada-Rivera
- Escuela de Medicina, Facultad de Medicina Clínica Alemana Universidad del Desarrollo, Santiago, Chile
- Unidad de Calidad y Seguridad del Paciente, Hospital Padre Hurtado, Santiago, Chile
| | | | - Leonardo A. Pérez
- Centro de Habilidades Clínicas, Facultad de Medicina, Universidad de Chile, Santiago, Chile
- Centro de Habilidades Clínicas y Disciplinares, Universidad de O'Higgins, Rancagua, Chile
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Cooper S, Connell C, Cant R. Review article: Use of the Team Emergency Assessment Measure in the rating of emergency teams' non-technical skills: A mapping review. Emerg Med Australas 2023; 35:375-383. [PMID: 36849717 DOI: 10.1111/1742-6723.14184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 01/12/2023] [Accepted: 01/31/2023] [Indexed: 03/01/2023]
Abstract
The present study aims to explore the utility of the Team Emergency Assessment Measure (TEAM) in relation to the enhancement of emergency team non-technical skills based on research conducted over the last decade. In this mapping review, a citation mining process identified 22 primary studies for inclusion, published between 2012 and 2022. It provides outcome data on emergency teams' non-technical skills following team training and/or real-life patient emergencies. Emergency team studies related to resuscitation teams (adult, paediatric, newborn and obstetric cases) and medical emergency team (MET) management of patient deterioration. Team performance ratings varied, ranging from approximately 90% for experienced clinical teams down to 38% for students. Statistically significant improvements in performance were notable following training and/or repeated practice. Validity evidence, across 11 studies that provided change data described positive learning outcomes and moderate intervention effects. However, according to Kirkpatrick's model of educational evaluation the studies were limited to professional development phases of learning and immediate post-training assessments rather than care quality improvement. The review highlights a lack of studies evidencing quality improvement or clinical impact such as change of patient care practice or health service performance. There is a need to conduct well-designed studies that explore both technical and non-technical skills of resuscitation teams and METs. Currently, non-technical skills training and repeated performance evaluations using the TEAM contribute immensely to the proficiency of emergency teams.
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Affiliation(s)
- Simon Cooper
- Institute of Health and Wellbeing, Federation University Australia, Melbourne, Victoria, Australia
| | - Clifford Connell
- Nursing and Midwifery, Monash University, Melbourne, Victoria, Australia
| | - Robyn Cant
- Institute of Health and Wellbeing, Federation University Australia, Melbourne, Victoria, Australia
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Parry AE, Richardson A, Kirk MD, Colquhoun SM, Durrheim DN, Housen T. Team effectiveness: epidemiologists' perception of collective performance during emergency response. BMC Health Serv Res 2023; 23:149. [PMID: 36782194 PMCID: PMC9925216 DOI: 10.1186/s12913-023-09126-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Accepted: 01/27/2023] [Indexed: 02/15/2023] Open
Abstract
BACKGROUND To describe epidemiologists' experience of team dynamics and leadership during emergency response, and explore the utility of the Team Emergency Assessment Measure (TEAM) tool during future public health emergency responses. The TEAM tool included categories for leadership, teamwork, and task management. METHODS We conducted a cross-sectional survey between October 2019 and February 2020 with the global applied field epidemiology workforce. To validate the TEAM tool for our context, we used exploratory and confirmatory factor analysis. RESULTS We analysed 166 completed surveys. Respondents included national and international emergency responders with representation of all WHO regions. We were unable to validate the TEAM tool for use with epidemiology teams involved in emergency response, however descriptive analysis provided insight into epidemiology emergency response team performance. We found female responders were less satisfied with response leadership than male counterparts, and national responders were more satisfied across all survey categories compared to international responders. CONCLUSION Functional teams are a core attribute of effective public health emergency response. Our findings have shown a need for a greater focus on team performance. We recommend development of a fit-for-purpose performance management tool for teams responding to public health emergencies. The importance of building and supporting the development of the national workforce is another important finding of this study.
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Affiliation(s)
- Amy Elizabeth Parry
- The Australian National University (ANU), National Centre for Epidemiology & Population Health (NCEPH), Building 62 Mills Road, Acton, ACT, Australia.
| | - Alice Richardson
- grid.1001.00000 0001 2180 7477The Australian National University, Statistical Support Network, Acton, Australia
| | - Martyn D. Kirk
- grid.1001.00000 0001 2180 7477The Australian National University (ANU), National Centre for Epidemiology & Population Health (NCEPH), Building 62 Mills Road, Acton, ACT Australia
| | - Samantha M. Colquhoun
- grid.1001.00000 0001 2180 7477The Australian National University (ANU), National Centre for Epidemiology & Population Health (NCEPH), Building 62 Mills Road, Acton, ACT Australia
| | - David N. Durrheim
- grid.266842.c0000 0000 8831 109XUniversity of Newcastle, Newcastle, NSW Australia
| | - Tambri Housen
- grid.1001.00000 0001 2180 7477The Australian National University (ANU), National Centre for Epidemiology & Population Health (NCEPH), Building 62 Mills Road, Acton, ACT Australia ,grid.266842.c0000 0000 8831 109XUniversity of Newcastle, Newcastle, NSW Australia
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Hosseini M, Heydari A, Reihani H, Kareshki H. Development and psychometric properties of teamwork scale in resuscitation: A sequential exploratory mixed-method study. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2023; 12:10. [PMID: 37034876 PMCID: PMC10079185 DOI: 10.4103/jehp.jehp_139_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 04/12/2022] [Indexed: 06/19/2023]
Abstract
BACKGROUND Non-technical skills as a complement to technical skills have become increasingly important in cardio-pulmonary resuscitation, and teamwork is one of the most prominent of these skills. Because of the limited number of tools introduced and validated for measuring teamwork in resuscitation, this study was conducted to develop and evaluate the psychometric properties of the Teamwork Scale in Resuscitation (TSR). MATERIALS AND METHODS This study was a sequential exploratory mixed-method study and was conducted between March 2020 and April 2021 and in two phases. In the first phase (qualitative), semi-structured interviews were performed with resuscitation team members who were selected using a purposeful sampling method with maximum variation in terms of experience, level of education, age, and gender. Using directed qualitative content analysis, the data were analyzed and the primary item pool was developed. In the second phase (quantitative), assessing face, content, and construct validity as well as reliability via the internal consistency and stability, the psychometric properties of the instrument are evaluated. RESULTS The initial tool consisted of 54 items; after assessing the face validity, ten items were removed during content validity, and the final tool consisted of 44 items and three main categories including the essential prerequisites for resuscitation, leadership, and teamwork, which was scored based on a 5-point Likert scale from strongly disagree to strongly agree. The convergent validity and concurrent validity of the tool were confirmed. The reliability of the instrument was also confirmed using Cronbach's alpha test and re-test and the intra-class correlation coefficient (ICC) between raters. CONCLUSION The validity and reliability of TSR for measuring teamwork in resuscitation in a simulated environment are approved. Further studies are suggested for different contexts of resuscitation and with trained raters to evaluate its use in real resuscitation situations.
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Affiliation(s)
- Mohammad Hosseini
- Department of Medical Surgical Nursing, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Abbas Heydari
- Nursing and Midwifery Care Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Hamidreza Reihani
- Department of Emergency Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Hossein Kareshki
- Department of Psychology, Faculty of Educational Sciences and Psychology, Ferdowsi University of Mashhad, Iran
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Muthelo L, Seimela HM, Mbombi MO, Malema R, Phukubye A, Tladi L. Challenges for Optimum Cardiopulmonary Resuscitation in the Emergency Departments of Limpopo Province: A Qualitative Study. Healthcare (Basel) 2023; 11:healthcare11020158. [PMID: 36673526 PMCID: PMC9859251 DOI: 10.3390/healthcare11020158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 12/28/2022] [Accepted: 12/30/2022] [Indexed: 01/06/2023] Open
Abstract
AIM To describe the challenges for optimum resuscitation processes in Emergency Departments in Limpopo Province, South Africa. DESIGN A qualitative explorative research approach was adopted to explore the resuscitation team's experiences in Emergency Departments. METHOD Five medical doctors and twelve professional nurses were purposively sampled to participate in the study. The depth of the information obtained from the participants determined the sample size. Data collected from semi-structured individual interviews were analyzed using thematic analysis. Data quality was ensured by applying four elements: credibility, transferability, dependability, and confirmability. RESULTS The study findings indicated diverse challenges for optimum resuscitation processes that include: A general shortage of emergency personnel, the lack of material resources and the unavailability of funds for payment of national and international trauma symposiums, the poor maintenance of emergency equipment, the lack of a continuous training program and the resuscitation team receiving different instructions from various team leaders about the standardized procedures and policies of the resuscitation process. The team leaders and managers often blamed, depreciated and disregarded the resuscitation team for failed resuscitation efforts. Public contribution: The study findings are a point of reference for the emergency resuscitation team and the department of health policymakers. Trained and well-equipped emergency resuscitation teams can improve the quality of life for patients with cardiac arrest.
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Affiliation(s)
- Livhuwani Muthelo
- Department of Nursing Science, University of Limpopo, Sovenga St, Polokwane 0727, South Africa
- Correspondence:
| | - Hendrica Mosima Seimela
- Department of Nursing Science, University of Limpopo, Sovenga St, Polokwane 0727, South Africa
| | - Masenyani Oupa Mbombi
- Department of Nursing Science, University of Limpopo, Sovenga St, Polokwane 0727, South Africa
| | - Rambelani Malema
- Department of Physiology and Environmental Health, University of Limpopo, Sovenga St, Polokwane 0727, South Africa
| | - Arthur Phukubye
- Department of Nursing Science, University of Limpopo, Sovenga St, Polokwane 0727, South Africa
| | - Lerato Tladi
- Department of Nursing Science, University of Limpopo, Sovenga St, Polokwane 0727, South Africa
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Sturesson LW, Persson K, Olmstead R, Bjurström MF. Influence of airway trolley organization on efficiency and team performance: A randomized, crossover simulation study. Acta Anaesthesiol Scand 2023; 67:44-56. [PMID: 36196685 PMCID: PMC10092151 DOI: 10.1111/aas.14155] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 09/13/2022] [Accepted: 09/27/2022] [Indexed: 12/29/2022]
Abstract
BACKGROUND Failed management of unanticipated difficult airway situations contributes to significant anesthesia-related morbidity and mortality. Optimization of design and layout of difficult airway trolleys (DATs) may influence outcomes during airway emergencies. The main objective of the current study was to evaluate whether a difficult airway algorithm-based DAT with integrated cognitive aids improves efficiency and team performance in difficult airway scenarios. METHODS In a crossover design, 16 teams (anesthetist, nurse anesthetist, assistant nurse) completed two high-fidelity simulated unanticipated difficult airway scenarios. Teams used both an algorithm-based DAT and a comparison, standard DAT, in the scenarios and were randomized to order of trolley type. Outcome measures included objective efficiency parameters, team performance assessment and subjective user-ratings. Linear mixed models ANOVA, including DAT type and order of condition as main factors, was utilized for the primary analyses of the team results. RESULTS Usage of the algorithm-based DAT was associated with fewer departures from the difficult airway algorithm (p = .010), and reduced number of unnecessary drawer openings (p = .002), but no significant differences in time to retrieval of airway devices or time to first effective ventilation, compared to the standard DAT. There were no significant differences in team performance, although participants expressed strong preference for the algorithm-based DAT (all user-rated measures p < .0001). Higher percentage of female members of the team improved adherence to the difficult airway algorithm (p = .043). CONCLUSIONS Algorithm-based DATs with integrated cognitive aids may improve efficiency in difficult airway situations, compared to traditional DATs. These findings have implications for improvement of anesthetic practice.
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Affiliation(s)
- Louise W Sturesson
- Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Anaesthesiology and Intensive Care, Lund, Sweden
| | - Karolina Persson
- Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Anaesthesiology and Intensive Care, Lund, Sweden
| | - Richard Olmstead
- Norman Cousins Center for Psychoneuroimmunology, Jane and Terry Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles (UCLA), Los Angeles, California, USA
| | - Martin F Bjurström
- Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Anaesthesiology and Intensive Care, Lund, Sweden.,Norman Cousins Center for Psychoneuroimmunology, Jane and Terry Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles (UCLA), Los Angeles, California, USA
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Leeman KT, Raju RM, O’Brien C, Casey D, Hansen A. Development and use of an infant resuscitation performance tool (Infa-RePT) to improve team performance. Pediatr Res 2023; 93:56-62. [PMID: 35568732 PMCID: PMC9659671 DOI: 10.1038/s41390-022-02097-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 03/30/2022] [Accepted: 04/27/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND Measurement of neonatal team resuscitation performance is critical to identify opportunities for improvement and to target education. An effective tool to measure team performance during infant resuscitations is lacking. METHODS We developed an in-hospital infant resuscitation performance tool (Infa-RePT) using the modified Delphi method. We employed a QI framework and targeted interventions, including the use of role responsibility checklists, mock codes, and an educational video. We tracked Infa-RePT scores, mock code team attendance, and confidence surveys. Our specific aim was to improve Infa-RePT score from a baseline of 7.4 to <5 (lower is better) over a 26-month period. RESULTS Twenty-five elements reached >80% consensus as essential components to include on the Infa-RePT. Independent observation showed 86% concordance on checklist items. Simulation (n = 26) and unit-based code (n = 10) Infa-RePT scores showed significant improvement after project start from 7.4 to 4.2 (p < 0.01) with special cause variation noted on control chart analysis. No significant difference was observed between simulations and in-unit codes. Staff confidence self-reports improved over the study period. CONCLUSIONS Use of a novel scoring tool can help monitor team progress over time and identify areas for improvement. Focused interventions can improve resuscitation team performance. IMPACT We developed and used a novel, comprehensive measurement tool for team infant resuscitation performance in both simulation and in-unit settings. Using QI methodology, team performance improved after the enhancement of a mock code simulation program. Review of team performance scores can highlight key areas to target interventions and monitor progress over time.
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Affiliation(s)
- Kristen T. Leeman
- Boston Children’s Hospital, Division of Newborn Medicine, Boston, MA 02115;,Harvard Medical School, Boston, MA, 02115
| | - Ravikiran M. Raju
- Boston Children’s Hospital, Division of Newborn Medicine, Boston, MA 02115
| | - Caitlin O’Brien
- Boston Children’s Hospital, Division of Newborn Medicine, Boston, MA 02115
| | - Denise Casey
- Boston Children’s Hospital, Division of Newborn Medicine, Boston, MA 02115
| | - Anne Hansen
- Boston Children’s Hospital, Division of Newborn Medicine, Boston, MA 02115;,Harvard Medical School, Boston, MA, 02115
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Calhoun AW, Scerbo MW. Preparing and Presenting Validation Studies: A Guide for the Perplexed. Simul Healthc 2022; 17:357-365. [PMID: 35470343 DOI: 10.1097/sih.0000000000000667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
SUMMARY STATEMENT Simulated environments are frequently used for learner assessment, and a wide array of assessment instruments have been created to assist with this process. It is important, therefore, that clear, compelling evidence for the validity of these assessments be established. Contemporary theory recognizes instrument validity as a unified construct that links a construct to be assessed with a population, an environment of assessment, and a decision to be made using the scores. In this article, we present a primer on 2 current frameworks (Messick and Kane), define the elements of each, present a rubric that can be used by potential authors to structure their work, and offer examples of published studies showing how each framework has been successfully used to make a validity argument. We offer this with the goal of improving the quality of validity-related publications, thereby advancing the quality of assessment in healthcare simulation.
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Affiliation(s)
- Aaron W Calhoun
- From the Division of Pediatric Critical Care (A.W.C.), Department of Pediatrics, University of Louisville School of Medicine, Louisville, KY; and Department of Psychology (M.W.S.), Old Dominion University, Norfolk, VA
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Hosseini M, Heydari A, Reihani H, Kareshki H. Resuscitation Team Members 'Experiences of Teamwork: A Qualitative Study. IRANIAN JOURNAL OF NURSING AND MIDWIFERY RESEARCH 2022; 27:439-445. [PMID: 36524141 PMCID: PMC9745842 DOI: 10.4103/ijnmr.ijnmr_294_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 12/21/2021] [Accepted: 03/06/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND Despite the obvious importance of teamwork in emergency care, the dimensions of teamwork in resuscitation remain a subject of debate among specialists and researchers. The aim of this study was to identify the dimensions of teamwork based on the experiences of members of the resuscitation team. MATERIALS AND METHODS This study was conducted between March 2020 and April 2021. By purposive sampling, participants were selected. Sixteen semi-structured interviews were conducted with experienced emergency nurses and emergency medicine residents individually and analysed through deductive content analysis by using the Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS) model. Interviews were encoded for analysis using MAXQDA software (version 2020). RESULTS Three main categories were identified around teamwork in resuscitation. These categories were as follows (1) leadership, (2) teamwork, and (3) essential prerequisites for resuscitation. The main leadership category consisted of three sub-categories of time management, resource allocation, and task management. From sub-categories, situation monitoring, communication, and mutual support, the main category of teamwork emerged. Also, the emerging category of essential prerequisites for regeneration included two generic categories: professional requirements and workplace requirements and the teamwork category included situation monitoring, communication, and mutual support. CONCLUSIONS Based on the experiences of the resuscitation team members, leadership, teamwork, and essential prerequisites for resuscitation are the most important dimensions of teamwork in resuscitation. Recognizing the dimensions of teamwork in resuscitation is an initial step and then should be reflected in educational programs and future guidelines.
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Affiliation(s)
- Mohammad Hosseini
- Department of Medical Surgical Nursing, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran
- Department of Medical Surgical Nursing, School of Nursing, North Khorsan University of Medical Sciences, Bojnurd, Iran
| | - Abbas Heydari
- Nursing and Midwifery Care Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Hamidreza Reihani
- Department of Emergency Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Hossein Kareshki
- Department of Educational Sciences and Psychology, Ferdowsi University of Mashhad, Iran
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Peltan ID, Guidry D, Brown K, Kumar N, Beninati W, Brown SM. Telemedical Intensivist Consultation During In-Hospital Cardiac Arrest Resuscitation: A Simulation-Based, Randomized Controlled Trial. Chest 2022; 162:111-119. [PMID: 35063451 DOI: 10.1016/j.chest.2022.01.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 12/15/2021] [Accepted: 01/08/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND High-quality leadership improves resuscitation for in-hospital cardiac arrest (IHCA), but experienced resuscitation leaders are unavailable in many settings. RESEARCH QUESTION Does real-time telemedical intensivist consultation improve resuscitation quality for IHCA? STUDY DESIGN AND METHODS In this multicenter randomized controlled trial, standardized high-fidelity simulations of IHCA conducted between February 2017 and September 2018 on inpatient medicine and surgery units at seven hospitals were assigned randomly to consultation (intervention) or simulated observation (control) by a critical care physician via telemedicine. The primary outcome was the fraction of time without chest compressions (ie, no-flow fraction) during an approximately 4- to 6-min analysis window beginning with telemedicine activation. Secondary outcomes included other measures of chest compression quality, defibrillation and medication timing, resuscitation protocol adherence, nontechnical team performance, and participants' experience during resuscitation participation. RESULTS No-flow fraction did not differ between the 36 intervention group (0.22 ± 0.13) and the 35 control group (0.19 ± 0.10) resuscitation simulations included in the intention-to-treat analysis (P = .41). The etiology of the simulated cardiac arrest was identified more often during evaluable resuscitations supported by a telemedical intensivist consultant (22/32 [69%]) compared with control resuscitations (10/34 [29%]; P = .001), but other measures of resuscitation quality, resuscitation team performance, and participant experience did not differ between intervention groups. Problems with audio quality or the telemedicine connection affected 14 intervention group resuscitations (39%). INTERPRETATION Consultation by a telemedical intensivist physician did not improve resuscitation quality during simulated ward-based IHCA. TRIAL REGISTRY ClinicalTrials.gov; No.: NCT03000829; URL: www. CLINICALTRIALS gov.
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Affiliation(s)
- Ithan D Peltan
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Intermountain Medical Center, Murray, UT; Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Utah School of Medicine, Salt Lake City, UT; Telecritical Care Program, Intermountain Healthcare, Salt Lake City, UT.
| | - David Guidry
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Intermountain Medical Center, Murray, UT; Telecritical Care Program, Intermountain Healthcare, Salt Lake City, UT
| | - Katie Brown
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Intermountain Medical Center, Murray, UT
| | - Naresh Kumar
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Intermountain Medical Center, Murray, UT
| | - William Beninati
- Telehealth Program, Intermountain Healthcare, Salt Lake City, UT; Department of Medicine, Stanford University School of Medicine, Palo Alto, CA
| | - Samuel M Brown
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Intermountain Medical Center, Murray, UT; Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Utah School of Medicine, Salt Lake City, UT; Telecritical Care Program, Intermountain Healthcare, Salt Lake City, UT
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Dewolf P, Vanneste M, Desruelles D, Wauters L. Measuring non-technical skills during prehospital advanced cardiac life support: A pilot study. Resusc Plus 2021; 8:100171. [PMID: 34693380 PMCID: PMC8517196 DOI: 10.1016/j.resplu.2021.100171] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 09/16/2021] [Accepted: 09/19/2021] [Indexed: 11/05/2022] Open
Abstract
Aim To analyse non-technical skills of mobile medical teams during out-of-hospital cardiac arrests (OHCA) using the validated Team Emergency Assessment Measure (TEAM) tool. To research the correlation between non-technical skills and patient outcome. Methods Adult patients who experienced an out-of-hospital cardiac arrest between July 2016, and June 2018, and were treated by a mobile medical team from the University Hospital Leuven, were eligible for the study. Resuscitations were video recorded from the team leader’s perspective. Video recordings were reviewed and scored by emergency physicians, using the TEAM evaluation form. Results In total 114 OHCAs were analysed. The mean TEAM score was 34.4/44 (SD = 5.5). The mean item score was 3.1/4 (SD = 0.8). On average, ‘effective team communication’ had the lowest score (2.4), while ‘acting with composure and control’ and ‘following of approved standards/guidelines’ scored the highest (3.4). The average non-technical skills theme scores were 2.9 (SD = 0.9) for ‘Leadership’, 3.1 (SD = 0.8) for ‘Teamwork’ and 3.3 (SD = 0.7) for ‘Task management’. ‘Leadership’ was rated significantly lower than ‘Teamwork’ (p = 0.004) and ‘Task management’ (p < 0.001). No significant correlation was found between TEAM and return of spontaneous circulation (p = 0.574) or one month survival (p = 0.225). Conclusion The mean overall TEAM score was categorized as good. Task management scored high, while leadership and team communication received lower scores. Future training programs should thus focus on improving leadership and communication. In this pilot study no correlation was found between non-technical skills and survival.
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Affiliation(s)
- Philippe Dewolf
- Department of Emergency Medicine, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium.,KULeuven, University, Faculty of Medicine, Belgium
| | - Maïté Vanneste
- Department of Emergency Medicine, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - Didier Desruelles
- Department of Emergency Medicine, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - Lina Wauters
- Department of Emergency Medicine, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium
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Jonsson K, Hultin M, Härgestam M, Lindkvist M, Brulin C. Factors Influencing Team and Task Performance in Intensive Care Teams in a Simulated Scenario. Simul Healthc 2021; 16:29-36. [PMID: 32433185 DOI: 10.1097/sih.0000000000000462] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Healthcare teams and their performance in a complex environment such as that of intensive care units (ICUs) are influenced by several factors. This study investigates the relationship between team background characteristics and team as well as task performance. METHODS This study included 105 professionals (26 teams), working at the ICUs of 2 hospitals in Northern Sweden. The team-based simulation training sessions were video recorded, and thereafter, team performance and task performance were analyzed based on ratings of the TEAM instrument and the ABCDE checklist. RESULTS The final analyses showed that a higher age was significantly associated with better total team performance (β = 0.35, P = 0.04), teamwork (β = 0.04, P = 0.04), and task management (β = 0.04, P = 0.05) and with a higher overall rating for global team performance (β = 0.09, P = 0.02). The same pattern was found for the association between age and task performance (β = 0.02, P = 0.04). In addition, prior team training without video-facilitated reflection was significantly associated with better task performance (β = 0.35, P = 0.04). On the other hand, prior team training in communication was significantly associated with worse (β = -1.30, P = 0.02) leadership performance. CONCLUSIONS This study reveals that a higher age is important for better team performance when caring for a severely ill patient in a simulation setting in the ICU. In addition, prior team training had a positive impact on task performance. Therefore, on a team level, this study indicates that age and, to some extent, prior team training without video-facilitated reflection have an impact on team performance in the care of critically ill patients.
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Affiliation(s)
- Karin Jonsson
- From the Departments of Nursing (K.J., M.Ha., C.B.), Surgical and Perioperative Sciences, Anesthesiology and Critical Care Medicine (K.J., M.Hu.), and Epidemiology and Global Health (M.L.), Umeå University, Umeå, Sweden
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Saunders R, Wood E, Coleman A, Gullick K, Graham R, Seaman K. Emergencies within hospital wards: An observational study of the non-technical skills of medical emergency teams. Australas Emerg Care 2020; 24:89-95. [PMID: 32747297 DOI: 10.1016/j.auec.2020.07.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 06/28/2020] [Accepted: 07/10/2020] [Indexed: 11/15/2022]
Abstract
BACKGROUND Medical emergency teams are essential in responding to acute deterioration of patients in hospitals, requiring both clinical and non-technical skills. This study aims to assess the non-technical skills of medical emergency teams during hospital ward emergencies and explore team members perceptions and experiences of the use non-technical skills during medical emergencies. METHODS A multi-methods study was conducted in two phases. During phase one observation and assessment of non-technical skills used in medical emergencies using the Team Emergency Assessment Measure (TEAM™) was conducted; and in the phase two in-depth interviews were undertaken with medical emergency team members. RESULTS Based on 20 observations, mean TEAM™ ratings for non-technical skill domains were: 'leadership' 5.0 out of 8 (±2.0); 'teamwork' 21.6 out of 28 (±3.6); and 'task management' 6.5 out of 8 (±1.4). The mean 'global' score was 7.5 out of 10 (±1.5). The qualitative findings identified three areas, 'individual', 'team' and 'other' contributing factors, which impacted upon the non-technical skills of medical emergency teams. CONCLUSION Non-technical skills of hospital medical emergency teams differ, and the impact of the skill mix on resuscitation outcomes was recognised by team members. These findings emphasize the importance non-technical skills in resuscitation training and well-developed processes for medical emergency teams.
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Affiliation(s)
- Rosemary Saunders
- School of Nursing and Midwifery, Edith Cowan University, Joondalup, WA 6027, Australia.
| | - Emma Wood
- Hollywood Private Hospital, Nedlands, WA 6009, Australia.
| | - Adam Coleman
- Hollywood Private Hospital, Nedlands, WA 6009, Australia.
| | - Karen Gullick
- Hollywood Private Hospital, Nedlands, WA 6009, Australia.
| | - Renée Graham
- School of Nursing and Midwifery, Edith Cowan University, Joondalup, WA 6027, Australia.
| | - Karla Seaman
- School of Nursing and Midwifery, Edith Cowan University, Joondalup, WA 6027, Australia.
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Doymaz S, Rizvi M, Orsi M, Giambruno C. How Prepared Are Pediatric Residents for Pediatric Emergencies: Is Pediatric Advanced Life Support Certification Every 2 Years Adequate? Glob Pediatr Health 2019; 6:2333794X19876809. [PMID: 31555721 PMCID: PMC6747847 DOI: 10.1177/2333794x19876809] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 08/11/2019] [Accepted: 08/21/2019] [Indexed: 12/02/2022] Open
Abstract
Objectives. We assessed pediatric residents’ retention of knowledge and clinical skills according to the time since their last American Heart Association Pediatric Advanced Life Support (AHA PALS) certification. Methods. Sixty-four pediatric residents were recruited and divided into 3 groups based on the time since their last PALS certification, as follows: group 1, 0 to 8 months; group 2, 9 to 16 months, and group 3, 17 to 24 months. Residents’ knowledge was tested using 10 multiple-choice AHA PALS pretest questions and their clinical skills performance was assessed with simulation mock code scenarios using 2 different AHA PALS checklists, and mean scores were calculated for the 3 groups. Differences in the test scores and overall clinical skill performances among the 3 groups were analyzed using analyses of variance, χ2 tests, and Jonckheere-Terpstra tests. Statistical significance was set at P < .05. Results. The pediatric residents’ mean overall clinical skills performance scores declined within the first 8 months after their last AHA PALS certification date and continued to decrease over time (87%, 82.6%, and 77.4% for groups 1, 2, and 3, respectively; P = .048). Residents’ multiple-choice test scores declined in all 3 groups, but the scores were not significantly different. Conclusions. Residents’ clinical skills performance declined within the first 8 months after PALS certification and continued to decline as the time from the last certification increased. Using mock code simulations and reinforcing AHA PALS guidelines during pediatric residency deserve further evaluation.
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Affiliation(s)
- Sule Doymaz
- SUNY Downstate Medical Center, Brooklyn, NY, USA
| | - Munaza Rizvi
- SUNY Downstate Medical Center, Brooklyn, NY, USA
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Hultin M, Jonsson K, Härgestam M, Lindkvist M, Brulin C. Reliability of instruments that measure situation awareness, team performance and task performance in a simulation setting with medical students. BMJ Open 2019; 9:e029412. [PMID: 31515425 PMCID: PMC6747650 DOI: 10.1136/bmjopen-2019-029412] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Revised: 08/06/2019] [Accepted: 08/07/2019] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES The assessment of situation awareness (SA), team performance and task performance in a simulation training session requires reliable and feasible measurement techniques. The objectives of this study were to test the Airways-Breathing-Circulation-Disability-Exposure (ABCDE) checklist and the Team Emergency Assessment Measure (TEAM) for inter-rater reliability, as well as the application of Situation Awareness Global Assessment Technique (SAGAT) for feasibility and internal consistency. DESIGN Methodological approach. SETTING Data collection during team training using full-scale simulation at a university clinical training centre. The video-recorded scenarios were rated independently by four raters. PARTICIPANTS 55 medical students aged 22-40 years in their fourth year of medical studies, during the clerkship in anaesthesiology and critical care medicine, formed 23 different teams. All students answered the SAGAT questionnaires, and of these students, 24 answered the follow-up postsimulation questionnaire (PSQ). TEAM and ABCDE were scored by four professionals. MEASURES The ABCDE and TEAM were tested for inter-rater reliability. The feasibility of SAGAT was tested using PSQ. SAGAT was tested for internal consistency both at an individual level (SAGAT) and a team level (Team Situation Awareness Global Assessment Technique (TSAGAT)). RESULTS The intraclass correlation was 0.54/0.83 (single/average measurements) for TEAM and 0.55/0.83 for ABCDE. According to the PSQ, the items in SAGAT were rated as relevant to the scenario by 96% of the participants. Cronbach's alpha for SAGAT/TSAGAT for the two scenarios was 0.80/0.83 vs 0.62/0.76, and normed χ² was 1.72 vs 1.62. CONCLUSION Task performance, team performance and SA could be purposefully measured, and the reliability of the measurements was good.
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Affiliation(s)
- Magnus Hultin
- Department of Surgical and Perioperative Sciences, Anesthesiology and Critical Care Medicine, Umeå University, Umeå, Sweden
| | - Karin Jonsson
- Department of Surgical and Perioperative Sciences, Anesthesiology and Critical Care Medicine, Umeå University, Umeå, Sweden
- Department of Nursing, Umeå University, Umeå, Sweden
| | | | - Marie Lindkvist
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
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Freytag J, Stroben F, Hautz WE, Schauber SK, Kämmer JE. Rating the quality of teamwork-a comparison of novice and expert ratings using the Team Emergency Assessment Measure (TEAM) in simulated emergencies. Scand J Trauma Resusc Emerg Med 2019; 27:12. [PMID: 30736821 PMCID: PMC6368771 DOI: 10.1186/s13049-019-0591-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Accepted: 11/14/2018] [Indexed: 01/01/2023] Open
Abstract
Background Training in teamwork behaviour improves technical resuscitation performance. However, its effect on patient outcome is less clear, partly because teamwork behaviour is difficult to measure. Furthermore, it is unknown who should evaluate it. In clinical practice, experts are obliged to participate in resuscitation efforts and are thus unavailable to assess teamwork quality. Consequently, we sought to determine if raters with little clinical experience and experts provide comparable evaluations of teamwork behaviour. Methods Novice and expert raters judged teamwork behaviour during 6 emergency medicine simulations using the Teamwork Emergency Assessment Measure (TEAM). Ratings of both groups were analysed descriptively and compared with U and t tests. We used a mixed effects model to identify the proportion of variance in TEAM scores attributable to rater status and other sources. Results Twelve raters evaluated 7 teams rotating through 6 cases, for a total of 84 observations. We found no significant difference between expert and novice ratings for 7 of the 11 items of the TEAM or in the sums of all item scores. Novices rated teamwork behaviour higher on 4 items and overall. Rater status accounted for 11.1% of the total variance in scores. Conclusions Experts’ and novices’ ratings were similarly distributed, implying that raters with limited experience can provide reliable data on teamwork behaviour. Novices show a consistent, but slightly more lenient rating behaviour. Clinical studies and real-life teams may thus employ novices using a structured observational tool such as TEAM to inform their performance review and improvement. Electronic supplementary material The online version of this article (10.1186/s13049-019-0591-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Julia Freytag
- Simulated Patients Program, Office of the Vice Dean for Teaching and Learning, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany
| | - Fabian Stroben
- Lernzentrum, Office of the Vice Dean for Teaching and Learning, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany.,AG Progress Test Medizin, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany
| | - Wolf E Hautz
- Department of Emergency Medicine, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 4, 3010, Bern, Switzerland.,Centre for Health Sciences Education, University of Oslo, Gaustadalléen 30, 0373, Oslo, Norway
| | - Stefan K Schauber
- Centre for Health Sciences Education, University of Oslo, Gaustadalléen 30, 0373, Oslo, Norway
| | - Juliane E Kämmer
- AG Progress Test Medizin, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany. .,Center for Adaptive Rationality, Max Planck Institute for Human Development, Lentzeallee 94, 14195, Berlin, Germany.
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Morse JC, Brown CW, Morrison I, Wood C. Interprofessional learning in immediate life support training does effect TEAM performance during simulated resuscitation. BMJ SIMULATION & TECHNOLOGY ENHANCED LEARNING 2018; 5:204-209. [DOI: 10.1136/bmjstel-2018-000394] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/05/2018] [Indexed: 11/04/2022]
Abstract
Aim of the studyTo assess performance in a simulated resuscitation after participating in either an interprofessional learning (IPL) or uniprofessional learning (UPL) immediate life support (ILS) training course.IntroductionThe Team Emergency Assessment Measure (TEAM) is routinely used in Resuscitation Council (UK) Advanced Life Support courses. This study used the psychometrically validated tool to assess if the delivery of an IPL ILS to final year medical and nursing students could improve overall behavioural performance and global TEAM score.MethodsA randomised study of medical (n=48) and nursing (n=48) students, assessing performance in a simulated resuscitation following the IPL or UPL ILS courses. Postcourse completion participants were invited back to undertake a video-recorded simulated-resuscitation scenario. Each of these were reviewed using the TEAM tool, at the time by an experienced advanced life support instructor and subsequently by a clinician, independent to the study and blinded as to which cohort they were reviewing.ResultsInter-rater reliability was tested using a Bland-Altman plot indicating non-proportional bias between raters. Parametric testing and analysis showed statistically significant higher global overall mean TEAM scores for those who had attended the IPL ILS courses.ConclusionOur results demonstrate that an IPL approach in ILS produced an increased effect on TEAM scores with raters recording a significantly more collaborative team performance. A postscenario questionnaire for students also found a significantly improved experience within the team following the IPL course compared with those completing UPL training. Although this study shows that team behaviour and performance can change and improve in the short-term, we acknowledge further studies are required to assess the long-term effects of IPL interventions. Additionally, through this type of study methodology, other outcomes in regard to resuscitation team performance may be measured, highlighting other potential benefit to patients, at level four of Kirkpatrick’s hierarchy.
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Boet S, Etherington N, Larrigan S, Yin L, Khan H, Sullivan K, Jung JJ, Grantcharov TP. Measuring the teamwork performance of teams in crisis situations: a systematic review of assessment tools and their measurement properties. BMJ Qual Saf 2018; 28:327-337. [PMID: 30309910 DOI: 10.1136/bmjqs-2018-008260] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Revised: 08/08/2018] [Accepted: 08/09/2018] [Indexed: 01/03/2023]
Abstract
BACKGROUND Educational interventions to improve teamwork in crisis situations have proliferated in recent years with substantial variation in teamwork measurement. This systematic review aimed to synthesise available tools and their measurement properties in order to identify the most robust tool for measuring the teamwork performance of teams in crisis situations. METHODS Searches were conducted in Embase (via OVID), PsycINFO, Cumulative Index to Nursing and Allied Health Literature, Education Resources Information Center, Medline and Medline In-Process (via OVID) (through 12 January 2017). Studies evaluating the measurement properties of teamwork assessment tools for teams in clinical or simulated crisis situations were included. Two independent reviewers screened studies based on predetermined criteria and completed data extraction. Risk of bias was assessed using the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) checklist. RESULTS The search yielded 1822 references. Twenty studies were included, representing 13 assessment tools. Tools were primarily assessed in simulated resuscitation scenarios for emergency department teams. The Team Emergency Assessment Measure (TEAM) had the most validation studies (n=5), which demonstrated three sources of validity (content, construct and concurrent) and three sources of reliability (internal consistency, inter-rater reliability and test-retest reliability). Most studies of TEAM's measurement properties were at no risk of bias. CONCLUSIONS A number of tools are available for assessing teamwork performance of teams in crisis situations. Although selection will ultimately depend on the user's context, TEAM may be the most promising tool given its measurement evidence. Currently, there is a lack of tools to assess teamwork performance during intraoperative crisis situations. Additional research is needed in this regard.
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Affiliation(s)
- Sylvain Boet
- Anesthesiology and Pain Medicine, The Ottawa Hospital, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Nicole Etherington
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Sarah Larrigan
- University of Ottawa Faculty of Medicine, Ottawa, Canada
| | - Li Yin
- University of Ottawa Faculty of Medicine, Ottawa, Canada
| | - Hira Khan
- Department of Health Sciences, Faculty of Science , Carleton University, Ottawa, Canada
| | - Katrina Sullivan
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - James J Jung
- Division of General Surgery, St. Michael's Hospital, Toronto, Canada
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Mete I, Brannick MT. Estimating the Reliability of Nontechnical Skills in Medical Teams. JOURNAL OF SURGICAL EDUCATION 2017; 74:596-611. [PMID: 28110855 DOI: 10.1016/j.jsurg.2016.12.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/11/2016] [Revised: 11/27/2016] [Accepted: 12/26/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVE To assess the reliability of measurement of assessments of nontechnical skills in medical teams. BACKGROUND There are several scales for assessing nontechnical skills in medical teams. In this critique, we describe the reliability of such assessments and discuss factors that may influence the obtained estimate of reliability for such scales. METHOD A review of the literature yielded 28 reliability estimates, mostly intraclass correlations. We analyzed the methods of scale development and reliability estimation for factors that are likely to influence the resulting estimate, including aspects of the judges, the targets, what is observed, and the kind of reliability coefficient. RESULTS Typical reliability was approximately 0.7, but estimates were quite varied in magnitude, from quite low (0.3) to quite high (0.9). Thus, highly reliable assessment is possible, but rarely achieved. Factors that are likely to influence the magnitude of reliability include the number of assessors, the participants' range in skill level, and the observational process. Most studies do not present enough information to make the estimates comparable from one study to the next. CONCLUSIONS Although nontechnical skills can be measured reliably under some circumstances, it is not clear from the existing literature that one scale provides more reliable data than another. We recommend several practices that would help readers to make informed decisions about which scales are most useful for their purposes.
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Affiliation(s)
- Ipek Mete
- Department of Psychology, Middle East Technical University, Ankara, Turkey
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Patel M, Hartswood M, Webb H, Gobbi M, Monger E, Jirotka M. Authority as an Interactional Achievement: Exploring Deference to Smart Devices in Hospital-Based Resuscitation. Comput Support Coop Work 2017. [DOI: 10.1007/s10606-017-9274-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Morineau T, Flach JM, Le Courtois M, Chapelain P. An extended version of the Rasmussen’s Dynamic Safety Model for measuring multitasking behaviors during medical emergency. ACTA ACUST UNITED AC 2017. [DOI: 10.1177/2327857917061052] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
An extended version of the Rasmussen’s Dynamic Safety Model was implemented to empirically index team activity during a medical emergency. The video recordings of two emergency training sessions during the simulation of an adverse event with two paramedical teams were analyzed with a coding scheme based on the model. We show that individual’s allocation of perceptions and actions to multiple work constraints (i.e., patient’s state monitoring, information processing with team, and equipment management) can be dynamically tracked.
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Affiliation(s)
| | - John M. Flach
- Wright State University, Department of Psychology, Dayton, OH USA
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Cant RP, Porter JE, Cooper SJ, Roberts K, Wilson I, Gartside C. Improving the non-technical skills of hospital medical emergency teams: The Team Emergency Assessment Measure (TEAM™). Emerg Med Australas 2016; 28:641-646. [DOI: 10.1111/1742-6723.12643] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Revised: 05/23/2016] [Accepted: 06/02/2016] [Indexed: 12/14/2022]
Affiliation(s)
- Robyn P Cant
- School of Nursing and Midwifery; Monash University; Narre Warren Victoria Australia
| | - Joanne E Porter
- School of Nursing, Midwifery and Healthcare; Federation University Australia; Churchill Victoria Australia
| | - Simon J Cooper
- School of Nursing, Midwifery and Healthcare; Federation University Australia; Churchill Victoria Australia
| | - Kate Roberts
- Emergency Department; Central Gippsland Health Service; Sale Victoria Australia
| | - Ian Wilson
- Emergency Department; Northeast Health (Wangaratta); Wangaratta Victoria Australia
| | - Christopher Gartside
- Emergency Department; Northeast Health (Wangaratta); Wangaratta Victoria Australia
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Measuring teamwork performance: Validity testing of the Team Emergency Assessment Measure (TEAM) with clinical resuscitation teams. Resuscitation 2016; 101:97-101. [DOI: 10.1016/j.resuscitation.2016.01.026] [Citation(s) in RCA: 64] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Revised: 12/14/2015] [Accepted: 01/11/2016] [Indexed: 11/19/2022]
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Maignan M, Koch FX, Chaix J, Phellouzat P, Binauld G, Collomb Muret R, Cooper SJ, Labarère J, Danel V, Viglino D, Debaty G. Team Emergency Assessment Measure (TEAM) for the assessment of non-technical skills during resuscitation: Validation of the French version. Resuscitation 2016; 101:115-20. [DOI: 10.1016/j.resuscitation.2015.11.024] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Revised: 11/19/2015] [Accepted: 11/29/2015] [Indexed: 11/26/2022]
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Dagnone JD, Hall AK, Sebok-Syer S, Klinger D, Woolfrey K, Davison C, Ross J, McNeil G, Moore S. Competency-based simulation assessment of resuscitation skills in emergency medicine postgraduate trainees - a Canadian multi-centred study. CANADIAN MEDICAL EDUCATION JOURNAL 2016; 7:e57-e67. [PMID: 27103954 PMCID: PMC4830374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
BACKGROUND The use of high-fidelity simulation is emerging as a desirable method for competency-based assessment in postgraduate medical education. We aimed to demonstrate the feasibility and validity of a multi-centre simulation-based Objective Structured Clinical Examination (OSCE) of resuscitation competence with Canadian Emergency Medicine (EM) trainees. METHOD EM postgraduate trainees (n=98) from five Canadian academic centres participated in a high fidelity, 3-station simulation-based OSCE. Expert panels of three emergency physicians evaluated trainee performances at each centre using the Queen's Simulation Assessment Tool (QSAT). Intraclass correlation coefficients were used to measure the inter-rater reliability, and analysis of variance was used to measure the discriminatory validity of each scenario. A fully crossed generalizability study was also conducted for each examination centre. RESULTS Inter-rater reliability in four of the five centres was strong with a median absolute intraclass correlation coefficient (ICC) across centres and scenarios of 0.89 [0.65-0.97]. Discriminatory validity was also strong (p < 0.001 for scenarios 1 and 3; p < 0.05 for scenario 2). Generalizability studies found significant variations at two of the study centres. CONCLUSIONS This study demonstrates the successful pilot administration of a multi-centre, 3-station simulation-based OSCE for the assessment of resuscitation competence in post-graduate Emergency Medicine trainees.
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Affiliation(s)
| | | | | | | | | | - Colleen Davison
- Department of Emergency Medicine, Queen’s University
- Department of Public Health Sciences, Queen’s University
| | - John Ross
- Department of Emergency Medicine, Dalhousie University
| | - Gordon McNeil
- Department of Emergency Medicine University of Calgary
| | - Sean Moore
- Department of Emergency Medicine, University of Ottawa
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Yeung J. Transforming a team of experts into an expert team. Resuscitation 2016; 101:A1-2. [PMID: 26860826 DOI: 10.1016/j.resuscitation.2016.02.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Accepted: 02/01/2016] [Indexed: 11/27/2022]
Affiliation(s)
- Joyce Yeung
- Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK; Academic Department of Anaesthesia, Critical Care, Pain and Resuscitation, Heart of England NHS Foundation Trust, Birmingham, UK.
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Innocenti F, Angeli E, Alesi A, Scorpiniti M, Pini R. Teamwork evaluation during emergency medicine residents’ high-fidelity simulation. BMJ SIMULATION & TECHNOLOGY ENHANCED LEARNING 2016; 2:12-18. [DOI: 10.1136/bmjstel-2015-000068] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/12/2016] [Indexed: 11/04/2022]
Abstract
BackgroundTeamwork training has been included in several emergency medicine (EM) curricula; the aim of this study was to compare different scales’ performance in teamwork evaluation during simulation for EM residents.MethodsIn the period October 2013–June 2014, we performed bimonthly high-fidelity simulation sessions, with novice (I–III year, group 1 (G1)) and senior (IV–V year, group 2 (G2)) EM residents; scenarios were designed to simulate management of critical patients. Videos were assessed by three independent raters with the following scales: Emergency Team Dynamics (ETD), Clinical Teamwork Scale (CTS) and Team Emergency Assessment Measure (TEAM). In the period March–June, after each scenario, participants completed the CTS and ETD.ResultsThe analysis based on 18 sessions showed good internal consistency and good to fair inter-rater reliability for the three scales (TEAM, CTS, ETD: Cronbach's α 0.954, 0.954, 0.921; Intraclass Correlation Coefficients (ICC), 0.921, 0.917, 0.608). Single CTS items achieved highly significant ICC results, with 12 of the total 13 comparisons achieving ICC results ≥0.70; a similar result was confirmed for 4 of the total 11 TEAM items and 1 of the 8 total ETD items. Spearman's r was 0.585 between ETD and CTS, 0.694 between ETD and TEAM, and 0.634 between TEAM and CTS (scales converted to percentages, all p<0.0001). Participants gave themselves a better evaluation compared with external raters (CTS: 101±9 vs 90±9; ETD: 25±3 vs 20±5, all p<0.0001).ConclusionsAll examined scales demonstrated good internal consistency, with a slightly better inter-rater reliability for CTS compared with the other tools.
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Sørensen JL, van der Vleuten C, Rosthøj S, Østergaard D, LeBlanc V, Johansen M, Ekelund K, Starkopf L, Lindschou J, Gluud C, Weikop P, Ottesen B. Simulation-based multiprofessional obstetric anaesthesia training conducted in situ versus off-site leads to similar individual and team outcomes: a randomised educational trial. BMJ Open 2015; 5:e008344. [PMID: 26443654 PMCID: PMC4611309 DOI: 10.1136/bmjopen-2015-008344] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To investigate the effect of in situ simulation (ISS) versus off-site simulation (OSS) on knowledge, patient safety attitude, stress, motivation, perceptions of simulation, team performance and organisational impact. DESIGN Investigator-initiated single-centre randomised superiority educational trial. SETTING Obstetrics and anaesthesiology departments, Rigshospitalet, University of Copenhagen, Denmark. PARTICIPANTS 100 participants in teams of 10, comprising midwives, specialised midwives, auxiliary nurses, nurse anaesthetists, operating theatre nurses, and consultant doctors and trainees in obstetrics and anaesthesiology. INTERVENTIONS Two multiprofessional simulations (clinical management of an emergency caesarean section and a postpartum haemorrhage scenario) were conducted in teams of 10 in the ISS versus the OSS setting. PRIMARY OUTCOME Knowledge assessed by a multiple choice question test. EXPLORATORY OUTCOMES Individual outcomes: scores on the Safety Attitudes Questionnaire, stress measurements (State-Trait Anxiety Inventory, cognitive appraisal and salivary cortisol), Intrinsic Motivation Inventory and perceptions of simulations. Team outcome: video assessment of team performance. Organisational impact: suggestions for organisational changes. RESULTS The trial was conducted from April to June 2013. No differences between the two groups were found for the multiple choice question test, patient safety attitude, stress measurements, motivation or the evaluation of the simulations. The participants in the ISS group scored the authenticity of the simulation significantly higher than did the participants in the OSS group. Expert video assessment of team performance showed no differences between the ISS versus the OSS group. The ISS group provided more ideas and suggestions for changes at the organisational level. CONCLUSIONS In this randomised trial, no significant differences were found regarding knowledge, patient safety attitude, motivation or stress measurements when comparing ISS versus OSS. Although participant perception of the authenticity of ISS versus OSS differed significantly, there were no differences in other outcomes between the groups except that the ISS group generated more suggestions for organisational changes. TRIAL REGISTRATION NUMBER NCT01792674.
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Affiliation(s)
- Jette Led Sørensen
- Juliane Marie Centre for Children, Women and Reproduction, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Cees van der Vleuten
- Faculty of Health, Medicine and Life Sciences, Department of Educational Development and Research, Maastricht University, Maastricht, The Netherlands
| | - Susanne Rosthøj
- Faculty of Health and Medical Sciences, Section of Biostatistics, Institute of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Doris Østergaard
- Danish Institute for Medical Simulation, Herlev Hospital, Capital Region of Denmark and University of Copenhagen, Herlev, Denmark
| | - Vicki LeBlanc
- University of Ottawa Skills and Simulation Centre, The Ottawa Hospital, University of Ottawa, Ottawa, Canada
| | - Marianne Johansen
- Department of Obstetrics, Juliane Marie Centre for Children, Women and Reproduction, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Kim Ekelund
- Department of Anaesthesiology, Juliane Marie Centre for Children, Women and Reproduction, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Liis Starkopf
- Faculty of Health and Medical Sciences, Section of Biostatistics, Institute of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Jane Lindschou
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Christian Gluud
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Pia Weikop
- Laboratory of Neuropsychiatry, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Bent Ottesen
- Juliane Marie Centre for Children, Women and Reproduction, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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Baker VO, Cuzzola R, Knox C, Liotta C, Cornfield CS, Tarkowski RD, Masters C, McCarthy M, Sturdivant S, Carlson JN. Teamwork education improves trauma team performance in undergraduate health professional students. JOURNAL OF EDUCATIONAL EVALUATION FOR HEALTH PROFESSIONS 2015; 12:36. [PMID: 26101404 PMCID: PMC4536358 DOI: 10.3352/jeehp.2015.12.36] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Accepted: 06/21/2015] [Indexed: 05/05/2023]
Abstract
PURPOSE Effective trauma resuscitation requires efficient and coordinated care from a team of providers; however, providers are rarely instructed on how to be effective members of trauma teams. Team-based learning using Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS) has been shown to improve team dynamics among practicing professionals, including physicians and nurses. The impact of TeamSTEPPS on students being trained in trauma management in an undergraduate health professional program is currently unknown. We sought to determine the impact of TeamSTEPPS on team dynamics among undergraduate students being trained in trauma resuscitation. METHODS We enrolled teams of undergraduate health professional students from four programs: nursing, physician assistant, radiologic science, and respiratory care. After completing an online training on trauma resuscitation principles, the participants completed a trauma resuscitation scenario. The participants then received teamwork training using TeamSTEPPS and completed a second trauma resuscitation scenario identical to the first. All resuscitations were recorded and scored offline by two blinded research assistants using both the Team Emergency Assessment Measure (TEAM) and Trauma Team Performance Observation Tool (TPOT) scoring systems. Pre-test and post-test TEAM and TPOT scores were compared. RESULTS We enrolled a total of 48 students in 12 teams. Team leadership, situational monitoring, and overall communication improved with TeamSTEPPS training (P=0.04, P=0.02, and P=0.03, respectively), as assessed by the TPOT scoring system. TeamSTEPPS also improved the team's ability to prioritize tasks and work together to complete tasks in a rapid manner (P<0.01 and P=0.02, respectively) as measured by TEAM. CONCLUSIONS Incorporating TeamSTEPPS into trauma team education leads to improved TEAM and TPOT scores among undergraduate health professionals.
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Affiliation(s)
- Valerie O’Toole Baker
- Villa Maria School of Nursing, Morosky College of Health Professions and Sciences, Gannon University, Erie, USA
| | - Ronald Cuzzola
- Radiologic Sciences Program, Morosky College of Health Professions and Sciences, Gannon University, Erie, USA
| | - Carolyn Knox
- Physician Assistant Program, Morosky College of Health Professions and Sciences, Gannon University, Erie, USA
| | - Cynthia Liotta
- Radiologic Sciences Program, Morosky College of Health Professions and Sciences, Gannon University, Erie, USA
| | - Charles S. Cornfield
- Respiratory Care Program, Morosky College of Health Professions and Sciences, Gannon University, Erie, USA
| | - Robert D. Tarkowski
- Respiratory Care Program, Morosky College of Health Professions and Sciences, Gannon University, Erie, USA
| | - Carolynn Masters
- Office of the Provost, Morosky College of Health Professions and Sciences, Gannon University, Erie, USA
| | - Michael McCarthy
- Villa Maria School of Nursing, Morosky College of Health Professions and Sciences, Gannon University, Erie, USA
| | - Suzanne Sturdivant
- Radiologic Sciences Program, Morosky College of Health Professions and Sciences, Gannon University, Erie, USA
| | - Jestin N. Carlson
- Patient Simulation Center, Morosky College of Health Professions and Sciences, Gannon University, Erie, USA
- Department of Emergency Medicine, Saint Vincent Health System, Erie, USA
- *Corresponding
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Beyond crisis resource management: new frontiers in human factors training for acute care medicine. Curr Opin Anaesthesiol 2014; 26:699-706. [PMID: 24113265 DOI: 10.1097/aco.0000000000000007] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
PURPOSE OF REVIEW Error is ubiquitous in medicine, particularly during critical events and resuscitation. A significant proportion of adverse events can be attributed to inadequate team-based skills such as communication, leadership, situation awareness and resource utilization. Aviation-based crisis resource management (CRM) training using high-fidelity simulation has been proposed as a strategy to improve team behaviours. This review will address key considerations in CRM training and outline recommendations for the future of human factors education in healthcare. RECENT FINDINGS A critical examination of the current literature yields several important considerations to guide the development and implementation of effective simulation-based CRM training. These include defining a priori domain-specific objectives, creating an immersive environment that encourages deliberate practice and transfer-appropriate processing, and the importance of effective team debriefing. Building on research from high-risk industry, we suggest that traditional CRM training may be augmented with new training techniques that promote the development of shared mental models for team and task processes, address the effect of acute stress on team performance, and integrate strategies to improve clinical reasoning and the detection of cognitive errors. SUMMARY The evolution of CRM training involves a 'Triple Threat' approach that integrates mental model theory for team and task processes, training for stressful situations and metacognition and error theory towards a more comprehensive training paradigm, with roots in high-risk industry and cognitive psychology. Further research is required to evaluate the impact of this approach on patient-oriented outcomes.
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Bogossian F, Cooper S, Cant R, Beauchamp A, Porter J, Kain V, Bucknall T, Phillips NM. Undergraduate nursing students' performance in recognising and responding to sudden patient deterioration in high psychological fidelity simulated environments: an Australian multi-centre study. NURSE EDUCATION TODAY 2014; 34:691-696. [PMID: 24183634 DOI: 10.1016/j.nedt.2013.09.015] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2013] [Revised: 09/13/2013] [Accepted: 09/18/2013] [Indexed: 06/02/2023]
Abstract
BACKGROUND Early recognition and situation awareness of sudden patient deterioration, a timely appropriate clinical response, and teamwork are critical to patient outcomes. High fidelity simulated environments provide the opportunity for undergraduate nursing students to develop and refine recognition and response skills. OBJECTIVES This paper reports the quantitative findings of the first phase of a larger program of ongoing research: Feedback Incorporating Review and Simulation Techniques to Act on Clinical Trends (FIRST2ACTTM). It specifically aims to identify the characteristics that may predict primary outcome measures of clinical performance, teamwork and situation awareness in the management of deteriorating patients. DESIGN Mixed-method multi-centre study. SETTING High fidelity simulated acute clinical environment in three Australian universities. PARTICIPANTS A convenience sample of 97 final year nursing students enrolled in an undergraduate Bachelor of Nursing or combined Bachelor of Nursing degree were included in the study. METHOD In groups of three, participants proceeded through three phases: (i) pre-briefing and completion of a multi-choice question test, (ii) three video-recorded simulated clinical scenarios where actors substituted real patients with deteriorating conditions, and (iii) post-scenario debriefing. Clinical performance, teamwork and situation awareness were evaluated, using a validated standard checklist (OSCE), Team Emergency Assessment Measure (TEAM) score sheet and Situation Awareness Global Assessment Technique (SAGAT). A Modified Angoff technique was used to establish cut points for clinical performance. RESULTS Student teams engaged in 97 simulation experiences across the three scenarios and achieved a level of clinical performance consistent with the experts' identified pass level point in only 9 (1%) of the simulation experiences. Knowledge was significantly associated with overall teamwork (p=.034), overall situation awareness (p=.05) and clinical performance in two of the three scenarios (p=.032 cardiac and p=.006 shock). Situation awareness scores of scenario team leaders were low overall, with an average total score of 41%. CONCLUSIONS Final year undergraduate nursing students may have difficulty recognising and responding appropriately to patient deterioration. Improving pre-requisite knowledge, rehearsal of first response and team management strategies need to be a key component of undergraduate nursing students' education and ought to specifically address clinical performance, teamwork and situation awareness.
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Affiliation(s)
- Fiona Bogossian
- The School of Nursing & Midwifery, The University of Queensland, Herston Campus, QLD, Australia.
| | - Simon Cooper
- The School of Nursing & Midwifery, Monash University, Berwick Campus, VIC, Australia
| | - Robyn Cant
- The School of Nursing & Midwifery, Monash University, Berwick Campus, VIC, Australia
| | - Alison Beauchamp
- The School of Nursing & Midwifery, Monash University, Berwick Campus, VIC, Australia; Population Health Strategic Research Centre, Deakin University, Burwood Campus, VIC, Australia
| | - Joanne Porter
- The School of Nursing & Midwifery, Monash University, Gippsland Campus, VIC, Australia
| | - Victoria Kain
- The School of Nursing & Midwifery, The University of Queensland, Herston Campus, QLD, Australia
| | - Tracey Bucknall
- School of Nursing and Midwifery Deakin University, Burwood Campus, VIC, Australia
| | - Nicole M Phillips
- School of Nursing and Midwifery Deakin University, Burwood Campus, VIC, Australia
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Tschan F, Semmer NK, Hunziker S, Kolbe M, Jenni N, Marsch SU. Leadership in different resuscitation situations. TRENDS IN ANAESTHESIA AND CRITICAL CARE 2014. [DOI: 10.1016/j.tacc.2013.12.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Cooper SJ, Cant RP. Measuring non-technical skills of medical emergency teams: An update on the validity and reliability of the Team Emergency Assessment Measure (TEAM). Resuscitation 2014; 85:31-3. [DOI: 10.1016/j.resuscitation.2013.08.276] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2013] [Revised: 07/25/2013] [Accepted: 08/01/2013] [Indexed: 11/29/2022]
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Sørensen JL, Van der Vleuten C, Lindschou J, Gluud C, Østergaard D, LeBlanc V, Johansen M, Ekelund K, Albrechtsen CK, Pedersen BW, Kjærgaard H, Weikop P, Ottesen B. 'In situ simulation' versus 'off site simulation' in obstetric emergencies and their effect on knowledge, safety attitudes, team performance, stress, and motivation: study protocol for a randomized controlled trial. Trials 2013; 14:220. [PMID: 23870501 PMCID: PMC3716971 DOI: 10.1186/1745-6215-14-220] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2013] [Accepted: 07/01/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Unexpected obstetric emergencies threaten the safety of pregnant women. As emergencies are rare, they are difficult to learn. Therefore, simulation-based medical education (SBME) seems relevant. In non-systematic reviews on SBME, medical simulation has been suggested to be associated with improved learner outcomes. However, many questions on how SBME can be optimized remain unanswered. One unresolved issue is how 'in situ simulation' (ISS) versus 'off site simulation' (OSS) impact learning. ISS means simulation-based training in the actual patient care unit (in other words, the labor room and operating room). OSS means training in facilities away from the actual patient care unit, either at a simulation centre or in hospital rooms that have been set up for this purpose. METHODS AND DESIGN The objective of this randomized trial is to study the effect of ISS versus OSS on individual learning outcome, safety attitude, motivation, stress, and team performance amongst multi-professional obstetric-anesthesia teams.The trial is a single-centre randomized superiority trial including 100 participants. The inclusion criteria were health-care professionals employed at the department of obstetrics or anesthesia at Rigshospitalet, Copenhagen, who were working on shifts and gave written informed consent. Exclusion criteria were managers with staff responsibilities, and staff who were actively taking part in preparation of the trial. The same obstetric multi-professional training was conducted in the two simulation settings. The experimental group was exposed to training in the ISS setting, and the control group in the OSS setting. The primary outcome is the individual score on a knowledge test. Exploratory outcomes are individual scores on a safety attitudes questionnaire, a stress inventory, salivary cortisol levels, an intrinsic motivation inventory, results from a questionnaire evaluating perceptions of the simulation and suggested changes needed in the organization, a team-based score on video-assessed team performance and on selected clinical performance. DISCUSSION The perspective is to provide new knowledge on contextual effects of different simulation settings. TRIAL REGISTRATION ClincialTrials.gov NCT01792674.
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Affiliation(s)
- Jette Led Sørensen
- Department of Obstetrics, Department of Anaesthesia and Juliane Marie Centre for Children, Women and Reproduction, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, Copenhagen, Denmark
| | - Cees Van der Vleuten
- Department of Educational Development and Research, Faculty of Health, Medicine and Life Sciences, Maastricht University, P.O. Box 616, 6200, MD Maastricht, The Netherlands
| | - Jane Lindschou
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, Copenhagen, Denmark
| | - Christian Gluud
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, Copenhagen, Denmark
| | - Doris Østergaard
- Danish Institute for Medical Simulation, Herlev Hospital, Capital Region of Denmark and Copenhagen University, Herlev Ringvej 75, 2730 Herlev, Denmark
| | - Vicki LeBlanc
- The Wilson Centre, University of Toronto, 200 Elizabeth Street, 1ES-565, Toronto, Ontario M5G 2C4 Canada
| | - Marianne Johansen
- Department of Obstetrics, Department of Anaesthesia and Juliane Marie Centre for Children, Women and Reproduction, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, Copenhagen, Denmark
| | - Kim Ekelund
- Department of Obstetrics, Department of Anaesthesia and Juliane Marie Centre for Children, Women and Reproduction, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, Copenhagen, Denmark
| | - Charlotte Krebs Albrechtsen
- Department of Obstetrics, Department of Anaesthesia and Juliane Marie Centre for Children, Women and Reproduction, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, Copenhagen, Denmark
| | - Berit Woetman Pedersen
- Department of Obstetrics, Department of Anaesthesia and Juliane Marie Centre for Children, Women and Reproduction, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, Copenhagen, Denmark
| | - Hanne Kjærgaard
- Department of Obstetrics, Department of Anaesthesia and Juliane Marie Centre for Children, Women and Reproduction, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, Copenhagen, Denmark
| | - Pia Weikop
- Laboratory of Neuropsychiatry, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, Copenhagen, Denmark
| | - Bent Ottesen
- Department of Obstetrics, Department of Anaesthesia and Juliane Marie Centre for Children, Women and Reproduction, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, Copenhagen, Denmark
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Nolan JP, Ornato JP, Parr MJ, Perkins GD, Soar J. Resuscitation highlights in 2012. Resuscitation 2013; 84:129-36. [DOI: 10.1016/j.resuscitation.2013.01.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2013] [Accepted: 01/02/2013] [Indexed: 12/19/2022]
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Cohen D, Sevdalis N, Patel V, Taylor M, Lee H, Vokes M, Heys M, Taylor D, Batrick N, Darzi A. Tactical and operational response to major incidents: feasibility and reliability of skills assessment using novel virtual environments. Resuscitation 2013; 84:992-8. [PMID: 23357703 DOI: 10.1016/j.resuscitation.2012.12.011] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2012] [Revised: 12/01/2012] [Accepted: 12/12/2012] [Indexed: 10/27/2022]
Abstract
OBJECTIVES To determine feasibility and reliability of skills assessment in a multi-agency, triple-site major incident response exercise carried out in a virtual world environment. METHODS Skills assessment was carried out across three scenarios. The pre-hospital scenario required paramedics to triage and treat casualties at the site of an explosion. Technical skills assessment forms were developed using training syllabus competencies and national guidelines identified by pre-hospital response experts. Non-technical skills were assessed using a seven-point scale previously developed for use by pre-hospital paramedics. The two in-hospital scenarios, focusing on a trauma team leader and a silver/clinical major incident co-ordinator, utilised the validated Trauma-NOTECHS scale to assess five domains of performance. Technical competencies were assessed using an ATLS-style competency scale for the trauma scenario. For the silver scenario, the assessment document was developed using competencies described from a similar role description in a real-life hospital major incident plan. The technical and non-technical performance of all participants was assessed live by two experts in each of the three scenarios and inter-assessor reliability was computed. Participants also self-assessed their performance using identical proformas immediately after the scenarios were completed. Self and expert assessments were correlated (assessment cross-validation). RESULTS Twenty-three participants underwent all scenarios and assessments. Performance assessments were feasible for both experts as well as the participants. Non-technical performance was generally scored higher than technical performance. Very good inter-rater reliability was obtained between expert raters across all scenarios and both technical and non-technical aspects of performance (reliability range 0.59-0.90, Ps<0.01). Significant positive correlations were found between self and expert assessment in technical skills across all three scenarios (correlation range 0.52-0.84, Ps<0.05), although no such correlations were observed in non-technical skills. CONCLUSIONS This study establishes feasibility and reliability of virtual environment technical and non-technical skills assessment in major incident scenarios for the first time. The development for further scenarios and validated assessment scales will enable major incident planners to utilise virtual technologies for improved major incident preparation and training.
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Affiliation(s)
- Daniel Cohen
- Division of Surgery, Department of Surgery and Cancer, Imperial College London, London, United Kingdom.
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Hodgson JL, Pelzer JM, Inzana KD. Beyond NAVMEC: competency-based veterinary education and assessment of the professional competencies. JOURNAL OF VETERINARY MEDICAL EDUCATION 2013; 40:102-118. [PMID: 23709107 DOI: 10.3138/jvme.1012-092r] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
The implementation of competency-based curricula within the health sciences has been an important paradigm shift over the past 30 years. As a result, one of the five strategic goals recommended by the North American Veterinary Medical Education Consortium (NAVMEC) report was to graduate career-ready veterinarians who are proficient in, and have the confidence to use, an agreed-upon set of core competencies. Of the nine competencies identified as essential for veterinary graduates, seven could be classified as professional or non-technical competencies: communication; collaboration; management (self, team, system); lifelong learning, scholarship, value of research; leadership; diversity and multicultural awareness; and adaptation to changing environments. Traditionally, the professional competencies have received less attention in veterinary curricula and their assessment is often sporadic or inconsistent. In contrast, the same or similar competencies are being increasingly recognized in other health professions as essential skills and abilities, and their assessment is being undertaken with enhanced scrutiny and critical appraisal. Several challenges have been associated with the assessment of professional competencies, including agreement as to their definition and therefore their evaluation, the fact that they are frequently complex and require multiple integrative assessments, and the ability and/or desire of faculty to teach and assess these competencies. To provide an improved context for assessment of the seven professional competencies identified in the NAVMEC report, this article describes a broad framework for their evaluation as well as specific examples of how these or similar competencies are currently being measured in medical and veterinary curricula.
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Affiliation(s)
- Jennifer L Hodgson
- Virginia Maryland Regional College of Veterinary Medicine, Virginia Polytechnic & State University, Blackburg, VA 24061, USA.
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Walker ST, Sevdalis N, McKay A, Lambden S, Gautama S, Aggarwal R, Vincent C. Unannounced in situ simulations: integrating training and clinical practice. BMJ Qual Saf 2012; 22:453-8. [PMID: 23211281 DOI: 10.1136/bmjqs-2012-000986] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Simulation-based training for healthcare providers is well established as a viable, efficacious training tool, particularly for the training of non-technical team-working skills. These skills are known to be critical to effective teamwork, and important in the prevention of error and adverse events in hospitals. However, simulation suites are costly to develop and releasing staff to attend training is often difficult. These factors may restrict access to simulation training. We discuss our experiences of 'in situ' simulation for unannounced cardiac arrest training when the training is taken to the clinical environment. This has the benefit of decreasing required resources, increasing realism and affordability, and widening multidisciplinary team participation, thus enabling assessment and training of non-technical team-working skills in real clinical teams. While there are practical considerations of delivering training in the clinical environment, we feel there are many potential benefits compared with other forms of simulation training. We are able to tailor the training to the needs of the location, enabling staff to see a scenario that is relevant to their practice. This is particularly useful for staff who have less exposure to cardiac arrest events, such as radiology staff. We also describe the important benefit of risk assessment for a clinical environment. During our simulations we have identified a number of issues that, had they occurred during a real resuscitation attempt, may have led to patient harm or patient death. For these reasons we feel in situ simulation should be considered by every hospital as part of a patient safety initiative.
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Affiliation(s)
- Susanna T Walker
- Centre for Patient Safety and Service Quality, Department of Surgery and Cancer, Imperial College London, St Mary's Hospital, London, UK.
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Sevdalis N, Hull L, Birnbach D. Improving patient safety in the operating theatre and perioperative care: obstacles, interventions, and priorities for accelerating progress. Br J Anaesth 2012; 109 Suppl 1:i3-i16. [DOI: 10.1093/bja/aes391] [Citation(s) in RCA: 86] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Challenges in using high-fidelity simulation to improve learning and patient safety. Resuscitation 2012; 83:1317-8. [DOI: 10.1016/j.resuscitation.2012.08.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2012] [Accepted: 08/15/2012] [Indexed: 11/21/2022]
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