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Farquharson B, Cortegiani A, Lauridsen KG, Yeung J, Greif R, Nabecker S. Teaching team competencies within resuscitation training: A systematic review. Resusc Plus 2024; 19:100687. [PMID: 39006135 PMCID: PMC11239706 DOI: 10.1016/j.resplu.2024.100687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Revised: 05/27/2024] [Accepted: 05/27/2024] [Indexed: 07/16/2024] Open
Abstract
Objectives To evaluate the effectiveness of life support training with specific emphasis on team competencies on clinical and educational outcomes. Methods This systematic review was prospectively registered (PROSPERO CRD42023473154) and followed the PICOST (population, intervention, comparison, outcome, study design, timeframe) format. All randomized controlled trials and non-randomized studies evaluating learners undertaking life support training with specific emphasis on team competencies in any setting (actual and simulated resuscitations) were included. Unpublished studies were excluded. Medline, Embase and Cochrane databases as well as trial registries were searched from inception to August 2023 (updated January 18, 2024). Two researchers performed title and abstract screening, full-text screening, data extraction, assessment of risk of bias (using RoB2 and ROBINS-I) and certainty of evidence (using GRADE). PRISMA reporting checklist was used to report the results. No funding was obtained to perform this systematic review. Results The literature search identified 5470 manuscripts. After the removal of 2073 duplicates, reviewing the remaining articles' titles and abstracts yielded 31 articles for full-text review. Of these, 17 studies were finally included. The studies involved the following training levels: basic life support, adult advanced life support, paediatric and neonatal resuscitations. Most studies (n = 16) evaluated outcomes in simulated, and only one study in actual resuscitations. Studies included in all training contexts showed either neutrality and/or benefits of life support training with specific emphasis on team competencies. Team competencies training improved CPR skill performance and CPR quality. Specific team competencies that improved included leadership, communication, decision-making and task management. No undesirable effects were observed. Meta-analysis was not possible due to significant methodological heterogeneity. Sub-group analysis was impossible due to lack of data. Risk of bias assessment ranged from some concerns to serious. Overall certainty of evidence was rated as low to very low due to risk of bias and imprecision. Conclusion This systematic review identified very low and low certainty evidence, almost entirely derived from simulation studies. The studies and their findings were heterogenous but suggest that teaching team competencies can improve resuscitation skills performance and CPR quality, as well as improve team competencies, specifically leadership, communication, decision-making, and task management. Further research is required to understand optimal configuration of team competencies training interventions and to understand the effect on clinical outcomes and cost-effectiveness.
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Affiliation(s)
- Barbara Farquharson
- Faculty of Health Sciences & Sport, University of Stirling, Stirling, United Kingdom
| | - Andrea Cortegiani
- Department of Precision Medicine in Medical Surgical and Critical Care (Me.Pre.C.C.), University of Palermo, Italy
- Department of Anesthesia Intensive Care and Emergency. University Hospital Policlinico ’Paolo Giaccone’, Palermo, Italy
| | - Kasper G. Lauridsen
- Research Center for Emergency Medicine, Aarhus University Hospital, Denmark
- Department of Anesthesiology and Intensive Care, Randers Regional Hospital, Denmark
- Department of Anesthesiology and Critical Care Medicine, Children’s Hospital of Philadelphia, USA
| | - Joyce Yeung
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Robert Greif
- Department of Surgical Science, University of Torino, Torino, Italy
- University of Bern, Bern, Switzerland
| | - Sabine Nabecker
- Anesthesiology and Pain Management, Sinai Health System, University of Toronto, Toronto, Canada
| | - Education Implementation Team Task Force of the International Liaison Committee on Resuscitation ILCOR1
- Faculty of Health Sciences & Sport, University of Stirling, Stirling, United Kingdom
- Department of Precision Medicine in Medical Surgical and Critical Care (Me.Pre.C.C.), University of Palermo, Italy
- Department of Anesthesia Intensive Care and Emergency. University Hospital Policlinico ’Paolo Giaccone’, Palermo, Italy
- Research Center for Emergency Medicine, Aarhus University Hospital, Denmark
- Department of Anesthesiology and Intensive Care, Randers Regional Hospital, Denmark
- Department of Anesthesiology and Critical Care Medicine, Children’s Hospital of Philadelphia, USA
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, United Kingdom
- Department of Surgical Science, University of Torino, Torino, Italy
- University of Bern, Bern, Switzerland
- Anesthesiology and Pain Management, Sinai Health System, University of Toronto, Toronto, Canada
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Koželj A, Strauss M, Poštuvan V, Strauss Koželj A, Strnad M. Perception of Personal Participation of the Nurses in Resuscitation Procedures: A Qualitative Study. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:196. [PMID: 38399484 PMCID: PMC10890641 DOI: 10.3390/medicina60020196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 12/18/2023] [Accepted: 01/19/2024] [Indexed: 02/25/2024]
Abstract
Background and Objectives: Resuscitation is one of the most stressful tasks in emergency medicine. The participation of nurses in this procedure can have specific effects on them. In this research, we wanted to find out what these effects are. Materials and Methods: A qualitative approach by conducting semi-structured interviews was used, and a thematic data analysis of the recorded interviews was carried out. The collected data were transcribed verbatim, with no corrections to the audio recordings. The computer program ATLAS.ti 22 was used for the qualitative data analysis. Results: Eleven male registered nurses were interviewed, with an average of 18.5 years of experience working in a prehospital environment (max. 32/min. 9). A total of 404 min of recordings were analyzed, and 789 codes were found, which were combined into 36 patterns and 11 themes. As the most stressful situations, the interviewees pointed out the resuscitation of a child, familiar persons, conflicts with the environment, conflicts within the resuscitation team, nonfunctioning or insufficient equipment, complications during resuscitation, and resuscitating a person only for training. As positive effects, the interviewees cited successful resuscitations or their awareness that, despite an unsuccessful resuscitation, they did everything they could. Conclusions: Participation in these interventions has a specific positive or negative impact on the performers. The interviewees shared the opinion that they can cope effectively with the adverse or stressful effects of resuscitation. Yet, despite everything, they allow the possibility of subconscious influences of this intervention on themselves.
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Affiliation(s)
- Anton Koželj
- Faculty of Health Sciences, University of Maribor, 2000 Maribor, Slovenia;
| | - Maja Strauss
- Faculty of Health Sciences, University of Maribor, 2000 Maribor, Slovenia;
| | - Vita Poštuvan
- Slovene Center for Suicide Research, Andrej Marušič Institute, University of Primorska, 6000 Koper, Slovenia;
| | | | - Matej Strnad
- Emergency Department, University Clinical Centre Maribor, 2000 Maribor, Slovenia;
- Center for Emergency Medicine, Prehospital Unit, Community Healthcare Center, 2000 Maribor, Slovenia
- Faculty of Medicine, University of Maribor, 2000 Maribor, Slovenia
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3
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Rossi S, Perri GA. A Place for Crisis Resource Management in Palliative Care. J Palliat Med 2023; 26:1018-1019. [PMID: 37428975 DOI: 10.1089/jpm.2023.0085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/12/2023] Open
Affiliation(s)
- Samantha Rossi
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Giulia-Anna Perri
- Division of Palliative Care, Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
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Rowland M, Adefuye AO. An Evaluation of Pre-Hospital Emergency Care Personnel Knowledge About Crisis Resource Management and Perspectives of Educators About Inclusion of Crisis Resource Management in the Pre-Hospital Emergency Care Curriculum. ADVANCES IN MEDICAL EDUCATION AND PRACTICE 2022; 13:849-864. [PMID: 35982855 PMCID: PMC9379110 DOI: 10.2147/amep.s365436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 06/20/2022] [Indexed: 06/15/2023]
Abstract
PURPOSE To evaluate the knowledge of pre-hospital emergency care personnel (PECP) in South Africa on the principles, practice of crisis resource management (CRM), and obtain emergency medical care (EMC) educators' views on the teaching and learning of CRM skills in the pre-hospital EMC curriculum. METHODS This research was designed as an exploratory study that used a semi-structured questionnaire administered to 2000 PECP and focus group discussion (FGD) with 19 emergency care educators. Chi-squared test and Cramér's V were used to examine the existence and the strength of an association between cross-tabulated variables. Responses to open-ended questions, as well as the data generated by the FGD, were analysed qualitatively using iterative inductive coding to identify themes. RESULTS A response rate of 76% was obtained for the survey. Findings are that the majority (64.5%) of the PECP were not familiar with CRM, though familiarity varied significantly across cadres of PECP (p <0.001). EMC educators reported that the concept of CRM must be thoroughly researched and developed in the emergency medical service (EMS) context before it is included in the EMC curriculum. The educators reported that early introduction of CRM in the EMC curriculum will have a positive effect on students' professional development. Difficulties with assessment, knowing what to teach, and lack of universally accepted guidelines or teaching modalities are some of the challenges identified by EMC educators in relation to teaching CRM in the EMC curriculum. CONCLUSION The findings of this study provide new insights into PECP's knowledge and EMC educators' views on the teaching and learning of CRM in the EMC curriculum. This study highlights that more research is needed to develop an EMS CRM curriculum. Investigation into the development of a teaching and learning framework for CRM in EMC education could be the focus of future studies.
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Affiliation(s)
- Mugsien Rowland
- Department of Emergency Medical Care, Boitekanelo College, Gaborone, Botswana
| | - Anthonio Oladele Adefuye
- Division of Health Sciences Education, Faculty of Health Sciences, University of the Free State, Bloemfontein, Free State, 9301, South Africa
- Western Atlantic University School of Medicine, Freeport, Bahamas
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Buljac-Samardžić M, Dekker-van Doorn CM, Maynard MT. What Do We Really Know About Crew Resource Management in Healthcare?: An Umbrella Review on Crew Resource Management and Its Effectiveness. J Patient Saf 2021; 17:e929-e958. [PMID: 34852415 PMCID: PMC8612906 DOI: 10.1097/pts.0000000000000816] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of this article was to present an overview of the crew resource management (CRM) literature in healthcare. The first aim was to conduct an umbrella review on CRM literature reviews. The second aim was to conduct a new literature review that aims to address the gaps that were identified through the umbrella review. METHODS First, we conducted an umbrella review to identify all reviews that have focused on CRM within the healthcare context. This step resulted in 16 literature reviews. Second, we conducted a comprehensive literature review that resulted in 106 articles. RESULTS The 16 literature reviews showed a high level of heterogeneity, which resulted in discussing 3 ambiguities: definition, outcome, and information ambiguity. As a result of these ambiguities, a new comprehensive review of the CRM literature was conducted. This review showed that CRM seems to have a positive effect on outcomes at Kirkpatrick's level 1, 2, and 3. In contrast, whether CRM has a positive effect on level 4 outcomes and how level 4 should be measured remains undetermined. Recommendations on how to implement and embed CRM training into an organization to achieve the desired effects have not been adequately considered. CONCLUSIONS The extensive nature of this review demonstrates the popularity of CRM in healthcare, but at the same time, it highlights that research tends to be situated within certain settings, focuses on particular outcomes, and has failed to address the full scope of CRM as a team intervention and a management concept.
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Affiliation(s)
| | | | - M. Travis Maynard
- Department of Management, College of Business, Colorado State University, Fort Collins, Colorado
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Dewolf P, Clarebout G, Wauters L, Van Kerkhoven J, Verelst S. The Effect of Teaching Nontechnical Skills in Advanced Life Support: A Systematic Review. AEM EDUCATION AND TRAINING 2021; 5:e10522. [PMID: 34041431 PMCID: PMC8138104 DOI: 10.1002/aet2.10522] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 08/14/2020] [Accepted: 08/17/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVES The objective of this study was to evaluate the effect of nontechnical skills (NTS) training on performance in advanced life support (ALS) simulation. Furthermore, we aimed to determine the ideal frequency of training sessions for an optimal retention and the value of debriefing. METHODS A systematic search was performed using PubMed, EMBASE, WoS, ERIC, CINAHL, and the Cochrane Library conducted through August 1, 2018. All primary studies mentioning NTS in ALS education were included. Three reviewers independently extracted data on study design and outcome. The MERSQI approach was used to evaluate the overall quality of evidence. RESULTS Of the 10,723 identified articles, 40 studies were included with a combined total of 3,041 participants, ranging from students to experts. Depending on the focus of the study, articles were categorized in NTS (n = 25), retention (n = 8), and feedback (n = 10). Incorporating NTS during ALS simulation showed significant improvements in timing for performing critical first steps. Furthermore, good leadership skills had a favorable effect on overall technical performance and teamwork during simulation improved team dynamics and performance. Finally, debriefing also had a beneficial effect on team performance. One particular type of debriefing does not appear to be superior to other types of debriefing. CONCLUSION Team simulation training resulted in improved NTS and a reduction in the time required to complete a simulated cardiac arrest. Therefore, a formal NTS program should be introduced into ALS courses. Feedback and repetitive practice are key factors to train NTS. The impact of training on team behaviors can persist for at least 3 to 6 months. In conclusion, understanding and improving NTS may help to create more effective teams. The effect on patient outcome requires further investigation.
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Affiliation(s)
- Philippe Dewolf
- Department of Emergency MedicineUniversity Hospitals LeuvenLeuvenFlandersBelgium
- Faculty of MedicineKU LeuvenLeuvenFlandersBelgium
| | - Geraldine Clarebout
- Faculty of Psychology and Pedagogical SciencesCentre for Instructional Psychology and TechnologyKU LeuvenLeuvenFlandersBelgium
| | - Lina Wauters
- Department of Emergency MedicineUniversity Hospitals LeuvenLeuvenFlandersBelgium
| | - Joke Van Kerkhoven
- Department of Emergency MedicineUniversity Hospitals LeuvenLeuvenFlandersBelgium
| | - Sandra Verelst
- Department of Emergency MedicineUniversity Hospitals LeuvenLeuvenFlandersBelgium
- Faculty of MedicineKU LeuvenLeuvenFlandersBelgium
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Maenhout G, Billiet V, Sijmons M, Beeckman D. The effect of repeated high-fidelity in situ simulation-based training on self-efficacy, self-perceived leadership qualities and team performance: A quasi-experimental study in a NICU-setting. NURSE EDUCATION TODAY 2021; 100:104849. [PMID: 33711585 DOI: 10.1016/j.nedt.2021.104849] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Revised: 02/11/2021] [Accepted: 02/24/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Simulation-based training has been widely used in various disciplines and has increasingly been recognized as useful in healthcare education during the past decade. In nursing schools, simulation-based training was initially used to train nursing students. However, there is a growing trend to use simulation-based training for continuing education and lifelong learning among professional healthcare workers. OBJECTIVES To investigate if simulation-based training has an effect on self-efficacy, self-perceived leadership qualities and team performance in a neonatal intensive care unit. DESIGN Time series design. SETTING One referral neonatal intensive care unit in a general hospital in Flanders, Belgium. PARTICIPANTS Convenience sample of 71 nurses and midwives. METHODS Participants were involved in a series of three simulation-based training sessions. Before and after these series, a set of validated questionnaires was completed to measure the self-efficacy and self-perceived leadership qualities of the participants. Each session was videotaped and assessed for team performance (n = 8). RESULTS Participating in repeated high-fidelity in situ simulation-based training resulted in a significant increase in self-efficacy (p < 0.001) and self-perceived leadership qualities (p < 0.001). The intervention did not lead to a significant improved team performance (p = 0.209). CONCLUSION Repeated high-fidelity in situ simulation-based training in the NICU had a positive effect on self-efficacy and self-perceived leadership abilities in registered nurses and midwives in acute care situations. Repeated participation in simulation-based training had a positive effect on these outcomes, regardless of the number of years of NICU experience. The effect on team performance could not be confirmed in this study.
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Affiliation(s)
- Gudrun Maenhout
- Department of Neonatology, AZ Sint-Jan Brugge-Oostende AV, Bruges, Belgium
| | - Valerie Billiet
- Department of Neonatology, AZ Sint-Jan Brugge-Oostende AV, Bruges, Belgium; Vives University College, Department of Nursing and Midwifery, Bruges, Belgium
| | - Marit Sijmons
- Department of Neonatology, AZ Sint-Jan Brugge-Oostende AV, Bruges, Belgium
| | - Dimitri Beeckman
- Skin Integrity Research Group (SKINT), University Centre for Nursing and Midwifery (UCVV), Department of Public Health and Primary Care, Ghent University, Ghent, Belgium; Swedish Centre for Skin and Wound Research, School of Health Sciences, Örebro University, Örebro, Sweden; Research Unit of Plastic Surgery, Department of Clinical Research, Faculty of Health Sciences, Odense, Denmark.
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Ratnitsky A, Havranek J, Mohr GL, Rüther-Wolf K, Schwendimann R. [Safety-II in daily clinical practice]. ZEITSCHRIFT FUR EVIDENZ FORTBILDUNG UND QUALITAET IM GESUNDHEITSWESEN 2021; 162:10-15. [PMID: 33722522 DOI: 10.1016/j.zefq.2021.02.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 02/05/2021] [Accepted: 02/06/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Providing patient safety is a central matter in health care requiring complex treatment processes containing many risks. In hospital care, adverse events and patient harm occur frequently. In this context, the safety sciences investigate causes and contributing factors of such events as well as improvement measures. With Safety-I and Safety-II, two complementary approaches come into play. While Safety-I aims to minimize adverse events, the Safety-II approach focuses on understanding the system as a whole whose normal operations can result in both desired and adverse events. With the implementation of the Critical Incident Report System (CIRS), the Safety-I approach (with a focus on errors and correction of negative consequences for patient safety) has become an integral part of the university hospital chosen for this study. The subject matter of this study is to determine if and how the Safety-II approach (focussing on normal operation and the understanding of positive effects for patient safety) is already in use and what measurements can support its integration in daily clinical practice. METHOD Through observation, the structures of daily feedback meetings (huddles) from six different hospital departments have been gathered to determine if they can be considered as potential starting points for the implementation of the Safety-II approach. The following expert interviews (n=7) discussed four potentials of the Safety-II approach using the Resilient Assessment Grid (RAG). Finally, a focus group discussed which measurements are central for the integration of the Safety-II approach in daily clinical practice. RESULTS The study shows that department teams partially follow the Safety-II approach. During team huddles, positive experiences are already exchanged. The expert interviews revealed that the RAG potentials respond, learn and anticipate have already been realized satisfactorily while the potential monitor fell behind. The focus groups regard the Safety-II approach more as a matter of corporate culture and less as a paradigm shift which is needed to be integrated into day-to-day business. DISCUSSION Successfully establishing the Safety-II approach requires a focus not just on unwanted occurrences. It is also necessary to focus on the often not directly apparent desired occurrences, which ensure patient safety, and to systematically reflect on them in order to contribute to the development of the organizational culture. Having a better understanding of how the system of daily clinical practice with all its subsystems works will make it possible to proactively counteract unwanted occurrences, for example through regular feedback sessions and debriefings, and to increase patient safety.
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Affiliation(s)
- Avital Ratnitsky
- Universitätsspital Basel, Abteilung Patientenzentriertes Management, Ärztliche Direktion, Basel, Schweiz
| | - Jennifer Havranek
- Hochschule für Angewandte Psychologie, Fachhochschule Nordwestschweiz (FHNW), Olten, Schweiz
| | - Giulia Lara Mohr
- Universitätsspital Basel, Abteilung für Patientensicherheit, Ärztliche Direktion, Basel, Schweiz
| | - Katharina Rüther-Wolf
- Universitätsspital Basel, Abteilung Patientenzentriertes Management, Ärztliche Direktion, Basel, Schweiz
| | - René Schwendimann
- Universitätsspital Basel, Abteilung für Patientensicherheit, Ärztliche Direktion, Basel, Schweiz.
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Paige JT, Garbee DD, Yu Q, Zahmjahn J, Baroni de Carvalho R, Zhu L, Rusnak V, Kiselov VJ. Brick in the wall? Linking quality of debriefing to participant learning in team training of interprofessional students. BMJ SIMULATION & TECHNOLOGY ENHANCED LEARNING 2021; 7:360-365. [DOI: 10.1136/bmjstel-2020-000685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/07/2020] [Indexed: 11/03/2022]
Abstract
BackgroundThe evidence for the conventional wisdom that debriefing quality determines the effectiveness of learning in simulation-based training is lacking. We investigated whether the quality of debriefing in using simulation-based training in team training correlated with the degree of learning of participants.MethodsForty-two teams of medical and undergraduate nursing students participated in simulation-based training sessions using a two-scenario format with after-action debriefing. Observers rated team performance with an 11-item Teamwork Assessment Scales (TAS) instrument (three subscales, team-based behaviours (5-items), shared mental model (3-items), adaptive communication and response (3-items)). Two independent, blinded raters evaluated video-recorded facilitator team prebriefs and debriefs using the Objective Structured Assessment of Debriefing (OSAD) 8-item tool. Descriptive statistics were calculated, t-test comparisons made and multiple linear regression and univariate analysis used to compare OSAD item scores and changes in TAS scores.ResultsStatistically significant improvements in all three TAS subscales occurred from scenario 1 to 2. Seven faculty teams taught learners with all scores ≥3.0 (except two) for prebriefs and all scores ≥3.5 (except one) for debriefs (OSAD rating 1=done poorly to 5=done well). Linear regression analysis revealed a single statistically significant correlation between debrief engagement and adaptive communication and response score without significance on univariate analysis.ConclusionsQuality of debriefing does not seem to increase the degree of learning in interprofessional education using simulation-based training of prelicensure student teams. Such a finding may be due to the relatively high quality of the prebrief and debrief of the faculty teams involved in the training.
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Conoscenti E, Martucci G, Piazza M, Tuzzolino F, Ragonese B, Burgio G, Arena G, Blot S, Luca A, Arcadipane A, Chiaramonte G. Post-crisis debriefing: A tool for improving quality in the medical emergency team system. Intensive Crit Care Nurs 2020; 63:102977. [PMID: 33358133 DOI: 10.1016/j.iccn.2020.102977] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 11/06/2020] [Accepted: 11/11/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVES To examine clinicians' perception of quality of technical and non-technical response to emergencies and application of post crisis debriefing. DESIGN Descriptive, anonymous, self-reporting survey on the needs and perception of a post-crisis debriefing implementation. SETTING Multi-specialist medical institute in Italy focused on solid organ transplantation and organ failure support. MAIN OUTCOMES Perception of application of guidelines and evaluation of debriefing implementation during in-hospital emergencies. RESULTS Response rate to the survey was 25% (148 health care workers). Of all respondents, 86% were employed >10 years, 75% were involved in ≤5 emergencies over the previous year. Resuscitation guidelines were considered fully applied by 55%; 64% of respondents considered the teaching programme as sufficient. Of all participants, 97% were aware of the importance of teamwork dynamics, 79% were aware of the importance of the personal performance, and 52% considered emergencies as valid opportunities for professional growth. Leadership was considered important by 45% of respondents; debriefing implemented by 41%, and considered a potentially useful tool by 85%. CONCLUSION Post-crisis debriefing is a way to diffuse self-reflective and life-long learning culture; it is perceived as a powerful tool for improving quality of the rapid response system by the vast majority of those surveyed.
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Affiliation(s)
- Elena Conoscenti
- Infectious Disease and Infection Control Service, ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad alta specializzazione), Palermo, Italy
| | - Gennaro Martucci
- Department of Anesthesia and Intensive Care, ISMETT, Palermo, Italy
| | - Marcello Piazza
- Department of Anesthesia and Intensive Care, ISMETT, Palermo, Italy
| | | | | | - Gaetano Burgio
- Department of Anesthesia and Intensive Care, ISMETT, Palermo, Italy
| | - Giuseppe Arena
- Department of Nursing and Healthcare Professionals, ISMETT, Palermo, Italy
| | - Stijn Blot
- Internal Medicine Department, Ghent University, Belgium
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Rajendram P, Notario L, Reid C, Wira CR, Suarez JI, Weingart SD, Khosravani H. Crisis Resource Management and High-Performing Teams in Hyperacute Stroke Care. Neurocrit Care 2020; 33:338-346. [PMID: 32794144 PMCID: PMC7426067 DOI: 10.1007/s12028-020-01057-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 07/20/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND PURPOSE Management of stroke patients in the acute setting is a high-stakes task with several challenges including the need for rapid assessment and treatment, maintenance of high-performing team dynamics, management of cognitive load affecting providers, and factors impacting team communication. Crisis resource management (CRM) provides a framework to tackle these challenges and is well established in other resuscitative disciplines. The current Coronavirus Disease 2019 (COVID-19) pandemic has exposed a potential quality gap in emergency preparedness and the ability to adapt to emergency scenarios in real time. METHODS Available resources in the literature in other disciplines and expert consensus were used to identify key elements of CRM as they apply to acute stroke management. RESULTS We outline essential ingredients of CRM as a means to mitigate nontechnical challenges providers face during acute stroke care. These strategies include situational awareness, triage and prioritization, mitigation of cognitive load, team member role clarity, communication, and debriefing. Incorporation of CRM along with simulation is an established tool in other resuscitative disciplines and can be incorporated into acute stroke care. CONCLUSIONS As stroke care processes evolve during these trying times, the importance of consistent, safe, and efficacious care facilitated by CRM principles offers a unique avenue to alleviate human factors and support high-performing teams.
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Affiliation(s)
- Phavalan Rajendram
- Brain Resuscitation Lab, Neurology Quality and Innovation Laboratory (NQIL), Division of Neurology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Room H335 - 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada
| | - Lowyl Notario
- Department of Emergency Services, Sunnybrook Health Sciences Centre, Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
| | - Cliff Reid
- Department of Emergency Medicine, Northern Beaches Hospital, Frenchs Forest, Sydney, Australia
| | - Charles R Wira
- Department of Emergency Medicine and Acute Stroke Service, Yale School of Medicine, New Haven, USA
| | - Jose I Suarez
- Division of Neurosciences Critical Care, Departments of Anesthesiology and Critical Care Medicine, Neurology, and Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, USA
| | - Scott D Weingart
- Division of Emergency Critical Care, Stony Brook Medicine, Stony Brook, USA
| | - Houman Khosravani
- Brain Resuscitation Lab, Neurology Quality and Innovation Laboratory (NQIL), Division of Neurology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Room H335 - 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada.
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Kilpatrick K, Paquette L, Jabbour M, Tchouaket E, Fernandez N, Al Hakim G, Landry V, Gauthier N, Beaulieu MD, Dubois CA. Systematic review of the characteristics of brief team interventions to clarify roles and improve functioning in healthcare teams. PLoS One 2020; 15:e0234416. [PMID: 32520943 PMCID: PMC7286504 DOI: 10.1371/journal.pone.0234416] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 05/25/2020] [Indexed: 11/18/2022] Open
Abstract
AIM Describe brief (less than half a day) interventions aimed at improving healthcare team functioning. METHODS A systematic review on brief team interventions aimed at role clarification and team functioning (PROSPERO Registration Number: CRD42018088922). Experimental or quasi-experimental studies were included. Database searches included CINAHL, Medline, EMBASE, PUBMED, Cochrane, RCT Registry-1990 to April 2020 and grey literature. Articles were screened independently by teams of two reviewers. Risk of bias was assessed. Data from the retained articles were extracted by one reviewer and checked by a second reviewer independently. A narrative synthesis was undertaken. RESULTS Searches yielded 1928 unique records. Final sample contained twenty papers describing 19 studies, published between 2009 and 2020. Studies described brief training interventions conducted in acute care in-patient settings and included a total of 6338 participants. Participants' socio-demographic information was not routinely reported. Studies met between two to six of the eight risk of bias criteria. Interventions included simulations for technical skills, structured communications and speaking up for non-technical skills and debriefing. Debriefing sessions generally lasted between five to 10 minutes. Debriefing sessions reflected key content areas but it was not always possible to determine the influence of the debriefing session on participants' learning because of the limited information reported. DISCUSSION Interest in short team interventions is recent. Single two-hour sessions appear to improve technical skills. Three to four 30- to 60-minute training sessions spread out over several weeks with structured facilitation and debriefing appear to improve non-technical skills. Monthly meetings appear to sustain change over time. CONCLUSION Short team interventions show promise to improve team functioning. Effectiveness of interventions in primary care and the inclusion of patients and families needs to be examined. Primary care teams are structured differently than teams in acute care and they may have different priorities.
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Affiliation(s)
- Kelley Kilpatrick
- Susan E. French Chair in Nursing Research and Innovative Practice, Ingram School of Nursing, Faculty of Medicine, McGill University, Montréal, Québec, Canada
- Centre intégré universitaire de santé et de services sociaux de l’Est-de-l’Île-de-Montréal-Hôpital Maisonneuve-Rosemont (CIUSSS-EMTL-HMR), Montréal, Québec, Canada
| | - Lysane Paquette
- Faculty of Nursing, Université de Montréal, Montréal, Québec, Canada
| | - Mira Jabbour
- Centre intégré universitaire de santé et de services sociaux de l’Est-de-l’Île-de-Montréal-Hôpital Maisonneuve-Rosemont (CIUSSS-EMTL-HMR), Montréal, Québec, Canada
| | - Eric Tchouaket
- Department of Nursing, Université du Québec en Outaouais, Saint-Jérôme, Québec, Canada
| | - Nicolas Fernandez
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université de Montréal, Montréal, Québec, Canada
| | - Grace Al Hakim
- Clinical and Professional Development Center, American University of Beirut Medical Center, Beirut, Lebanon
| | - Véronique Landry
- Faculty of Nursing, Université de Montréal, Montréal, Québec, Canada
| | - Nathalie Gauthier
- Nursing and Physical Health Directorate, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Québec, Québec, Canada
| | | | - Carl-Ardy Dubois
- Department of Management, Evaluation and Health Policy, School of Public Health, Université de Montréal, Montréal, Québec, Canada
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Van Hecke A, Duprez V, Pype P, Beeckman D, Verhaeghe S. Criteria for describing and evaluating training interventions in healthcare professions - CRe-DEPTH. NURSE EDUCATION TODAY 2020; 84:104254. [PMID: 31689586 DOI: 10.1016/j.nedt.2019.104254] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Revised: 08/27/2019] [Accepted: 10/17/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Descriptions of training intervention in healthcare include a lot of vagueness, leaving the reader in doubt about the intervention and the true value of the reported effects. A set of reporting criteria to improve the transparency and comprehensiveness in reporting training interventions in healthcare is recommended. OBJECTIVE This study aimed to develop and content validate a set of reporting criteria for the development and evaluation of training interventions for healthcare professionals. METHOD The set of criteria was developed along three stages: (1) a literature review, (2) the design of the criteria, and (3) a Delphi and consensus meeting process with ten experts from different professional disciplines. RESULTS The Criteria for Reporting on Development and Evaluation of Professional Training interventions in Healthcare (CRe-DEPTH) set was systematically developed and consisted of 12 items representing four categories: (1) development of the training, (2) characteristics of the training, (3) characteristics of the providers, and (4) assessment of the training outcomes. Each item has a detailed description to support its unambiguous interpretation. CONCLUSIONS The developed CRe-DEPTH reporting criteria guide high quality development, evaluation and reporting for complex training interventions, while preserving the flexibility to incorporate various teaching content or teaching methods. The Cre-DEPTH criteria will allow for detailed reporting on the training, its developmental process, as well as on the rationale for underlying choices, and will avoid non-reporting of training details.
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Affiliation(s)
- Ann Van Hecke
- University Centre for Nursing and Midwifery, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium; Nursing Department, Ghent University Hospital, Ghent, Belgium.
| | - Veerle Duprez
- University Centre for Nursing and Midwifery, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium. https://twitter.com/VeerleDuprez
| | - Peter Pype
- General Practice Medicine, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium; End-of-Life Care Research Group, Ghent University & Vrije Universiteit Brussel (VUB), Ghent, Belgium. https://twitter.com/ucvvgent
| | - Dimitri Beeckman
- University Centre for Nursing and Midwifery, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium; School of Nursing & Midwifery, Royal College of Surgeons in Ireland (RCSI), Dublin, Ireland; School of Health Sciences, Örebro University, Sweden. https://twitter.com/DimitriBeeckman
| | - Sofie Verhaeghe
- University Centre for Nursing and Midwifery, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium; Department of Nursing, VIVES University College, Roeselare, Belgium. https://twitter.com/Sofie_Verhaeghe
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Gross B, Rusin L, Kiesewetter J, Zottmann JM, Fischer MR, Prückner S, Zech A. Crew resource management training in healthcare: a systematic review of intervention design, training conditions and evaluation. BMJ Open 2019; 9:e025247. [PMID: 30826798 PMCID: PMC6410092 DOI: 10.1136/bmjopen-2018-025247] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVES Crew resource management (CRM) training formats have become a popular method to increase patient safety by consideration of the role that human factors play in healthcare delivery. The purposes of this review were to identify what is subsumed under the label of CRM in a healthcare context and to determine how such training is delivered and evaluated. DESIGN Systematic review of published literature. DATA SOURCES PubMed, PsycINFO and ERIC were searched through 8 October 2018. ELIGIBILITY CRITERIA FOR SELECTING STUDIES Individually constructed interventions for healthcare staff that were labelled as CRM training, or described as based on CRM principles or on aviation-derived human factors training. Only studies reporting both an intervention and results were included. DATA EXTRACTION AND SYNTHESIS The studies were examined and coded for relevant passages. Characteristics regarding intervention design, training conditions and evaluation methods were analysed and summarised both qualitatively and quantitatively. RESULTS Sixty-one interventions were included. 48% did not explain any keyword of their CRM intervention to a reproducible detail. Operating room teams and surgery, emergency medicine, intensive care unit staff and anaesthesiology came in contact most with a majority of the CRM interventions delivered in a 1-day or half-day format. Trainer qualification is reported seldomly. Evaluation methods and levels display strong variation. CONCLUSIONS Critical topics were identified for the CRM training community and include the following: the need to agree on common terms and definitions for CRM in healthcare, standards of good practice for reporting CRM interventions and their effects, as well as the need for more research to establish non-educational criteria for success in the implementation of CRM in healthcare organisations.
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Affiliation(s)
- Benedict Gross
- Institute for Emergency Medicine and Management in Medicine, University Hospital LMU Munich, Munich, Germany
| | - Leonie Rusin
- Institute for Emergency Medicine and Management in Medicine, University Hospital LMU Munich, Munich, Germany
| | - Jan Kiesewetter
- Institute for Medical Education, University Hospital LMU Munich, Munich, Germany
| | - Jan M Zottmann
- Institute for Medical Education, University Hospital LMU Munich, Munich, Germany
| | - Martin R Fischer
- Institute for Medical Education, University Hospital LMU Munich, Munich, Germany
| | - Stephan Prückner
- Institute for Emergency Medicine and Management in Medicine, University Hospital LMU Munich, Munich, Germany
| | - Alexandra Zech
- Institute for Emergency Medicine and Management in Medicine, University Hospital LMU Munich, Munich, Germany
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Peer-Led Written Debriefing Versus Instructor-Led Oral Debriefing: Using Multimode Simulation. Clin Simul Nurs 2018. [DOI: 10.1016/j.ecns.2018.02.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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