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Medina-Córdoba M, Cadavid S, Espinosa-Aranzales AF, Aguía-Rojas K, Bermúdez-Hernández PA, Quiroga-Torres DA, Rodríguez-Dueñas WR. The effect of interprofessional education on the work environment of health professionals: a scoping review. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2024; 29:1463-1480. [PMID: 38038831 PMCID: PMC11368981 DOI: 10.1007/s10459-023-10300-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 10/29/2023] [Indexed: 12/02/2023]
Abstract
To explore the existing literature on the effect of Interprofessional Education (IPE) on the work environment of health professionals. The research question was systematized according to the PCC (Population, Concept, and Context) format. A scoping review was performed. A search of multiple bibliographic databases identified 407 papers, of which 21 met the inclusion criteria. The populations of the 21 studies reviewed were composed of professionals in the fields of medicine, nursing, psychology, occupational therapy, physiotherapy, and social work, among others. The study contexts were both academic and nonacademic hospitals, mental health institutions, and community settings, and the topics examined were organizational climate, organizational culture, organizational attachment and job satisfaction. The findings from the reviewed studies showed positive effects of IPE interventions on organizational climate and culture, but the results on job satisfaction and organizational attachment were mixed (i.e., positive and no effects following IPE interventions). Research on IPE is worth more attention as IPE could be an effective alternative for the fulfillment of the Quadruple Aim and achieving the third of the United Nations Sustainable Development Goals, aimed at improving health and well-being. It seems critical for IPE to be positioned as a trend in global health, aiming at boosting human health resources as one of its building blocks and calling the attention of health decision-makers.
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Affiliation(s)
| | - Sara Cadavid
- Program of Psychology, People, Family and Society Research Group, School of Medicine and Health Sciences, Universidad del Rosario, Bogota, Colombia.
| | | | - Karen Aguía-Rojas
- Program of Occupational Therapy, Rehabilitation Science Research Group, School of Medicine and Health Sciences, Universidad del Rosario, Bogota, Colombia
| | - Pablo Andrés Bermúdez-Hernández
- Program of Medicine, Medical and Health Sciences Education Research Group, School of Medicine and Health Sciences, Universidad del Rosario, Bogota, Colombia
| | - Daniel-Alejandro Quiroga-Torres
- Program of Biomedical Engineering, Gibiome Research Group, School of Medicine and Health Sciences, Universidad del Rosario, Bogota, Colombia
| | - William R Rodríguez-Dueñas
- Program of Biomedical Engineering, Gibiome Research Group, School of Medicine and Health Sciences, Universidad del Rosario, Bogota, Colombia
- Electronics Engineering Department, Bioengineering Signal Analysis and Image Processing Research Group, Pontificia Universidad Javeriana, Bogota, Colombia
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Lee JE, Yu JH, Lee SK, Lee JH, Jung HJ. Comparison of medical students' perceptions of patient safety: Focusing on simulation training using a high-fidelity simulator. PLoS One 2024; 19:e0304883. [PMID: 39024336 PMCID: PMC11257313 DOI: 10.1371/journal.pone.0304883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Accepted: 05/20/2024] [Indexed: 07/20/2024] Open
Abstract
Patient safety education is necessary for the provision of high-quality medical services. A significant aspect of patient safety education is simulation training, which allows medical students to experience realistic clinical environments. This study aimed to verify the effectiveness of patient safety education using simulation training. We retrospectively analyzed the results of a 30-question questionnaire survey on the perceptions of patient safety before and after simulation training, which was completed by 40 medical students who participated in clinical practice between June and December 2021. A paired t-test was performed by calculating the mean and standard deviation for each item. We found that students' overall perceptions of patient safety improved after training. Specifically, after simulation training, attitudes toward patient safety were maintained at the same level as before training, while students' self-efficacy of patient safety increased. Simulation training is effective in improving students' perceptions of patient safety, and increasing students' confidence can improve their clinical performance. To maintain this effect, repeated learning is required, and theoretical classes and simulation training should be used appropriately for patient safety education in the future.
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Affiliation(s)
- Ji Eun Lee
- Office of Medical Education, Ajou University School of Medicine, Suwon, South Korea
| | - Ji Hye Yu
- Office of Medical Education, Ajou University School of Medicine, Suwon, South Korea
- Department of Medical Education, Ajou University School of Medicine, Suwon, South Korea
| | - Su Kyung Lee
- Ajou Center for Clinical Excellence, Ajou University School of Medicine, Suwon, South Korea
| | - Jang Hoon Lee
- Office of Medical Education, Ajou University School of Medicine, Suwon, South Korea
- Department of Medical Education, Ajou University School of Medicine, Suwon, South Korea
- Department of Pediatrics, Ajou University School of Medicine, Suwon, South Korea
| | - Hyun Joo Jung
- Department of Pediatrics, Ajou University School of Medicine, Suwon, South Korea
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Jahromi MK, Nick N, Bagheri S, Kalyani MN. Simulation effect on medical sciences students' motivation: A systematic review study. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2024; 13:163. [PMID: 39268453 PMCID: PMC11392312 DOI: 10.4103/jehp.jehp_393_23] [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: 03/18/2023] [Accepted: 06/02/2023] [Indexed: 09/15/2024]
Abstract
Simulation is an educational technology that can facilitate learning, improve performance, and develop critical thinking and self-confidence in students. Motivation is an effective factor in the level of efficiency and the use of individual talent, ability, and satisfaction. The aim of this study was to determine the effect of simulation on students' motivation based on existing studies. This systematic review was conducted using a full systematic search strategy based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for the identification of relevant literature in Cochrane, PubMed, Embase, Scopus, Web of Science, and ERIC electronic databases up to April 2023, utilizing search terms in the titles and abstracts. Finally, 21 articles were selected after being screened in accordance with our inclusion and exclusion criteria. Of 21 articles related to the study's aim, 19 articles (91%) were interventional studies (three randomized controlled trials (RCTs) and 16 non-RCTs) and two articles (9%) were noninterventional studies (cohort and cross-sectional). The results revealed that in 17 studies (77%), simulation studies had a positive effect on motivation, and in 19% of studies, simulation had no significant effect on motivation. Most of the studies improved students' learning motivation using different simulation methods. Simulation methods require appropriateness in three areas: comprehensiveness, the subjects of training, and the allocation of appropriate facilities.
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Affiliation(s)
- Mahdi Karimyar Jahromi
- Department of Nursing, School of Nursing, Jahrom University of Medical Sciences, Jahrom, Iran
| | - Narjes Nick
- Department of Nursing, School of Nursing and Midwifery, Community Based Psychiatric Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Shahpar Bagheri
- Department of Nursing, School of Nursing and Midwifery, Community Based Psychiatric Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Majid Najafi Kalyani
- School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran
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Keller S, Jelsma JGM, Tschan F, Sevdalis N, Löllgen RM, Creutzfeldt J, Kennedy-Metz LR, Eppich W, Semmer NK, Van Herzeele I, Härenstam KP, de Bruijne MC. Behavioral sciences applied to acute care teams: a research agenda for the years ahead by a European research network. BMC Health Serv Res 2024; 24:71. [PMID: 38218788 PMCID: PMC10788034 DOI: 10.1186/s12913-024-10555-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 01/03/2024] [Indexed: 01/15/2024] Open
Abstract
BACKGROUND Multi-disciplinary behavioral research on acute care teams has focused on understanding how teams work and on identifying behaviors characteristic of efficient and effective team performance. We aimed to define important knowledge gaps and establish a research agenda for the years ahead of prioritized research questions in this field of applied health research. METHODS In the first step, high-priority research questions were generated by a small highly specialized group of 29 experts in the field, recruited from the multinational and multidisciplinary "Behavioral Sciences applied to Acute care teams and Surgery (BSAS)" research network - a cross-European, interdisciplinary network of researchers from social sciences as well as from the medical field committed to understanding the role of behavioral sciences in the context of acute care teams. A consolidated list of 59 research questions was established. In the second step, 19 experts attending the 2020 BSAS annual conference quantitatively rated the importance of each research question based on four criteria - usefulness, answerability, effectiveness, and translation into practice. In the third step, during half a day of the BSAS conference, the same group of 19 experts discussed the prioritization of the research questions in three online focus group meetings and established recommendations. RESULTS Research priorities identified were categorized into six topics: (1) interventions to improve team process; (2) dealing with and implementing new technologies; (3) understanding and measuring team processes; (4) organizational aspects impacting teamwork; (5) training and health professions education; and (6) organizational and patient safety culture in the healthcare domain. Experts rated the first three topics as particularly relevant in terms of research priorities; the focus groups identified specific research needs within each topic. CONCLUSIONS Based on research priorities within the BSAS community and the broader field of applied health sciences identified through this work, we advocate for the prioritization for funding in these areas.
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Affiliation(s)
- Sandra Keller
- Department of Visceral Surgery and Medicine, Bern University Hospital, Bern, Switzerland.
- Department for BioMedical Research (DBMR), Bern University, Bern, Switzerland.
| | - Judith G M Jelsma
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Franziska Tschan
- Institute for Work and Organizational Psychology, University of Neuchâtel, Neuchâtel, Switzerland
| | - Nick Sevdalis
- Centre for Implementation Science, Health Service and Population Research Department, KCL, London, UK
| | - Ruth M Löllgen
- Pediatric Emergency Department, Astrid Lindgrens Children's Hospital; Karolinska University Hospital, Stockholm, Sweden
- Department of Women's and Children's Health, Karolinska Institute, Stockholm, Sweden
| | - Johan Creutzfeldt
- Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden
- Center for Advanced Medical Simulation and Training, (CAMST), Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden
| | - Lauren R Kennedy-Metz
- Department of Surgery, Harvard Medical School, Boston, MA, USA
- Division of Cardiac Surgery, VA Boston Healthcare System, Boston, MA, USA
- Psychology Department, Roanoke College, Salem, VA, USA
| | - Walter Eppich
- Department of Medical Education & Collaborative Practice Centre, University of Melbourne, Melbourne, Australia
| | - Norbert K Semmer
- Department of Work Psychology, University of Bern, Bern, Switzerland
| | - Isabelle Van Herzeele
- Department of Thoracic and Vascular Surgery, Ghent University Hospital, Ghent, Belgium
| | - Karin Pukk Härenstam
- Pediatric Emergency Department, Astrid Lindgrens Children's Hospital; Karolinska University Hospital, Stockholm, Sweden
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
| | - Martine C de Bruijne
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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Schram A, Jensen HI, Gamborg M, Lindhard M, Rölfing J, Kjaergaard-Andersen G, Bie M, Jensen RD. Exploring the relationship between simulation-based team training and sick leave among healthcare professionals: a cohort study across multiple hospital sites. BMJ Open 2023; 13:e076163. [PMID: 37899150 PMCID: PMC10618977 DOI: 10.1136/bmjopen-2023-076163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 10/11/2023] [Indexed: 10/31/2023] Open
Abstract
OBJECTIVE Burnout and mental illness are frequent among healthcare professionals, leading to increased sick leave. Simulation-based team training has been shown to improve job satisfaction and mental health among healthcare professionals. This study seeks to investigate the relationship between simulation-based team training and sick leave. DESIGN Cohort study. SETTING AND INTERVENTION Five Danish hospitals. PARTICIPANTS A total of 15 751 individuals were screened for eligibility. To meet the eligibility criteria, individuals had to be employed in the same group (intervention or control) for the whole study period. A total of 14 872 individuals were eligible for analysis in the study. INTERVENTION From 2017 to 2019, a simulation-based team training intervention was implemented at two hospital sites. Three hospital sites served as the control group. OUTCOME MEASURES Data on sick leave from 2015 to 2020 covered five hospital sites. Using a difference-in-difference analysis, the rate of sick leave was compared across hospital sites (intervention vs control) and time periods (before vs after intervention). RESULTS Significant alterations in sick leave were evident when comparing the intervention and control groups. When comparing groups over time, the increase in sick leave was -0.3% (95% CI -0.6% to -0.0%) lower in the intervention group than in the control group. The difference-in-difference for the complete case analysis showed that this trend remained consistent, with analysis indicating a comparable lower increase in sick leave by -0.7% (95% CI -1.3% to -0.1%) in the intervention group. CONCLUSION The increase in sick leave rate was statistically significantly lower in the intervention group, implying that simulation-based team training could serve as a protective factor against sick leave. However, when investigating this simulation intervention over 5 years, other potential factors may have influenced sick leave, so caution is required when interpreting the results.
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Affiliation(s)
| | - Hanne Irene Jensen
- Department of Anaesthesiology and Intensive Care, Lillebaelt Hospital-University Hospital of Southern Denmark, Kolding, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Maria Gamborg
- MidtSim, Central Denmark Region, Aarhus N, Denmark
- Department of Clinical Medicine, Aarhus Universitet, Aarhus, Denmark
| | - Morten Lindhard
- Department of Clinical Medicine, Aarhus Universitet, Aarhus, Denmark
- Department of Paediatrics, Randers Regional Hospital, Randers, Denmark
| | - Jan Rölfing
- MidtSim, Central Denmark Region, Aarhus N, Denmark
- Department of Orthopaedics, Aarhus Universitet, Aarhus, Denmark
| | - Gunhild Kjaergaard-Andersen
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
- Department of Anaesthesiology and Intensive Care, Lillebaelt Hospital-University Hospital of Southern Denmark, Vejle, Denmark
| | - Magnus Bie
- MidtSim, Central Denmark Region, Aarhus N, Denmark
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Fowler TO, Wise HH, Mauldin MP, Ragucci KR, Scheurer DB, Su Z, Mauldin PD, Bailey JR, Borckardt JJ. Alignment of an interprofessional student learning experience with a hospital quality improvement initiative. J Interprof Care 2023; 37:S53-S62. [PMID: 29641943 DOI: 10.1080/13561820.2018.1455649] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Revised: 11/22/2017] [Accepted: 03/19/2018] [Indexed: 01/17/2023]
Abstract
Assessment of interprofessional education (IPE) frequently focuses on students' learning outcomes including changes in knowledge, skills, and/or attitudes. While a foundational education in the values and information of their chosen profession is critical, interprofessional learning follows a continuum from formal education to practice. The continuum increases in significance and complexity as learning becomes more relationship based and dependent upon the ability to navigate complex interactions with patients, families, communities, co-workers, and others. Integrating IPE into collaborative practice is critical to enhancing students' experiential learning, developing teamwork competencies, and understanding the complexity of teams. This article describes a project that linked students with a hospital-based quality-improvement effort to focus on the acquisition and practice of teamwork skills and to determine the impact of teamwork on patient and quality outcome measures. A hospital unit was identified with an opportunity for improvement related to quality care, patient satisfaction, employee engagement, and team behaviours. One hundred and thirty-seven students from six health profession colleges at the Medical University of South Carolina underwent TeamSTEPPS® training and demonstrated proficiency of their teamwork-rating skills with the TeamSTEPPS® Team Performance Observation Tool (T-TPO). Students observed real-time team behaviours of unit staff before and after staff attended formal TeamSTEPPS® training. The students collected a total of 778 observations using the T-TPO. Teamwork performance on the unit improved significantly across all T-TPO domains (team structure, communication, leadership, situation monitoring, and mutual support). Significant improvement in each domain continued post-intervention and at 15-month follow-up, improvement remained significant compared to baseline. Student engagement in TeamSTEPPS® training and demonstration of their reliability as teamwork-observers was a valuable learning experience and also yielded an opportunity to gather unique, and otherwise difficult to attain, data from a hospital unit for use by quality managers and administrators.
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Affiliation(s)
- Terri O Fowler
- College of Nursing, Medical University of South Carolina (MUSC), Charleston, South Carolina, USA
| | - Holly H Wise
- Division of Physical Therapy, College of Health Professions, Faculty Development, Office of Interprofessional Initiatives, MUSC, Charleston, South Carolina, USA
| | - Mary P Mauldin
- Office of Interprofessional Initiatives, MUSC, Charleston, South Carolina, USA
| | - Kelly R Ragucci
- Department of Clinical Pharmacy and Outcomes Sciences, College of Pharmacy, MUSC, Charleston, South Carolina, USA
| | - Danielle B Scheurer
- Department of Medicine, College of Medicine, MUSC Medical Center, Charleston, South Carolina, USA
| | - Zemin Su
- Department of Medicine, College of Medicine, MUSC, Charleston, South Carolina, USA
| | - Patrick D Mauldin
- Section of Health Systems and Research Policy, Division of General Internal Medicine and Geriatrics, College of Medicine, MUSC, Charleston, South Carolina, USA
| | - Jennifer R Bailey
- Academic Affairs and Office of Interprofessional Initiatives, MUSC and Education and Evaluation, South Carolina Area Health Education Consortium, Charleston, South Carolina, USA
| | - Jeffrey J Borckardt
- Office of Interprofessional Initiatives, Departments of Psychiatry, Anesthesia, and Stomatology, Behavioral Medicine, College of Medicine, MUSC, Charleston, South Carolina, USA
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Escher C, Rystedt H, Creutzfeldt J, Meurling L, Hedman L, Felländer-Tsai L, Kjellin A. All professions can benefit - a mixed-methods study on simulation-based teamwork training for operating room teams. Adv Simul (Lond) 2023; 8:18. [PMID: 37460943 PMCID: PMC10351117 DOI: 10.1186/s41077-023-00257-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 07/09/2023] [Indexed: 07/20/2023] Open
Abstract
BACKGROUND Operating rooms have become more technically complex due to new advanced procedures, which has increased demands on teamwork in the operating room. In response, team training has been proposed to improve team performance, workplace culture, and patient safety. We developed and delivered a simulation-based team training course for entire professional surgical teams. This type of intervention has been proposed by researchers but has not been widely published. The aims of this intervention study were to examine participants' reactions to the course in terms of their motivation for the training and their self-efficacy in relation to their performance, as well as their views on transferring the lessons learned in the course to their workplace. METHODS In a prospective mixed-methods intervention study, operating room professionals participated in a full-day simulation-based teamwork training course. Learning objectives were nontechnical skills, specifically communication and collaboration across the team. Seventy-one staff members representing 5 operating room professions were included, and the average work experience of participants was 6 years. Quantitative data on self-efficacy and situational motivation were collected by questionnaires before and after training. Qualitative data were collected through 5 focus group interviews that took place in direct relation to the courses and included a total of 31 participants. Transcripts were coded and analyzed using thematic analysis. RESULTS All occupations showed a similar pattern in terms of increases in self-efficacy and intrinsic motivation after the training. Analysis of the qualitative data showed that training in one's profession and in authentic multiprofessional teams was important factors for motivation. Participating staff described an awareness of undesirable communication barriers in surgical teams that can lead to risks for patients. Systematic training was definitely perceived as a means to reduce barriers and improve communication and collaboration. CONCLUSION Simulation-based training was equally well received by all professional groups. Our results confirm the feasibility of this type of training for professional teams and promising opportunities for improving teamwork skills. The qualitative data reveal both opportunities and limitations for transferring the learning experiences to the workplace.
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Affiliation(s)
- Cecilia Escher
- Center for Advanced Medical Simulation and Training (CAMST), Karolinska University Hospital, Stockholm, Sweden.
- Department of Clinical Science Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden.
| | - Hans Rystedt
- Simulator Centre West, Region Västra Götaland, Gothenburg, Sweden
| | - Johan Creutzfeldt
- Center for Advanced Medical Simulation and Training (CAMST), Karolinska University Hospital, Stockholm, Sweden
- Department of Clinical Science Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden
| | - Lisbet Meurling
- Center for Advanced Medical Simulation and Training (CAMST), Karolinska University Hospital, Stockholm, Sweden
- Department of Clinical Science Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden
| | - Leif Hedman
- Department of Clinical Science Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden
- Department of Psychology, Umeå University, Umeå, Sweden
| | - Li Felländer-Tsai
- Center for Advanced Medical Simulation and Training (CAMST), Karolinska University Hospital, Stockholm, Sweden
- Department of Clinical Science Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden
| | - Ann Kjellin
- Center for Advanced Medical Simulation and Training (CAMST), Karolinska University Hospital, Stockholm, Sweden
- Department of Clinical Science Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden
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Lackie K, Hayward K, Ayn C, Stilwell P, Lane J, Andrews C, Dutton T, Ferkol D, Harris J, Houk S, Pendergast N, Persaud D, Thillaye J, Mills J, Grant S, Munroe A. Creating psychological safety in interprofessional simulation for health professional learners: a scoping review of the barriers and enablers. J Interprof Care 2023; 37:187-202. [PMID: 35403551 DOI: 10.1080/13561820.2022.2052269] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Interprofessional simulation-based education (IP-SBE) supports the acquisition of interprofessional collaborative competencies. Psychologically safe environments are necessary to address socio-historical hierarchies and coercive practices that may occur in IP-SBE, facilitating fuller student participation. A scoping review was conducted to understand the barriers and enablers of psychological safety within IP-SBE. Research papers were eligible if they included two or more undergraduate and/or post-graduate students in health/social care qualifications/degrees and discussed barriers and/or enablers of psychological safety within simulation-based education. Sources of evidence included experimental, quasi-experimental, analytical observational, descriptive observational, qualitative, and mixed-methodological peer-reviewed studies. English or English-translated articles, published after January 1, 1990, were included. Data were extracted by two members of the research team. Extraction conflicts were resolved by the principal investigators. In total, 1,653 studies were screened; 1,527 did not meet inclusion criteria. After a full-text review, 99 additional articles were excluded; 27 studies were analyzed. Psychological safety enablers include prebriefing-debriefing by trained facilitators, no-blame culture, and structured evidenced-based simulation designs. Hierarchy among/between professions, fear of making mistakes, and uncertainty were considered barriers. Recognition of barriers and enablers of psychological safety in IP-SBE is an important first step towards creating strategies that support the full participation of students in their acquisition of IPC competencies.
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Affiliation(s)
| | | | | | - Peter Stilwell
- School of Physical and Occupational Therapy, McGill University
| | | | | | - Tanya Dutton
- Nova Scotia Rehabilitation & Arthritis Centre, Canada
| | - Doug Ferkol
- Centre for Collaborative Clinical Learning and Research
| | | | | | | | | | | | | | - Shannan Grant
- Department of Applied Human Nutrition, Mount Saint Vincent University
| | - Andrew Munroe
- Nova Scotia Rehabilitation & Arthritis Centre, Canada
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Escher C, Nagy E, Creutzfeldt J, Dahl O, Ruiz M, Ericson M, Osika W, Meurling L. Fear of making a mistake: a prominent cause of stress for COVID-19 ICU staff-a mixed-methods study. BMJ Open Qual 2023; 12:e002009. [PMID: 36697055 PMCID: PMC9884924 DOI: 10.1136/bmjoq-2022-002009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 01/12/2023] [Indexed: 01/26/2023] Open
Abstract
INTRODUCTION The COVID-19 pandemic has had a profound effect on many domains of healthcare. Even in high-income countries such as Sweden, the number of patients has vastly outnumbered the resources in affected areas, in particular during the first wave. Staff caring for patients with COVID-19 in intensive care units (ICUs) faced a very challenging situation that continued for months. This study aimed to describe burnout, safety climate and causes of stress among staff working in COVID-19 ICUs. METHOD A survey was distributed to all staff working in ICUs treating patients with COVID-19 in five Swedish hospitals during 2020 and 2021. The numbers of respondents were 104 and 603, respectively. Prepandemic data including 172 respondents from 2018 served as baseline. RESULTS Staff exhaustion increased during the pandemic, but disengagement decreased compared with prepandemic levels (p<0.001). Background factors such as profession and work experience had no significant impact, but women scored higher in exhaustion. Total workload and working during both the first and second waves correlated positively to exhaustion, as did being regular ICU staff compared with temporary staff. Teamwork and safety climate remained unchanged compared with prepandemic levels.Respondents reported 'making a mistake' as the most stressful of the predefined stressors. Qualitative analysis of open-ended questions identified 'lack of knowledge and large responsibility', 'workload and work environment', 'uncertainty', 'ethical stress' and 'organization and teamwork' as major causes of stress. CONCLUSION Despite large workloads, disengagement at work was low in our sample, even compared with prepandemic levels. High levels of exhaustion were reported by the ICU staff who carried the largest workload. Multiple significant causes of stress were identified, with fear of making a mistake the most significant stressor.
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Affiliation(s)
- Cecilia Escher
- Clinical Sciences, Intervention and Technology (CLINTEC), Karolinska Institute, Stockholm, Sweden
- Department of Anesthesia and Intensive Care, Norrtälje Hospital, Stockholm, Sweden
- Center for Advanced Medical Simulation and Training (CAMST), Karolinska University Hospital, Stockholm, Sweden
| | - Elisabeth Nagy
- Clinical Sciences, Intervention and Technology (CLINTEC), Karolinska Institute, Stockholm, Sweden
- Center for Advanced Medical Simulation and Training (CAMST), Karolinska University Hospital, Stockholm, Sweden
- Department of Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden
| | - Johan Creutzfeldt
- Clinical Sciences, Intervention and Technology (CLINTEC), Karolinska Institute, Stockholm, Sweden
- Center for Advanced Medical Simulation and Training (CAMST), Karolinska University Hospital, Stockholm, Sweden
- Department of Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden
| | - Oili Dahl
- Department of Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden
- Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden
| | - Mini Ruiz
- Clinical Sciences, Intervention and Technology (CLINTEC), Karolinska Institute, Stockholm, Sweden
| | - Mats Ericson
- Division of Ergonomics, Royal Institute of Technology, Stockholm, Sweden
| | - Walter Osika
- Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden
| | - Lisbet Meurling
- Clinical Sciences, Intervention and Technology (CLINTEC), Karolinska Institute, Stockholm, Sweden
- Center for Advanced Medical Simulation and Training (CAMST), Karolinska University Hospital, Stockholm, Sweden
- Department of Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden
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Kaim A, Bodas M, Camacho NA, Peleg K, Ragazzoni L. Enhancing disaster response of emergency medical teams through "TEAMS 3.0" training package-Does the multidisciplinary intervention make a difference? Front Public Health 2023; 11:1150030. [PMID: 37124785 PMCID: PMC10130359 DOI: 10.3389/fpubh.2023.1150030] [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: 01/23/2023] [Accepted: 03/07/2023] [Indexed: 05/02/2023] Open
Abstract
Background In the aftermath of disasters, Emergency Medical Teams (EMTs) are dispatched to help local rescue efforts. Although EMTs are recognized to be a critical component of the global health workforce, concerns have emerged over their functioning and effectiveness. For example, lack of cooperation and coordination between different EMTs has been a longstanding issue, resulting in fragmented disaster management. Methods To enhance the provision of EMT's field teamwork, the Training for Emergency Medical Teams and European Medical Corps (TEAMS) project was established, and later further updated with novel scenarios and exercises (i.e., adapting EMT operations to a sudden disaster; becoming a modular team; reflecting on ethical dilemmas) in the complementary "TEAMS 3.0" project where a more comprehensive training package was developed. The aim of this study was to assess the effectiveness and quality of the TEAMS 3.0 training package in four training programs in Portugal, Germany, Norway, and Turkey. Participants completed a set of questionnaires designed to assess self-efficacy, teamwork, and quality of training. Results The results from all the trainings suggest an improvement for both teams' self-efficacy and teamwork. The mean score among all the participants (N = 100) for both the self-efficacy scale and teamwork scale was 3.217 (±0.223) prior to training and 3.484 (±0.217) following the training, and 2.512 (±1.313) prior to training and 3.281 (±0.864), respectfully, with statistically significant differences according to Wilcoxon paired samples test (p < 0.05). The quality of training is regarded as high and deemed as an appropriate tool package for addressing the objectives of the project and the perceived needs of EMT disaster deployment. Conclusion Thus far, the TEAMS 3.0 project has demonstrated to be effective in promoting EMT teamwork capacities.
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Affiliation(s)
- Arielle Kaim
- Israel National Center for Trauma and Emergency Medicine Research, Sheba Medical Center, The Gertner Institute for Epidemiology and Health Policy Research, Ramat-Gan, Israel
- Department of Emergency and Disaster Management, Faculty of Medicine, School of Public Health, Sackler Tel Aviv University, Tel Aviv, Israel
- *Correspondence: Arielle Kaim, ;
| | - Moran Bodas
- Israel National Center for Trauma and Emergency Medicine Research, Sheba Medical Center, The Gertner Institute for Epidemiology and Health Policy Research, Ramat-Gan, Israel
- Department of Emergency and Disaster Management, Faculty of Medicine, School of Public Health, Sackler Tel Aviv University, Tel Aviv, Israel
| | - Nieves Amat Camacho
- Department of Global Public Health, Center for Research on Health Care in Disasters, Karolinska Institute, Stockholm, Sweden
- CRIMEDIM-Center for Research and Training in Disaster Medicine, Humanitarian Aid and Global Health, Università del Piemonte Orientale, Novara, Italy
| | - Kobi Peleg
- Israel National Center for Trauma and Emergency Medicine Research, Sheba Medical Center, The Gertner Institute for Epidemiology and Health Policy Research, Ramat-Gan, Israel
| | - Luca Ragazzoni
- CRIMEDIM-Center for Research and Training in Disaster Medicine, Humanitarian Aid and Global Health, Università del Piemonte Orientale, Novara, Italy
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von Rüden C, Ewers A, Brand A, Hungerer S, Erichsen CJ, Dahlmann P, Werner D. The Influence of Human Factors Training in Air Rescue Service on Patient Safety in Hospitals: Results of an Online Survey. MEDICINES (BASEL, SWITZERLAND) 2022; 10:medicines10010002. [PMID: 36662486 PMCID: PMC9861563 DOI: 10.3390/medicines10010002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 12/09/2022] [Accepted: 12/15/2022] [Indexed: 12/24/2022]
Abstract
Background: Air rescue crew members work equally in aviation and medicine, and thus occupy an important interface between the two work environments of aviation and medicine. The aim of this study was to obtain responses from participants to a validated online-based questionnaire regarding whether hospitals may benefit from the commitment of a medical hospital staff which is also professionally involved in the aviation system as emergency physicians and Helicopter Emergency Medical Services Technical Crew Members (HEMS TC). Furthermore, it focused on the question of whether the skills acquired through Crew Resource Management (CRM) training in the air rescue service might also be used in the ground-based rescue service and, if so, whether they may have a positive effect. Methods: Medical air rescue staff of 37 German air rescue stations was included. Between 27 November 2020 and 03 March 2021, 253 out of 621 employees (response rate: 40.7%) participated voluntarily in a validated anonymized online survey. A quantitative test procedure was performed using the modified questionnaire on teamwork and patient safety (German version). Results: The examination and interpretation of the internal consistency (Cronbach's alpha) resulted in the following reliabilities: Factor I (Cooperation): α = 0.707 (good); Factor II (Human factors): α = 0.853 (very good); Factor III (Communication): α = 0.657 (acceptable); and Factor IV (Safety): α = 0.620 (acceptable). Factor analysis explained 53.1% of the variance. Conclusions: The medical clinicians participating in this online survey believed that the skills they learned in human factors training such as CRM are helpful in their daily routine work in hospitals or other medical facilities, as well as in their ground-based rescue service activities. These findings may result in the recommendation to make CRM available on a regular to the medical staff in all medical facilities and also to ground-based rescue service staff aiming to increase patient safety and employee satisfaction.
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Affiliation(s)
- Christian von Rüden
- Department of Trauma Surgery, BG Unfallklinik Murnau, 82418 Murnau, Germany
- Institute for Biomechanics, BG Unfallklinik Murnau, 82418 Murnau, Germany
- Institute for Biomechanics, Paracelsus Medical University, 5020 Salzburg, Austria
- Correspondence: ; Tel.: +49-8841-480; Fax: +49-8841-3026
| | - Andre Ewers
- Institute of Nursing Science and Practice, Paracelsus Medical University, 5020 Salzburg, Austria
| | - Andreas Brand
- Institute for Biomechanics, BG Unfallklinik Murnau, 82418 Murnau, Germany
- Institute for Biomechanics, Paracelsus Medical University, 5020 Salzburg, Austria
| | - Sven Hungerer
- Department of Trauma Surgery, BG Unfallklinik Murnau, 82418 Murnau, Germany
- Institute for Biomechanics, BG Unfallklinik Murnau, 82418 Murnau, Germany
- Institute for Biomechanics, Paracelsus Medical University, 5020 Salzburg, Austria
| | | | - Philipp Dahlmann
- Center for Academic Further Education, Deggendorf Institute of Technology, 94469 Deggendorf, Germany
| | - Daniel Werner
- Department of Anesthesiology, LMU Klinikum, University Hospital, Ludwig-Maximilians-University, 80539 Munich, Germany
- Department of Medicine, ADAC Air Rescue Service, 80686 Munich, Germany
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Schram AL, Lindhard MS, Bie M, Gamborg ML, Toxvig N, Skov G, Jensen RD. Using simulation-based training during hospital relocation: a controlled intervention study. ADVANCES IN SIMULATION (LONDON, ENGLAND) 2022; 7:41. [PMID: 36527102 PMCID: PMC9758894 DOI: 10.1186/s41077-022-00237-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 11/30/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND During hospital relocations, it is important to support healthcare professionals becoming familiar with new settings. Simulation-based training seems promising and in situ simulation has been suggested as a beneficial educational tool to prepare healthcare professionals for relocation. This study aimed to investigate the impact of a simulation-based training intervention on health professionals´ readiness to work in their new environment, as well as investigate sick leave before and after relocation. METHODS The study was a controlled intervention study implemented at a university hospital in Denmark. Simulation was used to prepare employees for workflows prior to relocation. Before relocation, 1199 healthcare professionals participated in the in situ simulation-based training program. Questionnaires on readiness to perform were distributed to participants at pre-, post-, and follow-up (6 months) measurement. In addition, data on participants' sick leave was gathered from a business intelligence portal. To compare dependent and independent groups, paired and unpaired t tests were performed on mean score of readiness to perform and sick leave. RESULTS Compared to the control group, healthcare professionals participating in the intervention felt significantly more ready to work in a new hospital environment. As a measure of psychological wellbeing, register data indicated no difference in sick leave, when comparing intervention and control groups before and after participating in the in situ simulation-based training program. CONCLUSIONS Healthcare professionals felt significantly more ready to work in a new environment, after participating in the in situ simulation-based training program, indicating that the intervention supported healthcare professionals during relocations. This may mitigate feelings of uncertainty; however, further research is needed to explore such effects. TRIAL REGISTRATION The study was approved by The Regional Ethics Committee (no. 1-16-02-222-22).
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Affiliation(s)
- Anders Lund Schram
- grid.425869.40000 0004 0626 6125Corporate HR, MidtSim, Central Denmark Region, Aarhus, Denmark
| | | | - Magnus Bie
- grid.425869.40000 0004 0626 6125Corporate HR, MidtSim, Central Denmark Region, Aarhus, Denmark
| | - Maria Louise Gamborg
- grid.425869.40000 0004 0626 6125Corporate HR, MidtSim, Central Denmark Region, Aarhus, Denmark
| | - Neel Toxvig
- grid.425869.40000 0004 0626 6125Corporate HR, MidtSim, Central Denmark Region, Aarhus, Denmark
| | - Gitte Skov
- grid.154185.c0000 0004 0512 597XDepartment for Psychosis, Aarhus University Hospital-Psychiatry, Aarhus, Denmark
| | - Rune Dall Jensen
- grid.425869.40000 0004 0626 6125Corporate HR, MidtSim, Central Denmark Region, Aarhus, Denmark
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13
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Olsen SL, Søreide E, Hansen BS. We Are Not There Yet: A Qualitative System Probing Study of a Hospital Rapid Response System. J Patient Saf 2022; 18:722-729. [PMID: 35384936 PMCID: PMC9524589 DOI: 10.1097/pts.0000000000001000] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The capability of a hospital's rapid response system (RRS) depends on various factors to reduce in-hospital cardiac arrests and mortality. Through system probing, this qualitative study targeted a more comprehensive understanding of how healthcare professionals manage the complexities of RRS in daily practice as well as identifying its challenges. METHODS We observed RRS through in situ simulations in 2 wards and conducted the debriefings as focus group interviews. By arranging a separate focus group interview, we included the perspectives of intensive care unit personnel. RESULTS Healthcare professionals appreciated the standardized use of the National Early Warning Score, when combined with clinical knowledge and experience, structured communication, and interprofessional collaboration. However, we identified salient challenges in RRS, for example, unwanted variation in recognition competence, and inconsistent routines in education and documentation. Furthermore, we found that a lack of interprofessional trust, different understandings of RRS protocol, and signs of low psychological safety in the wards disrupted collaboration. To help remedy identified challenges, healthcare professionals requested shared arenas for learning, such as in situ simulation training. CONCLUSIONS Through system probing, we described the inner workings of RRS and revealed the challenges that require more attention. Healthcare professionals depend on structured RRS education, training, and resources to operate such a system. In this study, they request interventions like in situ simulation training as an interprofessional educational arena to improve patient care. This is a relevant field for further research. The Consolidated Criteria for Reporting Qualitative Studies Checklist was followed to ensure rigor in the study.
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Affiliation(s)
- Siri Lerstøl Olsen
- From the Department of Quality and Health Technology, The Faculty of Health Sciences, SHARE—Centre for Resilience in Healthcare, University of Stavanger
- Stavanger University Hospital, Stavanger, Norway
| | | | - Britt Sætre Hansen
- From the Department of Quality and Health Technology, The Faculty of Health Sciences, SHARE—Centre for Resilience in Healthcare, University of Stavanger
- Stavanger University Hospital, Stavanger, Norway
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14
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Huang X, Gao Y, Chen H, Zhang H, Zhang X. Hospital Culture and Healthcare Workers' Provision of Patient-Centered Care: A Moderated Mediation Analysis. Front Public Health 2022; 10:919608. [PMID: 35734765 PMCID: PMC9207761 DOI: 10.3389/fpubh.2022.919608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 05/13/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundPatient-centered care (PCC) is globally recognized as a high-quality and high-value healthcare service. It emphasizes the broad participation of patients and families in health-related decision-making and the provision of healthcare services that cater to patients' needs, preferences, and values. However, the mechanisms driving healthcare workers' provision of PCC are yet to be fully uncovered.MethodsUsing stratified random sampling, we recruited 1,612 healthcare workers from different levels of public hospitals in Hangzhou. We conducted survey interviews using questionnaires based on psychometrically sound scales. Structural equation modeling was used to analyze the effects of hospital culture, self-efficacy, and achievement motivation on the perceived provision of PCC by healthcare workers and to explore the mechanisms underlying their relationships.ResultsSelf-efficacy had a positive mediating effect in the relationship between hospital culture and healthcare workers' perceived provision of PCC (β = 0.424, p < 0.001). Furthermore, the pursuit of success positively moderated the mediating role of self-efficacy (β = 0.128, p < 0.001), whereas, the avoidance of failure negatively moderated the mediating role of self-efficacy (β = -0.017, p < 0.001).ConclusionThe findings suggest that hospitals should foster patient-centered and innovative cultures and develop strategies focusing on both internal motivation (self-efficacy and achievement motivation) and external environments (hospital culture) to help and encourage healthcare workers to implement PCC. For example, hospitals could further communication skills training, enhance leadership, build team spirit, and promote collaboration among healthcare workers.
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Affiliation(s)
- Xianhong Huang
- Department of Health Policy and Management, School of Public Health, Hangzhou Normal University, Hangzhou, China
| | - Yuan Gao
- Department of Health Policy and Management, School of Public Health, Hangzhou Normal University, Hangzhou, China
| | - Hanlin Chen
- Department of Health Policy and Management, School of Public Health, Hangzhou Normal University, Hangzhou, China
| | - Hao Zhang
- Department of Health Policy and Management, School of Public Health, Hangzhou Normal University, Hangzhou, China
| | - Xiaoting Zhang
- Department of Administration, School of Public Administration, Hangzhou Normal University, Hangzhou, China
- *Correspondence: Xiaoting Zhang
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15
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Santana-Padilla YG, Bernat-Adell MD, Santana-Cabrera L. Nurses’ perception on competency requirement and training demand for intensive care nurses. Int J Nurs Sci 2022; 9:350-356. [PMID: 35891902 PMCID: PMC9305005 DOI: 10.1016/j.ijnss.2022.06.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 05/29/2022] [Accepted: 06/13/2022] [Indexed: 11/19/2022] Open
Affiliation(s)
- Yeray Gabriel Santana-Padilla
- Complejo Hospitalario Universitario Insular Materno Infantil, Las Palmas de Gran Canaria, Canary Islands, Spain
- Corresponding author.
| | | | - Luciano Santana-Cabrera
- Complejo Hospitalario Universitario Insular Materno Infantil, Las Palmas de Gran Canaria, Canary Islands, Spain
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16
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Kiessling A, Amiri C, Arhammar J, Lundbäck M, Wallingstam C, Wikner J, Svensson R, Henriksson P, Kuhl J. Interprofessional simulation-based team-training and self-efficacy in emergency medicine situations. J Interprof Care 2022; 36:873-881. [PMID: 35341425 DOI: 10.1080/13561820.2022.2038103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Teamwork quality has been shown to influence patient safety, and simulation-based team-training (SBTT) is an effective means to increase this quality. However, long-term effects are rarely studied. This study aims to investigate the long-term effects of interprofessional SBTT in emergency medicine in terms of global confidence, self-efficacy in interprofessional communication and in emergency medicine situations. Newly graduated doctors, nurses, auxiliary nurses, and medical and nursing students participated. Four emergency medicine scenarios focused on teamwork according to the A-B-C-D-E-strategy. All participants increased their global confidence from 5.3 (CI 4.9-5.8) before to 6.8 (CI 6.4-7.2; p < .0001) after SBTT. Confidence in interprofessional communication increased from 5.3 (CI 4.9-5.8) to 7.0 (CI 6.6-7.4; p < .0001). Students had the greatest gain. The self-efficacy following the A-B-C-D-E strategy increased from 4.9 (CI 4.4-5.3) to 6.6 (CI 6.2-7.0). Again, students had the steepest increase. Newly graduated doctors achieved a superior increase in global confidence as compared to nurses and auxiliary nurses (p < .0001). Their propensity to recommend SBTT to colleagues was 9.9 (CI 9.8-10.0). The positive effects were sustained over a six-month period, indicating that interprofessional SBTT had a positive impact on competence development, and a potential to contribute to increased team quality in emergency medicine care.
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Affiliation(s)
- A Kiessling
- Department of Clinical Sciences Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - C Amiri
- Department of Clinical Sciences Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - J Arhammar
- Department of Clinical Sciences Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - M Lundbäck
- Department of Clinical Sciences Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - C Wallingstam
- Department of Clinical Sciences Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - J Wikner
- Department of Clinical Science and Education Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - Rm Svensson
- Department of Clinical Sciences Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - P Henriksson
- Department of Clinical Sciences Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - J Kuhl
- Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.,Department of Specialised Medical Care, Danderyd Hospital, Stockholm, Sweden
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Bohmann FO, Guenther J, Gruber K, Manser T, Steinmetz H, Pfeilschifter W. Measuring Patient Safety Climate in Acute Stroke Therapy. Front Neurol 2021; 12:686649. [PMID: 34659080 PMCID: PMC8517443 DOI: 10.3389/fneur.2021.686649] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Accepted: 08/13/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Treatment of acute stroke is highly time-dependent and performed by a multiprofessional, interdisciplinary team. Interface problems are expectable and issues relevant to patient safety are omnipresent. The Safety Attitudes Questionnaire (SAQ) is a validated and widely used instrument to measure patient safety climate. The objective of this study was to evaluate the SAQ for the first time in the context of acute stroke care. Methods: A survey was carried out during the STREAM trial (NCT00032282) at seven university hospitals in Germany from October 2017 to October 2018. The anonymous survey included 33 questions (5-point Likert scale, 1 = disagree to 5 = agree) and addressed the entire multiprofessional stroke team. Statistical analyses were used to examine psychometric properties as well as descriptive findings. Results: 164 questionnaires were completed yielding a response rate of 66.4%. 67.7% of respondents were physicians and 25.0% were nurses. Confirmatory Factor Analysis revealed that the original 6-factor structure fits the data adequately. The SAQ for acute stroke care showed strong internal consistency (α = 0.88). Exploratory analysis revealed differences in scores on the SAQ dimensions when comparing physicians to nurses and when comparing physicians according to their duration of professional experience. Conclusion: The SAQ is a helpful and well-applicable tool to measure patient safety in acute stroke care. In comparison to other high-risk fields in medicine, patient safety climate in acute stroke care seems to be on a similar level with the potential for further improvements. Trial registration: www.ClinicalTrials.gov Identifier: NCT032282.
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Affiliation(s)
- Ferdinand O. Bohmann
- Department of Neurology, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany
| | - Joachim Guenther
- Department of Neurology, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany
| | - Katharina Gruber
- Department of Neurology, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany
| | - Tanja Manser
- FHNW School of Applied Psychology, University of Applied Sciences and Arts Northwestern Switzerland (FHNW), Olten, Switzerland
| | - Helmuth Steinmetz
- Department of Neurology, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany
| | - Waltraud Pfeilschifter
- Department of Neurology, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany
- Klinikum Lüneburg, Klinik für Neurologie und Klinische Neurophysiologie, Lüneburg, Germany
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18
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Bohmann FO, Guenther J, Gruber K, Manser T, Steinmetz H, Pfeilschifter W. Simulation-based training improves patient safety climate in acute stroke care (STREAM). Neurol Res Pract 2021; 3:37. [PMID: 34247651 PMCID: PMC8273945 DOI: 10.1186/s42466-021-00132-1] [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: 03/31/2021] [Accepted: 05/19/2021] [Indexed: 11/10/2022] Open
Abstract
Background Treatment of acute stroke performed by a multiprofessional, interdisciplinary team is highly time dependent. Interface problems are preprogrammed and pitfalls relevant to patient safety are omnipresent. The Safety Attitudes Questionnaire (SAQ) is a validated and widely used instrument to measure patient safety. The objective of this study was to evaluate the influence of Simulation-based Training of the Rapid Evaluation and Management of Acute Stroke (STREAM) on patient safety measured by SAQ in the context of acute stroke care. Methods During the STREAM trial at seven university hospitals in Germany from October 2017 to October 2018, an anonymous survey was conducted before and after the STREAM intervention centering around interdisciplinary simulation training. The questionnaire, based on the SAQ, included 33 items (5-point Likert scale, 1 = disagree to 5 = agree) and was addressed at the whole multiprofessional stroke team. Statistical analyses were used to examine psychometric properties as well as descriptive findings. Results In total 167 questionnaires were completed representing an overall response rate of 55.2%, including especially physicians (65.2%) and nurses (26.3%). Safety climate was significantly improved (pre-interventional: 3.34 ± .63 vs. post-interventional: 3.56 ± .69, p = .028). The same applies for teamwork climate among stroke teams (pre-interventional: 3.76 ± .59 vs. post-interventional: 3.84 ± .57, p = .001). The perceived benefit was most relevant among nurses. Conclusions The STREAM intervention centering around interdisciplinary simulation training increases perceived patient safety climate assessed by the SAQ in acute stroke therapy. These results have the potential to be a basis for future quality improvement programs. Supplementary Information The online version contains supplementary material available at 10.1186/s42466-021-00132-1.
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Affiliation(s)
- Ferdinand O Bohmann
- University Hospital Frankfurt, Department of Neurology, Goethe University, Theodor-Stern-Kai 7, Frankfurt am Main, Germany.
| | - Joachim Guenther
- University Hospital Frankfurt, Department of Neurology, Goethe University, Theodor-Stern-Kai 7, Frankfurt am Main, Germany
| | - Katharina Gruber
- University Hospital Frankfurt, Department of Neurology, Goethe University, Theodor-Stern-Kai 7, Frankfurt am Main, Germany
| | - Tanja Manser
- FHNW School of Applied Psychology, University of Applied Sciences and Arts Northwestern Switzerland (FHNW), Olten, Switzerland
| | - Helmuth Steinmetz
- University Hospital Frankfurt, Department of Neurology, Goethe University, Theodor-Stern-Kai 7, Frankfurt am Main, Germany
| | - Waltraud Pfeilschifter
- University Hospital Frankfurt, Department of Neurology, Goethe University, Theodor-Stern-Kai 7, Frankfurt am Main, Germany.,Klinik für Neurologie und Klinische Neurophysiologie, Klinikum Lüneburg, Lüneburg, Germany
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Rusiecki D, Walker M, Douglas SL, Hoffe S, Chaplin T. Multiprofessional perspectives on the identification of latent safety threats
via in situ simulation: a prospective cohort pilot study. BMJ SIMULATION & TECHNOLOGY ENHANCED LEARNING 2021; 7:102-107. [DOI: 10.1136/bmjstel-2020-000621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/05/2020] [Indexed: 11/04/2022]
Abstract
Objectives
To describe the association between participant profession and the number
and type of latent safety threats (LSTs) identified during in situ simulation
(ISS). Secondary objectives were to describe the association between both (a)
participants’ years of experience and LST identification and (b) type of
scenario and number of identified LSTs.
Methods
Emergency staff physicians (MDs), registered nurses (RNs) and respiratory
therapists (RTs) participated in ISS sessions in the emergency department (ED)
of a tertiary care teaching hospital. Adult and paediatric scenarios were
designed to be high-acuity, low-occurrence resuscitation cases. Simulations
were 10 min in duration. A written survey was administered to participants
immediately postsimulation, collecting demographic data and perceived LSTs.
Survey data was collated and LSTs were grouped using a previously described
framework.
Results
Thirteen simulation sessions were completed from July to November 2018,
with 59 participants (12 MDs, 41 RNs, 6 RTs). Twenty-four unique LSTs were
identified from survey data. RNs identified a median of 2 (IQR 1, 2.5) LSTs,
significantly more than RTs (0.5 (IQR 0, 1.25), p=0.04). Within respective
professions, MDs and RTs most commonly identified equipment issues, and RNs
most commonly identified medication issues. Participants with ≤10 years of
experience identified a median of 2 (IQR 1, 3) LSTs versus 1 (IQR 1, 2) LST in
those with >10 years of experience (p=0.06). Adult and paediatric patient
scenarios were associated with the identification of a median of 4 (IQR 3.0,
4.0) and 5 LSTs (IQR 3.5, 6.5), respectively (p=0.15).
Conclusions
Inclusion of a multidisciplinary team is important during ISS in order to
gain a breadth of perspectives for the identification of LSTs. In our study,
participants with ≤10 years of experience and simulations with paediatric
scenarios were associated with a higher number of identified LSTs; however, the
difference was not statistically significant.
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Weile J, Nebsbjerg MA, Ovesen SH, Paltved C, Ingeman ML. Simulation-based team training in time-critical clinical presentations in emergency medicine and critical care: a review of the literature. Adv Simul (Lond) 2021; 6:3. [PMID: 33472706 PMCID: PMC7816464 DOI: 10.1186/s41077-021-00154-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 01/07/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The use of simulation-based team training has increased over the past decades. Simulation-based team training within emergency medicine and critical care contexts is best known for its use by trauma teams and teams involved in cardiac arrest. In the domain of emergency medicine, simulation-based team training is also used for other typical time-critical clinical presentations. We aimed to review the existing literature and current state of evidence pertaining to non-technical skills obtained via simulation-based team training in emergency medicine and critical care contexts, excluding trauma and cardiac arrest contexts. METHODS This systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement. Before the initiation of the study, the protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO) database. We conducted a systematic literature search of 10 years of publications, up to December 17, 2019, in the following databases: PubMed/MEDLINE, EMBASE, Cochrane Library, and CINAHL. Two authors independently reviewed all the studies and extracted data. RESULTS Of the 456 studies screened, 29 trials were subjected to full-text review, and 13 studies were included in the final review. None of the studies was randomized controlled trials, and no studies compared simulation training to different modalities of training. Studies were heterogeneous; they applied simulation-training concepts of different durations and intensities and used different outcome measures for non-technical skills. Two studies reached Kirkpatrick level 3. Out of the remaining 11 studies, nine reached Kirkpatrick level 2, and two reached Kirkpatrick level 1. CONCLUSIONS The literature on simulation-based team training in emergency medicine is heterogeneous and sparse, but somewhat supports the hypothesis that simulation-based team training is beneficial to teams' knowledge and attitudes toward non-technical skills (Kirkpatrick level 2). Randomized trials are called for to clarify the effect of simulation compared to other modalities of team training. Future research should focus on the transfer of skills and investigate improvements in patient outcomes (Kirkpatrick level 4).
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Affiliation(s)
- Jesper Weile
- Emergency Department, Regional Hospital Horsens, Horsens, Denmark. .,Research Center for Emergency Medicine, Aarhus University Hospital, Palle Juul-Jensens Blvd. 161, 8200, Aarhus, Denmark.
| | - Mette Amalie Nebsbjerg
- Research Center for Emergency Medicine, Aarhus University Hospital, Palle Juul-Jensens Blvd. 161, 8200, Aarhus, Denmark
| | - Stig Holm Ovesen
- Research Center for Emergency Medicine, Aarhus University Hospital, Palle Juul-Jensens Blvd. 161, 8200, Aarhus, Denmark.,Department of Internal Medicine, Regional Hospital West Jutland, Herning, Denmark
| | | | - Mads Lind Ingeman
- Department of Emergency Medicine, Aarhus University Hospital, Aarhus, Denmark
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Transfer of an interprofessional emergency caesarean section training program: using questionnaire combined with outcome data of newborn. Arch Gynecol Obstet 2020; 302:585-593. [PMID: 32661755 PMCID: PMC7447674 DOI: 10.1007/s00404-020-05617-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2019] [Accepted: 05/26/2020] [Indexed: 10/30/2022]
Abstract
PUPROSE An emergency caesarean section is a potentially life-threatening situation both for the mother and the newborn. Non-technical skills can be improved by simulation training and are necessary to manage this urgent situation successfully. The objective of this study was to investigate, if training of emergency caesarean section can be transferred into daily work to improve the outcome parameters pH an APGAR of the newborn. METHODS In this pre-post study, 141 professionals took part in a training for emergency caesarean section. Participants received a questionnaire, based on the tools "Training Evaluation Inventory" and "Transfer Climate Questionnaire" 1 year after training. Outcome data of the newborn were collected from the hospitals information system. RESULTS Except the scale "extinction", Cronbach's alpha was higher than 0.62. All scales were rated lower than 2.02 on a 5-point Likert Scale (1 = fullest approval; 5 = complete rejection). "Negative reinforcement" was rated with 2.87 (SD 0.73). There were no significant differences in outcome data prior. The questionnaire fulfils criteria for application except the scale "extinction". CONCLUSION The presented training course was perceived as useful by the professionals and attitudes toward training were positive; the content was positively reinforced in practice 1 year after training. Parameters of the newborn did not change. It is conceivable that other outcome parameters (e.g. posttraumatic stress disorder) are addressed by the training. The development of relevant outcome parameters for the quality of emergency sections needs further investigation.
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Le Guen M, Costa-Pinto R. Medical emergency team training: needs assessment, feedback and learning objectives. Intern Med J 2020; 51:1298-1303. [PMID: 32449844 DOI: 10.1111/imj.14923] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 05/01/2020] [Accepted: 05/08/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND There are no published studies assessing learning needs and attitudes prior to attending a medical emergency team (MET) education programme. AIMS To conduct a learning needs assessment of MET education programme participants to assess what technical and non-technical skills should be incorporated. METHODS All participants in a MET education programme over a 12-month period were invited to complete a self-administered electronic survey. Participants were ICU team members (intensive care registrars and nurses) and medical registrars. Responses were captured through a 5-point Likert scale. RESULTS There were 62 responses out of 112 participants (55% response rate). Most participants either agreed or strongly agreed that MET training was valuable (59 respondents) and should be multidisciplinary (61 respondents). ICU team members were more likely to select 'Management of End-of-Life Care' (72% compared with only 16% of medical registrars, P < 0.05) as an important learning objective. Non-technical skills such as 'Task Management' (67% compared with 37%, P < 0.05) and 'Team Communication' (79% compared with 32%, P < 0.05) were also more likely to be selected by ICU team members. Nursing team members were more likely to select 'Approach to Common MET Calls' (100% compared with 50% of medical team members, P < 0.05). CONCLUSIONS MET education programme participants overwhelmingly feel that training should be multidisciplinary. However, there are disparities between the perceived learning needs of medical and nursing personnel, and between intensive care team members and medical registrars, which may impact on the design and implementation of a multidisciplinary education programme.
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Affiliation(s)
- Maurice Le Guen
- Department of Intensive Care, The Alfred Hospital, Melbourne, Victoria, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Rahul Costa-Pinto
- Department of Intensive Care, Austin Hospital, Melbourne, Victoria, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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Flentje M, Friedrich L, Eismann H, Koppert W, Ruschulte H. Expectations, training and evaluation of intensive care staff to an interprofessional simulation course in Germany - Development of a relevant training concept. GMS JOURNAL FOR MEDICAL EDUCATION 2020; 37:Doc9. [PMID: 32270023 PMCID: PMC7105761 DOI: 10.3205/zma001302] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Figures] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 11/11/2019] [Accepted: 12/16/2019] [Indexed: 06/11/2023]
Abstract
Objective: Increasingly, intensive care units (ICU) are operated by teams of physicians and nurses with specialist training in anaesthesia and intensive care. The aims of our study were to evaluate any prior experience, expectations and the requisites for interprofessional ICU simulation-based training (SBT), and to evaluate a newly designed training course incorporating these findings. Methods: The study was laid out as a cross-sectional study and is projected in three steps. First, questionnaires were sent out to ICU nurses and physicians from 15 different hospitals in a greater metropolitan area (> million citizens). Based upon this survey a one-day ICU simulator course designed for 12 participants (6 nurses and 6 physicians) was developed, with evaluation data from four subsequent courses being analysed. Results: In the survey 40% of nurses and 57% of the physicians had had prior exposure to SBT. Various course formats were explored with respect to duration, day of the week, and group composition. After completing the course, the majority deemed a full working day in interprofessional setting to be most appropriate (p<0.001). The scenarios were considered relevant and had a positive impact on communication, workflow and coping with stress. Conclusion: Currently SBT is not a mainstream tool used by German ICU teams for further education, and this lack of familiarity must be taken into consideration when preparing SBT courses for them. We developed a nontechnical skills training course for ICU teams which was undertaken in the setting of simulated clinical scenarios (pertinent to their work environment). The participants found the course's content to be relevant for their daily work, rated the course's impact on their workplace practices as being good and advocated for longer training sessions.
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Affiliation(s)
- Markus Flentje
- Hannover Medical School, Department of Anaesthesiology and Intensive Care Medicine, Hannover, Germany
| | - Lars Friedrich
- Hannover Medical School, Department of Anaesthesiology and Intensive Care Medicine, Hannover, Germany
| | - Hendrik Eismann
- Hannover Medical School, Department of Anaesthesiology and Intensive Care Medicine, Hannover, Germany
| | - Wolfgang Koppert
- Hannover Medical School, Department of Anaesthesiology and Intensive Care Medicine, Hannover, Germany
| | - Heiner Ruschulte
- Sana Klinikum Hameln-Pyrmont, Anaesthesia and Intensive Care Medicine, Hameln, Germany
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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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Safety culture in intensive care internationally and in Australia: A narrative review of the literature. Aust Crit Care 2019; 32:524-539. [PMID: 30799166 DOI: 10.1016/j.aucc.2018.11.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Revised: 11/05/2018] [Accepted: 11/06/2018] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE Assessment of safety culture in health care is of particular relevance in the complex intensive care setting, where the effects of human error can have catastrophic consequences. The aim of this review was to examine the literature on safety culture in intensive care units (ICUs) and specifically, to explore the state of knowledge regarding safety culture in the context of Australian ICUs. METHODS A search was conducted of key databases for studies published in English between January 2008 and December 2017 using terms 'safety culture', 'safety climate', 'safety attitude', 'intensive care', 'ICU' and 'critical care'. Studies were included if they presented original research, utilised the teamwork and safety climate factors of a quantitative survey tool to assess safety culture, the sample population included participants working in an adult intensive care, and the findings were reported in the context of intensive care. RESULTS Of the 36 studies identified, two were conducted in Australia. The studies demonstrate a rapid expansion in safety culture assessment globally. Three levels of safety culture application in intensive care were identified, including safety culture assessment, effect of an intervention on safety culture, and evaluation of the association between safety culture and structural, process and outcomes measures. The use of targeted safety culture domains is emerging. Common findings included variation in perceptions of safety culture between ICUs, unit and hospital management, and professional groups. CONCLUSION Though the assessment of safety culture in ICUs has been an area of prolific research internationally over the past ten years, the Australian context is limited and could be advanced through further research, including the effect on safety culture of interventions, and to establish the association between safety culture and patient safety outcomes. Longitudinal studies to demonstrate sustained intervention effects on safety culture should be considered.
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Dunstan E, Coyer F. Safety culture in two metropolitan Australian tertiary hospital intensive care units: A cross-sectional survey. Aust Crit Care 2019; 33:4-11. [PMID: 30660433 DOI: 10.1016/j.aucc.2018.11.069] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 11/28/2018] [Accepted: 11/28/2018] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Safety culture is significant in the complex intensive care environment, where the consequences of human error can be catastrophic. Research within Australian intensive care units has been limited and little is understood about the safety culture of intensive care units in Queensland. AIM The aim was to evaluate and compare safety culture in the intensive care units of two metropolitan tertiary hospitals in Queensland. METHOD A cross-sectional survey, Safety Attitudes Questionnaire, was administered to all medical, nursing and allied health professionals in the research sites (A and B) during January and February 2016. Data were collated into six safety culture domains of teamwork climate, safety climate, job satisfaction, stress recognition, working conditions and perceptions of management. Comparison was made using t-tests and between demographic groups using generalising estimating equations. RESULTS In total, 206 surveys were returned from 522 staff (39.5% response rate). The majority of respondents were nurses (80.6%). Site B scored all domains of the safety attitudes questionnaire significantly higher than Site A (p < 0.001). The scores for both site A and B were significantly higher in all domains (p < 0.001) than a previous Australian study conducted in 2013. Both sites returned low scores in the stress recognition domain. Medical staff perceived the teamwork climate as more positive than nursing staff (mean difference 16.6 [Wald χ2 = 10383.8, p < 0.001]). Allied health professionals reported poorer perceptions of working conditions than medical staff (mean difference 7.8 [Wald χ2 = 775.4, p < 0.001]). CONCLUSION Despite similar governance and external structures, differences were found in safety culture between the two research sites. This finding emphasises the importance of local, unit-level assessment of safety culture and planning of improvement strategies. This study adds to the evidence and implications for critical care clinical practice that these interventions need to be unit focused, supported by management and multidisciplinary in approach.
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Affiliation(s)
- Elspeth Dunstan
- Clinical Nurse, Intensive Care Unit, Princess Alexandra Hospital, Ipswich Rd, Woolloongabba, QLD, Australia.
| | - Fiona Coyer
- School of Nursing, Queensland University of Technology and Intensive Care Services, Royal Brisbane and Women's Hospital, Metro North Health Service District, Queensland, Australia; Institute for Skin Integrity and Infection Prevention, University of Huddersfield, United Kingdom.
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Villemure C, Georgescu LM, Tanoubi I, Dubé JN, Chiocchio F, Houle J. Examining perceptions from in situ simulation-based training on interprofessional collaboration during crisis event management in post-anesthesia care. J Interprof Care 2018; 33:182-189. [PMID: 30395755 DOI: 10.1080/13561820.2018.1538103] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Due to the potentially life-threatening conditions and risk of severe complications, post-anesthesia care units (PACU) require prompt team interventions. Miscommunication among professionals during crisis event management may directly affect patient safety. Therefore, developing strategies to enhance interprofessional collaboration (IPC) among critical care teams should be prioritized. In situ simulation (ISS) can be valuable in improving patient safety because it allows the practice of care team dynamics within a real clinical environment. However, its impact on IPC has yet to be demonstrated. The aim of this study was to evaluate the effect of in situ simulation-based training on interprofessional collaboration and satisfaction toward co-workers during crisis event management in post-anesthesia care. A quasi-experimental study, pretest and post-test design with a paired control group was performed. A convenience sample (N = 69) was recruited from the healthcare professionals of the regular PACU team. The intervention group (N = 33) underwent a 6-hour ISS-based interprofessional training session. Three scenarios of deteriorating cases encountered in critical care settings were used, each followed by a debriefing period. The measured outcomes were evaluated by the Collaborative Work Questionnaire and the Satisfaction Towards Coworkers Questionnaire. Questionnaires were answered by the two groups before the intervention (T1), immediately after (T2) and six to eight weeks later (T3). We found that the change from baseline (T1) was different between the groups for global IPC (F = 3.88; p = 0.025) and for communication (F = 4.09; p = 0.021). Regarding global IPC, we observed a significant group effect from T1 to T2 (F = 5.65; p = 0.021) and from T1 to T3 (F = 5.34; p = 0.024). Furthermore, we observed a significant time effect for the experimental group (F = 4.06; p = 0.027). Regarding communication, we observed a significant group effect from T1 to T2 (F = 7.5; p = 0.001). In conclusion, ISS-based training had a slight impact on self-assessed IPC and communication during crisis event management in the PACU. The use of ISS should be promoted among critical care teams to enhance IPC and contribute to patient safety.
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Affiliation(s)
- Catherine Villemure
- a Centre intégré , universitaire de santé et de services sociaux de la Mauricie-et-du-Centre-du-Québec (CIUSSS), Trois-Rivières , Québec , Canada
| | - L Mihai Georgescu
- b Centre d'Apprentissage des Attitudes et Habiletés Cliniques (CAAHC) , Université de Montréal , Montreal , Canada.,c Anesthesiology Department , Centre intégré universitaire de santé et de services sociaux de l'Est-de-l'Île-de-Montréal (CIUSSS) , Montréal , Canada
| | - Issam Tanoubi
- b Centre d'Apprentissage des Attitudes et Habiletés Cliniques (CAAHC) , Université de Montréal , Montreal , Canada.,c Anesthesiology Department , Centre intégré universitaire de santé et de services sociaux de l'Est-de-l'Île-de-Montréal (CIUSSS) , Montréal , Canada
| | - Jean-Nicolas Dubé
- a Centre intégré , universitaire de santé et de services sociaux de la Mauricie-et-du-Centre-du-Québec (CIUSSS), Trois-Rivières , Québec , Canada
| | | | - Julie Houle
- a Centre intégré , universitaire de santé et de services sociaux de la Mauricie-et-du-Centre-du-Québec (CIUSSS), Trois-Rivières , Québec , Canada
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Impact of a One Day Crisis Resource Management Training on the Work Satisfaction among Emergency Department Healthcare Staff. ACTA MEDICA MARISIENSIS 2018. [DOI: 10.2478/amma-2018-0019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
Objective: To evaluate the impact of a single day Crisis Resource Management (CRM) oriented team training, combining didactic and simulation sessions, on work satisfaction of the healthcare staff working in an Emergency Department. Methods: Seventy health professionals with different qualifications, working in an emergency department, were enrolled in the study. After enrollment, participants were asked to complete a work satisfaction questionnaire and to choose a day for the training session according to their availability. Each training session took place in the simulation center and consisted of several elements: didactic session and simulation session, followed by instructor facilitated debriefing. The lecture was focused on medical errors and CRM principles. Two months after, they were asked to complete again the work satisfaction questionnaire. Results: There were no significant improvements on the items evaluated through the work satisfaction questionnaire for none of the professional categories involved, except for ‘the possibility to refer the patient to a specialist whenever was considered necessary’ for the doctors. Improvements were seen for the same professional category on the following items: workload, leisure time, level of stress at work, time and energy spent on administrative tasks. Conclusions: The findings of this study do not support the effectiveness of a single day CRM training as a tool to improve the work satisfaction among medical staff in ED. Further research is necessary.
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Low XM, Horrigan D, Brewster DJ. The effects of team-training in intensive care medicine: A narrative review. J Crit Care 2018; 48:283-289. [PMID: 30268058 DOI: 10.1016/j.jcrc.2018.09.015] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 08/21/2018] [Accepted: 09/14/2018] [Indexed: 12/29/2022]
Abstract
PURPOSE Research into team-training within healthcare is growing exponentially. We aim to evaluate the effects of team-training within intensive care medicine (ICM) through a review of the literature and a narrative synthesis of the results. MATERIALS AND METHODS A search of OVID Medline, EMBASE and Scopus databases was undertaken. Keywords and MESH headings included were "team-based learning", "team-training", "interdisciplinary training", "intensive care medicine", "ICU", "intensive care unit", "critical care teams" and "critical care". Relevant papers were then analysed for a narrative synthesis. RESULTS Our search identified 187 articles. A total of 27 papers were analysed and their outcomes were evaluated based on the Kirkpatrick four step model of evaluation. CONCLUSIONS Team-training has been studied in multiple ICU team types, with crew resource management (CRM) and TeamSTEPPS curricula commonly used to support teaching via simulation. Clinical skills taught have included ALS provision, ECMO initiation, advanced airway management, sepsis management and trauma response skills. Team-training in ICU is well received by staff, facilitates clinical learning, and can positively alter staff behaviors. Few clinical outcomes have been demonstrated and the duration of the behavioral effects is unclear.
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Affiliation(s)
- X M Low
- Central Clinical School, Faculty of Medicine, Nursing & Health Sciences, Monash University, Victoria, Australia
| | | | - D J Brewster
- Central Clinical School, Faculty of Medicine, Nursing & Health Sciences, Monash University, Victoria, Australia; Cabrini Hospital, Victoria, Australia.
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Baik D, Abu-Rish Blakeney E, Willgerodt M, Woodard N, Vogel M, Zierler B. Examining interprofessional team interventions designed to improve nursing and team outcomes in practice: a descriptive and methodological review. J Interprof Care 2018; 32:719-727. [PMID: 30084723 DOI: 10.1080/13561820.2018.1505714] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Effective interprofessional (IP) team-based care is critical to enhance the delivery of efficient care and improve nursing and IP team outcomes. This study aims to review the most recent IP team intervention studies that focused on outcomes related to nursing and IP teams. PubMed, CINAHL, PsycINFO, and Embase were searched for existing literature published between January 2011 and December 2016. The search strategy was developed through both literature review and consultation with a health sciences librarian. This review included IP team intervention studies published in peer-reviewed journals and written in English. Studies were included if they conducted an IP team intervention for healthcare teams that include nurses and examined outcomes related to nursing and the IP teams. Based on inclusion and exclusion criteria, 41 articles were included for the final review. Two authors extracted data on the characteristics of IP team interventions, assessment methods, and their outcomes related to nursing and IP teams using a data abstraction tool developed by the research team. The quality of the included studies was assessed using the Mixed Methods Appraisal Tool. We found that most of the included studies were conducted in the US and on inpatient units. A quasi-experimental study design was most commonly employed. Most studies conducted IP team training such as TeamSTEPPS® as a one-time activity. The most common outcomes measured were attitudes or perceptions about IP teamwork or communication, followed by patient-related outcomes, and knowledge or skills about IP competencies. The quality of the included studies was generally low. The findings from this review will contribute to understanding the characteristics of current IP intervention studies and call for IP scholars to design more rigorous yet realistic IP intervention studies.
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Affiliation(s)
- Dawon Baik
- Department of Biobehavioral Nursing and Health Informatics, School of Nursing, University of Washington, Seattle, WA, USA
| | - Erin Abu-Rish Blakeney
- Department of Biobehavioral Nursing and Health Informatics, School of Nursing, University of Washington, Seattle, WA, USA
| | - Mayumi Willgerodt
- School of Nursing and Health Studies, University of Washington Bothell, WA, USA
| | - Nicole Woodard
- Center for Health Sciences Interprofessional Education, Research and Practice, University of Washington, Seattle, WA, USA
| | - Mia Vogel
- Department of Health Services, University of Washington, Seattle, WA, USA
| | - Brenda Zierler
- Department of Biobehavioral Nursing and Health Informatics, School of Nursing, University of Washington, Seattle, WA, USA
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O'Rourke J, Horsley TL, Doolen J, Mariani B, Pariseault C. Integrative Review of Interprofessional Simulation in Nursing Practice. J Contin Educ Nurs 2018; 49:91-96. [DOI: 10.3928/00220124-20180116-09] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Accepted: 11/13/2017] [Indexed: 11/20/2022]
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Wang YY, Wan QQ, Lin F, Zhou WJ, Shang SM. Interventions to improve communication between nurses and physicians in the intensive care unit: An integrative literature review. Int J Nurs Sci 2018; 5:81-88. [PMID: 31406806 PMCID: PMC6626231 DOI: 10.1016/j.ijnss.2017.09.007] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Revised: 07/31/2017] [Accepted: 09/29/2017] [Indexed: 11/19/2022] Open
Abstract
Effective communication among healthcare professionals in the intensive care unit (ICU) is a particular imperative, with accurate and efficient interdisciplinary communication being a critical prerequisite for high-quality care. Nurses and physicians are highly important parts of the healthcare system workforce. Thus, identifying strategies that would improve communication between these two groups can provide evidence for practical improvement in the ICU, which will ultimately improve patient outcomes. This integrative literature review aimed to identify interventions that improve communication between nurses and physicians in ICUs. Three databases (Medline, CINAHL, and Science Direct) were searched between September 2014 and June 2016 using 11 search terms, namely, nurse, doctor, physician, resident, clinician, ICU, intensive care unit, communication, teamwork, collaboration, and relationship. A manual search of the reference lists of found papers was also conducted. Eleven articles met the inclusion criteria. These studies reported on the use of communication tools/checklists, team training, multidisciplinary structured work shift evaluation, and electronic situation-background-assessment-recommendation documentation templates to improve communication. Although which intervention strategies are most effective remains unclear, this review suggests that these strategies improve communication to some extent. Future studies should be rigorously designed and outcome measures should be specific and validated to capture and reflect the effects of effective communication.
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Affiliation(s)
- Ya-Ya Wang
- School of Nursing, Peking University, Beijing, People's Republic of China
| | - Qiao-Qin Wan
- School of Nursing, Peking University, Beijing, People's Republic of China
| | - Frances Lin
- School of Nursing and Midwifery, Menzies Health Institute Queensland, Griffith University, Queensland, Australia
| | - Wei-Jiao Zhou
- School of Nursing, Peking University, Beijing, People's Republic of China
| | - Shao-Mei Shang
- School of Nursing, Peking University, Beijing, People's Republic of China
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Jakobsen RB, Gran SF, Grimsmo B, Arntzen K, Fosse E, Frich JC, Hjortdahl P. Examining participant perceptions of an interprofessional simulation-based trauma team training for medical and nursing students. J Interprof Care 2017; 32:80-88. [DOI: 10.1080/13561820.2017.1376625] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Rune Bruhn Jakobsen
- Department of Health Management and Health Economics, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of Orthopedic Surgery, Akershus University Hospital, University of Oslo, Oslo, Norway
| | - Sarah Frandsen Gran
- Department of Health Management and Health Economics, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of General Practice, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Bergsvein Grimsmo
- Department of Nursing, Faculty of Health Sciences, Oslo and Akershus University College of Applied Sciences, Oslo, Norway
| | - Kari Arntzen
- Department of Nursing, Faculty of Health Sciences, Oslo and Akershus University College of Applied Sciences, Oslo, Norway
| | - Erik Fosse
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
- The Intervention Centre, Oslo University Hospital, Oslo, Norway
| | - Jan C. Frich
- Department of Health Management and Health Economics, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Per Hjortdahl
- Department of General Practice, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
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Doepfer AK, Seemann R, Merschin D, Stange R, Egerth M, Münzberg M, Mutschler M, Bouillon B, Hoffmann R. [Safety culture in orthopedics and trauma surgery : Course concept: interpersonal competence by the German Society for Orthopaedics and Trauma (DGOU) and Lufthansa Aviation Training]. Ophthalmologe 2017. [PMID: 28643113 DOI: 10.1007/s00347-017-0522-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Patient safety has become a central and measurable key factor in the routine daily medical practice. The human factor plays a decisive role in safety culture and has moved into focus regarding the reduction of treatment errors and undesired critical incidents. Nonetheless, the systematic training in communication and interpersonal competences has so far only played a minor role. The German Society of Orthopaedics and Trauma (DGOU) in cooperation with the Lufthansa Aviation Training initiated a course system for interpersonal competence. Several studies confirmed the reduction of critical incidents and costs after implementation of a regular and targeted human factor training. The interpersonal competence should be an essential component of specialist training within the framework of a 3‑column model.
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Affiliation(s)
- A-K Doepfer
- AKK Altonaer Kinderkrankenhaus gGmbH, Bleickenallee 38, 22763, Hamburg, Deutschland.
| | - R Seemann
- Centrum für Muskuloskeletale Chirurgie, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
| | - D Merschin
- Klinik für Unfallchirurgie und Orthopädie, BG Klinikum Unfallkrankenhaus Berlin, Berlin, Deutschland
| | - R Stange
- Klinik für Unfall‑, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Münster, Münster, Deutschland
| | - M Egerth
- Lufthansa Aviation Training, Frankfurt am Main, Deutschland
| | - M Münzberg
- Klinik für Orthopädie und Unfallchirurgie, BG-Klinik Ludwigshafen, Ludwigshafen, Deutschland
| | - M Mutschler
- Klinik für Orthopädie, Unfallchirurgie und Sporttraumatologie, Kliniken Köln, Köln, Deutschland
| | - B Bouillon
- Klinik für Orthopädie, Unfallchirurgie und Sporttraumatologie, Kliniken Köln, Köln, Deutschland
| | - R Hoffmann
- BG Unfallklinik, Frankfurt am Main, Deutschland
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Healthcare Provider Perceptions of Causes and Consequences of ICU Capacity Strain in a Large Publicly Funded Integrated Health Region: A Qualitative Study. Crit Care Med 2017; 45:e347-e356. [PMID: 27635769 DOI: 10.1097/ccm.0000000000002093] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVES Discrepancy in the supply-demand relationship for critical care services precipitates a strain on ICU capacity. Strain can lead to suboptimal quality of care and burnout among providers and contribute to inefficient health resource utilization. We engaged interprofessional healthcare providers to explore their perceptions of the sources, impact, and strategies to manage capacity strain. DESIGN Qualitative study using a conventional thematic analysis. SETTING Nine ICUs across Alberta, Canada. SUBJECTS Nineteen focus groups (n = 122 participants). INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Participants' perspectives on strain on ICU capacity and its perceived impact on providers, families, and patient care were explored. Participants defined "capacity strain" as a discrepancy between the availability of ICU beds, providers, and ICU resources (supply) and the need to admit and provide care for critically ill patients (demand). Four interrelated themes of contributors to strain were characterized (each with subthemes): patient/family related, provider related, resource related, and health system related. Patient/family-related subthemes were "increasing patient complexity/acuity," along with patient-provider communication issues ("paucity of advance care planning and goals-of-care designation," "mismatches between patient/family and provider expectations," and "timeliness of end-of-life care planning"). Provider-related factor subthemes were nursing workforce related ("nurse attrition," "inexperienced workforce," "limited mentoring opportunities," and "high patient-to-nurse ratios") and physician related ("frequent turnover/handover" and "variations in care plan"). Resource-related subthemes were "reduced service capability after hours" and "physical bed shortages." Health system-related subthemes were "variable ICU utilization," "preferential "bed" priority for other services," and "high ward bed occupancy." Participants perceived that strain had negative implications for patients ("reduced quality and safety of care" and "disrupted opportunities for patient- and family-centered care"), providers ("increased workload," "moral distress," and "burnout"), and the health system ("unnecessary, excessive, and inefficient resource utilization"). CONCLUSIONS Engagement with frontline critical care providers is essential for understanding their experiences and perspectives regarding strained capacity and for the development of sustainable strategies for improvement.
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Zech A, Gross B, Jasper-Birzele C, Jeschke K, Kieber T, Lauterberg J, Lazarovici M, Prückner S, Rall M, Reddersen S, Sandmeyer B, Scholz C, Stricker E, Urban B, Zobel A, Singer I. Evaluation of simparteam - a needs-orientated team training format for obstetrics and neonatology. J Perinat Med 2017; 45:333-341. [PMID: 27464031 DOI: 10.1515/jpm-2016-0091] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Accepted: 06/22/2016] [Indexed: 11/15/2022]
Abstract
INTRODUCTION A standardized team-training program for healthcare professionals in obstetric units was developed based on an analysis of common causes for adverse events found in claims registries. The interdisciplinary and inter-professional training concept included both technical and non-technical skill training. Evaluation of the program was carried out in hospitals with respect to the immediate personal learning of participants and also regarding changes in safety culture. METHODS Trainings in n=7 hospitals including n=270 participants was evaluated using questionnaires. These were administered at four points in time to staff from participating obstetric units: (1) 10 days ahead of the training (n=308), (2) on training day before (n=239), (3) right after training (n=248), and (4) 6 months after (n=188) the intervention. Questionnaires included several questions for technical and non-technical skills and the Hospital Survey on Patient Safety (HSOPS). RESULTS Strong effects were found in the participants' perception of their own competence regarding technical skills and handling of emergencies. Small effects could be observed in the scales of the HSOPS questionnaire. Most effects differed depending on professional groups and hospitals. CONCLUSIONS Integrated technical and team management training can raise employees' confidence with complex emergency management skills and processes. Some indications for improvements on the patient safety culture level were detected. Furthermore, differences between professional groups and hospitals were found, indicating the need for more research on contributing factors for patient safety and for the success of crew resource management (CRM) trainings.
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Affiliation(s)
- Alexandra Zech
- Institut für Notfallmedizin und Medizinmanagement - INM, Klinikum der Universität München, LMU München, Schillerstr. 53, München 80336
| | - Benedict Gross
- Institut für Notfallmedizin und Medizinmanagement - INM, Klinikum der Universität München, LMU München
| | - Céline Jasper-Birzele
- Klinik und Poliklinik für Frauenheilkunde und Geburtshilfe, Klinikum der Universität München
| | | | - Thomas Kieber
- Klinik für Anästhesie und Operative Intensivmedizin, Kreiskliniken Esslingen
| | - Jörg Lauterberg
- Institute for Quality and Efficiency in Health Care - IQWiG, Cologne
| | - Marc Lazarovici
- Institut für Notfallmedizin und Medizinmanagement - INM, Klinikum der Universität München, LMU München
| | - Stephan Prückner
- Institut für Notfallmedizin und Medizinmanagement - INM, Klinikum der Universität München, LMU München
| | - Marcus Rall
- InPASS - Institute for Patient Safety and Team Training GmbH, Reutlingen
| | - Silke Reddersen
- Tüpass - Center for Patient-Safety and Simulation Tübingen, Department of Anesthesiology and Intensive Care Medicine, University Hospital Tübingen
| | - Benedikt Sandmeyer
- Institut für Notfallmedizin und Medizinmanagement - INM, Klinikum der Universität München, LMU München
| | - Christoph Scholz
- Klinik für Frauenheilkunde und Geburtshilfe, Klinikum der Universität Ulm
| | - Eric Stricker
- Tüpass - Center for Patient-Safety and Simulation Tübingen, Department of Anesthesiology and Intensive Care Medicine, University Hospital Tübingen
| | - Bert Urban
- Institut für Notfallmedizin und Medizinmanagement - INM, Klinikum der Universität München, LMU München
| | - Astrid Zobel
- Klinik für Psychiatrie und Psychotherapie, Rheinische Friedrich-Wilhelms-Universität Bonn
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Escher C, Creutzfeldt J, Meurling L, Hedman L, Kjellin A, Felländer-Tsai L. Medical students' situational motivation to participate in simulation based team training is predicted by attitudes to patient safety. BMC MEDICAL EDUCATION 2017; 17:37. [PMID: 28183316 PMCID: PMC5301395 DOI: 10.1186/s12909-017-0876-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Accepted: 02/03/2017] [Indexed: 05/28/2023]
Abstract
BACKGROUND Patient safety education, as well as the safety climate at clinical rotations, has an impact on students' attitudes. We explored medical students' self-reported motivation to participate in simulation-based teamwork training (SBTT), with the hypothesis that high scores in patient safety attitudes would promote motivation to SBTT and that intrinsic motivation would increase after training. METHODS In a prospective cohort study we explored Swedish medical students' attitudes to patient safety, their motivation to participate in SBTT and how motivation was affected by the training. The setting was an integrated SBTT course during the surgical semester that focused on non-technical skills and safe treatment of surgical emergencies. Data was collected using the Situational Motivation Scale (SIMS) and the Attitudes to Patient Safety Questionnaire (APSQ). RESULTS We found a positive correlation between students' individual patient safety attitudes and self-reported motivation (identified regulation) to participate in SBTT. We also found that intrinsic motivation increased after training. Female students in our study scored higher than males regarding some of the APSQ sub-scores and the entire group scored higher or on par with comparable international samples. CONCLUSION In order to enable safe practice and professionalism in healthcare, students' engagement in patient safety education is important. Our finding that students' patient safety attitudes show a positive correlation to motivation and that intrinsic motivation increases after training underpins patient safety climate and integrated teaching of patient safety issues at medical schools in order to help students develop the knowledge, skills and attitudes required for safe practice.
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Affiliation(s)
- Cecilia Escher
- Department of Clinical Science Intervention and Technology (CLINTEC), Division of Anaesthesia and Intensive Care, Karolinska Institutet, Stockholm, Sweden
- Center for Advanced Medical Simulation and Training (CAMST), Karolinska University Hospital, Stockholm, Sweden
| | - Johan Creutzfeldt
- Department of Clinical Science Intervention and Technology (CLINTEC), Division of Anaesthesia and Intensive Care, Karolinska Institutet, Stockholm, Sweden
- Center for Advanced Medical Simulation and Training (CAMST), Karolinska University Hospital, Stockholm, Sweden
| | - Lisbet Meurling
- Department of Clinical Science Intervention and Technology (CLINTEC), Division of Anaesthesia and Intensive Care, Karolinska Institutet, Stockholm, Sweden
- Center for Advanced Medical Simulation and Training (CAMST), Karolinska University Hospital, Stockholm, Sweden
| | - Leif Hedman
- Center for Advanced Medical Simulation and Training (CAMST), Karolinska University Hospital, Stockholm, Sweden
- Department of Psychology, Umeå University, Umeå, Sweden
| | - Ann Kjellin
- Center for Advanced Medical Simulation and Training (CAMST), Karolinska University Hospital, Stockholm, Sweden
- Department of Clinical Science Intervention and Technology (CLINTEC), Division of Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Li Felländer-Tsai
- Center for Advanced Medical Simulation and Training (CAMST), Karolinska University Hospital, Stockholm, Sweden
- Department of Clinical Science Intervention and Technology (CLINTEC), Division of Orthopaedics and Biotechnology, Karolinska Institutet, Stockholm, Sweden
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Da B, Buxbaum J. Training and Competency in Sedation Practice in Gastrointestinal Endoscopy. Gastrointest Endosc Clin N Am 2016; 26:443-62. [PMID: 27372769 DOI: 10.1016/j.giec.2016.02.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The practice of endoscopic sedation requires a thorough understanding of preprocedural assessment, sedation pharmacology, intraprocedure monitoring, adverse event management, and postprocedural care. The training process has become increasingly standardized and entails knowledge and practice-based components. The use of propofol in particular requires a higher level of structured training owing to its narrow therapeutic window. Simulation has increased opportunities for practice-based training in a controlled environment. After completion of training, the endoscopist must demonstrate competence in theoretical understanding and technical ability to administer sedation. Although individual institutions have certification processes, there is a lack of validated, standardized methods to confirm competence.
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Affiliation(s)
- Ben Da
- Division of Gastroenterology and Liver Diseases, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - James Buxbaum
- Division of Gastroenterology and Liver Diseases, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
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Tsuburaya A, Soma T, Yoshikawa T, Cho H, Miki T, Uramatsu M, Fujisawa Y, Youngson G, Yule S. Introduction of the non-technical skills for surgeons (NOTSS) system in a Japanese cancer center. Surg Today 2016; 46:1451-1455. [DOI: 10.1007/s00595-016-1322-8] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Accepted: 01/28/2016] [Indexed: 11/29/2022]
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Kullberg A, Bergenmar M, Sharp L. Changed nursing scheduling for improved safety culture and working conditions - patients' and nurses' perspectives. J Nurs Manag 2016; 24:524-32. [DOI: 10.1111/jonm.12352] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/11/2015] [Indexed: 11/29/2022]
Affiliation(s)
- Anna Kullberg
- Department of Oncology-Pathology; Karolinska Institutet; Stockholm Sweden
| | - Mia Bergenmar
- Department of Oncology-Pathology; Karolinska Institutet; Stockholm Sweden
- Center for Digestive Diseases; Karolinska University Hospital; Stockholm Sweden
| | - Lena Sharp
- Department of Learning, Informatics, Management and Ethics; Karolinska Institutet; Stockholm Sweden
- Regional Cancer Centre; Stockholm-Gotland Sweden
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Struksnes S, Engelien RI. Nursing students' conception of clinical skills training before and after their first clinical placement: A quantitative, evaluative study. Nurse Educ Pract 2016; 16:125-32. [DOI: 10.1016/j.nepr.2015.10.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2015] [Revised: 10/05/2015] [Accepted: 10/09/2015] [Indexed: 10/22/2022]
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Boling B, Hardin-Pierce M. The effect of high-fidelity simulation on knowledge and confidence in critical care training: An integrative review. Nurse Educ Pract 2015; 16:287-93. [PMID: 26520213 DOI: 10.1016/j.nepr.2015.10.004] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Revised: 07/21/2015] [Accepted: 10/06/2015] [Indexed: 11/28/2022]
Abstract
Patient outcomes in critical care have long been linked to provider experience, but with older providers retiring, it is becoming difficult to maintain a high-level of experience among the ICU staff. Innovative training methods that improve providers' knowledge and confidence may be able to make up for deficiencies in clinical experience. High-fidelity simulation training mimics clinical experience and has been extensively studied in the training of procedural skills, but what is the effect of this type of training on knowledge and confidence? To answer this question, we conducted a review of the literature for studies examining the effect of simulation training on knowledge and confidence among critical care providers. Seventeen papers were identified that met the inclusion criteria and a systematic approach was used to review the papers and synthesize the data. All 17 studies demonstrated an improvement in knowledge and while only 13 of the included studies examined the effect on provider confidence, all found an improvement. We conclude that high-fidelity simulation is a useful tool for improving knowledge and confidence among critical care providers and merits consideration for inclusion in critical care training programs.
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Patient Mortality Is Associated With Staff Resources and Workload in the ICU: A Multicenter Observational Study. Crit Care Med 2015; 43:1587-94. [PMID: 25867907 DOI: 10.1097/ccm.0000000000001015] [Citation(s) in RCA: 177] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Matching healthcare staff resources to patient needs in the ICU is a key factor for quality of care. We aimed to assess the impact of the staffing-to-patient ratio and workload on ICU mortality. DESIGN We performed a multicenter longitudinal study using routinely collected hospital data. SETTING Information pertaining to every patient in eight ICUs from four university hospitals from January to December 2013 was analyzed. PATIENTS A total of 5,718 inpatient stays were included. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS We used a shift-by-shift varying measure of the patient-to-caregiver ratio in combination with workload to establish their relationships with ICU mortality over time, excluding patients with decision to forego life-sustaining therapy. Using a multilevel Poisson regression, we quantified ICU mortality-relative risk, adjusted for patient turnover, severity, and staffing levels. The risk of death was increased by 3.5 (95% CI, 1.3-9.1) when the patient-to-nurse ratio was greater than 2.5, and it was increased by 2.0 (95% CI, 1.3-3.2) when the patient-to-physician ratio exceeded 14. The highest ratios occurred more frequently during the weekend for nurse staffing and during the night for physicians (p < 0.001). High patient turnover (adjusted relative risk, 5.6 [2.0-15.0]) and the volume of life-sustaining procedures performed by staff (adjusted relative risk, 5.9 [4.3-7.9]) were also associated with increased mortality. CONCLUSIONS This study proposes evidence-based thresholds for patient-to-caregiver ratios, above which patient safety may be endangered in the ICU. Real-time monitoring of staffing levels and workload is feasible for adjusting caregivers' resources to patients' needs.
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Wallin CJ, Kalman S, Sandelin A, Färnert ML, Dahlstrand U, Jylli L. Creating an environment for patient safety and teamwork training in the operating theatre: A quasi-experimental study. MEDICAL TEACHER 2015; 37:267-276. [PMID: 25180879 DOI: 10.3109/0142159x.2014.947927] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
INTRODUCTION Positive safety and a teamwork climate in the training environment may be a precursor for successful teamwork training. This pilot project aimed to implement and test whether a new interdisciplinary and team-based approach would result in a positive training climate in the operating theatre. METHOD A 3-day educational module for training the complete surgical team of specialist nursing students and residents in safe teamwork skills in an authentic operative theatre, named Co-Op, was implemented in a university hospital. Participants' (n=22) perceptions of the 'safety climate' and the 'teamwork climate', together with their 'readiness for inter-professional learning', were measured to examine if the Co-Op module produced a positive training environment compared with the perceptions of a control group (n=11) attending the conventional curriculum. RESULTS The participants' perceptions of 'safety climate' and 'teamwork climate' and their 'readiness for inter-professional learning' scores were significantly higher following the Co-Op module compared with their perceptions following the conventional curriculum, and compared with the control group's perceptions following the conventional curriculum. CONCLUSION The Co-Op module improved 'safety climate' and 'teamwork climate' in the operating theatre, which suggests that a deliberate and designed educational intervention can shape a learning environment as a model for the establishment of a safety culture.
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Salas E, Paige JT, Rosen MA. Creating new realities in healthcare: the status of simulation-based training as a patient safety improvement strategy. BMJ Qual Saf 2014; 22:449-52. [PMID: 23704117 DOI: 10.1136/bmjqs-2013-002112] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Eduardo Salas
- Institute for Simulation & Training, University of Central Florida, Orlando, FL 11111, USA.
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O'Dea A, O'Connor P, Keogh I. A meta-analysis of the effectiveness of crew resource management training in acute care domains. Postgrad Med J 2014; 90:699-708. [PMID: 25370080 DOI: 10.1136/postgradmedj-2014-132800] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
The healthcare industry has seen an increase in the adoption of team training, such as crew resource management (CRM), to improve teamwork and coordination within acute care medical teams. A meta-analysis was carried out in order to quantify the effects of CRM training on reactions, learning, behaviour and clinical care outcomes. Biases in the research evidence are identified and recommendations for training development and evaluation are presented. PUBMED, EMBASE and PsychInfo were systematically searched for all relevant papers. Peer reviewed papers published in English between January 1985 and September 2013, which present empirically based studies focusing on interventions to improve team effectiveness in acute health care domains, were included. A total of 20 CRM-type team training evaluation studies were found to fulfil the a priori criteria for inclusion in the meta-analysis. Overall, CRM trained participants responded positively to CRM (mean score 4.25 out of a maximum of 5), the training had large effects on participants' knowledge (d=1.05), a small effect on attitudes (d=0.22) and a large effect on behaviours (d=1.25). There was insufficient evidence to support an effect on clinical care outcomes or long term impacts. The findings support the premise that CRM training can positively impact teamwork in healthcare and provide estimates of the expected effects of training. However, there is a need for greater precision in outcome assessment, improved standardisation of methods and measures, and more robust research design. Stronger evidence of effectiveness will require multi-level, multicentre, multispecialty and longitudinal studies.
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Affiliation(s)
- Angela O'Dea
- Department of General Practice, National University of Ireland, Galway, Ireland
| | - Paul O'Connor
- Department of General Practice, National University of Ireland, Galway, Ireland
| | - Ivan Keogh
- Academic Department of Otolaryngology, National University of Ireland, Galway, Ireland
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Dietz AS, Pronovost PJ, Mendez-Tellez PA, Wyskiel R, Marsteller JA, Thompson DA, Rosen MA. A systematic review of teamwork in the intensive care unit: what do we know about teamwork, team tasks, and improvement strategies? J Crit Care 2014; 29:908-14. [PMID: 25001565 DOI: 10.1016/j.jcrc.2014.05.025] [Citation(s) in RCA: 74] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2014] [Revised: 05/13/2014] [Accepted: 05/27/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE Teamwork is essential for ensuring the quality and safety of health care delivery in the intensive care unit (ICU). This article addresses what we know about teamwork, team tasks, and team improvement strategies in the ICU to identify the strengths and limitations of the existing knowledge base to guide future research. METHODS A keyword search of the PubMed database was conducted in February 2013. Keyword combinations focused on 3 areas: (1) teamwork, (2) the ICU, and (3) training/quality improvement interventions. All studies that investigated teamwork, team tasks, or team interventions within the ICU (ie, intradepartment) were selected for inclusion. RESULTS Teamwork has been investigated across an array of research contexts and task types. The terminology used to describe team factors varied considerably across studies. The most common team tasks involved strategy and goal formulation. Team training and structured protocols were the most widely implemented quality improvement strategies. CONCLUSIONS Team research is burgeoning in the ICU, yet low-hanging fruit remains that can further advance the science of teams in the ICU if addressed. Constructs must be defined, and theoretical frameworks should be referenced. The functional characteristics of tasks should also be reported to help determine the extent to which study results might generalize to other contexts of work.
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Affiliation(s)
- Aaron S Dietz
- The Armstrong Institute for Patient Safety and Quality, The Johns Hopkins University School of Medicine, Baltimore, MD USA
| | - Peter J Pronovost
- The Armstrong Institute for Patient Safety and Quality, The Johns Hopkins University School of Medicine, Baltimore, MD USA; Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD USA
| | - Pedro Alejandro Mendez-Tellez
- Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD USA
| | - Rhonda Wyskiel
- The Armstrong Institute for Patient Safety and Quality, The Johns Hopkins University School of Medicine, Baltimore, MD USA
| | - Jill A Marsteller
- The Armstrong Institute for Patient Safety and Quality, The Johns Hopkins University School of Medicine, Baltimore, MD USA; Department of Health Policy and Management, The Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD USA
| | - David A Thompson
- The Armstrong Institute for Patient Safety and Quality, The Johns Hopkins University School of Medicine, Baltimore, MD USA; Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD USA
| | - Michael A Rosen
- The Armstrong Institute for Patient Safety and Quality, The Johns Hopkins University School of Medicine, Baltimore, MD USA; Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD USA.
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Trentzsch H, Urban B, Sandmeyer B, Hammer T, Strohm PC, Lazarovici M. [Does simulator-based team training improve patient safety?]. Unfallchirurg 2014; 116:900-8. [PMID: 24097241 DOI: 10.1007/s00113-013-2444-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Patient safety became paramount in medicine as well as in emergency medicine after it was recognized that preventable, adverse events significantly contributed to morbidity and mortality during hospital stay. The underlying errors cannot usually be explained by medical technical inadequacies only but are more due to difficulties in the transition of theoretical knowledge into tasks under the conditions of clinical reality. Crew Resource Management and Human Factors which determine safety and efficiency of humans in complex situations are suitable to control such sources of error. Simulation significantly improved safety in high reliability organizations, such as the aerospace industry.Thus, simulator-based team training has also been proposed for medical areas. As such training is consuming in cost, time and human resources, the question of the cost-benefit ratio obviously arises. This review outlines the effects of simulator-based team training on patient safety. Such course formats are not only capable of creating awareness and improvements in safety culture but also improve technical team performance and emphasize team performance as a clinical competence. A few studies even indicated improvement of patient-centered outcome, such as a reduced rate of adverse events but further studies are required in this respect. In summary, simulator-based team training should be accepted as a suitable strategy to improve patient safety.
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Affiliation(s)
- H Trentzsch
- Institut für Notfallmedizin und Medizinmanagement (INM), Klinikum der Universität München, Campus Innenstadt, Schillerstraße 53, 80336, München, Deutschland,
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Ballangrud R, Hall-Lord ML, Persenius M, Hedelin B. Intensive care nurses' perceptions of simulation-based team training for building patient safety in intensive care: a descriptive qualitative study. Intensive Crit Care Nurs 2014; 30:179-87. [PMID: 24731413 DOI: 10.1016/j.iccn.2014.03.002] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2013] [Revised: 03/10/2014] [Accepted: 03/17/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVES To describe intensive care nurses' perceptions of simulation-based team training for building patient safety in intensive care. BACKGROUND Failures in team processes are found to be contributory factors to incidents in an intensive care environment. Simulation-based training is recommended as a method to make health-care personnel aware of the importance of team working and to improve their competencies. DESIGN The study uses a qualitative descriptive design. METHODS Individual qualitative interviews were conducted with 18 intensive care nurses from May to December 2009, all of which had attended a simulation-based team training programme. The interviews were analysed by qualitative content analysis. RESULTS One main category emerged to illuminate the intensive care nurse perception: "training increases awareness of clinical practice and acknowledges the importance of structured work in teams". Three generic categories were found: "realistic training contributes to safe care", "reflection and openness motivates learning" and "finding a common understanding of team performance". CONCLUSIONS Simulation-based team training makes intensive care nurses more prepared to care for severely ill patients. Team training creates a common understanding of how to work in teams with regard to patient safety.
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Affiliation(s)
- Randi Ballangrud
- Department of Health Sciences, Faculty of Health, Science and Technology, Karlstad University, 651 88 Karlstad, Sweden; Faculty of Health, Care and Nursing, Gjøvik University College, Teknologivn. 22, 2815 Gjøvik, Norway.
| | - Marie Louise Hall-Lord
- Department of Health Sciences, Faculty of Health, Science and Technology, Karlstad University, 651 88 Karlstad, Sweden; Faculty of Health, Care and Nursing, Gjøvik University College, Teknologivn. 22, 2815 Gjøvik, Norway.
| | - Mona Persenius
- Department of Health Sciences, Faculty of Health, Science and Technology, Karlstad University, 651 88 Karlstad, Sweden.
| | - Birgitta Hedelin
- Faculty of Health, Care and Nursing, Gjøvik University College, Teknologivn. 22, 2815 Gjøvik, Norway.
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