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Skov RAC, Lawaetz J, Konge L, Westerlin L, Aasvang EK, Meyhoff CS, Vogt K, Ohrlander T, Resch TA, Eiberg JP. Simulation-Based Education of Endovascular Scrub Nurses Reduces Stress and Improves Team Performance. J Surg Res 2022; 280:209-217. [PMID: 35994983 DOI: 10.1016/j.jss.2022.07.030] [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: 02/14/2022] [Revised: 07/08/2022] [Accepted: 07/28/2022] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Endovascular procedures have become commonplace in vascular surgery. This development calls for new training strategies for future specialists. Most simulation-based education (SBE) programs have a monodisciplinary focus on physicians, although successful surgery is a multidisciplinary team effort. Mental stress impairs the learning process and surgical performance and heart rate variability (HRV) can be measured as a proxy for both mental and physical stress. This study aims to assess how SBE of endovascular scrub nurses affects team performance and HRV during endovascular aneurysm repair (EVAR). MATERIALS AND METHODS Prospective interventional study in which EVAR-inexperienced scrub nurses followed a focused SBE EVAR program. During real-life EVAR procedures, HRV was continuously recorded with a wireless electrocardiogram patch and multidisciplinary team performance was assessed with the Imperial College Error CAPture (ICECAP) tool, before and after the SBE program, allowing each scrub nurse to serve as their own control. Eight scrub nurses with experience in lower limb endovascular procedures, but not EVAR, were invited to participate. RESULTS Seven participants completed the study. In five of seven scrub nurses, HRV-derived stress levels during real-time EVAR procedures were lower after SBE compared to before SBE. Mean HRV increased from 24 msec to 35 msec (P < 0.001), indicating stress level reduction. Before SBE, the mean number of errors/hour was 7.3 (standard deviation ± 1.8) compared to 3.6 (standard deviation ± 2.7) after SBE. Most errors were categorized as technical (58 %) and communicative (23 %). CONCLUSIONS SBE of scrub nurses may improve team performance and may lower mental stress during EVAR procedures. In this small study, we suggest using mental stress, as evaluated with HRV, and multidisciplinary team performance, as evaluated with ICECAP, to assess SBE effectiveness in real-case EVAR procedures. This SBE program and live ICECAP observations and electrocardiogram patches was well-accepted by scrub nurses and the entire team.
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Affiliation(s)
- Rebecca Andrea Conradsen Skov
- Department of Vascular Surgery, Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark; Copenhagen Academy for Medical Education and Simulation (CAMES), Denmark.
| | - Jonathan Lawaetz
- Department of Vascular Surgery, Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark; Copenhagen Academy for Medical Education and Simulation (CAMES), Denmark
| | - Lars Konge
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark; Copenhagen Academy for Medical Education and Simulation (CAMES), Denmark
| | - Lise Westerlin
- Department of Vascular Surgery, Rigshospitalet, Copenhagen, Denmark
| | - Eske Kvanner Aasvang
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark; Department of Anaesthesiology, Rigshospitalet, Copenhagen, Denmark
| | - Christian Sylvest Meyhoff
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark; Department of Anaesthesia and Intensive Care, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - Katja Vogt
- Department of Vascular Surgery, Rigshospitalet, Copenhagen, Denmark
| | - Tomas Ohrlander
- Department of Vascular Surgery, Rigshospitalet, Copenhagen, Denmark
| | - Timothy Andrew Resch
- Department of Vascular Surgery, Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Jonas Peter Eiberg
- Department of Vascular Surgery, Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark; Copenhagen Academy for Medical Education and Simulation (CAMES), Denmark
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Otto CM. Heartbeat: increased use of NOACs in patients with atrial fibrillation reduces health care system costs by reducing stroke incidence. Heart 2020; 107:1-3. [PMID: 33310724 DOI: 10.1136/heartjnl-2020-318709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
- Catherine M Otto
- Division of Cardiology, University of Washington, Seattle, WA 98195, USA
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