1
|
Ohlenburg H, Arnemann PH, Hessler M, Görlich D, Zarbock A, Friederichs H. Flipped Classroom: Improved team performance during resuscitation training through interactive pre-course content - a cluster-randomised controlled study. BMC MEDICAL EDUCATION 2024; 24:459. [PMID: 38671434 PMCID: PMC11046966 DOI: 10.1186/s12909-024-05438-7] [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: 07/14/2023] [Accepted: 04/17/2024] [Indexed: 04/28/2024]
Abstract
BACKGROUND Resuscitation is a team effort, and it is increasingly acknowledged that team cooperation requires training. Staff shortages in many healthcare systems worldwide, as well as recent pandemic restrictions, limit opportunities for collaborative team training. To address this challenge, a learner-centred approach known as flipped learning has been successfully implemented. This model comprises self-directed, asynchronous pre-course learning, followed by knowledge application and skill training during in-class sessions. The existing evidence supports the effectiveness of this approach for the acquisition of cognitive skills, but it is uncertain whether the flipped classroom model is suitable for the acquisition of team skills. The objective of this study was to determine if a flipped classroom approach, with an online workshop prior to an instructor-led course could improve team performance and key resuscitation variables during classroom training. METHODS A single-centre, cluster-randomised, rater-blinded study was conducted on 114 final year medical students at a University Hospital in Germany. The study randomly assigned students to either the intervention or control group using a computer script. Each team, regardless of group, performed two advanced life support (ALS) scenarios on a simulator. The two groups differed in the order in which they completed the flipped e-learning curriculum. The intervention group started with the e-learning component, and the control group started with an ALS scenario. Simulators were used for recording and analysing resuscitation performance indicators, while professionals assessed team performance as a primary outcome. RESULTS The analysis was conducted on the data of 96 participants in 21 teams, comprising of 11 intervention groups and 10 control groups. The intervention teams achieved higher team performance ratings during the first scenario compared to the control teams (Estimated marginal mean of global rating: 7.5 vs 5.6, p < 0.01; performance score: 4.4 vs 3.8, p < 0.05; global score: 4.4 vs 3.7, p < 0.001). However, these differences were not observed in the second scenario, where both study groups had used the e-learning tool. CONCLUSION Flipped classroom approaches using learner-paced e-learning prior to hands-on training can improve team performance. TRIAL REGISTRATION German Clinical Trials Register ( https://drks.de/search/de/trial/DRKS00013096 ).
Collapse
Affiliation(s)
- Hendrik Ohlenburg
- Institute of Education and Student Affairs, Studienhospital Münster, University of Münster, 48149, Münster, Germany.
| | - Philip-Helge Arnemann
- Department of Anaesthesiology, Intensive Care and Pain Medicine, Münster University Hospital, Münster, Germany
| | - Michael Hessler
- Department of Anaesthesiology, Intensive Care and Pain Medicine, Münster University Hospital, Münster, Germany
| | - Dennis Görlich
- Institute of Biostatistics and Clinical Research, University of Münster, Münster, Germany
| | - Alexander Zarbock
- Department of Anaesthesiology, Intensive Care and Pain Medicine, Münster University Hospital, Münster, Germany
| | - Hendrik Friederichs
- Medical Education Research Group, Medical School OWL, Bielefeld University, Bielefeld, Germany
| |
Collapse
|
2
|
Kornelsen J, Ho H, Williams K, Skinner T. Optimizing rural healthcare through improved team function: a case study of the Rural Surgical Obstetrical Networks programme. J Interprof Care 2023:1-9. [PMID: 38038596 DOI: 10.1080/13561820.2023.2280586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 10/30/2023] [Indexed: 12/02/2023]
Abstract
We explored enablers and mechanisms of optimal team function within rural hospital teams, and the impact of these factors on health service sustainability in British Columbia. The data were drawn from interviews and focus groups with healthcare providers and administrators (n = 169) who participated in the Rural Surgical Obstetrical Networks (RSON) initiative to support low-volume rural surgical and obstetrical services in British Columbia, Canada. The 5-year programme (2018-2022) provided evidence-based system interventions across eight rural sites with the objective of providing sustainable, quality health services to meet population needs. To explore the impact of RSON interventions on local team function, we performed a scoping review, to assess the current literature surrounding enablers of effective rural hospital teamwork. Through inductive thematic analysis of interview data, we identified five enablers of good team function at RSON sites, including emphasis on local leadership, shared direction, commitment to sustainability, respect and solidarity among colleagues, and meaningful communication. The RSON project led to a shift in team culture in participating sites, improved team function, and contributed to improved clinical processes and patient outcomes. The findings have implications for rural health policy and practice in British Columbia and other jurisdictions with similar health service delivery models and geographic contexts.
Collapse
Affiliation(s)
- Jude Kornelsen
- Department of Family Practice, University of British Columbia, Vancouver, Canada
| | - Hilary Ho
- Department of Family Practice, University of British Columbia, Vancouver, Canada
| | - Kim Williams
- Rural Coordination Centre of British Columbia, Vancouver, Canada
| | - Tom Skinner
- Rural Coordination Centre of British Columbia, Vancouver, Canada
| |
Collapse
|
3
|
Chen MJ, Kao FH. Effects of safety attitude on factors related to burnout among nurses working at a dedicated infectious disease control hospital during the COVID-19 pandemic. Int J Nurs Pract 2023; 29:e13169. [PMID: 37272213 DOI: 10.1111/ijn.13169] [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: 12/20/2021] [Revised: 04/21/2023] [Accepted: 05/19/2023] [Indexed: 06/06/2023]
Abstract
AIM Repeated occupational exposure and increased stress and fatigue levels contribute to a high risk of coronavirus disease 2019 (COVID-19) infection among frontline nurses. This study aimed to explore the relationships among teamwork, work environment and resources, work-life balance, stress perception and burnout among nurses working at a dedicated infectious disease control hospital. METHODS The participants were 389 nurses at a dedicated infectious disease control hospital in Taipei City, Taiwan. This study adopted survey design with a questionnaire using the Safety Attitude Questionnaire. RESULTS The work-life balance among nurses at the dedicated hospital significantly mediated the effects of teamwork and work environment and resources on burnout. In addition, stress perception had interaction effects on work-life balance and burnout. CONCLUSION This study's results provide important recommendations for managing teamwork, work environment and resources, work-life balance, stress perception and burnout prevention in nurses to help them better prepare and cope with emergencies. Findings can serve as a reference for developing relevant hospital management policies.
Collapse
Affiliation(s)
- Mei-Ju Chen
- Department of Family Medicine, Heping Fuyou Branch of Taipei City Hospital, Taipei, Taiwan
- Department of Health Care Management, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
| | - Feng-Hsia Kao
- Department of Health Care Management, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
| |
Collapse
|
4
|
Armijo-Rivera S, Ferrada-Rivera S, Aliaga-Toledo M, Pérez LA. Application of the Team Emergency Assessment Measure Scale in undergraduate medical students and interprofessional clinical teams: validity evidence of a Spanish version applied in Chile. Front Med (Lausanne) 2023; 10:1256982. [PMID: 37771978 PMCID: PMC10525305 DOI: 10.3389/fmed.2023.1256982] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 08/23/2023] [Indexed: 09/30/2023] Open
Abstract
Background Teamwork is one of the competencies necessary for physicians to work effectively in health systems and is a competency that can be developed with simulation in professionals and medicine students. The Team Emergency Assessment Measurement (TEAM) was created to evaluate the non-technical performance of team members during resuscitation events in real teams. The TEAM scale includes items to assess leadership, teamwork, situational awareness, and task management. An objective evaluation tool in Spanish is valuable for training health professionals at all undergraduate and continuing education levels. This study aimed to generate evidence of the validity of the Team Emergency Assessment Measure (TEAM) in Spanish to measure the performance of medical students and adult, pediatric, and obstetric emergency clinical teams in simulated emergencies as a self-assessment tool. Methods To develop the Spanish version of the instrument, a forward and backward translation process was followed by independent translators, native and fluent in English and Spanish, and a review by a panel of Chilean experts comprising three trained simulation instructors to verify semantics and cultural equivalence. High-fidelity simulations with debriefing were conducted with 5th-year medical students, in which students and instructors applied the Spanish version of the TEAM scale. In the second stage, adult, pediatric, and obstetric emergency management simulations were conducted using the TEAM scale for real clinical teams as a self-assessment tool. Findings By applying the overall TEAM scale to medicine students and clinical teams, Cronbach's alpha was 0.921. For medical students' self-assessment, we obtained Cronbach's alpha of 0.869. No significant differences were found between the overall scores and the scores by dimensions evaluated by instructors and students (p > 0.05). In the case of clinical team training, Cronbach's alpha was 0.755 for adult emergency teams, 0.797 for pediatric emergency teams, and 0.853 for obstetric emergency teams. Conclusion The validated instrument is adequate for evaluating teamwork in medical student simulations by instructors and peers and for self-assessment in adult, pediatric, and obstetric emergency clinical teams.
Collapse
Affiliation(s)
- Soledad Armijo-Rivera
- Escuela de Medicina, Facultad de Medicina Clínica Alemana Universidad del Desarrollo, Santiago, Chile
| | - Sandra Ferrada-Rivera
- Escuela de Medicina, Facultad de Medicina Clínica Alemana Universidad del Desarrollo, Santiago, Chile
- Unidad de Calidad y Seguridad del Paciente, Hospital Padre Hurtado, Santiago, Chile
| | | | - Leonardo A. Pérez
- Centro de Habilidades Clínicas, Facultad de Medicina, Universidad de Chile, Santiago, Chile
- Centro de Habilidades Clínicas y Disciplinares, Universidad de O'Higgins, Rancagua, Chile
| |
Collapse
|
5
|
Boet S, Burns JK, Brehaut J, Britton M, Grantcharov T, Grimshaw J, McConnell M, Posner G, Raiche I, Singh S, Trbovich P, Etherington C. Analyzing interprofessional teamwork in the operating room: An exploratory observational study using conventional and alternative approaches. J Interprof Care 2023; 37:715-724. [PMID: 36739535 DOI: 10.1080/13561820.2023.2171373] [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: 08/31/2021] [Revised: 10/26/2022] [Accepted: 01/07/2023] [Indexed: 02/06/2023]
Abstract
Intraoperative teamwork is vital for patient safety. Conventional tools for studying intraoperative teamwork typically rely on behaviorally anchored rating scales applied at the individual or team level, while others capture narrative information across several units of analysis. This prospective observational study characterizes teamwork using two conventional tools (Operating Theatre Team Non-Technical Skills Assessment Tool [NOTECHS]; Team Emergency Assessment Measure [TEAM]), and one alternative approach (modified-Systems Engineering Initiative for Patient Safety [SEIPS] model). We aimed to explore the advantages and disadvantages of each for providing feedback to improve teamwork practice. Fifty consecutive surgical cases at a Canadian academic hospital were recorded with the OR Black Box®, analyzed by trained raters, and summarized descriptively. Teamwork performance was consistently high within and across cases rated with NOTECHS and TEAMS. For cases analyzed with the modified-SEIPS tool, both optimal and suboptimal teamwork behaviors were identified, and team resilience was frequently observed. NOTECHS and TEAM provided summative assessments and overall pattern descriptions, while SEIPS facilitated a deeper understanding of teamwork processes. As healthcare organizations continue to prioritize teamwork improvement, SEIPS may provide valuable insights regarding teamwork behavior and the broader context influencing performance. This may ultimately enhance the development and effectiveness of multi-level teamwork interventions.
Collapse
Affiliation(s)
- Sylvain Boet
- Department of Anesthesiology & Pain Medicine, University of Ottawa, Ottawa, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
- Department of Innovation in Medical Education, Faculty of Medicine, University of Ottawa, Ottawa, Canada
- Institut du Savoir Montfort, Montfort Hospital & Faculty of Education, University of Ottawa, Ottawa, Canada
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada
| | - Joseph K Burns
- Department of Anesthesiology & Pain Medicine, University of Ottawa, Ottawa, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Jamie Brehaut
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | - Meghan Britton
- Main Operating Room, The Ottawa Hospital (General Campus), Ottawa, Canada
| | - Teodor Grantcharov
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada
- Department of General Surgery, University of Toronto, Toronto, Canada
| | - Jeremy Grimshaw
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
- Department of Medicine, University of Ottawa, Ottawa, Canada
| | - Meghan McConnell
- Department of Anesthesiology & Pain Medicine, University of Ottawa, Ottawa, Canada
- Department of Innovation in Medical Education, Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - Glenn Posner
- Department of Innovation in Medical Education, Faculty of Medicine, University of Ottawa, Ottawa, Canada
- Department of Obstetrics and Gynecology, University of Ottawa, Ottawa, Canada
| | - Isabelle Raiche
- Department of General Surgery, University of Ottawa, Ottawa, Canada
| | - Sukhbir Singh
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
- Department of Obstetrics and Gynecology, University of Ottawa, Ottawa, Canada
| | - Patricia Trbovich
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Cole Etherington
- Department of Anesthesiology & Pain Medicine, University of Ottawa, Ottawa, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| |
Collapse
|
6
|
Ntalouka MP, Brotis AG, Angelis FA, Peroulis M, Matsagkas M, Fountas KN, Arnaoutoglou EM. Appraisal of the Clinical Practice Guidelines for the Use of Antithrombotic Therapy in Elective Spinal Procedures: Do We AGREE (II)? Asian Spine J 2023; 17:790-802. [PMID: 37226384 PMCID: PMC10460662 DOI: 10.31616/asj.2022.0277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 09/07/2022] [Accepted: 09/15/2022] [Indexed: 05/26/2023] Open
Abstract
The perioperative management of patients medicated with antithrombotic agents who require elective spinal surgery is extremely challenging because of the increased risk of surgical bleeding and the concurrent need to minimize the thromboembolic risk. The aims of the present systematic review are to: (1) identify clinical practice guidelines (CPGs) and recommendations (CPRs) on this topic and (2) assess their methodological quality and reporting clarity. An electronic systematic search of the English Medical Literature up to January 31, 2021 was conducted using PubMed, Google Scholar, and Scopus. Two raters assessed the methodological quality and reporting clarity of the gathered CPGs and CPRs using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) tool. The agreement between the two raters was assessed using Cohen's kappa. Of the initially gathered 38 CPGs and CPRs, 16 fulfilled our eligibility criteria and were evaluated using the AGREE II instrument. The reports published by "Narouze 2018" and "Fleisher 2014" were scored as being of "high-quality" and having an adequate interrater agreement (Cohen's kappa ≥0.60). Overall, the AGREE II domains of "clarity of presentation" and "scope and purpose" yielded the highest scores (100%), whereas the domain "stakeholder involvement" scored the lowest score (48.5%). The perioperative management of antiplatelet and anticoagulant agents in elective spine surgery may be challenging. Because of the lack of high-quality data in this field, uncertainty remains regarding the optimal practices to balance the risk of thromboembolism against that of bleeding.
Collapse
Affiliation(s)
- Maria P. Ntalouka
- Department of Anesthesiology, Faculty of Medicine, School of Health Sciences, University Hospital of Larissa, Larissa,
Greece
| | - Alexandros G. Brotis
- Department of Neurosurgery, General University Hospital of Larissa, Larissa,
Greece
| | - Fragkiskos A. Angelis
- Department of Orthopaedic Surgery & Musculoskeletal Trauma, University General Hospital of Larissa, Larissa,
Greece
| | - Michail Peroulis
- Unit of Minimal Invasive Vascular Surgery, Mediterranean Hospital, Athens,
Greece
| | - Miltiadis Matsagkas
- Department of Vascular Surgery, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa,
Greece
| | - Kostantinos N. Fountas
- Department of Neurosurgery, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa,
Greece
| | - Eleni M. Arnaoutoglou
- Department of Anesthesiology, Faculty of Medicine, School of Health Sciences, University Hospital of Larissa, Larissa,
Greece
| |
Collapse
|
7
|
Boyle TP, Dugas JN, Liu J, Stapleton SN, Medzon R, Walsh BM, Corey P, Shubitowski L, Horne JR, O'Connell R, Williams G, Nelson KP, Nadkarni VM, Camargo CA, Feldman JA. Adaptation of a Simulation Model and Checklist to Assess Pediatric Emergency Care Performance by Prehospital Teams. Simul Healthc 2023; 18:82-89. [PMID: 35238848 PMCID: PMC9437138 DOI: 10.1097/sih.0000000000000649] [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] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Simulation tools to assess prehospital team performance and identify patient safety events are lacking. We adapted a simulation model and checklist tool of individual paramedic performance to assess prehospital team performance and tested interrater reliability. METHODS We used a modified Delphi process to adapt 3 simulation cases (cardiopulmonary arrest, seizure, asthma) and checklist to add remote physician direction, target infants, and evaluate teams of 2 paramedics and 1 physician. Team performance was assessed with a checklist of steps scored as complete/incomplete by raters using direct observation or video review. The composite performance score was the percentage of completed steps. Interrater percent agreement was compared with the original tool. The tool was modified, and raters trained in iterative rounds until composite performance scoring agreement was 0.80 or greater (scale <0.20 = poor; 0.21-0.39 = fair, 0.40-0.59 = moderate; 0.60-0.79 = good; 0.80-1.00 = very good). RESULTS We achieved very good interrater agreement for scoring composite performance in 2 rounds using 6 prehospital teams and 4 raters. The original 175 step tool was modified to 171 steps. Interrater percent agreement for the final modified tool approximated the original tool for the composite checklist (0.80 vs. 0.85), cardiopulmonary arrest (0.82 vs. 0.86), and asthma cases (0.80 vs. 0.77) but was lower for the seizure case (0.76 vs. 0.91). Most checklist items (137/171, 80%) had good-very good agreement. Among 34 items with fair-moderate agreement, 15 (44%) related to patient assessment, 9 (26%) equipment use, 6 (18%) medication delivery, and 4 (12%) cardiopulmonary resuscitation quality. CONCLUSIONS The modified checklist has very good agreement for assessing composite prehospital team performance and can be used to test effects of patient safety interventions.
Collapse
Affiliation(s)
- Tehnaz P Boyle
- From the Department of Pediatrics (T.P.B., B.M.W.), Boston Medical Center, Boston University School of Medicine; Department of Emergency Medicine (J.N.D., J.L., S.N.S., R.M., J.A.F.), Boston Medical Center, Boston University School of Medicine; Solomont Center for Simulation (T.P.B., S.N.S., R.M., B.M.W., P.C.), Boston Medical Center; Boston Emergency Medical Services (L.S., J.R.H., R.O.C., G.W.); Department of Biostatistics (K.P.N.), Boston University, Boston, MA; Center for Simulation, Advanced Education and Innovation (V.M.N.); Department of Anesthesiology and Critical Care Medicine (V.M.N.); The Children's Hospital of Philadelphia (V.M.N.), University of Pennsylvania Perelman School of Medicine (V.M.N.), Philadelphia, PA; and Department of Emergency Medicine (C.A.C.), Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
8
|
Higham H, Greig P, Crabtree N, Hadjipavlou G, Young D, Vincent C. A study of validity and usability evidence for non-technical skills assessment tools in simulated adult resuscitation scenarios. BMC MEDICAL EDUCATION 2023; 23:153. [PMID: 36906567 PMCID: PMC10007667 DOI: 10.1186/s12909-023-04108-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 02/15/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Non-technical skills (NTS) assessment tools are widely used to provide formative and summative assessment for healthcare professionals and there are now many of them. This study has examined three different tools designed for similar settings and gathered evidence to test their validity and usability. METHODS Three NTS assessment tools designed for use in the UK were used by three experienced faculty to review standardized videos of simulated cardiac arrest scenarios: ANTS (Anesthetists' Non-Technical Skills), Oxford NOTECHS (Oxford NOn-TECHnical Skills) and OSCAR (Observational Skill based Clinical Assessment tool for Resuscitation). Internal consistency, interrater reliability and quantitative and qualitative analysis of usability were analyzed for each tool. RESULTS Internal consistency and interrater reliability (IRR) varied considerably for the three tools across NTS categories and elements. Intraclass correlation scores of three expert raters ranged from poor (task management in ANTS [0.26] and situation awareness (SA) in Oxford NOTECHS [0.34]) to very good (problem solving in Oxford NOTECHS [0.81] and cooperation [0.84] and SA [0.87] in OSCAR). Furthermore, different statistical tests of IRR produced different results for each tool. Quantitative and qualitative examination of usability also revealed challenges in using each tool. CONCLUSIONS The lack of standardization of NTS assessment tools and training in their use is unhelpful for healthcare educators and students. Educators require ongoing support in the use of NTS assessment tools for the evaluation of individual healthcare professionals or healthcare teams. Summative or high-stakes examinations using NTS assessment tools should be undertaken with at least two assessors to provide consensus scoring. In light of the renewed focus on simulation as an educational tool to support and enhance training recovery in the aftermath of COVID-19, it is even more important that assessment of these vital skills is standardized, simplified and supported with adequate training.
Collapse
Affiliation(s)
- Helen Higham
- Nuffield Department of Clinical Neurosciences, University of Oxford, Level 6, West Wing, John Radcliffe Hospital, Oxford, OX3 9DU England
| | - Paul Greig
- Nuffield Department of Clinical Neurosciences, University of Oxford, Level 6, West Wing, John Radcliffe Hospital, Oxford, OX3 9DU England
| | - Nick Crabtree
- The Medical Specialist Group LLP Guernsey, Saint Peter Port, Guernsey
| | | | - Duncan Young
- Nuffield Department of Clinical Neurosciences, University of Oxford, Level 6, West Wing, John Radcliffe Hospital, Oxford, OX3 9DU England
| | - Charles Vincent
- Department of Experimental Psychology, University of Oxford, Oxford, UK
| |
Collapse
|
9
|
Lapierre A, Lavoie P, Castonguay V, Lonergan AM, Arbour C. The influence of the simulation environment on teamwork and cognitive load in novice trauma professionals at the emergency department: Piloting a randomized controlled trial. Int Emerg Nurs 2023; 67:101261. [PMID: 36804137 DOI: 10.1016/j.ienj.2022.101261] [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: 08/01/2022] [Revised: 12/16/2022] [Accepted: 12/29/2022] [Indexed: 02/20/2023]
Abstract
INTRODUCTION This pilot study aimed to test the feasibility of conducting a randomized controlled trial to examine how simulation environments (in situ versus laboratory) influence teamwork skills development and cognitive load among novice healthcare trauma professionals in the emergency department. METHOD Twenty-four novice trauma professionals (nurses, medical residents, respiratory therapists) were assigned to in situ or laboratory simulations. They participated in two 15-minute simulations separated by a 45-minute debriefing on teamwork. After each simulation, they completed validated teamwork and cognitive load questionnaires. All simulations were video recorded to assess teamwork performance by trained external observers. Feasibility measures (e.g., recruitment rate, randomization procedure and intervention implementation) were recorded. Mixed ANOVAs were used to calculate effect sizes. RESULTS Regarding feasibility, several difficulties were encountered, such as a low recruitment rate and the inability to perform randomization. Outcome results suggest that the simulation environment does not affect novice trauma professionals' teamwork performance and cognitive load (small effect sizes), but a large effect size was observed for perceived learning. CONCLUSION This study highlights several barriers to conducting a randomized study in the context of interprofessional simulation-based education in the emergency department. Suggestions are made to guide future research in the field.
Collapse
Affiliation(s)
- Alexandra Lapierre
- Faculty of Nursing, Université de Montréal, 2375 Chem. de la Côte-Sainte-Catherine, Montréal, QC H3T 1A8, Canada; Research center, Hôpital du Sacré-Coeur de Montréal, 5400 Boul Gouin O, Montréal, QC H4J 1C5, Canada.
| | - Patrick Lavoie
- Faculty of Nursing, Université de Montréal, 2375 Chem. de la Côte-Sainte-Catherine, Montréal, QC H3T 1A8, Canada
| | - Véronique Castonguay
- Research center, Hôpital du Sacré-Coeur de Montréal, 5400 Boul Gouin O, Montréal, QC H4J 1C5, Canada
| | - Ann-Marie Lonergan
- Research center, Hôpital du Sacré-Coeur de Montréal, 5400 Boul Gouin O, Montréal, QC H4J 1C5, Canada
| | - Caroline Arbour
- Faculty of Nursing, Université de Montréal, 2375 Chem. de la Côte-Sainte-Catherine, Montréal, QC H3T 1A8, Canada; Research center, Hôpital du Sacré-Coeur de Montréal, 5400 Boul Gouin O, Montréal, QC H4J 1C5, Canada
| |
Collapse
|
10
|
Cooper S, Connell C, Cant R. Review article: Use of the Team Emergency Assessment Measure in the rating of emergency teams' non-technical skills: A mapping review. Emerg Med Australas 2023; 35:375-383. [PMID: 36849717 DOI: 10.1111/1742-6723.14184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 01/12/2023] [Accepted: 01/31/2023] [Indexed: 03/01/2023]
Abstract
The present study aims to explore the utility of the Team Emergency Assessment Measure (TEAM) in relation to the enhancement of emergency team non-technical skills based on research conducted over the last decade. In this mapping review, a citation mining process identified 22 primary studies for inclusion, published between 2012 and 2022. It provides outcome data on emergency teams' non-technical skills following team training and/or real-life patient emergencies. Emergency team studies related to resuscitation teams (adult, paediatric, newborn and obstetric cases) and medical emergency team (MET) management of patient deterioration. Team performance ratings varied, ranging from approximately 90% for experienced clinical teams down to 38% for students. Statistically significant improvements in performance were notable following training and/or repeated practice. Validity evidence, across 11 studies that provided change data described positive learning outcomes and moderate intervention effects. However, according to Kirkpatrick's model of educational evaluation the studies were limited to professional development phases of learning and immediate post-training assessments rather than care quality improvement. The review highlights a lack of studies evidencing quality improvement or clinical impact such as change of patient care practice or health service performance. There is a need to conduct well-designed studies that explore both technical and non-technical skills of resuscitation teams and METs. Currently, non-technical skills training and repeated performance evaluations using the TEAM contribute immensely to the proficiency of emergency teams.
Collapse
Affiliation(s)
- Simon Cooper
- Institute of Health and Wellbeing, Federation University Australia, Melbourne, Victoria, Australia
| | - Clifford Connell
- Nursing and Midwifery, Monash University, Melbourne, Victoria, Australia
| | - Robyn Cant
- Institute of Health and Wellbeing, Federation University Australia, Melbourne, Victoria, Australia
| |
Collapse
|
11
|
Parry AE, Richardson A, Kirk MD, Colquhoun SM, Durrheim DN, Housen T. Team effectiveness: epidemiologists' perception of collective performance during emergency response. BMC Health Serv Res 2023; 23:149. [PMID: 36782194 PMCID: PMC9925216 DOI: 10.1186/s12913-023-09126-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Accepted: 01/27/2023] [Indexed: 02/15/2023] Open
Abstract
BACKGROUND To describe epidemiologists' experience of team dynamics and leadership during emergency response, and explore the utility of the Team Emergency Assessment Measure (TEAM) tool during future public health emergency responses. The TEAM tool included categories for leadership, teamwork, and task management. METHODS We conducted a cross-sectional survey between October 2019 and February 2020 with the global applied field epidemiology workforce. To validate the TEAM tool for our context, we used exploratory and confirmatory factor analysis. RESULTS We analysed 166 completed surveys. Respondents included national and international emergency responders with representation of all WHO regions. We were unable to validate the TEAM tool for use with epidemiology teams involved in emergency response, however descriptive analysis provided insight into epidemiology emergency response team performance. We found female responders were less satisfied with response leadership than male counterparts, and national responders were more satisfied across all survey categories compared to international responders. CONCLUSION Functional teams are a core attribute of effective public health emergency response. Our findings have shown a need for a greater focus on team performance. We recommend development of a fit-for-purpose performance management tool for teams responding to public health emergencies. The importance of building and supporting the development of the national workforce is another important finding of this study.
Collapse
Affiliation(s)
- Amy Elizabeth Parry
- The Australian National University (ANU), National Centre for Epidemiology & Population Health (NCEPH), Building 62 Mills Road, Acton, ACT, Australia.
| | - Alice Richardson
- grid.1001.00000 0001 2180 7477The Australian National University, Statistical Support Network, Acton, Australia
| | - Martyn D. Kirk
- grid.1001.00000 0001 2180 7477The Australian National University (ANU), National Centre for Epidemiology & Population Health (NCEPH), Building 62 Mills Road, Acton, ACT Australia
| | - Samantha M. Colquhoun
- grid.1001.00000 0001 2180 7477The Australian National University (ANU), National Centre for Epidemiology & Population Health (NCEPH), Building 62 Mills Road, Acton, ACT Australia
| | - David N. Durrheim
- grid.266842.c0000 0000 8831 109XUniversity of Newcastle, Newcastle, NSW Australia
| | - Tambri Housen
- grid.1001.00000 0001 2180 7477The Australian National University (ANU), National Centre for Epidemiology & Population Health (NCEPH), Building 62 Mills Road, Acton, ACT Australia ,grid.266842.c0000 0000 8831 109XUniversity of Newcastle, Newcastle, NSW Australia
| |
Collapse
|
12
|
Laurens LM, Bañeras J, Biarnés A, Nuñez S. [Simulation in healthcare during COVID-19: An experience with residents in Anaesthesiology]. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2023; 70:77-82. [PMID: 34840352 PMCID: PMC8610838 DOI: 10.1016/j.redar.2021.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 08/01/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND The restrictions to stop COVID-19 pandemic have had a negative impact in simulation. However, it is imperative to develop new strategies that facilitate healthcare education. OBJECTIVE To describe a simulation in healthcare based on the learning of non-technical skills and performed under the restrictions of COVID-19 pandemic. METHODS Quasi-experimental study of an educational activity performed through simulation with Anaesthesiology residents in November 2020. Twelve residents participated in 2 consecutive days. A questionnaire was filled related to the performance of non-technical skills that encompasses leadership, teamwork and decision making. The complexity of the scenarios and the non-technical skills results obtained between the 2 days were analysed. Advantages and challenges were documented when a clinical simulation is performed under COVID-19 restrictions. RESULTS The global performance of the teams improved when comparing first and second day (79.5 vs. 88.6%, P < .01). Leadership was the worst section rated, however, was the one that showed the best improvement (70 vs. 87.5%, P < .01). The complexity of the simulation cases had no relation with the group performance in leadership and teamwork but affected task management results. General satisfaction was over 75%. The main challenges to develop the activity were the technology required to adapt virtuality to simulation and the time spent for the preparation of it. No cases of COVID-19 were reported within the first month after the activity. CONCLUSION Clinical simulation can be done in the context of COVID-19 pandemic, obtaining satisfactory learning results but requiring the adaptation of institutions to the new challenges it implies.
Collapse
Affiliation(s)
- L M Laurens
- Servicio de Anestesiología, Reanimación y Tratamiento del Dolor, Vall d'Hebron Hospital Universitari, Barcelona, España
| | - J Bañeras
- Servicio de Cardiología, Vall d'Hebron centre Simulació Clínica Avançada (VH_Centre de Simulació Clínica Avançada), Direcció de Docència, Vall d'Hebron Hospital Universitari, Barcelona, España
| | - A Biarnés
- Servicio de Anestesiología, Reanimación y Tratamiento del Dolor, Vall d'Hebron centre Simulació Clínica Avançada (VH_Centre de Simulació Clínica Avançada), Vall d'Hebron Hospital Universitari, Barcelona, España
| | - S Nuñez
- Servicio de Anestesiología, Reanimación y Tratamiento del Dolor, Vall d'Hebron centre Simulació Clínica Avançada (VH_Centre de Simulació Clínica Avançada), Vall d'Hebron Hospital Universitari, Barcelona, España
| |
Collapse
|
13
|
Laurens LM, Bañeras J, Biarnés A, Nuñez S. Simulation in healthcare during COVID-19: An experience with residents in Anaesthesiology. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2023; 70:77-82. [PMID: 36813026 PMCID: PMC9940464 DOI: 10.1016/j.redare.2021.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 08/01/2021] [Indexed: 02/22/2023]
Abstract
BACKGROUND The restrictions to stop COVID-19 pandemic have had a negative impact in simulation, however, it is imperative to develop new strategies that facilitate healthcare education. OBJECTIVE To describe a simulation in healthcare based on the learning of Non-Technical Skills (NTS) and performed under the restrictions of COVID-19 Pandemic. METHODS Quasi-experimental study of an educational activity performed through simulation with anaesthesiology residents in November 2020. Twelve residents participated in two consecutive days. A questionnaire was filled related to the performance of NTS that encompasses leadership, teamwork and decision making. The complexity of the scenarios and the NTS results obtained between the two days were analysed. Advantages and challenges were documented when a clinical simulation is performed under COVID-19 restrictions. RESULTS The global performance of the teams improved when comparing first and second day (79.5% vs 88.6%, p<0.01). Leadership was the worst section rated, however, was the one that showed the best improvement (70% vs 87.5%, p<0.01). The complexity of the simulation cases had no relation with the group performance in leadership and teamwork but affected task management results. General satisfaction was over 75%. The main challenges to develop the activity were the technology required to adapt virtuality to simulation and the time spent for the preparation of it. No cases of COVID-19 were reported within the first month after the activity. CONCLUSION Clinical simulation can be done in the context of COVID-19 Pandemic, obtaining satisfactory learning results but requiring the adaptation of institutions to the new challenges it implies.
Collapse
Affiliation(s)
- L M Laurens
- Servicio de Anestesiología, Reanimación y Tratamiento del Dolor, Vall d'Hebron Hospital Universitari, Barcelona, Spain
| | - J Bañeras
- Servicio de Cardiología, Vall d'Hebron centre Simulació Clínica Avançada (VH_Centre de Simulació Clínica Avançada), Direcció de Docència, Vall d'Hebron Hospital Universitari, Barcelona, Spain.
| | - A Biarnés
- Servicio de Anestesiología, Reanimación y Tratamiento del Dolor, Vall d'Hebron centre Simulació Clínica Avançada (VH_Centre de Simulació Clínica Avançada), Vall d'Hebron Hospital Universitari, Barcelona, Spain
| | - S Nuñez
- Servicio de Anestesiología, Reanimación y Tratamiento del Dolor, Vall d'Hebron centre Simulació Clínica Avançada (VH_Centre de Simulació Clínica Avançada), Vall d'Hebron Hospital Universitari, Barcelona, Spain
| |
Collapse
|
14
|
Morian H, Härgestam M, Hultin M, Jonsson H, Jonsson K, Nordahl Amorøe T, Creutzfeldt J. Reliability and validity testing of team emergency assessment measure in a distributed team context. Front Psychol 2023; 14:1110306. [PMID: 37151315 PMCID: PMC10157038 DOI: 10.3389/fpsyg.2023.1110306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 04/03/2023] [Indexed: 05/09/2023] Open
Abstract
Medical multi-professional teams are increasingly collaborating via telemedicine. In distributed team settings, members are geographically separated and collaborate through technology. Developing improved training strategies for distributed teams and finding appropriate instruments to assess team performance is necessary. The Team Emergency Assessment Measure (TEAM), an instrument validated in traditional collocated acute-care settings, was tested for validity and reliability in this study when used for distributed teams. Three raters assessed video recordings of simulated team training scenarios (n = 18) among teams with varying levels of proficiency working with a remotely located physician via telemedicine. Inter-rater reliability, determined by intraclass correlation, was 0.74-0.92 on the TEAM instrument's three domains of leadership, teamwork, and task management. Internal consistency (Cronbach's alpha) ranged between 0.89-0.97 for the various domains. Predictive validity was established by comparing scores with proficiency levels. Finally, concurrent validity was established by high correlations, >0.92, between scores in the three TEAM domains and the teams' overall performance. Our results indicate that TEAM can be used in distributed acute-care team settings and consequently applied in future-directed learning and research on distributed healthcare teams.
Collapse
Affiliation(s)
- Hanna Morian
- Department of Nursing, Umeå University, Umeå, Sweden
- *Correspondence: Hanna Morian,
| | | | - Magnus Hultin
- Department of Surgical and Perioperative Sciences, Anesthesia and Critical Care Medicine, Umeå University, Umeå, Sweden
| | - Håkan Jonsson
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | - Karin Jonsson
- Department of Nursing, Umeå University, Umeå, Sweden
| | - Torben Nordahl Amorøe
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Simulation Center West, Department of Research, Education, and Development, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Johan Creutzfeldt
- Department of Clinical Science, Intervention, and Technology, Karolinska Institute, Stockholm, Sweden
- Center for Advanced Medical Simulation and Training, Karolinska University Hospital, Stockholm, Sweden
| |
Collapse
|
15
|
Sturesson LW, Persson K, Olmstead R, Bjurström MF. Influence of airway trolley organization on efficiency and team performance: A randomized, crossover simulation study. Acta Anaesthesiol Scand 2023; 67:44-56. [PMID: 36196685 PMCID: PMC10092151 DOI: 10.1111/aas.14155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 09/13/2022] [Accepted: 09/27/2022] [Indexed: 12/29/2022]
Abstract
BACKGROUND Failed management of unanticipated difficult airway situations contributes to significant anesthesia-related morbidity and mortality. Optimization of design and layout of difficult airway trolleys (DATs) may influence outcomes during airway emergencies. The main objective of the current study was to evaluate whether a difficult airway algorithm-based DAT with integrated cognitive aids improves efficiency and team performance in difficult airway scenarios. METHODS In a crossover design, 16 teams (anesthetist, nurse anesthetist, assistant nurse) completed two high-fidelity simulated unanticipated difficult airway scenarios. Teams used both an algorithm-based DAT and a comparison, standard DAT, in the scenarios and were randomized to order of trolley type. Outcome measures included objective efficiency parameters, team performance assessment and subjective user-ratings. Linear mixed models ANOVA, including DAT type and order of condition as main factors, was utilized for the primary analyses of the team results. RESULTS Usage of the algorithm-based DAT was associated with fewer departures from the difficult airway algorithm (p = .010), and reduced number of unnecessary drawer openings (p = .002), but no significant differences in time to retrieval of airway devices or time to first effective ventilation, compared to the standard DAT. There were no significant differences in team performance, although participants expressed strong preference for the algorithm-based DAT (all user-rated measures p < .0001). Higher percentage of female members of the team improved adherence to the difficult airway algorithm (p = .043). CONCLUSIONS Algorithm-based DATs with integrated cognitive aids may improve efficiency in difficult airway situations, compared to traditional DATs. These findings have implications for improvement of anesthetic practice.
Collapse
Affiliation(s)
- Louise W Sturesson
- Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Anaesthesiology and Intensive Care, Lund, Sweden
| | - Karolina Persson
- Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Anaesthesiology and Intensive Care, Lund, Sweden
| | - Richard Olmstead
- Norman Cousins Center for Psychoneuroimmunology, Jane and Terry Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles (UCLA), Los Angeles, California, USA
| | - Martin F Bjurström
- Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Anaesthesiology and Intensive Care, Lund, Sweden.,Norman Cousins Center for Psychoneuroimmunology, Jane and Terry Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles (UCLA), Los Angeles, California, USA
| |
Collapse
|
16
|
Ravindran S, Cavilla R, Ashrafian H, Haycock A, Healey C, Coleman M, Archer S, Darzi A, Thomas-Gibson S. Development of the "Teamwork in Endoscopy Assessment Module for Endoscopic Non-Technical Skills" (TEAM-ENTS) behavioral marker system. Endoscopy 2022; 55:403-412. [PMID: 36223812 DOI: 10.1055/a-1959-6123] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
BACKGROUND Non-technical skills (NTS) are integral to team performance and subsequent quality and safety of care. Behavioral marker systems (BMSs) are now increasingly used in healthcare to support the training and assessment of team NTS. Within gastrointestinal endoscopy, this is an area of novel research. The aims of this study were to define the core relevant NTS for endoscopy teams and develop a preliminary framework for a team-based BMS known as TEAM-ENTS (Teamwork in Endoscopy Assessment Module for Endoscopic Non-Technical Skills). METHODS This study was conducted in two phases. In phase 1, a literature review of team-based BMSs was performed to inform an interview study of core endoscopy team members. Cognitive task analysis was used to break down the NTS relevant to endoscopy teams. Framework analysis generated the structure for the preliminary TEAM-ENTS framework. In phase 2, a modified Delphi process was undertaken to refine the items of the framework. RESULTS Seven consultant endoscopists and six nurses were interviewed. The final coding framework consisted of 88 codes grouped into five overarching categories. In total, 58 participants were recruited to the Delphi panel. In the first round, nine elements and 37 behavioral descriptors did not meet consensus. Following item adjustment, merging and deletion, all remaining items met consensus thresholds after the second round. The refined TEAM-ENTS BMS consists of five categories, 16 elements, and 47 behavioral descriptors. CONCLUSIONS The refined TEAM-ENTS behavioral marker system was developed to reflect the core NTS relevant to endoscopy teams. Future studies will aim to fully validate this tool.
Collapse
Affiliation(s)
- Srivathsan Ravindran
- Joint Advisory Group on Gastrointestinal Endoscopy, Royal College of Physicians, London, UK.,Wolfson Unit for Endoscopy, St Mark's Hospital, London, UK.,Department of Surgery and Cancer, Imperial College London, London, UK
| | | | - Hutan Ashrafian
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Adam Haycock
- Wolfson Unit for Endoscopy, St Mark's Hospital, London, UK
| | - Chris Healey
- Department of Gastroenterology, Airedale NHS Foundation Trust, Keighley, UK
| | - Mark Coleman
- Joint Advisory Group on Gastrointestinal Endoscopy, Royal College of Physicians, London, UK.,Department of Colorectal Surgery, University Hospitals Plymouth NHS Trust, Plymouth, UK
| | - Steph Archer
- Department of Surgery and Cancer, Imperial College London, London, UK.,Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK.,Department of Psychology, University of Cambridge, Cambridge, UK
| | - Ara Darzi
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Siwan Thomas-Gibson
- Wolfson Unit for Endoscopy, St Mark's Hospital, London, UK.,Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
| | | |
Collapse
|
17
|
Hałgas EA, van Eijndhoven KHJ, Gevers JMP, Wiltshire TJ, M. Westerink JHD, Rispens S. A Review of Using Wearable Technology to Assess Team Functioning and Performance. SMALL GROUP RESEARCH 2022. [DOI: 10.1177/10464964221125717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Wearable technology enables collecting continuous in situ data from multiple people in various modalities, which can enhance team research and support, as the dynamic coupling of signals between interacting individuals (i.e., team coordination dynamics) is believed to reflect underlying processes and states of team functioning and performance. We conducted a systematic review on existing literature to evaluate the prospective use of wearable technology in research and practice. Using the IMOI framework as an organizing tool, our review revealed considerable support linking team coordination dynamics in different modalities to team functioning and performance, but also explicated the field’s nascent status.
Collapse
Affiliation(s)
| | | | | | | | - Joyce H. D. M. Westerink
- Eindhoven University of Technology, The Netherlands
- Digital Engagement, Cognition and Behavior Group, Philips Research, Eindhoven, The Netherlands
| | | |
Collapse
|
18
|
Han S, Park HJ, Jeong WJ, Kim GW, Choi HJ, Moon HJ, Lee K, Choi HJ, Park YJ, Cho JS, Lee CA. Application of the Team Emergency Assessment Measure for Prehospital Cardiopulmonary Resuscitation. J Clin Med 2022; 11:jcm11185390. [PMID: 36143045 PMCID: PMC9502771 DOI: 10.3390/jcm11185390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 09/10/2022] [Accepted: 09/11/2022] [Indexed: 11/16/2022] Open
Abstract
Introduction: Communication and teamwork are critical for ensuring patient safety, particularly during prehospital cardiopulmonary resuscitation (CPR). The Team Emergency Assessment Measure (TEAM) is a tool applicable to such situations. This study aimed to validate the TEAM efficiency as a suitable tool even in prehospital CPR. Methods: A multi-centric observational study was conducted using the data of all non-traumatic out-of-hospital cardiac arrest patients aged over 18 years who were treated using video communication-based medical direction in 2018. From the extracted data of 1494 eligible patients, 67 sample cases were randomly selected. Two experienced raters were assigned to each case. Each rater reviewed 13 or 14 videos and scored the TEAM items for each field cardiopulmonary resuscitation performance. The internal consistency, concurrent validity, and inter-rater reliability were measured. Results: The TEAM showed high reliability with a Cronbach’s alpha value of 0.939, with a mean interitem correlation of 0.584. The mean item–total correlation was 0.789, indicating significant associations. The mean correlation coefficient between each item and the global score range was 0.682, indicating good concurrent validity. The mean intra-class correlation coefficient was 0.804, indicating excellent agreement. Discussion: The TEAM can be a valid and reliable tool to evaluate the non-technical skills of a team of paramedics performing CPR.
Collapse
Affiliation(s)
- Sangsoo Han
- Department of Emergency Medicine, Soonchunhyang University Bucheon Hospital, Bucheon 14584, Korea
| | - Hye Ji Park
- Department of Emergency Medicine, Hallym University, Dongtan Sacred Heart Hospital, Hwaseong 18450, Korea
| | - Won Jung Jeong
- Department of Emergency Medicine, Catholic University of Korea, St. Vincent’s Hospital, Seoul 06591, Korea
| | - Gi Woon Kim
- Department of Emergency Medicine, Soonchunhyang University Bucheon Hospital, Bucheon 14584, Korea
| | - Han Joo Choi
- Department of Emergency Medicine, Dankook University Hospital, Cheonan 31116, Korea
| | - Hyung Jun Moon
- Department of Emergency Medicine, College of Medicine, Soonchunhyang University, Cheonan 31151, Korea
| | - Kyoungmi Lee
- Department of Emergency Medicine, Myongji Hospital, Goyang 10475, Korea
| | - Hyuk Joong Choi
- Department of Emergency Medicine, Hanyang University Guri Hospital, Guri 11923, Korea
| | - Yong Jin Park
- Department of Emergency Medicine, Chosun University Hospital, Gwangju 61453, Korea
| | - Jin Seong Cho
- Department of Emergency Medicine, Gil Medical Center, Gachon University College of Medicine, Incheon 21565, Korea
| | - Choung Ah Lee
- Department of Emergency Medicine, Hallym University, Dongtan Sacred Heart Hospital, Hwaseong 18450, Korea
- Correspondence: ; Tel.: +82-31-8086-2611
| |
Collapse
|
19
|
Supporting Professionals in Critical Care Medicine: Burnout, Resiliency, and System-Level Change. Clin Chest Med 2022; 43:563-577. [PMID: 36116823 DOI: 10.1016/j.ccm.2022.05.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Burnout is occurring in epidemic proportions among intensive care unit physicians and other health-care professionals-accelerated by pandemic-driven stress. The impact of burnout is far-reaching, threatening the health of individual workers, the safety and quality of care our patients receive, and eroding the infrastructure of health care in general. Drivers of burnout include excessive quantity of work (nights, weekends, and acuity surges); excessive menial tasks; incivility, poor communication, and challenges to team success; and frequent moral distress and end-of-life issues. This article provides system-based practice and individual strategies to address these drivers and improve the well-being of our team and our patients.
Collapse
|
20
|
Emin EI, Emin E, Bimpis A, Pierides M, Dedeilia A, Javed Z, Rallis KS, Saeed F, Theophilou G, Karkanevatos A, Kitapcioglu D, Aksoy ME, Papalois A, Sideris M. Teaching and Assessment of Medical Students During Complex Multifactorial Team-Based Tasks: The "Virtual on Call" Case Study. ADVANCES IN MEDICAL EDUCATION AND PRACTICE 2022; 13:457-465. [PMID: 35547870 PMCID: PMC9084906 DOI: 10.2147/amep.s357514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 03/31/2022] [Indexed: 06/15/2023]
Abstract
Abstract Although considerable efforts have been made to incorporate simulation-based learning (SBL) in undergraduate medical education, to date, most of the medical school curricula still focus on pure knowledge or individual assessment of objective structured clinical examination skills (OSCE). To this end, we designed a case study named "iG4 (integrated generation 4) virtual on-call (iVOC)". We aimed to simulate an on-call shift in a high-fidelity virtual hospital setting in order to assess delegates' team-based performance on tasks related to patient handovers (prioritisation, team allocation). Methods A total of 41 clinical year medical students were split into 3 cohorts, each of which included 3 groups of 4 or 5 people. The groups consisted of a structured mix of educational and cultural backgrounds of students to achieve homogeneity. Each performing group received the handover for 5 patients in the virtual hospital and had to identify and deal with the acutely unwell ones within 15 minutes. We used TEAMTM tool to assess team-based performances. Results The mean handover performance was 5.44/10 ± 2.24 which was the lowest across any performance marker. The overall global performance across any team was 6.64/10 ± 2.11. The first rotating team's global performance for each cycle was 6.44/10 ± 2.01, for the second 7.89/10 ± 2.09 and for the third 6.78/10 ± 1.64 (p = 0.099 between groups). Conclusion This is one of the first reported, high-fidelity, globally reproducible SBL settings to assess the capacity of students to work as part of a multinational team, highlighting several aspects that need to be addressed during undergraduate studies. Medical schools should consider similar efforts with the aim to incorporate assessment frameworks for individual performances of students as part of a team, which can be a stepping-stone for enhancing safety in clinical practice.
Collapse
Affiliation(s)
- Elif Iliria Emin
- Department of Acute Medicine, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Ece Emin
- EGA Institute for Women’s Health, University College London, London, UK
| | - Alexios Bimpis
- Department of Neurosurgery, Tzaneio General Hospital, Piraeus, Greece
| | - Michael Pierides
- Department of Acute Medicine, Kettering General Hospital NHS Trust, Northamptonshire, UK
| | - Aikaterini Dedeilia
- School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Zibad Javed
- Faculty of Medicine and Dentistry, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Kathrine-Sofia Rallis
- Faculty of Medicine and Dentistry, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Ferha Saeed
- Faculty of Medicine and Dentistry, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Georgios Theophilou
- Department of Gynaecological Oncology, St James Institute of Oncology, Leeds, UK
| | | | - Dilek Kitapcioglu
- Center of Advanced Simulation and Education, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
| | - Mehmet Emin Aksoy
- Center of Advanced Simulation and Education, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
| | - Apostolos Papalois
- Special Unit for Biomedical Research and Education, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Michail Sideris
- Faculty of Medicine and Dentistry, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| |
Collapse
|
21
|
Bhangu A, Stevenson C, Szulewski A, MacDonald A, Nolan B. A scoping review of nontechnical skill assessment tools to evaluate trauma team performance. J Trauma Acute Care Surg 2022; 92:e81-e91. [PMID: 34908024 DOI: 10.1097/ta.0000000000003492] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The objective of this scoping review was to identify assessment tools of trauma team performance (outside of technical skills) and assess the validity and reliability of each tool in assessing trauma team performance. METHODS We searched Embase, Cochrane Library, Web of Science, Ovid Medline, and Cumulative Index to Nursing and Allied Health Literature from inception to June 1, 2021. English studies that evaluated trauma team performance using nontechnical skill assessment tools in a simulation or real-world setting were included. Studies were assessed by two independent reviewers for meeting inclusion/exclusion criteria. Data regarding team assessment tools were extracted and synthesized into behavior domains. Each tool was then assessed for validity and reliability. RESULTS The literature search returned 4,215 articles with 29 meeting inclusion criteria. Our search identified 12 trauma team performance assessment tools. Most studies were conducted in the United States (n = 20 [69%]). Twenty studies (69%) assessed trauma team performance in a simulation setting; Team Emergency Assessment Measure (TEAM) and Trauma Nontechnical Skills Scale (T-NOTECHS) were the only tools to be applied in a simulation and real-world setting. Most studies assessed trauma team performance using video review technology (n = 17 [59%]). Five overarching themes were designed to encompass behavioral domains captured across the 12 tools: (1) Leadership, (2) Communication, (3) Teamwork, (4) Assessment, and (5) Situation Awareness. The reliability and validity of T-NOTECHS were investigated by the greatest number of studies (n = 13); however, TEAM had the most robust evidence of reliability and validity. CONCLUSION We identified 12 trauma team performance tools that assessed nontechnical skills to varying degrees. Trauma Nontechnical Skills Scale and TEAM tools had the most evidence to support their reliability and validity. Considering the limited research in the impact of trauma team performance on patient outcomes, future studies could use video review technology in authentic trauma cases to further study this important relationship. LEVEL OF EVIDENCE Systematic reviews and meta-analyses, level IV.
Collapse
Affiliation(s)
- Avneesh Bhangu
- From the Faculty of Health Sciences (A.B.), School of Medicine, Queen's University, Kingston, Ontario, Canada; School of Medicine (C.S.), University of Limerick, Limerick, Ireland; Department of Emergency Medicine (A.S.) and Department of Psychology (A.S.), Queen's University, Kingston, Ontario; Department of Biological Sciences (A.M.), Bishop's University, Sherbrooke, Quebec; Division of Emergency Medicine, Department of Medicine (B.N.), University of Toronto; Li Ka Shing Knowledge Institute (B.N.), St. Michael's Hospital; and Department of Emergency Medicine (B.N.), St. Michael's Hospital, Toronto, Ontario, Canada
| | | | | | | | | |
Collapse
|
22
|
Bhangu A, Notario L, Pinto RL, Pannell D, Thomas-Boaz W, Freedman C, Tien H, Nathens AB, da Luz L. Closed loop communication in the trauma bay: identifying opportunities for team performance improvement through a video review analysis. CAN J EMERG MED 2022; 24:419-425. [PMID: 35412259 PMCID: PMC9002216 DOI: 10.1007/s43678-022-00295-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 03/09/2022] [Indexed: 01/17/2023]
Abstract
Objectives Communication among trauma team members in the trauma bay is vulnerable to errors, which may impact patient outcomes. We used the previously validated trauma-non-technical skills (T-NOTECHS) tool to identify communication gaps during patient management in the trauma bay and to inform development strategies to improve team performance. Methods Two reviewers independently assessed non-technical skills of team members through video footage at Sunnybrook Health Sciences Centre. Team performance was measured using T-NOTECHS across five domains using a five-point Likert scale (lower score indicating worse performance): (1) leadership; (2) cooperation and resource management; (3) communication and interaction; (4) assessment and decision making; (5) situation awareness/coping with stress. Secondary outcomes assessed the number of callouts, closed loop communications and parallel conversations. Results The study included 55 trauma activations. Injury severity score (ISS) was used as a measure of trauma severity. A case with an ISS score ≥ 16 was considered severe. ISS was ≥ 16 in 37% of cases. Communication and interaction scored significantly lower compared to all other domains (p < 0.0001). There were significantly more callouts and completed closed loop communications in more severe cases compared to less severe cases (p = 0.017 for both). Incomplete closed loop communications and parallel conversations were identified, irrespective of case severity. Conclusion A lower communication score was identified using T-NOTECHS, attributed to incomplete closed loop communications and parallel conversations. Through video review of trauma team activations, opportunities for improvement in communication can be identified by the T-NOTECHS tool, as well as specifically identifying callouts and closed loop communication. This process may be useful for trauma programs as part of a quality improvement program on communication skills and team performance. Supplementary Information The online version contains supplementary material available at 10.1007/s43678-022-00295-z.
Collapse
Affiliation(s)
- Avneesh Bhangu
- School of Medicine, Faculty of Health Sciences, Queen's University, Unit 505 - 91 King Street East, Kingston, ON, K7L 2Z8, Canada.
| | - Lowyl Notario
- Department of Emergency Services, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.,Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada.,Tory Regional Trauma Program and the Evaluative Clinical Sciences Program, Sunnybrook Research Institute, Toronto, ON, Canada
| | - Ruxandra L Pinto
- Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Dylan Pannell
- Department of Surgery, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Will Thomas-Boaz
- Department of Emergency Services, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.,Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada.,Tory Regional Trauma Program and the Evaluative Clinical Sciences Program, Sunnybrook Research Institute, Toronto, ON, Canada
| | - Corey Freedman
- Department of Emergency Services, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.,Tory Regional Trauma Program and the Evaluative Clinical Sciences Program, Sunnybrook Research Institute, Toronto, ON, Canada
| | - Homer Tien
- Tory Regional Trauma Program and the Evaluative Clinical Sciences Program, Sunnybrook Research Institute, Toronto, ON, Canada.,Department of Surgery, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.,, Ornge, Mississauga, ON, Canada
| | - Avery B Nathens
- Tory Regional Trauma Program and the Evaluative Clinical Sciences Program, Sunnybrook Research Institute, Toronto, ON, Canada.,Department of Surgery, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.,Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Luis da Luz
- Tory Regional Trauma Program and the Evaluative Clinical Sciences Program, Sunnybrook Research Institute, Toronto, ON, Canada.,Department of Surgery, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| |
Collapse
|
23
|
Melnyk R, Saba P, Holler T, Cameron K, Mithal P, Rappold P, Wu G, Cubillos J, Rashid H, Joseph JV, Ghazi AE. Design and Implementation of an Emergency Undocking Curriculum for Robotic Surgery. Simul Healthc 2022; 17:78-87. [PMID: 34387245 DOI: 10.1097/sih.0000000000000596] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Current training for robotic surgery crisis management, specifically emergency robotic undocking protocol (ERUP), remains limited to anecdotal experience. A curriculum to impart the skills and knowledge necessary to recognize and complete a successful ERUP was developed using an education approach then evaluated. METHODS Baseline knowledge and confidence regarding ERUP were established for 5 robotic teams before completing 2 full-immersion simulations separated by an online self-paced learning module. In each simulation, teams operated on a perfused hydrogel model and were tasked to dissect a retroperitoneal tumor abutting a major vessel. During vascular pedicle ligation, a major vascular bleed and nonrecoverable robotic fault were remotely induced, necessitating ERUP with open conversion. After the simulation, participants completed surgery task load index (cognitive load assessment) and realism surveys. Weighted checklists scored participants' actions during each simulation. Surgical metrics including estimated blood loss, time to control bleeding, and undocking time were recorded. Curriculum retention was assessed by repeating the exercise at 6 months. RESULTS Participants experienced high levels of cognitive demand and agreed that the simulation's realism and stress mimicked live surgery. Longitudinal analysis showed significant knowledge (+37.5 points, p = 0.004) and confidence (+15.3 points, p < 0.001) improvements from baseline to completion. Between simulations, checklist errors, undocking time, and estimated blood loss decreased (38⇾17, -40 seconds, and -500 mL, respectively), whereas action scores increased significantly (+27 points, p = 0.008). At 6 months, insignificant changes from curriculum completion were seen in knowledge (-4.8 points, p = 0.36) and confidence (+3.7 points, p = 0.1). CONCLUSIONS This simulation-based curriculum successfully improves operative team's confidence, knowledge, and skills required to manage robotic crisis events.
Collapse
Affiliation(s)
- Rachel Melnyk
- From the Simulation Innovation Lab (R.M., P.S., T.H., K.C., A.E.G.) and Department of Urology (P.M., P.R., G.W., J.C., H.R., J.V.J., A.E.G.), University of Rochester Medical Center (URMC), Rochester, NY
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
24
|
Pasquier P, Saleten M, Laitselart P, Martinez T, Descamps C, Debien B, Boutonnet M. Who's who in the trauma bay? Association between wearing of identification jackets and trauma teamwork performance: A simulation study. J Emerg Trauma Shock 2022; 15:139-145. [DOI: 10.4103/jets.jets_168_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 04/05/2022] [Accepted: 05/20/2022] [Indexed: 11/04/2022] Open
|
25
|
Dewolf P, Vanneste M, Desruelles D, Wauters L. Measuring non-technical skills during prehospital advanced cardiac life support: A pilot study. Resusc Plus 2021; 8:100171. [PMID: 34693380 PMCID: PMC8517196 DOI: 10.1016/j.resplu.2021.100171] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 09/16/2021] [Accepted: 09/19/2021] [Indexed: 11/05/2022] Open
Abstract
Aim To analyse non-technical skills of mobile medical teams during out-of-hospital cardiac arrests (OHCA) using the validated Team Emergency Assessment Measure (TEAM) tool. To research the correlation between non-technical skills and patient outcome. Methods Adult patients who experienced an out-of-hospital cardiac arrest between July 2016, and June 2018, and were treated by a mobile medical team from the University Hospital Leuven, were eligible for the study. Resuscitations were video recorded from the team leader’s perspective. Video recordings were reviewed and scored by emergency physicians, using the TEAM evaluation form. Results In total 114 OHCAs were analysed. The mean TEAM score was 34.4/44 (SD = 5.5). The mean item score was 3.1/4 (SD = 0.8). On average, ‘effective team communication’ had the lowest score (2.4), while ‘acting with composure and control’ and ‘following of approved standards/guidelines’ scored the highest (3.4). The average non-technical skills theme scores were 2.9 (SD = 0.9) for ‘Leadership’, 3.1 (SD = 0.8) for ‘Teamwork’ and 3.3 (SD = 0.7) for ‘Task management’. ‘Leadership’ was rated significantly lower than ‘Teamwork’ (p = 0.004) and ‘Task management’ (p < 0.001). No significant correlation was found between TEAM and return of spontaneous circulation (p = 0.574) or one month survival (p = 0.225). Conclusion The mean overall TEAM score was categorized as good. Task management scored high, while leadership and team communication received lower scores. Future training programs should thus focus on improving leadership and communication. In this pilot study no correlation was found between non-technical skills and survival.
Collapse
Affiliation(s)
- Philippe Dewolf
- Department of Emergency Medicine, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium.,KULeuven, University, Faculty of Medicine, Belgium
| | - Maïté Vanneste
- Department of Emergency Medicine, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - Didier Desruelles
- Department of Emergency Medicine, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - Lina Wauters
- Department of Emergency Medicine, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium
| |
Collapse
|
26
|
Karlgren K, Dahlström A, Birkestam A, Drevstam Norling A, Forss G, Andersson Franko M, Cooper S, Leijon T, Paulsson C. The TEAM instrument for measuring emergency team performance: validation of the Swedish version at two emergency departments. Scand J Trauma Resusc Emerg Med 2021; 29:139. [PMID: 34544459 PMCID: PMC8454124 DOI: 10.1186/s13049-021-00952-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Accepted: 09/08/2021] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND The Team Emergency Assessment Measure (TEAM) questionnaire is designed for rating the non-technical performance of emergency medical teams during emergencies, e.g., resuscitation or trauma management. Originally developed in Australia it has today been translated and validated into eleven languages, but a Swedish version is lacking. The aim was therefore to cross-culturally translate and evaluate the reliability and validity of the TEAM questionnaire in a Swedish health care setting. METHODS The instrument was forward and backward translated and adapted into a Swedish context according to established guidelines for cross-cultural adaptation of survey-based measures. The translated version was tested through 78 pairwise assessments of 39 high-priority codes at the emergency departments of two major hospitals. The raters observed the teams at work in real time and filled in the questionnaires immediately afterwards independently of each other. Psychometric properties of the instrument were evaluated. RESULTS The original instrument was translated by pairs of translators independently of each other and reviewed by an expert committee of researchers, nurses and physicians from different specialties, a linguist and one of the original developers of the tool. A few adaptations were needed for the Swedish context. A principal component factor analysis confirmed a single 'teamwork' construct in line with the original instrument. The Swedish version showed excellent reliability with a Cronbach's alpha of 0.955 and a mean inter-item correlation of 0.691. The mean item-scale correlation of 0.82 indicated high internal consistency reliability. Inter-rater reliability was measured by intraclass correlation and was 0.74 for the global score indicating good reliability. Individual items ranged between 0.52 and 0.88. No floor effects but ceiling effects were noted. Finally, teams displaying clear closed-loop communication had higher TEAM scores than teams with less clear communication. CONCLUSIONS Real time observations of authentic, high priority cases at two emergency departments show that the Swedish version of the TEAM instrument has good psychometric properties for evaluating team performance. The TEAM instrument is thus a welcome tool for assessing non-technical skills of emergency medical teams.
Collapse
Affiliation(s)
- Klas Karlgren
- Department of Research, Education, Development and Innovation, Södersjukhuset, 118 83 Stockholm, Sweden
- MINT, Department Learning, Informatics, Management and Ethics, Karolinska Institutet, 171 77 Stockholm, Sweden
- Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, 5063 Bergen, Norway
| | - Anders Dahlström
- Department of Research, Education, Development and Innovation, Södersjukhuset, 118 83 Stockholm, Sweden
- Department of Neonatology, Sachs’ Children and Youth Hospital, Stockholm, Sweden
| | - Anderz Birkestam
- Department of Emergency, 118 83 Södersjukhuset, Stockholm, Sweden
| | | | - Gustav Forss
- Department of Emergency, 118 83 Södersjukhuset, Stockholm, Sweden
| | - Mikael Andersson Franko
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Södersjukhuset, 118 83 Stockholm, Sweden
| | - Simon Cooper
- Health Innovation and Transformation Centre (HITC), School of Health, Federation University Australia, Room 113, Building 1, Berwick Campus, Clyde Road, Berwick, VIC 3922 Australia
| | - Thomas Leijon
- Department of Emergency Medicine,
Capio S:t Göran’s Hospital
, 112 81 Stockholm, Sweden
| | - Charlotta Paulsson
- Department of Emergency Medicine,
Capio S:t Göran’s Hospital
, 112 81 Stockholm, Sweden
| |
Collapse
|
27
|
Effectiveness of Interprofessional Manikin-Based Simulation Training on Teamwork Among Real Teams During Trauma Resuscitation in Adult Emergency Departments: A Systematic Review. Simul Healthc 2021; 15:409-421. [PMID: 32218090 DOI: 10.1097/sih.0000000000000443] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
STATEMENT This systematic review synthesizes the relevant evidence about the effectiveness of interprofessional manikin-based simulation training on teamwork among real teams during trauma resuscitation in adult civilian emergency departments. A systematic literature search was conducted in MEDLINE, CINAHL, EMBASE, EBM reviews, PsycINFO, and Web of Science with no time limit. Only experimental and quasi-experimental studies were included. Effects of the simulation intervention on teamwork were categorized according to a modified version of the Kirkpatrick's model. From the 1120 studies found, 11 studies were included for synthesis. All studies showed immediate improvement in teamwork after training, but divergent results were found regarding skills retention. Although this review focused on interprofessional manikin-based simulations in real trauma teams, the results are similar to previous systematic reviews including different types of simulation. This raises significant questions regarding the importance of simulation design characteristics to improve teamwork in trauma care.
Collapse
|
28
|
Evaluation of a combination protocol of CT-first triage and active telemedicine methods by a selected team tackling COVID-19: An experimental research study. J Infect Public Health 2021; 14:1212-1217. [PMID: 34425358 PMCID: PMC8372458 DOI: 10.1016/j.jiph.2021.08.016] [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: 01/27/2021] [Revised: 07/27/2021] [Accepted: 08/15/2021] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Many health care workers around the world tackled with COVID-19, however sadly, the infection of many medical care workers were reported. To reduce the risk of infection, we launched selected team (Team COVID) of non-specialists and brought in active telemedicine method and computed tomography (CT)-first protocol. We describe our actual practice and the health status of medical doctors dealing with COVID-19 patients. METHODS Between April 17, 2020 and May 24, 2020, 10 doctors worked with COVID-19 patients as part of Team COVID. The Team COVID doctors used a CT-first triage protocol for outpatients and telemedicine for inpatients and outpatients. We evaluated paired serum-specific antibodies for SARS-CoV-2 at the initial and end of the study duration and PCR results for SARS-CoV-2 at the end of the study duration. Furthermore, 36-item short-form of the Medical Outcome Study Questionnaire (SF-36) at the beginning and end of the study period were evaluated. RESULTS Ten doctors worked as Team COVID: seven internal medicine doctors and three surgeons. During the study period, Team COVID treated 165 individuals in the outpatient clinic and isolated hospitalized patients for 315 person-days. There were no positive results of serum-specific antibody testing and PCR testing for SARS-CoV-2 in Team COVID doctors. Furthermore, the SF-36 showed no deterioration in physical and mental QOL status. No in-hospital infection occurred during the study period. CONCLUSIONS The Team COVID fulfilled the treatment using the active telemedicine and CT-first triage protocol without in hospital infection and excess stress. The combination strategy seems acceptable for both the protection and stress relief among the medical staff.
Collapse
|
29
|
Bareka M, Ntalouka MP, Kolonia K, Koutalos AA, Hantes M, Arnaoutoglou E. Introducing the "Bleeding Team": Urgent Reconstruction of an Open Fracture in a Patient Receiving Acenocoumarol: A Case Report. JBJS Case Connect 2021; 11:01709767-202106000-00131. [PMID: 34166270 DOI: 10.2106/jbjs.cc.20.00786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE An elderly, polytrauma patient receiving vitamin K antagonist (VKA) for atrial fibrillation required immediate surgery for open distal tibial fracture. As the initial reversal with vitamin K and fresh frozen plasma by the trauma team was ineffective, the "Bleeding Team" was convened and administrated the appropriate four-factor prothrombin complex regimen, reversing the VKA in a timely manner. Surgery was performed under peripheral nerve blockade subsequently. The postoperative course of the patient was uneventful. CONCLUSION The individualized approach and the multidisciplinary experts' team guidance is of outmost importance in patients who are treated with anticoagulants and present for nonelective surgery.
Collapse
Affiliation(s)
- Metaxia Bareka
- Department of Anesthesiology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Maria P Ntalouka
- Department of Anesthesiology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Konstantina Kolonia
- Department of Anesthesiology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Antonios A Koutalos
- Department of Orthopaedic Surgery and Musculoskeletal Trauma, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Michael Hantes
- Department of Orthopaedic Surgery and Musculoskeletal Trauma, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Eleni Arnaoutoglou
- Department of Anesthesiology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| |
Collapse
|
30
|
Hayirli TC, Stark N, Bhanja A, Hardy J, Peabody CR, Kerrissey MJ. Masked and distanced: a qualitative study of how personal protective equipment and distancing affect teamwork in emergency care. Int J Qual Health Care 2021; 33:mzab069. [PMID: 33864362 PMCID: PMC8083305 DOI: 10.1093/intqhc/mzab069] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 03/31/2021] [Accepted: 04/16/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Newly intensified use of personal protective equipment (PPE) in emergency departments presents teamwork challenges affecting the quality and safety of care at the frontlines. OBJECTIVE We conducted a qualitative study to categorize and describe barriers to teamwork posed by PPE and distancing in the emergency setting. METHODS We conducted 55 semi-structured interviews between June 2020 and August 2020 with personnel from two emergency departments serving in a variety of roles. We then performed a thematic analysis to identify and construct patterns of teamwork challenges into themes. RESULTS We discovered two types of challenges to teamwork: material barriers related to wearing masks, gowns and powered air-purifying respirators, and spatial barriers implemented to conserve PPE and limit coronavirus exposure. Both material and spatial barriers resulted in disrupted communication, roles and interpersonal relationships, but they did so in unique ways. Material barriers muffled information flow, impeded team member recognition and role/task division, and reduced belonging and cohesion while increasing interpersonal strain. Spatial barriers resulted in mediated communication and added physical and emotional distance between teammates and patients. CONCLUSION Our findings identify specific aspects of how intensified PPE use disrupts teamwork and can inform efforts to ensure care quality and safety in emergency settings as PPE use continues during and, potentially beyond, the coronavirus disease-2019 pandemic.
Collapse
Affiliation(s)
- Tuna C Hayirli
- Harvard Medical School, Boston MA
- Harvard Business School, Boston MA
| | - Nicholas Stark
- Department of Emergency Medicine, University of California, San Francisco CA
- Department of Emergency Medicine, Zuckerberg San Francisco General Hospital and Trauma Center, CA
| | - Aditi Bhanja
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, MA
| | - James Hardy
- Department of Emergency Medicine, University of California, San Francisco CA
| | - Christopher R Peabody
- Department of Emergency Medicine, University of California, San Francisco CA
- Department of Emergency Medicine, Zuckerberg San Francisco General Hospital and Trauma Center, CA
| | - Michaela J Kerrissey
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, MA
| |
Collapse
|
31
|
Carpini JA, Calvert K, Carter S, Epee-Bekima M, Leung Y. Validating the Team Emergency Assessment Measure (TEAM) in obstetric and gynaecologic resuscitation teams. Aust N Z J Obstet Gynaecol 2021; 61:855-861. [PMID: 33908031 DOI: 10.1111/ajo.13362] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 03/04/2021] [Accepted: 03/30/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND Simulation-based training is an effective method of enhancing the knowledge, skill, and technical abilities of individuals and teams encountering obstetric and gynaecologic emergencies. Simulation may also enhance the non-technical performance of teams resulting in improved patient outcomes. Although simulation-based training is widely recognised as an effective educational approach, issues around feasibility - the lack of simulation experts and malleable outcome measures of team performance - remain critical barriers to their implementation. AIM To evaluate the psychometric properties of the Team Emergency Assessment Measure (TEAM) when used by medical professionals in simulated obstetric and gynaecological emergencies. METHODS There were 151 participants (63% female; 60% consultants; 69% no previous simulation-based training) who observed three live high-fidelity obstetric and gynaecological resuscitation simulations and completed the TEAM. RESULTS Confirmatory factor analysis evaluated the construct validity of the TEAM, yielding a second-order structure identified by 'leadership', 'teamwork', and 'team management'. Convergent validity was supported by the average item-to-scale total correlation which was 0.75, P < 0.001 and the average analysis of variance extracted (AVE) 0.88. The individual factors also yielded high factor-to-scale total correlations (mean [M] = 0.87), and AVE (M = 0.89). The internal reliability was high for the whole scale (average alpha = 0.92) and across the sub-factors (average alpha = 0.80). The inter-rater reliability was excellent (inter-class correlation coefficient 1 = 0.98). Participants with differing levels of simulation training experience did not significantly differ. CONCLUSION The TEAM is a viable instrument for the assessment of non-technical performance during simulated obstetric and gynaecologic emergencies, thus enhancing the feasibility of simulation-based training.
Collapse
Affiliation(s)
- Joseph A Carpini
- Management & Organisations Department, University of Western Australia Business School, Perth, Western Australia, Australia
| | - Katrina Calvert
- King Edward Memorial Hospital, Perth, Western Australia, Australia
| | - Sean Carter
- King Edward Memorial Hospital, Perth, Western Australia, Australia
| | | | - Yee Leung
- Department of the Western Australian Gynaecologic Cancer Service, King Edward Memorial Hospital, Perth, Western Australia, Australia.,School of Women's and Infant's Health, University of Western Australia, Perth, Western Australia, Australia
| |
Collapse
|
32
|
Ehrler F, Sahyoun C, Manzano S, Sanchez O, Gervaix A, Lovis C, Courvoisier DS, Lacroix L, Siebert JN. Impact of a shared decision-making mHealth tool on caregivers' team situational awareness, communication effectiveness, and performance during pediatric cardiopulmonary resuscitation: study protocol of a cluster randomized controlled trial. Trials 2021; 22:277. [PMID: 33849611 PMCID: PMC8042906 DOI: 10.1186/s13063-021-05170-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 03/05/2021] [Indexed: 01/10/2023] Open
Abstract
Background Effective team communication, coordination, and situational awareness (SA) by team members are critical components to deliver optimal cardiopulmonary resuscitation (CPR). Complexity of care during CPR, involvement of numerous providers, miscommunication, and other exogenous factors can all contribute to negatively influencing patient care, thus jeopardizing survival. We aim to investigate whether an mHealth supportive tool (the Interconnected and Focused Mobile Apps on patient Care Environment [InterFACE]) developed as a collaborative platform to support CPR providers in real-time and share patient-centered information would increase SA during pediatric CPR. Methods We will conduct a prospective, cluster randomized controlled trial by groups of 6 participants in a tertiary pediatric emergency department (33,000 consultations/year) with pediatric physicians and nurses. We will compare the impact of the InterFACE tool with conventional communication methods on SA and effective team communication during a standardized pediatric in-hospital cardiac arrest and a polytrauma high-fidelity simulations. Forty-eight participants will be randomized (1:1) to consecutively perform two 20-min video-recorded scenarios using either the mHealth tool or conventional methods. The primary endpoint is the SA score, measured with the Situation Awareness Global Assessment Technique (SAGAT) instrument. Enrollment will start in late 2020 and data analysis in early 2021. We anticipate that the intervention will be completed by early 2021 and study results will be submitted in mid 2021 for publication. Discussion This clinical trial will assess the impact of a collaborative mHealth tool on increasing situational awareness and effective team communication during in-hospital pediatric resuscitation. As research in this area is scarce, the results generated by this study may become of paramount importance in improving the care of children receiving in-hospital CPR, in the era of increasing communication technology. Trial registration ClinicalTrials.gov NCT04464603. Registered on 9 July 2020. Supplementary Information The online version contains supplementary material available at 10.1186/s13063-021-05170-3.
Collapse
Affiliation(s)
- Frédéric Ehrler
- Department of Diagnostic, Geneva University Hospitals, Geneva, Switzerland
| | - Cyril Sahyoun
- Department of Pediatric Emergency Medicine, Children's Hospital, Geneva University Hospitals, 47 Avenue de la Roseraie, 1211, Geneva 14, Switzerland
| | - Sergio Manzano
- Department of Pediatric Emergency Medicine, Children's Hospital, Geneva University Hospitals, 47 Avenue de la Roseraie, 1211, Geneva 14, Switzerland
| | - Oliver Sanchez
- Division of Pediatric Surgery, University Center of Pediatric Surgery of Western Switzerland, Geneva University Hospitals, Geneva, Switzerland
| | - Alain Gervaix
- Department of Pediatric Emergency Medicine, Children's Hospital, Geneva University Hospitals, 47 Avenue de la Roseraie, 1211, Geneva 14, Switzerland
| | - Christian Lovis
- Department of Radiology and Medical Informatics, Division of Medical Information Sciences, Geneva University Hospitals, Geneva, Switzerland
| | | | - Laurence Lacroix
- Department of Pediatric Emergency Medicine, Children's Hospital, Geneva University Hospitals, 47 Avenue de la Roseraie, 1211, Geneva 14, Switzerland
| | - Johan N Siebert
- Department of Pediatric Emergency Medicine, Children's Hospital, Geneva University Hospitals, 47 Avenue de la Roseraie, 1211, Geneva 14, Switzerland. .,University of Geneva, Geneva, Switzerland.
| |
Collapse
|
33
|
Ho LT, Chung VC, Wong CH, Wu IX, Lan KC, Wu D, Yeung JW, Zhang NL, Leung TH, Wu JC. Evaluating traditional Chinese medicine diagnostic instruments for functional dyspepsia: systematic review on measurement properties. Integr Med Res 2020; 10:100713. [PMID: 33665098 PMCID: PMC7903347 DOI: 10.1016/j.imr.2020.100713] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 12/08/2020] [Accepted: 12/20/2020] [Indexed: 02/07/2023] Open
Abstract
Background Pattern diagnosis-guided treatments in Traditional Chinese Medicine (TCM) has been recognised by the eleventh revision of the International Classification of Diseases (ICD-11). Accurate pattern diagnosis requires reliable and valid diagnostic instruments that guide the collection of TCM clinical data without bias. This study synthesised the existing TCM diagnostic instruments for functional dyspepsia (FD) and appraised their quality regarding their development process and measurement properties. Methods Seven electronic databases were searched for validation studies on TCM diagnostic instruments for FD. Synthesis and appraisal of the included studies were performed following the COSMIN (COnsensus-based Standards for the selection of health Measurement INstruments) Initiative guidelines adapted for TCM diagnostic instruments. Risk of bias assessment was conducted using the COSMIN Risk of Bias Checklist. Results Five studies were included, with five unique TCM diagnostic instruments for FD identified. All five diagnostic instruments were of inadequate quality in terms of their development process, implying a shortcoming in their relevance, comprehensibility, and comprehensiveness. Only the criterion validity of Stomach Qi Deficiency Pattern Assessment Scale was of sufficient quality and had no risk of bias in its validation. Conclusion The quality of TCM diagnostic instruments for FD warrants urgent improvements. None of them was considered reliable or valid for guiding TCM pattern diagnosis. To support the evidence base of the standardization of TCM patterns in ICD-11, TCM diagnostic instruments should be developed and validated rigorously under the COSMIN guidelines. Amendments should be made on the guidelines to accommodate the features and uniqueness of TCM diagnostic process.
Collapse
Affiliation(s)
- Leonard Tf Ho
- School of Chinese Medicine, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
| | - Vincent Ch Chung
- School of Chinese Medicine, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong.,The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
| | - Charlene Hl Wong
- The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
| | - Irene Xy Wu
- Xiangya School of Public Health, Central South University, Hunan, China
| | - Kun Chan Lan
- The Institute of Medical Informatics, National Cheng Kung University, Taiwan
| | - Darong Wu
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangdong, China
| | - Jerry Wf Yeung
- School of Nursing, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, Hong Kong
| | - Nevin L Zhang
- Department of Computer Science and Engineering, School of Engineering, The Hong Kong University of Science and Technology, Hong Kong
| | - Ting Hung Leung
- School of Chinese Medicine, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
| | - Justin Cy Wu
- Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
| |
Collapse
|
34
|
Lunde L, Bærheim A, Johannessen A, Aase I, Almendingen K, Andersen IA, Bengtsson R, Brenna SJ, Hauksdottir N, Steinsbekk A, Rosvold EO. Evidence of validity for the Norwegian version of the interprofessional collaborative competency attainment survey (ICCAS). J Interprof Care 2020; 35:604-611. [PMID: 32744140 DOI: 10.1080/13561820.2020.1791806] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
This was a validation study of the Norwegian version of The Interprofessional Collaborative Competency Attainment Survey (ICCAS). ICCAS consists of 20 retrospective pre- and post-questions, where respondents rate their agreement with regard to self-assessed competencies after participating in interprofessional education courses. It has been validated across various settings. The questionnaire was translated using the back-translation technique. We investigated evidence of validity regarding content, response process, and internal structure. Data were obtained from health and social care students (n = 1440, response rate 42.8%) participating in 12 different interprofessional courses in seven education institutions in Norway using a cross-sectional design. Exploratory factor analysis indicated one retracted factor for pre-scores and one retracted factor for post-scores. High McDonald's omega values indicated good internal consistency. Item deletion did not improve the scale's overall consistency on pre- or post-scores. We observed higher mean post-scores than pre-scores with moderate-to-large effect sizes, indicating a positive change in self-assessed interprofessional capabilities after training. Our findings indicate that the Norwegian version of ICCAS is a valid tool that may be implemented across a wide range of interprofessional education courses. Finally, our findings support earlier recommendations that ICCAS should be analyzed at an overall level to address change in interprofessional capabilities.
Collapse
Affiliation(s)
- Lene Lunde
- Department of Nursing Science, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Anders Bærheim
- Department of Global Public Health and Primary Care, Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Ane Johannessen
- Department of Global Public Health and Primary Care, Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Ingunn Aase
- SHARE- Center for Resilience in Healthcare, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
| | - Kari Almendingen
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Irene Aasen Andersen
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences (HVL), Førde, Norway
| | - Rutt Bengtsson
- Department of Social Studies, Faculty of Social Science, University of Stavanger, Stavanger, Norway
| | - Sissel Johansson Brenna
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences (HVL), Bergen, Norway
| | - Nanna Hauksdottir
- Centre for Faculty Development, Faculty of Health Sciences, The Arctic University of Norway, Tromsø, Norway
| | - Aslak Steinsbekk
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
| | - Elin Olaug Rosvold
- Department of General Practice, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
| |
Collapse
|
35
|
Navarro-Martínez J, Galiana-Ivars M, Rivera-Cogollos MJ, Gálvez C, Nadal SB, Lamaignère MO, Mazo ED. Management of Intraoperative Crisis During Nonintubated Thoracic Surgery. Thorac Surg Clin 2020; 30:101-110. [PMID: 31761278 DOI: 10.1016/j.thorsurg.2019.08.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Nonintubated video-assisted thoracoscopic surgery programs have gradually spread all over the world. The benefits are based on less invasiveness and earlier recovery. However, complications may appear. For the correct prevention and management of all these potentially critical situations, the principles of crisis resource management (CRM) must be followed. They should also include clinical simulation as a tool to generate different scenarios to improve teamwork. The purpose of this special issue is to appraise and summarize the design, implementation, and efficacy of simulation-based CRM training programs for a specific surgery, including the management of specific surgical and medical critical scenarios.
Collapse
Affiliation(s)
- Jose Navarro-Martínez
- Anesthesiology Department and Surgical Critical Care Unit, Hospital General Universitario de Alicante, C/Pintor Baeza no. 12, Alicante 03010, Spain.
| | - Maria Galiana-Ivars
- Anesthesiology Department and Surgical Critical Care Unit, Hospital General Universitario de Alicante, C/Pintor Baeza no. 12, Alicante 03010, Spain
| | - María Jesús Rivera-Cogollos
- Anesthesiology Department and Surgical Critical Care Unit, Hospital General Universitario de Alicante, C/Pintor Baeza no. 12, Alicante 03010, Spain
| | - Carlos Gálvez
- Thoracic Surgery Department, Hospital General Universitario de Alicante, C/Pintor Baeza no. 12, Alicante 03010, Spain
| | - Sergio Bolufer Nadal
- Thoracic Surgery Department, Hospital General Universitario de Alicante, C/Pintor Baeza no. 12, Alicante 03010, Spain
| | | | - Elena Díez Mazo
- Hospital General Universitario de Alicante, C/Pintor Baeza no. 12, Alicante 03010, Spain
| |
Collapse
|
36
|
Abstract
PURPOSE OF REVIEW The pediatric resuscitation environment is a high-stakes, environment in which a multidisciplinary team must work together with patient outcomes dependent, at least in part, on the performance of that team. Given constraints of the environment and the nature of these events, quality improvement work in pediatric resuscitation can be challenging. Ongoing collection of accurate and reliable data on team performance is necessary to inform and evaluate change. RECENT FINDINGS Despite the relative difficulty of quality improvement analysis and intervention implementation in the resuscitation environment, these efforts can have significant impact on patient outcomes. Although there are barriers to accurate data collection in real-life resuscitation, team performance of both technical and nontechnical skills can be reliably measured in video-based quality improvement programs. Training of nontechnical skills, using crisis resource management principles, can improve care delivery in resuscitation. SUMMARY Striving toward a learning healthcare system model in resuscitation care delivery can allow for efficient performance improvement. Given the possible impacts on mortality and quality of life of care delivered in the resuscitation environment, all providers who could possibly face a resuscitation event - no matter how rare - should consider how they are evaluating the quality of their care delivery in this arena.
Collapse
|
37
|
Johnson AP, Aggarwal R. Assessment of non-technical skills: why aren’t we there yet? BMJ Qual Saf 2019; 28:606-608. [DOI: 10.1136/bmjqs-2018-008712] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/15/2019] [Indexed: 01/07/2023]
|
38
|
Ahmed RA, Botsch A, Ballas D, Benner A, Hammond J, Schnick T, Khobrani A, George R, Polansky M. Advanced Practice Provider Critical Care Boot Camp: A Simulation-Based Curriculum. JOURNAL OF MEDICAL EDUCATION AND CURRICULAR DEVELOPMENT 2019; 6:2382120519840350. [PMID: 31001592 PMCID: PMC6454646 DOI: 10.1177/2382120519840350] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Accepted: 02/28/2019] [Indexed: 06/09/2023]
Abstract
The demand for advanced practice providers (APPs) is increasing across the United States to meet necessary provider staffing requirements including in intensive care settings. Currently, participation in formal postgraduate training programs, or residencies, for APPs is not required for clinical practice, such that most of the APPs immediately enter into the workforce following completion of their initial graduate-level training. Consequently, this results in a supervised training period until APPs develop the necessary competencies to practice more autonomously. Educational programs that support specialty competency development may facilitate the transition of APPs into clinical practice, allowing them to be credentialed to perform essential procedures as quickly as possible. The goal of this boot camp was to provide training for APPs in common critical care, high-risk procedures, and to provide leadership development for high-risk cases to expedite their orientation process. The following manuscript describes our experience with the development, implementation, and short-term evaluation of this training program.
Collapse
Affiliation(s)
- Rami A Ahmed
- Department of Medical Education, School
of Medicine, Indiana University, Indianapolis, IN, USA
| | - Alex Botsch
- Summa Health System, Division of Trauma,
Department of Surgery, Akron, OH, USA
| | - Derek Ballas
- Summa Health System, Division of Trauma,
Department of Surgery, Akron, OH, USA
| | - Alma Benner
- Summa Health System, Division of Trauma,
Department of Surgery, Akron, OH, USA
| | - Jared Hammond
- Summa Health System, Division of Trauma,
Department of Surgery, Akron, OH, USA
| | - Tim Schnick
- Summa Health System, Division of Trauma,
Department of Surgery, Akron, OH, USA
| | - Ahmad Khobrani
- Summa Health System, Division of Trauma,
Department of Surgery, Akron, OH, USA
| | - Richard George
- Summa Health System, Division of Trauma,
Department of Surgery, Akron, OH, USA
| | - Maura Polansky
- Department of Medical Education, School
of Medicine and Health Sciences, The George Washington University, Washington, DC,
USA
| |
Collapse
|
39
|
The impact of simulated multidisciplinary Trauma Team Training on team performance: A qualitative study. Australas Emerg Care 2018; 22:1-7. [PMID: 30998866 DOI: 10.1016/j.auec.2018.11.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 11/16/2018] [Accepted: 11/20/2018] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Effective teamwork is imperative in the emergency trauma setting as trauma teams work in the uncertain and complex context of resuscitating critically injured patients. Poorly performing teams have the potential to contribute to adverse events. Efforts to improve teamwork in trauma include simulation-based multidisciplinary team training with a non-technical skills (NTS) focus. However, there is a lack of evidence linking teamwork training programs with the uptake of NTS in real life trauma resuscitations. The aim of this study was to understand trauma team members' perspectives and experiences of teamwork in real world trauma resuscitations at a Level 1 Trauma Hospital, following completion of a simulated multidisciplinary Trauma Team Training (TTT) program. METHOD Semi-structured interviews were used to explore trauma team members' experiences and perspectives of the impact of TTT on the team's performance. Trauma team members who had completed TTT were invited to participate in the study. Fifteen participants from various disciplines (nursing, medical, allied health) and specialities (emergency, intensive care, trauma, anaesthetics, allied health) were interviewed. Qualitative data were thematically analysed. RESULTS The overarching finding was that teamwork was the essential component to facilitate a group of skilled experts to collectively perform at an optimum level in emergency trauma care. Four main themes were developed: Leader-follower synergy promotes trauma teamwork; Instability and inconsistency threaten trauma teamwork; Clear communication enhances trauma team decision-making and Team training improves trauma team performance. CONCLUSION A quickly constructed specialty team with unstable membership, will not transform naturally into an expert trauma team. The creation and maintenance of effective trauma teams requires training strategies such as multidisciplinary simulation that target team training and team interaction. Specifically, training should focus on developing non-technical skills for resuscitation trauma teams that have to form quickly and function effectively, often having never met before. As participants were overwhelmingly female, the data generated by this study are not necessarily generalisable to male members of trauma teams.
Collapse
|