An interprofessional training program for intrahospital transport of critically ill patients: model build-up and assessment

Educational and Patient Care Impacts of In Situ Simulation in Healthcare: A Systematic Review

ABSTRACT

This systematic review was performed to assess the effectiveness of in situ simulation education. We searched databases including MEDLINE and Embase for studies comparing in situ simulation with other educational approaches. Two reviewers screened articles and extracted information. Sixty-two articles met inclusion criteria, of which 24 were synthesized quantitatively using random effects meta-analysis. When compared with current educational practices alone, the addition of in situ simulation to these practices was associated with small improvements in clinical outcomes, including mortality [odds ratio, 0.66; 95% confidence interval (CI), 0.55 to 0.78], care metrics (standardized mean difference, -0.34; 95% CI, -0.45 to -0.21), and nontechnical skills (standardized mean difference, -0.52; 95% CI, -0.99 to -0.05). Comparisons between in situ and traditional simulation showed mixed learner preference and knowledge improvement between groups, while technical skills showed improvement attributable to in situ simulation. In summary, available evidence suggests that adding in situ simulation to current educational practices may improve patient mortality and morbidity.

Intrahospital transport of critically ill patients: A cross-sectional survey of Nurses' attitudes and experiences in adult intensive care units

AIMS

To describe adult intensive care nurses' experiences and attitudes towards intrahospital transport (IHT) of critically ill patients and to assess the relationship between nurses' characteristics, attitudes and experiences.

DESIGN

Cross-sectional survey.

METHODS

Factor analysis identified factors within the attitudinal and experience domains. Univariate analysis was performed to demonstrate the relationship between attitudinal and experience factors and demographic and professional characteristics of the participants. Multiple regression equations were applied to determine associations between nurses' experiences and attitudes. The study took place from July to August 2019.

RESULTS

A total of 480 nurses from 12 adult intensive care units in China participated, with a response rate of 65%. Most respondents had a baccalaureate nursing degree (75%). The majority (80%) had participated in IHT of critically ill more than five times in the previous 12 months and 90% agreed that checklists led to an improvement in patient safety during transport. However, 75% of respondents expressed that transport increased the workload of the nurses who accompany patients off unit and those who remained in the intensive care unit (66%). Variables that were associated with a favourable perception of transport competency and checklists/tool use were nurses' prior transport experiences and knowledge/training.

CONCLUSION

Nurses perceived IHT was a sourse of stress and increased workload. Checklists and training were beneficial for patient safety during IHT.

IMPACT

The findings point out a clear need for ICU nurse training, standardised policy/procedure and customisation of existing intrahospital transfer checklists according to hospital procedures and local circumstances. New research is needed to evaluate the impact of novel IHT interventions on patient safety and nurses' stress.

In situ simulation training for a better interprofessional team performance in transferring critically ill patients with COVID-19: a prospective randomised control trial

Background

Transferring critically ill patients with COVID-19 is a challenging task; therefore, well-trained medical team is needed. This study aimed to determine the role of in situ simulation training during pandemic by using high-fidelity manikin to improve interprofessional communication, skills and teamwork in transferring critically ill patients with COVID-19.

Methods

This single-blinded randomised control trial included 40 subjects allocated into standard low-fidelity simulator (LFS) and high-fidelity simulator (HFS) groups. Subjects, who were not members of multiprofessional team taking care of patients with COVID-19, in each group were assigned into small groups and joined an online interactive lecture session, two sessions of in-situ simulation and a debriefing session with strict health protocols. The first simulation aimed to teach participants the skills and steps needed. The second simulation aimed to assess transfer skills, communication and teamwork performance, that participants had learnt using a validated, comprehensive assessment tool. Data were analysed using unpaired t test or Mann-Whitney test.

Results

The HFS group showed significantly better overall transfer and communication skills than LFS group (89.70±4.65 vs 77.19±3.6, <0.05 and 100 vs 88.34 (63.33–100), p=0.022, respectively). The HFS group also demonstrated significantly better teamwork performance than the standard LFS group (90 (80–900) vs 80 (70–90), p=0.028).

Conclusion

In situ simulation training using HFS significantly showed better performance than the standard training using LFS in regards to overall transfer and communication skills as well as teamwork performance. The training using HFS may provide a valuable adjunct to improve interprofessional skills, communication and teamwork performance in transferring critically ill patients with COVID-19.

Trial registration number

NCT05113823.

Intervenções da equipe multiprofissional no transporte de pacientes em estado crítico: revisão sistemática de métodos mistos

RESUMO Objetivo Analisar como intervenções da equipe multiprofissional promovem a segurança no transporte de pacientes em estado crítico. Método Revisão sistemática de métodos mistos elaborada com as recomendações do Joanna Briggs Institute, seguindo uma abordagem integrada convergente. A pesquisa foi realizada nas bases de dados MEDLINE, CINAHL, Cochrane Database of Systematic Reviews e Cochrane Central Register of Controlled Trials, resultando em 107 estudos. Após a remoção de estudos duplicados e a aplicação de critérios de inclusão e exclusão, 17 estudos foram avaliados quanto à sua qualidade metodológica, havendo 15 estudos na amostra final. A extração dos dados foi realizada por um instrumento em forma de tabela e sintetizada por meio de análise temática. Resultados A decisão ponderada, o planejamento, a atuação na resolução de problemas e a ação para a melhoria são intervenções que a equipe multiprofissional promove na segurança do transporte de pacientes em estado crítico. Conclusão e implicações para a prática A padronização do transporte (criação de protocolos institucionais, check-list e adequação de equipamentos), a educação permanente e o treinamento de competências na capacitação das equipes fomentam uma cultura de segurança que evita o dano ao paciente. Sugerem-se pesquisas sobre a dimensão subjetiva e a inclusão da família no transporte.

Multiprofessional team interventions in transporting critically ill patients: a systematic mixed-methods review

ABSTRACT Aim To analyze how interventions of a multidisciplinary team promote the safe transportation of critically ill patients. Method A systematic mixed-methods review was developed using an integrated convergent approach according to the Joanna Briggs Institute. This study was conducted using MEDLINE, CINAHL, Cochrane Database of Systematic Reviews, and Cochrane Central Register of Controlled Trials electronic databases, which generated 107 references. After removing duplicates and applying inclusion and exclusion criteria, 17 articles were evaluated for methodological quality, resulting in 15 articles as the final sample. Data extraction was performed using a tool in the form of a table and synthesized through thematic analysis. Results Thoughtful decision, planning, problem-solving action and action for improvement are interventions that the multiprofessional team promotes the safe transportation of critically ill patients. Conclusion and implications for practice The standardization of transport (institutional protocols, a checklist, and equipment adequacy), continuing education, and skills training in the capacitation of teams foster a culture of safety that prevents harm to the patient. Further research is suggested on the subjective dimension and with the family in transportation.

Systematic review of the characteristics of brief team interventions to clarify roles and improve functioning in healthcare teams

AIM

Describe brief (less than half a day) interventions aimed at improving healthcare team functioning.

METHODS

A systematic review on brief team interventions aimed at role clarification and team functioning (PROSPERO Registration Number: CRD42018088922). Experimental or quasi-experimental studies were included. Database searches included CINAHL, Medline, EMBASE, PUBMED, Cochrane, RCT Registry-1990 to April 2020 and grey literature. Articles were screened independently by teams of two reviewers. Risk of bias was assessed. Data from the retained articles were extracted by one reviewer and checked by a second reviewer independently. A narrative synthesis was undertaken.

RESULTS

Searches yielded 1928 unique records. Final sample contained twenty papers describing 19 studies, published between 2009 and 2020. Studies described brief training interventions conducted in acute care in-patient settings and included a total of 6338 participants. Participants' socio-demographic information was not routinely reported. Studies met between two to six of the eight risk of bias criteria. Interventions included simulations for technical skills, structured communications and speaking up for non-technical skills and debriefing. Debriefing sessions generally lasted between five to 10 minutes. Debriefing sessions reflected key content areas but it was not always possible to determine the influence of the debriefing session on participants' learning because of the limited information reported.

DISCUSSION

Interest in short team interventions is recent. Single two-hour sessions appear to improve technical skills. Three to four 30- to 60-minute training sessions spread out over several weeks with structured facilitation and debriefing appear to improve non-technical skills. Monthly meetings appear to sustain change over time.

CONCLUSION

Short team interventions show promise to improve team functioning. Effectiveness of interventions in primary care and the inclusion of patients and families needs to be examined. Primary care teams are structured differently than teams in acute care and they may have different priorities.

Non-technical skills and otolaryngology: systematic review

OBJECTIVES

This study aimed to assess the published literature on non-technical skills in otolaryngology surgery and examine the applicability of any research to others' practice, and to explore how the published literature can identify areas for further development and guide future research.

METHODS

A systematic review was conducted using the following key words: 'otolaryngology', 'otorhinolaryngology', 'ENT', 'ENT surgery', 'ear, nose and throat surgery', 'head and neck surgery', 'thyroid surgery', 'parathyroid surgery', 'otology', 'rhinology', 'laryngology' 'skull base surgery', 'airway surgery', 'non-technical skills', 'non technical skills for surgeons', 'NOTSS', 'behavioural markers' and 'behavioural assessment tool'.

RESULTS

Three publications were included in the review - 1 randomised, controlled trial and 2 cohort studies - involving 78 participants. All were simulation-based studies involving training otolaryngology surgeons.

CONCLUSION

Little research has been undertaken on non-technical skills in otolaryngology. Training surgeons' non-technical skill levels are similar across every tested aspect. The research already performed can guide further studies, particularly amongst non-training otolaryngology surgeons and in both emergency and elective non-simulated environments.