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Impact of an embedded simulation team training programme in a paediatric intensive care unit: a prospective, single-centre, longitudinal study

Martin Stocker| Meredith Allen| Natasha Pool| Kumi De Costa| Julie Combes| Neil West| Margarita Burmester
Pediatric Original
Volume 38, Issue 1 / January , 2012

Pages 99 - 104

Abstract

Purpose

To evaluate the impact of an embedded simulation-based team training programme on perceived performance and to compare the effect over different phases of the programme.

Methods

This was a prospective, single-centre, longitudinal study over the first 2 years of the programme. A total of 219 multidisciplinary health-care professionals participated in simulation sessions, followed by anonymous evaluation questionnaires. The programme was divided into three different phases: introductory (first 6 months), intermediate (second 6 months) and established phase (second year).

Results

A total of 88.7% of participants evaluated the impact on overall practice as effective, 56.5% reported a highly effective impact. A total of 90.9% (391/430) of questions on non-technical skills (communication and teamwork) showed an effective impact, 55.6% a highly effective impact, whereas only 70.2% (262/373) of questions on technical skills showed an effective impact. There was a significant (p < 0.001) increased score for effective impact in all categories between the introductory and intermediate phase, which was maintained throughout the established phase. Overall, 72.7% of the participants felt more confident to attend a future critical event, 32.5% were highly confident. In the longitudinal analysis there was a stepwise significant (p < 0.05) increase of confidence of participants. In a subgroup analysis (n = 143) there was a significant (p < 0.001) higher confidence in participants who had attended at least 3 sessions (90.7 vs. 61%).

Conclusion

There is a 6- to 12-month learning curve in the implementation of an embedded multidisciplinary team training programme. Repeated exposure to simulation is most beneficial to crisis resource management training and single, isolated exposure may not be sufficient.

Keywords

References

  1. Hayes CW, Rhee A, Detsky ME, Leblanc VR, Wax RS (2007) Residents feel unprepared and unsupervised as leaders of cardiac arrest teams in teaching hospitals: a survey of internal medicine residents. Crit Care Med 35:1668–1672
    • View reference on PubMed
    • View reference on publisher's website
  2. Hunt EA, Patel S, Vera K, Shaffner DH, Pronovost PJ (2009) Survey of pediatric resident experiences with resuscitation training and attendance at actual cardiopulmonary arrests. Pediatr Crit Care Med 10:96–105
    • View reference on PubMed
    • View reference on publisher's website
  3. Hunt EA, Walker AR, Shaffner DH, Miller MR, Pronovost PJ (2008) Simulation of in-hospital pediatric medical emergencies and cardiopulmonary arrests: highlighting the importance of the first 5 minutes. Pediatrics 121:e34–e43
    • View reference on PubMed
    • View reference on publisher's website
  4. Anderson PO, Jensen MK, Lippert A, Ostergaard D (2010) Identifying non-technical skills and barriers for improvement of teamwork in cardiac arrest teams. Resuscitation 81:695–702
    • View reference on publisher's website
  5. Marsch SC, Müller C, Marquardt K, Conrad G, Tschan F, Hunziker PR (2004) Human factors affect the quality of cardiopulmonary resuscitation in simulated cardiac arrests. Resuscitation 60:51–56
    • View reference on PubMed
    • View reference on publisher's website
  6. Stockwell DC, Slonim AD, Pollack MM (2007) Physician team management affects goal achievement in the intensive care unit. Pediatr Crit care Med 8:540–545
    • View reference on PubMed
    • View reference on publisher's website
  7. Westli HK, Johnson BH, Eid J, Rasten I, Braftebo G (2010) Teamwork skills, shared mental models, and performance in simulated trauma teams: an independent group design. Scand J Trauma Resusc Emerg Med 18:47
    • View reference on PubMed
    • View reference on publisher's website
  8. Kumar RK (2009) Teamwork in pediatric heart care. Ann Pediatr Cardiol 2:140–145
    • View reference on PubMed
    • View reference on publisher's website
  9. Thomas EJ, Williams AL, Reichman EF, Lasky RE, Cramdell S, Toggart WR (2010) Team training in the neonatal resuscitation program for interns: teamwork and quality of resuscitations. Pediatrics 125:539–546
    • View reference on PubMed
    • View reference on publisher's website
  10. Morey JC, Simon R, Jay GD, Wears RL, Salisbury M, Dukes KA, Berns SD (2002) Errors reduction and performance improvement in the emergency department through formal teamwork training. Evaluation results of the MedTeams project. Health Serv Res 37:553–561
    • View reference on publisher's website
  11. Hunziker S, Tschan F, Semmer NK, Zobrist R, Spychiger M, Breuer M, Hunziker PR, Marsch SC (2009) Hands-on time during cardiopulmonary resuscitation is affected by the process of teambuilding: a prospective randomised simulator-based trial. BMC Emerg Med 9:3
    • View reference on PubMed
    • View reference on publisher's website
  12. Langhan TS, Rigby IJ, Walker IW, Howes D, Donnon T, Lord JA (2009) Simulation-based training in critical resuscitation procedures improves residents’ competence. CJEM 11:535–539
    • View reference on PubMed
  13. Sahu S, Lata I (2010) Simulation in resuscitation teaching and training, an evidence based practice review. J Emerg Trauma Shock 3:378–384
    • View reference on PubMed
    • View reference on publisher's website
  14. Shapiro MJ, Morey JC, Small SD, Langford V, Kaylor CJ, Jagminas L, Suner S, Salisbury ML, Simon R, Jay GD (2004) Simulation based teamwork training for emergency department staff: does it improve clinical team performance when added to an existing didactic teamwork curriculum? Qual Saf Health Care 13:417–421
    • View reference on PubMed
    • View reference on publisher's website
  15. Gilfoyle E, Gottesman R, Razach S (2007) Development of a leadership skills workshop in pediatric advanced resuscitation. Med Teach 29:e276–e283
    • View reference on PubMed
    • View reference on publisher's website
  16. Hunziker S, Bühlmann C, Tschan F, Balestra G, Legeret C, Schumacher C, Semmer NK, Hunziker P, Marsch S (2010) Brief leadership instructions improve cardiopulmonary resuscitation in a high-fidelity simulation: a randomized controlled trial. Crit Care Med 38:1086–1091
    • View reference on PubMed
    • View reference on publisher's website
  17. Schröder T, van Heymann CH, Ortwein H, Ran J, Wernecke KD, Spies C (2009) Simulation-based anaesthesia crisis resource management training. Results of a survey on learning success. Anaesthesist 58:992–1004
    • View reference on PubMed
    • View reference on publisher's website
  18. Thomas EJ, Taggart B, Crandell S, Lasky RE, Williams AL, Love LJ, Sexton JB, Tyson JE, Helmreich RL (2007) Teaching teamwork during the neonatal resuscitation program: a randomised trial. J Perinatol 27:409–414
    • View reference on PubMed
    • View reference on publisher's website
  19. VanSchaik SM, von Kohorn I, O’Sullivan P (2008) Pediatric resident confidence in resuscitation skills relates to mock code experience. Clin Pediatr 47:777–783
    • View reference on publisher's website
  20. Sehgal NL, Fox M, Vidyarthi AR, Sharpe BA, Gearhart S, Bookwalter T, Barker J, Alldredge BK, Blegen MA, Wachter RM, Triad for Optimal Patient Safety Project (2008) A multidisciplinary teamwork training program: the triad for optimal patient safety (TOPS) experience. J Gen Intern Med 23:2053–2723
    • View reference on PubMed
    • View reference on publisher's website
  21. Marshall SD, Flanagan B (2010) Simulation-based education for building clinical teams. J Emerg Trauma Shock 3:360–368
    • View reference on PubMed
    • View reference on publisher's website
  22. Mikrogianakis A, Osmond MH, Nuth JE, Shephard A, Gabowy I, Jabbour M (2008) Evaluation of a multidisciplinary pediatric trauma code educational initiative: a pilot study. J Trauma 64:761–767
    • View reference on PubMed
    • View reference on publisher's website
  23. Dine CJ, Gersk RE, Leary M, Rigby BS, Bellini LM, Abella BS (2008) Improving cardiopulmonary resuscitation quality and resuscitation training by combining audiovisual feedback and debriefing. Crit Care Med 36:2817–2822
    • View reference on PubMed
    • View reference on publisher's website
  24. Weinstock PH, Kappers LJ, Kleinman ME, Grenier B, Hickey P, Burns JP (2005) Toward a new paradigm in hospital-based pediatric education: the development of an onsite simulation program. Pediatr Crit Care Med 6:635–641
    • View reference on PubMed
    • View reference on publisher's website
  25. Friedman D, Zaveri P, O’Connell K (2010) Pediatrics mock code curriculum: improving resident resuscitations. Pediatr Emerg Care 26:490–494
    • View reference on PubMed
    • View reference on publisher's website
  26. Toback SL, Fiedor M, Kilpela B, Reis EC (2006) Impact of a pediatric primary care office-based mock code program on physician and staff confidence to perform life-saving skills. Pediatr Emerg Care 22:415–422
    • View reference on PubMed
    • View reference on publisher's website
  27. Tofil NM, Lee White M, Manzella B, McGill D, Zinkan L (2009) Initiation of a pediatric mock code program at a children’s hospital. Med Teach 36:e241–e247
    • View reference on publisher's website
  28. Allan CK, Thiagarajan RR, Beke D, Imprescia A, Kappus LJ, Garden A, Hayes G, Laussen PC, Bacha E, Weinstock PH (2010) Simulation-based training delivered directly to the pediatric cardiac intensive care unit engenders preparedness, comfort, and decrease anxiety among multidisciplinary resuscitation teams. J Thorac Cardiovasc Surg 140:646–652
    • View reference on PubMed
    • View reference on publisher's website

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