Board 376 - Research Abstract Initiating and Assessing a Novel Simulation-Based Team Training Curriculum in the Emergency Department (Submission #425)

Abstract

Introduction/Background Teamwork and communication failures are cited as the major contributing factor in medical errors.1 Teamwork training initiatives, a form of interprofessional education (IPE), have demonstrated improved outcomes in patient care and decreased errors in hospitals.2-5 In the emergency department (ED), patient care is contingent upon skilled resuscitation teams employing effective teamwork and communication skills to provide reliable and safe care. However, no formal or widely accepted didactic curriculum has been identified to address this most critical need. As a result, we developed and implemented an ED resuscitation team training interprofessional course utilizing simulation-based education and TeamSTEPPSTM principles.6 We hypothesized that we would demonstrate improved attitudes towards teamwork and provide a sustained, improved safety environment in the ED following the educational intervention. Methods Interprofessional educator teams were created and trained including TeamSTEPPSTM Master Trainer certification. Learners were scheduled to participate in the simulated sessions during previously established mandatory educational time for both nursing and physicians. The program began at the beginning of the first year of EM residency to introduce residents to practice with a teamwork focus. The simulation sessions were conducted at the New York Simulation Center for the Health Sciences (NYSIM). Six trainees, three residents and three nurses, were assigned to each team. The three hour course consisted of an introductory didactic session on teamwork principles, two 15-minute simulation scenarios on septic shock and cardiac arrest and video assisted debriefing with nursing and physician educators following each scenario discussing team management and medical knowledge issues. Furthermore, translation of teamwork training to the clinical environment was accomplished by in-situ resuscitations in the adult resuscitation room every other Thursday morning with a portable high-fidelity manikin over the next year. We utilized the previously validated TeamSTEPPS™ Teamwork Attitudes Questionnaire (T-TAQ) with a 5-point Likert scale model, designed to measure individual attitudes related to core components of teamwork and distributed them in person pre and post-session. The Hospital Survey on Patient Safety Culture (HSOPS), a validated Agency for Healthcare Research and Quality (AHRQ) survey distributed to our institution and hospitals nationwide annually, was also filled out pre-session and one year post intervention. Data analysis was performed using the Student t-test to compare scores. Results Over fourteen sessions from July to September 2012, a total of 38 nurses and 38 residents participated in the course. Survey response for T-TAQ was 100%. Four of the five teamwork construct question groups had a significant improvement in scores - 6.4%, 2.8%, 4.0% and 4.0% for Team Structure, Leadership, Situation Monitoring and Mutual Support respectively (p<0.0001, p=0.029, p=0.014, p=0.003). The Communication construct had a near significant 2.6% improvement (p=0.107). For HSOPS, there was 99% and 42% survey response pre-session and at one year respectively. Four of twelve safety culture composites showed a significant improvement as dictated in the protocol - 8.2%, 11.1%, 6.8%, 10.4% for Event Reporting, Teamwork within Hospital Units, Teamwork across Hospital Units and Patient Handoffs and Transitions respectively. The rest of the composites did not demonstrate significant changes. Due to the overwhelmingly positive response from the participants of the course, the Pediatric Emergency Medicine and Trauma services have started to create and implement a similar simulation-based course for team training in their departments as well. Conclusion A simulation-based Team Training curriculum utilizing TeamSTEPPS™ principles and interprofessional education is successful in improving individual attitudes toward teamwork and some components of patient safety culture in the emergency department setting. Co-founders of the study include new staff hires unfamiliar with the initial team training course, low response rate at one year follow-up, attending participation only at the instructor level (not as learners) and Hurricane Sandy causing disruption in clinical care at our institution.