Decision-Making in Emergency Medicine: Balancing Uncertainty, Time, and Human Factors

This consensus group from the 2017 Academic Emergency Medicine Consensus Conference "Catalyzing System Change through Health Care Simulation: Systems, Competency, and Outcomes" held in Orlando, Florida, on May 16, 2017, focused on the use of human factors (HF) and simulation in the field of emergency medicine (EM). The HF discipline is often underutilized within EM but has significant potential in improving the interface between technologies and individuals in the field. The discussion explored the domain of HF, its benefits in medicine, how simulation can be a catalyst for HF work in EM, and how EM can collaborate with HF professionals to effect change. Implementing HF in EM through health care simulation will require a demonstration of clinical and safety outcomes, advocacy to stakeholders and administrators, and establishment of structured collaborations between HF professionals and EM, such as in this breakout group.

Welcome to the era of universal airway management.

Major trauma is one of the leading contributors to death for several age groups globally making it a public health concern. There are approximately 20,000 cases of major trauma per year in England and over 25% of these result in deaths This Emergency Medicine (EM) course was designed for Specialty and Associate Specialist Grade (SASG) doctors to develop leadership skills and to demonstrate technical and non-technical skills as a trauma team leader (TTL) when assessing severely injured patients. This course has a strong focus on the understanding of hospital systems and processes for the timely assessment and treatment of complex trauma patients.After a successful HEE funding bid, a simulation training course was devised to cover the main principles of trauma management and the non-technical skills required to manage a trauma patient and help up-skill the 14 SASG doctors at an urban trauma unit. Five scenarios were designed based on real patients seen in urban trauma units in London. On designing the scenarios, an understanding of the functioning of hospital systems such as requesting and administering blood products and transferring patients both within the hospital and within the trauma network, were crucial learning objectives.This course was delivered weekly from January to June 2021. Sessions involved the EM SASG doctor, two EM nurses and the members of the wider MDT expected at each trauma call, to recreate the resuscitation room environment. Each SASG doctor underwent all five trauma simulation scenarios individually as the TTL. Each scenario was followed by a focussed debrief by two EM consultants, with discussion around human factors, technical and academic aspects of trauma management. All 14 SASG doctors completed the five trauma scenarios. As a result of this training, there has been an improvement in the management of patients with higher injury severity scores in the ED based on both clinical supervision and feedback from the candidates. Given the impact on practice that this training has had, this course will be delivered to the wider trauma teams within the trust, with the EM SASG doctors continuing as TTLs.

BackgroundPatient safety in the context of emergency medicine is a relatively new field of study. To date, no broad research agenda for patient safety in emergency medicine has been established. The objective of this study was to establish patient safety-related research priorities for emergency medicine. These priorities would provide a foundation for high-quality research, important direction to both researchers and health-care funders, and an essential step in improving health-care safety and patient outcomes in the high-risk emergency department (ED) setting.MethodsA four-phase consensus procedure with a multidisciplinary expert panel was organized to identify, assess, and agree on research priorities for patient safety in emergency medicine. The 19-member panel consisted of clinicians, administrators, and researchers from adult and pediatric emergency medicine, patient safety, pharmacy, and mental health; as well as representatives from patient safety organizations. In phase 1, we developed an initial list of potential research priorities by electronically surveying a purposeful and convenience sample of patient safety experts, ED clinicians, administrators, and researchers from across North America using contact lists from multiple organizations. We used simple content analysis to remove duplication and categorize the research priorities identified by survey respondents. Our expert panel reached consensus on a final list of research priorities through an in-person meeting (phase 3) and two rounds of a modified Delphi process (phases 2 and 4).ResultsAfter phases 1 and 2, 66 unique research priorities were identified for expert panel review. At the end of phase 4, consensus was reached for 15 research priorities. These priorities represent four themes: (1) methods to identify patient safety issues (five priorities), (2) understanding human and environmental factors related to patient safety (four priorities), (3) the patient perspective (one priority), and (4) interventions for improving patient safety (five priorities).ConclusionThis study established expert, consensus-based research priorities for patient safety in emergency medicine. This framework could be used by researchers and health-care funders and represents an essential guiding step towards enhancing quality of care and patient safety in the ED.Electronic supplementary materialThe online version of this article (doi:10.1186/s12245-014-0049-9) contains supplementary material, which is available to authorized users.

Emergency departments are one of the highest risk areas in health care. Emergency physicians have to assemble and manage unrehearsed multidisciplinary teams with little notice and manage critically ill patients....

IntroductionApproximately 70% of adverse events in healthcare are thought to be attributable to a failure of non-technical performance, including communication, teamwork and leadership.1 The integration of regular in situ simulation...

Recognized as a specialty by the American Board of Medical Specialties over 40 years ago, emergency medicine is unique since its inception-providing care to all patients in all times of unscheduled, time-sensitive need. Members of our specialty-whether working in an academic or private practice setting-provide this care without regard to a patient's sex, sexual orientation, gender, creed, physical ability, ability to pay, or race/ethnicity. The last human determinant of health bears emphasis in our current climate of a race-based inequity crisis.

Emergency medicine is a growing specialty and as hospital services become increasingly centralised, emergency physicians are expected to perform several rare, time-critical procedures if speciality teams are unavailable.The Royal College...

Background Simulation training is now widely well regarded throughout medical education. With the advance in available simulator technology, non technical skills have been explored more and training time has been as such directed at. At Leeds, in response to incidents that highlighted a breakdown in team dynamics between Emergency Medicine and Anaesthesia, a joint team working simulation workshop has been developed. Methodology Utilising a 3G SimMan, we run a one day workshop for anaesthetic and emergency medicine (EM) trainees of varying experience exploring non technical skill concepts from the perspective of the two specialties. We run scenarios which require the EM and anaesthetic trainees to work together to manage the case. Each scenario is designed to highlight various human factors. During the scenario observing follow the scenario via video link. Feedback is via structured debrief with focus largely on non-technical components of the scenarios. The course is run by an anaesthetic and EM consultant with supoprting technical staff. Where possible we have ED nursing staff within the scenarios. Candidates are limited to 6 trainees to ensure appropriate active participation. Courses are run free of charge to trainees and are supported by an education grant from LTHT charitable trust fund. Conclusions Feedback has been universally positive highlighting the enriched learning that has occurred by having participants from different specialties working in their own roles. As part of a region wide simulator strategy, the course will be recognised within the School of Anaesthesia as meeting the requirements to deliver non technical skills training within the RCOA curriculum. It will be a mandatory ARCP requirement for anaesthetic trainees to attend such a course. This project has seen very positive feedback from attendees and has served to improve working relationships between our two specialties. With the introduction of other specialties which commonly are thrown together clinically, we hope to further enrich this valuable learning resource at LTHT.

The Airway Lead: opportunities to improve institutional and personal preparedness for airway management

BackgroundSimWars Ireland was founded in 2017 at University College Dublin (UCD) as an intervarsity competition for medical students with a special interest in Emergency Medicine. Its primary aim is to...

Delivering safe and best practice is dependent on robust structural processes and optimal acquisition of skills and knowledge across disciplines [1]. An in-situ simulation-based education model was implemented to optimise the provision of best practice in emergency medicine [2]. In-situ simulation cases were developed based on critical incidents, complaints, and interesting cases. These simulations were designed to be complex cases, aimed at high-level multi-specialty working. Maintaining the real-life integrity of the simulation cases was paramount. The simulations were run in a busy Emergency Department (ED), during the working day while the normal service continued. Participants were instructed to make-up medication, collect blood products, and contact specialities in real time. Debriefing initially included identifying communication, human factor and process issues, and concluded with medical teaching on the topic covered, and included the speciality perspective on optimal medical management. Logistical support was provided by the simulation faculty. Data from feedback forms was collected. Over 12 months, 20 simulations cases were conducted in the resuscitation area of the ED. Simulations involved multidisciplinary, multi-speciality workforce covering the management of acute bronchitis in an infant, an episode of acute psychosis, upper gastrointestinal bleed requiring major haemorrhage protocol activation, and many other emergencies covering the full spectrum of specialities. All feedback strongly agreed/agreed that the simulation exercises were beneficial and would lead to an improvement in the participants’ clinical practice. The multidisciplinary approach was key to the discovery of system weaknesses and risk-factors. These were then addressed and improvements in system learning, and processes were proven by the re-running of similar scenarios. The learning points were communicated via the hospital ED guideline application (AskEarl) and departmental communication channels. Changes have included updating standard operating procedures, guidelines, and the application of a business case for a blood fridge located in ED to reduce blood administration length of time. These detailed simulations successfully tested the current hospital processes and resulted in significant improvements to the daily structural delivery of best practise. Additionally, the SBE model decreased clinician teaching preparation burden and increased simulation efficiency and effectiveness. After the success of this model, it is being rolled out to other specialities. We would like to acknowledge and thank the Dinwoodie Charitable Company for their support. 1. Gressgård LJ. Knowledge management and safety compliance in a high-risk distributed organizational system. Safety and health at work. 2014;5(2):53–59. 2. Petrosoniak A, Auerbach M, Wong AH, Hicks CM. In situ simulation in emergency medicine: moving beyond the simulation lab. Emergency Medicine Australasia. 2017;29(1):83–88.

The patient safety literature from the past decade emphasizes the importance of teamwork skills and human factors in preventing medical errors. Simulation has been used within aviation, the military, and now health care domains to effectively teach and assess teamwork skills. However, attempts to expand and generalize research and training principles have been limited due to a lack of a well-defined, well-researched taxonomy. As part of the 2008 Academic Emergency Medicine Consensus Conference on "The Science of Simulation in Healthcare," a subset of the group expertise and group assessment breakout sections identified evidence-based recommendations for an emergency medicine (EM) team taxonomy and performance model. This material was disseminated within the morning session and was discussed both during breakout sessions and via online messaging. Below we present a well-defined, well-described taxonomy that will help guide design, implementation, and assessment of simulation-based team training programs.

BackgroundIn-situ simulation is well established in medical education, being used from everything from assessment to human factors training.1 In emergency medicine, in-situ simulation has been used for many years to...

Executive Summary of the Spanish Society of Anesthesiology, Reanimation and Pain Therapy (SEDAR) Spanish Society of Emergency and Emergency Medicine (SEMES) and Spanish Society of Otolaryngology, Head and Neck Surgery (SEORL-CCC) Guideline for difficult airway management