Medical Team Training Research Articles

The Use of Simulation and a Modified TeamSTEPPS Curriculum for Medical and Nursing Student Team Training

We describe our adaptation of the team strategies and tools to enhance performance and patient safety (TeamSTEPPS) for use as an educational intervention for medical and nursing students. We hypothesized that participation in a team training program using the modified TeamSTEPPS program would positively affect knowledge and attitudes toward teamwork skills and their ability to recognize the presence and quality of team skills. Two hundred thirteen students participated in a 4-hour team training program that included a lecture followed by small group team training exercises. Nurse/physician pairs facilitated student team activities. Knowledge and attitudes were assessed before and after the educational intervention. Recognition of team skills was assessed using videos. Statistically significant differences were found with participant knowledge (P<0.001) and attitude (P=0.004). Students were able to identify the presence and quality of team skills in the video vignettes. Overwhelmingly, the students recognized team skills much better in the success video than in the opportunity video (P<0.001), and they rated the success video much higher than the opportunity video (P<0.001) with regards to the quality of team skills. We successfully adapted TeamSTEPPS for use with our medical and nursing students, educated facilitators, and implemented the course. Our students improved their knowledge of vital team and communication skills, attitudes toward working as teams, and were able to identify effective team skills.

Briefing guide study: preoperative briefing and postoperative debriefing checklists in the Veterans Health Administration medical team training program

BackgroundThe purpose of this study was to examine the outcomes of checklist-driven preoperative briefings and postoperative debriefings during the Veterans Health Administration (VHA) medical team training program. MethodsA briefing score (1, never started; 2, started then discontinued; 3, maintained on original targeted cases; 4, expanded to other services; 5, briefing all cases, all services) was established at 10.1 ± .3 months after introduction of the checklist. Outcomes included antibiotic and deep venous thrombosis prophylaxis compliance rates before and after use of the checklist. ResultsAntibiotic (97.0% ± .1% vs 92.1% ± 1.5%; P = .01) and deep venous thrombosis (95.7% ± .8% vs 85.1% ± 4.6%; P = .05) prophylaxis compliance rates were higher after initiation of a surgical checklist. ConclusionsChecklist-driven preoperative briefings and postoperative debriefings are associated with improvements in patient safety for surgical patients.

Association Between Implementation of a Medical Team Training Program and Surgical Mortality

There is insufficient information about the effectiveness of medical team training on surgical outcomes. The Veterans Health Administration (VHA) implemented a formalized medical team training program for operating room personnel on a national level. To determine whether an association existed between the VHA Medical Team Training program and surgical outcomes. A retrospective health services study with a contemporaneous control group was conducted. Outcome data were obtained from the VHA Surgical Quality Improvement Program (VASQIP) and from structured interviews in fiscal years 2006 to 2008. The analysis included 182,409 sampled procedures from 108 VHA facilities that provided care to veterans. The VHA's nationwide training program required briefings and debriefings in the operating room and included checklists as an integral part of this process. The training included 2 months of preparation, a 1-day conference, and 1 year of quarterly coaching interviews The rate of change in the mortality rate 1 year after facilities enrolled in the training program compared with the year before and with nontraining sites. The 74 facilities in the training program experienced an 18% reduction in annual mortality (rate ratio [RR], 0.82; 95% confidence interval [CI], 0.76-0.91; P = .01) compared with a 7% decrease among the 34 facilities that had not yet undergone training (RR, 0.93; 95% CI, 0.80-1.06; P = .59). The risk-adjusted mortality rates at baseline were 17 per 1000 procedures per year for the trained facilities and 15 per 1000 procedures per year for the nontrained facilities. At the end of the study, the rates were 14 per 1000 procedures per year for both groups. Propensity matching of the trained and nontrained groups demonstrated that the decline in the risk-adjusted surgical mortality rate was about 50% greater in the training group (RR,1.49; 95% CI, 1.10-2.07; P = .01) than in the nontraining group. A dose-response relationship for additional quarters of the training program was also demonstrated: for every quarter of the training program, a reduction of 0.5 deaths per 1000 procedures occurred (95% CI, 0.2-1.0; P = .001). Participation in the VHA Medical Team Training program was associated with lower surgical mortality.

The Role of the Operating Room Nurse Manager in the Successful Implementation of Preoperative Briefings and Postoperative Debriefings in the VHA Medical Team Training Program

To improve communication within surgical teams, Veterans Health Administration (VHA) implemented a Medical Team Training Program (MTT) based on the principles of crew resource management. One hundred two VHA facilities were analyzed. Nursing leadership participation in the planning stages of the program was compared with outcomes at follow-up. Nurse manager participation in planning was associated with higher rates of implementation of preoperative briefing and postoperative debriefing. Nurse managers are a critical component in the planning phase of team training programs focused on OR clinical staff.

The Efficacy of Medical Team Training: Improved Team Performance and Decreased Operating Room Delays

Medical team training (MTT) has been touted as a way to improve teamwork and patient safety in the operating room (OR). OR personal completed a 1-day intensive MTT training. A standardized briefing/debriefing/perioperative routine was developed, including documentation of OR miscues, delays, and a case score (1-5) assigned by the OR team. A multidisciplinary MTT committee reviewed and rectified any systems problems identified. Debriefing items were analyzed comparing baseline data with 12 and 24-month follow-up. A safety attitudes questionnaire was administered at baseline and 1 year. A total of 4863 MTT debriefings were analyzed. One year following MTT, case delays decreased (23% to 10%, P < 0.0001), mean case score increased (4.07-4.87, P < 0.0005), and both changes were sustained at 24 months. One-year and 24-month follow-up data demonstrated decreased frequency of preoperative delays (16%-7%, P = 0.004), hand-off issues (5.4%-0.3%, P < 0.0001), equipment issues/delays (24%-7%, P < 0.0001), cases with low (<3) case scores (23%-3%, P < 0.0005), and adherence to timing guidelines for prophylactic antibiotic administration improved (85%-97%, P < 0.0001). Surveys documented perception of improved teamwork and patient safety. A major systems issue regarding perioperative medication orders was identified and corrected. MTT produced sustained improvement in OR team function, including decreased delays and improved case scores. When combined with a high-level debriefing/problem-solving process, MTT can be a foundation for improving OR performance. This is the largest case analysis of MTT and one of the few to document an impact of MTT on objective measures of operating room function and patient safety.

Code Debriefing from the Department of Veterans Affairs (VA) Medical Team Training Program Improves the Cardiopulmonary Resuscitation Code Process

A Department of Veterans Affairs (VA) medical center developed a brief questionnaire to support the identification of issues and the continuous improvement of the cardiopulmonary resuscitation process and its outcomes.

Medical team training and coaching in the veterans health administration; assessment and impact on the first 32 facilities in the programme

BackgroundCommunication is problematic in healthcare. The Veterans Health Administration is implementing Medical Team Training. The authors describe results of the first 32 of 130 sites to undergo the programme. This...

The Role of the Operating Room Nurse Manager in the Successful Implementation of Preoperative Briefings and Postoperative Debriefings During the VHA Medical Team Training Program

Background: The purpose of this study was to determine which factors during the preparation and planning phase of the VHA Medical Team Training Program [MTT] were associated with successful implementation of checklist-guided operative briefings.

Sex differences in operating room care giver perceptions of patient safety: a pilot study from the Veterans Health Administration Medical Team Training Program

BackgroundAchieving a culture of safety is believed to be an important mechanism for improving patient safety. The Safety Attitudes Questionnaire (SAQ) measures provider perceptions of patient safety culture across six...

Spreading the Word: Search-and-Rescue Training for Medical Teams in the Israeli Home Front Command

Spreading the Word: Search-and-Rescue Training for Medical Teams in the Israeli Home Front Command

Cost free medical team training

Background Medical simulation and team training is widely used and the effect on learning is generally accepted. However, full scale simulation is expensive and time consuming. Mornings in the Emergency Department (ED) are often quiet leaving time for other activities. The trauma teams are well organized, and they participate in team training regularly. In contrast, even though medical and surgical patients are often at least as complex as trauma patients, they are managed only by a few nurses and a junior physician, and the team work is rarely trained. We wanted to test the feasibility of a simple and costfree setup, aimed at increasing the teamwork abilities of our staff.

Simulation-based learning: Just like the real thing

Simulation is a technique for practice and learning that can be applied to many different disciplines and trainees. It is a technique (not a technology) to replace and amplify real experiences with guided ones, often “immersive” in nature, that evoke or replicate substantial aspects of the real world in a fully interactive fashion. Simulation-based learning can be the way to develop health professionals’ knowledge, skills, and attitudes, whilst protecting patients from unnecessary risks. Simulation-based medical education can be a platform which provides a valuable tool in learning to mitigate ethical tensions and resolve practical dilemmas. Simulation-based training techniques, tools, and strategies can be applied in designing structured learning experiences, as well as be used as a measurement tool linked to targeted teamwork competencies and learning objectives. It has been widely applied in fields such aviation and the military. In medicine, simulation offers good scope for training of interdisciplinary medical teams. The realistic scenarios and equipment allows for retraining and practice till one can master the procedure or skill. An increasing number of health care institutions and medical schools are now turning to simulation-based learning. Teamwork training conducted in the simulated environment may offer an additive benefit to the traditional didactic instruction, enhance performance, and possibly also help reduce errors.

Predictors of successful implementation of preoperative briefings and postoperative debriefings after medical team training

Background The purpose of this study was to examine which factors at a medical team training learning session predict future success in the implementation of preoperative briefings and postoperative debriefings at health care facilities. Methods A Likert score rating for physician involvement, leadership support, and composition of the implementation team was recorded for 64 VHA facilities at the time of a learning session by 3 medical team training educators. At a mean follow-up period of 8.2 months (standard error, .4 mo), a briefing score was established from quarterly semistructured interviews with the facility's implementation team. Results In a multivariable regression, leadership involvement at the time of the learning session was the best predictor of future briefing/debriefing success ( R = .34, P = .03). Conclusions Full implementation of the patient safety tool preoperative briefings and postoperative debriefings is dependent on facility leadership support.

Medical Team Training In The VA System

Medical Team Training In The VA System

Medical Team Training: The Authors Respond

Letters Health AffairsVol. 28, No. 4: Delivering On Global Health Medical Team Training: The Authors RespondPeter J. PronovostPUBLISHED:July/August 2009No Accesshttps://doi.org/10.1377/hlthaff.28.4.1229AboutSectionsView articleView Full TextView PDFPermissions ShareShare onFacebookTwitterLinked InRedditEmail ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions View articleTOPICSPatient safetyElectronic medical recordsPatient harm Loading Comments... Please enable JavaScript to view the comments powered by Disqus. DetailsExhibitsReferencesRelated Article Metrics History Published online 1 July 2009 InformationCopyright 2009 by Project HOPE - The People-to-People Health Foundation, Inc.PDF download

Improving the spirit: Increasing the chances of survival. Multiprofessional training of medical teams

Improving the spirit: Increasing the chances of survival. Multiprofessional training of medical teams

Teamwork and Communication in Surgical Teams: Implications for Patient Safety

As part of a national program in the Department of Veterans Affairs to improve communication within the health-care environment, the Medical Team Training questionnaire was developed to assess organizational culture, communication, teamwork, and awareness of human factors engineering principles. The Medical Team Training questionnaire was pilot tested with 300 health-care clinicians. The final version of the Medical Team Training questionnaire was administered to an interdisciplinary group of 384 surgical staff members in 6 facilities as part of the Medical Team Training pilot project in the Department of Veterans Affairs. The results revealed a pattern of discrepancies among physicians and nurses in which surgeons perceive a stronger organizational culture of safety, better communication, and better teamwork than either nurses or anesthesiologists do. The Medical Team Training questionnaire was helpful in identifying hidden problems with communication before formal team training learning sessions, and it will be useful in focusing efforts to improve communication and teamwork in the operating room.

Medical Team Training: Applying Crew Resource Management in the Veterans Health Administration

Communication failure, a leading source of adverse events in health care, was involved in approximately 75% of more than 7,000 root cause analysis reports to the Department of Veterans Affairs (VA) National Center for Patient Safety (NCPS). The VA NCPS Medical Team Training (MTT) program, which is based on aviation principles of crew resource management (CRM), is intended to improve outcomes of patient care by enhancing communication between health care professionals. Unique features of MTT include a full-day interactive learning session (facilitated entirely by clinical peers in a health care context), administration of pre-and postintervention safety attitudes questionnaires, and follow-up semistructured interviews with reports of program activities and lessons learned. Examples of projects in these facilities include intensive care unit (ICU) teams' patient-centered multidisciplinary rounds, surgical teams' preoperative briefings and debriefings, an entire operating room (OR) unit's adoption of "Rules of Conduct" for expected staff behavior, and an ICU team's use of the model for daily administrative briefings. An MTT program based on applied CRM principles was successfully developed and implemented in 43 VA medical centers from September 2003 to May 2007.

Target-focused medical emergency team training using a human patient simulator: effects on behaviour and attitude

Full-scale simulation training is an accepted learning method for gaining behavioural skills in team-centred domains such as aviation, the nuclear power industry and, recently, medicine. In this study we evaluated the effects of a simulator team training method based on targets and known principles in cognitive psychology. This method was developed and adapted for a medical emergency team. In particular, we created a trauma team course for novices, and allowed 15 students to practise team skills in 5 full-scale scenarios. Students' team behaviour was video-recorded and students' attitude towards safe teamwork was assessed using a questionnaire before and after team practice. Nine of 10 observed team skills improved significantly in response to practice, in parallel with a global rating of team skills. In contrast, no change in attitude toward safe teamwork was registered. The use of team skills in 5 scenarios in a full-scale patient simulator environment implementing a training method based on targets and known principles in cognitive psychology improved individual team skills but had no immediate effect on attitude toward safe patient care.

Essential Work for Mothers of Children Living with Cancer

This paper, based on focus group interviews with mothers whose children have had cancer, describes the advocacy work in which mothers engaged during the period of diagnosis and treatment. Among the mothers' manifold responsibilities, advocacy was one of the most compelling. It was described as if it was a taken—for—granted moral imperative. Some mothers said they felt that it was necessary because of (1) perceived errors during diagnosis or later during the process of treatment; (2) perceived understaffing; (3) advice given by other mothers or fathers; and (4) perceived lack of coordination and communication in the medical care system. Many coped with the need to advocate through educating themselves, by keeping extensive notes and journals and by talking to other parents about their experiences. The paper concludes with clinical practice implications and recommendations for policy consideration including acknowledgment of the significant role of optimal family cohesion for managing the stresses and strains of advocacy and other home health care work; appointment of parent—child advocates associated with hospitals that provide pediatric oncology care; establishment of in—service training and education for guardians and medical care teams regarding their mutual roles and responsibilities; as well as, the provision of guaranteed and paid parental leave policies for guardians whose children have a catastrophic or severe chronic medical condition.