Simulation Team Training Research Articles

Does clinical experience influence the effects of team simulation training in stroke thrombolysis? A prospective cohort study

ObjectivesAfter introducing a team simulation training programme at our hospital, we saw a reduction in door-to-needle times (DNT) for stroke thrombolysis but persisting variability prompting further investigation. Our objective is...

Worth a try or a last resort: Healthcare professionals' experiences and opinions of above cuff vocalisation.

Above cuff vocalisation (ACV) involves the application of an external flow of air via the subglottic port of a tracheostomy. ACV can facilitate vocalisation and may improve swallowing and quality of life for patients with a tracheostomy. A recent systematic review highlighted the limited evidence available for the acceptability, effectiveness, safety or optimal implementation of ACV. To explore the experience of healthcare professionals (HCPs) using ACV and their perceptions of best practice. Semi-structured interviews were conducted with a range of HCPs with experience using ACV. Topics included: experiences with ACV, management of ACV, opinions about ACV, impact of COVID-19, future directions for ACV and impact on length of stay. Interviews were conducted online from December 2020 to March 2022. Data were analysed using reflexive thematic analysis. Twenty-four HCPs were interviewed from seven countries and five professional groups. Four interconnected themes were developed: (1) moral distress amplifying the need to fix patients; (2) subjectivity and uncertainty leading to variations in practice and purpose; (3) knowledge and experience leading to control and caution; and (4) worth a try or a last resort. Theme four contained three sub-themes: (a) part of the toolbox; (b) useful but limited tool; and (c) following the patient's lead. The moral distress experienced by HCPs and their essential 'need to fix' patients seems to underpin the varied opinions of ACV. These opinions appear to be formed primarily on the basis of experience, because of the underlying subjectivities and uncertainties. As knowledge and experience with ACV increased, and adverse events were experienced, most HCPs became more cautious in their approach to ACV. More research is needed to reduce the subjectivities and uncertainties surrounding ACV. The implementation of standardised procedures, processes, and competencies may help to reduce the frequency of adverse events and support a more controlled approach. Widening the focus of the purpose of ACV to include swallowing may help to maximise the potential benefits. What is already known on the subject There is limited and low-quality evidence for above cuff vocalisation (ACV) and clinical application and practice varies substantially. However, the reasons for this variation in practice and healthcare professionals' (HCPs') opinions of ACV were unclear. What this study adds HCPs' experiences and opinions of ACV vary as a result of the uncertainty and subjectivity surrounding ACV compounded by their personal experiences with it. A need for caution also appears to emerge as HCPs become more familiar and experienced with using ACV. What are the clinical implications of this work? Implementing standardised procedures, safety processes and competencies may help to compensate for the uncertainty and subjectivity surrounding ACV and may reduce the frequency of adverse events. Widening the focus of purpose of ACV, including swallowing in addition to communication, may increase the number of potential candidates and increase the potential benefits of ACV. Using multidisciplinary team (MDT) simulation training for ACV competency development might help to improve MDT working and ACV implementation.

Determining the educational impact of virtual patients on trauma team training during a multinational, large-scale civil military simulation exercise.

With asymmetrical conflicts ongoing, many countries have an increasing number of major trauma events but limited capacity to cope with these events. Training for such events comprises primarily of simulations requiring significant resources and that are time-consuming and expensive. Virtual patients are defined as computer-based programs presenting authentic cases support training in trauma management. Assisted learning technologies augment simulated trauma team training and can improve trauma team competencies. The aim was to investigate if virtual patients increased competencies in decision making required and to identify deficiencies in care for the management of trauma patients during a multinational civil military trauma exercise. A prospective educational intervention study with mixed methods, measuring the effects of a novel virtual patient model on trauma teams, was performed. The population consisted of surgeons, anesthesiologists, emergency department physicians, nurses, and paramedics (n = 30) and constituted six trauma teams from eight countries; three trauma teams formed the participating group, and three were allocated as control group. The participating group was exposed to virtual patients before, during, and after the live simulation exercise. Data sources were derived from individual preassessments and postassessments, evaluations made by experts in trauma, and video recordings of performance during the live simulation exercise and analyzed by the thematic analysis method. Using virtual patients contributed to improved individual knowledge about the management of major trauma patients and improved teamwork. Virtual patients as support for reasoning in decision making were directly correlated to level of previous knowledge and experience. Two of the three participating trauma teams showed lower levels of existing knowledge and competence in managing major trauma patients and therefore made more efficient use of the virtual patients. Results demonstrated advantages using virtual patients during a major civil military trauma live simulation exercise and appear to be supportive especially for teams who are not as experienced. Therapeutic/Care Management; Level IV.

Reliability and validity testing of team emergency assessment measure in a distributed team context.

Medical multi-professional teams are increasingly collaborating via telemedicine. In distributed team settings, members are geographically separated and collaborate through technology. Developing improved training strategies for distributed teams and finding appropriate instruments to assess team performance is necessary. The Team Emergency Assessment Measure (TEAM), an instrument validated in traditional collocated acute-care settings, was tested for validity and reliability in this study when used for distributed teams. Three raters assessed video recordings of simulated team training scenarios (n = 18) among teams with varying levels of proficiency working with a remotely located physician via telemedicine. Inter-rater reliability, determined by intraclass correlation, was 0.74-0.92 on the TEAM instrument's three domains of leadership, teamwork, and task management. Internal consistency (Cronbach's alpha) ranged between 0.89-0.97 for the various domains. Predictive validity was established by comparing scores with proficiency levels. Finally, concurrent validity was established by high correlations, >0.92, between scores in the three TEAM domains and the teams' overall performance. Our results indicate that TEAM can be used in distributed acute-care team settings and consequently applied in future-directed learning and research on distributed healthcare teams.

Use of quality improvement methodology to improve care of women with hypertensive disease in pregnancy and haemorrhage in Yemen (low-income, high-insecurity setting)

This safety improvement project used quality improvement methods in a Comprehensive Emergency Obstetric and Newborn Care facility in Yemen, managed by an international humanitarian non-governmental organisation. It is responsible for...

How to implement a clinical robotic mitral valve surgery program.

Minimally invasive, specifically, robot-assisted mitral valve surgery has evolved as a method to intervene on mitral valve disease without a median sternotomy while providing the advantages of excellent visualization and allowing for precise technical movements in a small space with the goal to decrease surgical invasiveness, post-operative pain, and hospital length of stay. As patient interest in minimally invasive cardiac procedures become more prevalent and patients seek the opportunity to undergo robotic valve surgery, institutions worldwide are exploring the potential of establishing a robotic mitral valve surgery program. While robust existing experience in open surgical mitral valve repair, careful patient selection, a dedicated team, and institution support are fundamental factors to implement a new robotic mitral valve surgery program, we believe that simulation team training prior to transitioning to live cases is also crucial and should be incorporated to establish a successful mitral valve surgery program.

REAL and SCOPE: Evolution from Simulation Team Training to Leadership Curriculum Development for Residents and Fellows

Postgraduate medical training and post-training career continuing medical education in surgical subspecialty fields focus predominately on developing and mastering technical expertise and voluminous educational content, all of which are important and necessary. However, there is limited organized learning on leadership and non-technical skills (situational awareness, teamwork, communication, task management, decision-making) for surgeons in training, and thereafter as attending faculty, to gain expertise in leading the OR team of surgeons, anesthesiologists, and nurses during complex surgery. Aside from our simulation work on technical skills, we started and grew our training in team skills, leadership, and followership over the past decade-plus. We advanced to not only in-person professional assessments of simulated performances of case scenarios but also the use of audiovisual review with validated scoring (NOTSS, ANTS, SPLINTS). This led to use of these tools in assessing live OR performance (REAL) and coaching (SCOPE) with educational debriefings for the betterment of the individual and the team of professionals. Now, we have a formal curriculum for orthopaedic surgery residents during their third year of training and pediatric surgical fellows (orthopaedic surgery, otolaryngology, plastic surgery, sports medicine, and urology) throughout their fellowship year. We use simulation, REAL, and SCOPE amongst other technics, with formative and summative assessments, to improve their leadership, non-technical skills, and emotional intelligence. Over the past 5 years, the leadership curriculum for surgical fellows and now residents has been highly successful. Our orthopaedic surgery residents and pediatric orthopaedic surgery and sports medicine fellows are better equipped to handle conflict, foster within and across profession collaboration, work in diverse environments, and build and lead a team both on a daily basis and over time. This increases patient safety, mitigates risk, and leads to better outcomes. We encourage others to use these or similar tools in their institutions and programs

Critical Care Resource Nurse Team: A Patient Safety and Quality Outcomes Model.

The Critical Care Resource Nurse Team (CCRNT) evolved from our traditional Rapid Response Team (RRT). The CCRNT is a unique paradigm created using the conceptual framework of the American Association of Critical Care Nursing Synergy Model for Patient Care. The goal of the CCRNT is to help align nurse competencies with patient needs. This team was seen as a much-needed strong clinical support by nursing leadership as large numbers of inexperienced new graduate registered nurses were hired and senior experienced nurses were leaving the workforce. The CCRNT supports 24/7 RRT, Code Blue, Code Stroke, Emergency Airway Response Team, Early Warning System, Medical Emergency Team, simulation team training, and bedside nurse support and mentoring. Coverage expanded from inpatient medical/surgical areas to all areas of the medical center and included hospital-wide initiatives. The focus for the CCRNT changed to a system-wide nursing and patient safety model to improve practice and intervene in near-miss events. This model improved communication between disciplines, provided critical surveillance of at-risk patients, supported patient safety with a significant decrease in patient mortality, and offered a 24/7 expert critical care nurse resource team for staff.

Interprofessional Clinical Simulation-Based Education to Develop Professional Identity and Professionalism in Japanese Medical and Nursing Students

Introduction: We conducted a multi-occupational team simulation training for medical and nursing students and clarified how professional identity and professionalism attitudes change with interprofessional education (IPE). Methods: Thirty-nine 4th-year medical students and 48 2nd-year nursing students were enrolled and distributed to the educational intervention group and the control group. We used a vocation identity scale including lower four subscales, a scale for professionalism including lower five subscales, a readiness for inter-professional learning scale (RIPLS), and an interdisciplinary education perception scale (IEPS). Results: Among the medical students, IPE using an advanced patient simulator improved the scores on the vocational identity scale, scale for professionalism, RIPLS, and IEPS. Among the nursing students, IPE improved the scores on the vocational identity scale, scale for professionalism, RIPLS, and IEPS. Conclusion: On-the-job training using simulated clinical training by a multi-occupational team improved vocational identification and professionalism.

Impact of simulation training for teamwork and communication intervention on patient safety in the emergency department

Background: The emergency department (ED) is the hospital division that is most vulnerable to poor communication and teamwork-based medical errors that affect patient safety. One approach to prevent medical errors is by training and assessing healthcare workers using simulation-based (SB) teamwork and communication training. This study aimed to explore the extent to which SB training could improve teamwork and communication and reduce preventable medical errors in the ED. Method: The study was conducted at the Ministry of National Guard Health Affairs, a tertiary care center with a 39-bed ED, in Saudi Arabia. A total of 123 ED healthcare staff participated in the study. This study adopted a single-subject experimental design with the intervention of simulation training in ED cases. The methodology focused on three domains: 1) patient safety in the ED, 2) inter-professional and multidisciplinary simulation team training, and 3) team dynamic enhancement use. Staff perceptions regarding teamwork and communication pre-and post-intervention and the relationship between changes in their perception of performance in the ED and patient outcomes. The chi-square test was used for univariate analysis, and a generalized linear regression model was adjusted for demographics in multivariate analysis. Results: Staff perceptions were collected from all multidisciplinary team members before and after simulation training. The data revealed a significant improvement in overall staff perceptions toward teamwork and communication (8% to 34%, p-value = 0.001). Conclusion: SB communication and teamwork training in the ED resulted in a sustained and measurable improvement in ED staff perceptions toward teamwork and communication. The results suggest that simulation sessions may improve staff perceptions and multidisciplinary team communication during critical situations in the ED.

Multidisciplinary Team Simulation Training for Successful Outcomes in Robotic Cardiac Surgery

Multidisciplinary Team Simulation Training for Successful Outcomes in Robotic Cardiac Surgery

A Novel Code Team Leader Card to Improve Leader Identification.

Prompt and clear code team leader identification is vital in effective cardiopulmonary resuscitation (CPR), and pediatric trainees often have limited experience in these scenarios. This project sought to develop a tangible object that provided clear leader identification and assisted in code team management and simulated team training. A Code Team Leader Card (CTLC) was designed to provide clear leader identification while simultaneously providing a cognitive aid via integration of pediatric advanced life support (PALS) algorithms. Additionally, CTLC served to occupy the leader's hands to limit their ability to intervene on procedural tasks. The CTLC was incorporated into pediatric resident simulation training, and pre- and postintervention survey data were analyzed. Analysis particularly focused on whether "a leader was clearly identified by all team members." The relationship between CTLC implementation and consistent leader recognition was evaluated using chi-squared test, and secondary qualitative data were obtained via debriefing sessions. Pediatric residents completed 131 surveys prior to CTLC implementation and 41 surveys after implementation. Consistent code team leader recognition increased significantly from 61.8% (81 of 131) pre-CTLC to 80.5% (33 of 41) after introduction of CTLC (P=0.027). Participants commented on the benefits of CTLC during debriefing sessions. Use of a CTLC significantly improved leader recognition during simulated CPR. Inclusion of PALS algorithms led to normalization and increased utilization of these adjunct materials. The CTLC provided a secondary benefit of occupying the leader's hands, thereby allowing that person to focus on overseeing the team rather than assisting with procedural tasks.

Healthcare professionals in COVID-19-intensive care units in Norway: preparedness and working conditions: a cohort study

ObjectiveTo survey the healthcare professionals’ background and experiences from work with patients with COVID-19 in intensive care units (ICUs) during the first wave of the COVID-19 pandemic in Norway.DesignObservational cohort...

Communication Patterns During Routine Patient Care in a Pediatric Intensive Care Unit: The Behavioral Impact of In Situ Simulation.

Effective communication minimizes medical errors and leads to improved team performance while treating critically ill patients. Closed-loop communication is routinely applied in high-risk industries but remains underutilized in healthcare. Simulation serves as an educational tool to introduce, practice, and appreciate the efficacy of closed-loop communication. This observational before-and-after study investigates behavioral changes in communication among nurses brought on by simulation team training in a pediatric intensive care unit (PICU). The communication patterns of PICU nurses, who had no prior simulation experience, were observed during routine bedside care before and after undergoing in situ simulation.One month before and 1 and 3 months after simulation (intervention), 2 trained raters recorded nurse communications relative to callouts, uttered by the sender, and callbacks, reciprocated by the recipient. The impact of simulation on communication patterns was analyzed quantitatively. Among the 15 PICU nurses included in this study, significant changes in communication behavior were observed during patient care after communication-focused in situ simulation. The PICU nurses were significantly less likely to let a callout go unanswered during clinical routine. The effect prevailed both 1 month (P = 0.039) and 3 months (P = 0.033) after the educational exposure. This observational before-and-after study describes the prevalence and pattern of communication among PICU nurses during routine patient care and documents PICU nurses transferring simulation-acquired communication skills into their clinical environment after a single afternoon of in situ simulation. This successful transfer of simulation-acquired skills has the potential to improve patient safety and outcome.

Costs of hospital trauma team simulation training: a prospective cohort study

ObjectivesThis study investigated the costs of 2-hour multiprofessional in situ hospital trauma team simulation training and its effects on teams’ non-technical skills using the T-NOTECHS instrument.BackgroundSimulation is a feasible and...

Major Vascular Injury (MVI) Simulation in Gynecologic Surgery: Teaching Intraoperative Crisis Management Skills

Study Objective To implement major vascular injury (MVI) in gynecologic surgery simulation. Design Development and evaluation of a gynecology-based operating room (OR) simulation. Setting Simulation center at the 2019 AAGL Fellowship in Minimally Invasive Gynecologic Surgery (FMIGS) Annual Bootcamp Patients or Participants Postgraduate year (PGY) 6 fellows participated as learners. Faculty oriented learners and lead the debriefing. Interventions MVI simulation session. Measurements and Main Results Pre- and post-simulation survey responses were compared using McNemar’ test. Median and interquartile ranges were calculated on responses collected via a Likert scale (1-5). A total of 34 fellows (median age 31.5) and 8 faculty (median age 37.5) responded. Fellows reported a median 8 hours per year spent participating in simulation team training and a median 5 hours per year spent teaching in this context. All fellows believed that simulation training is both an essential part of clinical practice and patient safety. 94.1% (n=32) thought that simulation team training should be a part of the boot camp. 94.1% (n=32) also thought that the training should be part of the fellowship curriculum in their respective institutions. Before the simulation, 97.1% (n=33) of the fellows desired to learn more about simulation training and curriculum development. Following the simulation, all fellows felt that knowledge gained could be transferred to the clinical setting, felt more confident in responding to a critical intraoperative event, learned techniques to communicate more effectively during a critical event, and felt that the simulation content was relevant to their training and clinical practice. The majority of the fellows felt more confident in managing intraoperative hemorrhage (median 5, IQR 4-5) following the simulation. Conclusion MVI training in gynecologic surgery is feasible and viewed favorably by participants. Further work should focus on performance assessment and clinical outcomes to allow for growth of simulation training within the field of gynecology.

The Effect of Teaching Nontechnical Skills in Advanced Life Support: A Systematic Review.

The objective of this study was to evaluate the effect of nontechnical skills (NTS) training on performance in advanced life support (ALS) simulation. Furthermore, we aimed to determine the ideal frequency of training sessions for an optimal retention and the value of debriefing. A systematic search was performed using PubMed, EMBASE, WoS, ERIC, CINAHL, and the Cochrane Library conducted through August 1, 2018. All primary studies mentioning NTS in ALS education were included. Three reviewers independently extracted data on study design and outcome. The MERSQI approach was used to evaluate the overall quality of evidence. Of the 10,723 identified articles, 40 studies were included with a combined total of 3,041 participants, ranging from students to experts. Depending on the focus of the study, articles were categorized in NTS (n=25), retention (n=8), and feedback (n=10). Incorporating NTS during ALS simulation showed significant improvements in timing for performing critical first steps. Furthermore, good leadership skills had a favorable effect on overall technical performance and teamwork during simulation improved team dynamics and performance. Finally, debriefing also had a beneficial effect on team performance. One particular type of debriefing does not appear to be superior to other types of debriefing. Team simulation training resulted in improved NTS and a reduction in the time required to complete a simulated cardiac arrest. Therefore, a formal NTS program should be introduced into ALS courses. Feedback and repetitive practice are key factors to train NTS. The impact of training on team behaviors can persist for at least 3 to 6months. In conclusion, understanding and improving NTS may help to create more effective teams. The effect on patient outcome requires further investigation.

Use of simulation training to teach the ABCDE primary assessment: an observational study in a Dutch University Hospital with a 3–4 months follow-up

ObjectivesTo investigate short-term and long-term effectiveness of simulation training to acquire a structured Airway Breathing Circulation Disability Exposure (ABCDE) approach for medical emergencies; and to examine which skills were learnt...

Developing a Code of Ethics amongst Social Workers in Supported Employment: Exploring the Socio-ecological Model

Abstract This study reveals the ethical dilemmas encountered by social workers who mentor workers with intellectual and developmental disabilities that work in the free labour market through supported employment frameworks. The aim of the study is to examine the social workers' ethical dilemmas, while extracting rules of conduct and ethical codes that are unique to supported employment frameworks, through team simulation training. The study included forty-eight social workers who attended nine sessions in the course of one year. The findings, which were analysed using a qualitative methodology, revealed that the dilemmas, rules of ethical conduct and the derived ethical codes ranged from flexible solutions to setting firm boundaries. It emerged that the ethical dilemmas were associated with interactions that take place on all layers of the socio-ecological model. The contribution of the study is in developing an ecological approach to coping with the multidimensional dilemmas that arise in the context of supported employment. The findings will help develop a systemic approach amongst social workers towards coping with the ethical challenges involved in this type of employment.

Reducing Time to Medical Intervention Through Code Team Reorganization and Simulation Training

Background Cardiac arrest is an acute event with very high morbidity and mortality rates. Ten in 1,000 admitted patients go into cardiac arrest each year and only a quarter of these patients survive to hospital discharge. Code environments are highly complex and require expert coordination among participants to improve patient survival. Despite recognition of the necessary elements for successful resuscitation. Time to medical intervention (TMI) and quality of chest compressions are well documented crucial aspects of a successful code, but other qualities such as demonstrative leadership, clear communication, effective team member interaction, and succinct task completion may also contribute to patient outcomes. Clearly identifying the role of each team member, their responsibilities, and bedside position may improve the success of a code situation. Similarly, pre-defined teams consistently outperform ad hoc teams. Aim The aim of this project was to decrease the time to medical intervention during mock code situations, improve close loop communication and leadership during a code. Methods We achieved our goals by restructuring our code team. First, all members necessary for a code team were identified, their respective roles clearly defined, and the most appropriate bedside positions for each role was carefully selected. Multidisciplinary team leaders were identified and trained as trainers by the core team for this project. Next, random mock codes were called to obtain baseline TMI. After the mock codes for baseline TMI to medical intervention, the trainers then trained the members of their unit on the appropriate roles and specific responsibilities they would be expected to complete during a code situation. Once training was completed, mock codes were randomly called and TMI was recorded. Also, there was a debriefing after these mock codes in which the participants were asked to give their impression of our Quality improvement project on the code team communication, leadership during the mock codes, quietness of the room and their comfort levels with performing the responsibilities of the role they performed. Time to medical intervention in these simulated codes were compared to the average time to medical intervention in our baseline mock codes. Results Post-code debriefings revealed a general sense of improved communication, improved crowd control, and clearer leadership when compared to other code situations the participants had been involved in. Similarly, time to shock delivery or medication administration shortened from the prior average of 2 minutes 46 seconds to 2 minutes 3 seconds, a statistically significant improvement (p-value 0.036). Participants also reported clearer communication, better understanding of their role and improved noise in the code environment. Conclusions Disorganized codes are costly in terms morbidity and post-arrest care. Having well organized codes with clear roles, responsibilities, and positions may decrease the TMI, communication, noise, leadership and improve patient outcomes. Real-life implementation and analysis of this intervention is needed. TMI was defined as the time from when a code is called to the time when the first medication or defibrillation was administered which ever was warranted first.