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Journal Club- Arrowe Park Hospital October 2013 Dr Binu T George

Journal Club- Arrowe Park Hospital October 2013 Dr Binu T George. Robert W. Frengley, et al, Crit Care Med 2011 Vol. 39, No. 12 2605. Literature search. Topic : Training in intensive/Critical care

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Journal Club- Arrowe Park Hospital October 2013 Dr Binu T George

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  1. Journal Club- Arrowe Park Hospital October 2013 Dr Binu T George Robert W. Frengley, et al, Crit Care Med 2011 Vol. 39, No. 12 2605.

  2. Literature search • Topic : Training in intensive/Critical care • 1. MEDLINE; exp *INTENSIVE CARE/ OR exp *INTENSIVE CARE UNITS/ OR exp *CRITICAL CARE/; 50375 results. • 2. MEDLINE; exp *EDUCATION, MEDICAL, GRADUATE/ OR exp *EDUCATION, MEDICAL/ OR exp *EDUCATION, MEDICAL, CONTINUING/; 94391 results. • 3. MEDLINE; 1 AND 2; 516 results.4. MEDLINE; 3 [Limit to: English Language and Humans and Publication Year 2010-Current]; 132 results • Manually went through 132- picked out 8 relevent studies

  3. Selected paper • The effect of a simulation based training intervention on the performance of established critical care unit teams (Robert W Frengley,Jennifer M Weller,JaneTirrie,PeterDzendrowskyj Critical Care Med 2011;39:2605-2611)

  4. OBJECTIVE Evaluation of the effectiveness of a simulation based intervention on improving teamwork in multidisciplinary critical care teams managing airway and cardiac crises Comparison of simulation-based learning and case-based learning

  5. BACKGROUND • The Institute of Medicine in its publication To Err Is Human issued a number of recommendations to enhance patient safety • “to train in teams those who are expected to work in teams.” • Evidence suggests that teams make fewer mistakes than individuals and that good team work improves patient safety • Evidence also suggests team work failures make substantial contributions to sub optimal patient care • In the critical care unit, teamwork is of particular importance in optimizing patient outcome in clinical crises, including emergency airway or cardiac events.

  6. METHODS • Self-controlled randomized crossover study design with blinded assessors. • Setting: A simulated critical care ward, using a high-fidelity patient simulator, • in a university simulation center. • Subjects: Forty teams from critical care units • - 1 doctor and 3 nurses • Intervention: • 10 hour study day • Assessment done at Beginning and End of the day • Each team undertook 2 pre-intervention and 2 post intervention assessments • The study day included • Presentations and discussions on human factors and crisis management • Airway and Cardiac skills stations. • For the intervention, teams were randomized to • Case-based learning or Simulation-based learning (for cardiac or airway scenarios) • Measurements: • Recording and analysis done by 3 blinded expert assessors • Structured rating tool was used with technical and behavioral components. • Participants were surveyed 3 months later.

  7. METHODS

  8. RESULTS

  9. RESULTS

  10. RESULTS

  11. DISCUSSION Paucity of literature documenting outcomes of MDT training interventions Case control study Wayne DB ,Didwala A ,Fienglass –Simulation based education improved quality of care during cadiac arrest team responses ( CHEST 2008;133:56-61) Steadman RH, Coates WC ,Huang YM/;simulation based training is superior to problem based learning for acquisition of critical assessment and management skills (Critical care Med 2006;34:151-157)

  12. CONCLUSIONS • Simulation-based intervention is effective in improving performance in multidisciplinary critical care teams • There is improved performance in the simulator after the course • There have been self reported changes to subsequent clinical practice • Supports that there is transfer of learning from simulation to the workplace over a period of time. • Results suggest that a mix of SBL and CBL is effective

  13. CRITIQUE • Quality of evidence 1 b (individual RCT with narrow confidence interval) • Responder Bias • Demonstrating objective ,improved patient outcome beyond scope of this study • Trend suggesting SBL better than CBL –small sample size, hence no statistical difference demonstrated

  14. Summary • Good evidence to suggest SBL improves team work behaviour and overall effectiveness of team • SBL and CBL combined makes better learning envoirnment • Further scope for research with larger groups to improve statistical difference between SBL and CBL

  15. references • 1. Institute of Medicine: To Err Is Human: Building a Safer Health System. Washington, DC, National Academy Press, 2000 • 2. Manser T: Teamwork and patient safety in dynamic domains of healthcare: A review of the literature. Acta Anaesthesiol Scand 2009; 53:143–151 • 3. Volpe CE, Cannon-Bowers JA, Salas E: The impact of cross-training on team function- • ing: An empirical investigation. Hum Factors • 1996; 38:87–1004. Smith-Jentsch KA, Salas E, Baker DP: Team • training performance related assertiveness. • Personnel Psychol 1996; 49:909–9365. Bognor M (Eds): Human Error in Medicine. Hillsdale, NJ, Lawrence Erlbaum Association • Inc, 19946. Helmreich R: Threat and Error in Aviation • and Medicine: Similar and Different. Special Medical Seminar, Lessons for Health Care: Applied Human Factors Research. Australian Council of Safety and Quality in Health Care & NSW Ministerial Council for Quality in Health Care, Department of Communica- tions, Information Technology and the Arts, Canberra, Australia, 2000; available at http:// www.dcita.gov.au/cca. Accessed July 13, 2011 • 7. Reader TW, Flin R, Cuthbertson BH: Com- munication skills and error in the intensive care unit. Curr Opin Crit Care 2007; 13: 732–736 • 8. Reason J: Human Error. First Edition. Cam- bridge, UK, Cambridge University Press, 1990 • 9. Webb RK, Currie M, Morgan CA, et al: The Australian Incident Monitoring Study: An analysis of 2000 incident reports. Anaesth Intensive Care 1993; 21:520 –528 • 10. Li J, Murphy-Lavoie H, Bugas C, et al: Com- plications of emergency intubation with and without paralysis. Am J Emerg Med 1999; 17:141–143 • 11. Schwartz DE, Matthay MA, Cohen NH: Death and other complications of emergency air- way management in critically ill adults. A prospective investigation of 297 tracheal in- tubations. Anesthesiology 1995; 82:367–376 • 12. Stauffer JL, Olson DE, Petty TL: Complica- tions and consequences of endotracheal in- tubation and tracheotomy: A prospective study of 150 critically ill adult patients. Am J Med 1981; 70:65–76 • 13. Le Tacon S, Wolter P, Rusterholtz T, et al: Complications of difficult tracheal intuba- tions in a critical care unit. Ann Fr Anesth Reanim 2000; 19:719 –724 • 14. Mort TC: Emergency tracheal intubation: Complications associated with repeated la- ryngoscopic attempts. Anesth Analg 2004; 99:607– 613 • 15. Nolan J, Baskett P: ERC guidelines. Resusci- tation 2005; 67:S1–S189

  16. references • 16. Emergency Cardiovascular Care, Subcom- mittees and Task Forces of the American Heart Association: 2005 American Heart As- sociation guidelines for cardiopulmonary re- suscitation and emergency cardiovascular care. Circulation 2005; 112:IV1–IV203 • 17. Institute of Medicine: Crossing the Quality Chasm: A New Health System for the 21st Century. Washington, DC, National Academy Press, 2001 • 18. Greiner AC, Knebel E (Eds): Health Profes- sional Education: A Bridge to Quality. Wash- ington, DC, National Academy Press, 2003 • 19. Wiener E, Kanki B, Helmreich R: Cockpit • Crit Care Med 2011 Vol. 39, No. 12 • 2609 • Resource Management. San Diego, CA, Aca- • demic Press, 1993 • Briggs GE, Naylor JC: Team versus individual • training, training task fidelity, and task or- ganization effects on transfer performance by three-man teams. J Appl Psychol 1965; 49: 387–392 • Wachtel J: The future of nuclear power plan simulation in the United States. In: Simula- tion for Nuclear Reactor Technology: Pro- ceedings of the International Conference. Walton DG (Ed). Cambridge, UK, Cambridge University Press, 1985, pp 339 –349 • Weller JM, Morris R, Watterson L, et al: Ef- fective management of anaesthetic crises: Development and evaluation of a college ac- credited simulation-based course for anaes- thesia education in Australia and New Zea- • land. Simul Healthc 2006; 1:209 –214 • Howard SK, Gaba DM, Fish KJ, et al: Anes- thesia crisis resource management training: Teaching anesthesiologists to handle critical incidents. Aviat Space Environ Med 1992; 63:763–770 • McCulloch P, Rathbone J, Catchpole K: In- terventions to improve teamwork and com- munications among healthcare staff. Br J • Surg 2011; 98:469 – 479 • 25. Malec J, Torsher L, Dunn W, et al: The Mayo high performance teamwork scale: Reliabil- • ity and validity for evaluating key crew re- source management skills. Simul Healthc 2007; 2:4 –10

  17. references • 26. Weller JM, Frengley RW, Torrie J, et al: Eval- uation of an instrument to measure team- work in multidisciplinary critical care teams. Qual Saf Health Care 2011; 20:216 –222 • 27. Reynolds S, Heffner J: Airway management of the critically ill patient: Rapid sequence intubation. Chest 2005; 127:1397–1412 • 28. Yee B, Naik VN, Joo HS, et al: Nontechnical skills in anesthesia crisis management with repeated exposure to simulation-based edu- cation. Anesthesiology 2005; 103:241–248 • 29. Weaver SJ, Lyons R, DiazGranados D, et al: The anatomy of health care team training and the state of practice: A critical review. Acad Med 2010; 85:1746 –1760 • 30. Mu ̈ ller MP, Ha ̈ nsel M, Fichtner A, et al: Ex- cellence in performance and stress reduction during two different full scale simulator training courses: A pilot study. Resuscitation 2009; 80:919 –924 • 31. Graham J, Hocking G, Giles J: Anaesthesia non-technical skills: Can anaesthetists be trained to reliably use this behavioural marker system in 1 day? Br J Anaesth 2010; 104:440 – 445 • 32. Mayo PH, Hackney JE, Mueck JT, et al: Achieving house staff competence in emer- • 33. • 34. • 35. • 36. • 37. • gency airway management: Results of a teaching program using a computerized pa- tient simulator. Crit Care Med 2004; 32: 2422–2427 • Kory PD, Eisen LA, Adachi M, et al: Initial airway management skills of senior resi- dents: Simulation training compared with traditional training. Chest 2007; 132: 1927–1931 • Wayne DB, Butter J, Siddall VJ, et al: Simu- lation-based training of internal medicine residents in advanced cardiac life support protocols: A randomized trial. Teaching & Learning in Medicine 2005; 17:210–216 Wayne DB, Didwania A, Feinglass J, et al: Simulation-based education improves quality of care during cardiac arrest team responses at an academic teaching hospi- tal: A case–control study. Chest 2008; 133: 56–61 • Steadman RH, Coates WC, Huang YM, et al: Simulation-based training is superior to problem-based learning for the acquisition of critical assessment and management skills. Crit Care Med 2006; 34:151–157 • Weller J, Jolly B, Robinson B: Generalisabil- ity of behavioural scores in simulation-based assessment. Anaesth Intensive Care 2008; 36:185–189

  18. Any Questions ????

  19. THANK YOU !!!

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