Teamwork Training Improves the Clinical Care of Trauma Patients Jeannette Capella, MD, Stephen ReMine, MD, Stephen Smith, MD, Allan Philp, MD, Tyler Putnam, MD, Carol Gilbert, MD, William Fry, MD, David Baker, PhD, Sonya Ranson, PhD, Ellen Harvey, MSN, Andi Wright, MSN, Krista Henderson, MSN Virginia Tech Carilion School of Medicine Roanoke, Virginia

Introduction Healthcare team performance –Needs to be better –Key to improved patient care Evidence –Obstetrics – Neillsen et al, Siassakos et al –Medicine - Strasser et al

Introduction Trauma – Fox et al., 2009 –Improved clinician perception of teamwork –Improved teamwork –TeamSTEPPS, no simulation Today you will see evidence that team training yields better clinical care in the trauma room

Purpose Does formal trauma team training improve team behaviors in the trauma resuscitation bay? If yes, then does improved teamwork lead to more efficiency in the trauma bay and/or improved clinical outcomes?

Methods DesignInterventionSubjectsTimelineMeasurement

Design Pre/post intervention study Quality improvement project

Intervention Didactic sessions –Two hours –TeamSTEPPS Health care team training program DOD, AHRQ Domains –Leadership –Mutual Support –Situation Monitoring –Communication

Five Tools DomainToolDescription Leadership Leadership Briefing Briefing ID team, make plans before patient arrival Mutual Mutual Support Support CUS CUS Concerned, Uncomfortable, Safety Situation Situation Monitoring Monitoring STEP STEP Situation, Team members, Equipment, Patient Communication Communication Call-outs Call-outs Physical exam information, orders Check-backs Check-backs Three-step exchange between doctor and nurse to verify orders

Intervention Didactic session –Trauma Room Policies and Procedures “shared mental model” Simulation session –Two hours –METI HPS or Laerdal SimMan –Three scenarios –Facilitated video feedback

Subjects Trauma Faculty (n=5) Surgery Residents (n=28) ED Nurses (n=45)

Timeline Pre-trainingTrainingPost-training Nine months November, 2008 July, 2009

Measures Teamwork Behaviors –Trauma Team Performance Observation Tool –Trained Evaluators Efficiency Parameters –Arrival to CT, FAST, intubation, OR –Time in ED Global Outcome Parameters –Mortality, Complications, HLOS, ICU LOS

Teamwork Behaviors Pre training N=33 Post training N=40 P value Leadership Situation monitoring Mutual support Communication Total <0.001

Efficiency Pre-trainingPost-training P value NMeanSDNMeanSD Time to CT (min) Time to ETT (min) Time to OR (min) Time to FAST (min) Time in ED (min)

Global Pre-trainingPost-trainingP value NMeanSDNMeanSD ICU LOS (days) Hospital LOS (days) % without complication % alive at discharge ISS

Conclusions Structured trauma resuscitation team training augmented by simulation improves team performance Better teamwork improves efficiency of patient care in the trauma bay Larger study may show improved global outcomes

Recommendation Formal teamwork training augmented by simulation should be included in surgery residency training as well as ATLS