Team Training in EM Residency Education CORD Academic Assembly 2012 Ryan Fringer, MD Christopher McDowell, MD MEd

Disclosures Dr. Fringer & Dr. McDowell have no financial conflicts or relationships to disclose

Goals Describe TeamSTEPPS and its role in EM Introduce team training to junior level residents Describe examples of team training assessment throughout residency Provide a framework for those wishing to add team training to their curriculum

The State of things in 2012 Teamwork Residents must care for patients in an environment that maximizes effective communication. This must include the opportunity to work as a member of effective interprofessional teams that are appropriate to the delivery of care in the specialty. VI.F.1. Interprofessional teams must be used to ensure effective and efficient communication for appropriate patient care for emergency medicine department admissions, transfers, and discharges. ACGME EM Program Requirements

How does this apply to EM? ACGME Systems-based Practice Trauma Teams Resuscitations Code Teams Can’t we extend team training from specific teams to our everyday pods Trauma Teams  everyday EM function

What Tools Exist to Help? TeamSTEPPS In house system resources Organizational Learning Department In-house funding (DIO, Hospital admin)

What is TeamSTEPPS? An evidence-based teamwork system Designed to improve: Quality Safety Efficiency of health care Practical and adaptable Provides ready-to-use materials for training and ongoing teamwork

TeamSTEPPS A framework for introducing the concepts of team training Designed by Dept of Defense 4 specific domains Leadership Communication Situation Monitoring Mutual Support Scalable to meet your needs

SMARTT Stepback in Trauma Bay S: Situation M: Management A: Activity R: Rapidity T: Troubleshooting T: Talk to Me

What TeamSTEPPS can do Emergency Department After implementation of multiple medical team training programs: Improved observed team behaviors. Enhanced staff attitudes toward teamwork. Reduced observed clinical errors. Medical Floors After implementation of SBAR to improve communication among clinical caregivers: Reduced rate of adverse drug events (from 30 to 18 per 1,000 patient days). Improved medication reconciliation at patient admission from 72% to 88% and at discharge from 53% to 89%.

Leadership Brief Huddle Debrief

Communication Call-out Airway? Patent and talking Check back (closing the loop) Fentanyl 50mcg nurse repeats Fentanyl 50mcg you say “correct” Handoffs

Situation Monitoring S: Status of the patient T: Teamwork E: Environment P: Progress toward patient goals

Mutual Support Culture Change & Empowerment Two challenge Rule Concerned Uncomfortable Safety Issue Stop the Line!

TeamSTEPPS at Beaumont Brief Timeline What worked What did not work Future directions

TeamSTEPPS at Beaumont Brief Timeline What worked What did not work Future directions

TeamSTEPPS Timeline September 2007 “Aha” moment March 2008 – TeamSTEPPS Consortium August 2008 – TeamSTEPPS Training October 2008 – Needs Assessment Jan – Dec 2009 – Facilitated Discussions Jan – Aug 2010 – Train the Trainers Aug 2010 – May 2011 – Comprehensive Training January 2011 – TeamSTEPPS “Go Live”

Needs Assessment This will guide your process Many methods to choose from Surveys Focused interviews Roundtable discussions Direct observation by trained observers In Situ simulation Exploratory, observational trips

Outcome Measures Very little data = opportunity Capella et al. LOS and other times Clinical Outcomes Safety Culture survey Nursing/Staff turnover Noise level monitoring

Take Home Points “Buy in” by all stakeholders is necessary Needs assessment is critical Role (re)definition needs to be individualized Process/culture change takes a long time Outcome measures? for any questions or