Division of Emergency Medicine Cincinnati Children’s Hospital

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Presentation transcript:

Division of Emergency Medicine Cincinnati Children’s Hospital Implementation of a multidisciplinary simulation based teamwork training in a pediatric Emergency Dept Division of Emergency Medicine Cincinnati Children’s Hospital

Introduction 1999 Institute of Medicine (IOM) report: To Err is Human: Recommended: Safety programs should… establish interdisciplinary team training programs for providers that incorporate proven methods of team training such as simulation

Specific aims Implement a multidisciplinary simulation-based safety curriculum in a pediatric ED Evaluate long term clinical impact by reduction of adverse events in the ED

Specific aims Intermediate measures Evaluate the effectiveness of this curriculum by assessing Knowledge Attitudes towards patient safety Teamwork behaviors Pre and post intervention as well as at a follow up reevaluation

Implementation Simulation based multidisciplinary teamwork, communication and error reduction training since March 2005 Plan Simulations to Reinforce Behaviors Around Difficult Concepts Equipment failures, difficult vascular access or difficult airways force teams to respond to critical scenarios in a time pressured environment Set up situations in which staff must use assertive statements, challenge authority gradient, etc

Project Results/Outcomes Through June 30, 2007 a total of 224 ED personnel - participated in initial teamwork training course 119 participants completed a re-evaluation session mean of 9.3 months (SD 3.3 months) after their initial training course

Results: Knowledge The pre and post tests for knowledge mean pre-test score of 85.5% and a mean post test score of 95.8%. The paired t test p <0.001. Retention of knowledge at the reevaluation utilizing a parallel post-test. Mean of 9.3 months post intervention Knowledge scores averaged 94% (SD: 7.5).

Results: Attitude Safety Attitudes Questionnaire: pre and post intervention for demonstrated improved Z values. p < 0.001, Repeated SAQ at the reevaluations at a mean of 9.3 months post intervention No continued improvement in attitude after intervention… But initial gain in attitude improvement sustained over 9 mos. Peter Pronovost study of Michigan Hospitals and ICU attitude= Rate of BSI related to % with safe attitude

Video review 5 video reviewers reviewed pre and post intervention simulations using Sexton’s Behavioral Markers scale Trend in improved score post intervention, not statistically significant at this time.

Project Results/Outcomes Unexpected Finding Twenty four latent safety threats and systems issues were identified during the multidisciplinary debriefings currently being addressed through ED operations and patient safety committees

Clinical Translation Baseline SSE rate 2-3 per year Result: Knowledge is important-but simulation (practice) reinforces the behavior we wish to see without harming patients Measure: ED has gone almost 18 months without a SSE Knowledge + Practice = Behavior Change

Real World Challenges Initial training intervention over > 1year Difficulty assessing contribution of simulation training as a special cause due to other changes in the environment Due to mix of providers working in ED, difficult to assess the impact of the training in the clinical environment due to mixed teams Staff turnover and new hires ensures that some fraction of providers will not be trained at any one time