1. 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

2. 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

3. 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

4. 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?

5. Methods DesignInterventionSubjectsTimelineMeasurement

6. Design Pre/post intervention study Quality improvement project

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

8. 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

9. 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

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

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

12. 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

13. Teamwork Behaviors Pre training N=33 Post training N=40 P value Leadership2.873.460.003 Situation monitoring 3.303.910.009 Mutual support 3.403.960.004 Communication2.903.460.001 Total3.123.70<0.001

14. Efficiency Pre-trainingPost-training P value NMeanSDNMeanSD Time to CT (min) 12426.414.517422.111.70.005 Time to ETT (min) 2110.16.8226.64.20.049 Time to OR (min) 46130.182.74794.563.80.021 Time to FAST (min) 1238.35.72219.67.80.131 Time in ED (min) 176186.1151.0263187.4159.30.930

15. Global Pre-trainingPost-trainingP value NMeanSDNMeanSD ICU LOS (days) 735.526.37886.326.820.445 Hospital LOS (days) 1767.6313.992636.255.810.210 % without complication 17670.4526376.800.113 % alive at discharge 17686.9326391.540.121 ISS 17613.9711.8526311.6311.040.036

16. 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

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