1. 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

2. 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

3. 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

4. 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

5. 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

6. 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

7. 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).

8. 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

9. 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.

10. 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

11. 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

12. 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