Division of Emergency Medicine

1
Implementation of a multidisciplinary simulation
based teamwork training in a pediatric Emergency
Dept

• Division of Emergency Medicine
• Cincinnati Childrens 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 aimsIntermediate 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 lt0.001.
• 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 lt 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.

9
Video review

• 5 video reviewers reviewed pre and post
  intervention simulations using Sextons
  Behavioral Markers scale
• Trend in improved score post intervention, not
  statistically significant at this time.

10
Project Results/OutcomesUnexpected 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 gt 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