Cincinnati Children's Hospital is one of the busiest paediatric emergency departments (ED) in the USA; high volume, high acuity and frequent interruptions contribute to an increased risk for error.
To improve patient safety in a paediatric ED by implementing a multidisciplinary, simulation-based curriculum emphasising teamwork and communication.
Subjects included all healthcare providers in the ED. Multidisciplinary teams participated in simulation-based training focused on teamwork and communication behaviours in critical clinical scenarios. The Safety Attitudes Questionnaire, tests of knowledge and evaluations of critical simulations and actual performance in the ED resuscitation bay were assessed. Methods to sustain improvements included mandatory participation of all new staff in simulation-based training and the introduction of routine in situ simulations.
289 participants attended the initial training. 151 participants attended the re-evaluation at a mean of 10.2 months later. Sustained improvements in knowledge and attitudes were demonstrated. Knowledge tests at baseline, postintervention and re-evaluation had scores of 86%, 96% and 93%, respectively. Friedman's test analysis of SAQ scores at baseline, postintervention and re-evaluation indicated significant attitude changes. The ED with a preintervention baseline of 2–3 patient safety events per year has now sustained more than 1000 days without a patient safety event. This improvement occurred even though the time required in initial simulation training has been condensed from 12 to 4 h.
Simulation training is an effective tool to modify safety attitudes and teamwork behaviours in an ED. Sustaining cultural and behavioural changes requires repeated practice opportunities.
Effective teamwork facilitates collective learning, which is integral to safety culture. There are no rigorous evaluations of the impact of team training on the four components of safety culture—reporting, just, flexible and learning cultures. We evaluated the impact of a year-long team training programme on safety culture in 24 hospitals using two theoretical frameworks.
We used two quasi-experimental designs: a cross-sectional comparison of hospital survey on patient safety culture (HSOPS) results from an intervention group of 24 hospitals to a static group of 13 hospitals and a pre-post comparison of HSOPS results within intervention hospitals. Dependent variables were HSOPS items representing the four components of safety culture; independent variables were derived from items added to the HSOPS that measured the extent of team training, learning and transfer. We used a generalised linear mixed model approach to account for the correlated nature of the data.
59% of 2137 respondents from the intervention group reported receiving team training. Intervention group HSOPS scores were significantly higher than static group scores in three dimensions assessing the flexible and learning components of safety culture. The distribution of the adoption of team behaviours (transfer) varied in the intervention group from 2.8% to 31.0%. Adoption of team behaviours was significantly associated with odds of an individual reacting more positively at reassessment than baseline to nine items reflecting all four components of safety culture.
Team training can result in transformational change in safety culture when the work environment supports the transfer of learning to new behaviour.
Oncology care is delivered largely in ambulatory settings by interdisciplinary teams. Treatments are often complex, extended in time, dispersed geographically and vulnerable to teamwork failures. To address this risk, we developed and piloted a team training initiative in the breast cancer programme at a comprehensive cancer centre.
Based on clinic observations, interviews with key staff and analyses of incident reports, we developed interventions to address four high-risk areas: (1) miscommunication of chemotherapy order changes on the day of treatment; (2) missing orders on treatment days without concurrent physician appointments; (3) poor follow-up with team members about active patient issues; and (4) conflict between providers and staff. The project team developed protocols and agreements to address team members’ roles, responsibilities and behaviours.
Using a train-the-trainer model, 92% of breast cancer staff completed training. The incidence of missing orders for unlinked visits decreased from 30% to 2% (p<0.001). Patient satisfaction scores regarding coordination of care improved from 93 to 97 (p=0.026). Providers, infusion nurses and support staff reported improvement in efficiency (75%, 86%, 90%), quality (82%, 93%, 93%) and safety (92%, 92%, 90%) of care, and more respectful behaviour (92%, 79%, 83%) and improved relationships among team members (91%, 85%, 92%). Although most clinicians reported a decrease in non-communicated changes, there was insufficient statistical power to detect a difference.
Team training improved communication, task coordination and perceptions of efficiency, quality, safety and interactions among team members as well as patient perception of care coordination.
Communication failures in healthcare teams are associated with medical errors and negative health outcomes. These findings have increased emphasis on training future health professionals to work effectively within teams. The Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS) communication training model, widely employed to train healthcare teams, has been less commonly used to train student interprofessional teams. The present study reports the effectiveness of a simulation-based interprofessional TeamSTEPPS training in impacting student attitudes, knowledge and skills around interprofessional communication.
Three hundred and six fourth-year medical, third-year nursing, second-year pharmacy and second-year physician assistant students took part in a 4 h training that included a 1 h TeamSTEPPS didactic session and three 1 h team simulation and feedback sessions. Students worked in groups balanced by a professional programme in a self-selected focal area (adult acute, paediatric, obstetrics). Preassessments and postassessments were used for examining attitudes, beliefs and reported opportunities to observe or participate in team communication behaviours.
One hundred and forty-nine students (48.7%) completed the preassessments and postassessments. Significant differences were found for attitudes toward team communication (p<0.001), motivation (p<0.001), utility of training (p<0.001) and self-efficacy (p=0.005). Significant attitudinal shifts for TeamSTEPPS skills included, team structure (p=0.002), situation monitoring (p<0.001), mutual support (p=0.003) and communication (p=0.002). Significant shifts were reported for knowledge of TeamSTEPPS (p<0.001), advocating for patients (p<0.001) and communicating in interprofessional teams (p<0.001).
Effective team communication is important in patient safety. We demonstrate positive attitudinal and knowledge effects in a large-scale interprofessional TeamSTEPPS-based training involving four student professions.
Whether for team training, research or evaluation, making effective use of simulation-based technologies requires robust, reliable and accurate assessment tools. Extant literature on simulation-based assessment practices has primarily focused on scenario and instructional design; however, relatively little direct guidance has been provided regarding the challenging decisions and fundamental principles related to assessment development and implementation.
The objective of this manuscript is to introduce a generalisable assessment framework supplemented by specific guidance on how to construct and ensure valid and reliable simulation-based team assessment tools. The recommendations reflect best practices in assessment and are designed to empower healthcare educators, professionals and researchers with the knowledge to design and employ valid and reliable simulation-based team assessments.
Information and actionable recommendations associated with creating assessments of team processes (non-technical ‘teamwork’ activities) and performance (demonstration of technical proficiency) are presented which provide direct guidance on how to Distinguish the underlying competencies one aims to assess, Elaborate the measures used to capture team member behaviours during simulation activities, Establish the content validity of these measures and Proceduralise the measurement tools in a way that is systematically aligned with the goals of the simulation activity while maintaining methodological rigour (DEEP).
The DEEP framework targets fundamental principles and critical activities that are important for effective assessment, and should benefit healthcare educators, professionals and researchers seeking to design or enhance any simulation-based assessment effort.