Patient safety curriculum elements and order of delivery
| Curriculum element | Delivery method | Content |
|---|---|---|
| Prework (advance organiser) Mandatory completion by participants prior to attending course | Intranet-based and interactive | Scope and type of medical errors Paediatric ED as a high risk environment A systems approach to error Development of CRM and its impact in aviation CRM concepts and techniques Definition of teams, communication techniques and foundations of teamwork |
| Day 1: Introduction to course | Instructor presented | Standard orientation to simulation environment, simulator(s) and behavioural expectations including confidentiality |
| Initial simulation and debriefing (baseline) | Simulation | Critical trauma patient. Team's initial exposure to simulation and video assisted debriefing with emphasis on teamwork and communication |
| ED as a high risk environment | Mini-lecture | Scope and magnitude of error, ED as a high risk environment, types of errors, systems approach to error |
| Aviation case study video and facilitated discussion | Video simulation of Tenerife disaster | Participant analysis of the factors that led to this disaster. Discussion linking high risk elements of this situation to the ED |
| CRM principles | Mini-lecture including video | CRM principles, teamwork and communication techniques, videos illustrating CRM techniques |
| Simulation and debriefing | Simulation | Critical medical patient presenting with shock and experiencing iatrogenic adverse drug event |
| Situational awareness and obstacles to teamwork | Mini-lecture and interactive video exercise | Video exercise demonstrates the difficulty of maintaining situation awareness in face of multiple competing demands for attention. Situation awareness deficit in video exercise linked to complex and competing demands in ED |
| Simulation and debriefing | Simulation | Critical medical patient with infrequently seen condition requiring rapid stabilisation. Entire team needs to actively participate to complete successfully |
| Day 1: Summary and evaluation | Instructor facilitated | Debriefing of day's activities, questions, summary |
| Day 2: Introduction and summary of day 1 activities | Instructor facilitated | Brief summary of key CRM concepts and behavioural expectations. Day 2 activities emphasise utilisation of the techniques and tools presented during day 1 |
| Simulation and debriefing Three scenarios presented and debriefed consecutively | Simulation | Critical trauma patient requiring rapid stabilisation. Scripted authority gradient and team leader's actions result in severe complications if not addressed by team. Authority gradient, assertive statements and ‘pinch’ addressed |
| Critical medical patient. An equipment malfunction prevents delivery of adequate tidal volume to patient. Team members need to identify the cause and address the patient's deteriorating condition | ||
| Critical medical patient with confusing presentation. Team needs to identify alternative aetiologies of presentation as well as address iatrogenic complications of therapy | ||
| Day 2: Summary and evaluation | Instructor facilitated | Debriefing, summary, course evaluation, knowledge test and SAQ completion |
Simulation denotes manikin-based simulation and video assisted debriefing.
CRM, crew resource management; ED, emergency department; SAQ, Safety Attitudes Questionnaire.