IntroductionIn today’s team-oriented healthcare environment, high-quality patient care requires physicians to possess not only medical knowledge and technical skills but also crisis resource management (CRM) skills. In emergency medicine (EM), the high acuity and dynamic environment makes CRM skills of physicians particularly critical to healthcare team success. The Accreditation Council of Graduate Medicine Education Core Competencies that guide residency program curriculums include CRM skills; however, EM residency programs are not given specific instructions as to how to teach these skills to their trainees. This article describes a simulation-based CRM course designed specifically for novice EM residents.MethodsThe CRM course includes an introductory didactic presentation followed by a series of simulation scenarios and structured debriefs. The course is designed to use observational learning within simulation education to decrease the time and resources required for implementation. To assess the effectiveness in improving team CRM skills, two independent raters use a validated CRM global rating scale to measure the CRM skills displayed by teams of EM interns in a pretest and posttest during the course.ResultsThe CRM course improved leadership, problem solving, communication, situational awareness, teamwork, resource utilization and overall CRM skills displayed by teams of EM interns. While the improvement from pretest to posttest did not reach statistical significance for this pilot study, the large effect sizes suggest that statistical significance may be achieved with a larger sample size.ConclusionThis course can feasibly be incorporated into existing EM residency curriculums to provide EM trainees with basic CRM skills required of successful emergency physicians. We believe integrating CRM training early into existing EM education encourages continued deliberate practice, discussion, and improvement of essential CRM skills.

Teams are the building blocks of the healthcare system, with growing evidence linking the quality of healthcare to team effectiveness, and team effectiveness to team training. Simulation has been identified as an effective modality for team training and assessment. Despite this, there are gaps in methodology, measurement, and implementation that prevent maximizing the impact of simulation modalities on team performance. As part of the 2017 Academic Emergency Medicine Consensus Conference "Catalyzing System Change Through Health Care Simulation: Systems, Competency, and Outcomes," we explored the impact of simulation on various aspects of team effectiveness. The consensus process included an extensive literature review, group discussions, and the conference "workshop" involving emergency medicine physicians, medical educators, and team science experts. The objectives of this work were to: 1) explore the antecedents and processes that support team effectiveness, 2) summarize the current role of simulation in developing and understanding team effectiveness, and 3) identify research targets to further improve team-based training and assessment, with the ultimate goal of improving healthcare systems.

ObjectiveThis article sought to define whether an alternative safety-engineered device (SED) could help prevent needlestick injury (NSI) in healthcare workers (HCWs) who place central venous catheters (CVCs).DesignThe study involved three phases: (1) A retrospective analysis of deidentified occupational health records from our tertiary care urban US hospital to clearly identify NSI risk and rates to an HCW during invasive catheter placement; (2) 95 residents were surveyed regarding their knowledge and experience with NSIs and SEDs; (3) A random sample of six residents participated in a focus group session discussing barriers to the use of SED.SettingA single urban US tertiary care teaching hospital.ParticipantsA retrospective analysis of NSI to HCWs in a tertiary care urban US hospital was conducted over a 4-year period (July 2007–June 2011). Ninety-five residents from specialties that often place CVC during training (surgery, surgical subspecialties, internal medicine, anaesthesia and emergency medicine) were surveyed regarding their experience with NSIs and SEDs. A random sample of six residents participated in a focus group session discussing barriers to the use of SED.Results314 NSIs were identified via occupational health records. 16% (21 of 131) of NSIs occurring in residents and fellows occurred during the securement of an invasive catheter such as a CVC. If an SED device had been used, the 5.25 NSIs/year could have been avoided. Each NSI occurring in an HCW incurred at least $2723 in charges. Thus, utilisation of the SED could have saved a minimum of $57 183 over the 4-year period.ConclusionsSEDs are currently available and can be used as an alternative to sharps. If safety and efficacy can be demonstrated, then implementation of such devices can significantly reduce the number of NSIs.

Introduction/Background: Healthcare worker (HCW) needlestick injuries (NSI) are associated with significant psychological stress for the provider. In addition, hospitals incur significant costs from occupational health testing, prophylaxis and follow-up that must be implemented for HCW NSI. The StatLock device is needleless safety engineered device (NSED) that uses an adhesive rather than sharps to secure a central venous catheter (CVC). The purpose of the study was to compare the effectiveness of live simulation practice to video instruction via a RCT to educate resident physicians to apply the alternative NSED to secure CVCs for future clinical use. Our hypothesis was that participants in the simulation based training group, (SBT) would be more likely to use the NSED to secure CVC and therefore sustain fewer NSIs as compared to the video (video) instruction group.Methods: Ninety five physicians likely to place CVCs during their training were enrolled in a randomized prospective longitudinal study to compare SBT to video instruction to teach HCW how to apply the alternative NSED. The SBT group was trained via active simulation practice to apply the device and allowed to practice until mastery. The video group watched the product video and participated in a question and answer session. All were queried regarding their prior knowledge and use of the NSED device and compensated if they returned in twelve months for a follow-up use questionnaire. NSI injury rates were monitored by the Division of Occupational Health and Safety within the institution and informed consent was given to view participants NSI records.Results: A total of 70 (81%), group participants completed the 12 month follow-up. The follow-up rates for the SBT and video groups were 95.6% and 67.3% respectively, indicating that those in the SBT group were more likely to return for 12 month follow up; p <0.001. Participants in the SBT group used the NSED more often in clinical practice n=22, as compared to video control group, n=8; p=0.034. There were a total of nine needlestick injuries to study subjects in the twelve month follow period. Five out of 9 (56%) of injuries occurred while suturing central lines. None of the injuries occurred while using the NSED device.Conclusion: Simulation trained HCW were more likely to adapt the use of alternative safety device to suture CVC in clinical practice. There was a 1 in 200 incidence of NSI to HCW while suturing CVC. Therefore, the potential number needed to treat (NNT) to prevent a single HCW NSI is 200 uses of the NSED. This study was underpowered to detect any differences in injury types or rates between the SBT and video groups. Future larger sample size studies are needed to determine if SBT to use this device will prevent HCW NSI.Introduction/Background: Nursing faculty are embracing simulation as an active teaching strategy to augment traditional classroom and clinical pedagogies, 1,2 but a gap remains in what is known about learning in simulation and if that learning transfers to the clinical setting....

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