Introduction: Crisis Resource Management (CRM) is a team training tool used in healthcare to enhance team performance and improve patient safety. Our program intends to determine the feasibility of high-fidelity simulation for teaching CRM to an interprofessional team in a community hospital and whether a microdebriefing intervention can improve performance during simulated pediatric resuscitation. Methods: We conducted a single-center prospective interventional study with 24 teams drawn from 4 departments. The program was divided into an initial assessment simulation case (pre), a 40-minute microdebriefing intervention, and a final assessment simulation case (post). Post and pre results were analyzed for each team using t tests and Wilcoxon signed-rank tests. Primary outcome measures included (a) completion of program, (b) percent enrollment, (c) participant reaction, and (d) support of continued programs on completion. Secondary outcomes included (a) change in teamwork performance, measured by the Clinical Teamwork Scale; (b) change in time to initiation of chest compressions and defibrillation; and (c) pediatric advanced life support adherence, measured by the Clinical Performance Tool. Results: We successfully completed a large-scale training program with high enrollment.Twenty-four teams with 162 participants improved in Clinical Teamwork Scale scores (42.8%-57.5%, P < 0.001), Clinical Performance Tool scores (61.7%-72.1%, P < 0.001), and time to cardiopulmonary resuscitation initiation (70.6-34.3 seconds, P < 0.001). Conclusions: Our center ran a well-attended, well-received interprofessional program in a community hospital site demonstrating that teaching CRM skills can improve simulated team performance in a diverse experienced cohort.

Lemierre's syndrome is an acute oropharyngeal infection with a secondary septic thrombophlebitis of the internal jugular vein (IVJ) that was first reported in literature in 1936. It involves the progression of disease from a focal suppurative peritonsillar infection to a local septic thrombophlebitis with hematogenous progression to and distant septic emboli. It is a rare and potentially fatal syndrome requiring prompt diagnosis and management. We present the case progression of an 18-year-old male who presented to our hospital with resolved sore throat, fever, and chest discomfort who experienced a sharp clinical decline. His case, physical exam, laboratory abnormalities, and radiologic studies highlight important facets of this rare but important syndrome.

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IntroductionTeamwork training is critical in the development of high-functioning rapid response teams (RRT). Rapid response teams involve interactions between a patient's core care team and a hospital contingency team, which can lead to disorganized and unsafe resuscitations, largely due to problems with communication and information dissemination. An extensive literature search found no assessment tools specific to the unique communicative challenges of an RRT, and thus, this study sought to develop an assessment rubric validated for training RRTs.MethodsThis study elucidates the development, implementation, and testing of an RRT rubric based on Kane's framework for validating testing instruments. Twenty-four inpatient code teams underwent team training using a Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS) didactic, an online module on the TeamSTEPPS RRT program, and a subsequent presimulation and postsimulation experience. Two raters were randomized to give a bedside assessment for each team using the proposed RRT rubric. Simulation scores were assessed with Wilcoxon signed-rank tests. Interrater reliability was assessed using intraclass correlation coefficients. These analyses were then used to argue Kane's scoring, generalization, and extrapolation inferences.ResultsAll teams significantly improved from the presimulation to postsimulation scenarios across all TeamSTEPPS domains. Content validity was obtained from 5 resuscitation experts with a scale-level content validity index of 0.9, with individual content validity index of 0.8 to 1.0. Intraclass correlation coefficient for “pre” scores were 0.856 (n = 24, P < 0.001), “post” scores of 0.738 (n = 24, P < 0.001), and a total of 0.890 (n = 48, P < 0.001).ConclusionsThe authors argue for the validity of a new RRT rubric based off Kane's framework, with a specific focus on teamwork training to improve coordination and function of core and contingency teams. A follow-up study with longitudinal data along with external validation of this rubric is needed.