ObjectiveThis study aimed to determine the effectiveness of a proficiency-based progression (PBP) training approach to clinical communication in the context of a clinically deteriorating patient.DesignThis is a randomised controlled trial with three parallel arms.SettingThis study was conducted in a university in Ireland.ParticipantsThis study included 45 third year nursing and 45 final year medical undergraduates scheduled to undertake interdisciplinary National Early Warning Score (NEWS) training over a 3-day period in September 2016.InterventionsParticipants were prospectively randomised to one of three groups before undertaking a performance assessment of the ISBAR (Identification, Situation, Background, Assessment, Recommendation) communication tool relevant to a deteriorating patient in a high-fidelity simulation facility. The groups were as follows: (i) E, the Irish Health Service national NEWS e-learning programme only; (ii) E+S, the national e-learning programme plus standard simulation; and (iii) E+PBP, the national e-learning programme plus PBP simulation.Main outcome measuresThe primary outcome was the proportion in each group reaching a predefined proficiency benchmark comprising a series of predefined steps, errors and critical errors during the performance of a standardised, high-fidelity simulation assessment case which was recorded and scored by two independent blinded assessors.Results6.9% (2/29) of the E group and 13% (3/23) of the E+S group demonstrated proficiency in comparison to 60% (15/25) of the E+PBP group. The difference between the E and the E+S groups was not statistically significant (χ2=0.55, 99% CI 0.63 to 0.66, p=0.63) but was significant for the difference between the E and the E+PBP groups (χ2=22.25, CI 0.00 to 0.00, p<0.000) and between the E+S and the E+PBP groups (χ2=11.04, CI 0.00 to 0.00, p=0.001).ConclusionsPBP is a more effective way to teach clinical communication in the context of the deteriorating patient than e-learning either alone or in combination with standard simulation.Trial registration numberNCT02886754; Results.

(2016) Towards the development of a decision support system for multi-agency decisionmaking during cross-border emergencies, Journal of Decision Systems, 25:sup1, 381-396, DOI: 10.1080/12460125.2016 ABSTRACTDeveloping decision support systems for emergency situations is a complex and challenging task. These difficulties are compounded further in the case of cross-border emergencies, which often require the coordination and collaboration of independent agencies. These agencies have different structures and resources in place, and follow their own internal policies and procedures. If a number of countries have been affected, agencies may not even share the same language. Large-scale disasters, whether natural, deliberate, or accidental do not respect borders and come with a high risk to human life and a variety of economic and health impacts. Thus, it is the aim of the S-HELP (Securing-Health Emergency Learning Planning) project to develop a decision support tool-set that supports multi-agency decision-making during cross-border emergencies. S-HELP seeks to provide a tool-set that supports rapid and effective decisionmaking across all stages of the emergency management lifecycle (i.e. mitigation, preparedness, response, and recovery). To address the challenges associated with multi-agency emergency management, a holistic framed approach to healthcare preparedness, response, and recovery is proposed. This holistic framework has been created to guide the development of the S-HELP solution. The framework integrates a number of components important in the phased iterative development of an emergency management decision support system, such as, interoperability standards, risk communication, spatial data management, agile development, healthcare responder training, and scenario development for system evaluation.

(2016) The creation of a training model to support decisionmaking of emergency management practitioners: a design research study, Journal of Decision Systems, 25:sup1, 558-565, DOI: 10.1080/12460125.2016 Errors in decision-making worldwide highlight the need for training in decision-making. The unpredictability and complexity of emergencies makes training in every possible emergency impossible. Rather than training in specific examples of major emergency events, training in a decision-making skill set will provide a method of response that will be transferable to all emergencies. Various scenarios will support the training as a decision needs a context for application. The resulting educational tool will focus on emergency services at the strategic and tactical levels in the response stage of an emergency. The continual engagement of stakeholder should result in a purpose-built training course. Design science research approach will be utilised, investigating connections between theories of cognitive load and expert performance. Key aspects of the developed training course will include the concepts of metrics, deliberate practice and proficiency based progression, to ensure an appropriate training programme rather than a mere educational experience.

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