Effect of a simulation-based workshop on multidisplinary teamwork of newborn emergencies: an intervention study

Abstract

BackgroundVideo analyses of real-life newborn resuscitations have shown that Neonatal Resuscitation Program (NRP) guidelines are followed in fewer than 50 % of cases. Multidisciplinary simulation is used as a first-rate tool for the improvement of teamwork among health professionals. In the study we evaluated the impact of the crisis resource management (CRM) and anesthesia non-technical skills instruction on teamwork during simulated newborn emergencies.MethodsNinety-nine participants of two delivery units (17 pediatricians, 16 anesthesiologists, 14 obstetricians, 31 midwives, and 21 neonatal nurses) were divided to an intervention group (I-group, 9 teams) and a control group (C-group, 6 teams). The I-group attended a CRM and ANTS instruction before the first scenario. After each scenario the I-group performed either self- or peer-assessment depending on whether they had acted or observed in the scenario. All the teams participated in two and observed another two scenarios. All the scenarios were video-recorded and scored by three experts with Team Emergency Assessment Measure (TEAM). SPSS software and nlme package were used for the statistical analyses.ResultsThe total TEAM scores of the first scenario between the I- and C-group did not differ from each other. Neither there was an increase in the TEAM scoring between the first and second scenario between the groups. The CRM instruction did not improve the I-group’s teamwork performance. Unfortunately the teams were not comparable because the teams had been allowed to self-select their members in the study design. The total TEAM scores varied a lot between the teams. Mixed-model linear regression revealed that the background of the team leader had an impact on differences of the total teamwork scores (D = 6.50, p = 0.039). When an anesthesia consultant was the team leader the mean teamwork improved by 6.41 points in comparison to specialists of other disciplines (p = 0.043).ConclusionThe instruction of non-technical skills before simulation training did not enhance the acquisition of teamwork skills of the intervention groups over the corresponding set of skills of the control groups. The teams led by an anesthesiologist scored the best. Experience of team leaders improved teamwork over the CRM instruction.

The Effect of Simulation-Based Neonatal Emergency Team Training on Clinical Performance and Patient Outcome: A Systematic Review

“…Two cohort studies explored minor interventions related to simulation-based team training. Rovamo et al studied 99 doctors, nurses and midwives on a one day high-delity neonatal resuscitation course (23). Both intervention and control groups had the same simulation training, but in addition the intervention group received a 1-hour interactive lecture on crisis resource management (CRM) and anaesthesia non-technical skills principles.…”

Improving nontechnical skills of an interprofessional emergency medical team through a one day crisis resource management training

“…In their study on the effect of simulation-based workshops on multidisciplinary teamwork of newborn emergencies, Liisa Rovamo and colleagues showed that by using a global teamwork performance score known as TEAM (The Team Emergency Assessment Measure), the additional experience of team leaders improved teams’ performances over the course of CRM instruction. [ 7 ]…”

“…As the majority of clinical errors (approximately 70%) are the result of human factors [ 7 ] and they are not technical in nature (failure in team communication, situational awareness, resource utilization and leadership), [ 1 ] it seems reasonable that the primary focus should be on human factor training. One way to achieve this goal is crew resource management (CRM) training, a tool that was developed initially by the aviation industry and is considered to be largely responsible for the decrease in aircraft accidents over the last 4 decades [ 8 ]…”

Education, Implementation, and Teams

“…Seven out of these 10 randomized trials showed improved teamwork whereas 3 trials were neutral. 234,238,247 Thomas 246 randomized interns to receive a neonatal resuscitation course with team training or a standard course. The interns with team training exhibited more frequent team behaviors (number of episodes per minute [95% CI]) than interns in the control group: information sharing 1.06 (0.24, 1.17) versus 0.13 (0.00, 0.43); inquiry 0.35 (0.11, 0.42) versus 0.09 (0.00, 0.10); assertion 1.80 (1.21, 2.25) versus 0.64 (0.26, 0.91); and any team behavior 3.34 (2.26, 4.11) versus 1.03 (0.48, 1.30) (P < 0.008 for all comparisons).…”