Efficacy of simulation‐based trauma team training of non‐technical skills. A systematic review

Abstract

Trauma resuscitation is a complex situation, and most organisations have multi-professional trauma teams. Non-technical skills are challenged during trauma resuscitation, and they play an important role in the prevention of critical incidents. Simulation-based training of these is recommended. Our research question was: Does simulation-based trauma team training of non-technical skills have effect on reaction, learning, behaviour or patient outcome? The authors searched PubMed, EMBASE and the Cochrane Library and found 13 studies eligible for analysis. We described and compared the educational interventions and the evaluations of effect according to the four Kirkpatrick levels: reaction, learning (knowledge, skills, attitudes), behaviour (in a clinical setting) and patient outcome. No studies were randomised, controlled and blinded, resulting in a moderate to high risk of bias. The multi-professional trauma teams had positive reactions to simulation-based training of non-technical skills. Knowledge and skills improved in all studies evaluating the effect on learning. Three studies found improvements in team performance (behaviour) in the clinical setting. One of these found difficulties in maintaining these skills. Two studies evaluated on patient outcome, of which none showed improvements in mortality, complication rate or duration of hospitalisation. A significant effect on learning was found after simulation-based training of the multi-professional trauma team in non-technical skills. Three studies demonstrated significantly increased clinical team performance. No effect on patient outcome was found. All studies had a moderate to high risk of bias. More comprehensive randomised studies are needed to evaluate the effect on patient outcome.

Crew Resource Management in the Intensive Care Unit: a prospective 3‐year cohort study

“…Rather than focusing on individual failure, CRM aims to identify system flaws and uses standardized communication tools to improve process effectiveness and safety 9. The message of “good people are set up to fail in bad systems – let's figure out how to keep everyone safe” is more easily accepted than “you have a problem that needs to be corrected.”10 This approach is fundamentally different from conventional quality and safety programs in medicine that focus on limiting variation in human behavior through regulations, or scenario‐based team training, when these are not embedded in the more broad CRM approach 11, 12. Contrary to aviation, there is currently no international standard for medical CRM training.…”

Trauma team discord and the role of briefing

“…(9–12) Simulation also holds value as a method to assess team members’ cognitive and non-technical skills. (13, 14) Prior work from our institution described role confusion among physicians and nurses in interprofessional trauma teams.…”

Human Factors and Simulation in Emergency Medicine

“…[17][18][19] Investigators have applied HF principles to the study of trauma resuscitation, cardiac arrest, and other areas of emergency care. 13,[20][21][22][23][24][25][26][27][28][29] In particular, HF methods have been used to examine aspects of individual performance, such as task switching exhibited by EM residents 28,30 and clinical decision-making for medical students, paramedics, and nurses. [31][32][33][34][35] Human factor methods have also been used to examine EM team performance, such as communication in trauma settings 36,37 and task saturation for those involved in rapid response and critical care transport.…”