Improving medical emergency team (MET) performance using a novel curriculum and a computerized human patient simulator

Abstract

Problem: Advance cardiac life support (ACLS) training does not address coordination of team resources to improve the ability of teams to deliver needed treatments reliably and rapidly. Our objective was to use a human simulation training educational environment to develop multidisciplinary team skills and improve medical emergency team (MET) performance. We report findings of a crisis team training course that is focused on organization. Setting: Large center for human simulation training at a university affiliated tertiary care hospital. Participants: Ten courses were delivered and 138 clinically experienced individuals were trained (69 critical care nurses, 48 physicians, and 21 respiratory therapists). All participants were ACLS trained and experienced in responding to cardiac arrest situations. Course design: Each course had four components: (1) a web based presentation and pretest before the course; (2) a brief reinforcing didactic session on the day of the course; (3) three of five different simulated scenarios; each followed by (4) debriefing and analysis with the team. Three of five simulator scenarios were used; scenario selection and order was random. Trainees did not repeat any scenario or role during the training. Participants were video recorded to assist debriefing. Debriefing focused on reinforcing organizational aspects of team performance: assuming designated roles independently, completing goals (tasks) assigned to each role, and directed communication. Measures for improvement: Participants graded their performance of specific organizational and treatment tasks within specified time intervals by consensus. Simulator ''survival'' depended on supporting oxygenation, ventilation, circulation within 60 seconds, and delivering the definitive treatment within 3 minutes. Effects of change: Simulated survival (following predetermined criteria for death) increased from 0% to 89%. The initial team task completion rate was 10-45% and rose to 80-95% during the third session. Lessons learnt: Training multidisciplinary teams to organize using simulation technology is feasible. This preliminary report warrants more detailed inquiry.

Development of Crisis Resource Management Skills: A Literature Review

“…According to Ten Eyck et al (2010), tasks were selected based on the criteria that they were "clear and measurable" (p. 141). It was suggested that task completion is an objective measure (DeVita et al, 2005) and "less susceptible to inter-rater differences" (p. 330). Lavigne Fadale et al (2014) reported 100% interrater reliability.…”

“…As noted above, all of the studies reviewed included simulation-based learning using a high-fidelity simulator. Thirteen studies compared pre-test and post-test results following an HFS learning program (Buckley & Gordon, 2011;Dadiz et al, 2013;DeVita et al, 2005;Gilfoyle et al, 2007;Huseman, 2012;Jankouskas et al, 2007;Liaw et al, 2011;Przybyl et al, 2015;Schubert, 2012;Shinnick & Woo, 2013;Sittner et al, 2009;Straka et al, 2012;Wolf, 2008). Standard education was compared to standard education plus HFS learning in four studies (Hall, 2015;Jankouskas et al, 2011;Maneval et al, 2012;Singer et al, 2013).…”

“…In the remaining studies, assessment measures varied. The "time to task", or the time that elapsed before performance of key behaviours, was used in four studies (DeVita et al, 2005;Lavigne Fadale et al, 2014;Meurling, 2015;TenEyck et al, 2010). According to Ten Eyck et al (2010), tasks were selected based on the criteria that they were "clear and measurable" (p. 141).…”

Evaluation of TEAM dynamics before and after remote simulation training utilizing CERTAIN platform

“…Clinical experience alone has not been associated with improved team performance [5]; therefore, training programs are focusing on team dynamics during medical crises as a point of improvement. Since team dynamics can be taught and practiced in simulated environments [6,7], various types of simulation have been developed – computer-based, manikin, and standardized patient [2,3,8]. These training tools may not be available in many hospitals and training facilities in low-middle income countries.…”

“…Since interprofessional teamwork has been linked with patient outcomes [1] and team dynamics can be improved with simulation [6,7], we set out to determine if team dynamics can be improved via remote simulation in resource-limited areas. The original purpose of the simulations was to assess the effectiveness of CERTAIN-ELITE training; however, we wanted to utilize this pre-existing platform to assess the effects of remote simulation on team dynamics.…”