The Impact of Telemedicine on Teamwork and Workload in Pediatric Resuscitation: A Simulation-Based, Randomized Controlled Study

Butler, Louise; Whitfill, Travis; Wong, Ambrose H.; Gawel, Marcie; Crispino, Lauren; Auerbach, Marc

doi:10.1089/tmj.2018.0017

Cited by 25 publications

(25 citation statements)

References 53 publications

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“…Teamwork can be facilitated through technology. Technology, such as telecommunication, facilitates teamwork as it creates the opportunity to involve and interact with professionals from a distance [271][272][273]. Technology also creates opportunities to exchange information through information platforms [276,277].…”

Section: Facilitating Toolsmentioning

confidence: 99%

Interventions to improve team effectiveness within health care: a systematic review of the past decade

2020

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Background: A high variety of team interventions aims to improve team performance outcomes. In 2008, we conducted a systematic review to provide an overview of the scientific studies focused on these interventions. However, over the past decade, the literature on team interventions has rapidly evolved. An updated overview is therefore required, and it will focus on all possible team interventions without restrictions to a type of intervention, setting, or research design. Objectives: To review the literature from the past decade on interventions with the goal of improving team effectiveness within healthcare organizations and identify the "evidence base" levels of the research. Methods: Seven major databases were systematically searched for relevant articles published between 2008 and July 2018. Of the original search yield of 6025 studies, 297 studies met the inclusion criteria according to three independent authors and were subsequently included for analysis. The Grading of Recommendations, Assessment, Development, and Evaluation Scale was used to assess the level of empirical evidence. Results: Three types of interventions were distinguished: (1) Training, which is subdivided into training that is based on predefined principles (i.e. CRM: crew resource management and TeamSTEPPS: Team Strategies and Tools to Enhance Performance and Patient Safety), on a specific method (i.e. simulation), or on general team training. (2) Tools covers tools that structure (i.e. SBAR: Situation, Background, Assessment, and Recommendation, (de)briefing checklists, and rounds), facilitate (through communication technology), or trigger (through monitoring and feedback) teamwork. (3) Organizational (re)design is about (re)designing structures to stimulate team processes and team functioning. (4) A programme is a combination of the previous types. The majority of studies evaluated a training focused on the (acute) hospital care setting. Most of the evaluated interventions focused on improving non-technical skills and provided evidence of improvements. Conclusion: Over the last decade, the number of studies on team interventions has increased exponentially. At the same time, research tends to focus on certain interventions, settings, and/or outcomes. Principle-based training (i.e. CRM and TeamSTEPPS) and simulation-based training seem to provide the greatest opportunities for reaching the improvement goals in team functioning.

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Section: Facilitating Toolsmentioning

confidence: 99%

Interventions to improve team effectiveness within health care: a systematic review of the past decade

2020

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“…While many studies described the use of provider-to-provider telemedicine involving a remote specialist, the optimal role for the provider delivering telemedicine and data on clinical efficacy is limited [20][21][22]. Butler et al [23] investigated the impact of telemedicine when involving a senior physician as a remote team leader and showed that workload (measured by NASA-TLX) was significantly increased with a remote leader. Fang et al [5] analyzed data from resuscitations with or without an additional telemedicine specialist as a team leader and demonstrated improvement in the quality of neonatal resuscitation.…”

Section: Discussionmentioning

confidence: 99%

“…There was no significant difference between the two groups in the subjectively perceived overall workload. Neonatal resuscitations are stressful events in most circumstances, and telemedicine is associated with increased workload compared to a physically present team leader [23]. Modalities need to be explored to decrease the workload when using telemedicine.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Two Telemedicine Delivery Modes for Neonatal Resuscitation Support: A Simulation-Based Randomized Trial

et al. 2020

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Introduction: Previous research has described technical aspects of telemedicine and the clinical impact of provider-topatient telemedicine; however, little is known about provider-to-provider telemedical interventions. Objective: The primary aim of this study was to compare two telemedicine delivery modes on the quality of a simulated neonatal resuscitation. Our secondary aim was to evaluate the providers' task load. Methods: This was a prospective, single-center, randomized, simulation-based trial comparing a remote neonatal team leader ("teleleader") versus a remote consultant ("teleconsultant"). Participants resuscitated a simulated, apneic, and bradycardic neonate. Performance was assessed by video review and task load was measured by the self-reported NASA task load index (NASA-TLX) tool. In the teleleader group, one remote neonatal specialist assumed the role of team leader in the resuscitation. In the teleconsultant group, the same remote specialist assumed the role of teleconsultant. Results: Twenty-two participants were included in the analyses. The teleleader group was associated with a higher overall checklist score compared to teleconsultants (median score 68%, interquartile range [IQR]: 66-69 vs. 58%, IQR: 42-62; p = 0.016). No significant difference was seen in overall subjective workload as measured by the NASA-TLX tool. However, mental demand and frustration were significantly greater with teleconsultants compared to teleleaders (mean mental demand: 14.1 vs. 17.0 out of 21; frustration: 7.9 vs. 14.7 out of 21). Conclusions: Simulated neonates randomized to teams with teleleaders received significantly better resuscitative care compared to those randomized to teams with teleconsultants. Mental demand and frustration were higher for providers in the teleconsultant compared to teleleader teams.

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“…Telesimulation occurs with either (1) one learner group remotely watching a simulation being performed by another group of learners and debriefing together, or (2) a remote instructor watching the learners and facilitating a debrief. This approach allows for extension of expensive and limited resources to help educate healthcare providers without access to traditional simulation [ 54 , 55 ]. During the SARS-CoV-2 pandemic, due to constraints on social gatherings, telesimulation was used in some institutions [ 56 , 57 ].…”

Section: Simulation Settingsmentioning

confidence: 99%

Recent Advances in Simulation for Pediatric Critical Care Medicine

2020

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Purpose of Review This review highlights the emerging fields of simulation research by tying innovation into principles of learning and process improvement. Recent Findings Advances have been made in both educational simulation and simulation for quality improvement, allowing this versatile modality to be more broadly applied to healthcare and systems. Summary Simulation in pediatric critical care medicine continues to evolve. Although the majority of simulation is focused on learner education, emerging research has broadened to focus on patient-and system-centered outcomes, leading to improvement in the quality of care delivered in the ICU.

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The Impact of Telemedicine on Teamwork and Workload in Pediatric Resuscitation: A Simulation-Based, Randomized Controlled Study

Abstract: In this simulation-based study, a telepresent team leader was associated with increased team workload compared to usual care. However, no differences were noted in teamwork and processes of care metrics.

Cited by 25 publications

References 53 publications

Interventions to improve team effectiveness within health care: a systematic review of the past decade

Interventions to improve team effectiveness within health care: a systematic review of the past decade

Comparison of Two Telemedicine Delivery Modes for Neonatal Resuscitation Support: A Simulation-Based Randomized Trial

Recent Advances in Simulation for Pediatric Critical Care Medicine

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