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Journal Club- Arrowe Park Hospital October 2013 Dr Binu T George Robert W. Frengley, et al, Crit Care Med 2011 Vol. 39, No. 12 2605.

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Presentation on theme: "Journal Club- Arrowe Park Hospital October 2013 Dr Binu T George Robert W. Frengley, et al, Crit Care Med 2011 Vol. 39, No. 12 2605."— Presentation transcript:

1 Journal Club- Arrowe Park Hospital October 2013 Dr Binu T George Robert W. Frengley, et al, Crit Care Med 2011 Vol. 39, No. 12 2605.

2  Topic : Training in intensive/Critical care  1. MEDLINE; exp *INTENSIVE CARE/ OR exp *INTENSIVE CARE UNITS/ OR exp *CRITICAL CARE/; 50375 results.  2. MEDLINE; exp *EDUCATION, MEDICAL, GRADUATE/ OR exp *EDUCATION, MEDICAL/ OR exp *EDUCATION, MEDICAL, CONTINUING/; 94391 results.  3. MEDLINE; 1 AND 2; 516 results. 4. MEDLINE; 3 [Limit to: English Language and Humans and Publication Year 2010-Current]; 132 results  Manually went through 132- picked out 8 relevent studies

3  The effect of a simulation based training intervention on the performance of established critical care unit teams (Robert W Frengley,Jennifer M Weller,Jane Tirrie,Peter Dzendrowskyj Critical Care Med 2011;39:2605-2611)

4 Evaluation of the effectiveness of a simulation based intervention on improving teamwork in multidisciplinary critical care teams managing airway and cardiac crises Comparison of simulation-based learning and case-based learning

5  The Institute of Medicine in its publication To Err Is Human issued a number of recommendations to enhance patient safety  “to train in teams those who are expected to work in teams.”  Evidence suggests that teams make fewer mistakes than individuals and that good team work improves patient safety  Evidence also suggests team work failures make substantial contributions to sub optimal patient care  In the critical care unit, teamwork is of particular importance in optimizing patient outcome in clinical crises, including emergency airway or cardiac events.

6 METHODS Self-controlled randomized crossover study design with blinded assessors. Setting: A simulated critical care ward, using a high-fidelity patient simulator, in a university simulation center. Subjects: Forty teams from critical care units - 1 doctor and 3 nurses Intervention: 10 hour study day Assessment done at Beginning and End of the day Each team undertook 2 pre-intervention and 2 post intervention assessments The study day included Presentations and discussions on human factors and crisis management Airway and Cardiac skills stations. For the intervention, teams were randomized to Case-based learning or Simulation-based learning (for cardiac or airway scenarios) Measurements: Recording and analysis done by 3 blinded expert assessors Structured rating tool was used with technical and behavioral components. Participants were surveyed 3 months later.





11 Paucity of literature documenting outcomes of MDT training interventions Case control study Wayne DB,Didwala A,Fienglass – Simulation based education improved quality of care during cadiac arrest team responses ( CHEST 2008;133:56-61) Steadman RH, Coates WC,Huang YM/;simulation based training is superior to problem based learning for acquisition of critical assessment and management skills (Critical care Med 2006;34:151-157)

12  Simulation-based intervention is effective in improving performance in multidisciplinary critical care teams  There is improved performance in the simulator after the course  There have been self reported changes to subsequent clinical practice  Supports that there is transfer of learning from simulation to the workplace over a period of time.  Results suggest that a mix of SBL and CBL is effective

13  Quality of evidence 1 b (individual RCT with narrow confidence interval)  Responder Bias  Demonstrating objective,improved patient outcome beyond scope of this study  Trend suggesting SBL better than CBL –small sample size, hence no statistical difference demonstrated

14  Good evidence to suggest SBL improves team work behaviour and overall effectiveness of team  SBL and CBL combined makes better learning envoirnment  Further scope for research with larger groups to improve statistical difference between SBL and CBL

15  1. Institute of Medicine: To Err Is Human: Building a Safer Health System. Washington, DC, National Academy Press, 2000  2. Manser T: Teamwork and patient safety in dynamic domains of healthcare: A review of the literature. Acta Anaesthesiol Scand 2009; 53:143–151  3. Volpe CE, Cannon-Bowers JA, Salas E: The impact of cross-training on team function-  ing: An empirical investigation. Hum Factors  1996; 38:87–100 4. Smith-Jentsch KA, Salas E, Baker DP: Team  training performance related assertiveness.  Personnel Psychol 1996; 49:909–936 5. Bognor M (Eds): Human Error in Medicine. Hillsdale, NJ, Lawrence Erlbaum Association  Inc, 1994 6. Helmreich R: Threat and Error in Aviation  and Medicine: Similar and Different. Special Medical Seminar, Lessons for Health Care: Applied Human Factors Research. Australian Council of Safety and Quality in Health Care & NSW Ministerial Council for Quality in Health Care, Department of Communica- tions, Information Technology and the Arts, Canberra, Australia, 2000; available at http:// Accessed July 13, 2011  7. Reader TW, Flin R, Cuthbertson BH: Com- munication skills and error in the intensive care unit. Curr Opin Crit Care 2007; 13: 732–736  8. Reason J: Human Error. First Edition. Cam- bridge, UK, Cambridge University Press, 1990  9. Webb RK, Currie M, Morgan CA, et al: The Australian Incident Monitoring Study: An analysis of 2000 incident reports. Anaesth Intensive Care 1993; 21:520 –528  10. Li J, Murphy-Lavoie H, Bugas C, et al: Com- plications of emergency intubation with and without paralysis. Am J Emerg Med 1999; 17:141–143  11. Schwartz DE, Matthay MA, Cohen NH: Death and other complications of emergency air- way management in critically ill adults. A prospective investigation of 297 tracheal in- tubations. Anesthesiology 1995; 82:367–376  12. Stauffer JL, Olson DE, Petty TL: Complica- tions and consequences of endotracheal in- tubation and tracheotomy: A prospective study of 150 critically ill adult patients. Am J Med 1981; 70:65–76  13. Le Tacon S, Wolter P, Rusterholtz T, et al: Complications of difficult tracheal intuba- tions in a critical care unit. Ann Fr Anesth Reanim 2000; 19:719 –724  14. Mort TC: Emergency tracheal intubation: Complications associated with repeated la- ryngoscopic attempts. Anesth Analg 2004; 99:607– 613  15. Nolan J, Baskett P: ERC guidelines. Resusci- tation 2005; 67:S1–S189

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