Simulation-based theatre team training : A pilot course to improve team working and patient safety

Abstract

Introduction: Ahead of the Chief Medical Officer’s report[1] we started to setup an interprofessional clinical team simulation-based training programme supported by senior clinicians and CPD funding from the East of England SHA. The aim is to raise patient safety awareness by training around 400 healthcare professionals from different clinical areas using high-fidelity scenario-based simulation. Methods: A pilot session was organised for two theatre teams from different hospitals. A training programme for the day was developed and included short lectures presenting key Crisis Resource Management[2] principles, tools from the TeamSTEPPS training package (SBAR, 2-challenge rule, check backs,…), a workshop on difficult airway management, and five anaesthetic scenarios (local anaesthetic toxicity, malignant hyperpyrexia and various difficult airway management cases) followed by debriefing. Each scenario encouraged participants to make use of what they had previously learnt. One faculty member acted as the surgeon in each scenario. A pre- and post-session Likert scale evaluation questionnaire was distributed to all participants (1=strongly disagree and 5=strongly agree). Results: 22 participants including anaesthetists (n=10), operating department practitioners (n=2), theatre/anaesthetic/recovery nurses (n=10) attended the course and 18 questionnaires were returned. It was the first simulation experience for 61.1% of the respondents. !00% of the respondents thought simulation should be available for all staff from their discipline. When analysing the feedback by profession and performing oneway ANOVA analysis, the doctors seemed better predisposed to simulation training as they were more familiar with simulation (4.33 versus 3.00 and 2.60, P=0.022). Although the differences in the following results were not statistically significant, doctors were apparently looking more forward to the session than the ODPs and nurses (4.17 versus 3.50 and 3.70, P=0.448), less apprehensive (2.83 versus 4.00 and 4.22, P=0.060), comfortable with the simulated environment (4.33 versus 2.00 and 2.50, P=0.004), and reported the scenarios prompted realistic responses from them (4.17 versus 3.00 and 3.10, P=0.257). All participants thought the scenarios were realistic (4.61 SD 0.50), the debriefing was handled sensitively (4.24 SD 0.75), they learnt from taking part in a scenario (4.24 SD 0.75) and observing others (4.28 SD 0.83), they will change their practice because of what they learnt on the course (4.00 SD 0.69), and the course was enjoyable (4.67 SD 0.59) and will help me to practise more safely (4.22, SD 0.81). On average doctors would like to take part in two simulation sessions per year while ODPs would like one and nurses 1.56. Discussion: The results of the pilot session were very positive and show that doctors, especially in the more junior grades are already acquainted with simulation training. Such training opportunity is valuable for the whole healthcare team in order to improve patient safety. Qualitative feedback provided indicated that the sessions should be organised with smaller teams and to expose them to a greater number of short and focused scenarios. Our future efforts will concentrate also on organising sessions for teams from A&E, delivery suites, ITU, cardiology, and respiratory care to involve additional healthcare professions and disciplines.