Multidisciplinary Simulation-based Team Training Course to Improve Patient Safety

Abstract

Context – This project was done in the University of Hertssimulation centre in collaboration with Lister hospital. Anaesthetists, obstetricians, nurses, midwives and operating department practitioners from a large general hospital in England participated in this project. Problem– Human errors negatively impact patient outcomes and are exacerbated by unpredictability, particularly during crisis situations such as in theatre or intensive care unit. During an acute decline in patient stability, urgent interventions necessitate rapid clinical assessments, good decision making and effective team performance. Recent report by the CMO identified that the human factors should be an integral part of training to health care teams to enhance patient safety. Assessment of problem and analysis of its causes- Multiprofessional team training in healthcare is very limited, and the acute crisis situations occur rarely (eg-malignant hyperpyrexia, failed intubation) and when they occur the acuity of the situation is such that there is limited time for teaching and training. Feedback regarding their team members rarely happens. These were confirmed by our staff and trainees. Training in non-technical skills is very poor and hence the Department of Health’s initiative is to improve human factor training for healthcare professionals, and there is a real need for change in training. Strategy for change– High-fidelity simulation is increasingly recognised as a vital part of building a safer healthcare and its use is particularly recommended to enhance human factors’ training.2 However, simulation training is expensive with the limited study leave budget for healthcare professionals, and we wanted to have our own simulation centre in our hospital to provide this training. We setup a multiprofessional clinical team simulation-based training programme supported by the senior clinicians, and funded by the deanery. The aim was to determine the participants views about the simulation training to improve their non-technical skills during crisis situations. Initially this was introduced to theatre, obstetric and intensive care teams and the initial results were presented to the hospital Education Board to obtain wider support to the initiative. Time for change was 1 year. Results- Different teams of 12 participants in each session received training in acute crisis resource management. Fully facilitated feedback was provided at the end of each scenario to include task management, team working, situation awareness, and decision making. Data was collected on a 5-point Likert score pre/post questionnaire.58 participants including doctors (n=30), theatre/ anaesthetic/ recovery nurses (n=28), attended the course. Feedback was extremely positive 100% of the respondents thought simulation should be available for all staff from their discipline. Effects of change- As a result of this project, simulation training would be an integral part of training for all our health care disciplines and we have successfully established funding for our own simulation centre in our hospital and appointed an Educational Fellow. Training the faculty members and funding for trainer time continue to be a challenge. We hope to extend this to A&E teams, respiratory and cardiology teams. Lessons Learnt- Planning ahead and collaboration with the neighbouring organisation was helpful. Message- The simulation training is valuable for the whole healthcare team, where they learn in a controlled environment in multidisciplinary teams, with immediate feedback in order to improve patient safety.