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Improved Clinical Performance and Teamwork of Pediatric Interprofessional Resuscitation Teams With a Simulation-Based
Elaine Gilfoyle1, Deanna A Koot, John C Annear
11KidSIM-ASPIRE Simulation Research Program, Department of Paediatrics, University of Calgary, Calgary, AB, Canada. 2Respiratory Therapy Program, New Brunswick Community College, Fredericton, NB, Canada. 3Department of Paediatrics, Centre for Medical Education, McGill University, Montreal, QC, Canada. 4Department of Paediatrics, University of Alberta, Edmonton, AB, Canada. 5Paediatric Cardiac Intensive Care Unit, Sick Kids Hospital, Toronto, ON, Canada. 6Department of Critical Care Medicine, Sick Kids Hospital, Toronto, ON, Canada. 7Canadian Society of Respiratory Therapists, Ottawa, ON, Canada. 8Children's Hospital of Eastern Ontario, Ottawa, ON, Canada. 9Division of Paediatric Critical Care, Université Laval, Quebec City, QC, Canada.
Insights
A 1-day team training improved pediatric resuscitation performance. Simulation-based education enhanced adherence to Pediatric Advanced Life Support guidelines and teamwork, leading to faster interventions.
Area of Science:
- Medical Education
- Pediatric Critical Care
- Teamwork and Simulation
Background:
- Pediatric resuscitation requires effective interprofessional team collaboration.
- Adherence to established guidelines like Pediatric Advanced Life Support (PALS) is crucial for optimal patient outcomes.
- Team dynamics significantly influence the efficiency and success of resuscitation efforts.
Purpose of the Study:
- To evaluate the impact of a 1-day simulation-based team training on pediatric resuscitation teams.
- To assess improvements in adherence to PALS guidelines, team efficiency, and teamwork.
- To determine the correlation between clinical performance and teamwork in simulated pediatric resuscitations.
Main Methods:
- A multicenter prospective interventional study involving 51 interprofessional pediatric resuscitation teams (300 members).
- Teams participated in a 1-day simulation-based training including lectures, discussions, and four simulated resuscitation scenarios (PRE and POST).
- Outcomes measured included adherence to PALS guidelines (Clinical Performance Tool), time to chest compressions/defibrillation, and teamwork (Clinical Teamwork Scale).
Main Results:
- Significant improvements were observed in adherence to PALS guidelines (67.3% to 79.6%) and teamwork scores (56.0% to 71.8%).
- Time to initiation of chest compressions decreased from 60.8 to 27.1 seconds, and time to defibrillation decreased from 164.8 to 122.0 seconds.
- A positive correlation (R = 0.281) was found between clinical performance and teamwork scores.
Conclusions:
- Simulation-based team training effectively enhances clinical performance and teamwork in pediatric resuscitation.
- Improved teamwork is associated with better adherence to guidelines and more efficient resuscitation.
- This training intervention offers a valuable strategy for improving pediatric resuscitation outcomes.
Objectives:
To measure the effect of a 1-day team training course for pediatric interprofessional resuscitation team members on adherence to Pediatric Advanced Life Support guidelines, team efficiency, and teamwork in a simulated clinical environment.
Design:
Multicenter prospective interventional study.
Setting:
Four tertiary-care children's hospitals in Canada from June 2011 to January 2015.
Subjects:
Interprofessional pediatric resuscitation teams including resident physicians, ICU nurse practitioners, registered nurses, and registered respiratory therapists (n = 300; 51 teams).
Interventions:
A 1-day simulation-based team training course was delivered, involving an interactive lecture, group discussions, and four simulated resuscitation scenarios, each followed by a debriefing. The first scenario of the day (PRE) was conducted prior to any team training. The final scenario of the day (POST) was the same scenario, with a slightly modified patient history. All scenarios included standardized distractors designed to elicit and challenge specific teamwork behaviors.
Measurements And Main Results:
Primary outcome measure was change (before and after training) in adherence to Pediatric Advanced Life Support guidelines, as measured by the Clinical Performance Tool. Secondary outcome measures were as follows: 1) change in times to initiation of chest compressions and defibrillation and 2) teamwork performance, as measured by the Clinical Teamwork Scale. Correlation between Clinical Performance Tool and Clinical Teamwork Scale scores was also analyzed. Teams significantly improved Clinical Performance Tool scores (67.3-79.6%; p < 0.0001), time to initiation of chest compressions (60.8-27.1 s; p < 0.0001), time to defibrillation (164.8-122.0 s; p < 0.0001), and Clinical Teamwork Scale scores (56.0-71.8%; p < 0.0001). A positive correlation was found between Clinical Performance Tool and Clinical Teamwork Scale (R = 0.281; p < 0.0001).
Conclusions:
Participation in a simulation-based team training educational intervention significantly improved surrogate measures of clinical performance, time to initiation of key clinical tasks, and teamwork during simulated pediatric resuscitation. A positive correlation between clinical and teamwork performance suggests that effective teamwork improves clinical performance of resuscitation teams.
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