Droogh Joep M, Kruger Hanneke L, Ligtenberg Jack J M, Zijlstra Jan G
Department of Critical Care, University Medical Center Groningen, University of Groningen, The Netherlands.
Jt Comm J Qual Patient Saf. 2012 Dec;38(12):554-9. doi: 10.1016/s1553-7250(12)38072-0.
Transporting critically ill ICU patients by standard ambulances, with or without an accompanying physician, imposes safety risks. In 2007 the Dutch Ministry of Public Health required that all critically ill patients transferred between ICUs in different hospitals be transported by a mobile ICU (MICU). Since March 2009 a specially designed MICU and a retrieval team have served the region near University Medical Center Groningen, in the northeastern region of the Netherlands. The MICU transport program includes simulator-based crew resource management (CRM) training for the intensivists and ICU nurses, who, with the drivers, constitute the MICU crews.
Training entails five pivotal aspects: (1) preparation, (2) teamwork, (3) new equipment, (4) mobility, and (5) safety. For example, the training accustoms participants to working in the narrow, moving ambulance and without benefit of additional manpower. The scenario-based team training, which takes about four hours, occurs in a training facility, with its reconstructed ICU, and then in the MICU itself. A "wireless" patient simulator that is able to mimic hemodynamic and respiratory patterns and to simulate lung and heart sounds is used. All scenarios can be adjusted to simulate medical, logistic, or technical problems.
Since the start of MICU training in 2009, more than 70 training sessions, involving 100 team members, have been conducted. Quality issues identified include failure to anticipate possible problems (such as failing to ask for intubation of a respiratory-compromised patient at intake); late responses to alarms of the ventilator, perfusor pump, or monitor; and not anticipating a possible shortage of medication.
Setting up and implementing simulator-based CRM training provides feasible and helpful preparation for an MICU team.
使用标准救护车运送重症监护病房（ICU）的重症患者，无论是否有随行医生，都存在安全风险。2007年，荷兰公共卫生部要求，所有在不同医院的ICU之间转运的重症患者都应由移动ICU（MICU）运送。自2009年3月起，一个专门设计的MICU和一个救援团队开始服务于荷兰东北部格罗宁根大学医学中心附近的地区。MICU转运计划包括为重症监护医生和ICU护士提供基于模拟器的机组资源管理（CRM）培训，这些人员与司机共同组成MICU团队。
培训包含五个关键方面：（1）准备工作，（2）团队协作，（3）新设备，（4）机动性，以及（5）安全性。例如，培训让参与者习惯在狭窄、移动的救护车上工作，且没有额外人力协助。基于场景的团队培训大约需要四个小时，先在配备重建ICU的培训设施中进行，然后在MICU内进行。使用一种“无线”患者模拟器，它能够模拟血流动力学和呼吸模式，并模拟肺部和心脏声音。所有场景都可以进行调整，以模拟医疗、后勤或技术问题。
自2009年MICU培训开始以来，已经进行了70多次培训课程，涉及100名团队成员。发现的质量问题包括未能预见可能出现的问题（例如在接收患者时未要求对呼吸功能受损的患者进行插管）；对呼吸机、灌注泵或监护仪警报的反应延迟；以及未预料到可能出现的药物短缺。
建立并实施基于模拟器的CRM培训为MICU团队提供了可行且有益的准备。
