Dworetzky Barbara A, Peyre Sarah, Bubrick Ellen J, Milligan Tracey A, Yule Steven J, Doucette Heidi, Pozner Charles N
Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA.
University of Rochester Medical Center, 601 Elmwood Avenue, Rochester, NY, 14642 USA.
Epilepsy Behav. 2015 Apr;45:229-33. doi: 10.1016/j.yebeh.2015.01.018. Epub 2015 Mar 23.
Patient safety is critical for epilepsy monitoring units (EMUs). Effective training is important for educating all personnel, including residents and nurses who frequently cover these units. We performed a needs assessment and developed a simulation-based team training curriculum employing actual EMU sentinel events to train neurology resident-nurse interprofessional teams to maximize effective responses to high-acuity events.
A mixed-methods design was used. This included the development of a safe-practice checklist to assess team response to acute events in the EMU using expert review with consensus (a modified Delphi process). All nineteen incoming first-year neurology residents and 2 nurses completed a questionnaire assessing baseline knowledge and attitudes regarding seizure management prior to and following a team training program employing simulation and postscenario debriefing. Four resident-nurse teams were recorded while participating in two simulated scenarios. Employing retrospective video review, four trained raters used the newly developed safe-practice checklist to assess team performance. We calculated the interobserver reliability of the checklist for consistency among the raters. We attempted to ascertain whether the training led to improvement in performance in the actual EMU by comparing 10 videos of resident-nurse team responses to seizures 4-8months into the academic year preceding the curricular training to 10 that included those who received the training within 4-8months of the captured video.
Knowledge in seizure management was significantly improved following the program, but confidence in seizure management was not. Interrater agreement was moderate to high for consistency of raters for the majority of individual checklist items. We were unable to demonstrate that the training led to sustainable improvement in performance in the actual EMU by the method we used.
A simulated team training curriculum using a safe-practice checklist to improve the management of acute events in an EMU may be an effective method of training neurology residents. However, translating the results into sustainable benefits and confidence in management in the EMU requires further study.
患者安全对于癫痫监测单元（EMU）至关重要。有效的培训对于教育所有人员很重要，包括经常负责这些单元的住院医师和护士。我们进行了需求评估，并开发了基于模拟的团队培训课程，利用实际的EMU哨点事件来培训神经内科住院医师 - 护士跨专业团队，以最大限度地提高对高敏锐度事件的有效反应。
采用混合方法设计。这包括制定一份安全实践检查表，通过专家评审并达成共识（改良的德尔菲法）来评估团队对EMU中急性事件的反应。所有19名新入职的一年级神经内科住院医师和2名护士在参加使用模拟和情景后汇报的团队培训项目之前和之后，完成了一份评估关于癫痫发作管理的基线知识和态度的问卷。四个住院医师 - 护士团队在参与两个模拟情景时被记录下来。通过回顾性视频审查，四名经过培训的评分者使用新开发的安全实践检查表来评估团队表现。我们计算了检查表在评分者之间一致性的观察者间信度。通过比较本学年课程培训前4 - 8个月住院医师 - 护士团队对癫痫发作反应的10个视频与包含在捕获视频后4 - 8个月内接受培训人员的10个视频，我们试图确定培训是否导致实际EMU中的表现有所改善。
该项目实施后，癫痫发作管理方面的知识有显著提高，但癫痫发作管理的信心没有提高。对于大多数单个检查表项目，评分者之间的一致性评分者间一致性为中等至高。我们无法通过所使用的方法证明培训导致实际EMU中的表现持续改善。
使用安全实践检查表的模拟团队培训课程可能是培训神经内科住院医师的有效方法。然而，将结果转化为EMU管理中的可持续益处和信心还需要进一步研究。
