Burke Peter A, Vest Michael T, Kher Hemant, Deutsch Joseph, Daya Sneha
J Am Osteopath Assoc. 2015 Jul;115(7):444-50. doi: 10.7556/jaoa.2015.090.
The Joint Commission requires hospitals to develop systems in which a team of clinicians can rapidly recognize and respond to changes in a patient's condition. The rapid response team (RRT) concept has been widely adopted as the solution to this mandate. The role of house staff in RRTs and the impact on resident education has been controversial. At Christiana Care Health System, eligible residents in their second through final years lead the RRTs.
To evaluate the use of a team-based, interdisciplinary RRT training program for educating and training first-year residents in an effort to improve global RRT performance before residents start their second year.
This pilot study was administered in 3 phases. Phase 1 provided residents with classroom-based didactic sessions using case-based RRT scenarios. Multiple choice examinations were administered, as well as a confidence survey based on a Likert scale before and after phase 1 of the program. Phase 2 involved experiential training in which residents engaged as mentored participants in actual RRT calls. A qualitative survey was used to measure perceived program effectiveness after phase 2. In phase 3, led by senior residents, simulated RRTs using medical mannequins were conducted. Participants were divided into 5 teams, in which each resident would rotate in the roles of leader, nurse, and respiratory therapist. This phase measured resident performance with regard to medical decision making, data gathering, and team behaviors during the simulated RRT scenarios. Performance was scored by an attending and a senior resident.
A total of 18 residents were eligible (N=18) for participation. The average multiple choice test score improved by 20% after didactic training. The average confidence survey score before training was 3.44 out of 5 (69%) and after training was 4.13 (83%), indicating a 14% improvement. High-quality team behaviors correlated with medical decision making (0.92) more closely than did high-quality data gathering (0.11). This difference narrowed during high-pressure scenarios (0.84 and 0.72, respectively).
Our data suggest that resident training using a team-based, interdisciplinary RRT training program may improve resident education, interdisciplinary team-based dynamics, and global RRT performance. In turn, data gathering and medical decision making may be enhanced, which may result in better patient outcomes during RRT scenarios.
联合委员会要求医院建立相关系统，以便临床医生团队能够迅速识别患者病情变化并做出反应。快速反应团队（RRT）的概念已被广泛采用以应对这一要求。住院医师在快速反应团队中的角色以及对住院医师培训的影响一直存在争议。在克里斯蒂安娜护理健康系统中，符合条件的二年级至最后一年的住院医师领导快速反应团队。
评估一项基于团队的跨学科快速反应团队培训计划对一年级住院医师的教育和培训效果，以期在住院医师进入二年级之前提高快速反应团队的整体表现。
这项试点研究分三个阶段进行。第一阶段为住院医师提供基于课堂的教学课程，使用基于病例的快速反应团队场景。进行多项选择题考试，并在该计划的第一阶段前后进行基于李克特量表的信心调查。第二阶段涉及体验式培训，住院医师作为受指导的参与者参与实际的快速反应团队呼叫。在第二阶段后使用定性调查来衡量感知到的计划效果。在第三阶段，由高年级住院医师领导，使用医学模拟人进行模拟快速反应团队演练。参与者被分成5个小组，每个住院医师轮流担任领导者、护士和呼吸治疗师的角色。该阶段在模拟快速反应团队场景中衡量住院医师在医疗决策、数据收集和团队行为方面的表现。表现由一名主治医师和一名高年级住院医师评分。
共有18名住院医师符合参与条件（N = 18）。经过教学培训后，多项选择题测试的平均成绩提高了20%。培训前信心调查的平均得分是5分中的3.44分（69%），培训后为4.13分（83%），提高了14%。高质量的团队行为与医疗决策的相关性（0.92）比与高质量数据收集的相关性（0.11）更紧密。在高压场景下这种差异缩小（分别为0.84和0.72）。
我们的数据表明，使用基于团队的跨学科快速反应团队培训计划对住院医师进行培训可能会改善住院医师教育、基于跨学科团队的动态以及快速反应团队的整体表现。相应地，数据收集和医疗决策可能会得到加强，这可能会在快速反应团队场景中带来更好的患者治疗结果。
