Gittinger Matthew, Brolliar Sarah M, Grand James A, Nichol Graham, Fernandez Rosemarie
From the Division of Emergency Medicine (M.G., S.B., R.F.), University of Washington, Seattle, WA; Department of Psychology (J.G.), University of Maryland, College Park, MD; and Department of Medicine and Harborview Center for Prehospital Emergency Care (G.N.), University of Washington, Seattle, WA.
Simul Healthc. 2017 Jun;12(3):139-147. doi: 10.1097/SIH.0000000000000205.
This pilot study used a simulation-based platform to evaluate the effect of an automated mechanical chest compression device on team communication and patient management.
Four-member emergency department interprofessional teams were randomly assigned to perform manual chest compressions (control, n = 6) or automated chest compressions (intervention, n = 6) during a simulated cardiac arrest with 2 phases: phase 1 baseline (ventricular tachycardia), followed by phase 2 (ventricular fibrillation). Patient management was coded using an Advanced Cardiovascular Life Support-based checklist. Team communication was categorized in the following 4 areas: (1) teamwork focus; (2) huddle events, defined as statements focused on re-establishing situation awareness, reinforcing existing plans, and assessing the need to adjust the plan; (3) clinical focus; and (4) profession of team member. Statements were aggregated for each team.
At baseline, groups were similar with respect to total communication statements and patient management. During cardiac arrest, the total number of communication statements was greater in teams performing manual compressions (median, 152.3; interquartile range [IQR], 127.6-181.0) as compared with teams using an automated compression device (median, 105; IQR, 99.5-123.9). Huddle events were more frequent in teams performing automated chest compressions (median, 4.0; IQR, 3.1-4.3 vs. 2.0; IQR, 1.4-2.6). Teams randomized to the automated compression intervention had a delay to initial defibrillation (median, 208.3 seconds; IQR, 153.3-222.1 seconds) as compared with control teams (median, 63.2 seconds; IQR, 30.1-397.2 seconds).
Use of an automated compression device may impact both team communication and patient management. Simulation-based assessments offer important insights into the effect of technology on healthcare teams.
本试点研究使用了一个基于模拟的平台来评估自动机械胸外按压装置对团队沟通和患者管理的影响。
将由四名成员组成的急诊科跨专业团队随机分配，在模拟心脏骤停的两个阶段进行手动胸外按压（对照组，n = 6）或自动胸外按压（干预组，n = 6）：第一阶段为基线（室性心动过速），随后是第二阶段（室颤）。使用基于高级心血管生命支持的清单对患者管理进行编码。团队沟通分为以下4个领域：（1）团队合作重点；（2）碰头事件，定义为专注于重新建立态势感知、强化现有计划以及评估调整计划必要性的陈述；（3）临床重点；（4）团队成员的专业。对每个团队的陈述进行汇总。
在基线时，两组在沟通陈述总数和患者管理方面相似。在心脏骤停期间，与使用自动按压装置的团队相比，进行手动按压的团队的沟通陈述总数更多（中位数为152.3；四分位间距[IQR]为127.6 - 181.0），而使用自动按压装置的团队中位数为105；IQR为99.5 - 123.9）。在进行自动胸外按压的团队中，碰头事件更为频繁（中位数为4.0；IQR为3.1 - 4.3，而对照组为2.0；IQR为1.4 - 2.6）。与对照组团队（中位数为63.2秒；IQR为30.1 - 397.2秒）相比，随机分配到自动按压干预组的团队首次除颤延迟（中位数为208.3秒；IQR为153.3 - 222.1秒）。
使用自动按压装置可能会影响团队沟通和患者管理。基于模拟的评估为技术对医疗团队的影响提供了重要见解。
