医院范围内代码响应模拟期间的沟通和安全行为评估。

Evaluation of Communication and Safety Behaviors During Hospital-Wide Code Response Simulation.

机构信息

From the Division of Emergency Medicine (D.M.R., R.B., J.M.C, P.Z.), Children's National Hospital, Washington, DC; Division of Emergency Medicine (A.A.), Children's Hospital Colorado, Aurora, CO; Department of Anesthesiology and Critical Care Medicine (M.B.), Children's Hospital of Philadelphia, Philadelphia, PA; Department of Pediatrics (R.B., J.M.C., A.G., R.I., P.Z.), George Washington University School of Medicine and Health Sciences; Simulation Program (L.N., H.A.W.), Children's National Hospital; School of Nursing & Allied Health (A.G.), Liverpool John Moores University in Liverpool, England; Division of Biostatistics and Study Methodology (R.I.), Children's Research Institute, Children's National Hospital, Washington, DC; Department of Pediatrics (M.O.), Maine Medical Center, Portland, ME; Department of Emergency Medicine (M.P.), University of Florida College of Medicine; University of Florida Center for Experiential Learning and Simulation (M.P.), University of Florida College of Medicine, Gainesville, FL; and Global Health Initiative Children's National Hospital (R.S.), Washington, DC.

出版信息

Simul Healthc. 2022 Feb 1;17(1):e45-e50. doi: 10.1097/SIH.0000000000000575.

DOI:10.1097/SIH.0000000000000575

PMID:33787552

Abstract

INTRODUCTION

To understand the baseline quality of team communication behaviors at our organization, we implemented institution-wide simulation training and measured the performance of safety behaviors of ad hoc teams in emergent situations.

METHODS

Clinicians participated in 2 interprofessional video-recorded simulation scenarios, each followed by debriefing. Using a standardized evaluation instrument, 2 reviewers independently evaluated the presence or absence of desired team safety behaviors, including escalating care, sharing a mental model, establishing leadership, thinking out loud, and identifying roles and responsibilities. We also scored the quality of sharing the mental model, closed-loop communication, and overall team performance on a 7-point scale. Discordant reviews were resolved with scoring by an additional reviewer.

RESULTS

A total of 1404 clinicians participated in 398 simulation scenarios, resulting in 257 usable videos. Overall, teams exhibited desired behaviors at the following frequencies: escalating care, 85%; sharing mental models, 66%; verbally establishing leadership, 6%; thinking out loud, 87%; and identifying roles and responsibilities, 27%. Across all reviews, the quality of the graded behaviors (of 7 points) was 2.8 for shared mental models, 3.3 for closed-loop communication, and 3.2 for overall team performance.

CONCLUSIONS

In a simulation setting with ad hoc teams, there was variable performance on completing safety behaviors and only a fair quality of graded communication behaviors. These results establish a baseline assessment of communication and teamwork behaviors and will guide future quality improvement interventions.

摘要

简介

为了了解我们组织内团队沟通行为的基线质量，我们实施了全机构模拟培训，并测量了紧急情况下临时团队的安全行为表现。

方法

临床医生参与了 2 个跨专业的视频记录模拟场景，每个场景后都进行了讨论。使用标准化评估工具，2 位评审员独立评估期望的团队安全行为的存在或缺失情况，包括升级护理、共享心理模型、建立领导、大声思考和确定角色和职责。我们还对共享心理模型、闭环沟通和整体团队绩效的质量进行了 7 分制评分。有分歧的评审由额外的评审员进行评分来解决。

结果

共有 1404 名临床医生参与了 398 个模拟场景，产生了 257 个可用视频。总体而言，团队表现出以下期望行为的频率：升级护理，85%；共享心理模型，66%；口头建立领导，6%；大声思考，87%；确定角色和职责，27%。在所有评审中，分级行为（7 分制）的质量为共享心理模型 2.8 分，闭环沟通 3.3 分，整体团队绩效 3.2 分。