Berg Helen, Båtnes Ronald, Steinsbekk Aslak
Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway.
Department of Health Sciences, Norwegian University of Science and Technology, Ålesund, Norway.
BMJ Simul Technol Enhanc Learn. 2020 May 19;7(2):75-80. doi: 10.1136/bmjstel-2019-000527. eCollection 2021.
The aim was to describe changes in the performance of clinical actions, during repeated in-situ simulations with different cases, by teams of healthcare professionals with different experiences of the systematic clinical observation of deteriorating patients, after an introduction to the Airways, Breathing, Circulation, Disability, Environment/Exposure (ABCDE) approach.
A descriptive observational study was conducted of repeated in-situ simulations using a patient simulator (SimMan 3G), carried out by teams in a public nursing home (NH, least experienced), an out-of-hours general practice (OOH-GP) service and a hospital emergency department (ED, most experienced). The cases had similar clinical presentations but different underlying diagnoses unknown to the teams. Four blinded clinical experts independently assessed the simulations on the basis of transcripts, providing comments, an overall score and scores for the clinical actions.
The assessors commented on the overall lack of a systematic ABCDE approach in the NH and OOH-GP in all simulations, while the comments for the ED concerned the choice of treatment. Across the teams, the overall score was highest in the first simulation and second highest in the third simulation. The team in the NH received low overall scores for all simulations, but the last simulation received markedly better scores on the clinical actions. The teams in the OOH-GP and ED had no such clear pattern in the scores for clinical actions and thus no indications of improvement with repeated simulations.
The observation in this study was that the overall assessment by the blinded assessors showed no consistent improvement in clinical actions from repeated in-situ simulations, and the teams did not seem to adhere to the ABCDE approach throughout the simulations. This indicates that the teams were not able to apply their newly acquired experiences of using the ABCDE approach from one case to another, different case.
目的是描述在向医护人员介绍气道、呼吸、循环、残疾、环境/暴露（ABCDE）方法后，不同经验的医护团队在对病情恶化患者进行系统临床观察的情况下，针对不同病例进行重复现场模拟时临床操作表现的变化。
采用描述性观察研究，使用患者模拟器（SimMan 3G）进行重复现场模拟，由一家公立养老院（NH，经验最少）、非工作时间全科医疗（OOH - GP）服务机构和医院急诊科（ED，经验最丰富）的团队实施。病例具有相似的临床表现，但团队对其潜在诊断并不知晓。四名盲法临床专家根据模拟记录独立评估模拟情况，给出评论、总体评分以及临床操作评分。
评估者评论称，在所有模拟中，NH和OOH - GP普遍缺乏系统的ABCDE方法，而对ED的评论则涉及治疗选择。在所有团队中，总体评分在第一次模拟中最高，在第三次模拟中次之。NH团队在所有模拟中的总体评分都较低，但在最后一次模拟中临床操作得分明显提高。OOH - GP和ED团队在临床操作得分方面没有如此明显的模式，因此没有迹象表明重复模拟能带来改善。
本研究观察到，盲法评估者的总体评估显示，重复现场模拟后临床操作没有持续改善，并且团队在整个模拟过程中似乎未遵循ABCDE方法。这表明团队无法将新获得的使用ABCDE方法的经验从一个病例应用到另一个不同的病例中。
