Keilman Ashley, Reid Jennifer, Thomas Anita, Uspal Neil, Stone Kimberly, Beardsley Elaine, Burns Brian, Burns Rebekah
Pediatrics, University of Washington School of Medicine, Seattle, Washington, USA.
Quality and Patient Safety, Children's Health Children's Medical Center Dallas, Dallas, Texas, USA.
BMJ Simul Technol Enhanc Learn. 2020 May 6;7(1):44-46. doi: 10.1136/bmjstel-2019-000578. eCollection 2021.
Effective team leadership is linked to improved resuscitation outcomes. Previous studies have focused primarily on trainee performance and simulation-based outcomes. We hypothesised that a targeted simulation-based educational intervention for experienced physicians focusing on specific process and communication goals would result in improved performance during actual resuscitations. We conducted an observational pilot study evaluating specific process metrics during clinical resuscitations before and after a 1-hour training intervention for paediatric emergency medicine (PEM) supervising physicians using rapid cycle deliberate practice simulation-based training. Videos of clinical resuscitations from before and after the intervention were retrospectively reviewed to assess time to patient transfer to emergency department stretcher, time to primary assessment and time to team leader summary statement. Between March and July 2018, 21/38 of PEM supervising physicians participated in a training session. After the intervention period, clinical resuscitation teams showed significant improvements in targeted process metrics: transfer of patient within 1 min (79% vs 100%, p=0.03), assessment completed within 3 min (28% vs 75%, p=0.01) and summary statement within 5 min (50% to 85%, p=0.03). Brief, focused simulation-based team leader training can improve the teamwork and communication performance of experienced clinicians during clinical resuscitations.
有效的团队领导与改善复苏结果相关。以往的研究主要集中在实习生的表现和基于模拟的结果上。我们假设，针对经验丰富的医生开展的基于模拟的、以特定流程和沟通目标为重点的教育干预，将在实际复苏过程中提高表现。我们进行了一项观察性试点研究，在对儿科急诊医学（PEM）督导医生进行为期1小时的基于快速循环刻意练习模拟训练的培训干预前后，评估临床复苏期间的特定流程指标。对干预前后的临床复苏视频进行回顾性审查，以评估患者转移至急诊科担架的时间、初次评估时间和团队领导总结陈述时间。2018年3月至7月期间，38名PEM督导医生中有21名参加了培训课程。在干预期之后，临床复苏团队在目标流程指标方面有显著改善：1分钟内转移患者（79%对100%，p=0.03）、3分钟内完成评估（28%对75%，p=0.01）以及5分钟内完成总结陈述（50%至85%，p=0.03）。简短、有针对性的基于模拟的团队领导培训可改善经验丰富的临床医生在临床复苏期间的团队协作和沟通表现。
