Knight Jimmie, Richelieu Jessica, Velasco Jose M, Lubinsky Graham, Day Elizabeth, Weiss Tyler, Omotosho Philip, Siparsky Nicole
Department of Surgery, Rush University Medical Center, Chicago, Illinois.
Department of Anesthesiology, Rush University Medical Center, Chicago, Illinois.
J Surg Educ. 2025 Aug;82(8):103544. doi: 10.1016/j.jsurg.2025.103544. Epub 2025 May 15.
Early and late surgical airway complications, such as tracheostomy dislodgment, obstruction, and bleeding, are associated with a high rate of morbidity and mortality. The number of times a provider will face such a complication in their training will be limited, due to the rarity of these events. A simulation-based, multidisciplinary approach can be used to improve the quality of care delivered during these rare events. Our aim was to design and implement a simulation experience to provide trainees with the opportunity to practice team-based surgical airway emergency management.
Population: Inexperienced intensive care unit providers (novice nurses, respiratory therapy students, and junior surgery and anesthesiology residents) who care for patients with tracheostomy complications.
Simulated intensive care unit in a large urban academic hospital.
A novel simulation curriculum was authored to reflect the tracheostomy emergency scenarios encountered in our clinical practice: early tracheostomy dislodgment, early tracheostomy obstruction, and late bleeding after tracheostomy. Multidisciplinary teams, composed of general surgery and anesthesia residents, ICU nurses and respiratory therapy students, completed a 60-minute training experience in our high-fidelity simulation lab. Post graduate year 2 or 3 general surgery residents, post graduate year 2 or 3 anesthesia residents, novice ICU nurse (less than 1 year of ICU experience), and senior respiratory therapy students were invited to participate. Participants were surveyed before and after the experience to assess their confidence. Participants were scored by a faculty moderator using a standardized checklist to assess their function as a team. Outcome and Statistical Assessment: Seven multidisciplinary teams (n = 28) were created. A composite group, consisting of all trainees, showed a statistically significant increase in reported confidence for assessing respiratory distress, communicating basic life support algorithms, and managing tracheostomy dislodgement, obstruction, and bleeding (p < 0.05). An average of 52% improvement was observed in team function from the first to third training scenario. All trainees reported a high level of satisfaction in all categories.
Trainees providing care in intensive care unit lack confidence in managing tracheostomy-related emergencies. Utilizing a multidisciplinary simulation-based training program in a high-fidelity simulation environment, we demonstrated improved trainee confidence and team-based management of these challenging scenarios. Future study focused on the outcomes of airway emergencies in our institution will determine whether or not this intervention can promote a culture of safety and translate to improved patient safety.
早期和晚期手术气道并发症，如气管造口移位、阻塞和出血，与高发病率和死亡率相关。由于这些事件罕见，医疗人员在培训中遇到此类并发症的次数有限。基于模拟的多学科方法可用于提高在这些罕见事件中提供的护理质量。我们的目标是设计并实施一种模拟体验，为学员提供基于团队的手术气道应急管理的实践机会。
研究对象：照顾气管造口并发症患者的经验不足的重症监护病房医护人员（新手护士、呼吸治疗专业学生以及初级外科和麻醉科住院医师）。
大型城市学术医院的模拟重症监护病房。
编写了一套新颖的模拟课程，以反映我们临床实践中遇到的气管造口紧急情况：早期气管造口移位、早期气管造口阻塞以及气管造口术后晚期出血。由普通外科和麻醉科住院医师、重症监护病房护士和呼吸治疗专业学生组成的多学科团队，在我们的高保真模拟实验室完成了一次60分钟的培训体验。邀请了二年级或三年级普通外科住院医师、二年级或三年级麻醉科住院医师、新手重症监护病房护士（重症监护病房经验少于1年）以及高年级呼吸治疗专业学生参加。在体验前后对参与者进行调查，以评估他们的信心。由一名教员主持人使用标准化检查表对参与者进行评分，以评估他们作为团队的表现。结果与统计评估：组建了7个多学科团队（n = 28）。由所有学员组成的综合组在报告的评估呼吸窘迫、传达基本生命支持算法以及处理气管造口移位、阻塞和出血的信心方面有统计学显著提高（p < 0.05）。从第一个培训场景到第三个培训场景，团队表现平均提高了52%。所有学员在各个类别中都报告了高度满意度。
在重症监护病房提供护理的学员在处理气管造口相关紧急情况方面缺乏信心。通过在高保真模拟环境中采用基于多学科模拟的培训计划，我们证明了学员信心得到提高，并且在这些具有挑战性的场景中实现了基于团队的管理。未来针对我们机构气道紧急情况结果的研究将确定这种干预措施是否能够促进安全文化并转化为改善患者安全。
