Crisis management on surgical wards: a simulation-based approach to enhancing technical, teamwork, and patient interaction skills

TY - JOUR

T1 - Crisis management on surgical wards: a simulation-based approach to enhancing technical, teamwork, and patient interaction skills

AU - Arora, Sonal

AU - Hull, Louise

AU - Fitzpatrick, Maureen

AU - Sevdalis, Nick

AU - Birnbach, David J

PY - 2015/5

Y1 - 2015/5

N2 - OBJECTIVE: To establish the efficacy of simulation-based training for improving residents' management of postoperative complications on a surgical ward.BACKGROUND: Effective postoperative care is a crucial determinant of patient outcome, yet trainees learn this through the Halstedian approach. Little evidence exists on the efficacy of simulation in this safety-critical environment.METHODS: A pre-/postintervention design was employed with 185 residents from 5 hospitals. Residents participated in 2 simulated ward-based scenarios consisting of a deteriorating postoperative patient. A debriefing intervention was implemented between scenarios. Resident performance was evaluated by calibrated, blinded assessors using the validated Global Assessment Toolkit for Ward Care. This included an assessment of clinical skills (checklist of 35 tasks), team-working skills (score range 1-6 per skill), and physician-patient interaction skills.RESULTS: Excellent interrater reliability was achieved in all assessments (reliability 0.89-0.99, P < 0.001). Clinically, improvements were obtained posttraining in residents' ability to recognize/respond to falling saturations (pre = 73.7% vs post = 94.8%, P < 0.01), check circulatory status (pre = 21.1% vs post = 84.2% P < 0.001), continuously reassess patient (pre = 42.1% vs post = 100%, P < 0.001), and call for help (pre = 36.8% vs post = 89.8%, P < 0.001). Regarding teamwork, there was a significant improvement in residents' communication (pre = 1.75 vs post = 3.43), leadership (pre = 2.43 vs post = 4.20), and decision-making skills (pre = 2.20 vs post = 3.81, P < 0.001). Finally, residents improved in all elements of interaction with patients: empathy, organization, and verbal and nonverbal expression (Ps < 0.001).CONCLUSIONS: The study provides evidence for the efficacy of ward-based team training using simulation. Such exercises should be formally incorporated into training curricula to enhance patient safety in the high-risk surgical ward environment.

AB - OBJECTIVE: To establish the efficacy of simulation-based training for improving residents' management of postoperative complications on a surgical ward.BACKGROUND: Effective postoperative care is a crucial determinant of patient outcome, yet trainees learn this through the Halstedian approach. Little evidence exists on the efficacy of simulation in this safety-critical environment.METHODS: A pre-/postintervention design was employed with 185 residents from 5 hospitals. Residents participated in 2 simulated ward-based scenarios consisting of a deteriorating postoperative patient. A debriefing intervention was implemented between scenarios. Resident performance was evaluated by calibrated, blinded assessors using the validated Global Assessment Toolkit for Ward Care. This included an assessment of clinical skills (checklist of 35 tasks), team-working skills (score range 1-6 per skill), and physician-patient interaction skills.RESULTS: Excellent interrater reliability was achieved in all assessments (reliability 0.89-0.99, P < 0.001). Clinically, improvements were obtained posttraining in residents' ability to recognize/respond to falling saturations (pre = 73.7% vs post = 94.8%, P < 0.01), check circulatory status (pre = 21.1% vs post = 84.2% P < 0.001), continuously reassess patient (pre = 42.1% vs post = 100%, P < 0.001), and call for help (pre = 36.8% vs post = 89.8%, P < 0.001). Regarding teamwork, there was a significant improvement in residents' communication (pre = 1.75 vs post = 3.43), leadership (pre = 2.43 vs post = 4.20), and decision-making skills (pre = 2.20 vs post = 3.81, P < 0.001). Finally, residents improved in all elements of interaction with patients: empathy, organization, and verbal and nonverbal expression (Ps < 0.001).CONCLUSIONS: The study provides evidence for the efficacy of ward-based team training using simulation. Such exercises should be formally incorporated into training curricula to enhance patient safety in the high-risk surgical ward environment.

KW - Clinical Competence

KW - Humans

KW - Internship and Residency

KW - Patient Care Team

KW - Patient Simulation

KW - Physician-Patient Relations

KW - Postoperative Care

KW - Postoperative Complications

KW - Prospective Studies

KW - Surgery Department, Hospital

U2 - 10.1097/SLA.0000000000000824

DO - 10.1097/SLA.0000000000000824

M3 - Article

C2 - 25647057

SN - 0003-4932

VL - 261

SP - 888

EP - 893

JO - Annals of Surgery

JF - Annals of Surgery

IS - 5

ER -