Abstract
Background: Many adverse events in health care are caused by teamwork and communication breakdown. This study was conducted to investigate the effect of a point-of-care simulation-based team training curriculum on measurable teamwork and communication skills in staff caring for postoperative patients.
Methods: Twelve facilities involving 334 perioperative surgical staff underwent simulation-based training. Pretest and posttest self-report data included the Self-Efficacy of Teamwork Competencies Scale. Observational data were captured with the Clinical Teamwork Scale.
Results: Teamwork scores (measured on a five-point Likert scale) improved for all eight survey questions by an average of 18% (3.7 to 4.4, p < .05). The observed communication rating (scale of 1 to 10) increased by 16% (5.6 to 6.4, p < .05).
Conclusion: Simulation-based team training for staff caring for perioperative patients is associated with measurable improvements in teamwork and communication.
J Contin Educ Nurs 2013;44(11):516–524.
- Agency for Healthcare Research and Quality. (2010). HealthGrades seventh annual patient safety in American hospitals study. Retrieved from http://psnet.ahrq.gov/resource.aspx?resourceID=17898 Google Scholar
- Barsuk J. H., Cohen E. R., McGaghie W. C., Wayne D. B. (2010). Long-term retention of central venous catheter insertion skills after simulation-based mastery learning. Academic Medicine, 85(10 Suppl.), S9–S12.
10.1097/ACM.0b013e3181ed436c Crossref MedlineGoogle Scholar - Beaubien J. M., Baker D. P. (2004). The use of simulation for training teamwork skills in healthcare: How low can you go?Quality and Safety in Health Care, 13(Suppl. 1), i51–i56.
10.1136/qshc.2004.009845 Crossref MedlineGoogle Scholar - Bertram D. (2006). Likert scales. Retrieved from http://poincare.matf.bg.ac.rs/~kristina/topic-dane-likert.pdf Google Scholar
- Brown C., Hofer T., Johal A., Thomson R., Nicholl J., Franklin B. D., Lilford R. J. (2008a). An epistemology of patient safety research: A framework for study design and interpretation. Part 1. Conceptualising and developing interventions. Quality and Safety in Health Care, 17(3), 158–162.
10.1136/qshc.2007.023630 Crossref MedlineGoogle Scholar - Brown C., Hofer T., Johal A., Thomson R., Nicholl J., Franklin B. D., Lilford R. J. (2008b). An epistemology of patient safety research: A framework for study design and interpretation. Part 2. Study design. Quality and Safety in Health Care, 17(3), 163–169.
10.1136/qshc.2007.023648 Crossref MedlineGoogle Scholar - Carney B. T., West P., Neily J., Mills P. D., Bagian J. P. (2010). Differences in nurse and surgeon perceptions of teamwork: Implications for use of a briefing checklist in the OR. AORN Journal, 91(6), 722–729.
10.1016/j.aorn.2009.11.066 Crossref MedlineGoogle Scholar - Carroll J. S., Rudolph J. W. (2006). Design of high reliability organizations in health care. Quality and Safety in Health Care, 15(Suppl. 1), i4–i9.
10.1136/qshc.2005.015867 Crossref MedlineGoogle Scholar - Clark P. R. (2009). Teamwork: Building healthier workplaces and providing safer patient care. Critical Care Nursing Quarterly, 32(3), 221–231.
10.1097/CNQ.0b013e3181ab923f Crossref MedlineGoogle Scholar - Clay-Williams R., Braithwaite J. (2009). Determination of health-care teamwork training competencies: A Delphi study. International Journal for Quality in Health Care, 21(6), 433–440.
10.1093/intqhc/mzp042 Crossref MedlineGoogle Scholar - de Vries E. N., Hollmann M. W., Smorenburg S. M., Gouma D. J., Boermeester M. A. (2009). Development and validation of the SURgical PAtient Safety System (SURPASS) checklist. Quality and Safety in Health Care, 18(2), 121–126.
10.1136/qshc.2008.027524 Crossref MedlineGoogle Scholar - de Vries E. N., Prins H. A., Crolla R. M., den Outer A. J., van Andel G., van Helden S. H., Boermeester M. A. (2010). Effect of a comprehensive surgical safety system on patient outcomes. New England Journal of Medicine, 363(20), 1928–1937.
10.1056/NEJMsa0911535 Crossref MedlineGoogle Scholar - Dunn E. J., Mills P. D., Neily J., Crittenden M. D., Carmack A. L., Bagian J. P. (2007). Medical team training: Applying crew resource management in the Veterans Health Administration. Joint Commission Journal on Quality and Patient Safety, 33(6), 317–325. Crossref MedlineGoogle Scholar
- Fanning R. M., Gaba D. M. (2007). The role of debriefing in simulation-based learning. Simulation in Healthcare, 2, 115–125.
10.1097/SIH.0b013e3180315539 Crossref MedlineGoogle Scholar - Flin R., Patey R. (2011). Non-technical skills for anaesthetists: Developing and applying ANTS. Best Practice & Research: Clinical Anaesthesiology, 25(2), 215–227.
10.1016/j.bpa.2011.02.005 Crossref MedlineGoogle Scholar - Gaba D. (2004). The future vision of simulation in health care. Quality and Safety in Health Care, 13(Suppl.), i2–i10.
10.1136/qshc.2004.009878 Crossref MedlineGoogle Scholar - Gaba D. M., Howard S. K., Flanagan B., Smith B. E., Fish K. J., Botney R. (1998). Assessment of clinical performance during simulated crises using both technical and behavioral ratings. Anesthesiology, 89(1), 8–18.
10.1097/00000542-199807000-00005 Crossref MedlineGoogle Scholar - Gosbee J. (2010). Handoffs and communication: The underappreciated roles of situational awareness and inattentional blindness. Clinical Obstetrics and Gynecology, 53(3), 545–558.
10.1097/GRF.0b013e3181ec1ac7 Crossref MedlineGoogle Scholar - Guise J.-M., Deering S. H., Kanki B. G., Osterweil P., Li H., Mori M., Lowe N. K. (2008). Validation of a tool to measure and promote clinical teamwork. Simulation in Healthcare, 3(4), 217–223.
10.1097/SIH.0b013e31816fdd0a Crossref MedlineGoogle Scholar - Haynes A. B., Weiser T. G., Berry W. R., Lipsitz S. R., Breizat A. H., Dellinger E. P., Gawande A. A. (2009). A surgical safety checklist to reduce morbidity and mortality in a global population. New England Journal of Medicine, 360(5), 491–499.
10.1056/NEJMsa0810119 Crossref MedlineGoogle Scholar - Heard G. (2005). Errors in medicine: A human factors perspective. Australasian Anaesthesia, 1–12. Google Scholar
- Higgins J. P. T., Ramsay C., Reeves B. C., Deeks J. J., Shea B., Valentine J. C., Wells G. (2013). Issues relating to study design and risk of bias when including non-randomized studies in systematic reviews on the effects of interventions. Research Synthesis Methods, 4(1), 12–25.
10.1002/jrsm.1056 Crossref MedlineGoogle Scholar - Hull L., Arora S., Kassab E., Kneebone R., Sevdalis N. (2011). Observational teamwork assessment for surgery: Content validation and tool refinement. Journal of the American College of Surgeons, 212(2), 234–243.
10.1016/j.jamcollsurg.2010.11.001 Crossref MedlineGoogle Scholar - Issenberg S. B., McGaghie W. C., Petrusa E. R., Gordon D. L., Scalese R. J. (2005). Features and uses of high-fidelity medical simulations that lead to effective learning: A BEME systematic review. Medical Teacher, 27(2), 10–28.
10.1080/01421590500046924 Crossref MedlineGoogle Scholar - Johnson H. L., Kimsey D. (2012). Patient safety: Break the silence. AORN Journal, 95(5), 591–601.
10.1016/j.aorn.2012.03.002 Crossref MedlineGoogle Scholar - Kirkegaard M., Fish J. (2004). Doc-U-drama: Using drama to teach about patient safety. Family Medicine, 36(9), 628–630. MedlineGoogle Scholar
- Kirkpatrick D. (1998). Evaluating training programs: The four levels(2nd ed.). San Francisco, CA: Berrett-Koehler. Google Scholar
- Kohn L. T., Corrigan J. M., Donaldson M. S. (2000). To err is human: Building a safer health system. Washington, DC: National Academy Press. Google Scholar
- Leonard M., Graham S., Bonacum D. (2004). The human factor: The critical importance of effective teamwork and communication in providing safe care. Quality and Safety in Health Care, 13(Suppl. 1), i85–i90.
10.1136/qshc.2004.010033 Crossref MedlineGoogle Scholar - Malec J. F., Torsher L. C., Dunn W. F., Wiegmann D. A., Arnold J. J., Brown D. A., Phatak V. (2007). The Mayo High Performance Scale: Reliability and validity for evaluating key crew resource management skills. Simulation in Healthcare, 2(1), 4–10.
10.1097/SIH.0b013e31802b68ee Crossref MedlineGoogle Scholar - McCulloch P., Mishra A., Handa A., Dale T., Hirst G., Catchpole K. (2009). The effects of aviation-style non-technical skills training on technical performance and outcome in the operating theatre. Quality and Safety in Health Care, 18(2), 109–115.
10.1136/qshc.2008.032045 Crossref MedlineGoogle Scholar - Neily J., Mills P. D., Lee P., Carney B., West P., Percarpio K., Bagian J. P. (2010). Medical team training and coaching in the Veterans Health Administration: Assessment and impact on the first 32 facilities in the program. Quality and Safety in Health Care, 19(4), 360–364.
10.1136/qshc.2008.031005 Crossref MedlineGoogle Scholar - Neily J., Mills P. D., Young-Xu Y., Carney B. T., West P., Berger D. H., Bagian J. P. (2010). Association between implementation of a medical team training program and surgical mortality. Journal of the American Medical Association, 304(15), 1693–1700.
10.1001/jama.2010.1506 CrossrefGoogle Scholar - Paige J. T., Kozmenko V., Yang T., Paragi Gururaja R., Hilton C. W., Cohn I., Chauvin S. W. (2008). High fidelity, simulation-based training at the point-of-care improves teamwork in the operating room. Journal of the American College of Surgeons, 207(3, Suppl.), S87–S88.
10.1016/j.jamcollsurg.2008.06.219 CrossrefGoogle Scholar - Paull D. E., Mazzia L. M., Izu B. S., Neily J., Mills P. D., Bagian J. P. (2009). Predictors of successful implementation of preoperative briefings and postoperative debriefings after medical team training. American Journal of Surgery, 198(5), 675–678.
10.1016/j.amjsurg.2009.07.008 Crossref MedlineGoogle Scholar - Pruitt C. M., Liebelt E. L. (2010). Enhancing patient safety in the pediatric emergency department: Teams, communication, and lessons from crew resource management. Pediatric Emergency Care, 26(12), 942–948.
10.1097/PEC.0b013e3181fec9cf Crossref MedlineGoogle Scholar - Rogers S. O., Gawande A. A., Kwaan M., Puopolo A. L., Yoon C., Brennan T. A., Studdert D. M. (2006). Analysis of surgical errors in closed malpractice claims at 4 liability insurers. Surgery, 140(1), 25–33.
10.1016/j.surg.2006.01.008 Crossref MedlineGoogle Scholar - Rosen M. A., Salas E., Wilson K. A., King H. B., Salisbury M., Augenstein J. S., Birnbach D. J. (2008). Measuring team performance in simulation-based training: Adopting best practices for healthcare. Simulation in Healthcare, 3(1), 33–41.
10.1097/SIH.0b013e3181626276 Crossref MedlineGoogle Scholar - Salas E., DiazGranados D., Klein C., Burke C. S., Stagl K. C., Goodwin G. F., Halpin S. M. (2008). Does team training improve team performance? A meta-analysis. Human Factors, 50(6), 903–933.
10.1518/001872008X375009 Crossref MedlineGoogle Scholar - Sax H. C., Browne P., Mayewski R. J., Panzer R. J., Hittner K. C., Burke R. L., Coletta S. (2009). Can aviation-based team training elicit sustainable behavioral change?Archives of Surgery, 144(12), 1133–1137.
10.1001/archsurg.2009.207 Crossref MedlineGoogle Scholar - Sevdalis N., Davis R., Koutantji M., Undre S., Darzi A., Vincent C. A. (2008). Reliability of a revised NOTECHS scale for use in surgical teams. American Journal of Surgery, 196(2), 184–190.
10.1016/j.amjsurg.2007.08.070 Crossref MedlineGoogle Scholar - Solomon D. J. (2004). The rating reliability calculator. BMC Medical Research Methodology, 4(11), 1–3.
10.1186/1471-2288-4-11 CrossrefGoogle Scholar - U.S. Department of Veterans Affairs. (2010). Interactive U.S. map. Retrieved from www2.va.gov/directory/guide/map.asp?dnum=1 Google Scholar
- Veterans Administration. (2010). VA medical centers designated for surgical complexity. Retrieved from www.patientcare.va.gov/20100518a1.asp Google Scholar