Reader introduction resulted in execution of all critical actions. During the debriefing of the simulated scenarios, subjects acknowledged the benefit of the Reader.
Damage control laparotomy has become an accepted practice in trauma surgery. A number of methods leading to delayed primary closure of the abdomen have been advocated; complications are recognized with all these methods. The approach to staged repair using the Wittmann patch (Star Surgical Inc., Burlington, WI) combines the advantages of planned relaparotomy and open management, while minimizing the rate of complications. The authors hypothesized that use of the Wittmann patch would lead to a high rate of delayed primary closure of the abdomen. The patch consists of two sheets sutured to the abdominal fascia, providing for temporary closure. Advancement of the patch and abdominal exploration can be done at bedside. When the fascial edges can be reapproximated without tension, abdominal closure is performed. Twenty-six patients underwent staged abdominal closure during the study period. All were initially managed with intravenous bag closure. Eighty-three per cent (20 of 24) went on to delayed primary closure of the abdomen, with a mean time of 13.1 days from patch placement to delayed primary closure. The rate of closure using the Wittmann patch is equivalent to other commonly used methods and should be considered when managing patients with abdominal compartment syndrome or severe abdominal trauma.
Background
Cardiopulmonary arrests are rare, high-stakes events that benefit from using crisis resource management (CRM). Simulation-based education with deliberate practice can promote skill acquisition.
Objective
We assessed whether using simulation-based education to teach CRM would lead to improved performance, compared to a lecture format.
Methods
We tested third-year internal medicine residents in simulated code scenarios. Participants were randomly assigned to simulation-based education with deliberate practice (SIM) group or lecture (LEC) group. We created a checklist of CRM critical actions (which includes announcing the diagnosis, asking for help/suggestions, and assigning tasks), and reviewed videotaped performances, using a checklist of skills and communications patterns to identify CRM skills and communication efforts. Subjects were tested in simulated code scenarios 6 months after the initial assessment.
Results
At baseline, all 52 subjects recognized distress, and 92% (48 of 52) called for help. Seventy-eight percent (41 of 52) did not succeed in resuscitating the simulated patient or demonstrate the CRM skills. After intervention, both groups (n = 26 per group) improved. All SIM subjects announced the diagnosis compared to 65% LEC subjects (17 of 26, P = .01); 77% (20 of 26) SIM and 19% (5 of 26) LEC subjects asked for suggestions (P < .001); and 100% (26 of 26) SIM and 27% (7 of 26) LEC subjects assigned tasks (P < .001).
Conclusions
The SIM intervention resulted in significantly improved team communication and cardiopulmonary arrest management. During debriefing, participants acknowledged the benefit of the SIM sessions.
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