BackgroundThe Royal London hospital is a busy major trauma centre, committed to delivering a high level of trauma care to our patients. The education academy has been developing an in situ simulation programme to support the trauma team to improve systems, and embed new protocols.Through this training, the trauma team identified a need for neurosurgical attendance at trauma calls in patients with suspected head injury, to improve time to definitive management. This has led to the development of a new protocol,1 which we are now using simulation to embed.MethodologyWe organise an hour long, in-situ simulated trauma call per month in the Emergency Department, attended by the multidisciplinary trauma team of the day. During the debrief, any issues that have been raised are fed back to the monthly trauma team consultant meeting. Protocols are amended accordingly and the education academy work closely to assist in embedding these new protocols through simulation.OutcomesWe will assist the trauma service to measure the impact of the new neurosurgical trauma protocol by measuring time to CT and time to critical intervention following the introduction of the new protocol.Potential impactIt was through simulation, that the need for a change in practice was identified. This may have a significant impact on time to critical intervention and ultimately neurosurgical outcomes for our patients.We hope that we can continue to work with the trauma team to continue to identify areas that require improvement and to support the team in embedding new practices to improve outcomes for our patients.ReferenceHeron M, Weaver A, Durge N. Neurosurgical Trauma Call at the Royal London Hospital to be published in June 2015 at at http://bartshealthintranet/Policies-and-Guidelines/Trust-wide-policies.aspx
BackgroundTeams traditionally train in specialty-specific silos, missing opportunities for learning crisis resource management skills based on team interactions. We introduced in-situ whole team training to address this. Debriefing teams brought specific challenges. There is scant literature on debriefing teams. We reviewed the literature and applied it to our practice.MethodologyWe ran twelve in-situ simulated trauma scenarios, the debrief involved the whole team. Significant deviations from standard debriefing were identified as we learned from each situation.OutcomesWe changed our debriefing method based on our experiences. The traditional ‘describe, analyse, apply’ (‘DAA’) model did not fit in the short time allowed before the team returned to clinical duties. We facilitated discussions ‘back-to-front’ headlining a non-technical skill, such as communication and encouraged team self-debriefing centred on ‘TEAM’ and T-NOTECHS scales for trauma team working. This allowed discussions to focus on key behaviours in a short time-frame.Encouraging a flexible debriefing structure ensured all team members contributed to the discussion. Secondly, we found that structuring the debrief around two or three key issues, emerging from how the scenario played out, allowed us to draw in each component of the trauma team, whereas the ‘DAA’ approach had been driven by the leaders and did not encourage the followers to contribute.Thirdly, these debriefs created a series of action points which have been put into place to improve trauma team interaction and patient outcomes.Potential impactAdapting a debrief for an entire team is important in reducing the ‘authority gradient’ and has potential to translate into improved patient care. Turning a debrief round highlighting specific non-technical skills first allows whole team involvement and a focused debrief in a short time. In-situ team debriefing requires skill and flexibility different from traditional approaches used in our simulation suites.ReferencesSteinemann S, et al. In-situ, multidisciplinary, simulation-based teamwork training improves early trauma care. J Surg Educ 2011;68(6):472–7Salas E, et al. Debriefing teams: 12 evidence-based practices and tips. Jt Comm J Qual Patient Saf 2008;34(9):518–27Lyons R, et al. Enhancing the effectiveness of team debriefings in medical simulation: more best practice. Jt Comm J Qual Patient Saf 2015;41(3):115–25Fanning RM, Gaba DM. The role of debriefing in simulation-based learning. Simul Healthc. 2007;2(2):115–25
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