Regular in situ simulation training of paediatric Medical Emergency Team improves hospital response to deteriorating patients

Theilen, U; Leonard, Paul; Jones, Patricia A.; Ardill, R; Weitz, Jürgen; Agrawal, Dewesh; Simpson, Dave

doi:10.1016/j.resuscitation.2012.06.027

Cited by 86 publications

(85 citation statements)

References 18 publications

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“…However, this was beyond the scope of this current work although would be a valuable area for future assessment. Despite this, we feel that the fact that this course did lead to a significant improvement in nursing staff clinical confidence, in keeping with results from more elaborate and established programmes (Hogg & Miller, 2016), suggests that the objective improvements in clinical practice and clinical outcome that simulation can lead to (Ruesseler et al, 2010, Theilen et al, 2013, Cant & Cooper, 2010, Zendejas et al, 2013 should be realisable from this course.…”

Section: Limitationsmentioning

confidence: 85%

“…Simulation courses have been shown to be an effective tool in critical illness management training (Hogg & Miller, 2016, Ruesseler et al, 2010, Theilen et al, 2013, Cant & Cooper, 2010, Zendejas et al, 2013 and therefore may be of particular value in low resource settings, like Malawi, where access to on-going professional development is known to be limited (Muula et al, 2004, Manafa et al, 2009). However, simulation courses can be difficult to set up due to the nature of the equipment involved and the requirement for instructors, which can be a particular issue in low resource settings.…”

Section: Summary Of Findingsmentioning

confidence: 99%

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Improving Care of Critically Unwell Patients through Development of a Simulation Programme in a Malawian Hospital

Barnes

Paterson-Brown

2017

JETS

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Introduction: Malawi is one of the world's poorest countries with very limited healthcare spending and a lack of post-graduate training for healthcare workers, including in critical illness management. Critical illness simulation courses have been shown to be an effective training tool and form a key part of training for healthcare professionals in the developed world. However, these courses can be difficult and costly to set. We therefore developed an affordable and simple to run programme for use in a regional hospital in Malawi.Methods: We delivered a series of lectures alongside a simulation course based around critical illness management, including cardio-pulmonary-resuscitation. The course was taught by a visiting physician who trained a local clinical officer to continue running the course in the future. Feedback on candidate confidence in managing acutely unwell patients was collected before and after the course.Results: All staff in the unit attended the course. Median candidate confidence across all seven assessed areas increased significantly.Conclusions: Despite the basic equipment used in our course, we received very positive feedback and feel that this highlights that significant improvements in staff skillset, and therefore patient outcomes, can be achieved using a relatively simple and low cost intervention that can also easily be continued by local members of staff, ensuring sustainability. Introduction of similar courses in other resource poor settings may help improve patient outcomes without the significant financial outlay and lack of future-proofing seen with many healthcare initiatives that are deployed, and are often unsuccessful, in the developing world.

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Section: Limitationsmentioning

confidence: 85%

Section: Summary Of Findingsmentioning

confidence: 99%

Improving Care of Critically Unwell Patients through Development of a Simulation Programme in a Malawian Hospital

Barnes

Paterson-Brown

2017

JETS

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“…16 In situ simulation allows a better identification of systems issues 8,9 or safety threats 10,17 and has been shown to improve the management of deteriorating patients. 18 In situ training is less developed than training in a simulation center probably because it is more difficult to organize particularly when…”

Section: Discussionmentioning

confidence: 99%

In Situ Simulation Training for Neonatal Resuscitation: An RCT

Rubio-Gurung¹,

et al. 2014

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WHAT'S KNOWN ON THIS SUBJECT: High-fidelity simulation improves individual skills in neonatal resuscitation. Usually, training is performed in a simulation center. Little is known about the impact of in situ training on overall team performance. WHAT THIS STUDY ADDS:In situ high-fidelity simulation training of 80% of a maternity' s staff significantly improved overall team performance in neonatal resuscitation (technical skills and teamwork). Fewer hazardous events occurred, and delay in improving the heart rate was shorter. abstract OBJECTIVES: High-fidelity simulation is an effective tool in teaching neonatal resuscitation skills to professionals. We aimed to determine whether in situ simulation training (for ∼80% of the delivery room staff) improved neonatal resuscitation performed by the staff at maternities. METHODS:A baseline evaluation of 12 maternities was performed: a random sample of 10 professionals in each unit was presented with 2 standardized scenarios played on a neonatal high-fidelity simulator. The medical procedures were video recorded for later assessments. The 12 maternities were then randomly assigned to receive the intervention (a 4-hour simulation training session delivered in situ for multidisciplinary groups of 6 professionals) or not receive it. All maternities were evaluated again at 3 months after the intervention. The videos were assessed by 2 neonatologists blinded to the pre-/postintervention as well as to the intervention/control groups. The performance was assessed using a technical score and a team score. RESULTS:After intervention, the median technical score was significantly higher for scenarios 1 and 2 for the intervention group compared with the control group (P = .01 and 0.004, respectively), the median team score was significantly higher (P , .001) for both scenarios. In the intervention group, the frequency of achieving a heart rate .90 per minute at 3 minutes improved significantly (P = .003), and the number of hazardous events decreased significantly (P , .001). CONCLUSIONS:In situ simulation training with multidisciplinary teams can effectively improve technical skills and teamwork in neonatal resuscitation. Pediatrics 2014;134:e790-e797

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“…The use of high-fidelity data has facilitated identification of causes of cardiopulmonary arrest and has enabled us to review the quality of chest compressions and the "time off the chest," which has been acknowledged as a key to successful resuscitation. 12 Although it was not quantified, we have noted a marked improvement in the quality of chest compressions and a decrease in no-flow time without compressions.…”

Section: Discussionmentioning

confidence: 80%

“…Efforts to improve team performance during a cardiopulmonary arrest promote optimal results from such high-intensity, low-frequency events. 11,12 Although these types of reviews occur very shortly after the resuscitation, they tend to be focused primarily on issues related to resuscitation and overlook system-based issues.…”

mentioning

confidence: 99%

Multidisciplinary Review of Code Events in a Heart Center

Blankenship

Fernandez

Joy

et al. 2016

American Journal of Critical Care

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Objective To identify a cause for clinical deterioration, examine resuscitation efforts, and identify and correct system issues (thus improving outcomes) via a multidisciplinary code-review process soon after cardiopulmonary arrest. Methods Retrospective analysis of code events in a tertiary pediatric heart center from September 2010 to December 2013 and review of surgical-cardiac data from January 2010 to December 2013. Results A multidisciplinary team reviewed 47 code events, 16 of which (34%) were deemed potentially preventable. At least 2 issues were identified during 66% (31/47) of cardiopulmonary arrests reviewed. Key issues identified were related to communication (62%), environment/ culture/policy (47%), patient care (including resuscitation, 41%), and equipment (38%). About 60% of reviewed arrests resulted in educational initiatives (eg, mock code, in-service education) and 47% resulted in a new policy or modification of existing policy. Less common were changes in equipment (32%) or modification of staffing needs (11%). Changes most frequently occurred in the unit specific to the event (68%) but some changes occurred throughout the Heart Center (32%) or across the hospital system (13%). Survival to discharge after cardiopulmonary arrest has improved over time (P = .03) to 81% for cardiac surgical patients in our center. Conclusion A multidisciplinary code-review committee can identify deficiencies and lead to educational initiatives and improvements in care. When coupled with a hospitalwide "code blue" review process, these changes may benefit the institution as a whole.

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Regular in situ simulation training of paediatric Medical Emergency Team improves hospital response to deteriorating patients

Cited by 86 publications

References 18 publications

Improving Care of Critically Unwell Patients through Development of a Simulation Programme in a Malawian Hospital

Improving Care of Critically Unwell Patients through Development of a Simulation Programme in a Malawian Hospital

In Situ Simulation Training for Neonatal Resuscitation: An RCT

Multidisciplinary Review of Code Events in a Heart Center

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