Regular in-situ simulation training of paediatric Medical Emergency Team leads to sustained improvements in hospital response to deteriorating patients, improved outcomes in intensive care and financial savings

Theilen, U; Fraser, Laura; Jones, Patricia A.; Leonard, Paul; Simpson, Dave

doi:10.1016/j.resuscitation.2017.03.031

Cited by 68 publications

(68 citation statements)

References 28 publications

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“…53 Wehbe-Janek et al 54 suggested that a simulation-based training program could overcome system barriers and augment the use of RRT. Theilen et al 55 demonstrated that regular in-situ simulation training of a paediatric RRT led to sustained improvement.…”

Section: Major Findingsmentioning

confidence: 99%

Succeeding with rapid response systems – a never-ending process: A systematic review of how health-care professionals perceive facilitators and barriers within the limbs of the RRS

et al. 2019

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Background: Meta-analyses show that hospital rapid response systems (RRS) are associated with reduced rates of cardiorespiratory arrest and mortality. However, many RRS fail to provide appropriate outcomes. Thus an improved understanding of how to succeed with a RRS is crucial. By understanding the barriers and facilitators within the limbs of a RRS, these can be addressed.Objective: To explore the barriers and facilitators within the limbs of a RRS as described by health-care professionals working within the system. Methods:The electronic databases searched were: EMBASE, MEDLINE, CINAHL, Epistemonikos, Cochrane, PsychInfo and Web of Science. Search terms were related to RRS and their facilitators and barriers. Studies were appraised guided by the CASP tool. Twenty-one qualitative studies were identified and subjected to content analysis.Results: Clear leadership, interprofessional trust and collaboration seems to be crucial for succeeding with a RRS. Clear protocols, feedback, continuous evaluation and interprofessional training were highlighted as facilitators. Reprimanding down the hierarchy, underestimating the importance of call-criteria, alarm fatigue and a lack of integration with other hospital systems were identified as barriers. Conclusion:To succeed with a RRS, the keys seem to lie in the administrative and quality improvement limbs. Clear leadership and continuous quality improvement provide the foundation for the continuing collaboration to manage deteriorating patients. Succeeding with a RRS is a never-ending process.

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Section: Major Findingsmentioning

confidence: 99%

Succeeding with rapid response systems – a never-ending process: A systematic review of how health-care professionals perceive facilitators and barriers within the limbs of the RRS

et al. 2019

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“…The first wave of expensive, high tech, highly realis c manikins now coexists with low tech, low cost and in-situ simula on regardless of a country's GDP. Concentra on on communica on skills, team dynamics and processes can result in significant skill acquisi on and improved quality of care and both outcomes are difficult to achieve or demonstrate in tradi onal educa on 7,8 modali es. The keys to the use of simula on for educa on are appropriately trained and experienced facilitators and clarity of learning objec ves and group outcomes, and measuring whether or not these are achieved.…”

Section: Roseby Rmentioning

confidence: 99%

Journeys, Frontiers and Medical Education

Roseby

2019

Birat J. Health Sci.

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“…13 Improvement in simulated performance, and to some extent in clinical behaviour and patient outcomes, has been Quality improvement report shown for several medical emergencies including acute ischaemic stroke. [14][15][16] In a recent article regarding simulation training in acute stroke, human factors in the stroke team is suggested as the most important rate-limiting factor in acute stroke care. 17 Simulation training directed at improving healthcare systems and patient care, so-called translational simulation, is particularly useful as part of quality improvement (QI) projects because of its potential both for diagnosing system performance and delivering simulation-based interventions.…”

Section: Introductionmentioning

confidence: 99%

Reducing door-to-needle times in stroke thrombolysis to 13 min through protocol revision and simulation training: a quality improvement project in a Norwegian stroke centre

et al. 2019

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BackgroundIn eligible patients with acute ischaemic stroke, rapid revascularisation is crucial for good outcome. At our treatment centre, we had achieved and sustained a median door-to-needle time of under 30 min. We hypothesised that further improvement could be achieved through implementing a revised treatment protocol and in situ simulation-based team training sessions. This report describes a quality improvement project aiming to reduce door-to-needle times in stroke thrombolysis.MethodsAll members of the acute stroke treatment team were surveyed to tailor the interventions to local conditions. Through a review of responses and available literature, the improvement team suggested changes to streamline the protocol and designed in situ simulation-based team training sessions. Implementation of interventions started in February 2017. We completed 14 simulation sessions from February to June 2017 and an additional 12 sessions from November 2017 to March 2018. Applying Kirkpatrick’s four-level training evaluation model, participant reactions, clinical behaviour and patient outcomes were measured. Statistical process control charts were used to demonstrate changes in treatment times and patient outcomes.ResultsA total of 650 consecutive patients, including a 3-year baseline, treated with intravenous thrombolysis were assessed. Median door to needle times were significantly reduced from 27 to 13 min and remained consistent after 13 months. Risk-adjusted cumulative sum charts indicate a reduced proportion of patients deceased or bedridden after 90 days. There was no significant change in balancing measures (stroke mimics, fatal intracranial haemorrhage and prehospital times).ConclusionsImplementing a revised treatment protocol in combination with in situ simulation-based team training sessions for stroke thrombolysis was followed by a considerable reduction in door-to-needle times and improved patient outcomes. Additional work is needed to assess sustainability and generalisability of the interventions.

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Regular in-situ simulation training of paediatric Medical Emergency Team leads to sustained improvements in hospital response to deteriorating patients, improved outcomes in intensive care and financial savings

Cited by 68 publications

References 28 publications

Succeeding with rapid response systems – a never-ending process: A systematic review of how health-care professionals perceive facilitators and barriers within the limbs of the RRS

Succeeding with rapid response systems – a never-ending process: A systematic review of how health-care professionals perceive facilitators and barriers within the limbs of the RRS

Journeys, Frontiers and Medical Education

Reducing door-to-needle times in stroke thrombolysis to 13 min through protocol revision and simulation training: a quality improvement project in a Norwegian stroke centre

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