Transcript Team Training in EM Residency Education

Team Training in EM Residency
Education
CORD Academic Assembly 2012
Ryan Fringer, MD
Christopher McDowell, MD MEd
Disclosures

Dr. Fringer & Dr. McDowell have no financial conflicts or
relationships to disclose
Goals
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Describe TeamSTEPPS and its role in EM
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Introduce team training to junior level residents
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Describe examples of team training assessment throughout
residency
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Provide a framework for those wishing to add team training to
their curriculum
The State of things in 2012
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Teamwork
Residents must care for patients in an environment that maximizes
effective communication. This must include the opportunity to
work as a member of effective interprofessional teams that are
appropriate to the delivery of care in the specialty.
VI.F.1.
Interprofessional teams must be used to ensure effective and efficient
communication for appropriate patient care for emergency
medicine department admissions, transfers, and discharges.
ACGME EM Program Requirements
How does this apply to EM?
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ACGME
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Systems-based Practice
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Trauma Teams
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Resuscitations
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Code Teams
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Can’t we extend team training from specific teams to our everyday pods
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Trauma Teams  everyday EM function
What Tools Exist to Help?
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TeamSTEPPS
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In house system resources
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Organizational Learning Department
In-house funding (DIO, Hospital admin)
What is TeamSTEPPS?
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An evidence-based teamwork system
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Designed to improve:
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Quality
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Safety
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Efficiency of health care
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Practical and adaptable
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Provides ready-to-use materials for training and ongoing teamwork
TeamSTEPPS
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A framework for introducing the concepts of team training
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Designed by Dept of Defense
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4 specific domains
 Leadership
 Communication
 Situation Monitoring
 Mutual Support
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Scalable to meet your needs
SMARTT Stepback in Trauma Bay
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S: Situation
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M: Management
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A: Activity
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R: Rapidity
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T: Troubleshooting
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T: Talk to Me
What TeamSTEPPS can do
Emergency Department
After implementation of multiple
medical team training programs:
•
Improved observed team
behaviors.
•
Enhanced staff attitudes toward
teamwork.
•
Reduced observed clinical errors.
Medical Floors
After
implementation of SBAR to
improve communication among
clinical caregivers:
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• Reduced rate of adverse drug
events (from 30 to 18 per 1,000
patient days).

• Improved medication
reconciliation at patient
admission from 72% to 88% and
at discharge from 53% to 89%.
Leadership
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Brief
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Huddle
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Debrief
Communication
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Call-out
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Check back (closing the loop)
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Airway?
Patent and talking
Fentanyl 50mcg
nurse repeats Fentanyl 50mcg
you say “correct”
Handoffs
Situation Monitoring
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S: Status of the patient
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T: Teamwork
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E: Environment
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P: Progress toward patient goals
Mutual Support
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Culture Change & Empowerment
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Two challenge Rule
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Concerned
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Uncomfortable
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Safety Issue
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Stop the Line!
TeamSTEPPS at Beaumont
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Brief Timeline
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What worked
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What did not work
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Future directions
TeamSTEPPS at Beaumont
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Brief Timeline

What worked
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What did not work
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Future directions
TeamSTEPPS Timeline
September 2007 “Aha” moment
March 2008 – TeamSTEPPS Consortium
August 2008 – TeamSTEPPS Training
October 2008 – Needs Assessment
Jan – Dec 2009 – Facilitated Discussions
Jan – Aug 2010 – Train the Trainers
Aug 2010 – May 2011 – Comprehensive Training
January 2011 – TeamSTEPPS “Go Live”
Needs Assessment
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This will guide your process
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Many methods to choose from
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Surveys
Focused interviews
Roundtable discussions
Direct observation by trained observers
In Situ simulation
Exploratory, observational trips
Outcome Measures
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Very little data = opportunity
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Capella et al.
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LOS and other times
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Clinical Outcomes
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Safety Culture survey
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Nursing/Staff turnover
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Noise level monitoring
Take Home Points
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“Buy in” by all stakeholders is necessary
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Needs assessment is critical
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Role (re)definition needs to be individualized
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Process/culture change takes a long time
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Outcome measures?
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Email: [email protected] for any questions or resources