Transcript Interdisciplinary simulations to reduce communication

Team Training in
Anaesthesia
Jennifer Weller
1
Acknowledgements
•
•
•
•
•
•
•
•
•
•
•
•
•
Dr Jane Torrie
Dr Rob Frengley
Prof Brian Jolly
Prof Alan Merry
Dr Brian Robinson
Dr Boaz Shulruf
Dr Robert Henderson
Ms Kaylene Henderson
Dr Bevan Yee
Dr Pete Dzendrowskyj
Dr Adam Paul
ANZCA
Plus hosts of others
2
A private Hospital: wrong side
surgery (knee).
“A team is called a team for a very good
reason; there is an expectation that
there will be sufficient co-operation
and communication amongst its
members to minimise the risk of harm
to the patient.”
A Report by the Health and Disability Commissioner. (Case
00/06857), 2002; Orthopaedic Surgeon/Anaesthetist/Theatre
Nurse/Anaesthetic Nurse/Scrub Nurse
3
4
“If you can’t measure it you can’t improve
it.”
Lord Kelvin
5
Global performance measure
Behaviour
•
•
•
•
•
•
•
•
•
•
1
2
3
4
5
Acquisition of all available information
Anticipates and plans
Calls for help appropriately
Reevaluates situation
Utilises team resources effectively
Allocates attention wisely
Prioritises
Concise, directed instructions, closes communication loop
Communicates problem clearly to team, Listens to team
Manages Conflict (if required)
Weller et al. Anaesthesia. 2005
Weller et al. British Journal of Anaesthesia. 2003
6
7
Role in
commun
-ication
Who to
Type of
Communication
Situational
content
Pre
Initiation
induction
Tech
Statement
Verbalises patient
parameters
Post
Response
induction
Surgeon
When
Circn.
Nurse
All
Task assignment
Gave tech 2 or more
instructions
Assessment of
patient status
Anticipates future
problems
Proposes plan of
action
Requests information
Other
Asks for suggestions
Unspecified
Receiver
Responds to
suggestions
Ignored suggestions
Requested help
Request to surgeon
8
9
10
Validation of the instrument
40 critical care
teams
4 scenarios
Randomised
scenario order
Respiratory / Cardiac
Scenario order
randomised
160 videos
Three trained
assessors
independently rated
the scenarios.
480 scores
11
Exploratory Factor Analysis
Leadership
and Team
Coordination
α = 0.917
Mutual
Performance
Monitoring
α = 0.915
Verbalising
Situational
Information
α = 0.893
Internal consistency measured with Cronbach’s α
12
Generalisability analysis
G-Coeff
Overall behaviour score
0.78
Leadership and Team Coordination
0.85
Mutual Performance Monitoring
0.4
Verbalising Situational Information
0.37
13
Improvement in teamwork and its components
following training
Item
Simulation Type
Difference
P value
Overall
Teamwork
Behavior
Airway
1.107
<0.005
Cardiac
0.826
<0.005
Airway
0.849
<0.005
Cardiac
0.691
<0.005
Airway
0.747
<0.005
Cardiac
0.472
<0.005
Airway
0.113
0.76
Cardiac
-0.034
0.365
Leadership and
Team
Co-ordination
Verbalizing
Situational
Information
Mutual
Performance
Monitoring
14
Participant’s evaluation of the team training
intervention
15
Recap
So far we’ve considered:
• Different ways of looking at teamwork
• Need for robust measures
• Evidence that teamwork behaviours
can be learnt
BUT
16
HDC commenting further on case of
wrong side surgery
“It is critical for a theatre team to operate as a team
rather than as a group of individuals with separate and
independent responsibilities.
There must be an acknowledgment of the necessity of
collective responsibility for a team of trained health
professionals operating as a team within the operating
theatre environment.”
17
Understanding communication failures
If you get a team leader who verbalises well,
there’s no mixed messages going through and
everybody knows what the .. objectives are
Issues we identified
• Sharing goals
• Establishing
capabilities of team
members
• Challenging
behaviour
Weller et al Interdisciplinary team interactions. Medical Education 2008
18
Value of multidisciplinary
team training
“The nurses can take some of the load from a doctor. The nurses
are valuable members of the team and their ideas have value
too.” [N]
“so they can both see from the other’s eyes what they are
responsible for, what they’re going through” [N]
“new appreciation of the expert assistant role of the nurse” [D]
“It’s highlighted that doctors need to be able to take on
information, process it and spit it out at a great rate of knots.
But -just because they’re the doctor doesn’t mean that they
can see absolutely everything -we have to work together as a
team to get a desired outcome”. [N]
19
Issues in Multidisciplinary Team
training
Limited numbers of studies – McCulloch 2011
• MDT approach to training and
assessment
• Real teams playing themselves
• Meaningful engagement of all players
• Simulations of sufficient fidelity and
relevance to engage all
20
Innovations in health professionals training in
the management of the surgical patient.
We aim to:
• Create realistic
simulated operating
room environments to
engage the whole
team.
• Target identified
communication
problems.
• Evaluate change in
practice in the
workplace.
• Demonstrate improved
outcomes for patients.
Innovations in health professionals training in the management of the
21
surgical patient. J Weller et al (Health Workforce NZ Innovations funding)
22
23
A SNAPPI Call-out
S top and gather the team
Stand back and get the attention
of the room
N otify team re patient
status
A ssessment of the
situation
Provide an overview of the
situation e.g. Vital signs, blood
results, events.
P roposed plan for
treatment
P riorities
Say what you think needs to be
done
I nvite ideas
Invite suggestions, other ideas
24
on diagnosis or treatment.
Verbalise your assessment of
the situation e.g. “I think this
may be anaphylaxis” plus
options
And in which order
Voice your concerns
P robe
A lert
C hallenge
E mergency
R esponse
The two Challenge
Rule
“If a pilot is clearly
challenged twice about
an unsafe situation
during a flight without
a satisfactory reply, the
subordinate is
empowered to take
over the controls.”
Juniors are expected to
express their concerns.
Seniors are expected to
listen and reply.
25
I dentify
S ituation
B ackground
A ssessment
R ecommendatio
n
26