Journal Club- Arrowe Park Hospital October 2013 Dr Binu T George

1. Journal Club- Arrowe Park Hospital October 2013 Dr Binu T George Robert W. Frengley, et al, Crit Care Med 2011 Vol. 39, No. 12 2605.

2. Literature search • Topic : Training in intensive/Critical care • 1. MEDLINE; exp *INTENSIVE CARE/ OR exp *INTENSIVE CARE UNITS/ OR exp *CRITICAL CARE/; 50375 results. • 2. MEDLINE; exp *EDUCATION, MEDICAL, GRADUATE/ OR exp *EDUCATION, MEDICAL/ OR exp *EDUCATION, MEDICAL, CONTINUING/; 94391 results. • 3. MEDLINE; 1 AND 2; 516 results.4. MEDLINE; 3 [Limit to: English Language and Humans and Publication Year 2010-Current]; 132 results • Manually went through 132- picked out 8 relevent studies

3. Selected paper • The effect of a simulation based training intervention on the performance of established critical care unit teams (Robert W Frengley,Jennifer M Weller,JaneTirrie,PeterDzendrowskyj Critical Care Med 2011;39:2605-2611)

4. OBJECTIVE Evaluation of the effectiveness of a simulation based intervention on improving teamwork in multidisciplinary critical care teams managing airway and cardiac crises Comparison of simulation-based learning and case-based learning

5. BACKGROUND • The Institute of Medicine in its publication To Err Is Human issued a number of recommendations to enhance patient safety • “to train in teams those who are expected to work in teams.” • Evidence suggests that teams make fewer mistakes than individuals and that good team work improves patient safety • Evidence also suggests team work failures make substantial contributions to sub optimal patient care • In the critical care unit, teamwork is of particular importance in optimizing patient outcome in clinical crises, including emergency airway or cardiac events.

6. METHODS • Self-controlled randomized crossover study design with blinded assessors. • Setting: A simulated critical care ward, using a high-fidelity patient simulator, • in a university simulation center. • Subjects: Forty teams from critical care units • - 1 doctor and 3 nurses • Intervention: • 10 hour study day • Assessment done at Beginning and End of the day • Each team undertook 2 pre-intervention and 2 post intervention assessments • The study day included • Presentations and discussions on human factors and crisis management • Airway and Cardiac skills stations. • For the intervention, teams were randomized to • Case-based learning or Simulation-based learning (for cardiac or airway scenarios) • Measurements: • Recording and analysis done by 3 blinded expert assessors • Structured rating tool was used with technical and behavioral components. • Participants were surveyed 3 months later.

7. METHODS

8. RESULTS

9. RESULTS

10. RESULTS

11. DISCUSSION Paucity of literature documenting outcomes of MDT training interventions Case control study Wayne DB ,Didwala A ,Fienglass –Simulation based education improved quality of care during cadiac arrest team responses ( CHEST 2008;133:56-61) Steadman RH, Coates WC ,Huang YM/;simulation based training is superior to problem based learning for acquisition of critical assessment and management skills (Critical care Med 2006;34:151-157)

12. CONCLUSIONS • Simulation-based intervention is effective in improving performance in multidisciplinary critical care teams • There is improved performance in the simulator after the course • There have been self reported changes to subsequent clinical practice • Supports that there is transfer of learning from simulation to the workplace over a period of time. • Results suggest that a mix of SBL and CBL is effective

13. CRITIQUE • Quality of evidence 1 b (individual RCT with narrow confidence interval) • Responder Bias • Demonstrating objective ,improved patient outcome beyond scope of this study • Trend suggesting SBL better than CBL –small sample size, hence no statistical difference demonstrated

14. Summary • Good evidence to suggest SBL improves team work behaviour and overall effectiveness of team • SBL and CBL combined makes better learning envoirnment • Further scope for research with larger groups to improve statistical difference between SBL and CBL

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18. Any Questions ????

19. THANK YOU !!!