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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. Describe TeamSTEPPS and its role in EM

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Team Training in EM Residency Education

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  1. Team Training in EM Residency Education CORD Academic Assembly 2012 Ryan Fringer, MD Christopher McDowell, MD MEd

  2. Disclosures • Dr. Fringer & Dr. McDowell have no financial conflicts or relationships to disclose

  3. Goals • Describe TeamSTEPPSand its role in EM • Introduce team training to junior level residents • Describe examples of team training assessment throughout residency • Provide a framework for those wishing to add team training to their curriculum

  4. The State of things in 2012 • 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

  5. How does this apply to EM? • ACGME • Systems-based Practice • Trauma Teams • Resuscitations • Code Teams • Can’t we extend team training from specific teams to our everyday pods • Trauma Teams  everyday EM function

  6. What Tools Exist to Help? • TeamSTEPPS • In house system resources • Organizational Learning Department • In-house funding (DIO, Hospital admin)

  7. What is TeamSTEPPS? • An evidence-based teamwork system • Designed to improve: • Quality • Safety • Efficiency of health care • Practical and adaptable • Provides ready-to-use materials for training and ongoing teamwork

  8. TeamSTEPPS • A framework for introducing the concepts of team training • Designed by Dept of Defense • 4 specific domains • Leadership • Communication • Situation Monitoring • Mutual Support • Scalable to meet your needs

  9. SMARTT Stepback in Trauma Bay • S: Situation • M: Management • A: Activity • R: Rapidity • T: Troubleshooting • T: Talk to Me

  10. What TeamSTEPPS can do Emergency Department Medical Floors After implementation of SBAR to improve communication among clinical caregivers: • 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% to89%. After implementation of multiple medical team training programs: • Improved observed team behaviors. • Enhanced staff attitudes toward teamwork. • Reduced observedclinical errors.

  11. Leadership • Brief • Huddle • Debrief

  12. Communication • Call-out • Airway? • Patent and talking • Check back (closing the loop) • Fentanyl 50mcg • nurse repeats Fentanyl 50mcg • you say “correct” • Handoffs

  13. Situation Monitoring • S: Status of the patient • T: Teamwork • E: Environment • P: Progress toward patient goals

  14. Mutual Support • Culture Change & Empowerment • Two challenge Rule • Concerned • Uncomfortable • Safety Issue • Stop the Line!

  15. TeamSTEPPS at Beaumont • Brief Timeline • What worked • What did not work • Future directions

  16. TeamSTEPPS at Beaumont • Brief Timeline • What worked • What did not work • Future directions

  17. 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”

  18. Needs Assessment • This will guide your process • Many methods to choose from • Surveys • Focused interviews • Roundtable discussions • Direct observation by trained observers • In Situ simulation • Exploratory, observational trips

  19. Outcome Measures • Very little data = opportunity • Capella et al. • LOS and other times • Clinical Outcomes • Safety Culture survey • Nursing/Staff turnover • Noise level monitoring

  20. Take Home Points • “Buy in” by all stakeholders is necessary • Needs assessment is critical • Role (re)definition needs to be individualized • Process/culture change takes a long time • Outcome measures? • Email: rfringer@beaumont.edu for any questions or resources

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