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Improving team communication at delivery among obstetric, anesthesia and neonatal team members using didactic instruction and on-site simulation-based training

2006; Lippincott Williams & Wilkins; Volume: 1; Issue: 2 Linguagem: Inglês

10.1097/01266021-200600120-00018

1559-713X

Kristine Larison, Jeffrey T. Butler, Janice Schriefer, Kimberly A. Yaeger, Louis P. Halamek, Shaun M. Elam,

Patient Safety and Medication Errors

Background: Crew Resource Management (CRM) training has been used in non-medical domains to enhance communication in situations where risk to life is high. In part based on these findings and other data in the literature, a subgroup of hospitals in the Vermont Oxford Network (VON), a national collaborative of hospitals dedicated to evidence-based quality improvement in neonatology, embarked on a project to improve communication in the delivery room. Methods: Six tertiary obstetric and neonatal intensive care units* are in the first year of this two-year project to improve communication among obstetric, anesthesia and neonatal team members. Each site has applied for and received authorization from its Institutional Review Board to conduct this project and enroll human subjects. Baseline performance at each site is being assessed by: 1) staff survey (3-point Likert scale) designed to evaluate knowledge of CRM behaviors, and 2) team communication scoring tool developed specifically for the delivery room. CRM skills are then introduced with a didactic presentation followed by real-time, simulation-based training conducted in the labor and delivery units of each hospital using commercially available technologies. Scenarios emphasizing CRM strategies such as SBAR (situation, background, assessment, recommendation), repeat-backs and transparent thinking have been developed and refined at each site. Self-selected leaders have received training in communication and serve as the primary debriefing and assessment teams. Follow-up data will be obtained in the second year of the project. Staff surveys will be re-issued after didactic training is complete and again after simulation-based training is compete. The team communication scoring tool will be used to assess communication in both simulated and real deliveries. Results pre- and post-training will be compared to assess the effect of simulation-based training on performance during real deliveries. Results: The members of this collaborative have accomplished a number of important tasks as they near the end of the first year of this project. They have developed and refined two assessment tools (staff survey, team communication scoring tool), designed a number of training scenarios, standardized the content and equipment used in these scenarios across six sites, trained leaders at each site in debriefing and scoring team performance, and have begun assessing baseline content knowledge and communication in the real delivery room. Over 500 staff surveys have been returned thus far and real delivery room performance is being scored on a daily basis. Conclusions: Implementation of simulation-based training can be accomplished using current technologies in the actual clinical environments at centers lacking dedicated simulation facilities. By first identifying focused learning objectives, then developing pertinent assessment tools and practical implementation strategies, it is possible to carry out simulation-based training in the “real world” that has the potential to improve staff performance, institutional safety culture, and ultimately patient care. *Akron Children’s Hospital, Akron, Ohio; Baptist Children’s Hospital, Miami, Florida; Children’s Hospital at Bronson, Kalamazoo, Michigan; Children’s Hospitals and Clinics, St. Paul, Minnesota; Providence St. Vincent Medical Center, Portland, Oregon; Rockford Memorial Hospital, Rockford, Illinois. Conflict of Interest: Authors indicated they have nothing to disclose.