In situ, multidisciplinary, simulation-based teamwork training improves early trauma care

Abstract

Objective: Evaluate the impact of a team training curriculum for residents and multidisciplinary trauma team members on team communication, coordination and clinical efficacy of trauma resuscitation.

Design: Prospective, cohort intervention comparing pre- vs. post-training performance. The intervention was a human patient simulator (HPS)-based, in situ team training curriculum, comprising a one-hour web based didactic followed by HPS training in the emergency department (ED). Teams were trained in multidisciplinary groups of 5-8 persons. Each HPS session included three fifteen minute scenarios with immediate video-enabled debriefing. Structured debriefing and teamwork assessment was performed with a modified NOTECHS scale for trauma (T-NOTECHS). Teams were assessed for performance changes during HPS-based training, as well as in actual trauma resuscitations.

Setting: The Queen's Trauma Center (Level II); the primary teaching hospital for the University of Hawaii Surgical Residency.

Participants: 137 multidisciplinary trauma team members, including residents (n = 24), ED and trauma attending physicians, nurses, respiratory therapists, and ED technicians.

Results: During HPS-based training sessions, significant improvements in teamwork ratings, and in clinical task speed and completion rates were noted between the first and the last scenario.244 real-life blunt trauma resuscitations were observed for six months before and after training. There was a significant improvement in mean teamwork scores from the pre-to post-training resuscitations. Moreover, there were significant improvements in the objective parameters of speed and completeness of resuscitation. This was manifest by a 76% increase in the frequency of near-perfect task completion (≤ 1 unreported task), and a reduction in the mean overall ED resuscitation time by 16%.

Conclusions: A relatively brief (four-hour) HPS-based curriculum can improve the teamwork and clinical performance of multidisciplinary trauma teams that include surgical residents. This improvement was evidenced both in simulated and actual trauma settings, and across teams of varying composition. HPS-based trauma teamwork training appears to be an educational method that can impact patient care.