Using Simulation to Enhance TeamSTEPPS Implementation - PowerPoint Presentation

Slide1

Using Simulation to Enhance TeamSTEPPS Implementation

July

10, 2013Slide2

AcknowledgementsProject SponsorsJim Battles, PhD (AHRQ)

Heidi King, MS (DoD)Project TeamHealth Research & Educational Trust (HRET)

Barb Edson (Project Director)Chris Hund (Project Manager)IMPAQ International David Baker (Team Lead) Slide3

TeamSTEPPS Master TrainingTwo-day training c

ourseTrain-the-trainer approachPrepares you to serve as a TeamSTEPPS Master Trainer by

Providing instruction on TeamSTEPPS tools and strategiesProviding an opportunity to develop and plan your TeamSTEPPS implementation

Prepares

y

ou to serve as a leader for implementing TeamSTEPPS within your

o

rganizationSlide4

Help Line (312) 422-2609

Or email: AHRQTeamSTEPPS@aha.org Slide5

Rules of Engagement Written questions are encouraged throughout the presentation and will be answered during the Q&A session

A Q&A session will be held at the end of the presentation The lines will open for call-in questions during the Q&A sessionSlide6

Today’s Webinar Presenter

Jim Korndorffer, MD, MHPE, FACS Medical Director, Tulane Center for Advanced Medical SimulationProgram Director, General Surgery Residency

Assistant Dean for Graduate Medical EducationProfessor and Vice Chair, Department of Surgery

Responsible for the efficacy of curricula at the Sim Center and supporting faculty in their creation

TeamSTEPPS Master Trainer since 2010Slide7

ObjectivesAt the completion of this webinar the learner will successfully be able to:Utilize simulation strategies to teach and reinforce working as a team

Understand which scenarios are appropriate for utilization in team training simulationAssess the integration of team training using simulation metrics to measure successSlide8

What is Simulation?

‘‘In broad, simple terms a simulation is a person,device, or set of conditions which attempts to

present [education and] evaluation problems

authentically. The student or trainee is required to

respond to the problems as he or she would under

natural circumstances. Frequently the trainee

receives performance feedback as if he or she were

in the real situation.” (McGaghie, 1999)Slide9

What is Simulation? Slide10

Simulation MethodsAnimal/cadaver modelsProsthetic modelsTask trainers

Video trainersSimulation CenterReproduce the actual healthcare environment

Allow learners to “dispel disbelief”

In SituSlide11

Why Use Simulation?EducationTraining

AssessmentSuccessful implementationSlide12

Simulation Features and Education

  Principles of best Simulation features that

  educational practice lead to effective learning

1. Active learning Opportunity for repetitive practice

Realistic learning as an active participant

2. Prompt feedback Trainer provides real-time feedback

Debriefing and reflection after learning

3. High expectations Clearly defined objectives

Tangible outcome measures

Range of difficulty and complexity

  Slide13

Simulation Features and Education

 Principles of best Simulation features that

  educational practice lead to effective learning

4. Collaboration among learners Working together as a multidisciplinary team Crisis resource management skills

5. Respect for diverse ways of learning Complements multiple learning strategies

6. High level of learner–faculty Teacher as coach/facilitator

   interaction

Eric R. Weinberg, Marc A.

Auerbachband

, Nikhil B.

Shaha

, The use of simulation for pediatric training and assessment, Current Opinion in Pediatrics, 2009, 21:282–287

 Slide14

Why Use Simulation?Active LearningDeliberate Practice of Teamwork

Given a task with a well defined goalMotivated to improveProvided with feedback

Self, instructor, simulator, or other team membersProvided with ample opportunities for repetition and gradual refinements of their performanceSlide15

Why Use Simulation?Collaboration Among Learner G

roupsSafe EnvironmentCollegialNo stress of patient safetyIncreased willingness to speak up

Learn to speak upReinforce CUS toolsSlide16

Simulation and Teaching TeamworkTeam training in healthcare often means role playing scenarios

Team training for healthcare should be traditional simulation for teamsAllow team members to simulate their normal processes and procedure.Run simulation scenarios as you normally do.

The learning comes from the debriefing. Debriefing for team training is not traditional.Slide17

Simulation and Teaching TeamworkWhat do you want to achieve? Clear goals and objectives

What levels/types of learners are involved?Novice (students) vs. experiencedProfessional disciplinesWhat are your plans for debriefing?How will you know if you have achieved your objectives?Slide18

Where Does Simulation Fit In?

Benefits of Combining Simulation with Team TrainingIntegrate procedural skills and simulation to achieve patient safety

The real world = hard skills (simulation) + soft skills (communication and team work)Tulane example: Rural ED Team Training courseTeams of 6-8Nurses, pre-hospital, allied health and Medicine

MDs

Simulation stations by specialty that give procedural practice, but debrief on teamwork and communication and NOT medical knowledge and

skillsSlide19

Rural ED Training: The SetupHospital’s high acuity events of concern are discussed with administration, CMO, CNOAgenda is finalized with scenarios that cover desired low frequency – high acuity events

Instructors from each specialtyHospital team of 6-8 members of nurses, paramedics and physicians from the EDSlide20

Rural ED Training: The StrategyKEY that hospital administration, instructors and participants understand …

primary purpose = develop the ED teamNOT to teach medical knowledgeNOT to practice advanced skills

IS to improve individual communication skillsIS to improve teamworkIS to improve individual leadership skillsSlide21

Tulane Rural ED Training2-day course for rural emergency departments, 6-8 participants

Combination of physicians and nursesShort version of TeamSTEPPS Refresher starts Day 1Rotate in small 3-4 person teams through:

OB scenariosNeonatal scenariosACLS scenarios

Pediatric scenarios

Airway Management procedures

Emergency Trauma procedures

Rapid Response Team scenariosSlide22

Managing SimulationsOB example: What if the scenario drags out because the physician does not know how to make the maneuver in a shoulder dystocia?

This is a classic example of a procedural mistake.What does the Instructor do?Slide23

Managing DebriefingRapid Response example: The team is sidetracked by the length of time it took them to diagnose.

Just as in simulation, healthcare professionals are used to focusing on their technical and cognitive abilities during training. What if the purpose is team training?How does the Instructor manage this in debriefing?Slide24

Rural ED TrainingGoal: Improve Patient SafetyObjectives: Team BehaviorsDemonstrate the TeamSTEPPS skills

Provide opportunity for application of TeamSTEPPS tools and strategies in clinical setting Provide opportunity to debrief on aboveOnly if necessary, briefly address medical issuesFocus on Skills, Behaviors, and AttitudesSlide25

How Has it Worked? Just a day after a team from Franklin Medical Center went to Tulane University in New Orleans to learn how to better respond to medical emergencies, they got an unexpected chance to put their lessons into action…. ‘She was in active labor. There was no way I was going to transfer her,’ said ER physician Dr. Jeffrey Combetta…‘We were ready for anything, and we were ready because we had just come from the simulator.’Slide26

TeamSTEPPS Master TrainingThe Call: The hospital Code Team has been called to the cafeteria for a hospital visitor who collapsed after clutching his chest. He is not a patient of the hospital, therefore no medical history is available, nor any information on symptoms or complaints. Hospital staff were able to determine his name, but have not been able to get any other information.

The Call: A nurse has returned to a patient’s room to transfer him to a stretcher to be taken to radiology for a chest x-ray. Upon complaints of chest pain, the Hospital Code Team has been called.Slide27

TeamSTEPPS Master TrainingThe Scenario: Patient was painting her home when she fell from the ladder. She has been unable to walk because of excruciating pain her left hip. She was admitted to the ER and is being sent to radiology. When moving her from the exam table to a stretcher she is dropped.

The Scenario: Two nurses are helping a “new resident” put in a central line. While doing the procedure, he/she (purposely) contaminates and breaks the sterile field.Slide28

Tulane’s Experience with Simulation for TeamSTEPPS Master Training

Activities and

Simulation

S

cenarios

W

ere Effective

in

Demonstrating

C

oncepts

Not at All

Slightly

Moderately

Mostly

Completely

Lego

Tower building

0%

2%

4%

24%

62%

Basic

healthcare

simulation

1%

1%

4%

24%

62%

Advanced

healthcare

simulation

0%

0%

4%

19%

69%Slide29

Why Use Simulation?EducationTraining

AssessmentSuccessful implementationSlide30

How to Evaluate Competency?

Traditional methods emphasize faculty/mentor impressionRecall

bias, central tendency, halo effectAnecdotalPerpetuation of sub-optimal methods

“

It

’

s how we always do it

”

Poor

correlation with actual performance

Difficult

to standardize and reproduce

Members of healthcare team are trained and evaluated in isolationSlide31

Simulation to Evaluate Medical Competency?

Standardized methods

“

check list

”

of learning objectives and skills

Emphasizes independent observer/instructor

Reproducible

Can test all 6 competency areas simultaneously

Healthcare team members test together in more realistic settingSlide32

Performance Checklist: Leadership and Teamwork Skills Slide33

Formative AssessmentMiller’s PyramidSlide34

Conclusion

Simulation enhances TeamSTEPPS

Improving learningDidactic Lectures ------- Active Learning

Improving assessment of implementation

Knows

------ DoesSlide35

Questions and AnswersSlide36

Upcoming TeamSTEPPS Events

Upcoming Webinars

August 14, 2013

September 11,

2013

Topics, speakers, and registration information will be posted on the portal as details become availableSlide37

Thank You!For more information, please contact our team at:

AHRQTeamSTEPPS@aha.org