Advances in simulation (London, England)
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Adult and paediatric basic life support (BLS) training are often conducted via group training with an accredited instructor every 24 months. Multiple studies have demonstrated a decline in the quality of cardio-pulmonary resuscitation (CPR) performed as soon as 3-month post-training. The 'Resuscitation Quality Improvement' (RQI) programme is a quarterly low-dose, high-frequency training, based around the use of manikins connected to a cart providing real-time and summative feedback. We aimed to evaluate the effects of the RQI Programme on CPR psychomotor skills in UK hospitals that had adopted this as a method of BLS training, and establish whether this program leads to increased compliance in CPR training. ⋯ This data demonstrated an increased adherence with guidelines for high-quality CPR post-training with the RQI cart, for all adult and most infant measures, but not infant CPR. However, the relationship between a formalised quarterly RQI curriculum and improvements in resuscitation skills is not clear. It is also unclear whether the RQI approach is superior to the current classroom-based BLS training for CPR skill acquisition in the UK. Further research is required to establish how to optimally implement the RQI system in the UK and how to optimally improve hospital wide compliance with CPR training to improve the outcomes of in-hospital cardiac arrests.
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The use of simulation-based team training has increased over the past decades. Simulation-based team training within emergency medicine and critical care contexts is best known for its use by trauma teams and teams involved in cardiac arrest. In the domain of emergency medicine, simulation-based team training is also used for other typical time-critical clinical presentations. We aimed to review the existing literature and current state of evidence pertaining to non-technical skills obtained via simulation-based team training in emergency medicine and critical care contexts, excluding trauma and cardiac arrest contexts. ⋯ The literature on simulation-based team training in emergency medicine is heterogeneous and sparse, but somewhat supports the hypothesis that simulation-based team training is beneficial to teams' knowledge and attitudes toward non-technical skills (Kirkpatrick level 2). Randomized trials are called for to clarify the effect of simulation compared to other modalities of team training. Future research should focus on the transfer of skills and investigate improvements in patient outcomes (Kirkpatrick level 4).
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Why is this important?
Most simulation research focuses on skills and knowledge (the easiest factors to measure), even though:
- It is clinical outcomes that primarily matter, and;
- Simulation is uniquely positioned to address improvements in the many domains of teamwork.
Brazil et al. applied a relational coordination (RC) framework to understand teamwork-aspects of simulation research, particularly as these impact wider institutional and healthcare system performance.
“The RC framework — shared knowledge, shared goals and mutual respect in the context of communication that is timely, accurate, frequent and problem-solving based — can provide a common language for simulation educators to design and debrief simulation exercises that aim to have a translational impact” (Brazil et al. 2019)
What did they do?
The researchers undertook a narrative survey of staff involved in early major trauma care at a university teaching hospital. Over half of the respondents had participated in the institution’s existing in situ trauma simulation program.
Survey responses were analysed using the RC framework, and found to be consistent with each RC domain. Most notably trauma simulation acted as an enabler of mutual respect and improved communication, along with enhancing the understanding of team roles and prioritising problem-solving focused communication.
The take-home
The impact of simulation needs to be understood in the context of the greater goal – healthcare system improvement – and that this occurs with pre-existing organisational cultures and relationships. Simulation outcomes goals are not exclusive to small teams or individual performance.
The various domains within the relational coordination framework provide an easy to use guide for understanding, communicating and deploying simulation benefits, drawing a path from the ‘here’ to the ‘there’ of improved outcomes.
summary“Simulation should be considered as a tool to build and strengthen relationships between practitioners across traditional boundaries.”