team training in em residency education
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Team Training in EM Residency Education
CORD Academic Assembly 2012
Ryan Fringer, MDChristopher McDowell, MD MEd
DisclosuresDr. Fringer & Dr. McDowell have no financial conflicts or
relationships to disclose
GoalsDescribe TeamSTEPPS and 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
The State of things in 2012Teamwork
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
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
What Tools Exist to Help?TeamSTEPPS
In house system resources Organizational Learning Department In-house funding (DIO, Hospital admin)
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
TeamSTEPPSA 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
SMARTT Stepback in Trauma BayS: Situation
M: Management
A: Activity
R: Rapidity
T: Troubleshooting
T: Talk to Me
What TeamSTEPPS can doEmergency Department
After implementation of multiple medical team training programs:
• Improved observed team behaviors.
• Enhanced staff attitudes toward teamwork.
• Reduced observed clinical errors.
Medical FloorsAfter 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% to 89%.
LeadershipBrief
Huddle
Debrief
CommunicationCall-out
Airway? Patent and talking
Check back (closing the loop) Fentanyl 50mcg nurse repeats Fentanyl 50mcg you say “correct”
Handoffs
Situation MonitoringS: Status of the patient
T: Teamwork
E: Environment
P: Progress toward patient goals
Mutual Support Culture Change & Empowerment
Two challenge Rule
Concerned
Uncomfortable
Safety Issue
Stop the Line!
TeamSTEPPS at BeaumontBrief Timeline
What worked
What did not work
Future directions
TeamSTEPPS at BeaumontBrief Timeline
What worked
What did not work
Future directions
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”
Needs AssessmentThis 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
Outcome Measures Very little data = opportunity
Capella et al.
LOS and other times
Clinical Outcomes
Safety Culture survey
Nursing/Staff turnover
Noise level monitoring
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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