Dataset Information

Simulation-based team training in time-critical clinical presentations in emergency medicine and critical care: a review of the literature.

ABSTRACT:

Background

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.

Methods

This systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement. Before the initiation of the study, the protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO) database. We conducted a systematic literature search of 10?years of publications, up to December 17, 2019, in the following databases: PubMed/MEDLINE, EMBASE, Cochrane Library, and CINAHL. Two authors independently reviewed all the studies and extracted data.

Results

Of the 456 studies screened, 29 trials were subjected to full-text review, and 13 studies were included in the final review. None of the studies was randomized controlled trials, and no studies compared simulation training to different modalities of training. Studies were heterogeneous; they applied simulation-training concepts of different durations and intensities and used different outcome measures for non-technical skills. Two studies reached Kirkpatrick level 3. Out of the remaining 11 studies, nine reached Kirkpatrick level 2, and two reached Kirkpatrick level 1.

Conclusions

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).

SUBMITTER: Weile J

PROVIDER: S-EPMC7816464 | biostudies-literature | 2021 Jan

REPOSITORIES: biostudies-literature

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Publications

Simulation-based team training in time-critical clinical presentations in emergency medicine and critical care: a review of the literature.

Weile Jesper J Nebsbjerg Mette Amalie MA Ovesen Stig Holm SH Paltved Charlotte C Ingeman Mads Lind ML

Advances in simulation (London, England) 20210120 1

<h4>Background</h4>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 ...[more]

PMID: 33472706

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Project description:ObjectiveEmergency medical services (EMS) professionals infrequently transport children leading to difficulty in recognition and management of pediatric critical illness. Simulation provides an opportunity to train EMS professionals on pediatric emergencies. The objective of this study was to examine the effect of serial simulation training over 6 months on EMS psychomotor and cognitive performance during team-based care.MethodsThis was a longitudinal prospective study of a simulation curriculum enrolling EMS professionals over a 6-month period during which they performed three high-fidelity simulations at 3-month intervals. The simulation scenarios included a 15-month-old seizure (T0), 1-month-old with hypoglycemia (T1), and 4-year-old clonidine ingestion (T2). All scenarios were standardized and required recognition and management of respiratory failure and decompensated shock. Scenarios were videotaped and two investigators scored EMS team interventions during simulations using a standardized scoring tool. Inter-rater reliability was assessed on 30% of videos using kappa analysis. Volumes of administered intravenous fluid (IVF) and medications were measured to assess for errors in administration. The primary outcome was the change in scenario score from T0 to T2.ResultsA total of 135 team-based simulations were conducted over the study period (48, 40, and 47 at T0, T1, and T2, respectively). Inter-rater reliability between reviewers was very good (κ = 0.7). Median simulation score improved from T0 to T2 (24 vs 31, p < 0.001, maximum score possible = 42). The proportion of completed tasks increased across multiple categories including improved recognition of respiratory decompensation (19% vs. 56%), management of the pediatric airway (44% vs. 88%), and timeliness of vascular access (10% vs. 38%). Correct IVF administration varied by scenario (25% vs. 52% vs. 30%, p = 0.02).ConclusionSerial simulation improved EMS team-based care in both recognition and management of pediatric emergencies. A standardized pediatric simulation curriculum can be used to train EMS professionals on pediatric emergencies and improve performance.

Project description:IntroductionIn the emergency department (ED), critical events, including death and severe illness, are not uncommon. Critical events involving children, while less frequent, may be especially distressing. Debriefing following a critical event may serve several purposes: review of team performance, education, identification of errors, emotional support, and planning for future events. Debriefing skills and habits learned during training may be carried forward throughout an emergency physician's career. This study evaluates how educators in emergency medicine (EM) view debriefing after pediatric critical events and identifies barriers to use of debriefing in postgraduate training programs.MethodsIn this cross-sectional observational study, we surveyed program directors (PDs) from EM residency and pediatric emergency medicine (PEM) fellowship programs via e-mail listserv. A panel of PEM experts and survey methodologists designed the survey, which was reviewed for content validity by an independent panel of EM educators. We obtained data on current debriefing practices following pediatric critical events, PDs' perceptions of ideal debriefing practices, and barriers to implementation. Data were analyzed using descriptive statistics.ResultsA total of 109 PDs completed the survey (45% overall response rate). All respondents feel that debriefing pediatric critical events is useful. The majority of debriefings are initiated and led by emergency physicians as informal meetings shortly following a critical event. Debriefings are most commonly held following a patient death, although PDs feel that debriefings should also occur for other specific patient scenarios (e.g., child abuse). Barriers to debriefing include timing, scheduling, location, discomfort with debriefing, participant buy-in, and leader buy-in.ConclusionsProgram leaders in both EM and PEM believe that debriefing after pediatric critical events is important for training. Barriers to debriefing specific to the ED setting should be explored to optimize the implementation of this practice.

Dataset Information

Simulation-based team training in time-critical clinical presentations in emergency medicine and critical care: a review of the literature.

Background

Methods

Results

Conclusions

Publications

Simulation-based team training in time-critical clinical presentations in emergency medicine and critical care: a review of the literature.

Similar Datasets

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