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Teamwork Training Improves the Clinical Care of Trauma Patients

Teamwork Training Improves the Clinical Care of Trauma Patients. Jeannette Capella, MD, Stephen ReMine, MD, Stephen Smith, MD, Allan Philp, MD, Tyler Putnam, MD, Carol Gilbert, MD, William Fry, MD, David Baker, PhD, Sonya Ranson, PhD, Ellen Harvey, MSN, Andi Wright, MSN, Krista Henderson, MSN

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Teamwork Training Improves the Clinical Care of Trauma Patients

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  1. Teamwork Training Improves the Clinical Care of Trauma Patients Jeannette Capella, MD, Stephen ReMine, MD, Stephen Smith, MD, Allan Philp, MD, Tyler Putnam, MD, Carol Gilbert, MD, William Fry, MD, David Baker, PhD, Sonya Ranson, PhD, Ellen Harvey, MSN, Andi Wright, MSN, Krista Henderson, MSN Virginia Tech Carilion School of Medicine Roanoke, Virginia

  2. Introduction • Healthcare team performance • Needs to be better • Key to improved patient care • Evidence • Obstetrics – Neillsen et al, Siassakos et al • Medicine - Strasser et al

  3. Introduction • Trauma – Fox et al., 2009 • Improved clinician perception of teamwork • Improved teamwork • TeamSTEPPS, no simulation • Today you will see evidence that team training yields better clinical care in the trauma room

  4. Purpose • Does formal trauma team training improve team behaviors in the trauma resuscitation bay? • If yes, then does improved teamwork lead to more efficiency in the trauma bay and/or improved clinical outcomes?

  5. Methods • Design • Intervention • Subjects • Timeline • Measurement

  6. Design • Pre/post intervention study • Quality improvement project

  7. Intervention • Didactic sessions • Two hours • TeamSTEPPS • Health care team training program • DOD, AHRQ • Domains • Leadership • Mutual Support • Situation Monitoring • Communication

  8. Five Tools

  9. Intervention • Didactic session • Trauma Room Policies and Procedures • “shared mental model” • Simulation session • Two hours • METI HPS or Laerdal SimMan • Three scenarios • Facilitated video feedback

  10. Subjects • Trauma Faculty (n=5) • Surgery Residents (n=28) • ED Nurses (n=45)

  11. Timeline Nine months Pre-training Training Post-training November, 2008 July, 2009

  12. Measures • Teamwork Behaviors • Trauma Team Performance Observation Tool • Trained Evaluators • Efficiency Parameters • Arrival to CT, FAST, intubation, OR • Time in ED • Global Outcome Parameters • Mortality, Complications, HLOS, ICU LOS

  13. Teamwork Behaviors

  14. Efficiency

  15. Global

  16. Conclusions • Structured trauma resuscitation team training augmented by simulation improves team performance • Better teamwork improves efficiency of patient care in the trauma bay • Larger study may show improved global outcomes

  17. Recommendation • Formal teamwork training augmented by simulation should be included in surgery residency training as well as ATLS

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