Evaluation of a Computer-Based Educational Intervention to Improve Medical Teamwork and Performance During Simulated Patient Resuscitations
ABSTRACT To determine the impact of a low-resource-demand, easily disseminated computer-based teamwork process training intervention on teamwork behaviors and patient care performance in code teams.
A randomized comparison trial of computer-based teamwork training versus placebo training was conducted from August 2010 through March 2011.
This study was conducted at the simulation suite within the Kado Family Clinical Skills Center, Wayne State University School of Medicine.
Participants (n = 231) were fourth-year medical students and first-, second-, and third-year emergency medicine residents at Wayne State University. Each participant was assigned to a team of four to six members (nteams = 45).
Teams were randomly assigned to receive either a 25-minute computer-based training module targeting appropriate resuscitation teamwork behaviors or a placebo training module.
Teamwork behaviors and patient care behaviors were video recorded during high-fidelity simulated patient resuscitations and coded by trained raters blinded to condition assignment and study hypotheses. Teamwork behavior items (e.g., "chest radiograph findings communicated to team" and "team member assists with intubation preparation") were standardized before combining to create overall teamwork scores. Similarly, patient care items ("chest radiograph correctly interpreted"; "time to start of compressions") were standardized before combining to create overall patient care scores. Subject matter expert reviews and pilot testing of scenario content, teamwork items, and patient care items provided evidence of content validity.
When controlling for team members' medically relevant experience, teams in the training condition demonstrated better teamwork (F [1, 42] = 4.81, p < 0.05; ηp = 10%) and patient care (F [1, 42] = 4.66, p < 0.05; ηp = 10%) than did teams in the placebo condition.
Computer-based team training positively impacts teamwork and patient care during simulated patient resuscitations. This low-resource team training intervention may help to address the dissemination and sustainability issues associated with larger, more costly team training programs.
- [Show abstract] [Hide abstract]
ABSTRACT: This paper presents a general statistical methodology for the analysis of multivariate categorical data arising from observer reliability studies. The procedure essentially involves the construction of functions of the observed proportions which are directed at the extent to which the observers agree among themselves and the construction of test statistics for hypotheses involving these functions. Tests for interobserver bias are presented in terms of first-order marginal homogeneity and measures of interobserver agreement are developed as generalized kappa-type statistics. These procedures are illustrated with a clinical diagnosis example from the epidemiological literature.Biometrics 04/1977; 33(1):159-74. DOI:10.2307/2529310 · 1.52 Impact Factor
Article: A typology for health care teams[Show abstract] [Hide abstract]
ABSTRACT: Effective interdisciplinary health care teamwork improves clinical and financial outcomes, and training and assessment of team competencies are central to establishing high-functioning health care teams. The roles that team members assume in the provision of patient care are important contributors to effective health care team performance; however, variability among health care practitioners can lead to philosophical, political, social, and clinical differences in perceptions and recommendations for patient care as well as expected communication patterns and protocols. The purpose of this study was to describe the roles and behaviors within variable health care teams in the provision of patient care across multiple clinical practice areas to inform a model for team development strategies. Interdisciplinary health care teams were observed in vivo during the routine course of their work in multiple patient care contexts. Data were collected and analyzed using qualitative methods of observation and categorization, with supplemental interviews to substantiate, to clarify, and to verify observations. The constant comparative method of data analyses was used to derive a compositional typology for health care teams. A compositional typology for health care teams emerged from the data specifying four types of health care teams: stable role, stable personnel (Type SRSP); stable role, variable personnel (Type SRVP); variable role, stable personnel (Type VRSP); and variable role, variable personnel (Type VRVP). Results suggest that health care teams may be more complicated than non-health care teams, and team models with associated derived competencies from other professions may not wholly transfer to health care. A singular model to inform best practices for health care team development may not adequately address the specific performance challenges of each team type. Adaptable development strategies for each type of team and its associated role membership may be required to optimize team performance. The health care team typology derived from this study may help inform the selection of appropriate team development strategies and define associated team competencies.Health care management review 01/2010; 35(4):345-54. DOI:10.1097/HMR.0b013e3181e9fceb · 1.30 Impact Factor
- [Show abstract] [Hide abstract]
ABSTRACT: There is insufficient information about the effectiveness of medical team training on surgical outcomes. The Veterans Health Administration (VHA) implemented a formalized medical team training program for operating room personnel on a national level. To determine whether an association existed between the VHA Medical Team Training program and surgical outcomes. A retrospective health services study with a contemporaneous control group was conducted. Outcome data were obtained from the VHA Surgical Quality Improvement Program (VASQIP) and from structured interviews in fiscal years 2006 to 2008. The analysis included 182,409 sampled procedures from 108 VHA facilities that provided care to veterans. The VHA's nationwide training program required briefings and debriefings in the operating room and included checklists as an integral part of this process. The training included 2 months of preparation, a 1-day conference, and 1 year of quarterly coaching interviews The rate of change in the mortality rate 1 year after facilities enrolled in the training program compared with the year before and with nontraining sites. The 74 facilities in the training program experienced an 18% reduction in annual mortality (rate ratio [RR], 0.82; 95% confidence interval [CI], 0.76-0.91; P = .01) compared with a 7% decrease among the 34 facilities that had not yet undergone training (RR, 0.93; 95% CI, 0.80-1.06; P = .59). The risk-adjusted mortality rates at baseline were 17 per 1000 procedures per year for the trained facilities and 15 per 1000 procedures per year for the nontrained facilities. At the end of the study, the rates were 14 per 1000 procedures per year for both groups. Propensity matching of the trained and nontrained groups demonstrated that the decline in the risk-adjusted surgical mortality rate was about 50% greater in the training group (RR,1.49; 95% CI, 1.10-2.07; P = .01) than in the nontraining group. A dose-response relationship for additional quarters of the training program was also demonstrated: for every quarter of the training program, a reduction of 0.5 deaths per 1000 procedures occurred (95% CI, 0.2-1.0; P = .001). Participation in the VHA Medical Team Training program was associated with lower surgical mortality.JAMA The Journal of the American Medical Association 10/2010; 304(15):1693-700. DOI:10.1001/jama.2010.1506 · 30.39 Impact Factor