Team Training in Anaesthesia Jennifer Weller 1. Acknowledgements Dr Jane Torrie Dr Rob Frengley Prof...
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Transcript of Team Training in Anaesthesia Jennifer Weller 1. Acknowledgements Dr Jane Torrie Dr Rob Frengley Prof...
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Team Training in Anaesthesia
Jennifer Weller
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Acknowledgements
• Dr Jane Torrie• Dr Rob Frengley• Prof Brian Jolly• Prof Alan Merry• Dr Brian Robinson• Dr Boaz Shulruf• Dr Robert Henderson• Ms Kaylene Henderson• Dr Bevan Yee• Dr Pete Dzendrowskyj• Dr Adam Paul• ANZCA • Plus hosts of others
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A private Hospital: wrong side surgery (knee).
“A team is called a team for a very good reason; there is an expectation that there will be sufficient co-operation and communication amongst its members to minimise the risk of harm to the patient.”
A Report by the Health and Disability Commissioner. (Case 00/06857), 2002; Orthopaedic Surgeon/Anaesthetist/Theatre Nurse/Anaesthetic Nurse/Scrub Nurse
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“If you can’t measure it you can’t improve it.” Lord Kelvin
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Global performance measure
Behaviour 1 2 3 4 5
• Acquisition of all available information• Anticipates and plans • Calls for help appropriately• Reevaluates situation • Utilises team resources effectively• Allocates attention wisely• Prioritises• Concise, directed instructions, closes communication loop • Communicates problem clearly to team, Listens to team• Manages Conflict (if required)
Weller et al. Anaesthesia. 2005 Weller et al. British Journal of Anaesthesia. 2003
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WhenRole in
commun-ication
Who to Type of Communication
Situational content
Pre induction Initiation Tech Statement
Verbalises patient
parameters
Post induction
Response Surgeon Task assignment Assessment of
patient status
Circn.Nurse
Gave tech 2 or more instructions
Anticipates future problems
All Requests information
Proposes plan of action
Other Asks for suggestions
Unspecified Receiver
Responds to suggestions
Ignored suggestions
Requested helpRequest to surgeon
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Randomised scenario order
4 scenariosRespiratory / Cardiac
160 videos
Validation of the instrument
40 critical care teams
Scenario order randomised
Three trained assessors
independently rated the scenarios.
480 scores
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Exploratory Factor Analysis
Leadership and Team
Coordinationα = 0.917
Mutual Performance Monitoringα = 0.915
Verbalising Situational Informationα = 0.893
Internal consistency measured with Cronbach’s α
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Generalisability analysis
G-Coeff
Overall behaviour score 0.78
Leadership and Team Coordination 0.85
Mutual Performance Monitoring 0.4
Verbalising Situational Information 0.37
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Item Simulation Type Difference P value
Overall Teamwork Behavior
Airway 1.107 <0.005
Cardiac 0.826 <0.005
Leadership and Team
Co-ordination
Airway 0.849 <0.005
Cardiac 0.691 <0.005
Verbalizing Situational Information
Airway 0.747 <0.005
Cardiac 0.472 <0.005
Mutual Performance Monitoring
Airway 0.113 0.76
Cardiac -0.034 0.365
Improvement in teamwork and its components following training
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Participant’s evaluation of the team training intervention
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Recap
So far we’ve considered: • Different ways of looking at
teamwork• Need for robust measures• Evidence that teamwork behaviours
can be learnt
BUT
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“It is critical for a theatre team to operate as a team rather than as a group of individuals with separate and independent responsibilities.There must be an acknowledgment of the necessity of collective responsibility for a team of trained health professionals operating as a team within the operating theatre environment.”
HDC commenting further on case of wrong side surgery
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Understanding communication failures
Issues we identified
• Sharing goals
• Establishing capabilities of team members
• Challenging behaviour
Weller et al Interdisciplinary team interactions. Medical Education 2008
If you get a team leader who verbalises well, there’s no mixed messages going through and everybody knows what the .. objectives are
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Value of multidisciplinary team training
“The nurses can take some of the load from a doctor. The nurses are valuable members of the team and their ideas have value too.” [N]
“so they can both see from the other’s eyes what they are responsible for, what they’re going through” [N]
“new appreciation of the expert assistant role of the nurse” [D]
“It’s highlighted that doctors need to be able to take on information, process it and spit it out at a great rate of knots. But -just because they’re the doctor doesn’t mean that they can see absolutely everything -we have to work together as a team to get a desired outcome”. [N]
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Issues in Multidisciplinary Team training
Limited numbers of studies – McCulloch 2011
• MDT approach to training and assessment
• Real teams playing themselves• Meaningful engagement of all
players• Simulations of sufficient fidelity and
relevance to engage all
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Innovations in health professionals training in the management of the surgical patient.
We aim to: • Create realistic simulated
operating room environments to engage the whole team.
• Target identified communication problems.
• Evaluate change in practice in the workplace.
• Demonstrate improved outcomes for patients.
Innovations in health professionals training in the management of the surgical patient. J Weller et al (Health Workforce NZ Innovations funding)
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A SNAPPI Call-out
S top and gather the team Stand back and get the attention of the room
Notify team re patient status
Provide an overview of the situation e.g. Vital signs, blood results, events.
Assessment of the situation
Verbalise your assessment of the situation e.g. “I think this may be anaphylaxis” plus options
P roposed plan for treatment
Say what you think needs to be done
P riorities And in which order
I nvite ideas Invite suggestions, other ideas on diagnosis or treatment.
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Voice your concerns
Probe
Alert
Challenge
Emergency
Response
The two Challenge Rule
“If a pilot is clearly challenged twice about an unsafe situation during a flight without a satisfactory reply, the subordinate is empowered to take over the controls.”
Juniors are expected to express their concerns.
Seniors are expected to listen and reply.
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I dentify
S ituation
B ackground
A ssessment
R ecommendation
ISBAR – handover tool