Journal Club- Arrowe Park HospitalOctober 2013Dr Binu T George

Robert W. Frengley, et al,

Crit Care Med 2011 Vol. 39, No. 12 2605.

Topic : Training in intensive/Critical care

1. MEDLINE; exp *INTENSIVE CARE/ OR exp *INTENSIVE CARE UNITS/ OR exp *CRITICAL CARE/; 50375 results.

2. MEDLINE; exp *EDUCATION, MEDICAL, GRADUATE/ OR exp *EDUCATION, MEDICAL/ OR exp *EDUCATION, MEDICAL, CONTINUING/; 94391 results.

3. MEDLINE; 1 AND 2; 516 results.4. MEDLINE; 3 [Limit to: English Language and Humans and Publication Year 2010-Current]; 132 results

Manually went through 132- picked out 8 relevent studies

The effect of a simulation based training intervention on the performance of established critical care unit teams

(Robert W Frengley,Jennifer M Weller,Jane Tirrie,Peter Dzendrowskyj Critical Care Med 2011;39:2605-2611)

Evaluation of the effectiveness of a simulation based intervention on improving teamwork in multidisciplinary

critical care teams managing airway and cardiac crises

Comparison of simulation-based learning and case-based learning

The Institute of Medicine in its publication To Err Is Human issued a number of recommendations to enhance patient safety

“to train in teams those who are expected to work in teams.”

Evidence suggests that teams make fewer mistakes than individuals and that good team work improves patient safety

Evidence also suggests team work failures make substantial contributions to sub optimal patient care

In the critical care unit, teamwork is of particular importance in optimizing patient outcome in clinical crises, including emergency airway or cardiac events.

Self-controlled randomized crossover study design with blinded assessors.

Setting: A simulated critical care ward, using a high-fidelity patient simulator, in a university simulation center.

Subjects: Forty teams from critical care units - 1 doctor and 3 nurses

Intervention: 10 hour study day Assessment done at Beginning and End of the day Each team undertook 2 pre-intervention and 2 post intervention assessments

The study day included •Presentations and discussions on human factors and crisis management•Airway and Cardiac skills stations.

For the intervention, teams were randomized toCase-based learning or Simulation-based learning (for cardiac or airway scenarios)

Measurements:•Recording and analysis done by 3 blinded expert assessors•Structured rating tool was used with technical and behavioral components.•Participants were surveyed 3 months later.

Paucity of literature documenting outcomes of MDT training interventions

Case control study Wayne DB ,Didwala A ,Fienglass –Simulation based education improved quality of care during cadiac arrest team responses( CHEST 2008;133:56-61)

Steadman RH, Coates WC ,Huang YM/;simulation based training is superior to problem based learning for acquisition of critical assessment and management skills (Critical care Med 2006;34:151-157)

Simulation-based intervention is effective in improving performance in multidisciplinary critical care teams

There is improved performance in the simulator after the course

There have been self reported changes to subsequent clinical practice Supports that there is transfer of learning from simulation to

the workplace over a period of time.

Results suggest that a mix of SBL and CBL is effective

Quality of evidence 1 b (individual RCT with narrow confidence interval)

Responder Bias

Demonstrating objective ,improved patient outcome beyond scope of this study

Trend suggesting SBL better than CBL –small sample size, hence no statistical difference demonstrated

Good evidence to suggest SBL improves team work behaviour and overall effectiveness of team

SBL and CBL combined makes better learning envoirnment

Further scope for research with larger groups to improve statistical difference between SBL and CBL

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