new alert - live vs. telepresence team leader on teamwork & communication

ALERT Presentation: Impact of physical presence vs.

telepresence of team leader on teamwork and communication in simulated pediatric

emergency cases: an RCT

Lucas Butler

Yale School of Medicine

INSPIRE @ IMSH 2016 – San Diego, CA / USA

International Network for Simulation-based Pediatric Innovation, Research and Education

• Telemed consults used in critical community ED peds cases

• Little front-end research guiding implementation and best

uses for this technology

• Paucity of rigorous research on impact of telemed on quality

of care in peds emergency cases

• No research on teamwork—crucial contributor to outcomes—

in peds emergency telemed cases (despite clear change in

team dynamic when team leader physically absent)


Background

• P: resident peds and EM teams (Sr., Jr.,

intern/PA/RN)

• I: team leader (Sr. resident) on videoconference

• C: team leader in room (normal sim)

• O: 1°STAT human factors score

2°STAT clinical skills score

3°teamwork/workload self-assessments


PICO / Research Question

• Recruit 18 teams of 3-4 resident/PA/RN

• Randomize. Intervention= TL on videoconference

(multiple views of room and monitors)


Approach / Design

• Demographic data survey

• Run sim for which STAT validated (see next slide)

• Scripted debriefing, gather qualitative data on

perspectives of telemed’s

impact on teamwork

• Self-assessment surveys:

teamwork & workload

• Review case videos, score

with STAT tool


Approach / Design cont.

• Simulation: – Scenario: 2 y.o. in septic shock with subsequent apnea and Vfib

– Location: Yale Sim Center (AV control room, sim technician)

– Manikin: Laerdal SimBaby

– Equipment: B-Line SimCapture

(bird’s eye, room, monitor views)

• Data Collection Instruments:

– STAT tool

– Demographic data survey

– Post-sim subjective assessments of

leadership and overall teamwork


Design—Case & Instrument

• Independent two-sample t-tests

• Calculated sample size n=18

• Gather qualitative data during scripted debriefing


Methods—analyses

• H 1: Teamwork improved due to:+ Increased team member idea-sharing & engagement in decision-making

+ More “huddles” and sharing of mental model

+ Increased verbal communication, improved closed-loop communication

- Decreased non-verbal communication

• H 2: Quality of care increased + Decreased TL task fixation/distractions

+ Reduced team anxiety

- Reduced team structure/clearly defined roles given lack of TL physical presence

- Most skilled person physically outside room

• H 4: Decreased self-reported TL leadership skills by TL & team


Hypotheses

• ALERT Presentation—Jan 15, 2016

• Grant Proposal (if applicable)—N/A

• IRB Submission—10/30/2015

• Recruitment/Data Collection—pilot Nov 16, testing Jan-Mar ‘16

• Data Analysis—March-April 2016

• Abstract Presentation—May 2016

• Manuscript Preparation—June 2016


Timeline

1. Proper choice of data collection tools/forms?

2. Will this work generalize to non-pediatric

cases and non-resident providers?

3. Right # of data collection forms to amass

sufficient data without overburdening subjects?


4 questions to improve study

At INSPIRE @ IMSH 2016: Feedback/direction from industry experts, network

with others interested in telemed/sim/teamwork

In 2 months: Introduction & methods written,

enrolling subjects, all study elements in place


Goals to accomplish

Lucas Butler

Yale Medical School

[email protected], 203-215-1111


Contact Information

mailto:[email protected]

new alert - live vs. telepresence team leader on teamwork & communication

Health & Medicine