Team training mattersfor patient outcome

Stefan Gisin, MD

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Critical Incident Reporting System (CIRS)

New culture for Patient Safetyand Error Handling

Crisis Resource Management (CRM)

Guidelines & Algorithms

Use of Simulation

TEAM TRAINING

Patient safety

Emergency Situation

• 3 important facts:

– Characteristics of crisis situation• Not influenceable!

– Knowledge and competences• Can be improved!

– Multidisciplinary teamwork• Can be improved!

Simulation

• Collaboration Swissair / Anesthesiology Basel

Aviation US Airways 1549

Aviation Training

Umbilical Cord Prolapse

Umbilical Cord Prolapse

Confidential enquiries UK (CEMACH,CESDI)

• Potentially avoidable!– 50% maternal deaths

– 75% intrapartum related deaths

• Contributing factors– Communication problems

– Absent or poor teamwork

– Poor interpersonal relationship

• Fire drills“ for better management of obstetrical emergencies– Multiprofessional

– Teamwork training

– Annual repetition of training for all staff

– CTG-courses every 6 months

• 1 day emergency training interprofessional every 2 months

• Decrease interval decision delivery :

25 vs 14,5 min p <0.001

• Increase in recommended actions to alleviate cord compression

34,7% vs 82,3% p=0.003

Siassakos D et al BJOG 2009

Emergency C-section

Simulation

Retrospective analysis 1998 – 1999 (8430 births)

Intervention 2000: multiprofessional training

Neonatal outcome

86/10.000 births 44/10.000 births

27/10.000 births 13/10.000 births

Results 2001 – 2003 (11’030 births): 50% reduction APGAR < 6 50% reduction hypoxic-ischemic encephalopathy 70% reduction plexus injuries after shoulder dystocia

Neonatal outcome

Neonatal outcome

Surgical outcome

Surgical outcome

… 50% greater decline in risk-adjusted mortality …

Surgical outcome

Teamwork

Teamwork

Team oriented medical simulation

спасибоstefan.gisin@simulation.ch