Team Training in EM Residency Education

CORD Academic Assembly 2012

Ryan Fringer, MDChristopher McDowell, MD MEd

DisclosuresDr. Fringer & Dr. McDowell have no financial conflicts or

relationships to disclose

GoalsDescribe TeamSTEPPS and its role in EM

Introduce team training to junior level residents

Describe examples of team training assessment throughout residency

Provide a framework for those wishing to add team training to their curriculum

The State of things in 2012Teamwork

Residents must care for patients in an environment that maximizes effective communication. This must include the opportunity to work as a member of effective interprofessional teams that are appropriate to the delivery of care in the specialty.

VI.F.1.

Interprofessional teams must be used to ensure effective and efficient communication for appropriate patient care for emergency medicine department admissions, transfers, and discharges.

ACGME EM Program Requirements

How does this apply to EM? ACGME

Systems-based Practice

Trauma Teams

Resuscitations

Code Teams

Can’t we extend team training from specific teams to our everyday pods Trauma Teams everyday EM function

What Tools Exist to Help?TeamSTEPPS

In house system resources Organizational Learning Department In-house funding (DIO, Hospital admin)

What is TeamSTEPPS?An evidence-based teamwork system

Designed to improve: Quality Safety Efficiency of health care

Practical and adaptable

Provides ready-to-use materials for training and ongoing teamwork

TeamSTEPPSA framework for introducing the concepts of team training

Designed by Dept of Defense 4 specific domains

Leadership Communication Situation Monitoring Mutual Support

Scalable to meet your needs

SMARTT Stepback in Trauma BayS: Situation

M: Management

A: Activity

R: Rapidity

T: Troubleshooting

T: Talk to Me

What TeamSTEPPS can doEmergency Department

After implementation of multiple medical team training programs:

• Improved observed team behaviors.

• Enhanced staff attitudes toward teamwork.

• Reduced observed clinical errors.

Medical FloorsAfter implementation of SBAR to

improve communication among clinical caregivers:• Reduced rate of adverse drug

events (from 30 to 18 per 1,000 patient days).

• Improved medication reconciliation at patient admission from 72% to 88% and at discharge from 53% to 89%.

LeadershipBrief

Huddle

Debrief

CommunicationCall-out

Airway? Patent and talking

Check back (closing the loop) Fentanyl 50mcg nurse repeats Fentanyl 50mcg you say “correct”

Handoffs

Situation MonitoringS: Status of the patient

T: Teamwork

E: Environment

P: Progress toward patient goals

Mutual Support Culture Change & Empowerment

Two challenge Rule

Concerned

Uncomfortable

Safety Issue

Stop the Line!

TeamSTEPPS at BeaumontBrief Timeline

What worked

What did not work

Future directions

TeamSTEPPS at BeaumontBrief Timeline

What worked

What did not work

Future directions

TeamSTEPPS Timeline

September 2007 “Aha” moment

March 2008 – TeamSTEPPS Consortium

August 2008 – TeamSTEPPS Training

October 2008 – Needs Assessment

Jan – Dec 2009 – Facilitated Discussions

Jan – Aug 2010 – Train the Trainers

Aug 2010 – May 2011 – Comprehensive Training

January 2011 – TeamSTEPPS “Go Live”

Needs AssessmentThis will guide your process

Many methods to choose from Surveys Focused interviews Roundtable discussions Direct observation by trained observers In Situ simulation Exploratory, observational trips

Outcome Measures Very little data = opportunity

Capella et al.

LOS and other times

Clinical Outcomes

Safety Culture survey

Nursing/Staff turnover

Noise level monitoring

Take Home Points “Buy in” by all stakeholders is necessary

Needs assessment is critical

Role (re)definition needs to be individualized

Process/culture change takes a long time

Outcome measures?

Email: rfringer@beaumont.edu for any questions or resources