Project

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Combined technical and non-technical skills training for managing unanticipated difficult intubations

English title Combined technical and non-technical skills training for managing unanticipated difficult intubations
Applicant Grote Gudela
Number 138545
Funding scheme Project funding (Div. I-III)
Research institution Departement Management, Technologie und Ökonomie D-MTEC ETH Zürich
Institution of higher education ETH Zurich - ETHZ
Main discipline Psychology
Start/End 01.11.2011 - 30.11.2013
Approved amount 370'300.00
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All Disciplines (2)

Discipline
Psychology
Surgery

Keywords (6)

Patient safety; Anesthesia; Non-technical skills; Training; Evaluation; Teamwork

Lay Summary (English)

Lead
Lay summary

Improving patient safety is a major concern in healthcare, especially in high-risk medical domains such as anesthesia. Although there is abundant evidence that teamwork plays a central role in improving patient safety in anesthesia, this has not yet been adequately considered in the actual management of anesthesia emergencies like unanticipated difficult airway situations. We seek to fill this gap by applying and verifying research findings on effective anesthesia teamwork through training development and evaluation. Based on findings of an extensive prestudy, we seek to evaluate a training that address physicians and nurses and focuses on the technical as well as non-technical skills for the management of unanticipated difficult intubation. Specifically, the training design consists of state-of-the-art training techniques such as simulation-based learning and structured debriefing involving guided team self-correction, advocacy and inquiry, and systemic questions. Additional interventions involve measures of assertiveness and cross-training. The training evaluation design involves three treatment and control groups in order to assess effects of the different training components. There will be four measurement points: one pretest before the training intervention (t1), a post-test immediately after the second (t2) and third training scenario (t3), and one follow up three months after the training (t4). Corresponding to the three main training objectives these interventions are expected to positively impact team performance and improve individual outcomes on three levels: cognitive, skill, and affective. From the results we expect to learn (a) to what extent our previous findings about effective teamwork in anesthesia can be transferred into team training, (b) how technical and non-technical medical skills can be meaningfully trained together, and (c) to what extent anesthesia team training improves actual performance. In doing so, we contribute to both evidence-based patient safety research and to the design of effective team training in medicine. 

Direct link to Lay Summary Last update: 21.02.2013

Responsible applicant and co-applicants

Employees

Publications

Publication
Why didn’t you say something? Using after-event reviews to affect voice behavior and hierarchy beliefs in multi-professional action teams
Weiss Mona, Kolbe Michaela, Grote Gudela, Spahn Donat R., Grande Bastian (2016), Why didn’t you say something? Using after-event reviews to affect voice behavior and hierarchy beliefs in multi-professional action teams, in European Journal of Work and Organization Psychology, Advanced online publication, 1-2016.
Ist Reden wichtig? Technisches versus kombiniert technisches / nicht-technisches Atemwegstraining in der Anästhesie und Intensivmedizin
Grande Bastian, Weiss Mona, Biro Peter, Grote Gudela, Steiger Peter, Spahn Donat R., Kolbe Michaela (2015), Ist Reden wichtig? Technisches versus kombiniert technisches / nicht-technisches Atemwegstraining in der Anästhesie und Intensivmedizin, in Anästhesiologie & Intensivmedizin, 56, 5-12.
Simulation With PARTS (Phase-Augmented Research and Training Scenarios)A Structure Facilitating Research and Assessment in Simulation
Schick Carl J., Weiss Mona, Kolbe Michaela, Marty Adrian, Dambach Micha, Knauth Axel, Spahn Donat R., Grote Gudela, Grande Bastian (2015), Simulation With PARTS (Phase-Augmented Research and Training Scenarios)A Structure Facilitating Research and Assessment in Simulation, in Simulation in Healthcare: The Journal of the Society for Simulation in Healthcare, 10(3), 178-187.
Agency and communion predict speaking up in acute care teams
Weiss Mona, Kolbe Michaela, Grote Gudela, Dambach Micha, Marty Adrian, Spahn Donat R., Grande Bastian (2014), Agency and communion predict speaking up in acute care teams, in Small Group Research, 45, 290-313.
Five simple processes that improve high-risk team effectiveness
Kolbe Michaela (2013), Five simple processes that improve high-risk team effectiveness, in Salas Eduardo, Tannenbaum Scott, Cohen Debra & Latham Gary (ed.), Jossey-Bass, San Francisco, CA, 609-643.
Team coordination during cardiopulmonary resuscitation
Kolbe Michaela, Grande Bastian (2013), Team coordination during cardiopulmonary resuscitation, in JOURNAL OF CRITICAL CARE, 28(4), 522-523.
TeamGAINS: a tool for structured debriefings for simulation-based team trainings
Kolbe Michaela, Weiss Mona, Grote Gudela, Knauth Axel, Dambach Micha, Spahn Donat R., Grande Bastian (2013), TeamGAINS: a tool for structured debriefings for simulation-based team trainings, in BMJ QUALITY & SAFETY, 22(7), 541-553.
Human factors training in aviation and healthcare: What we know works best and how to put it into practice
Kolbe Michaela, Grote Gudela (2011), Human factors training in aviation and healthcare: What we know works best and how to put it into practice, in Proceedings of the Human Factors and Ergonomics Society 55th Annual Meeting, Las Vegas, NEHuman Factors and Ergonomics Society, Santa Monica.

Collaboration

Group / person Country
Types of collaboration
Center for Medical Simulation United States of America (North America)
- in-depth/constructive exchanges on approaches, methods or results
- Exchange of personnel

Scientific events

Active participation

Title Type of contribution Title of article or contribution Date Place Persons involved
IMSH 2014 Poster The magic of the inquiry: A micro-level communication analysis of debriefing conversations 31.10.2013 San Francisco, CA, United States of America Grote Gudela; Schick Carl; Weiss Mona; Spahn Donat; Grande Bastian; Kolbe Michaela;
IMSH 2014 Poster "Do we have to talk?" Comparing technical vs. combined technical/behavioral training for difficult airway management 31.10.2013 San Francisco, CA, United States of America Grote Gudela; Spahn Donat; Weiss Mona; Schick Carl; Grande Bastian; Kolbe Michaela;
29th Annual Conference of the Society for Industrial and Organizational Psychology Talk given at a conference We can do it! The interplay of leader communication and intergroup relations on nurses’ and physicians’ speaking up intentions 31.10.2013 Chicago, IL, USA, United States of America Kolbe Michaela; Weiss Mona; Grande Bastian; Grote Gudela; Spahn Donat; Schick Carl;
Jahrestagung der Deutschen, Österreichischen und Schweizerischen Gesellschaft für Thoraxchirurgie Talk given at a conference Tödliche Stille - Kommunikation und Team Performance im OP 24.10.2013 Basel, Switzerland Grande Bastian;
13. biannual Congress of the Swiss Psychological Society Talk given at a conference How to Break the Silence? Development and Evaluation of a Speaking Up Intervention for Acute Care Teams 11.09.2013 Basel, Switzerland Grote Gudela; Grande Bastian; Weiss Mona; Spahn Donat; Schick Carl; Kolbe Michaela;
8th Annual INGroup Conference Talk given at a conference “What was on your mind?” Promoting team learning through simulation-based trainings in healthcare. 11.07.2013 Atlanta, GA, United States of America Kolbe Michaela; Grande Bastian; Weiss Mona; Grote Gudela; Schick Carl; Spahn Donat;
8th Annual INGroup Conference Talk given at a conference Should I Voice My Concerns? Self-perceptions of Agency and Communion Predict Speaking Up in Acute Care Teams 11.07.2013 Atlanta, United States of America Grande Bastian; Grote Gudela; Spahn Donat; Kolbe Michaela; Weiss Mona; Schick Carl;
SESAM Talk given at a conference Potentials for advancing debriefings 13.06.2013 Paris, France Spahn Donat; Grande Bastian; Weiss Mona; Grote Gudela; Schick Carl; Kolbe Michaela;
16th International Convention of the EAWOP (European Association of Work and Organizational Psychology) Talk given at a conference Do I Have What It Takes? Agency and Communion Predict Speaking Up in Acute Care Teams. 22.05.2013 Münster, Germany Spahn Donat; Kolbe Michaela; Weiss Mona; Grote Gudela; Grande Bastian;
28th Annual SIOP Conference Talk given at a conference Training anesthesia team members to speak up: A simulation-based study 11.04.2013 Houston, TX, United States of America Spahn Donat; Grote Gudela; Grande Bastian; Weiss Mona; Kolbe Michaela; Schick Carl;
ISMH 2013 Talk given at a conference Training anesthesia team members to speak up: A simulation-based study. 28.01.2013 Orlando, United States of America Spahn Donat; Grote Gudela; Schick Carl; Grande Bastian; Kolbe Michaela; Weiss Mona;
10th Interdisciplinary Symposium for Simulation in Medicine Talk given at a conference Strukturiertes Debriefing 12.12.2012 Nottwil, Switzerland Grande Bastian; Kolbe Michaela;
6th International Workshop on Behavioural Science Poster Scenario design for simulation-based team trainings 15.11.2012 Copenhagen, Denmark Kolbe Michaela; Grote Gudela; Grande Bastian; Weiss Mona; Schick Carl; Spahn Donat;
48th Conference of the German Society of Psychology Talk given at a conference Solving problems under stress: Interaktionsanalyse von Anästhesieteams 23.09.2012 Bielefeld, Germany, Germany Grande Bastian; Spahn Donat; Weiss Mona; Kolbe Michaela; Grote Gudela;
7th Annual Ingroup Conference Talk given at a conference Debriefing acute care teams during simulation-based trainings 12.07.2012 Chicago, Il, USA, United States of America Kolbe Michaela; Spahn Donat; Grande Bastian; Weiss Mona; Grote Gudela;
7th Annual INGroup Conference Talk given at a conference Being rather assertive or helpful? Relating team members’ self-perceptions to speaking up and psychological safety 12.07.2012 Chicago, IL, United States of America Grande Bastian; Weiss Mona; Spahn Donat; Grote Gudela; Kolbe Michaela;
Annual Meeting of the International Anesthesia Research Society (IARS) Poster Combined training of clinical and behavioral skills for airway management in the ICU 18.05.2012 Boston, MA, USA, United States of America Weiss Mona; Grote Gudela; Grande Bastian; Spahn Donat; Kolbe Michaela;


Self-organised

Title Date Place
Symposium "Interaktionsmuster, Stress und Trainingsinterventionen in Acute Care Medical Teams" 23.09.2012 Bielefeld, Germany, Germany
5th International Workshop on Behavioral Science Applied to Acute Care Teams 20.11.2011 Zurich, Switzerland, Switzerland

Knowledge transfer events

Active participation

Title Type of contribution Title of article or contribution Date Place Persons involved
Advanced debriefing techniques: Combining advocacy-inquiry with methods from systemic family therapy Workshop 29.11.2013 San Francisco, United States of America
Advanced debriefing techniques: Combining advocacy-inquiry with methods from systemic family therapy Workshop 12.06.2013 Paris, France
Guided team self-correction and systemic constructivist methods for debriefing teams Workshop 28.01.2013 Orlando, FL, United States of America
Strukturiertes Debriefing Workshop 12.12.2012 Notwill, Switzerland
Scientifica 2012 ETH Zürich („Gesund werden, Gesund bleiben“): Ausstellungsstand "Der simulierte Patient-Notfalltraining für Ärzte und Pflegekräfte" Performances, exhibitions (e.g. for education institutions) 01.09.2012 Zürich, Switzerland


Communication with the public

Communication Title Media Place Year
Media relations: print media, online media „Notfalltraining-Eine Puppe hilft Leben retten“ Vista German-speaking Switzerland 2013
Media relations: radio, television Wie sicher sind Narkosen? SRF German-speaking Switzerland 2013
Talks/events/exhibitions "What were you thinking?" Debriefing of Acute Care Teams during Simulation-Based Trainings International 2012
Talks/events/exhibitions Analyzing and training teamwork in anesthesia: A psychological perspective International 2012
Media relations: radio, television Die Puppe im Operationssaal SRF Radio German-speaking Switzerland 2012
Talks/events/exhibitions Speak Up and Have a Break. Wie Kommunikation in der Anästhesie Leben retten kann. German-speaking Switzerland 2012
Talks/events/exhibitions TeamGAINS. A tool for structured debriefings in simulation-based team trainings International 2012

Awards

Title Year
Grande, B., Weiss, M., Schick, C., & Kolbe, M. Über den «Elefanten im Raum» sprechen können – sogar in der Akutmedizin: Simulationstrainings zur Verbesserung kommunikativer und klinischer Kompetenzen interprofessioneller Teams in der Akutmedizin. Swiss Quality Award 2014, Kategorie «stationärer Sektor». 2014
Prämierung durch das Qualitätsboard des Universitätsspitals Zürich mit dem Q-Award 2013 "TeamGAINS: Stärkeres Nutzen des Potentials von medizinischen Teams durch innovatives Debriefing nach Simulationen und Krisensituationen" 2013

Associated projects

Number Title Start Funding scheme
116673 Adaptive coordination in anaesthesia teams and its relationship to clinical performance 01.05.2007 Project funding (Div. I-III)

Abstract

Improving patient safety is a major concern in healthcare, especially in high-risk medical domains such as anesthesia. Although there is abundant evidence that teamwork plays a central role in improving patient safety and much is known about effective teamwork in anesthesia, this has not yet been adequately considered in the actual management of anesthesia emergencies like unanticipated difficult airway situations. Current unanticipated difficult intubation literature discusses how its severe risks of injury and death can be technically managed. The major shortcoming of this literature is that the difficult intubation situation is not considered a team task. Likewise, there is no evaluated training available yet for anesthesia that addresses the task-specific coordination demands in combination with technical skills training, as most of the respective training literature focuses either on very specific technical aspects or on general non-technical skills and addresses either physicians or nurses. This project will contribute to evidence-based patient safety research by applying and verifying research findings on effective anesthesia teamwork through training development and evaluation. In an extensive prestudy we developed a training that addresses all team members, that is, physicians and nurses, and focuses on the technical as well as non-technical skills for the management of unanticipated difficult intubation. In this project, we will evaluate the training in order to allow for prospectively defining its impact on team performance. The training design combines state-of-the-art training techniques such as simulation-based learning and structured debriefing involving guided team self-correction, advocacy and inquiry, and systemic questions. It includes two specific interventions focusing on assertiveness and cross-training. The training aims at improving outcomes on three levels: cognitive, skill, and affective. The training evaluation design involves three treatment and control groups in order to evaluate effects of the different training components. There will be four measurement points: one pretest before the training intervention (t1), a post-test immediately after the second (t2) and third training scenario (t3), and one follow up three months after the training (t4). Corresponding to the three main training objectives we will evaluate the training outcome on the cognitive, skill-based and affective level, measuring outcome variables linked to both technical and non-technical skills.From the results we expect to extent our previous findings on the relationship between teamwork in anesthesia and clinical performance. Specifically we expect to learn (a) to what extent our previous findings about effective teamwork in anesthesia can be transferred into team training, (b) how technical and non-technical medical skills can be meaningfully trained together, and (c) to what extent anesthesia team training improves actual performance. In doing so, we contribute to evidence-based patient safety research and to the design of effective team training in medicine. Besides the scientific impact, we also foresee a significant practical impact of our project. A combined training for technical and non-technical skills and instruments for assessing its effects will be implemented and evaluated, which will directly benefit the anesthesia staff. The situation-specific training interventions are expected to improve the effective handling of unanticipated difficult intubations in real-life. Furthermore, using training strategies that also focus on general rules of teamwork we will enable anesthesia staff to learn and apply skills that transcend the specifics of difficult intubations.
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