Project

Discipline

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

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

Active participation

Self-organised

Active participation

Communication	Title	Media	Place	Year

Title	Year

Number	Title	Start	Funding scheme

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.