Teamwork Training Improves the Clinical Care of Trauma Patients
Teamwork Training Improves the Clinical Care of Trauma Patients
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DOI：
10.1016/j.jsurg.2010.06.006
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发表时间：
2010-11-01
影响因子：
2.9
通讯作者：
ReMine, Stephen
中科院分区：
文献类型：
--
作者：
Capella, Jeannette;Smith, Stephen;ReMine, Stephen
目标：我们调查了以下问题：正式的团队培训是否可以改善创伤复苏室中的团队行为？如果是，那么改进的团队合作是否会提高创伤区的效率和/或改善临床结果？ 设计：这项干预研究使用了训练前/训练后设计。 TeamSTEPPS 通过模拟增强了干预措施。评估工具是创伤团队绩效观察工具（TPOT），由训练有素的评估人员使用来评估团队在创伤复苏期间的表现。从 2008 年 11 月到 2009 年 2 月，对创伤复苏的方便样本（n = 33）进行了评估。 2009年2月至4月进行团队训练。 2009 年 5 月至 7 月，对另一个复苏样本（n = 40）进行了评估。临床数据是从我们的创伤登记处收集的。临床参数包括到达计算机断层扫描 (CT) 扫描仪的时间、到达插管的时间、到达手术室的时间、到达创伤超声重点评估 (FAST) 检查的时间、急诊科 (ED) 的时间、住院时间 (LOS)、重症监护室 LOS、并发症和死亡率。比较训练前和训练后的复苏，我们计算了团队合作评级和临床参数的平均值、标准差和 p 值，并使用独立样本 t 检验确定了显着性。地点：I 级创伤中心。参与者：创伤团队包括外科住院医生、教职员工和护士。结果：我们的创伤团队在所有团队合作领域评级和从培训前到培训后领导力的总体评级方面均显示出显着改善（2.87-3.46， p = 0.003）、情况监测（3.30-3.91，p = 0.009）、相互支持（3.40-3.96，p = 0.004）、沟通（2.90-3.46，p = 0.001）和整体（3.12-3.70，p < 0.001）。培训后，到达 CT 扫描仪（26.4-22.1 分钟，p = 0.005）、气管插管（10.1-6.6 分钟，p = 0.49）和进入手术室（130.1-94.5 分钟，p = 0.021）的时间显着减少。结论：通过模拟增强的结构化创伤复苏团队培训提高了团队绩效，从而提高了团队的效率。创伤区的病人护理。我们建议将通过模拟增强的正式团队合作培训纳入外科住院医师培训以及高级创伤生命支持 (AILS) 中。 （J Surg 67:439-443。(C) 2010 年外科项目总监协会。由 Elsevier Inc. 出版。保留所有权利。）
OBJECTIVES: We investigated these questions: Does formal team training improve team behaviors in the trauma resuscitation bay? If yes, then does improved teamwork lead to more efficiency in the trauma bay and/or improved clinical outcomes?DESIGN: This intervention study used a pretraining/posttraining design. The intervention was TeamSTEPPS augmented by simulation. The evaluation instrument, which was the Trauma Team Performance Observation Tool (TPOT), was used by trained evaluators to assess teams' performance during trauma resuscitations. From November 2008 to February 2009, a convenience sample (n = 33) of trauma resuscitations was evaluated. From February to April 2009, team training was conducted. From May to July 2009, another sample (n = 40) of resuscitations were evaluated. Clinical data were gathered from our trauma registry. The clinical parameters included time from arrival to computed tomography (CT) scanner, arrival to intubation, arrival to operating room, arrival to Focused Assessment Sonography in Trauma (FAST) examination, time in emergency department (ED), hospital length of stay (LOS), intensive care unit LOS, complications, and mortality. Comparing pretraining and posttraining resuscitations, we calculated means, standard deviations, and p values for teamwork ratings and clinical parameters, and we determined significance using the independent samples t-test.SETTING: Level I Trauma Center.PARTICIPANTS: The trauma team included surgery residents, faculty, and nurses.RESULTS: Our trauma team showed significant improvement in all teamwork domain ratings and overall ratings from pretraining to posttraining leadership (2.87-3.46, p = 0.003), situation monitoring (3.30-3.91, p = 0.009), mutual support (3.40-3.96, p = 0.004), communication (2.90-3.46, p = 0.001), and overall (3.12-3.70, p < 0.001). The times from arrival to the CT scanner (26.4-22.1 minutes, p = 0.005), endotracheal intubation (10.1-6.6 minutes, p = 0.49) and the operating room (130.1-94.5 minutes, p = 0.021) were decreased significantly after the training.CONCLUSIONS: Structured trauma resuscitation team training augmented by simulation improves team performance, resulting in improved efficiency of patient care in the trauma bay. We propose that formal teamwork training augmented by simulation be included in surgery residency training as well as Advanced Trauma Life Support (AILS). (J Surg 67:439-443. (C) 2010 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.)