In Situ Teamwork Training and Detection of Safety Threats in High Risk Settings

项目概述：1999年医学研究所（IOM）的报告《人孰能无过》指出，急诊科是医院中发生不良事件风险最高的区域。这项工作的长期目标是确定医疗差错的原因，以及通过在儿科医院使用多学科模拟为基础的团队合作培训，减少医疗差错的数量和减轻医疗差错的影响。该项目的目标直接对应于AHRQ确定为优先事项的领域，包括：识别威胁，识别、评估和实施有效的患者安全措施；保持警惕。在这个项目中，所有医疗保健提供者（包括住院医师）将参与在工作日在临床环境中进行的关键儿科模拟。除了在工作场所嵌入团队合作培训之外，这项工作的一个关键目标是验证模拟作为检测潜在安全威胁和系统问题的方法。关键模拟和实际复苏将被数字化记录，并评估团队行为和可观察到的错误。参与者的知识和态度将每半年评估一次。还将分析安全威胁的识别和分类以及为解决这些威胁而采取的行动。本项目的具体目标是：1。实施持续的现场多学科模拟训练，包括团队合作行为和临床环境中的关键沟通技巧；2. 利用现场模拟培训和汇报来评估临床环境中潜在的安全威胁以及资源和系统问题；3. 通过评估关键儿科模拟的团队行为和可观察到的错误来评估该培训的有效性；4. 通过对实际护理高危患者过程中观察到的团队合作行为进行评估，评估关键模拟技能向急诊科及其他高风险环境的转移。相关性：该项目使用模拟作为识别临床环境中的安全威胁和系统问题的工具，并为临床护理团队提供持续加强的团队合作培训。这将使团队合作训练成为临床实践的常规部分，并促进这些技能的频繁刻意练习。它在使用模拟来了解和影响临床环境方面是独一无二的。

DESCRIPTION: Project Summary: The 1999 Institute of Medicine (IOM) report, To Err is Human, identified the emergency department as the area of the hospital with the highest risk of adverse events. The long term goal of this work is to identify the causes of medical error as well as to decrease the numbers of and mitigate the effects of medical error through the use of multidisciplinary simulation-based teamwork training in a pediatric hospital. The goals of this project directly correspond to the areas identified as priorities for AHRQ including: identifying threats, identifying, evaluating and implementing effective patient safety practices; and maintaining vigilance. In this project, all healthcare providers (including residents) will participate in critical pediatric simulations that take place in the clinical setting during the workday. In addition to embedding teamwork training in the workplace, a critical goal of this work is the validation of simulation as a method to detect latent safety threats and system issues. Critical simulations and actual resuscitations will be digitally recorded and evaluated for teamwork behaviors and observable errors. Knowledge and attitudes of participants will be assessed on a semi-annual basis. Identification and classification of safety threats as well as actions taken to address these will also be analyzed. The specific aims of this project are: 1. To implement ongoing in situ multidisciplinary simulation training that encompasses teamwork behaviors and critical communication skills in the clinical environment; 2. To use in situ simulation training and debriefing to assess latent safety threats as well as resource and system issues in the clinical environment; 3. To evaluate the effectiveness of this training by assessing teamwork behaviors and observable errors for critical pediatric simulations; 4. To evaluate the transfer of the skills from critical simulations to the emergency department and other high risk environments through the evaluation of teamwork behaviors observed during the actual care of high risk patients. Relevance: This project uses simulation as a tool for the identification of safety threats and system issues in the clinical environment as well as providing ongoing reinforcement of teamwork training for the clinical care team. This will establish teamwork training as a routine part of clinical practice and promote frequent deliberate practice of these skills. It is unique in using simulation to learn about and impact the clinical environment.