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

描述：项目摘要：1999年医学研究所(IOM)的报告指出，急诊科是不良事件风险最高的医院领域。这项工作的长期目标是确定医疗差错的原因，并通过在儿科医院使用基于模拟的多学科团队合作培训来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被确定为AHRQ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做法；以及保持警惕。在该项目中，所有医疗保健提供者(包括住院医生)都将参与在工作日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一种检测潜在安全威胁和系统问题的方法。关键的模拟和实际的复苏将被数字化记录，并针对团队合作行为和可观察到的错误进行评估。参与者的知识和态度将每半年进行一次评估。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.实施持续的多学科现场模拟培训，涵盖临床环境中的团队行为和关键沟通技能；2.使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合作行为和可观察到的错误，评估此培训的有效性；4.通过评估在实际护理高危患者期间观察到的团队合作行为，评估从关键模拟到急诊科和其他高风险环境的技能转移。相关性：该项目使用模拟作为一种工具，用于识别临床环境中的安全威胁和系统问题，并持续加强临床护理团队的团队合作培训。这将使团队合作训练成为临床实践的常规部分，并促进对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.