STRAIT: Simulation Training for Rapid Assessment and Improved Teamwork

描述(由申请人提供)：临床医生之间的有效沟通可能是安全护理的关键组成部分。在临床医生之间的护理过渡(移交)期间，高质量的沟通可能尤其关键。在这个为期两年的准实验质量改进项目中，我们将使用模拟学习来评估和改善麻醉提供者和护士之间的沟通和协调，因为护理正在从手术室过渡到麻醉后护理单元(PACU)。采用多基线、交错进入、具有重复措施的前瞻性队列设计，将在两个PACU引入一种新的训练干预措施(快速评估和改进团队合作的模拟训练-海峡)。基本假设是，对PACU人员进行基于模拟的通信技能培训将显著提高切换质量。我们还假设，这种培训将加强太平洋医疗服务中心的沟通文化和护理质量。我们的三个目标是：1)开发针对PACU移交的培训干预(海峡)；2)确定海峡是否改善了PACU移交质量；以及3)研究单一重点培训干预对PACU的通信文化和结果的影响。在最初两个月的实际患者移交观察基线之后，来自一个PACU的临床医生将接受Sstraal。第二个PACU的培训将在九个月后开始。日常现场观察的结果将在干预期间反馈给临床医生。海峡将包括预备性网络教学和使用人体模型和标准化临床医生的体验式学习。在每次培训之前，临床医生都会进行录像模拟交接。临床医生在培训(目标1)前后的模拟交接表现将在交接有效性的四个维度上进行比较：信息传递；最佳证据交接策略的使用；人际交往技能；以及团队行为。临床医生也将对他们自己的移交进行评级。对于目标2，训练有素的观察员将对海峡前后的实际PACU移交应用相同效力维度的简化指标。对于目标3，我们将评估培训前和培训后临床医生对沟通文化调查的反应以及选定的特定于PACU的过程和结果指标的差异。成功地展示海峡的有效性将导致该方法迅速传播到其他临床移交情况。

DESCRIPTION (PROVIDED BY APPLICANT): Effective communication between clinicians may be a crucial component of safe care. High-quality communication may be especially critical during care transitions between clinicians (handoffs). In this two-year quasi-experimental Quality Improvement project, we will use simulation learning to evaluate and improve communication and coordination between anesthesia providers and nurses as care is transitioned from the operating room to the post-anesthesia care unit (PACU). Using a multiple baseline, staggered entry, prospective cohort design with repeated measures, a new training intervention (Simulation Training for Rapid Assessment and Improved Teamwork - STRAIT) will be introduced into two PACUs. The primary hypothesis is that simulation-based communication skills training of PACU personnel will significantly improve the quality of handoffs. We also hypothesize that such training will enhance the PACU's culture of communication and quality of care. Our three Aims are to: 1) develop a training intervention (STRAIT) for PACU handoffs; 2) determine if STRAIT improves PACU handoff quality; and 3) study the impact of a single focused training intervention on the PACU's communication culture and outcomes. After an initial two-month baseline of observations of actual patient handoffs, clinicians from one PACU will receive STRAIT. Training in the second PACU will begin nine months later. The results of daily field observations will be fed back to clinicians during the intervention. STRAIT will consist of preparatory web didactics and experiential learning using both manikins and standardized clinicians. Prior to every training session, clinicians will perform a videotaped simulated handoff. Individual clinician's simulated handoff performance will be compared before and after their training (Aim 1) on four dimensions of handoff effectiveness: information transfer; use of best evidence handoff strategies; interpersonal skills; and team behaviors. Clinicians will also rate their own handoffs. For Aim 2, trained observers will apply abbreviated metrics of the same effectiveness dimensions to actual PACU handoffs pre- versus post-STRAIT. For Aim 3, we will assess pre- versus post-training differences in clinician responses to a communication culture survey as well as for selected PACU-specific process and outcome measures. Successful demonstration of STRAIT'S effectiveness will lead to rapid dissemination of the methods to other clinical handoff situations.