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（交接）期间，高质量的沟通可能尤其重要。在这个为期两年的准实验性质量改进项目中，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，因为护理从手术室过渡到麻醉后护理单元（PACU）。采用多基线、交错进入、重复测量的前瞻性队列设计，将在两个pacu中引入新的训练干预（快速评估和改进团队合作模拟训练- STRAIT）。主要假设是PACU人员基于模拟的沟通技巧培训将显著提高交接质量。我们也假设这样的训练将提升PACU的沟通文化和护理质量。我们的三个目标是：1)为PACU移交开发一个训练干预（STRAIT）；2)确定STRAIT是否提高了PACU切换质量；3)研究单一重点培训干预对PACU沟通文化和结果的影响。在最初两个月的实际患者交接基线观察后，来自一个PACU的临床医生将接受STRAIT治疗。第二个PACU的训练将于9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。STRAIT将包括预备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，临床医生将进行录像模拟交接。个体临床医生在培训前后的模拟交接绩效（目标1）将在交接有效性的四个维度上进行比较：信息传递；使用最佳证据移交策略；人际交往能力;以及团队行为。临床医生也将评估他们自己的交接。对于目标2，训练有素的观察员将把相同有效性维度的简化指标应用于海峡前后实际的PACU移交。在目标3中，我们将评估临床医生对沟通文化调查以及选定的pacu特定过程和结果测量的反应的培训前和培训后差异。STRAIT的有效性的成功示范将导致该方法在其他临床交接情况下的迅速传播。

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.