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Improved Clinical Performance and Teamwork of Pediatric Interprofessional Resuscitation Teams With a Simulation-Based Educational Intervention*

Gilfoyle, Elaine MD, MMEd, FRCPC; Koot, Deanna A. RN, BScN, MN; Annear, John C. BSc, RRT; Bhanji, Farhan MD, MSc (Ed), FRCPC, FAHA; Cheng, Adam MD, FRCPC; Duff, Jonathan P. MD, MEd, FRCPC; Grant, Vincent J. MD, FRCPC; St. George-Hyslop, Cecilia E. RN, MEd, CNCCPC; Delaloye, Nicole J. BA, BSc; Kotsakis, Afrothite MD, MEd, FRCPC; McCoy, Carolyn D. BHS, RRT, FCSRT; Ramsay, Christa E. RRT; Weiss, Matthew J. MD, FRCPC; Gottesman, Ronald D. MDCM, FRCPC; for the Teams4Kids Investigators and the Canadian Critical Care Trials Group

Pediatric Critical Care Medicine: February 2017 - Volume 18 - Issue 2 - p e62–e69
doi: 10.1097/PCC.0000000000001025
Online Clinical Investigations

Objectives: To measure the effect of a 1-day team training course for pediatric interprofessional resuscitation team members on adherence to Pediatric Advanced Life Support guidelines, team efficiency, and teamwork in a simulated clinical environment.

Design: Multicenter prospective interventional study.

Setting: Four tertiary-care children’s hospitals in Canada from June 2011 to January 2015.

Subjects: Interprofessional pediatric resuscitation teams including resident physicians, ICU nurse practitioners, registered nurses, and registered respiratory therapists (n = 300; 51 teams).

Interventions: A 1-day simulation-based team training course was delivered, involving an interactive lecture, group discussions, and four simulated resuscitation scenarios, each followed by a debriefing. The first scenario of the day (PRE) was conducted prior to any team training. The final scenario of the day (POST) was the same scenario, with a slightly modified patient history. All scenarios included standardized distractors designed to elicit and challenge specific teamwork behaviors.

Measurements and Main Results: Primary outcome measure was change (before and after training) in adherence to Pediatric Advanced Life Support guidelines, as measured by the Clinical Performance Tool. Secondary outcome measures were as follows: 1) change in times to initiation of chest compressions and defibrillation and 2) teamwork performance, as measured by the Clinical Teamwork Scale. Correlation between Clinical Performance Tool and Clinical Teamwork Scale scores was also analyzed. Teams significantly improved Clinical Performance Tool scores (67.3–79.6%; p < 0.0001), time to initiation of chest compressions (60.8–27.1 s; p < 0.0001), time to defibrillation (164.8–122.0 s; p < 0.0001), and Clinical Teamwork Scale scores (56.0–71.8%; p < 0.0001). A positive correlation was found between Clinical Performance Tool and Clinical Teamwork Scale (R2 = 0.281; p < 0.0001).

Conclusions: Participation in a simulation-based team training educational intervention significantly improved surrogate measures of clinical performance, time to initiation of key clinical tasks, and teamwork during simulated pediatric resuscitation. A positive correlation between clinical and teamwork performance suggests that effective teamwork improves clinical performance of resuscitation teams.

1KidSIM-ASPIRE Simulation Research Program, Department of Paediatrics, University of Calgary, Calgary, AB, Canada.

2Respiratory Therapy Program, New Brunswick Community College, Fredericton, NB, Canada.

3Department of Paediatrics, Centre for Medical Education, McGill University, Montreal, QC, Canada.

4Department of Paediatrics, University of Alberta, Edmonton, AB, Canada.

5Paediatric Cardiac Intensive Care Unit, Sick Kids Hospital, Toronto, ON, Canada.

6Department of Critical Care Medicine, Sick Kids Hospital, Toronto, ON, Canada.

7Canadian Society of Respiratory Therapists, Ottawa, ON, Canada.

8Children’s Hospital of Eastern Ontario, Ottawa, ON, Canada.

9Division of Paediatric Critical Care, Université Laval, Quebec City, QC, Canada.

*See also p. 199.

This work was performed at Alberta Children’s Hospital, Calgary, AB, Canada; Stollery Children’s Hospital, Edmonton, AB, Canada; Sick Kids Hospital, Toronto, ON, Canada; and Montreal Children’s Hospital, Montreal, QC, Canada.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (http://journals.lww.com/pccmjournal).

This study was jointly funded by Heart and Stroke Foundation of Canada and Canadian Institutes of Health Research.

Dr. Gilfoyle’s institution received funding from Heart and Stroke Foundation of Canada and Canadian Institutes of Health Research related to this study. She received in kind donations (equipment loan) from Zoll Corporation from other research on cardiopulmonary resuscitation quality. Ms. Koot’s institution received funding from Heart and Stroke Foundation of Canada and Canadian Institutes of Health Research related to this study. Dr. Chengt’s institution received funding from Heart and Stroke Foundation of Canada and Canadian Institutes of Health Research related to this study. He is employed as an academic emergency physician at Alberta Health Services and the University of Calgary. He also received reimbursement for travel and accommodation from Emergency Cardiovascular Care Committee of the American Heart Association. Ms. McCoy received reimbursement for travel and accommodation to Ottawa from Saint John, New Brunswick, to attend a meeting regarding this study. Dr. Gottesman’s institution received funding from Heart and Stroke Foundation of Canada and Canadian Institutes of Health Research related to this study. The remaining authors have disclosed that they do not have any potential conflicts of interest. regarding this article, E-mail: elaine.gilfoyle@albertahealthservices.ca

©2017The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies