Objective:To determine whether implementation of Composite Resuscitation Team Training is associated with improvement in survival to discharge and code team performance after pediatric in-hospital cardiopulmonary arrest.Design, Setting, and Subjects:We conducted a prospective observational study wit

Improving code team performance and survival outcomes: implementation of pediatric resuscitation team training

PURPOSE OF REVIEW

Evidence of suboptimal cardiopulmonary resuscitation (CPR) delivery in practice has driven interest in strategies to improve CPR quality Early data suggest that debriefing may be an effective strategy In this review, we analyse types of debriefing and the evidence to support their usage

RECENT FINDINGS

There is a general lack of standardization in terminology and methods used for debriefing that limits evaluation Debriefing interventions generally take two different formats Hot debriefing is one where individuals or teams are provided with debriefing immediately after the event Although perhaps the most widely used and easiest to implement, research evidence for its effectiveness is scant Cold debriefing, where individuals or teams are provided with feedback sometime after the event, is associated with improvements in process and patient outcomes Such feedback usually involves the use of objective performance data, such as defibrillator downloads or videotape records Before and after cohort studies have found that both verbal debriefing in groups and individual written feedback seem to be associated with an improvement in performance

SUMMARY

Debriefing is a useful strategy to improve resuscitation performance, but the optimal delivery method remains unclear Future high-quality research is required to identify the most effective form of debriefing

Debriefing after resuscitation.

Background In situ simulation is an emerging technique involving interdisciplinary teams working through simulated scenarios which replicate events encountered in healthcare institutions, particularly those which are either low frequency or associated with high risk to patients. Since it takes place in the clinical environment, it is ideally suited to improving patient safety outcomes. Objective To identify and appraise all studies assessing contribution of in situ simulation to patient safety, identify gaps in knowledge and areas for future research, as well as suggesting strategies for maximising its impact on patient safety within an institution. Study selection Three electronic databases (MEDLINE, PubMed and EMBASE) as well as the Cochrane Library were searched for articles relating to patient safety outcomes in in situ simulation. In addition a subject expert was approached to suggest any additional articles not identified by electronic searches. A total of 1795 abstracts were identified and screened, 35 full articles assessed for eligibility for inclusion and a total of 18 full articles included in the review after unsuitable articles were excluded. Conclusions In situ simulation can improve real-life patient safety outcomes, with 2 studies demonstrating improved morbidity and mortality outcomes following initiation of in situ simulation. There is good evidence to suggest that its implementation leads to improved clinical skills, teamwork and observed behaviours. Additionally, it is ideally suited to detecting latent safety errors (errors identified within a scenario which, if they had occurred in real life, could have led to a degree of harm occurring to a patient).

https://stel.bmj.com/content/bmjstel/1/3/103.full.pdf

In situ simulation as a tool for patient safety: a systematic review identifying how it is used and its effectiveness

IntroductionSudden cardiac arrest is the leading cause of death in the United States. Despite new therapies, progress in this area has been slow, and outcomes remain poor even in the hospital setting, where providers, drugs, and devices are readily available. This is partly attributed to the quality

In situ simulated cardiac arrest exercises to detect system vulnerabilities.

In situ simulation is the practice of using simulated scenarios in a clinical environment itself rather than in training facilities to promote learning and improved clinical care. The use of in situ simulation has been increasingly used to train healthcare staff in dealing with emergencies, resuscitation and clinical skills. The aim of this study is to provide an overview of the themes, perspectives and approaches to in situ simulation for educational purposes with healthcare staff. The literature search included studies describing and evaluating in situ simulations with an educational component. We carried out a narrative synthesis and extracted data on the clinical setting, the simulation purpose, design, evaluation method and impact. In situ simulation has proved useful in a range of different specialties for skills improvement and team development. Simulation design ranges in terms of fidelity, duration and topic. No specific design has shown to be the most efficient. However, adopting a design that fits into the specific centers resources, educational needs and clinical demands is the most important consideration.

/pdf/the-use-of-in-situ-simulation-in-healthcare-education-5atdntd1w2.pdf

The Use of in situ Simulation in Healthcare Education: Current Perspectives.

In response to a successful, although difficult resuscitation in one of our paediatric wards, we developed and implemented an educational program to improve the resuscitation skills, teamwork and safety climate in our multidisciplinary acute-care paediatric service. The program is ongoing and consists of didactic presentations, high-fidelity in situ simulation and facilitated debriefing to encourage reflective learning. The underlying goal, to provide this training to all staff over a two-year period, should be achieved by late 2011. In this preliminary report we describe teamwork difficulties that are commonly found during such training. These included inconsistent leadership behaviours, inadequate delegation of areas of responsibility, failure to communicate problems during the execution of technical tasks (such as difficulty opening the resuscitation trolley) and failure to challenge inadequate or inappropriate therapy (such as poor chest expansion during bag-mask ventilation). In addition, we unexpectedly discovered seven latent errors in our clinical environment during the first nine months of course delivery. The most disturbing of these was that participants repeatedly struggled to identify and overcome the locking-mechanism and tamper-proof device on a newly introduced resuscitation trolley.

https://journals.sagepub.com/doi/pdf/10.1177/0310057X1003800613

In situ simulation training for paediatric cardiorespiratory arrest: initial observations and identification of latent errors.

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In situ simulation training for paediatric cardiorespiratory arrest: initial observations and identification of latent errors.