The intensive care unit (ICU) is a high-risk environment that requires cross-professional teams to provide life-saving patient care. There is ample evidence that poor communication creates situations where medical errors are likely to occur and affect patient safety. We tested whether communication-oriented debriefing following high-fidelity simulation improves quality of information exchange reflecting collaborative work in ICU teams. Ten teams of six cross-professional ICU workers participated in three simulation-based training sessions. After each training session, the experimental group was debriefed on communication-oriented skills (based on Crew Resource Management, CRM), while the control group was debriefed on technical skills. The analysis was double-blind; 30 videotaped sessions were coded for three types of communication measures by four observers showing adequate inter-rater reliability. Results suggest that high-fidelity simulation training can improve non-technical skills in cross-professional ICU teams. Further investigation is needed on the performance effects of communication-focused debriefing.
Get full access to this article
View all access options for this article.
References
1.
American Heart Association. (2005). Circulation. The 2005 International Consensus Conference on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations (p. IV-57–IV-66).
2.
BlumR. H.RaemerD. B.CarrollJ. S.DufresneR. L.CooperJ. B. (2005). A method for measuring the effectiveness of simulation-based team training for improving communication skills. Anesthesia and analgesia, 100(5), 1375–80, table of contents. doi:10.1213/01.ANE.0000148058.64834.80
3.
BowersC. A.JentschF.SalasE.BraunC. C. (1998). Analyzing Communication Sequences for Team Training Needs Assessment. Human Factors, 40(4), 672–678.
4.
CampbellR. D.BagshawM.NetLibraryInc (1999). Human performance and limitations in aviation (p. 160). Malden, Mass: Blackwell Science.
5.
CollinsD. E. (2008). Multidisciplinary teamwork approach in labor and delivery and electronic fetal monitoring education: a medicallegal perspective. Journal of Perinat Neonatal Nursing, 22(2), 125–32.
6.
EspevikR.EidJ. (2011). Outcomes of Shared Mental Models of Team Members in Cross Training and High-Intensity Simulations. Human Factors, 5(4), 352–377. doi:10.1177/1555343411424695.
7.
FrankJ. R. E. (2005). The CanMEDS 2005 Physician Competency Framework. Better standards. Better physicians. Better care. Ottawa, Canada.
8.
FrankJ. R. E.BrienS.CommitteeS. C. S. (2008). The Safety Competencies: Enhancing patient safety across the health professions. Ottawa.
9.
FrengleyR. W.WellerJ. M.TorrieJ.DzendrowskyjP.YeeB.PaulA. M.ShulrufB.. (2011). The effect of a simulation-based training intervention on the performance of established critical care unit teams. Critical care medicine, 39(12), 2605–11. doi:10.1097/CCM.0b013e3182282a98
10.
GabaD. M.DeAndaA. (1988). A comprehensive anesthesia simulation environment: recreating the operating room for research and training. Anesthesiology, 69(3), 387–94.
11.
GabaD. M.HowardS. K.FishK. J.SmithB. E.SowbY. A. (2001). Simulation-Based Training in Anesthesia Crisis Resource Management (ACRM): A Decade of Experience. Simulation & Gaming, 32(2), 175–193. doi:10.1177/104687810103200206
12.
GrundgeigerT.SandersonP. M.MacdougallH. G.VenkateshB. (2010). Interruption management in the intensive care unit: Predicting resumption times and assessing distributed support. Journal of experimental psychology. Applied, 16(4), 317–34. doi:10.1037/a0021912
13.
GuerlainS.AdamsR. B.TurrentineB. F.ShinT.GuoH.CollinsS. R.CallandJ. F. (2005). Assessing team performance in the operating room: development and use of a “black-box” recorder and other tools for the intraoperative environment. Journal of the American College of Surgeons, 200(1), 29–37. doi:10.1016/j.jamcollsurg.2004.08.029
14.
GuerlainS.TurrentineF. E.BauerD. T.CallandJ. F.AdamsR. (2007). Crew resource management training for surgeons: feasibility and impact. Cognition,Technology & Work, 255–264. doi:10.1007/s10111-007-0091-y
15.
HunzikerS.BühlmannC.TschanF.BalestraG.LegeretC.SchumacherC.SemmerN. K.. (2010). Brief leadership instructions improve cardiopulmonary resuscitation in a high-fidelity simulation: a randomized controlled trial. Critical care medicine, 38(4), 1086–91. doi:10.1097/CCM.0b013e3181cf7383
16.
IssenbergS.McGaghieW.PetrusaE.Lee GordonD.ScaleseR. (2005). Features and uses of high-fidelity medical simulations that lead to effective learning: a BEME systematic review. Medical teacher, 27(1), 10–28.
17.
KimJ.NeilipovitzD.CardinalP.ChiuM.ClinchJ. (2006). A pilot study using high-fidelity simulation to formally evaluate performance in the resuscitation of critically ill patients: The University of Ottawa Critical Care Medicine, High-Fidelity Simulation, and Crisis Resource Management I Study. Critical Care Medicine. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/16775567
18.
KohnL. T.CorriganJ. M.DonaldsonM. S. (2000). To err is human: Building a safer health system. (National Academy Press, Ed.). Washington, DC.
19.
LingardL.HaberR. J. (1999). Teaching and learning communication in medicine: a rhetorical approach. Academic Medicine, 74(5), 507–10.
20.
MarksM. A.ZaccaroS. J.MathieuJ. E. (2000). Performance implications of leader briefings andteam interaction training for team adaptation to novel environments. Journal of Applied Psychology, 85(6), 971–86.
21.
MillerK.RileyW.DavisS. (2009). Identifying key nursing and team behaviours to achieve high reliability. Journal of nursing management, 17(2), 247–55. doi:10.1111/j.1365-2834.2009.00978.x
22.
MoreyJ. C.SimonR.JayG. D.WearsR. L.SalisburyM. L.DukesK. A.BernsS. D. (2002). Error Reduction and Performance Improvement in the Emergency Department through Formal Teamwork Training: Evaluation Results of the MedTeams Project. Health Services Research, 37(6), 1553–1581. doi:10.1111/1475-6773.01104
23.
NeumarR. W.OttoC. W.LinkM. S.KronickS. L.ShusterM.CallawayC. W.KudenchukP. J.. (2010). Part 8: adult advanced cardiovascular life support: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation, 122(Suppl 3), S729–67. doi:10.1161/CIRCULATIONAHA.110.970988
24.
NishisakiA.NguyenJ.ColbornS.WatsonC.NilesD.HalesR.DevaleS.. (2011). Evaluation of multidisciplinary simulation training on clinical performance and team behavior during tracheal intubation procedures in a pediatric intensive care unit. Pediatric critical care medicine, 12(4), 406–14. doi:10.1097/PCC.0b013e3181f52b2f
25.
OkudaY.BrysonE. O.DeMariaS.JacobsonL.QuinonesJ.ShenB.LevineA. (2009). The utility of simulation in medical education: What is the evidence?Mount Sinai Journal of Medicine, 76, 330– 343.
26.
ParkerS. H. (2009). The impact of protocolized communication during cardiac surgery. Human Factors and Ergonomics Society Annual Meeting Proceedings (Vol. 53, pp. 684–688). doi:10.1518/107118109X12524442636580
27.
ReaderT.FlinR.CuthbertsonB. (2007). Communication skills and error in the intensive care unit. Current opinion in critical care, 13(6), 732–6. doi:10.1097/MCC.0b013e3282f1bb0e
28.
ReaderT. W.FlinR. H.MearnsK.CuthbertsonB. H. (2009). Developing a team performance framework for the intensive care unit. Critical care medicine, 37(5), 1787–93. doi:10.1097/CCM.0b013e31819f0451
29.
SalasE.RosenM. a.KingH. (2007). Managing teams managing crises: principles of teamwork to improve patient safety in the Emergency Room and beyond. Theoretical Issues in Ergonomics Science, 8(5), 381–394. doi:10.1080/14639220701317764
30.
SchoopM. (1999). An Empirical Study of Multidisciplinary Communication in Healthcare using a Language-Action Perspective. Perspective (pp. 59–73).
SevdalisN.BrettS. J. (2009). Improving care by understanding the way we work: human factors and behavioural science in the context of intensive care. Critical care (London, England), 13(2), 139. doi:10.1186/cc7787
33.
ShapiroM. J. (2004). Simulation based teamwork training for emergency department staff: does it improve clinical team performance when added to an existing didactic teamwork curriculum?Quality and Safety in Health Care, 13(6), 417–421. doi:10.1136/qshc.2003.005447
34.
St. PierreM.HofingerG.BuerschaperC. (2008). Crisis Management in Acute Care Settings (p. 234). Berlinl; New York: Springer.
35.
ValentinA.CapuzzoM.GuidetB.MorenoR. P.DolanskiL.BauerP.MetnitzP. G. H. (2006). Patient safety in intensive care: results from the multinational Sentinel Events Evaluation (SEE) study. Intensive care medicine, 32(10), 1591–8. doi:10.1007/s00134-006-0290-7
36.
VarpioL.HallP.LingardL.SchryerC. (2008). Interprofessional communication and medical error: a reframing of research questions and approaches. Academic Medicine, 83(10), 76–81
