Oral Themed Presentation


The Use of Rapid Cycle Deliberate Practice to Teach Team Performance Skills to a Nursing Lead Rapid Response Team

Tuesday, May 15
13:30 - 15:00
Location: Jupiter 1&2

Context: : Rapid Response (RR) teams aid in early identification and management of decompensating patients outside of the ICU. Our system is unique in that our RR team is composed of nurses and respiratory therapists and no physician. Evaluation of the rapid response process highlighted an opportunity for our team to undergo formal training in leadership, teamwork, and communication skills necessary to manage a decompensating patient. We implemented a three-hour simulation training program using a technique which blended Rapid Cycle Deliberate Practice (RCDP) with traditional debriefing. The project aim was to teach teamwork skills and apply a newly developed algorithm for patient management and disposition. This project highlights an innovative blend of traditional debriefing and use of RCDP to teach teamwork skills.

Description: : A total of 72 nurses and respiratory therapists were trained during 22 sessions. A detailed script with “hard” and “soft” stops was developed with distinct learning objectives for each discipline. The workshop included 3 scenarios each targeted to an arm of the patient escalation algorithm. Learning objectives included role assignment, task delegation, situational awareness, positioning of team members, global assessment, and shared mental model. In the first scenario, which was the most medically complex, learners completed the simulation uninterrupted. This was followed by a structured traditional debrief. The first scenario was then repeated with the use of RCDP, giving each learner the opportunity to run through the entire scenario and refine their teamwork skills and behaviors. The following two scenarios were taught only via RCDP.

Observation/Evaluation: : Prior to simulation training an anonymous survey was sent out to PICU and floor nurses assessing perceptions in teamwork and barriers to effective communication. A modified version of the Clinical Teamwork Scale was used to evaluate scenario one. Evaluations compared team performance during the first uninterrupted cycle and following the final RCDP cycle. Paired T-testing demonstrated a significant improvement in each team work skill measured (p<0.001, Table 1). Data was collected on how often participants were paused for "hard stops" and given constructive feedback for predetermined objectives. The percentage of how often participants required coaching for each predetermined "hard stop" decreased with each subsequent cycle (Figure 1). Participants then completed a post intervention survey evaluating the effectiveness of the simulation training .

Discussion: : RCDP is a technique that was well received by our staff. It has potential to be used in ways other than application to algorithmic medical management. Our project suggests that this technique can be used to teach non-technical skills focused on teamwork behaviors and communication. By blending traditional debriefing and RCDP we were able to close performance gaps, and reinforce teamwork concepts by allowing each learner to practice and refine their behaviors. Further work is needed to determine if RCDP is more effective in teaching teamwork skills compared to traditional debriefing.

Kiran Hebbar, MD

Children's Healthcare of Atlanta, Emory University, GA

Kiran Hebbar, MD, FCCM is a pediatric intensivist, Associate professor and the Medical Director of Children's Healthcare of Atlanta Simulation Center. He recently completed his quality scholars certifcation from the The James M. Anderson Center for Health Systems Excellence. His center and work focus around system integration approach to simulation based solutions for quality and patient safety measures, shifting bedside practice to improve patient outcomes and in applying simulation testing to inform hospital processes and hospital design. His team uses rapid cycle deliberate practice methodology for a number of training activities such as medication safety, eCPR and rapid response response training.


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Nora Colman, MD

PICU Fellow
Children's Healthcare of Atlanta, Emory University, GA


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Abbie Patera

PICU Simulation Educator
Children's Healthcare of Atlanta, Emory University


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Roberta Hales, MHA, RRT-NPS, RN, CHSE

Senior Simulation Educator
Center for Simulation, Advanced Education and Innovation; The Children's Hospital of Philadelphia


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