Oral Themed Presentation
Background: : Current American Heart Association (AHA) guidelines for pediatric advanced life support incorporating team leadership skills practice into resuscitation training.1 Quality assurance reviews of clinical resuscitation events in our emergency department (ED) identified opportunities for advanced leadership training for pediatric emergency medicine (PEM) attending and fellow physicians to optimize team performance. Strong team leadership is tied to resuscitation success. Simulation is a setting where leaders may be provided formative feedback and engage in rapid cycle deliberate practice.1-3 Literature describing specifically how to improve the resuscitation leadership skills of experienced physicians is limited.2,4-5
Research Question: : Assess the impact of a new simulation – based advanced team leader training course on team performance in clinical resuscitation events.
Methodology: : PEM attending and fellow physicians attended a one-hour session on team leadership skills prior to participating in an interprofessional emergency department (ED) simulation. Four specific goals were identified: team huddle with role assignments prior to patient arrival, rapid patient transfer, primary survey complete within three minutes and summary statement within five minutes. Participants then practiced caring for a simulated seizing patient. Facilitators provided feedback using rapid cycle deliberate practice. Team leader goals were shared with all interprofessional participants. Quality assurance monitoring of real resuscitations occurred both before and after training.
Results: : During the intervention (Mar - May 2018), 21/38 (55%) of ED supervising physicians completed team leader training. Quality assurance reviews of real resuscitations showed that primary survey exams were completed within 3 minutes pre-intervention 4/14 (28%) and post-intervention 15/20 (75%). The frequency with which team leaders made summary statements within 5 minutes pre-intervention was 7/14 (50%) and post-intervention 17/20 (85%). Time to bed data is under analysis.
Discussion/Conclusions: : Teams showed improvement in time to primary survey and summary statement completion in real resuscitations following the implementation of team leader training. Time to bed data is under analysis. Improvement occurred despite including a new academic year in the post-intervention data, with less experienced trainees joining resuscitation teams. Team huddles were difficult to assess: frequently, resuscitation videos start upon a patient’s arrival. Team performance metrics increased, despite only half of the supervising physicians in the division participating in team leader training. Qualitatively, teams appeared more organized. On-going quality assurance review will monitor performance and identify additional areas for improvement.