Impact of Non-technical Skills Training on Performance and Effectiveness of a Medical Emergency Team
Impact on a Medical Emergency Team of Non-Technical Skills Training in a before-and-after trial assessing performance and effectiveness
Dr Richard Chalwin
80 participants
Jul 1, 2014
Interventional
Conditions
Summary
The concept of non-technical skills training (NTST) arose in the aviation industry after observation that a number of avoidable incidents were caused by human error rather than mechanical failure. In medical training, clinical knowledge and skills are emphasised with little attention given to “human factors”. These encompass such aspects as leadership, team-working, communication and decision-making. Thus far, study in this area has been restricted to simulations. Our project aims to evaluate the impact of implementation of training in non-technical skills for our Medical Emergency Team (MET) service on team performance and patient outcomes. This will be a multi-partite quality improvement project run at the Lyell McEwin Hospital, a tertiary metropolitan hospital in Adelaide. We plan to perform a retrospective audit of existing MET service data to establish baseline data. Then a period of prospective study will occur before and after delivery of NTST to members of the MET service. Team attendances will be independently observed for demonstration of non-technical skills and patients will be tracked during their hospital admission. A pilot observation will also be conducted to validate the observational assessment tool and measure inter-rater reliability between the investigators. The primary outcomes will be 1) MET performance of non-technical skills as graded by a specifically developed qualitative assessment tool and 2) incidence of efferent limb failure as defined by a) requirement for a second MET attendance within 24 hours for the same calling criterion, b) unplanned admission to the Intensive Care Unit (ICU) within 24 hours of MET attendance, c) unexpected cardiac arrest and/or death within 24 hours of MET attendance. Secondary outcomes will include hospital and ICU length-of-stay, and vital status at hospital discharge. These will be used as a comparator between all periods of the project. NTST will be delivered to MET members by the investigators in collaboration with a group of active instructors from QANTAS and the Royal Australian Air Force Reserves. Oversight will be provided by the hospital Safety and Quality Unit. The baseline audit will include 2000 patients and the observational stage of the study is anticipated to enrol 600 patients, equally divided between the before- and after-NTST periods. We aim to demonstrate that training in non-technical skills improves MET service performance leading to a reduction in incidence of efferent limb failure. The anticipation is that this will then extrapolate to reductions in length-of-stay and mortality.
Eligibility
Inclusion Criteria2
- Patients or persons subject to LMH MET service review.
- All MET members (currently numbering approximately 80 total eligible clinicians, with ad-hoc involvement per working patterns to provide 5 members per MET activation) will all be eligible for inclusion as the aim of the study is to assess the performance and function of the team (as an entity), rather than any individual. The members are not currently aware of the nature of the trial to facilitate(limited) blinding; they will be aware of observation occurring but not the nature of the data being recorded. Departmental heads and hospital executive have approved conduct of the observation.
Exclusion Criteria4
- Patients in the ICU, Emergency Department or Operating Theatre suite
- Cancellation of the MET response prior to, or on arrival at, the location of activation
- Patients < 16 years of age
- MET attendances involving members of the investigating team acting in a clinical role will not be observed due to awareness of the study purpose and inevitable confounding
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Interventions
Non-technical skills training will be provided for members of a hospital Medical Emergency Team (MET) currently drawn from a pool of approximately 80 clinicians. This will take the form of a half-day group session to be conducted annually which will include lectures and simulations. The training will be delivered by experienced clinicians under the supervision of accredited Royal Australian Air Force Reserve Crew Resource Management trainers. This training will occur after the Medical Emergency Team has been observed during actual patient attendances. Their performance of non-technical skills will be quantatively assessed with a (yet to be validated) observational tool. A similar period of observation will occur after the training session has been delivered. The trial is only planned to observe performance before and after delivery of the first training session at this stage. A second period of after-observation may be conducted depending on funding availability. Training sessions will continue annually for at least 3 years after completion of the trial as part of a planned hospital quality improvement initiative. 600 patients attended during both observational periods will be followed up for hospital outcome per the secondary outcomes. Baseline MET activity and patient outcomes will be assessed by audit of 2000 historical MET service records.
Locations(1)
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ACTRN12612000280808